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Hypertension

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Hypertension is a long-term medical condition characterized by persistently elevated blood pressure in the arteries.

Blausen 0486 HighBloodPressure 01
Blausen 0486 HighBloodPressure 01

This condition is a major global health concern and a significant cause of premature death. It often remains hidden because it usually does not cause any obvious symptoms. Because of this, about half of all people with hypertension are unaware they have it. Many cases are only discovered during routine health screenings or when seeking care for unrelated issues.

Main complications of persistent high blood pressure
Main complications of persistent high blood pressure

Blood pressure is measured using two distinct values. The first value is the systolic pressure, which measures the force during a heartbeat. The second value is the diastolic pressure, which measures the force between beats. For most adults, a normal resting pressure is below 120/80 mmHg. Hypertension is classified into stages based on these numbers. Stage 1 hypertension occurs when pressure is persistently at or above 130/80 mmHg. Stage 2 hypertension is present when readings reach 140/90 mmHg or higher.

Mean arterial pressure
Mean arterial pressure

Medical professionals categorize hypertension into two main types: primary and secondary. Primary, or essential, hypertension accounts for approximately 90–95% of all cases. This type results from a complex interaction between genetic factors and lifestyle. It is often linked to excess salt intake, physical inactivity, smoking, and alcohol use. In contrast, secondary hypertension makes up only 5–10% of cases. This type is caused by a clearly identifiable medical condition. Common causes include chronic kidney disease, endocrine disorders, or the narrowing of kidney arteries.

In most people with established primary hypertension, the high pressure is caused by increased total peripheral resistance. This means the blood faces more resistance as it moves through the vessels. This resistance often comes from the structural narrowing of small arteries and arterioles. In some younger people, a different pattern called hyperkinetic borderline hypertension may occur. These individuals have a high cardiac output and an elevated heart rate. As they age, their peripheral resistance typically rises, leading to established hypertension.

Mean arterial pressure
Mean arterial pressure

Secondary hypertension can present with very specific clinical signs depending on the cause. For example, Cushing's syndrome may cause a "buffalo hump" of fat behind the neck. Hyperthyroidism can lead to a fast heart rate and bulging eyes. Renal artery stenosis might be detected by a localized abdominal bruit, which is a sound heard through a stethoscope. Other causes include sleep apnea, obesity, and the use of certain medicines or stimulants. Identifying these specific signs helps doctors find the underlying cause of the high pressure.

When blood pressure reaches extremely high levels, it is called a hypertensive crisis. This occurs when systolic pressure is 180 mmHg or higher, or diastolic pressure is 120 mmHg or higher. There are two types of crisis: urgency and emergency. Hypertensive urgency means the pressure is very high, but there is no evidence of organ damage. In these cases, oral medications are used to lower pressure over 24 to 48 hours. A hypertensive emergency involves direct damage to organs like the brain, heart, or lungs. This requires rapid medical intervention to stop ongoing damage.

Hypertension also presents unique challenges during pregnancy. It affects approximately 8–10% of pregnancies and can be classified in several ways. Pre-eclampsia is a serious condition in the second half of pregnancy involving high pressure and protein in the urine. It occurs in about 5% of pregnancies and is responsible for 16% of maternal deaths globally. If it progresses to eclampsia, it becomes a life-threatening emergency. Women who experience pregnancy-related complications have three times the risk of developing cardiovascular disease later in life.

Managing hypertension is vital for reducing health risks. Uncontrolled high blood pressure is a major risk factor for stroke, heart failure, and kidney disease. It can also lead to vision loss and dementia.

Lifestyle changes like weight loss, regular exercise, and reducing salt intake are effective. If these changes are not enough, medications can be used. Up to three medications taken together can control blood pressure in 90% of people. Treating moderately high pressure can significantly improve life expectancy.

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Blausen 0486 HighBloodPressure 01.png
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Hypertension adults 30 79, World, 2019...
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Hypertension World Map Men 2014.png
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Hypertensive heart disease world map -...
File:Main complications of persistent high blood pressure.svg
Main complications of persistent high...
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William Harvey ( 1578-1657) Venenbild.jpg
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