HYPERTENSION

Hypertension, also known as High Blood Pressure is a serious medical and cardiovascular condition. Blood pressure is the force exerted by blood against the arterial walls of the heart. Therefore, Hypertension is the condition that occurs when the force against the walls of the arteries is too high. Arteries carry blood from the heart to other parts of the body. The higher the pressure, the harder the heart has to pump. Hypertension can also be defined as blood pressure above 140/90 mmHg. There are two measures:

  1. The systolic blood pressure: which is the highest pressure on blood vessels when the heart pushes blood out.
  2. The diastolic blood pressure: the lowest pressure on blood vessels when the heart relaxes.

Both measures are measured in millimeters of mercury (mmHg) and are presented as a ratio of systolic over diastolic. For example: 120/80 mmHg.

There are different ranges of hypertension. They are:

 Systolic (mmHg)Diastolic (mmHg)
Normal Blood PressureLess than 130Less than 85
Prehypertension130-13985-89
Grade 1 Hypertension140-15990-99
Grade 2 Hypertension160 and above100 and above

Types of Hypertension

There are two different types of hypertension and this is based on some factors that might have led to the condition:

  1. Primary Hypertension: This is high blood pressure that is not due to any underlying or preexisting disease. They can result from other factors such as environmental or genetic. It can be as a result of high salt intake, obesity, smoking, excessive alcohol intake, etc.
  2. Secondary Hypertension: High blood pressure that is caused by an underlying condition or it is as a result of complication of another health problem e.g., chronic kidney disease, diabetes, hyperthyroidism.

Risk Factors of Hypertension

Below are some factors that could increase one’s chances of having a high blood pressure:

  1. Age: People older than 65 years of age are at more risk of developing high blood pressure. Blood pressure increases with age as the arteries stiffen and narrow due to plaque buildup.
  2. Family History of Hypertension:  This can make a person more likely to develop hypertension as genetic plays an important role.
  3. Ethnicity: Some ethnic group such as the African Americans have a greater risk of developing hypertension than other ethnic groups.
  4. Alcohol and Tobacco Use: Excessive and regular intake of alcohol or tobacco can increase an individual’s chance of having increased blood pressure.
  5. High Salt Intake: Too much salt in diet put a person at risk of developing hypertension. This is because excessive salt increases the sodium levels in the blood and cause the body to hold onto more water. This in turn increases the fluid surrounding our cells and volume of blood in the bloodstream. As the volume of blood increases, the pressure on our blood vessels increases which makes our heart work harder in order to move blood round the body. Over time as we do not watch our salt intake or diet, the extra strain on the heart can lead to stiffening of blood vessels and increases the risk of hypertension and other cardiovascular diseases.
  6. Weight: Obesity is a primary risk for hypertension because blood pressure often increases as weight increases. Obesity can also cause disrupted breathing while sleeping which further raises blood pressure.
  7. Existing health conditions: diabetes, chronic disease, high cholesterol level can lead to hypertension.
  8. Stress: High level of stress can lead to a temporary increase in blood pressure.
  9. Pregnancy: A woman’s blood volume increases during pregnancy and the extra blood must be pumped by the heart throughout the body. This allows the heart to work harder and can increase the woman’s risk of developing hypertension. However, high blood pressure during pregnancy should decrease after the baby is delivered.
  10. Menopause: Hormonal changes can lead to weight gain and also make blood pressure more sensitive to salt in diet, which in turn can lead to high blood pressure
  11. Birth control pills: estrogen in the pill may trigger the release of other hormones that can increase blood pressure.

