Hypertension (HTN), commonly known as high blood pressure, is one of the most prevalent chronic conditions worldwide. Often called the “silent killer”, hypertension may remain asymptomatic for years while silently damaging vital organs such as the heart, brain, kidneys, and eyes.
When left uncontrolled, hypertension leads to severe complications including heart failure, stroke, kidney failure, and visual impairment. Understanding its causes, risk factors, stages, and treatments is critical for prevention and long-term health management.
What is Hypertension?
Blood pressure (BP) is the force of blood against the walls of arteries. It has two components:
Systolic BP (“squeeze”): Pressure when the heart contracts.Categories of Blood Pressure
| Category | Systolic (mmHg) | Diastolic (mmHg) |
|---|---|---|
| Normal | <120 | <80 |
| Pre-HTN | 120–139 | 80–89 |
| Stage 1 HTN | 140–159 | 90–99 |
| Stage 2 HTN | ≥160 | ≥100 |
| HTN Crisis | ≥180 | ≥120 |
Key Point: Hypertension is diagnosed after repeated elevated readings, not just a single high measurement.
Types of Hypertension
1. Primary Hypertension (Essential / Idiopathic)
- Most common form.
- No identifiable direct cause.
- Influenced by genetics, lifestyle, and environmental factors.
- Can only be controlled, not cured.
2. Secondary Hypertension
Caused by an underlying medical condition or drug use.- Chronic kidney disease
- Diabetes
- Hyperthyroidism or hypothyroidism
- Cushing’s syndrome
- Pregnancy
- Oral contraceptives and other medications
Risk Factors for Hypertension
The mnemonic “FACTORS RISK” can help recall risk contributors:
- F: Family history
- A: Advanced age
- C: High cholesterol
- T: Too much caffeine
- O: Obesity
- R: Restricted activity
- S: Sleep apnea
- R: Race (African Americans at higher risk)
- I: Intake of sodium (Na) / alcohol (ETOH)
- S: Smoking
- K: Low potassium & vitamin D levels
Signs and Symptoms
Hypertension is often asymptomatic, making it the “silent killer.” When present, symptoms may include:
- Blurred vision
- Headache
- Chest pain
- Nosebleeds
- Shortness of breath
Complications (if untreated):
- Heart: Congestive Heart Failure (CHF) – due to overworked ventricles
- Brain: Stroke – rupture of weak vessels
- Kidneys: Renal failure – damage from high pressure
- Eyes: Visual changes – retinal vessel damage
Taking a Proper Blood Pressure
Accurate BP measurement is essential.
Locate the brachial artery.Patient should:
- Sit in a chair with feet flat, legs uncrossed.
- Keep arm at heart level.
- Rest for at least 5 minutes before measurement.
Avoid:
- Smoking, caffeine, exercise, or alcohol 30 minutes before reading.
Use a correct-sized cuff:
- Too small → false high BP.
- Too large → false low BP.
Avoid BP readings in arms with:
- Mastectomy
- AV shunt
- Blood clots
- Current IV line
Education and Lifestyle Modifications
Patient education is crucial for long-term blood pressure control.
- Limit sodium and alcohol intake.
- Quit smoking.
- Maintain a healthy weight.
- Engage in regular physical activity.
- Follow a balanced diet (DASH diet recommended).
- Manage stress.
- Keep a home BP log for self-monitoring.
Antihypertensive Medications
The mnemonic “ABCDD” covers the main drug classes:
| Class | Examples / Suffix | Mechanism |
|---|---|---|
| A – ACE inhibitors | -pril (e.g., Lisinopril) | Prevent angiotensin II formation → vasodilation |
| B – Beta blockers | -olol (e.g., Metoprolol) | Reduce HR and cardiac output |
| C – Calcium channel blockers | -pine, -amil (e.g., Amlodipine, Verapamil) | Relax blood vessels |
| D – Digoxin | (rare, used in heart failure) | Strengthens contractions, slows HR |
| D – Diuretics | (e.g., Hydrochlorothiazide, Furosemide) | Reduce fluid volume, lowering BP |
Combination therapy is often needed for optimal BP control.
Comparative Table: Primary vs Secondary Hypertension
| Feature | Primary HTN | Secondary HTN |
|---|---|---|
| Cause | Unknown | Identifiable (e.g., CKD, endocrine disorders) |
| Prevalence | ~90–95% of cases | ~5–10% of cases |
| Treatment | Lifelong management | Treat underlying cause + medications |
| Control | Achieved with lifestyle + drugs | May be curable if cause is removed |
Conclusion
Hypertension (HTN) is a global health problem and a leading cause of heart disease, stroke, kidney failure, and blindness. Its silent nature underscores the importance of screening, early detection, and continuous management.
Key message: Measure blood pressure regularly, adopt a healthy lifestyle, and adhere to prescribed medications.FAQs on Hypertension
Q1: Why is hypertension called the “silent killer”?
Because it often has no symptoms until severe complications develop, such as stroke or heart failure.
Q2: Can hypertension be cured?
Primary hypertension cannot be cured, only controlled. Secondary hypertension may be reversible if the underlying cause is treated.
Q3: What is the best diet for high blood pressure?
The DASH diet (Dietary Approaches to Stop Hypertension) – low in sodium, rich in fruits, vegetables, and whole grains.
Q4: At what BP level is it considered an emergency?
A hypertensive crisis is defined as ≥180/120 mmHg, requiring immediate medical attention.
Q5: How often should blood pressure be checked?
At least once every 1–2 years for healthy adults; more frequently if risk factors or elevated readings are present.
