Complete guide about Hypertension: Causes, symptoms, diagnosis, treatment and overall management

We’re living in an era of lifestyle diseases. We’re plagued with health conditions like heart diseases, stroke, hypertension, obesity, diabetes, cancer, autoimmune disorders and so many other health issues. There are plenty of factors which are related to our fast-paced yet sedentary lifestyle leading to such an upsurge in the prevalence of these health conditions. Some of the factors are as follows:

1. Lack of physical activity: Although a few people have begun to compensate for this with regular workouts, a majority of the population is sitting throughout the day with minimal physical activity. This certainly leads to obesity, giving way to so many lifestyle diseases.
2. Increasing stress: While the competition is on the rise; whether you’re a student or a working person, you’re always competing with someone around you. And, then, there is peer pressure, regular reprimanding from the boss, too much workload, little time for entertainment, emotional stress, economic issues etc. all building up to high levels of stress among the people. This stress is a precursor to a whole range of health issues.
3. Poor diet: When you have so little time for yourself, it’s hard to find time to cook good food for yourself. In fact, it’s even hard to find to take a meal at a proper time. While you’re running around with an errand you realize that you’re already hours late for your lunch. So, you eat whatever you can get your hands on; junk food, stale leftovers, unhygienic food. And, what it does to your body?
4. Pollution: While the technology is on the rise, also on the rise is the pollution associated with it. Whether it’s the air, water or earth. Everything is polluted. The air you breathe is toxic, water you drink (or at least exposed to for various reasons) is toxic. In fact, there is this noise pollution that is constantly ringing in your ears. How much can your body take? These toxins harm your body in the worst way possible.   

What is hypertension?

Hypertension is basically a term given to high blood pressure. It is a chronic health condition where arterial blood pressure is persistently elevated. What makes hypertension an alarming health condition is the lack of clear symptoms leading to late detection of the disease when it has already done much damage to the overall body. The longer a person has uncontrolled hypertension, higher is the risk and extent of complications. Hypertension is associated with high risk of stroke, heart disease, and death.

A common myth is that when a person takes too much tension (stress) or gets too angry, he develops hypertension. Although, the statement is true in its sense and stress certainly is a causative factor for hypertension, hypertension is much more than just stress.

What is blood pressure?

Blood pressure is the measure of pressure or force that the blood exerts over the walls of the blood vessels. This pressure is dependent on the amount of work done by the heart and the resistance offered by the blood vessels. Thus, conditions where the heart is working more than normal or vessels exerts too much resistance, blood pressure tends to rise. Although, a rise in blood pressure might be seen in healthy individuals as well, like while working out, during an emotional crisis, while watching a very intense movie etc. However, it is the chronic increase in blood pressure even at rest which is alarming.

To measure blood pressure in a single reading two different pressures are noted, which in common language people refer to as ‘higher pressure’ and ‘lower pressure’ (these terms are actually misnomers). The first number refers to the systolic blood pressure which is maximum pressure during contractions of cardiac muscles (i.e. during a heartbeat), while the second number refers to diastolic blood pressure which refers to the minimum blood pressure in between two heartbeats.

How to diagnose hypertension?

Blood pressure is categorized by the doctors as normal, elevated or stage 1 or 2 hypertension. Although, you must always consult your doctor to establish the diagnosis of hypertension, just to make it simpler we’ll try to inform you how these categories are classified.

Normal blood pressure is considered as 120/80 mmHg where 120 is the systolic blood pressure while 80 mmHg is the diastolic blood pressure. However, it is much complicated than that. Below is the clinical classification of blood pressure:

Source: “Guideline for the diagnosis and management of hypertension in adults” (PDF). Heart Foundation. 2016. p. 12. Retrieved 12 January 2017.

To confirm the diagnosis at least 3 reading must be taken at different time. If the readings are noted more than normal on three or more occasions, you must consult your doctors and appropriate measures need to be taken.

In case, a reading fall under hypertensive urgency, wait 5 minutes to take another reading. If the readings are still elevated to the urgency levels consider this as a medical emergency and the person must be taken to a hospital for immediate attention.

