What is high blood pressure?

Definition: Hypertension or simply we call it as high blood pressure, is increase amount of blood pressure which is unhealthy in your systemic arteries.

It is common reason for causing various heart diseases. When the force of blood increases, arterial wall gets damaged; which may cause brain stroke.

Normally, blood pressure is measured in two ways:

1) Systolic blood pressure: when pressure is exerted on arterial wall during contraction of heart, systolic pressure. The value is higher.

2) Diastolic pressure: Measured as pressure on arteries during relaxation of heart, i.e. in between two heart beats.

Blood pressure is categories according to recent guideline according to American college of cardiology

Category	Systolic in mmHg	Diastolic in mmHg
Normal	<120	<80
Elevated	120 to 129	<80
Stage 1	130 to 139	80-89
Stage 2	At least 140	At least 90
Hypertension crisis	>180	>120

In hypertension crisis, patient represents as having; shortness of breath, chest pain and dizziness.

Causes

High blood pressure is divided into two types, and according to the type causes differ.

Primary hypertension or essential hypertension:

No specific cause has yet been identified, researches are undergoing to find the exact cause for essential hypertension.

Gene: Due to mutation of gene or due to inherited abnormal gene.
Physical changes: As age advances, the functional activities of organs and cells gets deteriorate.
Other causes like; overweight, unhealthy lifestyle, poor diet and sedentary life.

Secondary hypertension:

It is due to underlying conditions, such as;

Kidney diseases
Obstructive sleep apnea
Heart disease
Hypothyrodism or Hyperthyrodism
Alcohol/ drug abuse
Certain medication
Tumor
Adrenal gland dysfunction

Symptoms of high blood pressure

Generally, it is asymptomatic, but it may present in patient who under goes in hypertensive crisis:

Headache
Bleeding nose (Epistaxis)
Dizziness
Chest pain
Shortness of breath
Difficult vision
Blood in urine (Hematuria)

It is always better to keep your blood pressure in check, especially when there is positive family history.

Diagnosis

It is diagnosed when you visit your family doctor for regular check-up.

Blood pressure is measured through instrument known as sphygmomanometer. Cuff is tied around your arm tightly. If your blood pressure is measured high persistently at least after 2 readings, then your doctor will label you a hypertensive patient; and he will start the treatment accordingly.

Work up

When you are labelled as hypertensive patient, doctor will suggest you few tests to diagnose the type of blood pressure, you are having.

Urine analysis
Cholesterol screening
Echocardiogram
Kidney sonography
2D- Echo

Treatment and Management

For primary/essential hypertension:

Life style changes: It is the first line of treatment followed by medication accordingly.

For secondary hypertension:

Pharmacological:

Beta blockers: It reduces amount of blood pump to arteries. It decreases cardiac output, renin release, adrenergic central nervous system effect. Eg.: Atenolol and Metoprolol.
Diuretics: It is also known as water pills. It removes excess amount of sodium, by acting upon kidneys and decreases blood pressure. Eg.: Loop acting- furosemide and bumetanide; Potassium sparing- spironolactone and amiloride; Thiazide- chlorothiazide and hydrochlorothiazide. Adverse effects of diuretics includes, electrolyte dysfunction.
ACE inhibitors: It relaxes blood vessels and decreases blood pressure. It stops the production of angiotensin. Eg.: Benazepril, captopril, enalapril.
Angiotensin-ll receptor blockers: It stops the binding of angiotensin and thus relaxes arteries, which in turn decreases blood pressure. Eg.: losartan, telmisartan, valsartan, and azilsartan.
Calcium channel blockers: Calcium movements become slower into heart's cell, and decreases forceful heartbeats. Eg.: amlodipine, nifedipine, and verapamil.
Alpha-2 agonist: Changes nerve impulse, which causes tightening of blood vessels. Eg.: guanabenz, clonidine and tizanidine.

Non- pharmacological:

Just by changing life style also you can avoid taking medicines. Here, are some tips:

Eat healthy such as fruits, vegetables, whole grain, proteins.
Avoid excess amount of salt.
Exercise regularly.
If you are overweight then decrease weight.
Meditation, yoga help to decreases the chances high blood pressure.
Quite medication.

Complications

Heart failure
Cardiac arrest
Arrhythmia
Heart attack
Transient Ischemic Attack
Brain stroke
Hypertension during pregnancy; causes low birth weight of baby, premature baby. Pre-eclampsia damages kidney, followed by eclampsia which causes seizures and still birth.

Keywords: high blood pressure, definition, types, categories, hypertension, symptoms, pharmacological

References:

1.https://www.healthline.com/health/high-blood-pressure-hypertension#preventing-high-blood-pressure

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477925/

3. https://www.webmd.com/hypertension-high-blood-pressure/guide/understanding-high-blood-pressure-basics#2