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Hypertension; The Silent Killer

The increasing prevalence of this condition is blamed on lifestyle and dietary factors, such as physical inactivity, alcohol and tobacco use, and a diet high in sodium (usually from processed
and fatty foods).

This page offers detailed but easy-to-follow information about hypertension.

Contents of this article

 1.   What is hypertension (high blood
pressure)?
2.  Causes
3.  Diagnosis
4.  Treatment
5.  Prevention

What is hypertension?

Hypertension also known as high blood pressure is the force of blood pushing against the
walls of arteries as it flows through them.
Arteries are the blood vessels that carry oxygenated blood from the heart to the body's tissues .

Description

As blood flows through arteries it pushes against the inside of the artery walls. The more pressure the blood exerts on the artery walls, the higher the blood pressure will be. The size of small arteries also affects the blood pressure. When the
muscular walls of arteries are relaxed or dilated,the pressure of the blood flowing through them is lower than when the artery walls are narrow, or constrict.
Blood pressure is highest when the heart beats to push blood out into the arteries. When the heart relaxes to fill with blood again, the pressure is at its lowest point. Blood pressure when the heart beats is called systolic pressure. Blood pressure
when the heart is at rest is called diastolic pressure. When blood pressure is measured, the systolic pressure is stated first and the diastolic pressure second. Blood pressure is measured in
millimeters of mercury (mm Hg). For example, if a person's systolic pressure is 120 and diastolic pressure is 80, it is written as 120/80 mm Hg.
Hypertension is a major health problem, especially because it has no symptoms. Many people have hypertension without knowing it. Hypertension is more common in men than women and in people over the age of 65 than in younger persons.
Hypertension is serious because people with the condition have a higher risk for heart disease and other medical problems than people with normal blood pressure. Serious complications can be avoided by getting regular blood pressure check and treating hypertension as soon as it is diagnosed.

If left untreated, hypertension can lead to the following medical conditions:

1)  arteriosclerosis, also called atherosclerosis

2) heart attack

3) stroke

4) enlarged heart

5) kidney damage.

Arteriosclerosis is hardening of the arteries. The walls of arteries have a layer of muscle and elastic tissue that makes them flexible and able
to dilate and constrict as blood flows through them. High blood pressure can make the artery walls thicken and harden. When artery walls
thicken, the inside of the blood vessel narrows.
Cholesterol and fats are more likely to build up on the walls of damaged arteries, making them even
narrower. Blood clots also can get trapped in narrowed arteries, blocking the flow of blood.
Arteries narrowed by arteriosclerosis may not deliver enough blood to organs and other tissues.
Reduced or blocked blood flow to the heart can cause a heart attack. If an artery to the brain is blocked, a stroke can result.
Hypertension makes the heart work harder to pump blood through the body. The extra work load can make the heart muscle thicken and stretch.When the heart becomes too enlarged it cannot pump enough blood. If the hypertension is not
treated, the heart may fail.

The kidneys remove the body's wastes from the blood. If hypertension thickens the arteries to the kidneys, less waste can be filtered from the blood. As the condition worsens, kidney failure occurs and wastes build up in the blood. Dialysis or a kidney transplant are needed when the kidneys
fail. About 25% of people who receive kidney dialysis have kidney failure caused by hypertension.

Causes of hypertension

Many different actions or situations can normally raise blood pressure. Physical activity can temporarily raise blood pressure. Stressful
situations can make blood pressure go up. When the stress goes away, blood pressure usually returns to normal. These temporary increases in blood pressure are not considered hypertension. A diagnosis of hypertension is made only when a
person has multiple high blood pressure reading over a period of time.The cause of hypertension is not known in 90 to 95 percent of the people who have it.
Hypertension without a known cause is called primary or essential hypertension.
When a person has hypertension caused by another medical condition, it is called secondary
hypertension. Secondary hypertension can be caused by a number of different illnesses. Many
people with kidney disorders have secondary hypertension. The kidneys regulate the balance of salt and water in the body. If the kidneys cannot rid the body of excess salt and water, blood pressure goes up.
Cushing's syndrome and tumors of the pituitary and adrenal glands often increase levels of the
adrenal gland hormones cortisol, adrenalin, and aldosterone, which can cause hypertension. Other
conditions that can causes hypertension are blood
vessel diseases, thyroid gland disorders, some
prescribed drugs, alcoholism, and pregnancy .
Even though the cause of most hypertension is not known, some people have risk factors that
give them a greater chance of getting hypertension. Many of these risk factors can be changed to lower the chance of developing hypertension or as part of a treatment program to lower blood pressure.

