Hypertension: Causes, Complications & Management

Hypertension, also known as high blood pressure, is one of the most common chronic diseases. It affects all ages and anyone. 

  • 108 million people (45% of the population) in the US have hypertension (BP > 130/85). 

  • Only 25% of those with hypertension have it under control.

  • New York State ranks 43rd in the nation (29% of New Yorkers have hypertension)

  • Hypertension was the primary or contributing cause of death for approximately 500,000 people in United States in 2018.

  • Hypertension has cost Americans $131 billion annually.*

*Averaged over 12-year data (2003-2014) 

High Blood Pressure

Blood pressure is composed of two numbers, systolic (upper) and diastolic (lower). Systolic blood pressure is when your heart pumps blood out of your heart (left ventricle). Diastolic pressure is when blood returns to your heart (right auricle) and fills the heart with blood. 

Normal blood pressure is 120/80 at rest. Hypertension has two broadly defined stages.

  • Stage I: Systolic 130 - 139 / diastolic 80–89 

  • Stage II: Systolic >140 / diastolic >90 

  • Referred to as Essential when no cause can be identified.

  • Referred to as Secondary when a cause can be identified (e.g., kidney disease, thyroid disease, adrenal gland issues, etc.).

How To Take Your Blood Pressure

Blood pressure is usually taken with a blood pressure monitor using your right upper arm. Monitoring units that utilize the upper arms are more accurate than those that utilize the wrist. Electronic units are accurate and it’s important to ensure blood pressure cuffs are the appropriate size. For example, the artery marked on the cuff should be over your artery. Some considerations below before you take your blood pressure. 

  • Do not drink coffee or exercise for 30 minutes prior to the test. 

  • Sit and relax for 10 minutes. 

  • Do not talk before your test and while taking blood pressure. 

  • Uncover your arm to put the blood pressure cuff on the skin. 

  • Rest your arm on a table, so it is supported and is at heart level. 

If your blood pressure is unusually high, wait for another 10 minutes and repeat. A Hypertension diagnosis is made when your blood pressure is very high (>160/90) at rest or on 2 separate occasions. Alternatively, a diagnosis can be made if your blood pressure is persistently elevated for 2 weeks. Keep a log of blood pressure and pulse readings, which will provide good insight to the medical provider that is helping you.

What Causes Hypertension?

Regulation of blood pressure is extraordinarily complex and multifactorial. Kidneys and autonomic nervous system play a significant role in blood pressure regulation. 

Factors regulating blood pressures are: 

  • Neurohormonal system, such as autonomic nervous system.

  • Renin-angiotensin-aldosterone system (RAAS). 

Factors that influence blood pressure regulation include: 

  • Age, genetics and family history.

  • Chronic anxiety and stress.

  • Increased salt intake.

  • Obesity.

  • Sedentary lifestyle. 

  • Certain prescription and OTC medications. 

  • High consumption of unhealthy or processed foods. 

Hypertension Symptoms

Hypertension does not have any specific symptoms and can exist without someone experiencing any symptoms. Sometimes vague symptoms may develop transiently. These include: 

  • Blurred vision. 

  • Nausea. 

  • Vertigo. 

  • Dizziness. 

  • Anxiety. 

  • Headaches. 

  • Chest discomfort. 

  • Palpitations.

  • Exertional shortness of breath. 

Symptoms develop gradually and usually due to ill effects of chronically uncontrolled hypertension. Hypertension causes significant damage to small blood vessels (capillaries) throughout the body. Organs commonly affected are the kidneys, heart, brain and eyes. Reversing the damage due to uncontrolled hypertension is very difficult.

Complications Of Hypertension

Uncontrolled hypertension affects all organs of the body, some are affected more than others. Some complications of hypertension include: 

  • Kidney disease leading to kidney failure and dialysis.

  • Atherosclerotic heart disease leading to heart attack (AMI) and heart failure (HF).

  • Left ventricular hypertrophy (LVH) and heart enlargement (cardiomegaly) leading to diastolic heart failure (HF).

  • Retinopathy (damage to eye blood vessels) leading to significant loss of vision or blindness.

  • Peripheral arterial disease (PAD) due to chronic damage to the arteries of extremities, which can lead to chronic nonhealing ulcers, gangrene and amputations.

  • Narrowing of carotid arteries and other brain blood vessels leading to vascular dementia and stroke.

  • Sexual dysfunction due to damage to the genital arteries, both male and female.

  • Pre-eclampsia and eclampsia during pregnancy, which can adversely affect mother and/or baby.

  • Development and rupture of arterial aneurysms causing significant damage or death.

  • Hypertensive crisis (rapid rise of blood pressure over 180/120). Not very common but can cause significant permanent damage. 

Preventing Hypertension

Prevention is better than treatment and treatment is better than uncontrolled hypertension.

The following suggestions can help prevent hypertension or reverse the condition:

  • Decrease salt intake, less than 2000 mg per day. This includes all salt (NaCl) intake, including hidden salt (e.g., soups, frozen meals, salty snacks, etc.)

  • Physical activity equal to 3 miles per day for 5 days a week, gradually increasing it to 5 miles per day. Walking should include 5-10 minutes of brisk walking. Activity could also be in the form of sports.

  • Tobacco and alcohol cessation. Tobacco use needs to be completely cut out. Can have alcohol socially, but try to keep to less than 5 drinks per week.

  • DASH Diet or similar diet. Consume decreased quantity of processed foods (most processed foods have a label outlining calories and other ingredients). Recent studies have found direct correlation between processed foods and atherosclerosis/heart disease. 

Maintaining a healthy weight and physique are also important (i.e., aim to have a BMI less than 24, waist measurements less than 40 inches for men and 35 inches for women).

 Treating Hypertension

The goal for those who suffer from hypertension is to keep a resting blood pressure of less than 130/80 most of the time. Some treatment ideas below. : 

Without medications. 

  • Reduce salt intake 2000 mg or less per day.

  • Moderate activity equal to 3-5 miles per day.

  • Adequate sleep. Usually 6-8 hours per day.

  • Stress management and reduction (may need to keep stress diary to identify stressors).

  • Healthy weight.

  • Decrease nonessential digital screen time (usually social media, less Internet browsing). 

With medications. 

Individual medications can decrease 15-20 mm of systolic blood pressure. Based on your blood pressure numbers you may end up needing one to three medications. Initially one medication is started. The second or third medications are added one week apart, if needed. Diuretics, beta-blockers or calcium blockers are started initially. Your physician may choose one over another, based on your risk factors.

You can significantly reduce your hypertension by following "without medication" suggestions. Your blood pressure will start improving in 4 to 6 weeks. Eventually you may get off the medications or may need less medications. Controlling hypertension without medications has many other health benefits and improves quality of life.

- Mian Majeed, MD

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