Things to remember while measuring blood pressure at home

One can either get his/her blood pressure checked by a doctor or can also check at home using a sphygmomanometer, or a digital blood pressure monitor. As already discussed the blood pressure may be affected by other factors leading to a temporary rise in blood pressure. Thus, before to set up a routine to measure you must keep the following things in mind:

1. Take the blood pressure measurement at the same time each day to reduce diurnal variations and other factors. It is advised to take your blood pressure readings in the morning an hour after you wake up and before breakfast.
2. If you choose any other time of the day make sure to take a break of minimum 30 mins. between measurement and activities like workouts, meals, smoking, bath, taking caffeine, or any other activity which is likely to affect your blood pressure.
3. Make sure your posture is appropriate while taking the measurement.
   • The person should lie or sit in a comfortable position.
   • When lying arm should be completely supported and at the level of the heart.
   • When sitting the arm should be comfortably rested on a table with the palm facing up. The cuff should remain at the level of the heart.
   • Legs should not be crossed while sitting.
   • The person should sit at rest at least for 5 minutes before measuring and avoid talking, moving or doing any other activity.
4. Also, use the right sized cuff. Good brand BP monitors like Omron comes in different sizes including small, medium and large cuff sizes.
5. If there is a doubt take 3 measurements at the gap of ten minutes and record their mean as the correct measurement.
6. Don’t move while measuring as that may lead to false reading.
7. Placing cuff:When wrapping the cuff around the elbow consider following things:
   • Wear thin sleeves. Never place the cuff over jackets or sweater. Never pull the sleeves above as that may put unnecessary pressure on the blood vessels.
   • Make sure the cuff is comfortable around the arm.
   • Some cuffs come with a mark that needs to be kept in the center such that the cuff is aligned with respect to the artery which is present on the inner side of your elbow fold.
   • The bottom of the cuff should be 1 inch above the elbow joint.
   • Rest your elbow comfortably on the table with your palm facing upwards.
8. Some BP monitors come with advanced features like cuff wrapping indicators, body movement indicators. Make sure you keep a check on them and if there is a problem, rectify it.
9. Sometimes the blood pressure measurements may be abnormal, either more than actual, or lesser than it. We’ve already talked about conditions where BP is elevated after intense activity, meals, emotional stress or similar conditions. However, sometimes the BP might be abnormal even at rest while you’re visiting your doctor. On this basis of abnormal BP reading, we can classify such hypertension as:

1. • White coat hypertension:This is a false positive abnormal reading seen when a patient visits a doctor. The patient may be anxious by just thinking about the doctor and, thus, blood pressure elevates out of anxiety leading to abnormal readings. Sometimes, when a patient walks or take stairs to reach the doctor and there isn’t much rest in between, the BP may be raised as well.
   • Masked hypertension: This is a false negative abnormal reading. The patient might feel unusually relaxed visiting a doctor leading to lower readings than it should be. Another reason for this might be when a patient takes medicine just before visiting the doctor to show their doctor or relatives that their blood pressure is in control.

Why choose digital monitors to measure blood pressure at home?

1. The ease of use: The older BP measuring sphygmomanometer require a bit of expertise, as well as a bulky mercury instrument along with a stethoscope. Though, for a trained person the method is easy, same may not be the case for all. All you have to do is place the cuff correctly and press the start button.
2. Environment effect: A digital monitor is least likely to be affected by environmental factors like noise, temperature etc.
3. Influence of high blood flow: In certain conditions where blood volume is higher than normal like during pregnancy, in athletes, or during hyperthyroidism, the readings may be affected in a traditional BP monitor. Digital monitors aren’t affected by blood volume.
4. Fewer chances of malfunction: Digital monitors are more durable and remain calibrated for a longer period than a traditional sphygmomanometer will. Truly speaking I had a sphygmomanometer once, and I happened to drop it just once, and it never worked again.
5. Affordable: Many models of digital monitors are available with different price range and features. You can always choose one that suits your budget.
6. Advance features: With the advent of technology each day newer BP Monitors are being invented with advanced features. Some devices even tell you if your cuff size is wrong, or cuff is placed incorrectly, and if you’re moving too much to affect the reading. Well, if that’s not enough, I happen to get my hands on the latest BP monitor by Omron, HEM-7600 T (available on Amazon here).

Not only does it measure the blood pressure, but it helps you in measuring it with accuracy and keeping a record of it through Omron Connect app with the help of its Bluetooth connectivity feature. The device is tubeless, thus comfortable, and has a one-touch measurement making it easy to use for technically challenged elderly as well. Other features include:

• Intellisense technology: This is an Omron’s patented tech. This algorithm allows the monitor to detect even the minor changes in the blood pressure and automatically adjust the inflation of the cuff to ensure comfort, accuracy, and speed.
• Intelli wrap cuff: This allows the accuracy of the monitor with its 360 degrees smartcuff. You don’t have to worry about positioning the cuff in the right direction as whichever direction you place it in, it will do great.
• Bluetooth connectivity: You can directly connect this device with a single click to your smartphone using the Omron Connect App. The app will keep a tab on all your blood pressure readings, make a chart of it that you can easily share online with your doctor or anyone else. It also helps in managing hypertension better as now you are able to better understand how your blood pressure is behaving.
• More features included in this model are: detection of irregular heartbeats and detection of body movement during BP monitoring which can both be responsible for inaccurate readings.
• This device also has the memory feature that could record the blood pressure measurements and help you keep an eye on it during a period.

