Hypertension (high blood pressure)Also known as High Blood Pressure and High BP
Hypertension or high blood pressure is one of the common disorders affecting 1.13 billion people worldwide, as per 2021 WHO report. There are numerous factors that put you at risk of hypertension which include sedentary lifestyle, increased age, stress, family history, cigarette smoking, being overweight, high salt diet, etc. Moreover, certain diseases can also lead to high blood pressure such as diabetes, chronic kidney disease, and hypercholesterolemia.
The condition causes thickening of your blood vessel walls which leads to increased blood flow with high pressure. This in turn can lead to microscopic injuries to various organs of the body. Most patients have no obvious symptoms and hence, do not even know that they have hypertension. As a result, a large number of hypertension cases go undetected. However, patients can experience symptoms such as severe headache, fatigue, dizziness, chest pain, difficulty in breathing, etc.
Once diagnosed with hypertension, you need to take proper measures to keep your blood pressure under control. These steps mostly focus on strict diet control, routine exercise/workouts, weight control, active lifestyle and stress management. In some cases, use of medications along with lifestyle measures are required. If ignored, uncontrolled high blood pressure can lead to complications like heart diseases, stroke, kidney diseases and eye damage.
- Adults above 40 years of age
- Both men and women but more common in men
- Blood vessels
- Secondary Hypertension
- Coarctation of the aorta
- Renal artery stenosis
- Chronic kidney disease
- Aortic valve disease
- Thiazides diurectics: Hydrochlorothiazide & Chlorthalidone
- Loop diuretics: Furosemide & Torsemide
- Potassium-sparing diuretics: Triamterene & Amiloride
- Calcium channel blockers: Amlodipine & Nifedipine
- ACE inhibitors: Captopril & Enalapril
- Angiotensin II receptor blockers (ARBs): Telmisartan & Losartan
- Beta-blockers: Atenolol & Metoprolol
- Vasodilators: Hydralazine & Minoxidil
- Aldosterone antagonist: Spironolactone
- Alpha blockers: Doxazosin & Prazosin
- Cardiac surgeon
Symptoms Of Hypertension
The signs and symptoms include
- Changes in vision
- Chest pain
- Swelling in the legs and feet
- Abnormal heart sounds
- Narrowing of the eye blood vessels
- Retinal bleeding
- Changes in reflexes
Hypertension is a ‘silent killer’. Most of the time, the signs and symptoms are none. Symptoms may show up in long-standing or severe hypertension.
Causes Of Hypertension
The cause for hypertension is unknown in the majority of cases. The interplay of genetic, environmental, behavioral and dietary factors is responsible for the development of hypertension. There are two types of high blood pressure which include:
2. Secondary hypertension: If your high blood pressure is caused by an underlying condition, it is called secondary hypertension. Various conditions and medications can lead to secondary hypertension, including:
- Obstructive sleep apnea
- Kidney disease
- Adrenal gland tumors
- Thyroid problems
- Certain defects you're born with (congenital) in blood vessels
- Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers
- Certain illicit drugs such as cocaine and amphetamines
- Lifestlye factors such as being overweight/obese, smoking, no exercise, etc
Types Of Hypertension
The American Heart Association has classified the blood pressure into five different ranges. These are:
1. Normal blood pressure (BP): If your blood pressure is less than 120/80 mm Hg (where systolic BP is less than 120 mm Hg and diastolic BP is less than 80 mm Hg), then your blood pressure is considered to be in the normal range. This indicates that your heart is healthy and hence, it is important to stick to your habits when it comes to diet and exercise.
2. Elevated blood pressure: This is the stage where your blood pressure readings consistently in the range of systolic BP is 120 – 129 mm Hg and diastolic BP is less than 80 mm Hg). If you suffer from elevated blood pressure there are high chances that you might develop hypertension in the future if proper steps are not taken to control your blood pressure. These steps mostly focus on strict diet control, exercise routine, weight control, active lifestyle and stress management.
3. Stage 1 hypertension: It is when your blood pressure readings are consistently 130 – 139/ 80 – 89 mm Hg (where systolic BP is 130 – 139 mm Hg and diastolic BP is 80 – 89 mm Hg). Based on your age and risk factors, your doctors might recommend diet control or prescribe medications. If you or your family have a history of heart disease or are obese, then it is likely that doctors might advise medications to prevent cardiovascular complication such as heart attack or stroke.
