What is Hypertension?
Hypertension is also known as high blood pressure. It is defined by two factors: systolic blood pressure (SBP) and diastolic pressure (DBP). Systolic blood pressure is defined by the amount of pressure within the arteries when the heart is beating. Comparatively, diastolic pressure is defined by how much pressure there is when the heart relaxes.
According to the American Heart Association, normal blood pressure is defined as SBP <120mmHg, with DBP <80mmHg. Hypertension occurs when SBP is >130 and DBP is >80.
Diagnosis of hypertension often involves many factors such as age and medical history. Take for example a person below the age of twenty with no medical complications; they will have a lesser likelihood of being diagnosed with hypertension. Comparatively, a 70 year-old post-stroke patient with elevated blood pressure (BP) levels is at much higher risk. Additionally, appropriate use of a blood pressure machine also plays a role in diagnosing hypertension. If used incorrectly, it can lead to erroneous results.
One phenomenon that plays a role in BP measurement is known as “white coat hypertension”. People that undergo BP tests in a clinical setting often have higher than normal BP levels. This is due to the environment, and the fact that they are in the presence of a medical professional. When measured at home however, these same patients reported having normal blood pressure levels.
As a result, many providers recommend patients to test their BP levels in areas where they feel at ease. If your average BP readings are >130/80mmHg in your own home, you may have hypertension.
In contrast, masked hypertension is when a person has consistently elevated BP measurements at home, but when measured in a clinical setting, their BP is normal (Basile & Bloch, 2020). Additionally, hypertension is asymptomatic.
Prevalence of Hypertension
In low and middle-income countries, there is an estimated 1.13 billion people that suffer from hypertension. This means that approximately 1 in every 4 men/5 women have hypertension (WHO, 2019).
Between 2015-2016, 30.2% of men, and 27.7% of women suffered from hypertension. The prevalence of hypertension also increases as a person gets older, with hypertension being prevalent in only 7.5% of young adults, but 63.1% in those older than 60 (Fryar et al, 2017).
Hypertension is a global issue that affects many people. The cost from clinic visits, maintenance medications, complications and hospital admissions makes it a public health concern. The World Health Organization in partnership with the US CDC launched the Global Hearts Initiative. Their aim is to lessen the prevalence of cardiovascular diseases through prevention, detection and management of hypertension. By promoting healthier lifestyles, establishing treatment protocols and making healthcare more accessible, they are taking steps to reduce the prevalence of hypertension (WHO, 2019).
What Causes Hypertension?
Hypertension is affected by the elasticity of our arterial walls and the volume within our circulatory system. The faster our hearts beat, the more pressure there is in your arteries and veins. As well, the amount of blood circulating through the body also affects how much fluid gets filtered through the kidneys.
Vasoconstriction occurs from the narrowing and contraction of the blood vessels. The more contracted your blood vessels are, the higher your blood pressure. Hormones like aldosterone, and neurotransmitters such as epinephrine and norepinephrine play a part in affecting blood pressure.
Elasticity of our arterial walls is affected by many factors, but cholesterol plaques, inflammation and smoking are the major ones.
There are 2 main types of hypertension: primary and secondary hypertension.
Primary or essential hypertension has no specific cause. Rather, it is the cumulative effect of various risk factors that lead to the development of hypertension. A large majority of adults that are diagnosed have this type of hypertension. The risk factors that lead to increased risk of hypertension are: , and are at risk of the following:
- Advanced age
- Obesity or weight gain
- Hereditary/ genetic (incidence is higher in people whose parents are both diagnosed with hypertension)
- Intrinsic defects in the kidney
- Salt-rich diet (>3g/day)
- High alcohol consumption
- Sedentary lifestyle
Plaque build up is one of the main causes of coronary artery disease, which is related to hypertension. As we get older, cholesterol plaques tend to accumulate in the walls of our blood vessels, which can lead to high blood pressure. People who are obese and have a sedentary lifestyle are also prone to developing abnormalities in their lipid (fat) levels, which can also lead to plaque build up.