What causes hypertension?

Based on causes of hypertension is classified as essential hypertension and secondary hypertension. The cause for hypertension is unknown in 95% of the patients. This type of hypertension with idiopathic causes is termed as primary or essential hypertension. When a proper cause can be established, such hypertension is called as secondary hypertension.

Essential hypertension

This hypertension is diagnosed when the doctor has found the patient’s blood pressure higher than normal three or more times and an obvious cause of hypertension cannot be found. Commonly, these patients do not notice any symptoms, though the patient may experience recurrent headaches, fatigue, nosebleeds or dizziness. Recent researches attribute such hypertension to different factors like smoking, obesity, alcohol, diet, and heredity.

Secondary hypertension

The commonest cause of this type of hypertension is kidney disease with an aberration in the blood vessels delivering blood to the kidneys. When kidneys are unable to filter out enough fluid, it leads to excessive blood volume eventually causing hypertension. Apart from kidney disease, other causative factors can be diseases or tumors of adrenal glands, upper airway obstruction during sleep, hormonal imbalance, thyroid diseases, excessive salt intake, or alcohol intake. Certain drugs can also cause hypertension like ibuprofen or pseudoephedrine. Fortunately, when a cause is established, it is easier to manage the issue.

What are the risk factors associated with hypertension?

There are plenty of risk factors which elevates the chances of developing hypertension, such as:

1. Age: The risk of hypertension increases with age with people above 60 years at maximum risk. The major reason behind it is that with age the blood vessels get inflexible and narrow from the plaque deposition.
2. Ethnicity: Some ethnic groups are at a higher risk of hypertension than others like Afro-Caribbeans and South Asians.
3. Family history
4. Weight: Obesity or even overweight is a leading factor associated with hypertension.
5. Alcohol intake and tobacco smoking: Both alcohol and tobacco are known to cause elevated blood pressure.
6. Sex: The overall risk for hypertension is same for both genders. However, males are more vulnerable to hypertension during younger years
7. Predisposing health conditions: Several lifestyle diseases are known to cause or worsen hypertension like diabetes, cardiovascular disease, chronic kidney disease and raised cholesterol levels.
8. Physical inactivity
9. Unmanaged stress
10. Excessive salt intake: It’s not necessarily the salt that you add to your cooked food. Sometimes you may be restricting salt in your cooked food, but the use of other products like processed foods, fatty foods, and preserved foods may lead to salt excess.
11. Low potassium diet
12. Medicationslike ibuprofen, or pseudoephedrine

What are the signs and symptoms of hypertension?

The most obvious sign of hypertension is the rise in blood pressure, as we’ve discussed before.

Usually, a person with hypertension remains asymptomatic. However, if hypertension remains undetected for long it keeps on harming the body especially cardiovascular system and other internal organs like kidneys. Thus, it is vital that even seemingly healthy individuals must regularly check their blood pressure from time to time, particularly those above the age of 30-35 years.

Many cases of hypertension are diagnosed when a patient visits a doctor for recurrent headaches and the doctor measures their blood pressure. So, one should never ignore the headaches. Other symptoms of hypertension include anxiety, sweating, sleep problems, flushing etc. A person may suffer from a severe headache or nosebleed during a hypertensive crisis.

Preventions and management of hypertension

The most important step taken in the prevention or management of hypertension include monitoring your blood pressure regularly. To prevent the development of hypertension one should make a few lifestyle changes including modification of diet. Nonetheless, when a person develops hypertension there are several treatment options available. As a matter of fact, lifestyle modification is considered as the standard first-line choice of treatment.

Lifestyle modifications

Various lifestyle modifications are needed in the management of hypertension are as follows:

1. Regular workouts: It is recommended that patients with hypertension must perform regular dynamic, aerobic workouts of minimum 30 minutes of moderate intensity. Brisk walking, jogging, swimming, cycling are good examples of cardio workouts helpful in hypertension. One must engage in aerobic exercises up to 5-7 days a week.
2. Stress control: Stress being an aggravating factor for hypertension must be avoided or controlled. There are several methods to reduce stress like behavioral changes, yoga, and meditation, engaging in happy music and other hobbies. Never consume alcohol or other forms of intoxication to relieve stress.
3. Quit smoking: Smoking is a risk factor for hypertension. Quitting smoking helps in fighting hypertension along with other cardiac diseases and health conditions.
4. Avoid intoxication: Intoxication of any form like alcohol, smoking, drugs should be avoided.
5. Weight control: Overweight and obesity are both risk factors for the development of hypertension, heart diseases, and other lifestyle-related conditions. Weight reduction shows a quick positive effect on hypertension as well. There are, of course, several methods of reducing weight including workouts (most preferred method) and dieting (with proper nutrition). Please remember whenever dieting, take help from an expert dietician who will take into consideration your weight, height, sex, activity level and any special condition requiring special dietary modification.
6. Dietary modification: A healthy diet goes a long way in keeping you healthy. While formulating a balanced diet for hypertension, keep following points in mind:
7. Avoid junk food: Junk food is not only a causative factor for hypertension but also for several other lifestyle-related diseases. Only consume such foods rarely for taste.
8. Salt restricted diet: On an average, a person takes the daily salt content of 9-12 g/day. However, WHO recommends a daily salt uptake of less than 5g/day to prevent the development of hypertension and other lifestyle-related conditions.
9. Low carb diet: You must restrict carbohydrates in your diet, especially those with high glycaemic index.
10. Alcohol moderation: Alcohol intake in moderate to excessive quantities increases the risk of hypertension and stroke. According to American Heart Association, males should restrict alcohol intake to 2 drinks, and females should restrict to 1 drink per day. Usually, people have a notion that they could avoid drinking on a regular basis but drink occasionally to any amount they want. However, the truth lies in the fact that it is not the regularity of the alcohol intake but the overall amount in a day. Binge drinking is always risky, even if you do it once a week. Now, if you’re wondering what one drink means let’s quantify it:
    • 4 ounces (oz.) of wine (118 ml)
    • 12 oz. of beer (350ml)
    • 5 oz. of 80 proof spirits (45ml)
    • 1 oz. of 100 proof spirits (30ml)
11. Consume more fruits and vegetables, nuts, beans
12. Reduce fat intake, especially animal and dairy fats. Avoid hydrogenated vegetable oils (margarine).
13. Making food switches:
    • Whole-grain instead of refined grains
    • Switch to carbs with low glycaemic index and sustained release
    • Unpolished pulses instead of polished pulses
    • Omega-3 fats like fish fat, cod-liver oil
    • Vegetable oils like olive oil, canola oil, coconut oil etc. instead of animal and dairy fats
    • Low-fat dairy products like skimmed milk instead of regular dairy products
14. DASH Diet: NHLBI (National Heart Lung and Blood Institute, U.S.) has formulated a dietary recommendation for patients with hypertension. The target of DASH (Dietary Approaches to Stop Hypertension) is to help the hypertensives in lowering and controlling their blood pressure, apart from balancing the cholesterol levels and reducing the risk of cardiovascular diseases. You can also find a cookbook provided by NHLBI named ‘Keep the Beat Recipes’ here. The book contains some great cooking ideas to attain the dietary goals.
15. Add probiotics to your diet: Researchhas shown that taking probiotic supplements to regularly for more than 8 weeks can benefit hypertensive people.

Medications for hypertension

The drugs for hypertension are usually begun with lower doses. Normally, the side effects associated with antihypertensive medicines are minimal. After some time a drug combination of minimum two medicines are given to the patients. Once a control in blood pressure has been obtained the dosage and combination is kept as it is unless indicated otherwise. If control is not obtained either the dosage or drug is changed. The dose may be reduced if the blood pressure falls more than it should on several occasions after taking the drugs.

Some of the drug types available for hypertension are:

1. Calcium channel blockers
2. Diuretics chiefly thiazides like indapamide or chlorthalidone
3. Alpha-blockers and beta-blockers
4. ACE (angiotensin-converting enzyme) Inhibitors
5. Central agonists
6. Vasodilators
7. Peripheral adrenergic inhibitors
8. Angiotensin receptor blockers

The choice of drug depends on a patient’s age, sex, and any co-existing condition. It’s important that a person on medication for hypertension must proceed with caution when buying over-the-counter drugs (like decongestants) to avoid possible drug interaction. It’s always better to consult your physician before taking any other medicine.

What are the complications of hypertension?

Hypertension is known to cause a lot of complications especially when it is uncontrolled and/or has existed for a long time. Hypertension can cause atherosclerosis resulting in plaque deposits and narrowing of blood vessels. Not only does it worsen hypertension but also predispose the patient to a plethora of other diseases. Some of the complications associated with hypertension are as follows:

1. Heart failure and heart attack
2. Kidney failure
3. An aneurysm which can cause the arterial wall to burst leading to severe bleeding and death
4. Stroke
5. Hypertensive retinopathy which can result in blindness
6. Amputation

You must regularly monitor your blood pressure and make appropriate efforts to keep it under control. It is advised to make the necessary lifestyle changes immediately even if you’re not hypertensive.

[su_note note_color=”#efefef”]See also: 7 Things you must know to prevent heart attack[/su_note]