5. Hypertensive crisis: This is the fifth but most severe stage of hypertension which requires urgent medical attention. In this stage, your blood pressure readings exceed 180/120 mm Hg (where systolic BP is higher than 180 mm Hg and diastolic BP is higher than 120 mm Hg). It is advised to wait for five minutes and check your readings again. If the readings are still extremely high, then contact your doctor immediately. This indicates that you might be experiencing signs of organ damage such as shortness of breath, chest pain, back pain, weakness or numbness, difficulty in speaking or changes in vision. Do not wait for the readings to come down but rush to a hospital at the earliest.
Resistant Vs refractory hypertension
Resistant hypertension is defined as blood pressure that remains above the normal range in spite of the use of 3 antihypertensive agents of different classes. You may have resistant hypertension if you are on 3 antihypertensive medications which when taken together, relieve high blood pressure (complementary mechanisms of action) but are still not able to achieve control over your high blood pressure or if you need ≥4 medications to achieve BP control.
Whereas, refractory hypertension (RfH) is an extreme phenotype of resistant hypertension (RH), being considered an uncontrolled blood pressure besides the use of 5 or more antihypertensive medications, including a long-acting thiazide diuretic and a mineralocorticoid antagonist.
Older age, obesity, chronic kidney disease and diabetes are some of the factors that increase the risk for resistant hypertension. Resistant hypertension increases the risk of myocardial infarction, stroke, kidney failure, and death by two to sixfold.
Risk Factors For Hypertension
The risk factors of hypertension are divided into:
Modifiable risk factors
Current cigarette smoking, secondhand smoking
Physical inactivity/low fitness
Excessive use of alcohol
Non-modifiable risk factors
- Chronic Kidney Disease (CKD)
- Family history
- Increased age
- Low socio-economic/educational status
- Globalization, urbanization
- Gender (more prevalent in males)
- Obstructive sleep apnea
- Psychosocial stress
Diagnosis Of Hypertension
Diagnosis of hypertension is based on blood pressure measurements. According to WHO, the measurements need to be recorded for several days before a diagnosis of hypertension can be made. Two consecutive measurements at least a few minutes apart are taken and recorded twice daily (morning and evening). A standard way to measure blood pressure is to take the average of more than two measurements in separate visits.
Hypertension is generally treated with medicines when the average systolic blood pressure is 140 mmHg or higher, or when the average diastolic blood pressure is 90 mmHg or higher, taken on two or more separate days. Systolic and diastolic blood pressure of less than 120 mmHg and 80 mmHg, respectively, is considered normal.
Important note: One important thing to note is that if a person records high blood pressure at any single occasion, it does not imply that the person is hypertensive. The blood pressure readings are based on an average of more than two careful readings recorded on more than two occasions.
You will be evaluated through your medical history, physical examination, routine laboratory tests, and certain diagnostic procedures. Your doctor will identify the signs and symptoms that may be due to high blood pressure. The clinical findings may help uncover an underlying health disorder too.
Laboratory tests are done for CVD (cardiovascular disease) risk factor profiling. The tests to screen secondary causes of hypertension & include:
- Lipid profile
Laboratory tests are done for screening secondary causes of hypertension when the clinical indications and physical examination findings are present. Adults with resistant hypertension are also screened for secondary hypertension. Additional diagnostic tests may include complete blood count, urinalysis, urine culture, BUN, creatinine, electrolytes test, lipid profile, renal ultrasound, etc.
Prevention Of Hypertension
1. Go easy on yourself. De-stress!
Chronic stress is an important contributor to high blood pressure. Even occasional stress can contribute to high blood pressure if you react to stress by eating unhealthy food, drinking alcohol or smoking. Managing stress can help you prevent high blood pressure.
- Give yourself time to get things done.
- Learn to say no and to live within manageable limits.
- Try to learn to accept things you can’t change.
- Know your stress triggers and try to avoid them.
- Take 15 to 20 minutes a day to sit quietly and breathe deeply.
- Meditate! Whether it involves chanting, breathing, visualization, it can be an effective stress-management tool for many people.
2. Cut down your salt intake
Restricting the salt intake to less than 6gm/day can not only lower the blood pressure but is also good for the heart. To decrease sodium in your diet, consider these tips:
- Read the food labels carefully and opt for foods with low sodium.
- Avoid having processed foods as they have high sodium content.
- Develop a taste for unsalted/low salted food.
- Resist the urge to sprinkle salt over salads and cooked food.
3. Eat heart-healthy foods
Foods rich in healthy fats such as monounsaturated fats and polyunsaturated fats are good for your heart. Also, foods loaded with vitamins & minerals are important for maintaining proper blood circulation. Foods rich in fibre can aid in lowering cholesterol levels. So make sure to include foods such as nuts, green leafy vegetables, tomatoes, garlic, ginger, apples, etc in diet for better heart health.
