Disease and Condition

Hypertension

Also known as: High blood pressure
See also: Essential Hypertension
What is it?

Hypertension is when there is excessive pressure against the blood vessel walls. The heart has to work harder in order to pump the blood through the body when it is working against this elevated pressure, and this can eventually lead to an enlarged heart and heart damage. It can also lead to injury to blood vessels in the kidneys which can lead to chronic renal failure. Hypertension is the second leading cause of chronic renal failure. Blood pressure is measured by two numbers, the systolic pressure and the diastolic pressure. The systolic pressure, or the first number, measures the pressure in the blood vessels when the heart contracts to pump blood to the body. The diastolic pressure, or the second number, measures the pressure in the blood vessels when the heart is relaxed and refilling with blood.

Normal blood pressure is less than 130/85. High normal is 130-139/85-89. Anything above these numbers is considered hypertension, and puts the patient at risk for complications. If a patient is determined to have hypertension, regardless of whether it is mild or severe, it needs the attention of a physician to determine the best method of management.
Who gets it and what are its causes?

There are several risk factors for hypertension, some which are out of the patients control, and others that can be altered to reduce a patient’s risk. Family history, genetic factors, and age over 40 are examples of risk factors that cannot be altered. Patients that are overweight, have high levels of stress, have high intake of caffeine or alcohol, who smoke, or do not exercise regularly can make lifestyle changes to decrease their risk for hypertension. Certain medications can also increase the risk of developing high blood pressure—steroids, oral contraceptives, and estrogen have all been found to be culprits. Long term use of over-the-counter non-steroidal anti-inflammatory agents (NSAIDS), such as aspirin, ibuprofen, indomethacin and naprosyn, can cause kidney damage which can lead to further problems with high blood pressure. Some medical conditions such as cirrhosis, kidney disease, Cushing’s disease and pregnancy can cause hypertension, sometimes only temporarily.
What are the symptoms?

Unfortunately, hypertension usually has no symptoms. This is why it is often called the "silent killer." The best way to monitor for the disease is to have regular blood pressure checks by the patient’s physician, especially if the patient has any of the risk factors for developing the disease.
Diagnosis

Just about every physical examination includes checking the patient’s blood pressure. It is done with an inflatable cuff around the arm, and the person checking the blood pressure listens over the patient’s artery. This test may, however, not always be accurate. Recent exercise, stress, or incorrect cuff size can temporarily increase the measurement. If the first reading is found to be high, it is suggested that the reading be repeated a few minutes later. People with normal blood pressure should be rechecked at least every two years. If someone if found to have high normal blood pressure or above, they should be monitored more closely. Evaluating the blood pressure at home can eliminate those patients with a syndrome known as "white-coat syndrome." This is when the patient’s blood pressure is slightly elevated when in the doctor’s office, most likely due to anxiety, and once the patient is at home, the blood pressure returns to normal. If this syndrome is ruled out, and the hypertension is found to be real, the patient will need further follow up. Mild hypertension should be rechecked at least twice over several weeks, and the patient should be evaluated for other organ damage. This is most often done through laboratory studies. If the patient is found to have severe hypertension or any evidence of organ damage, they should be considered for initiation of drug therapy immediately.
Treatment

For high normal blood pressure or for mild hypertension, physicians usually have patients try to get it under control with lifestyle changes. These can include increasing exercise, stopping smoking, and dietary modification. Lowering salt intake is one of the most frequent changes suggested to patients. Unfortunately, these are not always successful, either because the hypertension is resistant, or the patient is not compliant with making the changes. At this point, anti-hypertensive medications are needed to help control the blood pressure. There are several different classifications of drugs that are used to treat hypertension. The physician most often will prescribe a combination of medications to try to lower the blood pressure, and make adjustments as necessary to get it under control. Any treatment should always include lifestyle modification, regardless of whether or not medications are needed.
Surgical Treatment

At this time, there is no surgical treatment for hypertension.

This information has been designed as a comprehensive and quick reference guide written by our health care reviewers. The health information written by our authors is intended to be a supplement to the care provided by your physician. It is not intended nor implied to be a substitute for professional medical advice.
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