High Blood Pressure (Hypertension)

High blood pressure, or also known as hypertension, is a common condition. Some people can have the condition for years but did not show any symptoms. However, even the symptoms do not show, the damage to blood vessels and heart remains, and these damages are detectable. High blood pressure that is uncontrolled will increase the risk of chronic health issues such as heart attack and stroke. The condition tends to develop over several years and eventually affects everyone.

What are the symptoms of hypertension? 

In general, those with high blood pressure tend not to have any signs or symptoms even though the blood pressure readings appear at too high levels. Some people with high blood pressure may show headaches, shortness of breath, or having nosebleeds. However, these symptoms don’t always occur until the blood pressure has reached a severe stage.

When to see a doctor?

The patient will have the blood pressure taken as a routine process for every doctor’s appointment. The doctor will most likely recommend frequent readings if the patient has been diagnosed with high blood pressure or have some of the risk factors of developing cardiovascular disease. Children age three or older will have their blood pressure taken as part of their annual health check-up.

What are the causes of hypertension?

High blood pressure can be divided into two types: primary hypertension and secondary hypertension.  

• Primary hypertension - This type of high blood pressure will mostly develop over several years.  
• Secondary hypertension - This type of high blood pressure is caused by underlying health conditions. It will suddenly appear and cause higher blood pressure than the first type. Several conditions and drugs can cause secondary hypertension; as follows:
  • • Obstructive sleep apnea problem
    • Kidney diseases
    • Tumors at Adrenal gland
    • Thyroid diseases
    • Some birth defects in blood vessel
    • Some drugs such as contraceptives, drugs to treat the common cold, decongestants, pain relievers, and some prescription other drugs
    • Using illegal drugs; for example, cocaine and amphetamines

What are the risk factors of hypertension?

• Age - The more you age, the risk of developing high blood pressure will be higher than the younger ones. Up until the age of 64, high blood pressure will be more common in men. However, women tend to develop high blood pressure after the age of 65.  
• Race - Those with African-American heritage tend to have high blood pressure at an earlier age compared to caucasian. Severe complications, such as stroke, heart attack, or kidney failure, also appear more to African-Americans.  
• Family medical history -  This condition usually passes on from generation to generation.  
• Obesity -  High blood pressure often happens with overweight people because the more you weigh, the more blood the body needs to supply oxygen and nutrients.  
• Sedentary lifestyle -  Those who are physically inactive tend to have a higher heart rate, which means the heart now has to work more with each contraction.  
• Smoking - Smoking does not only immediately temporarily increase the blood pressure, but the chemicals found in tobacco can cause lining damage to artery walls. This will result in narrow arteries and a higher risk of heart disease. Secondhand smoke will also cause an increase in the risk of developing heart diseases.  
• Diet high in salt - High sodium diet can result in fluid retention, causing high blood pressure.   
• Diet low in potassium - Low potassium diet causes the body to store too much sodium in the blood as potassium works to balance the body's sodium amount.  
• Heavy alcohol consumption - Drinking too much alcohol can damage the heart over time. If women have more than one drink and men have more than two drinks a day, this could affect the blood pressure.  
• High stress - High-stress levels can cause blood pressure to increase temporarily. 
• Some chronic diseases -  Diseases such as kidney disease, diabetes, and sleep apnea, could increase high blood pressure.  

Pregnancy can sometimes contribute to the development of high blood pressure. High blood pressure is most commonly found in adults, but it can also occur in children. For children, the cause of high blood pressure is kidney or heart problems. Other risk factors include a poor diet, obesity, and less exercise.  

What are the complications of hypertenstion? 

The higher the level of the blood pressure, the more damage it could cause. Several complications are caused by uncontrolled high blood pressure; as follows:  

• Heart attack or stroke 
• Aneurysm 
• Heart failure
• Narrowed blood vessels in the kidneys
• Thickened or narrowed blood vessels in the eyes
• Metabolic syndrome
• Memory or understanding problems
• Dementia 

How is hypertension diagnosed? 

The doctor will measure the blood pressure using a pressure-measuring gauge. The measurements for blood pressure can be divided into four categories:  

• Normal - If the blood pressure is below systolic pressure of 120/80 mm Hg, it is normal blood pressure. 
• Elevated - If the blood pressure is somewhere between systolic pressure of 120 to 129 mm Hg and diastolic pressure is below 80 mm Hg, it is considered elevated blood pressure. 
• Stage 1 hypertension - If the blood pressure is somewhere between systolic pressure of 130 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg, it is considered stage 1 hypertension. 
• Stage 2 hypertension - If the blood pressure is somewhere between the systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher, it is a severe type of high blood pressure, and it is considered stage 2 hypertension. 

