What is hypertension?

Also known as high blood pressure, hypertension is a common condition in which there is increased pressure of your blood against the inner walls of your arteries as it is pumped by your heart. Hypertension can contribute to several serious diseases including heart disease, stroke and kidney failure. In 2011-2012, 32% of all Australians aged 18 years and over were diagnosed with hypertension. [1]

Blood travelling through an artery creates pressure against its walls (blue arrows). 

Arteries

A blood vessel carrying blood saturated with oxygen from the heart to the body's tissues.

Kidney

A pair of organs responsible primarily for regulating the water balance in the body and filtering the blood.

1. High blood pressure. National Heart Foundation of Australia. Accessed 30 March 2014 from

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Causes

The causes of hypertension can be divided into two main types.

Primary hypertension

Primary hypertension, also known as 'essential hypertension', has no specific underlying cause. It tends to develop slowly over many years. 

Secondary hypertension

This type of hypertension is caused by an underlying medical condition. Secondary hypertension can appear more suddenly than primary hypertension. Some conditions contributing to secondary hypertension can include:

Kidney

A pair of organs responsible primarily for regulating the water balance in the body and filtering the blood.

1. High blood pressure. National Heart Foundation of Australia. Accessed 30 March 2014 from

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Risk factors

There are many risk factors associated with hypertension. Most of these are lifestyle-related, for example, obesity and a lack of physical activity. If you are overweight or obese, more blood is needed to supply oxygen and nutrients to your tissues. As more blood is circulating through your blood vessels, the pressure on the walls of your arteries increase. People who are less physically active also tend to have a higher heart rate. If you have a high heart rate, your heart has to work harder with each contraction, which causes more pressure on your arteries. Other risk factors can include:

  • Increasing age;
  • Family history of hypertension;
  • Stress;
  • Smoking;
  • Alcohol;
  • Diabetes mellitus;
  • High salt diet, and;
  • High cholesterol (dyslipidaemia).

Arteries

A blood vessel carrying blood saturated with oxygen from the heart to the body's tissues.

Cholesterol

A type of fat produced by the body that is necessary for metabolism.

1. High blood pressure. National Heart Foundation of Australia. Accessed 30 March 2014 from

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Signs and symptoms

Most people with hypertension do not show any signs or symptoms, even when blood pressure readings are extremely high. Others may experience dull headaches, dizzy spells or nosebleeds.

1. High blood pressure. National Heart Foundation of Australia. Accessed 30 March 2014 from

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Methods for diagnosis

To diagnose hypertension, your blood pressure will be measured by your doctor using an inflatable arm cuff, called a blood pressure monitor. As the heart pumps blood through your arteries, your blood pressure peaks (known as 'systole') and falls as your heart relaxes (known as 'diastole'). The reading of your blood pressure is measured in millimetres of mercury (mm Hg) and has two numbers, the systolic (upper reading) and diastolic (lower reading) pressure. 

Your blood pressure may be checked on two separate visits before you are diagnosed with hypertension. Alternatively, your doctor may advise you to keep a record of your blood pressure readings taken at home using an automated monitor, or recommend an ambulatory monitor, to get a more accurate overview of your blood pressure on a daily basis. This may be done because your blood pressure can be artificially high when it is checked in a medical clinic, known as 'white coat syndrome', for a number of reasons, such as anxiety. Other factors that can increase your blood pressure and are best to avoid at least an hour before having your blood pressure checked, include caffeinated drinks (such as coffee and tea), smoking cigarettes and strenuous physical activity.  

 

A blood pressure test. 

Arteries

A blood vessel carrying blood saturated with oxygen from the heart to the body's tissues.

1. High blood pressure. National Heart Foundation of Australia. Accessed 30 March 2014 from

External link

Types of blood pressure

Blood pressure readings not only help diagnose hypertension, but they can also help assess its severity.

 

Systolic BP (mm Hg)

 

Diastolic BP (mm Hg)

Normal blood pressure

100 to 119

or

60 to 79

High-normal blood pressure

120 to 139

or

80 to 89

Mild hypertension

140 to 159

or

90 to 99

Moderate hypertension

160 to 179

or

100 to 109

Severe hypertension

180 or greater

or

110 or greater

Isolated systolic hypertension

140 or greater

and

greater than 90

1. High blood pressure. National Heart Foundation of Australia. Accessed 30 March 2014 from

External link

Types of treatment

A healthy lifestyle is a good way to help control your blood pressure. This could involve a healthy diet with less salt and reduced alcohol intake, maintaining a healthy body weight and regular exercise. In addition to this, medications may also be used to lower your blood pressure. Medications are normally started in low doses and are sometimes used in combination, if recommended by your doctor. Common medications include:

  • Thiazide diuretics - these medicines act on your kidneys to help reduce sodium and water, lowering your blood volume. Examples of thiazide diuretics include hydrochlorothiazide; 
  • Beta-blockers - these help to make your heart beat slower and reduce the workload on the heart. Examples of beta-blockers include atenolol, metoprolol, pindolol and propranolol;
  • Angiotensin-converting enzyme (ACE) inhibitors - these block the formation of a natural chemical that causes the narrowing of blood vessels. This helps blood vessels to relax and reduce blood pressure. Some examples of ACE inhibitors include perindopril, enalapril and lisinopril;
  • Angiotensin II receptor blockers (ARBs) - these medications are similar to ACE inhibitors, but instead of blocking the formation, they block the action of the natural hormone that causes narrowing of blood vessels. Some ARBs include irbesartan and losartan, and;
  • Calcium-channel blockers - these help to relax blood vessels, therefore allowing blood to flow more freely. Examples of calcium-channel blockers include amlodipine and diltiazem.

Additional medications

Other medications that can be used to treat high blood pressure include:

  • Alpha blockers;
  • Alpha-beta blockers;
  • Central-acting agents;
  • Vasodilators, and;
  • Aldosterone antagonists.

Beta-blockers

Substances that hinder the activity of hormones such as adrenaline by blocking the beta receptors, found in many organs but particuarly the heart and blood vessels. These are used to treat a range of conditions including high blood pressure and migraines.

Diuretics

A substance that promotes the production and excretion of urine.

Kidneys

A pair of organs responsible primarily for regulating the water balance in the body and filtering the blood.

Calcium-channel blockers

Also called a calcium antagonist. A group of medications that is used to treat high blood pressure and other conditions. It works by blocking calcium from entering cells of the heart and blood vessels, which ultimately lowers blood pressure.

1. High blood pressure. National Heart Foundation of Australia. Accessed 30 March 2014 from

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Potential complications

Potential complications associated with hypertension can include:

Resistant hypertension

Resistant hypertension refers to blood pressure that is resistant to treatment. This means that your hypertension remains after taking at least three different types of medications, so you may need four or more different types of antihypertensive medications to control it.

Stroke

Hypertension can lead to a stroke by causing hardening of the arteries. A stroke occurs when an artery in the brain is blocked or ruptured. This causes brain cells to be starved of oxygen and die. A stroke can sometimes be fatal.

Heart attack

Hypertension can also lead to a heart attack by causing hardening of the arteries. A heart attack is caused by a sudden stoppage of blood flow to your heart when a clot blocks one of your coronary arteries. If the artery is not unblocked quickly, heart muscle cells that are supplied blood from that artery will begin to die. Any damage that is done is permanent, as these cells cannot be replaced. It is a serious medical emergency. Some heart attacks are fatal, or can leave you with chronic health issues, while others see you make a full recovery after treatment.

Heart failure

Hypertension makes your heart work harder than it needs to. Over time, as your heart pumps blood against the higher pressure in your vessels, the heart muscle thickens. The thickened heart muscle may eventually not be able to pump enough blood to meet the requirements of your body, which can lead to heart failure.

Aneurysm

High blood pressure for a sustained period of time can cause your blood vessels to bulge and weaken, forming an aneurysm. If an aneurysm ruptures, it may be life-threatening.

Vision loss

Hypertension can lead to thickened, narrowed or torn blood vessels in the eyes, resulting in vision loss.

Kidney failure

Hypertension can lead to weakened and narrowed blood vessels in your kidneys. If this occurs, your kidneys might not work properly, leading to chronic renal failure.

Long-term complications of hypertension. 

Aneurysm

An abnormal dilatation in the wall of a blood vessel. This occurs when there is a weakness in the vessel wall. Aneurysms can be fatal if they rupture.

Arteries

A blood vessel carrying blood saturated with oxygen from the heart to the body's tissues.

Cells

The fundamental unit of life; the simplest living unit that can exist, grow, and reproduce independently. The human body is composed of trillions of cells of many kinds.

Kidneys

A pair of organs responsible primarily for regulating the water balance in the body and filtering the blood.

Coronary arteries

An artery that supplies blood to the heart muscle.

1. High blood pressure. National Heart Foundation of Australia. Accessed 30 March 2014 from

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Prognosis

The prognosis for hypertension is generally good if it is detected early and managed effectively. If hypertension is left untreated it can lead to many serious, yet potentially preventable, medical conditions. 

1. High blood pressure. National Heart Foundation of Australia. Accessed 30 March 2014 from

External link

Prevention

A healthy lifestyle is recommended to help prevent you developing hypertension. This could involve eating healthy foods, exercising regularly, reducing stress, maintaining a healthy weight, quitting smoking and reducing your alcohol and salt intake. It is recommended that you have your blood pressure checked regularly by your doctor to ensure you do not have hypertension.

1. High blood pressure. National Heart Foundation of Australia. Accessed 30 March 2014 from

External link