Hypertension is the most frequent cause of adult death in the Western world. Nowadays this disease may soon become the leading cause of death on all continents. Here we try to understand about Hypertension causes treatment, Hypertension symptoms, and Hypertension management.
Increased blood pressure is now has become the most important public health problem in developed countries.
It is common, asymptomatic, readily detectable, usually easily treatable, and often leads to lethal complications if left untreated. Hypertension is a very strong risk factor for cardiovascular diseases (CVDs).
It is estimated that it increases the risk at least two-fold for CVDs including coronary artery disease (CAD), congestive heart failure (CHF)/stroke (ischaemic and haemorrhagic), renal failure and peripheral arterial disease.
Usually, other risk factors like diabetes are also commonly associated with hypertension. Let us see about the definition of Hypertension and its causes and symptoms.
What is Hypertension?
There is a continuous relationship between the level of BP and the risk of its complications. All definitions of hypertension, including those issued by Joint National Committee (JNC) in prevention, detection, evaluation and treatment of high blood pressure (seventh report) (JNC-7) and World Health Organization (WHO)/International society of hypertension (ISH) are arbitrary.
At present, hypertension in adults aged 18 years and older who are not acutely ill, is defined as “Systolic Blood Pressure of 140 mm Hg or greater and/or Diastolic Blood Pressure of 90 mm Hg or greater or any level of BP in patients taking antihypertensive medication”.
In an easy way to understand- the blood gives more pressure against the blood vessel walls.
Prevalence of Hypertension Globally
Hypertension is present globally but its prevalence varies amongst countries and subpopulations. The prevalence of hypertension can also depend on both the racial composition of the population studied and the criteria used to define the condition.
The prevalence of diabetes increases with growing age and it is estimated that starting from around 15% to 20% in the early age it increases to 75% to 80% in individuals above 70 years of age.
Till present, there is no well-coordinated national survey of the prevalence for high blood pressure varies amongst countries and subpopulations.
Several regional small surveys in the last two decades with varying protocols have reported a prevalence which varies from 6.15% to 36.36% in men and 2% to 39.4% in women in urban areas and from 3% to 36% in men and 5.80% to 37.2% in women in rural areas.
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Why Hypertension is Caused?
Hypertension causes and symptoms: There are many factors that are responsible for increasing systolic as well as diastolic blood pressure. These factors are thus categorized according to the causes
In cases where only systolic blood pressure is increased
- Decreased compliance of aorta (arteriosclerosis)
- Increased stroke volume
- Aortic regurgitation
- Thyrotoxicosis
- Hyperkinetic heart syndrome
- Fever
- Arteriovenous fistula
- Patent ductus arteriosus
In cases where both systolic and diastolic blood pressure increased
- Renal
- Chronic pyelonephritis
- Acute and chronic glomerulonephritis
- Polycystic renal disease
- Renovascular stenosis or renal infarction
- Most other severe renal diseases (arteriolar nephrosclerosis, diabetic nephropathy, etc.)
- Renin-producing tumours
- Endocrine
- Oral contraceptives
- Adrenocortical hyperfunction- Cushing’s disease and syndrome and Primary hyperaldosteronism
- Pheochromocytoma
- Myxedema
- Acromegaly
- Neurogenic
- Psychogenic
- Diencephalic syndrome
- Familial dysautonomia (Riley-Day)
- Polyneuritis (acute porphyria, lead poisoning)
- Increased intracranial pressure (acute)
- Spinal cord section (acute)
- Miscellaneous
- Coarctation of aorta
- Increased intravascular volume (excessive transfusion, polycythemia vera)
- Polyarteritis nodosa
- Hypercalcemia
- Medications, e.g., glucocorticoids, cyclosporine
- Unknown aetiology
- Essential hypertension (_90% of all cases of hypertension)
- Toxaemia of pregnancy
- Acute intermittent porphyria
Above all are the disease conditions which are responsible for increasing both systolic and diastolic blood pressure.
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Determinants
Besides the above conditions, there are other factors also which plays an important role in increasing blood pressure(Hypertension causes and symptoms). These are as follows
- It is said that genetics plays a very important role. A strong familial and genetic predisposition exists behind hypertension and a number of modifiable predisposing factors also been identified.
- It has been seen that as the age in both sexes increases, according to the survey blood pressure raises with increased age in both male and female.
- But now with the change in lifestyle and way of living, increased blood pressure is seen in middle-aged people also.
- Increased weight also plays an important role.
- As this weight gains also contributes to the risk factors.
- Abdominal obesity is said to more dangerous for heart for both males and females.