4. Exercise regularly
People who are physically active are often able to improve heart health and prevent complications such as hypertension.
- 30-45 minutes of brisk walking 3-4 times a week could lower the blood pressure by 7-8 mm Hg.
- You could pick any physical activity you like such as walking, running, swimming or cycling.
5. Lose those extra kilos
If you are overweight or obese, losing weight may be enough to prevent blood pressure in addition to other lifestyle conditions
- Limit your calorie intake to around 1500 Kcal per day. Have a diet rich in fruits, vegetables and low-fat dairy products.
- Stay hydrated. Drink around 2 liters of fluids throughout the day.
6. Limit your tea/coffee intake
Caffeine can cause short-term spikes in blood pressure, even in people without hypertension. Limit your caffeine intake to about 2 cups of coffee per day.
7. Stay away from alcohol
Consuming more than 2 drinks a day increases the risk of hypertension in both men and women. It can also reduce the effectiveness of blood pressure medications. Restrict your alcohol intake to special occasions or weekends. And remember, moderation is the key.
8. Quit smoking
Smoking is tied to higher risk of hypertension.
- Each cigarette you smoke increases your blood pressure for many minutes after you finish.
- Quitting smoking helps your blood pressure return to normal.
- People who quit smoking, regardless of age have a higher life expectancy.
Specialist To Visit
If you observe any signs and symptoms of hypertension, then it is wise to consult a doctor without fail because immediate diagnosis and treatment can improve your overall well being. Also, if you are above 40 years or age or have any risk factors of high blood pressure, then it is wise to visit a doctor at least once a year and check your blood pressure.
- General physician (family doctor)
- Cardiothoracic vascular surgeon (CTVS)
If you have other health problems along with hypertension, then you might be recommended to specialists such as:
Treatment Of Hypertension
The main aim of treatment of hypertension is to keep the blood pressure within the normal range to lower the risk of future complications. Many drugs like diuretics, calcium channel blockers (CCBs), angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), beta blockers, vasodilators, etc. are currently available for reducing blood pressure. More than two-thirds of hypertensive individuals are suggested two or more antihypertensive drugs, selected from different classes of drugs to treat their hypertension.
Calcium channel blockers (CCB)
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers (ARBs)
Alpha and Beta blockers
The first drugs that you may be prescribed to treat your hypertension (First-line treatment) may include thiazide diuretics, CCBs and ACEI/ARBs. If you have stage 2 hypertension but do not possess any high-risk situation then you may be prescribed two antihypertensive drugs from different classes instead of any specific drug.
Diuretics like hydrochlorothiazide eliminate excess salt and water from the body and also decrease calcium excretion. There are different types of diuretics that act at different sites of the renal tubules (small tubes) in the nephrons (functional unit of kidney). A few types of diuretics used in the treatment of hypertension are:
2. Calcium channel blockers
They bind to calcium channels in the blood vessels and block the entry of calcium. This causes dilatation of the blood vessels which helps decrease blood pressure. Calcium channel blockers are of two types:
3. Angiotensin-converting enzyme (ACE) inhibitors
These inhibit the angiotensin-converting enzyme which regulates salt and water retention in the body. They also lower blood pressure by relaxing the blood vessels, decreasing blood volume and increasing sodium excretion in the urine. A few examples in this class of drugs are
4. Angiotensin Receptor Blockers (ARBs)
If you are unable to tolerate ACE inhibitors, ARBs are used. They block angiotensin-II (a hormone which causes your blood vessel to constrict) from binding to its receptor and antagonize its action. This helps reduce your blood pressure. Some examples in this class of drugs are
If you are suffering from some serious conditions of the heart like heart failure, myocardial infarction, etc., beta-blockers are the prescribed alternatives. Some of the drugs in this class are
It helps to lower blood pressure by relaxing the blood vessels’ walls and decreasing their resistance. These medications are vasodilators that work directly on the vessel walls to decrease blood pressure. Examples include
7. Aldosterone Antagonists
Aldosterone antagonists are also considered diuretics. Examples are spironolactone and eplerenone (Inspra). These drugs block the effect of a natural chemical that can lead to salt and fluid buildup, which can contribute to high blood pressure. They may be used to treat resistant hypertension.
8. Alpha blockers
These medications reduce nerve signals to blood vessels, lowering the effects of natural chemicals that narrow blood vessels. Alpha blockers include
Tips to keep in mind when taking blood pressure medications
You should always take blood pressure medications as prescribed.
Never skip a dose or abruptly stop taking your blood pressure medication. Suddenly stopping certain blood pressure drugs, such as beta blockers, can cause a sharp increase in blood pressure (rebound hypertension).
