Hypertension

Hypertension (also known as high blood pressure) is a very common condition that affects the body’s main arteries. Blood pressure is often measured in millimeters of mercury (mm Hg). A normal blood pressure reading is 120/80 mmHg. With hypertension, the force of blood against the walls of the arteries is elevated above normal levels. Hypertension is very common, affecting ~ 47% of adults and contributing to over 670,000 deaths in the United States in 2020.

There are two numbers captured in blood pressure measurement. The top number, systolic blood pressure, is the pressure of the blood flow when the heart muscle squeezes and pumps blood. The bottom number, diastolic blood pressure, is the pressure of blood in the arteries between heartbeats, when the heart is relaxed and filling. Two or more blood pressure readings that are elevated, or one severely elevated blood pressure reading, leads to the diagnosis of hypertension. When patients are diagnosed with hypertension they occasionally need to undergo an electrocardiogram (EKG), to check if the heart has been affected by the increased stress it must overcome to pump blood.  

There are two main types of hypertension: primary and secondary. Primary hypertension is caused by a diet high in sodium, a sedentary lifestyle, and high consumption of alcohol. Secondary hypertension is caused by certain medications like immunosuppressants and NSAIDs.  It can also be caused by kidney disease, Conn’s syndrome, and Renal Vascular diseases. Nicotine use is also a major cause of secondary hypertension. Lastly, sleep apnea (a sleep disorder that is characterized by episodes of interrupted breathing during sleep) is a major cause of hypertension if left untreated.

Risk factors for hypertension include older age, genetics, being overweight, being inactive, a diet high in sodium, and drinking too much alcohol. Certain medications and nicotine can also cause elevated blood pressure. Another important risk factor for development of hypertension is stress.

According to the National Jewish Health, “hypertension is also called the silent killer because it generally does not have symptoms that warn [patients] about a developing problem.” Thus, patients are typically diagnosed during screenings at annual physicals or when complications manifest. When symptoms are present, they can include headaches, shortness of breath, nosebleeds, dizziness, and more. Certain symptoms occur when hypertension reaches a severe or life-threatening stage (blood pressure greater than 180/110 mmHg). This is called hypertensive emergency. Symptoms include chest pain, dizziness, difficulty breathing, facial flushing, irregular heartbeat. Uncontrolled hypertension can lead to heart attacks, aneurysms, heart failure, vision problems, kidney disease, dementia, and many more complications.

Treatment with hypertension can vary with each patient. One thing that is recommended for all patients diagnosed with hypertension is incorporating healthy lifestyle changes. Doctors suggest eating a well-balanced diet that avoids salt and processed foods. While also maintaining a healthy diet, it is important to maintain a healthy weight. One of the best ways to reduce high blood pressure is exercise. Quitting smoking and limiting alcohol can also help to reduce high blood pressure. Doctors also suggest blood pressure medications for patients who have hypertension despite lifestyle changes.

Prevention strategies for hypertension include healthy diet and weight, knowing how to cope with stress, and getting enough quality sleep. Learning how to manage stress is a key factor to help reduce high blood pressure.

Hypertension is more prevalent amongst low income families. The cause of this is likely multifactorial: these populations may experience higher levels of stress, and are often less able to eat healthy diets which are typically more expensive, there is also higher rates of nicotine/tobacco and alcohol use in these populations.              

Written by Tanisha Patel, Medical Scholars Program Student

Edited by Mallory Kane MD 

References

1. “Causes and Risk Factors.” National Heart Lung and Blood Institute, U.S. Department of Health and Human Services, www.nhlbi.nih.gov/health/sleep-apnea/causes. Accessed 24 Mar. 2025.
2. “Elevated Blood Pressure.” Mayo Clinic, Mayo Foundation for Medical Education and Research, www.mayoclinic.org/diseases-conditions/prehypertension/diagnosis-treatment/drc-20376708.  Accessed 20 Mar. 2025.
3. “High Blood Pressure: What You Need to Know.” Cleveland Clinic, 19 Mar. 2025, my.clevelandclinic.org/health/diseases/4314-hypertension-high-blood-pressure.
4. “High Blood Pressure (Hypertension).” Mayo Clinic, Mayo Foundation for Medical Education and Research, www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410.  Accessed 14 Mar. 2025.
5. “High Blood Pressure Treatment: Hypertension Medication.” National Jewish Health, www.nationaljewish.org/conditions/hypertension/treatment. Accessed 20 Mar. 2025.
6. “Hypertension.” World Health Organization, World Health Organization, www.who.int/news-room/fact-sheets/detail/hypertension#:~:text=Overview,get%20your%20blood%20pressure%20checked.  Accessed 18 Mar. 2025.
7. Schutte, Aletta E, et al. “Hypertension in Low- and Middle-Income Countries.” Circulation Research, U.S. National Library of Medicine, 2 Apr. 2021,pmc.ncbi.nlm.nih.gov/articles/PMC8091106/#:~:text=Social%20determinants%20influence%20the%20distribution,and%20use%20tobacco%20and%20alcohol. Accessed 26 Mar. 2025