Hypertension

Hypertension(High Blood Pressure) is defined as elevated blood vessel pressure (140/90mmHg or higher). Around 1.28 billion adults aged 30 to 79 suffer from HTN. However, most of the time, hypertension remains undiagnosed. According to the WHO, around 46% of adults are unaware that they have the condition. The only way to diagnose it is to get blood pressure checked.

Maintaining a healthy lifestyle keeps blood pressure in the optimum range. The American Heart Association explains the limits as follows;

Factors include modifiable and non-modifiable;

1. Modifiable:

• Obesity
• Lack of exercise
• Nutrition having excessive salt or fats
• Depression or anxiety

2. Non-Modifiable:

• Family history

-One or more of your close relatives of age <60 years, suffering from HTN, increases the risk two times.

-A strong family history means three or more relatives having HTN before the age of 60 years.

• Age >65 years
• Other comorbidities i.e. Diabetes Mellitus, CKD

Most of the time, high blood pressure goes unnoticed. Very high blood pressure and hypertensive crisis may be associated with the following symptoms;

• Headache
• Dizziness
• Chest pain
• Visual disturbance
• Confusion
• Nausea
• Epistaxis
• Difficult breathing

It is defined as the blood pressure >180/120mmHg. This is a medical emergency, and urgent treatment should be sought from healthcare professionals.

1. Hypertensive Urgency:

It is blood pressure >180/120mmHg without target organ damage.

2. Hypertensive Emergency:

It is blood pressure >180/120mmHg associated with one or more target organ damage.

Complications can occur either by the sudden rise of blood pressure or an attempt to lower blood pressure aggressively.

• Stroke can be hemorrhagic or ischemic. A sudden rise in blood pressure leads to hemorrhagic stroke, and a sudden drop in blood pressure causes ischemic stroke.
• Myocardial Infarction occurs due to a sudden drop in blood pressure as a result of ‘hypoperfusion injury.’ ECG should be carried out on individuals having hypertensive emergencies.
• Acute Kidney Injury can occur due to glomerular vessel shutdown. This is followed by ‘azotemia‘ or ‘renal shutdown.’ Chronic hypertension and diabetes mellitus are the leading cause of CKD, which causes the highest deaths in kidney-related diseases.

Management of Hypertensive Emergency:

Drugs of choice in a hypertensive emergency are intravenous Nitroglycerin, Nitroprusside, Clevipine, and Isosorbide Nitrate.

The target for lowering blood pressure should be no more than 20-25% per hour; otherwise, it will cause hypoperfusion injury.

The prognosis of this disease depends on the patient’s compliance. Controlling blood pressure and adopting a healthy lifestyle can delay the onset of complications.

A recent meta-analysis shows that the risk of death from stroke and heart failure doubles with a rise of 20mmHg and 10mmHg of Systolic and Diastolic blood pressure, respectively.

Following are the drug classes of anti-hypertensives;

• Beta-blockers
• ARBs
• ACE-inhibitors
• Diuretics
• Calcium channel blockers
• Alpha-2 receptor agonists
• Vasodilators
• Alpha-blockers

Detailed pharmacological guidelines have been issued by WHO in 2021.

Lifestyle Modifications:

• Work-life balance
• Reduce stress
• Decrease intake of salt diet
• Regular exercise
• Meditation
• Treatment compliance
• Weight control
• Prophylactic Blood Pressure measurement if family history is positive