High blood pressure, or hypertension, is a condition where the force of blood against artery walls is consistently too high, requiring the heart to work harder to circulate blood. Over time, this can lead to serious health issues. The most prevalent form is essential hypertension, which arises without a single, specific cause.
Defining Essential Hypertension
Essential hypertension, also known as primary hypertension, signifies that the high blood pressure is not the result of a separate, identifiable medical condition. It develops gradually over many years and is thought to be the result of a combination of genetic and lifestyle factors. This type accounts for 90% to 95% of all hypertension cases. The diagnosis is one of exclusion, meaning a healthcare provider will first rule out any specific underlying problems.
A small percentage of people have secondary hypertension, which is high blood pressure caused directly by another health issue. Identifiable causes for secondary hypertension can include conditions like chronic kidney disease, thyroid disorders, tumors on the adrenal glands, or certain medications. When the underlying cause of secondary hypertension is treated, blood pressure often returns to normal or is significantly lowered.
Associated Risk Factors
While essential hypertension lacks a single cause, numerous factors are known to increase a person’s risk of developing it. These risks can be separated into two categories: those you cannot change and those related to lifestyle choices.
Non-modifiable risk factors are ones that are beyond an individual’s control. A family history of high blood pressure is a significant contributor, as genetic predispositions can account for a substantial portion of blood pressure variability among people. Age is another factor, as the risk of hypertension increases as you get older. Ethnicity also plays a role, with individuals of African and Black Caribbean descent having a higher risk of developing high blood pressure.
Modifiable risk factors are largely connected to daily habits and lifestyle. Being overweight or obese is a primary risk factor, as excess body weight makes the heart work harder to pump blood. A diet high in sodium is another major contributor; excess salt causes the body to retain water, which increases blood volume and blood pressure. Other significant lifestyle risks include a lack of physical activity, excessive alcohol consumption, smoking, and chronic stress.
Diagnosis and Measurement
A blood pressure reading is composed of two numbers, measured in millimeters of mercury (mm Hg), that represent different phases of your heart’s action. This measurement is taken with a cuff placed around the upper arm.
The top number in the reading is the systolic pressure, which measures the pressure inside your arteries when your heart beats. The bottom number is the diastolic pressure, which measures the pressure in your arteries when your heart is at rest between beats. An ideal blood pressure reading for most adults is considered to be below 120/80 mm Hg.
A diagnosis of hypertension is not made from a single high reading, as blood pressure can fluctuate. A healthcare professional will confirm the diagnosis based on the average of two or more high readings taken on separate occasions. Blood pressure levels are categorized to help guide treatment:
- Normal: Less than 120/80 mm Hg
- Elevated: 120-129/less than 80 mm Hg
- Hypertension Stage 1: 130-139/80-89 mm Hg
- Hypertension Stage 2: 140/90 mm Hg or higher
Health Complications from Uncontrolled Blood Pressure
Sustained high blood pressure can cause damage throughout the body over many years, which is why it is often called the “silent killer.” The constant high force of blood against the artery walls can injure the delicate inner lining. This damage can lead to atherosclerosis, a condition where fatty plaques build up, causing the arteries to harden and narrow.
This arterial damage has consequences for major organs. In the heart, narrowed or blocked arteries can lead to a heart attack. The increased workload from pumping against high pressure can also cause the heart muscle to weaken and enlarge, eventually leading to heart failure. The brain is also at high risk; hypertension can damage the arteries that supply it with blood, increasing the risk of a stroke.
The kidneys are also vulnerable to the effects of uncontrolled hypertension. High blood pressure can damage the small blood vessels within the kidneys, impairing their ability to filter waste and excess fluid from the blood. This can create a dangerous cycle, as damaged kidneys are less able to help regulate blood pressure, which can cause it to rise even further. Over time, this can lead to chronic kidney disease or kidney failure.
Management Strategies
Managing essential hypertension is a long-term commitment that involves a combination of lifestyle adjustments and, when necessary, medical treatment. Lifestyle modifications are the foundation of hypertension management.
The Dietary Approaches to Stop Hypertension (DASH) diet is often recommended; it emphasizes fruits, vegetables, whole grains, and low-fat dairy products while limiting foods high in saturated fat and sodium. Reducing sodium intake is a key step, as is engaging in regular physical activity. Maintaining a healthy weight, limiting alcohol consumption, quitting smoking, and finding healthy ways to manage stress are also important components.
When lifestyle changes alone are not enough to control blood pressure, a healthcare provider may prescribe medication. There are several different classes of blood pressure medications, and they work in different ways.
- Diuretics, or “water pills,” help the body remove excess sodium and water.
- ACE inhibitors and angiotensin II receptor blockers (ARBs) help relax blood vessels by blocking the action of a chemical that narrows them.
- Beta-blockers work by making the heart beat slower and with less force.
- Calcium channel blockers also help relax blood vessels.
A doctor will determine the most appropriate medication or combination of medications based on an individual’s specific health profile.