What is hypertension?

WHAT IS HYPERTENSION?
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I. SYSTOLIC AND DIASTOLIC
PRESSURES
• The top and bottom numbers of blood pressure
reading are called systolic and diastolic pressures
respectively.
• When your heart contracts, it forces blood through the
arteries, which in turn creates a pressure and that
pressure is called systolic pressure. A normal systolic
pressure is below 120mmHg.
• The bottom number or the diastolic pressure is the
pressure in the arteries when the heart is in the phase
of relaxation. This number should ideally be below 90.

II. WHAT IS HYPERTENSION?
• A sustained elevation of the systemic arterial
pressure is termed as hypertension and is also
called arterial hypertension.
• A systolic blood pressure (SBP) of 140 mmHg
or a diastolic blood pressure (DBP) of > 90
mmHg indicates the presence of hypertension.
• In presence of diabetes a blood pressure >
130/80 mmHg is defined as hypertension.

III. CLASSIFICATION OF
HYPERTENSION
1. Hypertension in Adults
- A person is said to be pre-hypertensive if their systolic pressure is in the
range of 120-139mmHg and diastolic pressure falls in the range of 80-
90mmHg.
- The following table clearly shows how the new classification is different
from the older version.

2. Hypertension in Children and Adolescents
- Blood pressure readings normal for an adult are above the normal range
for a child.
- Children who are overweight or obese with abnormal eating habits should
specifically get their blood pressures checked during medical checkups.

IV. CAUSES OF HYPERTENSION
1. Essential Hypertension
- A systolic blood pressure of 140mmHg or a diastolic
blood pressure of >90mmHg on multiple readings,
in the absence of a specific, identifiable underlying
cause is known as essential hypertension.
- The most common presentation of essential
hypertension is an asymptomatic patient, in whom
an elevated blood pressure is found during a
routine examination.

- When a patient presents with symptoms then
they are more likely associated with:
• Hypertensive emergency.
• Long-term complications of end-organ
damage.
• Symptoms of diseases underlying secondary
causes of hypertension.

2. Secondary hypertension
Presentation in this case depends on the underlying cause and the organ
that is affected.
The following table shows the types of hypertension and the percentage of
the population affected

Most common secondary causes of
hypertension are:
a. Sleep apnea: around 50 percent of people
with sleep apnea have hypertension.
a. Renal hypertension: renal diseases that cause
vascular damage, reduce the ability of the
kidneys to excrete the salt and water, which
in turn causes fluid retention and leads to
hypertension.

c. Endocrine hypertension
Three major conditions that cause over the
functioning of the adrenal gland and result in
hypertension are:
- Primary aldosteronism
- Cushing’s disease
- Pheochromocytoma
d. Monogenic hypertension: mutations in a number
of single genes are known to cause hypertension.
This type of hypertension is known as monogenic
hypertension.

e. Coarctation of aorta: coarctation of the aorta
is congenital narrowing of the aorta which
causes hypertension, mostly in teenagers.
f. Thyroid hormone imbalance
Other secondary causes of hypertension include,
stress, anxiety and depression, anabolic steroids,
non-steroidal anti-inflammatory drugs, and
decongestants and stimulants.

V. RISK FACTORS FOR HYPERTENSION
• Family history
• Co-morbid diseases like diabetes or renal disease
• African-American heritage
• Obesity
• Smoking
• Alcohol consumption (more than two drinks/day)
• Oral contraceptive pills
• Physical inactivity
• Stress

VI. HYPERTENSION SYMPTOMS
- The most common presentation of essential hypertension is an
asymptomatic patient. Such patients are unaware of their elevated
blood pressures and get to know about this at a routine check up
- Hypertensive emergency symptoms
• Signs and symptoms of cardiac, neurological, renal and retinal
involvement
• There is evidence of stroke, subarachnoid hemorrhage, myocardial
ischemia and other abnormalities on fundoscopy
• Most commonly and acutely this condition results in headaches,
dizziness, chest pain, dyspnea, blurred vision, and palpitations.
- In secondary hypertension the symptoms are associated with the
underlying disease that has resulted in elevated blood pressure
symptoms.

VII. CONDITION RESULTING FROM
VASCULAR INJURY
1. Cardiac complications
Myocardial infarction, heart failure, left ventricular
hypertrophy, aortic aneurysm and dissection are
few of those complications that could be a result of
persistent elevation of blood pressure.
2. Cerebrovascular complications
One-third of the population affected by hypertension
is not aware of their condition, until they have an
attack of stroke.

3. Renal proteinuria and failure
An elevated blood pressure is one of the
leading causes of kidney damage that
eventually requires a transplant.
4. Retinopathy
Hemorrhages, exudates and arteriolar
narrowing can occur. They result in blurred
vision and sometimes blindness as well

VIII. MANAGEMENT OF
HYPERTENSION
1. Lifestyle modification
• Weight reduction
• Dietary sodium restriction
• Aerobic exercise
• Avoiding excessive alcohol intake
• DASH diet- increase fruits, vegetables, low-fat dairy and low-fat diet
2. Drug treatment
There are around 50 medications approved for initial treatment of
hypertension. Candidates ideal for drug therapy are those whose
diastolic blood pressure remains above 90mmHg despite a 3-6
month trial of non-pharmacological therapy.

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