Secondary hypertension is caused by a specific organic or medical issue. For example, medications such as oral contraceptives, NSAIDs and antidepressants can elevate a person’s blood pressure. Hence, it is important that you discuss with your healthcare provider your complete medical history. If you are hypertensive and you need to take any of these medications, they can adjust the timing, dosing and frequency of these medications to lessen any side effects.
Secondary hypertension can be caused by many factors. These include:
– Over the counter medications like sodium-containing antacids or decongestants
– Drugs such as ecstasy and cocaine
– Medical conditions like chronic kidney disease
– Tumours in the adrenal glands
– Hormonal imbalances like hyperthyroidism and Cushing’s syndrome
For these cases, treatment of the primary cause can work to alleviate blood pressure elevation (Basile & Bloch, 2020).
What happens if I have uncontrolled hypertension?
If you notice that your BP is consistently greater than 130/90, you should visit your primary care provider. Ignoring these factors may lead to complications associated with uncontrolled hypertension.
There are three types of uncontrolled hypertension.
- The first includes those who are unaware that they have it.
- The second group are those who are aware they are hypertensive, but do not take medications or apply any lifestyle changes.
- The third group includes those who are taking medications, but are resistant to them (CDC, 2012).
Uncontrolled hypertension can lead to several life-threatening complications such as:
- Intracerebral hemorrhage or bleed in the brain
- Left ventricular hypertrophy or heart enlargement
- Heart failure
- Ischemic and hemorrhagic stroke
- Angina (chest pain)
- Myocardial infarction or heart attack
- Kidney damage/ chronic kidney disease
The higher your blood pressure is, the higher your risk of having a stroke (Basile & Bloch, 2020). Additionally, these complications have a significant socioeconomic burden. According to statistics compiled by the CDC (2020):
– Someone in the US dies from stroke every 4 minutes
– Approximately $34 billion each year is spent on stroke-related burdens
– Stroke patients older than 65 also suffer from a significant disability
– A heart attack occurs every 40 seconds in the United States, with 805,000 heart attacks a year
– Between 2014 and 2015, heart disease amounted to $219 billion in healthcare costs
– Approximately 647,000 adult Americans die because of a cardiovascular disease (CDC, 2020).
Management of Hypertension
Lifestyle changes can aid those with hypertension. This includes weight loss (if the person has a higher than normal BMI), eating a heart-friendly diet, restricting sodium intake and getting regular exercise. As well, restricting alcohol consumption to 1-2 drinks a day is also part of managing hypertension.
Incorporating one of these changes has been shown to decrease systolic blood pressure by at least 4-5mmg, and diastolic blood pressure by 2-4mmHg. Additionally, dietary changes can decrease SBP by an average of 11mmHg (Whelton et al., 2018).
In most cases, lifestyle changes alone cannot adequately control elevated blood pressure levels. This is why many clinicians also prescribe medication in conjunction with lifestyle changes. These include thiazide diuretics, ACEIs, ARBs, and CCBs.
Thiazide diuretics inhibit sodium and chloride reabsorption in the kidneys. We mentioned earlier that a diet rich in salt is a risk factor for hypertension. This is because salt absorbs water and increases the volume of circulating fluid. This results in increased blood pressure from greater volumes of fluid.
Some examples of thiazide diuretics include indapamide, hydrochlorothiazide and chlorthalidone. The ACC/AHA recommends the use of chlorthalidone, as studies show it can be used to protect against cardiovascular disease.
ACEI stands for Angiotensin converting enzyme (ACE) inhibitors. ACE is responsible for converting angiotensin I to angiotensin II, which constricts small blood vessels. By inhibiting the production of this potent vasoconstrictor, blood pressure can be lowered. In addition, ACE inhibitors exert a protective effect against heart failure and heart attacks. Examples of these ACE inhibitors are captopril, enalapril and lisinopril.
