Hypertension Overview and Management

Hypertension, also known as high blood pressure, is a condition in which the blood vessels have persistently raised pressure. Blood is carried from the heart to all parts of the body in the vessels. Each time the heart beats, it pumps blood into the vessels. Blood pressure is created by the force of blood pushing against the walls of blood vessels (arteries) as it is pumped by the heart. The higher the pressure, the harder the heart has to pump.

The Joint National Committee 7 (JNC7) defines normal blood pressure as a systolic BP (that is, the pressure that the blood exerts on the arterial walls when the heart contracts) of less than 120 mmHg and a diastolic BP (the pressure when the heart rests between beats) of less than 80 mmHg. Hypertension is defined as a systolic BP of 140 mmHg or higher and/or a diastolic BP of 90 mmHg or higher. Prehypertension is the grey area falling between 120–139 mmHg systolic BP and 80–89 mmHg diastolic BP.

Hypertension is a serious medical condition that can increase the risk of heart, brain, kidney, and other diseases. It is a major cause of premature death worldwide, with over a billion people affected. Many people with hypertension do not notice symptoms and may be unaware there is a problem. Symptoms can include early morning headaches, nosebleeds, irregular heart rhythms, vision changes, and buzzing in the ears. More severe forms may exhibit fatigue, nausea, vomiting, confusion, anxiety, chest pain, and muscle tremors.

Several factors can predispose to hypertension. These include obesity, physical inactivity, smoking, alcohol intake, and a family history of hypertension. Urbanization is also a determinant of health and one of the key drivers of noncommunicable diseases (NCDs). Urban people are more at risk of these diseases as compared to their rural counterparts.

The aetiology of hypertension involves the complex interplay of environmental and pathophysiological factors that affect multiple systems, as well as genetic predisposition. Evaluation of patients with hypertension includes accurate standardized blood pressure measurement, assessing patients' predicted risk of atherosclerotic CVD, evidence of target organ damage, detection of secondary causes of hypertension, and presence of comorbidities, including CVD and kidney disease. Lifestyle changes, including dietary modifications and increased physical activity, are effective in lowering blood pressure and preventing hypertension and its CVD sequelae. Pharmacological therapy is also effective in lowering blood pressure and preventing CVD outcomes in most patients.

In treating hypertension, it is important to consider a person's predicted atherosclerotic CVD (ASCVD) risk more than the level of blood pressure alone. Regular check-ups are important for early detection and management of hypertension. Reducing modifiable risk factors is the best way to prevent hypertension and associated diseases of the heart, brain, kidney, and other organs. These factors include unhealthy diets, physical inactivity, consumption of tobacco and alcohol, and being overweight or obese. Hypertension can be managed by reducing and managing mental stress, regularly checking blood pressure, and consulting with health professionals. Cessation of tobacco use and the harmful use of alcohol, as well as improvements in diet and exercise, can help reduce symptoms and risk factors from hypertension.