Hypertension

Hypertension, also known as high blood pressure, is a chronic medical condition characterised by persistently elevated blood pressure in the arteries. It is a major risk factor for various cardiovascular diseases, including stroke, coronary artery disease, and heart failure, as well as other conditions like chronic kidney disease and dementia.

Causes and Risk Factors

Hypertension is classified into primary (essential) and secondary types. Primary hypertension, accounting for 90-95% of cases, results from a combination of lifestyle and genetic factors, such as excess salt intake, obesity, smoking, physical inactivity, and alcohol consumption.

Secondary hypertension is due to identifiable causes like chronic kidney disease, endocrine disorders, and certain medications.

Diagnosis

Hypertension is diagnosed based on persistently high resting blood pressure, with readings exceeding 130/80 mmHg or 140/90 mmHg. Accurate measurement techniques are very important, involving multiple readings and sometimes ambulatory blood pressure monitoring over 24 hours.

Signs and Symptoms

Hypertension is often asymptomatic, earning it the moniker "silent killer." Some individuals may experience headaches, lightheadedness, tinnitus, altered vision, or fainting, often related to anxiety rather than the blood pressure itself. Long-term untreated hypertension can cause organ damage, visible in changes to the optic fundus or development of chronic kidney disease.

Complications

Untreated hypertension can lead to severe health issues:

• Cardiovascular diseases: Stroke, heart attack, heart failure, and peripheral arterial disease.
• Kidney damage: Chronic kidney disease due to prolonged high pressure.
• Eye damage: Hypertensive retinopathy, potentially leading to vision loss.
• Cognitive impairment: Increased risk of dementia and cognitive decline.

Management

Lifestyle Modifications

Lifestyle changes are the first line of treatment:

• Weight loss
• Regular physical activity
• Reduced salt intake
• Limited alcohol consumption
• Healthy diet rich in fruits, vegetables, and whole grains

These modifications can significantly lower blood pressure and reduce the risk of complications.

Medications

When lifestyle changes are insufficient, antihypertensive medications are prescribed. Common classes include:

• Thiazide diuretics
• Calcium channel blockers
• ACE inhibitors
• Angiotensin receptor blockers (ARBs)

Often, a combination of medications is required to achieve optimal blood pressure control.

Hypertensive Crisis

A hypertensive crisis, with blood pressure readings equal to or greater than 180/120 mmHg, requires immediate medical attention. It is categorised as:

• Hypertensive urgency: No evidence of organ damage, managed with oral medications.
• Hypertensive emergency: Evidence of organ damage, requiring rapid blood pressure reduction.

Special Considerations

Pregnancy: Hypertension in pregnancy can lead to conditions like pre-eclampsia, posing risks to both mother and baby. Blood pressure monitoring and management are very important.

Children: Hypertension in children, although less common, requires careful evaluation to identify underlying causes and appropriate treatment.

Prognosis and Epidemiology

Hypertension affects about 33% of the global population, contributing significantly to morbidity and mortality. Early diagnosis and effective management are very important in reducing the risk of severe complications and improving life expectancy.

Despite its prevalence, nearly half of those with hypertension are unaware of their condition, underscoring the need for regular screening and public health awareness.

In summary, hypertension is a pervasive and often silent condition with significant health implications. Effective management through lifestyle changes and medications can mitigate its impact, emphasising the importance of early detection and comprehensive treatment strategies.

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Self-assessment MCQs (single best answer)

What is the primary characteristic of hypertension?

Which of the following is a common risk factor for primary hypertension?

Which lifestyle modification is NOT typically recommended to manage hypertension?

Which measurement confirms a diagnosis of hypertension in adults?

What is a potential complication of long-term untreated hypertension?

Which antihypertensive medication is commonly used as a first-line treatment?

What defines a hypertensive crisis?

What is the most accurate method to confirm a diagnosis of hypertension?

Which condition is a common cause of secondary hypertension?

Which symptom is most likely related to hypertension itself rather than anxiety?