- Those people whose intake of salt is high in their diet, according to a various survey they have the high chances of having high blood pressure.
- Various studies have shown that there is a strong relationship between alcohol intake and high BP.
- Those who consume excess alcohol have the risk of having high BP. About 5% to 30% of people who take alcohol are hypertensive.
- People who live a sedentary life, they have 20% to 40% chances for having high BP.
- People who are habitual tobacco smokers also have a high risk of developing high BP.
Classification of Hypertension for adults
| Category | Systolic (mm Hg) | Diastolic (mm Hg) | |
| Optimal | <120 | <80 | Normal |
| Normal | 120 to 129 | 80 to 84 | Pre-hypertension |
| High normal | 130 to 139 | 85 to 89 | |
| Hypertensive | 140 | 90 | Hypertension |
| Stage 1 | 140 to 159 | 90 to 99 | Stage 1 |
| Stage 2 | 160 to 179 | 100 to 109 | Stage 2 |
| Stage 3 | 180 | 110 |
This classification is done on the basis on that those who are not taking any antihypertensive drugs and not actually ill.
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Symptoms of Hypertension
Most patients with hypertension have no specific symptoms referable to their blood pressure elevation and are identified only in the course of a physical examination.
When symptoms do bring the patient to the physician, they fall into three categories
- The elevated pressure itself
- The hypertensive vascular disease
- The underlying disease, in the case of secondary hypertension.
Though popularly considered a symptom of elevated arterial pressure, headache is characteristic of only severe hypertension; most commonly such headaches are localized to the occipital region and are present when the patient awakens in the morning but subside spontaneously after several hours.
Other complaints that may be related to elevated blood pressure include
- Dizziness,
- Palpitations,
- Easy fatigability
- Impotence.
Complaints referable to the vascular disease include
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- Epistaxis,
- Hematuria,
- The blurring of vision owing to retinal changes,
- Episodes of weakness or dizziness due to transient cerebral ischemia,
- Angina pectoris, and
- Dyspnea due to cardiac failure.
Pain due to a dissection of the aorta or to a leaking aneurysm is a rare presenting symptom. In addition, symptoms related to organ damage involving the heart, brain, kidneys, and eyes may be present in severe hypertension.
An approach to a Hypertensive patient
A Patient who is hypertensive is normal like other normal people. They are only diagnosed when they show some symptoms or either they are diagnosed accidentally.
For the approach to a hypertensive patient, following things should be kept in mind for finding Hypertension causes and symptoms.
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History of a patient
For asking about the history following question should be asked to the patient to understand the Hypertension causes and symptoms.
Family history of hypertension
Is any of the family members is taking any hypertensive drugs? This question should be asked for the paternal and maternal sides of the family members. As hypertensive patients have strong background history of hypertension.
History of repeated Urinary tract infection (UTI)
Few of the hypertensive patients have a history of repeated UTI which as a result get developed in the form of diseases like chronic pyelonephritis. Though this disease condition may develop without showing any symptoms.
History of weight gain.
If the patient gives the history of weight gain than rule out for the disease like Cushing syndrome.
History of weight loss
If the patient gives the history of weight loss than rule out for the disease like pheochromocytoma.
History of any other vascular diseases
It is essential to ask for the other vascular diseases to rule out any other CVS diseases which may be responsible for hypertension.
This disease includes angina pectoris (chest pain), cerebrovascular insufficiency, congestive heart failure and any other peripheral vascular diseases.
Other risk factors
A patient must be asked for the risk factors which include smoking, diabetes mellitus, lipid disorders, and a family history of early death due to cardiovascular diseases.
Patient’s lifestyle
It is important to ask about the patient’s lifestyle that could contribute to hypertension or affect its treatment should be assessed, including diet, physical activity, family status, work, and educational level.
History of oral contraceptives: Use of any oral contraceptive during hypertension during pregnancy.
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Physical examination of a patient
The physical examination of the patient is important to understand Hypertension causes and symptoms. Physical examination starts with..
- Patient’s general appearance
- Comparison of the blood pressures and pulses in both the arms and also in the supine and standing positions of the patient for at least 2 min.
- Examination of heart and lungs, in which evidence of left ventricular hypertrophy and cardiac decompensation should be sought off.
- Palpitation and auscultation of carotid arteries, for the evidence of stenosis or occlusion, should be carried.
- Examination of the chest for the search of extracardiac murmurs (abnormal sound).
- Abdominal examination to rule of any abnormal organ enlargement and to rule of any diseases.
Laboratory Investigation for High Blood Pressure
For most hypertensive patients
- Urine for protein, glucose and microscopic (red blood cells/ other sediments)
- Haemoglobin,
- Fasting blood glucose,
- Serum creatinine, Potassium
- Total cholesterol
- Electrocardiogram
Additional investigations when the cost is not a constraint
- Lipid profile,
- Uric acid
- Chest radiography
- Echocardiogram
Complications of High Blood Pressure
The adverse effects of hypertension can be detected clinically:-
Blood Vessels
Due to high blood pressure, structural changes often take place which can be seen in the form of arteriosclerosis, narrowing of the lumen, aneurysm.
These condition leads to the diseases of coronary and cardiovascular, particularly if other risk factors are also present. If hypertension is aggravated this will increases the peripheral vascular resistance and reduces the renal blood flow.
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Central Nervous System
Stroke is a common complication of hypertension and may be due to cerebral haemorrhage or infarction. Carotid atheroma and transient ischaemic attacks are more common in hypertensive patients.
Subarachnoid haemorrhage is also associated with hypertension. Papilloedema is common. A CT scan when done may show haemorrhage in and around the basal ganglia in the brain.
however, the neurological complaints which arise due to high BP is usually reversible if the hypertension is properly controlled.
Retina
Hypertension is associated with central retinal vein thrombosis. A gradation of changes may be seen with the severity of hypertension.
Heart
High BP places a pressure load on the heart and may lead to left ventricular hypertrophy with a forceful apex beat and fourth heart sound. Atrial fibrillation is common.
Severe hypertension to the patient may also result in left ventricular failure with the absence of coronary artery disease, and renal function also gets disturbed as a result sodium excretion, is also get impaired.
Kidneys
Long-standing hypertension may cause proteinuria and progressive renal failure by damaging the renal vasculature.
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Management of Hypertension
The management of hypertension comprises of two major aspects:
- Lifestyle modification
- Medication for hypertension
Lifestyle modification
| Intervention | Recommendation | Expected BP reduction |
| Weight reduction | Maintain body mass index <23kg/m3 | 10mm Hg/10 kg weight loss |
| Diet | Rich in fruits, vegetables, low-fat dairy products, and Less of saturated and total fat | 8 to 14 mm Hg |
| Dietary sodium restriction | Reduce dietary sodium intake to <2.4 g sodium or < 6 g NaCl | 2 to 8 mm Hg |
| Physical activity | Regular aerobic physical activity, e.g. brisk walking for at least 30 min most days | 4 to 9 mm Hg |
| Alcohol moderation | Men <60 mL per day Women <30 mL per day. Abstinence is preferred | . 2 to 4 mm Hg |
| Tobacco | Total abstinence |
Behavioural techniques, meditation and yoga
Transcendental meditation and yoga are also widely believed to reduce BP. However, larger and more randomized controlled trials are needed to confirm the benefits of these practices.
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Anti-hypertensive Drugs
Principles of Treatment
The BP remains poorly controlled in many of the patients. The most important reason is a lack of awareness about the condition and its ensuing complications. The asymptomatic nature of the condition results in poor compliance.
And last but not least side effects of antihypertensive agents like weakness, sleepiness, forgetfulness, and impotence cause the patients to avoid the drugs. But this can be overcome by prescribing newer agents that have fewer side effects.
Drugs
Choices of drugs depend upon the condition of the patient. There are many drugs which are having different compositions. Such as:-
- Diuretics
- Beta-blockers
- Calcium channel blockers
- Angiotensin-converting enzymes (ACE) inhibitors
- Angiotensin II receptor blockers (ARBs)
- Alpha-blockers
Drugs are included under the classes mentioned above. Though they can control the high blood pressure but there are even side effects of these drugs are also present.
For prescribing these drugs there are some contradictions are also present in which drugs should not be given to the patient, otherwise, the patient condition will go to worsen and death may ensure.
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Hypertensive Emergencies
Hypertension causes and symptoms: Hypertensive emergencies are severe elevations (increase) in BP, often higher than 220/140 mm Hg, complicated by clinical evidence of progressive target organ dysfunction.
These patients require immediate admission to the hospital and medicines are given for their BP reduction (not necessarily to normal ranges) so as to prevent or limit further target organ damage.
After the admission of the patient and medicine prescribes, carefully monitoring of the patient is very important.Manifesting symptoms may include headache, shortness of breath, and pedal oedema (swelling in lower legs).
Management in the emergency department with oral agents is sufficient. Follow-up within 24 to 72 hours is recommended.
