Hypertension, or high blood pressure (HBP), is a very common condition. The blood moving through the blood vessels has higher pressure than normal. Normal blood pressure should be 120/80. The top number is systolic pressure, or the pressure as the heart pumps, and the bottom number is diastolic pressure as the heart is resting between heart beats. According to new guidelines, the threshold for a high blood pressure diagnosis is 130/80.
Hypertension is considered a silent killer because it almost never has symptoms. Over time, hypertension can increase the workload of the vessels and heart. This can damage arteries and allow plaque to form more easily. HBP increases the risk of heart attack, stroke, and heart failure.
There are several forms of high blood pressure. While it's usually divided into two types -- primary and secondary -- there are also special forms of hypertension that may come with higher risks.
Common Forms of High Blood Pressure
Primary Hypertension
Primary hypertension, also known as essential hypertension, is the most common type of HBP. Primary hypertension can be diagnosed when someone has HBP on at least three doctor visits and all other causes of hypertension have been ruled out. About 90% of all people diagnosed with HBP have this form without an identifiable cause.
In most cases, primary hypertension has no symptoms at all, although some people have fatigue, dizziness, and frequent headaches. The cause of essential primary hypertension is unknown, but it is linked to smoking, alcohol, a high salt diet, diabetes, obesity, dietary choices and genetics.
Secondary Hypertension
When hypertension is caused by a different medical condition, it's considered secondary HBP. When the underlying cause of the HBP is treated, the blood pressure will likely return to a normal level or be significantly reduced.
There are many conditions that can cause secondary hypertension such as sleep apnea, kidney disease, alcoholism, thyroid dysfunction and pregnancy. Women who take birth control pills can also develop secondary hypertension. Abnormalities in how blood is supplied to the kidneys represent the most common cause of secondary HBP.
Malignant Hypertension
A few types of hypertension go beyond mere high blood pressure. Malignant hypertension refers to extremely high blood pressure that comes on very suddenly and quickly. While normal blood pressure is no higher than 120/80, someone with malignant high blood pressure exceeds 180/120. This type of hypertension is considered a medical emergency and can cause organ damage.
Malignant hypertension can be the result of normal high blood pressure that isn't well managed or missed doses of prescription medication. It can also be the result of kidney disease, illegal drugs, an adrenal gland tumor, and certain medications. Just 1% of people with a history of hypertension develop malignant hypertension, but it can be life-threatening.
Pulmonary Hypertension
Pulmonary hypertension is a specific type of high blood pressure that only affects a specific part of the body's circulatory system: the heart-to-lunge system. This form of hypertension affects the arteries of the lungs and the right side of the heart. Pulmonary blood pressure refers to the pressure the heart must exert to pump blood from the heart and through the lungs. This type of hypertension makes it harder for blood to reach the lungs, which increases pressure in the arteries of the lungs. This causes the right ventricle of the heart to work harder.
Pulmonary high blood pressure often develops slowly and displays few if any symptoms. When symptoms do occur, they are often attributed to another lung condition or asthma. Early symptoms may include shortness of breath during exercise, pain in the upper right side of the abdomen, and fatigue.
Renal Hypertension
Renal hypertension is a specific form of the disease that refers to high blood pressure caused by kidney disease. This form of hypertension happens when the arteries that supply blood to the kidney become narrow. One or both arteries can be affected by renal artery stenosis. When the kidneys receive too little blood, they respond as if the body is dehydrated by releasing hormones that help the body retain water and sodium. As blood vessels fill with more fluid, blood pressure begins to increase.
In most cases, narrowing of renal arteries is a result of atherosclerosis, a potentially life-threatening disease in which the arteries harden. Along with affecting the kidneys, atherosclerosis can also cause a stroke or heart attack. There are several treatment options that may be effective for renal high blood pressure such as stenting, angioplasty, or surgery on the blood vessels themselves.
Resistant Hypertension
Resistant hypertension refers to high blood pressure that does not respond to medical intervention. Someone can meet the diagnosis guidelines if their blood pressure remains elevated despite concurrent use of at least three high blood pressure medications of different classes. This strict guideline is in place before hypertension by its nature can be hard to treat and usually requires several medications.
High blood pressure can become resistant for many reasons. Sometimes it's the result of another disease or condition but it can also be caused by the patient. The most common cause of resistant blood pressure is patient noncompliance, which may include failing to take medication as prescribed, inconsistent dosing, or gaps between treatment.
White Coat Hypertension
This is a common phenomenon in which people only have HBP during doctor appointments. Some people have a stress reaction when visiting their doctor that prompts their blood pressure to increase. Persistently elevated readings during check-ups should be evaluated, but they don't always indicate actual hypertension.
Hypertension FAQs
Q:How common is HBP?
A: According to the CDC, 75 million adults in the United States have hypertension. This is 1 out of every 3 adults.
Q: Does hypertension come in stages?
A: There are two stages of hypertension. Stage 1 HBP is diagnosed in people with a systolic pressure of 130 to 139 mmHG or a diastolic pressure of 80 to 89 mmHg. Stage 2 hypertension is diagnosed when either the systolic or diastolic pressure exceed these limits.
Q: Are hypertension and diabetes linked?
A: Most people who have diabetes eventually develop HBP, which can lead to complications of diabetes like kidney disease and eye disease. Diabetes and hypertension together can be life-threatening. Uncontrolled diabetes increases the risk of developing HBP, as can a high-sodium diet, high cholesterol, obesity, smoking, and a sedentary lifestyle.
Q: What are the risks of HBP?
A: When HBP is not well controlled, it can damage the blood vessels which makes it easier for LDL cholesterol to accumulate in the arteries. This directly increases the strain on the circulatory system and the workload of the heart. HBPincreases the risk of a heart attack as damaged arteries prevent blood from flowing to the heart muscle. It also raises the risk of a stroke when blood vessels in the brain get clogged or burst. The strain on the heart may cause the heart to enlarge which can lead to heart failure when it cannot supply enough blood to the body. Other risks of hypertension include angina or chest pain, vision loss if blood vessels in the eyes are damaged, kidney disease or failure, sexual dysfunction, and peripheral artery disease (PAD).
Q: Can the risk of hypertension be reduced?
A: There are many ways to reduce the risk of hypertension and keep blood pressure within the normal range. Eating a healthy diet that isn't high in sodium or fat is one of the most effective ways to manage blood pressure. Maintaining a healthy weight and staying physically active can also dramatically reduce blood pressure. Limiting alcohol use and avoiding smoking are also important to prevent HBP.
