Everything you need to know about hypertension
Hypertension is another name for high blood pressure. It can lead to severe health complications and increase the risk of heart disease, stroke, and sometimes death.
Blood pressure is the force that a person's blood exerts against the walls of their blood vessels. This pressure depends on the resistance of the blood vessels and how hard the heart has to work.
Almost half of all adults in the United States have high blood pressure, but many are not aware of this fact.
Hypertension is a primary risk factor for cardiovascular disease, including stroke, heart attack, heart failure, and aneurysm. Keeping blood pressure under control is vital for preserving health and reducing the risk of these dangerous conditions.
In this article, we explain why blood pressure can increase, how to monitor it, and ways to keep it within a normal range.
Lifestyle adjustments are the standard, first-line treatment for hypertension. We outline some recommendations here:
Regular physical exercise
Current guidelines recommend that all people, including those with hypertension, engage in at least 150 minutes of moderate-intensity, aerobic exercise every week, or 75 minutes a week of high-intensity exercise.
People should exercise on at least 5 days of the week.
Examples of suitable activities are walking, jogging, cycling, or swimming.
Stress reduction
Avoiding or learning to manage stress can help a person control blood pressure.
Meditation, warm baths, yoga, and simply going on long walks are relaxation techniques that can help relieve stress.
People should avoid consuming alcohol, recreational drugs, tobacco, and junk food to cope with stress, as these can contribute to elevated blood pressure and the complications of hypertension.
Smoking can increase blood pressure. Avoiding or quitting smoking reduces the risk of hypertension, serious heart conditions, and other health issues.
Medication
People can use specific medications to treat hypertension. Doctors will often recommend a low dose at first. Antihypertensive medications will usually only have minor side effects.
Eventually, people with hypertension will need to combine two or more drugs to manage their blood pressure.
Medications for hypertension include:
- diuretics, including thiazides, chlorthalidone, and indapamide
- beta-blockers and alpha-blockers
- calcium-channel blockers
- central agonists
- peripheral adrenergic inhibitor
- vasodilators
- angiotensin-converting enzyme (ACE) inhibitors
- angiotensin receptor blockers
The choice of medication depends on the individual and any underlying medical conditions they may experience.
Anyone on antihypertensive medications should carefully read the labels of any over-the-counter (OTC) drugs they may also take, such as decongestants. These OTC drugs may interact with the medications they are taking to lower their blood pressure.
People can prevent high blood pressure by following a heart-healthy diet.
Reducing salt intake
People's average salt intake is between 9 grams (g) and 12 g per day in most countries around the world.
The World Health Organization (WHO) recommends reducing intake to under 5 g a day to help decrease the risk of hypertension and related health problems.
Lowering salt intake can benefit people both with and without hypertension.
Moderating alcohol consumption
Moderate to excessive alcohol consumption can increase blood pressure.
The American Heart Association (AHA) recommends a maximum of two alcoholic drinks a day for men, and one for women.
The following would count as one drink:
- a 12-ounce (oz) bottle of beer
- 4 oz of wine
- 1.5 oz of 80-proof spirits
- 1 oz of 100-proof spirits
A healthcare provider can help people reduce consumption if they find it difficult to moderate their alcohol intake.
Eating more fruit and vegetables and less fat
People who have high blood pressure or people at high risk of developing high blood pressure should eat as little saturated and total fat as possible.
Instead, experts recommend:
- whole grain, high fiber foods
- a variety of fruit and vegetables
- beans, pulses, and nuts
- fish rich in omega-3 twice a week
- nontropical vegetable oils, for example, olive oil
- skinless poultry and fish
- low fat dairy products
It is important to avoid trans fats, hydrogenated vegetable oils, and animal fats, as well as large portion sizes.
Some fats, such as those in oily fish and olive oil, have protective effects on the heart. However, these are still fats. While they are typically healthful, people with a risk of hypertension should still include them in their total fat intake.
Managing bodyweight
Excess body weight can contribute to hypertension. A fall in blood pressure usually follows weight loss, as the heart does not have to work so hard to pump blood around the body.
A balanced diet with a calorie intake that matches the individual's size, sex, and activity level will help.
The DASH diet
The U.S. National Heart, Lung, and Blood Institute (NHLBI) recommend the DASH diet for people with high blood pressure. DASH stands for "Dietary Approaches to Stop Hypertension."
DASH is a flexible and balanced eating plan with a firm grounding in research by the NHLBI who advise that the diet:
- lowers high blood pressure
- improves levels of fats in the bloodstream
- reduces the risk of cardiovascular disease
The NHLBI produce a cookbook called Keep the Beat Recipes that provides meal ideas to help reduce blood pressure.
