High blood pressure

High blood pressure (hypertension) is a chronic condition in which the force of blood against artery walls is too high, increasing the risk of heart disease, stroke, kidney disease, and other complications.

Hypertension is often called the “silent killer” because it usually has no noticeable symptoms but can cause serious long-term damage. 1 in 3 adults worldwide has high blood pressure, and it is a leading cause of preventable deaths.

Blood Pressure Classification

Category        Systolic (mmHg) Diastolic (mmHg)
Normal                              <120          <80
Elevated                           120-129      <80
Hypertension Stage 1    130-139      80-89
Hypertension Stage 2    ≥140           ≥90
Hypertensive Crisis        ≥180          ≥120

Note: Blood pressure readings should be measured on multiple occasions before diagnosing hypertension.

1. Primary (Essential) Hypertension
•       Accounts for 90-95% of cases.
•       Develops gradually over time due to genetic and lifestyle factors.
•       No single identifiable cause.

2. Secondary Hypertension
•       Caused by an underlying condition, such as:
•       Kidney disease (e.g., chronic kidney disease, renal artery stenosis)
•       Hormonal disorders (e.g., hyperthyroidism, Cushing’s syndrome, pheochromocytoma)
•       Obstructive sleep apnea
•       Certain medications (e.g., NSAIDs, steroids, oral contraceptives, decongestants)
•       Excessive alcohol or drug use (e.g., cocaine, amphetamines)

Secondary hypertension is often more severe and may require treatment of the underlying cause.

Non-Modifiable Risk Factors

• Age – Risk increases with age.
• Family History – Genetic predisposition.
• Ethnicity – Higher risk in Black African and South Asian populations.

Modifiable Risk Factors

• Excess Salt Intake – Causes fluid retention and raises blood pressure.
• Low Potassium Intake – Potassium helps balance sodium levels.
• Physical Inactivity – Leads to weight gain and vascular stiffness.
• Obesity & Poor Diet – Linked to metabolic syndrome.
• Smoking & Alcohol Consumption – Constricts blood vessels and increases BP.
• Chronic Stress – Raises blood pressure over time.
• Excess Sugar Intake – Can contribute to obesity, insulin resistance, and hypertension.

Most people with hypertension do not experience symptoms, which is why regular screening is essential.

When symptoms do occur (often in severe hypertension), they may include:
•       Severe headaches
•       Blurred vision
•       Chest pain
•       Shortness of breath
•       Nosebleeds

Hypertensive Crisis (BP ≥180/120 mmHg) can cause:
•       Confusion or difficulty speaking
•       Severe anxiety
•       Nausea & vomiting
•       Seizures or loss of consciousness

If you experience these symptoms, seek emergency medical attention immediately!

Chronic high blood pressure damages arteries and organs over time, which can lead to:

• Heart Disease (Heart Attack, Heart Failure, Left Ventricular Hypertrophy) – Excess strain thickens the heart muscle and increases the risk of heart attacks.
• Stroke (Ischemic & Hemorrhagic Stroke) – Hypertension is the leading cause of strokes.
• Aneurysms – High BP weakens artery walls, increasing the risk of life-threatening ruptures.
• Chronic Kidney Disease (CKD) – Hypertension damages kidney arteries, leading to kidney failure.
• Dementia & Cognitive Decline – Hypertension contributes to vascular dementia and Alzheimer’s disease.
• Vision Loss (Hypertensive Retinopathy) – Damage to the retinal blood vessels can lead to blindness.

Diagnosis is confirmed through multiple blood pressure readings over time.

Diagnostic Tests Include:

• Office Blood Pressure Readings – Should be measured on multiple occasions.
• Ambulatory Blood Pressure Monitoring (ABPM) – 24-hour monitoring to confirm persistent hypertension.
• Home Blood Pressure Monitoring – Used to detect white-coat hypertension.
• Blood & Urine Tests – To check for kidney disease, diabetes, and hormone imbalances.

1. Medications for High Blood Pressure

• First-Line Medications (Proven to Reduce BP & Risk of Stroke/Heart Disease)
•  ACE Inhibitors (Ramipril, Lisinopril) – Prevent blood vessel constriction.
• Angiotensin Receptor Blockers (ARBs) (Losartan, Candesartan) – Alternative to ACE inhibitors.
• Calcium Channel Blockers (Amlodipine, Diltiazem) – Prevent arteries from narrowing.
• Thiazide Diuretics (Indapamide, Bendroflumethiazide) – Help remove excess fluid.
• Beta-Blockers (Bisoprolol, Atenolol) – Used for patients with hypertension & heart disease.

Combination therapy is often needed for better BP control.

2. Lifestyle Modifications for High Blood Pressure

• DASH Diet (Dietary Approaches to Stop Hypertension)
• Rich in fruits, vegetables, whole grains, and low-fat dairy.
• Low in sodium, saturated fats, and processed foods.

Salt Restriction (<2g per day)
•       Reducing salt intake can lower BP by 5-6 mmHg.
Weight Loss
•       Losing just 5-10% of body weight can significantly reduce BP.
Regular Exercise
•       150 minutes per week of moderate-intensity activity.
Limit Alcohol & Caffeine
•       Excessive alcohol and caffeine cause temporary BP spikes.
Stress Management
•       Techniques like yoga, meditation, and deep breathing can help lower BP.

Blood Pressure Targets for Different Populations

Population                                              Target Blood Pressure
General Adults (<80 years old)                       <140/90 mmHg
Adults with Diabetes                                          <130/80 mmHg
Chronic Kidney Disease (CKD)                        <130/80 mmHg
Elderly (≥80 years old)                                      <150/90 mmHg

Resistant Hypertension
Hypertension that remains uncontrolled despite 3+ medications (including a diuretic) is called resistant hypertension.

Causes Include:

• Uncontrolled secondary hypertension (kidney disease, hormonal disorders)
• Poor adherence to medications or lifestyle changes
• Excessive salt or alcohol intake

Advanced Treatments:

• Aldosterone Antagonists (Spironolactone) – Can help control resistant hypertension.
• Renal Denervation Therapy – A procedure that reduces nerve signals raising BP.

Future Treatments & Research in Hypertension

• Gene Therapy – Potential future treatment targeting BP-regulating genes.
• Wearable AI Blood Pressure Monitors – Continuous BP tracking for early intervention.
• New Medications in Clinical Trials – Exploring novel pathways for BP reduction.