Both the upper numbers and the lower numbers in the blood pressure reading are equally important. However, after you turn 50, the upper systolic reading is even more critical. A condition called isolated systolic hypertension occurs when the diastolic pressure is normal (when it is less than 80 mm Hg), but the systolic pressure is high. (This is when the number is equal to 130 mm Hg or more). This condition is common among those that are older than 65.

During each appointment, the doctor will take two to three readings at separate appointments before the doctor begins the diagnosis process. As blood pressure generally varies throughout the day. The doctor may ask the patient to record the blood pressure at home to ensure that the patient has high blood pressure.  

If the patient is diagnosed with high blood pressure, the family's medical history will be reviewed, and the doctor will examine the patient through physical examination. The doctor will recommend the patient undergo tests, including urine tests, blood tests, and cholesterol tests. The doctor will sometimes order an echocardiogram to check for signs of heart diseases.

Measure blood pressure at home

The patient should monitor the blood pressure at home as it will help check if the treatment is working or detect if the symptoms of high blood pressure are worsening.  

If lifestyle changes, including good diet and exercise, do not help lower the blood pressure, the doctor will prescribe medicine to lower the blood pressure. The blood pressure treatment goal should be less than 130/80 mm Hg if the patient is a healthy adult aged 65 or older. It also applies to the patient younger than 65 but has a 10 percent higher risk of having cardiovascular disease within ten years. This treatment goal is also suitable for the patient with chronic diseases such as kidney disease, diabetes, or coronary artery disease.

Medication groups use for treating high blood pressure 

• Thiazide diuretics
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor blockers (ARBs)
• Calcium channel blocker 

 Additional medications that the doctor could prescribe to treat high blood pressure  

• Alpha-blockers 
• Alpha-beta blockers 
• Beta-blockers 
• Aldosterone antagonists 
• Renin-inhibitors
• Vasodilators
• Central-acting agents 

Resistant hypertension 

Resistant hypertension is when the blood pressure remains extremely high, even using three different drug types to treat high blood pressure. One of the drugs for the treatment tends to be a diuretic.  

Those who have controlled high blood pressure requiring four different medications to treat them also mean they have resistant hypertension. Therefore, the doctor will re-examine the possibility of another cause of hypertension. Those who have resistant hypertension conditions do not mean they will always have high blood pressure. The doctor will examine the cause of persistent high blood pressure and find a more effective treatment. 

It is essential to take the prescribed high blood pressure medications as directed by the doctor. Don’t change the treatment without the doctor’s guidance. 

Lifestyle and home remedies 

The changes in lifestyle behaviors can help and prevent high blood pressure; suggestions are as follow:  

• Consume a healthy diet 
• Lower salt intake in the diet 
• Maintain a healthy weight
• Exercise regularly
• Limit alcohol consumptions
• Do not smoke
• Try to manage or reduce stress
• Monitor the blood pressure at home
• Maintain the blood pressure during the pregnancy period 

Preparing for the doctor appointment 

The doctor's appointment requires no special preparations or instructions, but the patient should consume caffeinated beverages or smoke before the test.

Suggestions for the patient  

• Note down any symptoms the patient is experiencing and inform the doctor of any other symptoms such as chest pain or shortness of breath. This will let the doctor know and determine the severity of the high blood pressure issue.   
• List out personal information, including the family member's medical history with high blood pressure, high cholesterol, heart disease, stroke, kidney disease, or diabetes. The patient should also note down any stressors or recent life changes that could cause triggers.
• List all medications, vitamins, or supplements that the patient is currently taking.
• Come to the doctor's appointment with a friend or a relative. 
• Note down the diet or exercise pattern and prepare to discuss them with the doctor. 
• List down questions to ask the doctor.

Some questions the patient can ask the doctor.  

• What kinds of tests do I need to undergo? 
• Do I need to take any medications? 
• Are there types of food that I need to avoid?  
• What would be an appropriate level of physical activity for me?
• How often do I need to schedule doctor appointments to check the blood pressure? 
• Is it necessary for me to monitor my blood pressure at home?
• I have other underlying health conditions. How can I manage high blood pressure? 
• Do I need to follow any restrictions? 

What to expect from the doctor

The doctor may ask the following questions:  

• Are there any family members with a history of high cholesterol, high blood pressure, or heart disease? 
• What are your diet and exercise habits as of the present?  
• Do you drink alcohol? And how many drinks do you have in a week?
• Do you smoke?
• When was the last time you last had your blood pressure checked? What was the blood pressure reading then?