Hypertension (high blood pressure)

The signs and symptoms include:

• Headache
• Dyspnea
• Dizziness
• Nosebleeds
• Changes in vision
• Chest pain
• Fatigue
• Swelling in the legs and feet
• Abnormal heart sounds
• Narrowing of the eye blood vessels
• Retinal bleeding
• Changes in reflexes

Hypertension is a silent killer. Most of the time, there are no signs or symptoms. Symptoms may appear in cases of long-standing or severe hypertension.

The cause of hypertension is unknown in the majority of cases. The interplay of genetic, environmental, behavioral, and dietary factors contributes to the development of hypertension. There are two types of high blood pressure:

• Primary (essential) hypertension: For most adults, there is no identifiable cause of high blood pressure. This type tends to develop gradually over many years.
• Secondary hypertension: If high blood pressure is caused by an underlying condition, it is referred to as secondary hypertension. Various conditions and medications can lead to secondary hypertension, including:

• Obstructive sleep apnea
• Kidney disease
• Adrenal gland tumors
• Thyroid problems
• Congenital defects in blood vessels
• Certain medications, such as birth control pills, cold remedies, decongestants, and over-the-counter pain relievers
• Certain illicit drugs, such as cocaine and amphetamines
• Lifestyle factors, including being overweight or obese, smoking, and lack of exercise

The risk factors of hypertension are divided into:

Modifiable Risk Factors

• Current cigarette smoking and secondhand smoking
• Diabetes mellitus
• Dyslipidemia/hypercholesterolemia
• Overweight/obesity
• Physical inactivity/low fitness
• Unhealthy diet
• Excessive use of alcohol

Non-Modifiable Risk Factors

• Chronic Kidney Disease (CKD)
• Family history
• Increased age
• Low socio-economic/educational status
• Globalization and urbanization
• Gender (more prevalent in males)
• Obstructive sleep apnea
• Psychosocial stress

Diagnosis of hypertension is based on blood pressure measurements. According to WHO, the measurements need to be recorded for several days before a diagnosis of hypertension can be made. Two consecutive measurements, taken at least a few minutes apart, are recorded twice daily (morning and evening). A standard way to measure blood pressure is to take the average of more than two measurements in separate visits.

Hypertension is generally treated with medications when the average systolic blood pressure is 140 mmHg or higher, or when the average diastolic blood pressure is 90 mmHg or higher, taken on two or more separate days. Systolic and diastolic blood pressure of less than 120 mmHg and 80 mmHg, respectively, is considered normal.

It is important to note that if a person records high blood pressure on any single occasion, it does not imply that the person is hypertensive. Blood pressure readings should be based on an average of more than two careful readings recorded on multiple occasions.

You will be evaluated through your medical history, physical examination, routine laboratory tests, and certain diagnostic procedures. Your doctor will identify the signs and symptoms that may be due to high blood pressure. The clinical findings may help uncover an underlying health disorder as well.

Laboratory tests are done for cardiovascular disease (CVD) risk factor profiling. The tests to screen for secondary causes of hypertension include:

• Blood glucose test
• Complete blood count
• Lipid profile
• Kidney function test
• Serum sodium, potassium, calcium
• Thyroid-stimulating hormone
• Urinalysis
• Electrocardiogram

Optional testing includes:

• Echocardiogram
• Uric acid
• Urinary albumin to creatinine ratio

Laboratory tests are conducted for screening secondary causes of hypertension when clinical indications and physical examination findings are present. Adults with resistant hypertension are also screened for secondary hypertension. Additional diagnostic tests may include complete blood count, urinalysis, urine culture, BUN, creatinine, electrolyte tests, lipid profile, renal ultrasound, and others.