ARBs, or Angiotensin II receptor blockers directly inhibit the action of the potent vasoconstrictor. Examples of this include candesartan, losartan and valsartan. This type of medication is not used in combination with ACE inhibitors, due to risk factors. Both ARBs and ACE inhibitors should be avoided in pregnant patients and in those with bilateral renal artery stenosis.
CCBs, or Calcium Channel Receptor Blockers inhibit the influx of calcium ions in the smooth muscle cells of coronary and systemic arteries. Additionally, it also inhibits vasoconstriction and lowers blood pressure. Examples of CCBs include amlodipine, nicardipine and diltiazem.
As with all medications, CCB usage carries risk. Some CCBs cannot be used for people with heart failure. As well, CCBs cannot be used with antihypertensives called beta-blockers because of the risk of heart block and bradycardia.
Some patients require more than one type of antihypertensive medication. As a result, some clinicians may prescribe two or three medications, depending on how well your blood pressure is under control.
Upon taking medication, the goal is to have a BP reading of <130/80. However, if your average BP reading is >140/90, your provider may consider giving you 2 different types of antihypertensives (Whelton et al., 2018).
Compliance is an important aspect of controlling blood pressure. Medications need to be taken daily and consistently for the best risk reduction.
How can I prevent hypertension?
Hypertension is very common amongst the elderly. In fact, it is rare to meet someone older than 60 who is not on maintenance medication for hypertension.
Primary hypertension is classified as a non-communicable lifestyle disease. If you are under the age of 50 with high blood pressure, you may be advised to change your lifestyle. There are real-life examples of people who were diagnosed with high blood pressure; these people were advised to change their lifestyle as well as take medication. On their follow-up visits, their blood pressure levels were normal. As a result, their provider declared they no longer needed medication and advised them to continue with their lifestyle modifications.
One specific diet that you can apply is the DASH diet. DASH stands for Dietary Approaches to Stop Hypertension. This plan is flexible and involves a balanced intake of various macronutrients with an appropriate caloric requirement. The DASH diet does not require you to eat or restrict any specific kind of food. Rather, there are nutritional goals that you should focus on achieving. The DASH diet is recommended by the U.S. based National Heart, Lung, and Blood Institute for hypertensive patients.
The DASH diet encourages intake of fruits, vegetables and whole grains. Prioritize low-fat dairy products and eat lean meat like fish and poultry (without the skin). As well, a healthy intake of beans and nuts are also encouraged. Junk foods should be avoided, as they are rich in saturated fats, trans fats, and salt. The DASH diet also recommends limiting intake of artificially sweetened beverages that contain sugars.
The total daily required calories depends on your age and gender. For example, if you’re >51 years old and you have a sedentary lifestyle, your daily caloric intake should be 1,600 calories a day. But for a 45 year old person with a high level of daily activity, the recommended caloric intake is 2,200 calories. It is also emphasized that your daily salt intake should be less than or equal to 1,500mg (National Heart, Lung and Blood Institute, 2020).
To create a DASH diet plan that caters to you, visit your primary care provider and/or a nutritionist.
Another lifestyle change that can prevent hypertension is regular physical activity. Do moderately intense aerobic exercise 3-5 days a week, with days dedicated specifically to weight training. Examples of aerobic exercises include cycling, running and brisk walking. For those diagnosed with hypertension, your frequency of physical activity should be 5-7 days a week.
Experts recommend 30-60 minutes of aerobic exercise a day, which does not have to be done continuously. Even if periodic breaks are needed, BP levels will still improve (Zaleski, 2019).
If your family tree consists of individuals that are hypertensive, you may be at risk as well. Start monitoring your blood pressure and apply these lifestyle modifications as soon as possible. Eat a healthy diet, exercise regularly and limit your alcohol consumption.
If you believe you are at risk of hypertension, consult a primary care provider at Well Life ABQ today. Our team of clinicians can provide you with advice for dietary changes, exercise and medical management.
We take pride in treating our patients with the care and patience they deserve. If you’re looking for a health clinic that’ll treat you like family, get in touch with us today!