Sign and Symptoms of Hypertension

Hypertension is sometimes referred to as a “silent killer” because a person with hypertension may not notice any symptom. Signs and symptoms of hypertension may include:

  1. Severe headaches
  2. Fatigue
  3. Dizziness
  4. Irregular heart beat
  5. Pounding in the chest, neck or ears
  6. Blurred vision
  7. Nausea: feeling of sickness with an urge to vomit
  8. Sweating
  9. Leg swelling
  10. Anxiety
  11. Sleeping problems
  12. Decreased urine output
  13. Blood in the urine

Diagnosis of Hypertension

To diagnose hypertension, it requires several readings using digital sphygmomanometer or manual sphygmomanometer and a stethoscope that show sustained high blood pressure over time. A blood pressure that is consistently higher than 140/90 mmHg. Other diagnostic measures include:

  1. History taking: This is necessary to know what may be the cause of high blood pressure.
  2. Physical examination: A heart examination, examination of legs for edema (fluid buildup), examination of abdomen using a stethoscope to listen to the blood vessels for abnormal sounds. All these are necessary for the diagnosis of hypertension.
  3. Urinalysis: this is to check for markers that can show that the high blood pressure is caused by an underlying medical condition.
  4. Blood test: Blood test can be carried out for measurement of electrolytes, creatinine level and blood urea nitrogen to assess kidney involvement. Lipid profile can also be done to check levels of various kinds of cholesterol.
  5. Electrocardiogram (ECG or EKG): This measures the heart’s electrical activity.
  6. Echocardiogram: It uses sound waves to produce images of the heart.

Treatment of Hypertension

Asides prescribed medications that helps to lower high blood pressure, lifestyle modifications are recommended to control and manage high blood pressure. They include:

  1. Eating a heart-healthy diet: the Dietary Approach to Stop Hypertension (DASH) diet is rich in fruits, vegetables, whole grains, and low-fat dairy foods. The DASH diet promotes food that are lower in sodium as well as foods that are rich in potassium, magnesium and calcium to help lower blood pressure. Also, eat fewer processed foods.
  2. Ensure regular physical exercise
  3. Maintaining a healthy weight
  4. Limit alcohol consumption
  5. Stop smoking
  6. Reduce stress level
  7. Get support from family and friends or join a support group

Medications that can be prescribed to treat high blood pressure includes:

  1. Diuretics: Also called water pills. They help the kidneys to eliminate sodium and water from the body. Examples are Chlorthalidone, Hydrochlorothiazide, etc.
  2. Angiotensin-converting enzyme (ACE) inhibitors: They help to relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. Examples are Lisinopril (Prinivil, Zestril), Benazepril (Lotensin), etc.
  3. Calcium channel blockers: They help to relax the muscles of the blood vessels. Some slow the heart rate. Examples are Amlodipine (Norvasc), Diltiazem (Cardizem), etc. Don’t eat or drink grapefruit products when taking calcium channel blockers. Grapefruit increases blood levels of certain calcium channel blockers, which can be dangerous.
  4. Alpha-beta blockers: They block nerve signals to blood vessels and slow the heartbeat to reduce the amount of blood that must be pumped through the vessels. Examples are Carvedilol (Coreg) and Labetalol (Trandate).
  5. Beta blockers: These medications reduce the workload on the heart and widen the blood vessels, causing the heart to beat slower and with less force. Examples are Acebutolol, atenolol (Tenormin), etc.
  6. Vasodilators: They work directly on the muscles in the walls of the arteries, preventing the muscles from tightening and the arteries from narrowing. Examples are Hydralazine and Minoxidil.
  7. Central-acting agents: These medications prevent the brain from telling the nervous system to increase the heart rate and narrow the blood vessels. Examples include Clonidine (Catapres), Guanfacine (Intuniv) and methyldopa.

Complications of Hypertension

Uncontrolled high blood pressure can lead to:

  1. Heart attack or stroke
  2. Heart failure
  3. Aneurysm: excessive swelling in the wall of the arteries of the heart.
  4. Weakened and narrowed blood vessels in the kidneys.
  5. Hypertensive retinopathy: thickened, narrowed or torn blood vessels in the eyes which can lead to vision loss.
  6. Dementia: narrowed or blocked arteries can reduce blood flow to the brain, causing a type of dementia which is vascular dementia.
  7. Death

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