Research from 2014 suggests that using probiotic supplements for 8 weeks or more may benefit people with hypertension.
The cause of hypertension is often not known. In many cases, it is the result of an underlying condition.
Doctors call high blood pressure that is not due to another condition or disease primary or essential hypertension.
If an underlying condition is the cause of increasing blood pressure, doctors call this secondary hypertension.
Primary hypertension can result from multiple factors, including:
- blood plasma volume
- hormone activity in people who manage blood volume and pressure using medication
- environmental factors, such as stress and lack of exercise
Secondary hypertension has specific causes and is a complication of another health problem.
Chronic kidney disease (CKD) is a common cause of high blood pressure, as the kidneys no longer filter out fluid. This excess fluid leads to hypertension.
Conditions that can lead to hypertension include:
- diabetes, due to kidney problems and nerve damage
- kidney disease
- pheochromocytoma, a rare cancer of an adrenal gland
- Cushing syndrome that corticosteroid drugs can cause
- congenital adrenal hyperplasia, a disorder of the cortisol-secreting adrenal glands
- hyperthyroidism, or an overactive thyroid gland
- hyperparathyroidism, which affects calcium and phosphorus levels
- pregnancy
- sleep apnea
- obesity
Risk factors
A number of factors increase the risk of hypertension.
- Age: Hypertension is more common in people who are more than 60 years of age. Blood pressure can increase steadily with age as the arteries stiffen and narrow due to plaque buildup.
- Ethnicity: Some ethnic groups are more prone to hypertension than others. African Americans have
a higher risk than other ethnic groups, for example. · Size and weight: Being overweight or obese is a primary risk factor. - Alcohol and tobacco use: Regularly consuming large quantities of alcohol or tobacco can increase blood pressure.
- Sex: According to
a 2018 review , males have a higher risk of developing hypertension than females. However, this is only until after women reach menopause. - Existing health conditions: Cardiovascular disease, diabetes, chronic kidney disease, and high cholesterol levels can lead to hypertension, especially as people age.
Other risk factors include:
- sedentary lifestyle
- salt rich, high fat diet
- low potassium intake
Poorly managed stress and a family history of high blood pressure can also contribute to the risk of developing hypertension.
Below is a 3-D model of hypertension, which is fully interactive.
Explore the model using your mouse pad or touchscreen to understand more about hypertension.
A person with hypertension may not notice any symptoms, and so people often call it the "silent killer." Without detection, hypertension can damage the heart, blood vessels, and other organs, such as the kidneys.
It is vital to check blood pressure regularly.
In rare and severe cases, high blood pressure causes sweating, anxiety, sleeping problems, and blushing. However, most people with hypertension will experience no symptoms at all.
If high blood pressure becomes a hypertensive crisis, a person may experience headaches and nosebleeds.
Complications
Long term hypertension can cause complications through atherosclerosis where plaque develops on the walls of blood vessels, causing them to narrow.
This narrowing makes hypertension worse, as the heart must pump harder to circulate the blood.
Hypertension-related atherosclerosis can lead to:
- heart failure and heart attacks
- aneurysm, or abnormal bulge in the wall of an artery that can burst
- kidney failure
- stroke
- amputation
- hypertensive retinopathies in the eye, which can lead to blindness
Regular blood pressure monitoring can help people avoid these more severe complications.
A sphygmomanometer, or blood pressure monitor, can help people keep track of their blood pressure.
A doctor's visit is not always necessary for blood pressure monitoring. Home blood pressure monitors are available for purchase online.
Having high blood pressure for a short time can be a normal response to many situations. Acute stress and intense exercise, for example, can briefly elevate blood pressure in an otherwise healthy person.
For this reason, a diagnosis of hypertension requires several readings that show sustained high blood pressure over time.
The AHA issued guidelines in November 2017 that define hypertension as blood pressure that is consistently higher than 130 over 80 millimeters of mercury (mmHg).
The systolic reading of 130 mmHg refers to the pressure as the heart pumps blood around the body. The diastolic reading of 80 mmHg refers to the pressure as the heart relaxes and refills with blood.
The AHA 2017 guidelines define the following ranges of blood pressure:
| Systolic (mmHg) | Diastolic (mmHg) | |
| Normal blood pressure | Less than 120 | Less than 80 |
| Elevated | Between 120 and 129 | Less than 80 |
| Stage 1 hypertension | Between 130 and 139 | Between 80 and 89 |
| Stage 2 hypertension | At least 140 | At least 90 |
| Hypertensive crisis | Over 180 | Over 120 |
If the reading indicates a hypertensive crisis, wait 2 or 3 minutes and then repeat the test.
If the reading is the same or higher, this indicates a medical emergency.
The person should seek immediate assistance at the nearest hospital.
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