Hypertension is a condition defined by high blood pressure in the vascular system. It is diagnosed when the systolic pressure surpasses 140 mmHg or the diastolic pressure exceeds 90 mmHg.
The risk of developing hypertension increases with age. However, in younger individuals, it can be caused by other underlying health problems. When measuring blood pressure, the systolic pressure is measured first, followed by the diastolic pressure as the second value.
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We have two main types. Those are primary and secondary hypertension. More information about them is below.
Primary hypertension accounts for over 90% of all hypertension cases. It is characterized by an inability to determine a specific cause for the condition. A diagnosis of primary hypertension is made only after ruling out any abnormalities that could lead to the disease, which means excluding secondary hypertension.
Genetic and environmental aspects impact the development of primary hypertension. Genetic factors can disrupt the hormonal and nervous systems that regulate blood pressure. These changes can increase the volume of circulating blood and cardiac output, cause blood vessels to constrict, and promote structural changes in blood vessel walls. As a result, this increases blood flow resistance and contributes to the development of hypertension. The genetic component is significant, as indicated by the fact that many individuals with hypertension also have a parent who suffers from the condition.
Environmental factors that contribute to hypertension include a high salt intake, a sedentary lifestyle, obesity, and stress. Hypertension likely develops from the interaction between genetic predispositions and environmental influences, meaning that certain environmental factors can trigger hypertension in individuals with a genetic vulnerability.
In contrast, secondary hypertension has specific identifiable causes.
For example, the kidneys have a significant function in regulating blood pressure. They produce renin, which is involved in the hormonal and nervous regulation of blood pressure. Normal blood pressure is maintained through various mechanisms, including the control of circulating blood volume, vascular wall tension, thirst regulation, and fluid intake—all influenced by renin and hormones released under its influence. Therefore, any dysfunction in the kidneys can impair blood pressure regulation, leading to the development of hypertension. Pathology may affect various structures of the kidney:
Moreover, obstruction of the airways at the throat level caused by the tongue collapsing during sleep leads to chronic sleep deprivation and fatigue. It activates the sympathetic nervous system, which stimulates the heart to contract more frequently and strongly.
Neurological diseases, such as brain tumors and injuries, and conditions like polyneuritis can disrupt blood pressure regulation at the level of the central nervous system.
Drug-induced hypertension can occur due to certain medications, including steroids, oral contraceptives, catecholamines, and immunosuppressive drugs, which elevate blood pressure by affecting various metabolic pathways.
Hypertension can also be caused by toxic substances, including recreational drugs such as amphetamines and cocaine, as well as nicotine, alcohol abuse, and heavy metal poisoning.
Additionally, hypertension that develops during pregnancy is a distinct concern. It typically arises in the second half of pregnancy and resolves after delivery.
Many factors increase the risk of developing hypertension. We divide them into two categories. Those are modifiable and unmodifiable ones.
The risk factors for hypertension that are beyond our control include:
The risk factors for hypertension that depend on us are:
Hypertension is accompanied by:
In more advanced stages of the disease, symptoms resulting from complications of hypertension appear:
A hypertensive crisis requires immediate medical intervention. Symptoms heralding the occurrence of a hypertensive crisis include:
The non-specific symptoms resulting from high blood pressure listed at the beginning do not require urgent medical consultation. Still, they should prompt you to check your blood pressure at home and discuss your symptoms with your doctor during a scheduled visit. However, they should certainly not be underestimated because early detection and treatment of hypertension can reduce the likelihood of dangerous complications.
Hypertension is when, in at least two separate measurements, the systolic blood pressure values exceed 140 and the diastolic blood pressure exceeds 90 mmHg (millimeters of mercury).
Diagnostic methods used to diagnose hypertension:
Treatment aims to maintain blood pressure below 140/90 mmHg. In the case of secondary hypertension, the basis is to remove the cause of hypertension, e.g.:
The choice of specific pharmacotherapy is determined by:
For individuals with a low cardiovascular risk (less than 5%) and blood pressure below 180/110 mmHg, as long as there are no organ complications, lifestyle modifications may be adequate. If, after a few months, blood pressure decreases to below 140/90 mmHg, it’s significant to continue with the lifestyle changes and consult your doctor annually.
If blood pressure is below 180/110 mmHg but there are organ complications or the overall cardiovascular risk exceeds 5%, it’s advisable to consider pharmacological treatment in addition to lifestyle modifications.
Blood pressure readings above 180/110 mmHg, particularly in life-threatening situations require immediate intervention. It should involve the intravenous administration of fast-acting blood pressure-lowering medications.
Treatment of hypertension in seniors often requires lifestyle changes and the combination of several drugs with different mechanisms of action (diuretics and calcium channel blockers are preferred).
In the case of patients with diabetes, in addition to lifestyle changes, it is most often necessary to use at least three drugs, including ACEI or ARB. The goal of antihypertensive treatment in patients with diabetes is to achieve a blood pressure value of <130/80 mmHg.
Pregnant women with hypertension should limit physical activity, rest on their left side, follow a normal diet without salt restriction, and use specific medications. The preferred drugs include methyldopa, labetalol, calcium channel blockers, and β-blockers, while ACE inhibitors and ARBs are contraindicated. Diuretics should be avoided unless urination is impaired. A blood pressure of more than 170/110 mmHg in pregnant women is an urgent condition that requires immediate medical attention.
Pharmacological treatment involves the use of one or more drugs that, by acting on the mechanisms regulating the blood pressure value, lead to its reduction. The basic hypotensive (antihypertensive) drugs are:
One of the factors contributing to the development of hypertension is an increase in blood volume. We can address this issue by administering diuretics, such as indapamide or furosemide, which help eliminate excess fluid. Alternatively, β-blockers can be used to reduce cardiac output, which is the amount of blood the heart pumps in one minute.
The second basic mechanism of hypertension is vasoconstriction; it can be prevented by administering drugs that act directly on the vessel wall and lead to relaxation:
In addition to these basic drugs, many others are also used, differing in their mechanisms of action.
The doctor should inform the patient about the temporary side effects of the medication, which usually subside after 2-4 weeks. Patients often stop taking these medications on their own, unaware that the feelings of fatigue and lack of energy are only temporary.
Blood pressure-lowering medications should be taken in the morning, as blood pressure tends to be highest just after waking up. The timing of any additional doses during the day should be based on the patient's blood pressure readings and overall condition. Generally, it is advised to avoid taking medication before bed, as blood pressure typically drops at night, which could lead to cerebral ischemia and neurological issues.
Single-drug therapy is effective in some cases. If it does not yield satisfactory results, a second or third drug with a different mechanism of action should be added. When using multiple medications, the dosage of each can be lower than if they were taken alone, achieving the same antihypertensive effect. This approach helps reduce side effects, and targeting multiple mechanisms of blood pressure regulation makes the treatment more effective.
People with high blood pressure higher than optimal should introduce modifications to their lifestyle such as those of patients with mild hypertension. It allows one to avoid pharmacological treatment or at least delay the moment of its initiation.
When properly managed, hypertension does not restrict a patient's normal daily activities. To achieve the desired therapeutic outcomes, patients must actively participate in their treatment. Taking daily blood pressure measurements at home can be beneficial for monitoring treatment effectiveness. By recording these results, patients can track the success of their therapy over time.
The basis for achieving proper blood pressure control is not pharmacotherapy, but activities that the patient can independently implement in their daily life:
The most serious complications of hypertension are:
