What is Hypertension?
Hypertension, commonly known as high blood pressure, occurs when the force of the blood against the walls of your blood vessels is consistently too high enough to increase the risk of heart disease and stroke. Hypertension is a widespread condition that affects over 45% of the adult population in the United States.
Blood pressure is categorized as the following:
- Normal blood pressure (systolic <120 mmHg and diastolic <80 mmHg)
- Elevated blood pressure (systolic 120-129 mmHg and diastolic <80 mmHg)
- Stage 1 hypertension (systolic 130-139 or diastolic 80-89)
- Stage 2 hypertension (systolic ≥140 mmHg or diastolic ≥90)
Blood pressure is measured in millimeters of mercury (mmHg) and is recorded with two numbers. The first (systolic) is the pressure measured as your heart is contracting, and the second (diastolic) is the pressure measured as the heart is at rest.
What causes hypertension?
Hypertension can be classified into two main types: primary hypertension and secondary hypertension, each with different causes and treatment approaches. In short, primary hypertension has no readily identifiable cause, while secondary hypertension is associated with at least one readily identifiable cause.
Primary hypertension affects most people with hypertension. This type of hypertension is caused by a complex set of conditions, which may include a person’s genetic factors and certain modifiable risk factors, including excessive dietary sodium intake, alcohol use, poor sleep hygiene, infrequent exercise, and high stress environmental conditions.
Secondary hypertension is less frequently encountered, but it does occur in up to 10% of cases of hypertension. Common causes of secondary hypertension include kidney disease, sleep apnea, hormone issues, and certain medications. In certain cases of hypertension, physicians may become especially suspicious of the presence of secondary hypertension. Factors which may make the possibility of secondary hypertension more likely include those involving younger persons, those occurring with abrupt onset, those associated with severe degrees of elevation, and those which prove highly resistant to antihypertensive medications. In certain cases of secondary hypertension, treating the identified cause of hypertension can be a highly effective way to control blood pressure.
What are the effects on the body?
When you have untreated high blood pressure, several things happen in your body.
One issue is that the high pressure causes your arteries to adapt over time. Part of this vascular adaptation is a thickening of the vessel walls. Over time, the abnormally high force applied to the arteries may damage their inner lining and contribute to the buildup of plaque. Eventually, the rupture of plaque from a coronary artery may lead to a myocardial infarction (heart attack) with downstream harm to the heart muscle. Alternatively, rupture of plaque from a brain artery may lead to stroke, with downstream harm to the brain.
In addition to the impacts on the vascular system, high blood pressure over time can also lead to changes in the heart’s structure. In some cases, the heart muscle may thicken or become abnormally enlarged. In either case, the resulting heart disease may result in less effective heart function and eventually heart failure.
High blood pressure can also produce disease in other parts of the body, including the eyes and kidneys, leading to poorer vision or chronic kidney disease.
Risk Factors
Various risks are understood to contribute to the development of hypertension, including:
- Family history (genetic factors)
- Age
- Chronic kidney disease
- Decreased physical activity
- Excessive dietary sodium intake
- Overweight or obese status
- Sleep apnea
- Alcohol consumption
- Smoking and tobacco use
- Excessive stress
What symptoms suggest hypertension?
Hypertension is often called the “silent killer” because it usually does not produce any obvious symptoms. Many people with high blood pressure do not feel any different until they experience complications, such as a heart attack or stroke.
However, when blood pressure changes suddenly or becomes severely high, symptoms might include:
- Headache
- Dizziness
- Fatigue
- Visual changes
- Shortness of breath
- Chest pain
- Nausea
- Vomiting
- Confusion
Who treats hypertension?
Most often, primary care providers, such as those specializing in Family Medicine or Internal Medicine, diagnose and treat hypertension.. They can prescribe lifestyle changes such reducing sodium (table salt) intake. They may also prescribe antihypertensive medications, especially in cases in which lifestyle modification is not sufficient to reduce blood pressure adequately. In certain cases of hypertension, other physicians such as Nephrologists or Cardiologists may help treat hypertension too.
Can hypertension be prevented?
Certain risks for the development of hypertension, such as family history and age, are not modifiable. However, many risks are modifiable. Attending to modifiable risk factors proactively can help to prevent the development of hypertension.
What helps prevent hypertension?
Hypertension can often be prevented through healthy lifestyle choices. Participating in regular physical activity, maintaining a healthy weight, , and choosing healthy dietary options have been shown to lower blood pressure and reduce the risk of developing hypertension. Similarly, avoiding alcohol and tobacco, prompt treatment of sleep apnea, and reducing exposures to high stress conditions can also be effective.
For many people, hypertension can be managed or controlled simply by changing diet and lifestyle.
- Physical Activity: Regular exercise, preferably at least 150 minutes of moderate intensity exercise per week, helps to maintain a healthy weight and can lower blood pressure.
- Weight Management: Being overweight or obese increases the risk of developing high blood pressure.
- Diet: A diet high in salt can increase the risk of developing hypertension. A general recommendation is to limit to 2,000 mg/day may be helpful; however, in other cases with preexisting conditions such as heart failure, limiting sodium to 1,500 mg/day is more effective at reducing blood pressure which can improve overall health outcomes.
- Alcohol: Drinking excessive alcohol can raise blood pressure, so avoidance or moderation is key. In general this means limiting alcohol intake to one drink per day for women and two drinks per day for men.
- Tobacco: Tobacco use damages blood vessels and raises blood pressure, so avoiding tobacco exposure can improve overall cardiovascular health.
- Stress Management: Chronic stress may contribute to high blood pressure, so finding effective ways to manage stress can be highly beneficial.
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