A Complete Guide to Hypertension

Hypertension, more commonly known as high blood pressure, is diagnosed when the pressure your bloodstream puts on the inner walls of your blood vessels is consistently higher than acceptable, healthy levels. This increased pressure causes damage to the inner blood vessel walls and can increase your risk of cardiovascular disease. Unfortunately, hypertension can cause damage while not causing symptoms.

Worldwide, hypertension contributes to an estimated 7.5 million premature deaths and 4.5 percent of the worldwide disease burden.¹ It affects about 103 million U.S. adults and is second only to cigarette smoking as a preventable cause of death.²

Primary vs. Secondary Hypertension

Primary hypertension does not have a known and specific cause. It typically develops gradually over time and is influenced by a combination of genetic, environmental, and lifestyle factors. Primary hypertension accounts for about 90% of all cases.³

Blood moves from an area of high pressure to one of low pressure. Blood flow as a result of the force from heart contractions drives blood forward in arterial blood vessels.

Resistance to blood flow due to friction or narrowing in the blood vessel impedes its flow. Any disease process, medication, environmental, or lifestyle factor that affects cardiac output, blood vessel compliance, blood volume, blood viscosity or thickness, or blood vessel length or diameter can affect blood pressure.

Secondary hypertension has a known and specific cause. Underlying medical conditions that increase the risk of hypertension include kidney disease, hormonal disorders, and medication side effects.

Examples of causes of secondary hypertension include:

• Excessive stress and sympathetic nervous system stimulation
• Increased thyroid hormone
• Increased calcium levels
• Atherosclerosis
• Heart failure
• Liver cirrhosis
• Glucocorticoids
• Blood cell cancers
• Stimulant medications
• Sleep apnea
• Chronic kidney disease
• Pheochromocytoma
• Coarctation of the aorta

Causes of Hypertension

Environmental and lifestyle factors, as well as genetic and other unmodifiable risk factors, can also increase your risk of hypertension. Examples of factors that may increase your risk of primary hypertension include:

• Increased age
• Genetic predisposition
• High cholesterol
• Sedentary lifestyle
• Chronic stress
• Obesity
• Tobacco use/smoking
• High sodium intake
• Excessive alcohol consumption

Symptoms of Hypertension

Unfortunately, hypertension does not cause symptoms or have any warning signs. The only way to diagnose high blood pressure is to measure your blood pressure using a sphygmomanometer (blood pressure monitor).

Talk to your doctor about your risk of hypertension. Discuss how often you should have your blood pressure monitored, both in the medical office and at home.

Long-Term Complications of Hypertension

Long-term hypertension can damage blood vessels and increase your risk of several medical conditions, including:

• Heart disease: increased blood pressure, especially when combined with increased cholesterol, can increase your risk for cardiac arrests and heart attacks.
• Stroke: high blood pressure can damage blood vessels in the brain, contributing to a stroke.
• Aneurysms: high blood pressure can weaken support in blood vessels, causing them to bulge. These aneurysms can rupture, causing severe internal bleeding.
• Kidney damage: kidney filtering units filter waste and remove excess fluids from the blood. High blood pressure can harm these tiny clumps of capillaries.
• Vision problems: damage to small vessels in the back of the eye can cause vision problems and, if untreated, blindness.
• Cognitive decline: Untreated, long-term hypertension is associated with cognitive decline.
• Peripheral artery disease: increased blood pressure can damage the lining of blood vessels, causing narrowing and blockages. This can cause leg pain and weakness and limit mobility.
• Sexual dysfunction: blood vessel damage is associated with erectile dysfunction and can contribute to sexual dysfunction in men and women.

How Is Hypertension Diagnosed?

Hypertension is diagnosed by using a blood pressure cuff and monitoring. The blood pressure cuff is wrapped around the upper arm and inflated. It compresses the brachial artery in the arm until there is no blood flow through the vessel.

The cuff is gradually deflated, and blood flow resumes through the artery. As blood flow resumes, this number is read as the systolic blood pressure. As blood flow is fully restored and turbulence decreases in the vessel, blood flow sounds are no longer heard. This is diastolic blood pressure. Automatic blood pressure monitors read off blood pressure measurements without the need to listen for blood flow.

If your doctor needs more data to make a diagnosis, a 24-hour blood pressure test can provide multiple measurements throughout the day. This can be important because blood pressure fluctuates throughout the day and in response to environmental factors.

Understanding Blood Pressure Readings

The systolic blood pressure is the upper number in a blood pressure read-out. It is the point of maximum pressure in the artery. It occurs when the left ventricle is contracting. A normal systolic reading should be less than 120 mmHg.

The diastolic blood pressure is the lower number in the blood pressure read-out. It is recorded when the left ventricle is relaxing. A normal diastolic reading is less than 80 mmHg.

Blood pressure varies throughout the day. Taking more than one blood pressure measurement at different times of the day and in different situations is essential to accurately diagnosing hypertension.