Risk factors for hypertension include:

1. age over 60
2. male sex
3. race
4. heredity
5. salt sensitivity
6. obesity
7. inactive lifestyle
8. heavy alcohol consumption
9. use of oral contraceptives
Some risk factors for getting hypertension can be changed, while others cannot. Age, male sex, and
race are risk factors that a person can't do anything about. Some people inherit a tendency
to get hypertension. People with family members who have hypertension are more likely to develop it than those whose relatives are not hypertensive. People with these risk factors can avoid or eliminate the other risk factors to lower their chance of developing hypertension.

Diagnosis

Because hypertension doesn't cause symptoms, it is important to have blood pressure checked regularly. Blood pressure is measured with an
instrument called a sphygmomanometer. A cloth-
covered rubber cuff is wrapped around the upper arm and inflated. When the cuff is inflated, an
artery in the arm is squeezed to momentarily stop
the flow of blood. Then, the air is let out of the cuff while a stethoscope placed over the artery is used to detect the sound of the blood spurting back through the artery. This first sound is the systolic pressure, the pressure when the heart beats. The last sound heard as the rest of the air is released is the diastolic pressure, the pressure
between heart beats. Both sounds are recorded on the mercury gauge on the sphygmomanometer.
Normal blood pressure is defined by a range of values. Blood pressure lower than 120/80 mm Hg
is considered normal.
A number of factors such as pain, stress or anxiety can cause a temporary increase in blood pressure. For this reason, hypertension is not diagnosed on one high blood pressure reading. If a blood pressure reading is
120/80 or higher for the first time, the physician will have the person return for another blood pressure check. Diagnosis of hypertension usually is made based on two or more readings after the
first visit.
Systolic hypertension of the elderly is common
and is diagnosed when the diastolic pressure is normal or low, but the systolic is elevated,e.g.170/70 mm Hg. This condition usually co-
exists with hardening of the arteries
(atherosclerosis).
Blood pressure measurements are classified in stages, according to severity:
normal blood pressure: less than less than
120/80 mm Hg
pre-hypertension: 120-129/80-89 mm Hg
Stage 1 hypertension: 140-159/90-99 mm Hg
Stage 2 hypertension: at or greater than
160-179/100-109 mm Hg
A typical physical examination to evaluate
hypertension includes:
medical and family history
physical examination
ophthalmoscopy

Treatment

There is no cure for primary hypertension, but blood pressure can almost always be lower with the correct treatment. The goal of treatment is to lower blood pressure to levels that will prevent heart disease and other complications of hypertension. In secondary hypertension, the disease that is responsible for the hypertension is treated in addition to  the hypertension itself.Successful treatment of the underlying disorders may cure the secondary hypertension. Treatment to lower blood pressure may include changes in diet, getting regular exercise,and taking antihypertensive medications. Patients falling into the pre-hypertension range who don't have damage to the heart or kidneys often are advised to make needed lifestyle changes only.Eat more fruit and vegetables.
Lifestyle changes that may reduce blood pressure by about 5 to 10 mm Hg include:
reducing salt intake
reducing fat intake
losing weight
getting regular exercise
quitting smoking
reducing alcohol consumption
managing stress

Prevention

Prevention of hypertension centers on avoiding or eliminating known risk factors. Even persons at risk because of age, race, or sex or those who have an inherited risk can lower their chance of developing hypertension.

The risk of developing hypertension can be reduced by making the same changes recommended for treating hypertension:

  • reducing salt intake
  • reducing fat intake
  • losing weight
  • getting regular exercise
  • quitting smoking
  • reducing alcohol consumption
  • managing stress