Understanding Hypertension: Key Insights to Protect Your Health

What Is blood pressure, and what is hypertension?                    

Blood pressure is the force exerted by circulating blood against the walls of the large arteries as it travels from the heart to the rest of the body.

Hypertension, or high blood pressure, occurs when this pressure consistently exceeds normal levels. It is one of the most pressing public health concerns today due to the mortality, morbidity, and disability it causes worldwide.

What are the normal blood pressure levels?
According to the new European Society of Cardiology 2024 guidelines:

• Non-elevated blood pressure: <120/70 mmHg
• Elevated blood pressure: 120-139/70-89 mmHg. The attending physician will decide whether treatment is indicated
• Hypertension: blood pressure ≥ 140/90 mmHg
• The target for blood pressure control should be <130/80 mmHg.

What is systolic and diastolic pressure?
The heart functions as a pump. Systolic pressure (the higher number) occurs when the heart contracts, pushing blood against the arteries. Diastolic pressure (the lower number) occurs when the heart relaxes and fills with blood. Both high systolic and diastolic pressure can be harmful, but elevated systolic pressure is particularly concerning in older individuals.

How common is hypertension?
According to the World Health Organization, an estimated 1.2 billion adults aged 30-79 worldwide have hypertension. One in four adults has hypertension and the likelihood of developing it increases with age. By age 65, nearly half of individuals are hypertensive. Unfortunately, many are unaware of their condition, as hypertension often presents without symptoms. Additionally, many individuals diagnosed with hypertension do not manage their blood pressure effectively.

How do I know if I have high blood pressure?
You cannot rely on symptoms to diagnose hypertension, as high blood pressure usually has no warning signs. It is possible to have very high blood pressure without experiencing any symptoms. The only reliable way to determine if your blood pressure is high is to measure it.

How to measure blood pressure at home?
Home blood pressure monitoring does not replace regular doctor visits.

Sometimes, office blood pressure measurements can be unclear. A doctor may recommend home blood pressure measurements twice a day for a week or a 24-hour ambulatory blood pressure monitor during normal daily activities. Home measurements are essential for controlling hypertension because they can sometimes provide more accurate readings than those in a clinical setting.
To measure blood pressure accurately at home, use a reliable blood pressure monitor with the correct cuff size, ideally, one that measures pressure at the upper arm (validated blood pressure monitors can be found on the STRIDE BP website). Wrist and finger monitors are not recommended due to their lower reliability.

Take measurements while sitting, with your arm supported on a flat surface, after resting for 5-10 minutes. Avoid stress, physical activity, or caffeine for 30 minutes before measurement, as these can lead to inaccurate results. Take two readings one minute apart; take a third measurement if there is a significant difference.
Be aware that some medications, such as anti-inflammatory drugs or steroids used for pain relief or rheumatic diseases, can increase blood pressure. High alcohol consumption may also have a similar effect.

What is white coat hypertension?
Approximately 15% of individuals experience elevated blood pressure readings in a doctor’s office while having normal readings at home. In these cases, 24-hour ambulatory blood pressure monitoring during a normal day or home measurements taken twice a day in the morning and in the evening for a week can help the doctor make an accurate diagnosis.

What causes hypertension?

In 90-95% of cases, hypertension has no identifiable cause and is referred to as primary or essential hypertension. In these instances, managing blood pressure is the primary focus.

In 5-10% of cases, high blood pressure is due to an underlying condition such as kidney disease, benign adrenal gland tumor, renal artery stenosis, coarctation of the aorta, or sleep apnea syndrome, and it is classified as secondary hypertension. Your doctor will determine if further investigation is needed.

What are the risks of hypertension?
Hypertension is often called the "silent killer" because it typically has no symptoms and can go undetected for long periods, significantly increasing the risk of stroke, heart attack, heart failure, and kidney failure.

What is the treatment of hypertension?

Hypertension is usually not curable but can be effectively managed through lifestyle changes and medication.

- Medical treatment is indicated if blood pressure is ≥ 140/90 mmHg.

- In cases of elevated blood pressure (120-139/70-89 mmHg), the attending physician will decide if treatment is necessary after assessing the risk factors for cardiovascular accidents in high-risk patients with established atherosclerotic disease, diabetes, mellitus, familial hyperlipidemia, or chronic kidney disease.

Lifestyle changes include:

• Maintaining a healthy weight
• Reducing salt intake
• Increasing potassium intake by eating fruits and vegetables
• Regular exercise (150 minutes of aerobic activity per week over 5 days with an additional three sessions of 20 minutes of resistance training per week)
• Limiting alcohol consumption

Medical treatment is also crucial.

Highly effective medications or combinations of medications are available to control blood pressure. The attending physician tailors treatment plans to each individual, considering the severity of hypertension, other health issues, and specific coexisting risk factors.

In cases of secondary hypertension, treatment may involve addressing the underlying cause, such as by surgically removing an adrenal gland adenoma or performing angioplasty for renal artery stenosis.

Why should blood pressure be monitored during pregnancy?
High blood pressure during pregnancy can pose risks for both the mother and the baby. The most serious complication, preeclampsia, can develop after the 20th week of pregnancy and requires close monitoring and immediate treatment to ensure the health of both mother and child.

Key summary points for hypertensive individuals

• Hypertension is one of the leading risk factors for stroke, heart attack, heart failure, and kidney failure.
• High blood pressure usually has no symptoms. The only way to know if you have high blood pressure is to measure it.
• High blood pressure can be effectively controlled with lifestyle changes and medication, reducing the serious complications associated with hypertension.
• Doctors assess the overall risk of hypertensive patients for cardiovascular events, considering coexisting risk factors like diabetes, smoking, and high cholesterol, and then proceed with a personalised approach to treatment.