1. Go easy on yourself. De-stress! Chronic stress is a significant contributor to high blood pressure. Even occasional stress can lead to high blood pressure if you respond by eating unhealthy food, drinking alcohol, or smoking. Managing stress can help you prevent high blood pressure.
   • Give yourself time to get things done.
   • Learn to say no and live within manageable limits.
   • Accept things you can’t change.
   • Know your stress triggers and try to avoid them.
   • Take 15 to 20 minutes a day to sit quietly and breathe deeply.
   • Meditate! Whether it involves chanting, breathing, or visualization, it can be an effective stress-management tool for many people.
2. Cut down your salt intake Restricting salt intake to less than 6g per day can lower blood pressure and benefit heart health. To decrease sodium in your diet, consider these tips:
   • Read food labels carefully and choose low-sodium options.
   • Avoid processed foods, as they often contain high sodium levels.
   • Develop a taste for unsalted or low-salted foods.
   • Resist the urge to sprinkle salt over salads and cooked meals.
3. Eat heart-healthy foods Foods rich in healthy fats, such as monounsaturated and polyunsaturated fats, are beneficial for your heart. Additionally, foods loaded with vitamins and minerals are crucial for maintaining proper blood circulation. Include fiber-rich foods to help lower cholesterol levels. Incorporate nuts, green leafy vegetables, tomatoes, garlic, ginger, and apples into your diet for better heart health.
4. Exercise regularly Physical activity can significantly improve heart health and prevent complications such as hypertension.
   • Engage in 30-45 minutes of brisk walking 3-4 times a week, which could lower blood pressure by 7-8 mm Hg.
   • Choose any physical activity you enjoy, such as walking, running, swimming, or cycling.
5. Lose those extra kilos If you are overweight or obese, losing weight may be sufficient to prevent high blood pressure and other lifestyle-related conditions.
   • Limit your calorie intake to around 1500 Kcal per day, focusing on a diet rich in fruits, vegetables, and low-fat dairy products.
   • Stay hydrated by drinking around 2 liters of fluids throughout the day.
6. Limit your tea/coffee intake Caffeine can cause short-term spikes in blood pressure, even in individuals without hypertension. Limit your caffeine intake to about 2 cups of coffee per day.
7. Stay away from alcohol Consuming more than 2 drinks a day increases the risk of hypertension in both men and women and can reduce the effectiveness of blood pressure medications. Restrict your alcohol intake to special occasions or weekends. Remember, moderation is key.
8. Quit smoking Smoking is associated with a higher risk of hypertension.
   • Each cigarette you smoke raises your blood pressure for several minutes afterward.
   • Quitting smoking helps your blood pressure return to normal.
   • People who quit smoking, regardless of age, tend to have a higher life expectancy.

The main aim of treatment of hypertension is to keep blood pressure within the normal range to lower the risk of future complications. Many drugs, such as diuretics, calcium channel blockers (CCBs), angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), beta blockers, and vasodilators, are currently available for reducing blood pressure. More than two-thirds of hypertensive individuals are prescribed two or more antihypertensive drugs selected from different classes to treat their hypertension.

Drug Classes

• Diuretics
• Calcium channel blockers (CCB)
• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor blockers (ARBs)
• Alpha and Beta blockers
• Vasodilators

The first drugs that may be prescribed to treat hypertension (first-line treatment) include thiazide diuretics, CCBs, and ACEI/ARBs. If you have stage 2 hypertension but do not possess any high-risk situation, you may be prescribed two antihypertensive drugs from different classes instead of any specific drug.

1. Diuretics

Diuretics like hydrochlorothiazide eliminate excess salt and water from the body and also decrease calcium excretion. There are different types of diuretics that act at different sites of the renal tubules in the nephrons. A few types of diuretics used in the treatment of hypertension are:

• Thiazides: hydrochlorothiazide, chlorthalidone
• Loop diuretics: furosemide, torsemide
• Potassium-sparing diuretics: triamterene, amiloride

2. Calcium Channel Blockers

Calcium channel blockers bind to calcium channels in the blood vessels and block the entry of calcium. This causes dilation of the blood vessels, helping to decrease blood pressure. Calcium channel blockers are of two types:

• Dihydropyridines: amlodipine, nifedipine
• Nondihydropyridines: verapamil, diltiazem