If you skip doses because you can't afford the medications, because you have side effects or because you simply forget to take your medications, talk to your doctor about solutions.
Don't change your treatment without your doctor's guidance.
Home-care For Hypertension
Adopting a healthy lifestyle and making small but conscious dietary changes can go a long way in controlling blood pressure. In some cases, it can even help to reduce the dose and number of medications. Here are some easy ways of keeping blood pressure in check:
- Exercise regularly
- Cut down on salt intake
- Limit your calorie consumption
- Restrict your intake of caffeine
- Manage stress
- Quit smoking & cut down on alcohol
If you are diagnosed with High BP, then you need BP monitoring as advised by your doctor. But even if you are not diagnosed with Hypertension you should check your BP at least once a month. This is because most of the time, high blood pressure has no symptoms. And owing to the unhealthy eating habits and stressful lifestyle, you are at risk of high blood pressure. Also, if you have a family history, you should check your BP regularly.
Logging your blood pressure everyday is not a bad idea to keep a close tab on your BP levels. Here is a printable BP tracker for you to record your levels every day.
There are two types of kits to measure BP. The digital and the manual BP monitor.
1. When using a digital monitor
- Secure your arm (any arm as you please) in the cuff from your elbow upwards.
- Switch the monitor on.
- Inflate the cuff by pressing the bulb with whichever hand is free. For monitors with automatic inflators, just sit back and relax.
- Your cuff will start deflating, listen out for the long beep sounds. The first one will signify the systolic pressure, the second one will signify the diastolic pressure.
- After your monitor has registered both readings, it will display them on the screen.
- Let the cuff deflate completely and unwrap your arm.
Still not sure about how to use a digital BP monitor? No worries. Watch this video to know the right way to use it.
2. When using a manual monitor
- Secure your arm (any arm as you please) in the cuff from your elbow upwards.
- You will need a stethoscope. Insert the head under the lower end of the cuff just above the elbow pit so that it rests on the radial artery.
- Tighten the screw on the airflow valve.
- Inflate the cuff by pressing the bulb with whichever hand is free.
- Once the meter shows 180 mm Hg, slightly loosen the screw of the airflow valve and let the air escape slowly.
- Listen for beats in the stethoscope with eyes on the meter. Record the meter readings when you start hearing them (systolic BP) and then again once you stop hearing them completely (Diastolic BP).
Complications Of Hypertension
Long-standing hypertension can cause harmful consequences. The thickening of the walls of the blood vessels leads to reduced blood flow to different organs of your body. Hypertension can increase the risk of developing coronary artery disease, heart failure, stroke, aortic aneurysm (bleeding from large blood vessels), nephropathy (kidney damage), retinopathy (vision loss), etc. Many people with hypertension also have other health risk factors like smoking, obesity, high cholesterol and diabetes which increase their odds of complications.
1. Coronary artery disease: The damaged blood vessels of the heart can reduce the efficiency of the heart and also increase its workload. This can cause angina (chest pain) and left ventricular hypertrophy (thickening of heart muscle wall), eventually leading to heart failure.
2. Stroke: Uncontrolled hypertension damages and weakens the small vessels in the brain causing them to rupture and leak. It can also lead to the formation of blood clots in the vessels which block the blood flow and potentially cause a stroke.
3. Dementia: Hypertension in midlife is also a major risk factor for dementia. Chronically elevated blood pressure causes thickening of the blood vessel wall, thereby narrowing the tiny blood vessels. Plaque accumulation also leads to narrowing of the larger arteries of the brain. These plaques may rupture and completely block the passage of blood within the blood vessels resulting in the death of tissue in areas of the brain responsible for memory and executive function.
3. Aortic aneurysm/dissection: Hypertension weakens the wall of the blood vessels and over time, may cause it to bulge. This forms an aneurysm (a pouch-like structure) in the blood vessel wall which can be fatal when ruptured.
4. Hypertensive nephropathy/CKD: Damaged small vessels in the kidney reduce its blood supply. This leads to reduced kidney functions and eventually to kidney failure.
5. Hypertensive retinopathy: The retina, choroid, and optic nerve of the eye are affected. Blood vessels in the retina of the eye are narrowed. This impairs the vision and leads to retinopathy and eventually blindness.
These complications can be prevented by controlling the blood pressure and the known risk factors. Reduction of blood pressure to <130/80 mmHg has been shown to reduce heart complications by 25%.