Blood pressure category	Systolic blood pressure (mmHg)	and/or	Diastolic blood pressure (mmHg)
Normal	Less than 120	and	Less than 80
Elevated	120-129	and	Less than 80
Stage 1 hypertension	130-139	or	80-89
Stage 2 hypertension	140 or higher	or	90 or higher
Hypertension crisis	higher than 180	and/or	higher than 120

Common Comorbid Diseases

Comorbid diseases are one or more additional health conditions or diseases that cooccur with a primary medical condition. Comorbid conditions are common and can complicate diagnosis and treatment.

Common comorbid conditions linked to hypertension include:⁴

• Obesity
• Diabetes mellitus
• Insulin resistance
• Dyslipidemia
• Cardiovascular disease
• Chronic kidney disease
• Coronary artery disease
• Metabolic syndrome
• Heart failure
• Stroke

High Blood Pressure During Pregnancy

It is not uncommon for blood pressure to increase during pregnancy. Common physiologic changes that can increase blood pressure include:

• Increased blood volume
• Hormonal changes
• Weight gain

In addition to these, chronic hypertension, gestational hypertension, and pre-eclampsia can cause increased blood pressure.

• Chronic hypertension is hypertension diagnosed before pregnancy or in the first 20 weeks.
• Gestational hypertension is more common in the second half of pregnancy. The contributing causes are not fully understood.
• Pre-eclampsia is a serious medical condition that may occur in the second half of pregnancy. Pre-eclampsia requires immediate medical evaluation and treatment.

If you are pregnant, talk to your doctor about your blood pressure. Have regular checkups to monitor your blood pressure and identify any changes early. Unmanaged hypertension during pregnancy can cause complications for the mother and the baby.

Lifestyle Changes To Treat Hypertension

Lifestyle changes associated with better cardiovascular function that can help treat hypertension include:

• Make heart-healthy exercise a priority
• Attain a healthy weight
• Decrease sodium intake
• Increase potassium intake
• Moderate alcohol consumption
• Stop smoking
• Manage stress

Medications To Treat Hypertension

If lifestyle modifications do not reduce your blood pressure to healthy levels, your doctor may add an antihypertensive medication to treat your high blood pressure. Medication classes used to treat hypertension include:

• Diuretics: decrease blood volume by eliminating excess sodium and water and reduce blood vessel resistance
• Calcium channel blockers: dilate blood vessels
• Alpha-blockers: dilate blood vessels
• Angiotensin-converting enzyme inhibitors: dilate blood vessels and decrease blood volume
• Angiotensin II receptor blockers (ARBs): dilate blood vessels and reduce blood volume
• Beta-blockers: decrease heart rate and contractility
• Vasodilators: dilate blood vessels

If you are concerned about your blood pressure or have questions about hypertension, contact a doctor on the TelegraMD platform. Telemedicine provides a convenient and affordable option to receive a hypertension diagnosis and, if appropriate, antihypertension medications. These medications can be prescribed online and transmitted to your local pharmacy.

Surgical Options for Treating Hypertension

Surgical options are available to treat risk factors and causes of secondary hypertension. For example, bariatric surgery may be recommended if obesity is a comorbid disease with hypertension. Stents may be placed in narrowed blood vessels to improve blood flow and reduce blood pressure.

When You Should Check Your Blood Pressure at Home

Talk to your doctor to determine how frequently you should check your blood pressure at home. Blood pressure fluctuates throughout the day, so take readings at different times of the day. Record all your results and look for a pattern. The first time you take a blood pressure measurement, take it in both arms. After that, you can take a measurement using the same arm.

There are many options to measure your blood pressure, and new and upcoming wearable devices coming out all the time. Options include finger cuff monitors, wrist monitors, smartphone technology, blood pressure cuffs, and blood pressure kiosks in stores.

Disclaimer

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

References

1. World Health Organization. (2002). The World Health Report 2002: Risks to Health. Geneva: World Health Organization.
2. Whelton, P.K., Carey, R.M., Aronow, W.S., Casey, D.E. Jr., Collins, K.J., Dennison Himmelfarb, C., DePalma, S. M., Gidding, S., Jamerson, K. A., Jones, D. W., MacLaughlin, E. J., Muntner,  P., Ovbiagele,  B., Smith, S. C. Jr., Spencer,  C. C., Stafford, R. S., Taler,  S. J., Thomas, R. J., Williams, K.A. Sr., Williamson, J.D., & Wright,  J.T. Jr.(2018).  2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol.;71(19): e127-e248. DOI: 10.1016/j.jacc.2017.11.006. Epub 2017 Nov 13. Erratum in: J Am Coll Cardiol. 2018 May 15;71(19):2275-2279. PMID: 29146535.
3. Oparil, S. Zaman, A., & Calhoun, D. (2003). Pathogenesis of Hypertension. Ann Intern Med. 139:761-776
4. Noh J, Kim HC, Shin A, Yeom H, Jang SY, Lee JH, Kim C, Suh I. Prevalence of Comorbidity among People with Hypertension: The Korea National Health and Nutrition Examination Survey 2007-2013. Korean Circ J. 2016 Sep;46(5):672-680. doi: 10.4070/kcj.2016.46.5.672. Epub 2016 Sep 28. PMID: 27721859; PMCID: PMC5054180.