Hypertension meaning
Hypertension is the persistent increase of blood pressure on the wall of the blood vessels, which is the result of two forces: systole and diastole.
- Systolic pressure: The pressure created by pumping blood from the heart into the arteries.
- Diastolic pressure: The pressure created by the resting of the heart between heartbeats.
These two forces are represented during the measurement of blood pressure.
The pressure of blood is ever exerted on the walls of the blood vessels, but only when it shows a constant increase; it is called hypertension (high blood pressure). The blood pressure is exerted in arteries in the first place due to the pumping of blood by the heart.
Pumping of blood to all the tissues and organs of the body is necessary for their survival and proper functioning as oxygen is being delivered by the blood.
Hypertension definition
In accordance with most major guidelines, it is recommended that a person can be deemed hypertensive if the systolic blood pressure (SBP) in the office or clinic is ≥140 mm Hg and/or the diastolic blood pressure (DBP) is ≥90 mm Hg after repeated examinations.
The normal blood pressure is
- Systolic blood pressure <130 mmHg
- Diastolic blood pressure <85 mmHg
Prevalence of hypertension in India
An estimated 22 crores are suffering from hypertension, although only approximately 12% of them have it under control. According to the National Family Health Survey (NFHS-5) 2019–2020 report, the prevalence of hypertension in:
- Men is 24% which was a 5% increase since the previous report (2015–16).
- Women is 21% which was a 4% increase since the previous report (2015–16).
Currently, the medical body, India Hypertension Control Initiative (IHCI) has been working on the target of reducing at least 25% in the prevalence of hypertension by the year 2025.
Etiology of hypertension | Causes of hypertension
Based on the etiology of hypertension, the two causes of hypertension are – essential or primary hypertension and secondary hypertension.
- Causes of essential or primary hypertension: In most patients (about 90% of people), hypertension results from an unknown pathologic etiology (cause) of essential or primary hypertension. This form of hypertension cannot be cured, but it can be controlled. Genetic factors may play an important role in the development of essential hypertension.
- Causes of secondary hypertension: If hypertension occurs a specific cause, it is called secondary hypertension, which is seen in a small percentage of patients. There are many potential causes of secondary hypertension (comorbid diseases or drugs), such as:
| Diseases | Drugs |
|---|---|
| Chronic kidney disease | Amphetamines |
| Cushing’s syndrome | Anti-vascular endothelin growth factor agents |
| Coarctation of the Aorta | Corticosteroids |
| Obstructive sleep apnoea | Calcineurin inhibitors |
| Parathyroid disease | Decongestants |
| Pheochromocytoma | Ergot alkaloids |
| Primary aldosteronism | Erythropoiesis-stimulating agents |
| Renovascular disease | Oestrogen-containing oral contraceptives |
| Thyroid disease | Nonsteroidal anti-inflammatory drugs (NSAIDs) |
Sign and symptoms of hypertension
While the majority of the people suffering from hypertension do not feel any hypertension symptoms (asymptomatic). Hypertension headache is one of the prominent symptoms which can be seen in symptomatic patients with high blood pressure (usually 180/120 mm Hg or higher). The other presenting symptoms include:
- Dizziness
- Vomiting
- Nausea
- Chest pain
- Confusion
- Anxiety
- Nosebleeds
- Buzzing in the ears
- Difficulty breathing
- Abnormal heart rhythm
- Blurred vision or other vision changes
Hypertension in pregnancy
Hypertension during pregnancy is a major cause of maternal and neonatal morbidity and mortality. Various hypertensive disorders in pregnancy include the following preeclampsia, eclampsia, gestational, chronic, and superimposition of preeclampsia on chronic hypertension.
Definitive treatment of preeclampsia is delivery. Also, management consists of restricting activity, bedrest, and close monitoring. An important albeit interesting attribute in treating hypertension in pregnancy is that neither salt restriction, nor any other measures that contract blood volume, will not be employed as it could disrupt the circulatory system of the mother and foetus.
Although various there are various medical agents that can be used to treat chronic hypertension in pregnancy, the gynaecologists take utmost care in prescribing the correct pharmaceuticals as the chances of side effects are high.
Complications of hypertension
Complications of hypertension can develop target-organ damage. The primary organs involved are the eye, brain, heart, kidneys, and peripheral blood vessels.
- Hypertension accelerates atherosclerosis (fat deposition in arteries) and stimulates left ventricular hypertrophy (abnormal increase in the heart muscle), among other diseases.
- Hypertension can cause cerebrovascular diseases, especially hemiparesis (paralysis of one side of the body) and other gross neurologic deficits.
- Retinopathies (diseases of the eye) can occur in hypertension, such as hypertensive retinopathy. Accelerated arteriosclerosis also plays an important role in these retinopathies.
- The best-identified form of target-organ damage is the heart diseases such as ventricular hypertrophy (abnormal increase in the muscle of heart ventricle), coronary heart disease, angina coronary revascularization, heart failure (heart muscle can’t pump blood as needed) etc. These can also lead to sudden death.
- Hypertension-induced kidney damage is associated with arteriosclerosis, arteriolar hypertrophy (thickening of small arteries in kidneys), fibrinoid necrosis (cell death in small blood vessels), and atheroma (fat deposition) of the major renal arteries and nephrosclerosis (hardening of the kidney).
Prevention of hypertension
Severe hypertension increases cardiovascular risk. Reducing blood pressure can reduce the risk and prevent or delay age-related hypertension. Even minor changes in a person’s lifestyle can be beneficial. Hypertension prevention can be done through the incorporation of various lifestyle changes such as:
- Weight loss
- Reduced sodium intake
- Increased potassium intake
- Increased physical activity
- Reduced alcohol consumption
- Incorporation of Dietary Approaches to Stop Hypertension (DASH) diet.