Hypertension: What It Is, Symptoms, and Treatment

A person's blood pressure is the force exerted by blood against the walls of arteries as it circulates through the body. Blood pressure is measured in two parts: the systolic blood pressure, commonly known as "high" blood pressure, and diastolic blood pressure, known as "low" blood pressure. The unit of blood pressure is millimeters of mercury (mmHg). Systolic blood pressure measures the maximum pressure in the arteries when the heart contracts to pump blood. Diastolic blood pressure reflects the minimum pressure in the arteries when the heart rests between beats.

What is Hypertension?

Hypertension is defined as the condition where blood exerts excessive pressure against the walls of blood vessels. Prolonged high blood pressure damages the inner lining of the vessels, leading to blockages, tears, or dilation, which disrupt blood flow and may result in organ failure. In adults, a diagnosis of hypertension is typically made when diastolic blood pressure is above 90 mmHg and systolic blood pressure exceeds 140 mmHg on three separate measurements.

Hypertension, which indicates elevated blood pressure, is one of the primary preventable risk factors for various conditions such as heart failure, heart attack, atrial fibrillation (an irregular heartbeat), and chronic kidney disease. For maintaining healthy body functions, it is crucial for blood pressure to remain within normal limits. Based on the measured blood pressure values, hypertension is classified into different stages. Blood pressure between 140/90 mmHg and 159/99 mmHg is considered stage 1 hypertension. Readings between 160/100 mmHg and 179/109 mmHg are classified as stage 2 hypertension. Stage 3 hypertension refers to a systolic pressure of 180 mmHg or higher and a diastolic pressure of 110 mmHg or above.

Acute severe hypertension, when blood pressure exceeds 180/110 mmHg, represents a life-threatening condition where high blood pressure starts to damage organs, leading to clinical complications such as hypertensive encephalopathy, acute ischemic stroke, acute aortic dissection, intracerebral hemorrhage, acute left heart failure, and acute coronary syndromes.

What Causes Hypertension?

There are many risk factors that can predispose an individual to the development of high blood pressure. The risk of developing hypertension increases with age. Having family members or relatives who suffer from hypertension is also considered a risk factor for the development of hypertension in an individual. In addition to these, individuals who are overweight, do not engage in physical activity, or use tobacco are also considered at risk for developing hypertension. The conditions that can cause high blood pressure are divided into primary and secondary causes. Primary (essential) hypertension is a term used when the underlying cause of high blood pressure cannot be identified. Primary hypertension typically develops gradually over time. Secondary hypertension refers to high blood pressure that results from a specific health condition. Unlike primary hypertension, secondary high blood pressure rises suddenly due to an identifiable cause. Secondary hypertension may develop after certain illnesses or the use of specific medications or substances. Below are the factors that can cause hypertension:

• High salt intake
• Stress, obesity
• Genetic factors
• Diabetes, high cholesterol
• Low physical activity
• Insufficient intake of magnesium, potassium, and calcium
• Birth control pills, certain painkillers
• Obstructive sleep apnea
• Kidney disorders
• Adrenal gland tumors
• Thyroid disorders
• Abnormalities in vascular development during fetal life
• Use of illicit substances such as cocaine or amphetamines

What Are the Symptoms of Hypertension?

Hypertension often develops gradually and can persist without causing any symptoms, making it a stealthy health issue. In some individuals, symptoms of high blood pressure may not become apparent until years after the onset of hypertension. There are many signs and symptoms that may indicate the presence of severe hypertension:

• Headaches
• Shortness of breath
• Nosebleeds
• Flushing
• Palpitations
• Weakness
• Tinnitus (ringing in the ears)
• Dizziness
• Chest pain
• Vision problems
• Presence of blood in urine

The appearance of such symptoms in conjunction with hypertension requires medical attention, as waiting could lead to more severe health problems. These signs serve as important warnings for the need to seek treatment.

Diagnosis and Treatment of Hypertension

If blood pressure measurements taken by a doctor during a routine physical examination are found to be higher than normal, and if this is confirmed in subsequent measurements, hypertension can be diagnosed. Regular measurements are taken with the consideration that environmental factors may influence an individual's blood pressure. If the blood pressure values obtained through measurements are consistently high, the doctor may conduct various diagnostic tests such as urine, blood, EKG, and ultrasound to determine the underlying conditions that may be causing the elevated blood pressure. If deemed appropriate, the doctor may initiate hypertension treatment to prevent the harmful effects of high blood pressure on the organs. One of the most important stages in the long-term management and treatment of hypertension involves lifestyle changes, which include the following:

• Healthy and balanced nutrition
• Regular physical activity
• Reducing body weight to a healthy level
• Stopping exposure to tobacco smoke, both actively and passively
• Effective stress management
• Reducing salt intake in the diet
• Limiting the consumption of caffeinated products

In addition to these lifestyle changes, various hypertension medications, which act through different mechanisms, may be prescribed by the doctor. If necessary, combinations of these medications may be used to control the individual's high blood pressure.

• Diuretics

Known as "water pills" or diuretics, these medications help remove excess water and salt from the body through the kidneys. Diuretics are among the most commonly used medications in the treatment of hypertension, as they reduce the amount of fluid in the circulatory system.

• Beta-Blockers

Beta-blockers are medications that reduce the strength and speed of heartbeats. The use of these medications decreases the amount of blood pumped by the heart, which in turn reduces the pressure in the blood vessels.

• ACE (Angiotensin-Converting Enzyme) Inhibitors

ACE inhibitors are a class of antihypertensive drugs that suppress the secretion of a hormone called angiotensin 2, which causes blood vessels to constrict. By using these medications, blood pressure in the dilated blood vessels is reduced.

• Angiotensin 2 Receptor Blockers

Medications in this group block the effects of the angiotensin hormone directly in the bloodstream, helping to lower blood pressure in the treatment of hypertension.

• Calcium Channel Blockers

Calcium plays a role in the contraction of muscle tissues in the body. By blocking the channels associated with calcium, these medications prevent excessive contraction of the heart and vascular muscles, aiming to bring the high blood pressure back to normal levels.

• Alpha-2 Agonists

These medications work on the nervous system to suppress electrical activities that cause blood vessels to constrict. This results in the expansion of the blood vessels and a reduction in blood pressure.

If the cause of hypertension is identified, treatment planning will be based on the underlying cause. By treating the factors contributing to hypertension, an individual's blood pressure can return to normal levels.