Alternative Therapies For Hypertension
According to Ayurveda, hypertension can be attributed to 2 types of causes:
Diet-related Causes (Aharaj-nidana): These include excessive salt intake (atilavana), alcohol intake (atimadyapana), and meat consumption (mansa-sewan)
Lifestyle-related Causes (Viharaj-nidana): These causes chiefly include staying awake at night (ratrijagarana), sleeping during the day (divasvapna), holding on to natural urges like urination (vegavidharana), sedentary lifestyle (avyayama), overexertion (ativyayam), stress and anxiety (manashetu)
Ayurveda herbs: Individual drugs like Gokshura, Guggulu, Gomutra (cow urine), Arjuna, Punarnava, Ashwagandha, and Triphala can be used for the treatment of hypertension.
- Garlic powder in the dosage of 600-900 mg per day is a useful remedy for high blood pressure.
- Arjuna bark powder when taken in the dosage of 4 gm twice daily causes significant improvement in hypertension.
- Two tablets of Sarpagandha vati (250 mg) taken twice daily have shown good results in reducing blood pressure.
- Having Ashwagandha powder 2 gm with milk also helps to reduce blood pressure.
Panchakarma : Procedure of full body massage (Sarvanga Abhyanga) with medicated oils followed by induced vomiting and purgative therapy (Vaman and Virechan) or medicated enema (basti) may be administered depending upon the vitiated dosha and condition of the patient.
Yoga: Meditation and other relaxing techniques can help you in stress reduction. If practiced regularly and appropriately, you can also benefit from.
Living With Hypertension
Hypertension is a lifelong disease which needs to be managed for the rest of your life. You will need to make the necessary dietary and lifestyle changes to efficiently manage your condition. Eating healthy, exercising regularly, reducing weight, limiting alcohol intake, quitting smoking, etc. can go a long way in managing the condition.
However, with lifestyle changes and medication you may feel fine, you need to prevent health complications that may arise from hypertension. Also, managing your condition may take a toll on you, both physically and emotionally.
1. Invest in a digital BP monitor and use it regularly to check your blood pressure at home. Here are tips on how to choose a blood pressure monitor. Also, get your blood pressure tested at a hospital (from an expert or a qualified professional) once a year or during your regular health check-ups at a doctor’s clinic.
2. Rush to a hospital immediately if your blood pressure exceeds 180/120 mm Hg as it is a sign of hypertensive crisis. Also, if you experience symptoms of low blood pressure such as fainting, headache, dizziness, or fatigue, then do consult your doctor.
3. Eat a healthy diet low in sodium and fats to control your blood pressure along with regular intake of medicines and timely health checkups. Also, include lots of fresh fruits and vegetables in your diet and say no to sweetened beverages and processed foods. Here is a list of foods that people with hypertension should avoid.
4. Ideally, it is advised to exercise 30 – 45 minutes at least five times a day which includes brisk walking and strenuous workouts. For older individuals, it is recommended to perform physical activities at least twice a week. This is because it not only improves your blood circulation but also helps to control your blood pressure and lowers your risk of heart disease.
5. Limit the intake of alcohol as excessive drinking can increase the risk of hypertension. Also quit smoking as it can reduce the overall risk of cardiovascular diseases, a complication of high blood pressure.
6. If stress is the cause of high blood pressure, stress management should be considered as an effective intervention. Some of the techniques that can help to calm your mind and body and relieve stress include indulging in hobbies, playing a sport, joining a swim class or dance class or performing yoga and meditation.
7. Getting help from support groups for hypertension can help you to fight your condition. It also helps you to be more aware of your condition and its associated complications. You may be able to find one (in person or online) and share your story which in turn can help you to manage hypertension.
Frequently Asked Questions
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- Anchala R, Kannuri NK, Pant H, et al. Hypertension in India: a systematic review and meta-analysis of prevalence, awareness, and control of hypertension. J Hypertens. 2014 Jun;32(6):1170-7.
- Understanding Blood Pressure Readings. The American Heart Association.
- Hypertension. Screening, Diagnosis, Assessment, and Management of Primary Hypertension in Adults in India. Standard. Treatment Guidelines. Ministry of Health & Family Welfare. Government of India. Feb 2016.
- Hegde S, Aeddula NR. Secondary Hypertension. [Updated 2021 Jun 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.
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- Facts About Hypertension. High Blood Pressure. Centers for Disease Control and Prevention (CDC). Last reviewed in July 2021
- Chopra HK, Ram CVS. Recent Guidelines for Hypertension. Circ Res. 2019 Mar 29;124(7):984-986
- Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020 Jun;75(6):1334-1357.
- The Facts About High Blood Pressure. The American Heart Association. Last Reviewed in Nov 2017.
- Armstrong C. High Blood Pressure: ACC/AHA Releases Updated Guideline. Am Fam Physician. 2018 Mar 15;97(6):413-415.