3. Angiotensin-Converting Enzyme (ACE) Inhibitors

ACE inhibitors inhibit the angiotensin-converting enzyme, which regulates salt and water retention in the body. They also lower blood pressure by relaxing blood vessels, decreasing blood volume, and increasing sodium excretion in the urine. Examples of ACE inhibitors include:

• Fosinopril
• Captopril
• Enalapril
• Ramipril
• Lisinopril

4. Angiotensin Receptor Blockers (ARBs)

If you are unable to tolerate ACE inhibitors, ARBs are used. They block angiotensin II from binding to its receptor and antagonize its action, helping to reduce blood pressure. Examples of ARBs include:

• Telmisartan
• Losartan
• Valsartan
• Irbesartan

5. Beta-Blockers

If you are suffering from serious heart conditions such as heart failure or myocardial infarction, beta-blockers are prescribed alternatives. Some drugs in this class include:

• Atenolol
• Metoprolol
• Propranolol
• Labetalol

6. Vasodilators

Vasodilators help lower blood pressure by relaxing blood vessel walls and decreasing their resistance. Examples include:

• Hydralazine
• Minoxidil

7. Aldosterone Antagonists

Aldosterone antagonists are also considered diuretics. Examples are spironolactone and eplerenone (Inspra). These drugs block the effect of a natural chemical that can lead to salt and fluid buildup, contributing to high blood pressure. They may be used to treat resistant hypertension.

8. Alpha Blockers

Alpha blockers reduce nerve signals to blood vessels, lowering the effects of natural chemicals that narrow blood vessels. Examples include:

• Doxazosin
• Prazosin

Tips for Taking Blood Pressure Medications

• Always take blood pressure medications as prescribed.
• Never skip a dose or abruptly stop taking your blood pressure medication. Suddenly stopping certain drugs, such as beta blockers, can cause a sharp increase in blood pressure (rebound hypertension).
• If you skip doses due to affordability, side effects, or forgetfulness, talk to your doctor about solutions.
• Do not change your treatment without your doctor's guidance.

Adopting a healthy lifestyle and making small but conscious dietary changes can go a long way in controlling blood pressure. In some cases, it can even help to reduce the dose and number of medications. Here are some easy ways to keep blood pressure in check:

• Exercise regularly
• Cut down on salt intake
• Limit your calorie consumption
• Restrict your intake of caffeine
• Manage stress
• Quit smoking and cut down on alcohol

Tips to Measure BP at Home

If you are diagnosed with high blood pressure, then you need BP monitoring as advised by your doctor. However, even if you are not diagnosed with hypertension, you should check your BP at least once a month. This is because most of the time, high blood pressure has no symptoms. Due to unhealthy eating habits and a stressful lifestyle, you are at risk of high blood pressure. Additionally, if you have a family history, you should check your BP regularly.

There are two types of kits to measure BP: the digital and the manual BP monitor.

1. When Using a Digital Monitor
   • Secure your arm (any arm) in the cuff from your elbow upwards.
   • Switch the monitor on.
   • Inflate the cuff by pressing the bulb with whichever hand is free. For monitors with automatic inflators, just sit back and relax.
   • Your cuff will start deflating. Listen for the long beep sounds. The first one will signify the systolic pressure, and the second one will signify the diastolic pressure.
   • After your monitor has registered both readings, it will display them on the screen.
   • Let the cuff deflate completely and unwrap your arm.
2. When Using a Manual Monitor
   • Secure your arm (any arm) in the cuff from your elbow upwards.
   • You will need a stethoscope. Insert the head under the lower end of the cuff just above the elbow pit so that it rests on the radial artery.
   • Tighten the screw on the airflow valve.
   • Inflate the cuff by pressing the bulb with whichever hand is free.
   • Once the meter shows 180 mm Hg, slightly loosen the screw of the airflow valve and let the air escape slowly.
   • Listen for beats in the stethoscope while keeping your eyes on the meter. Record the meter readings when you start hearing them (systolic BP) and then again once you stop hearing them completely (diastolic BP).

Long-standing hypertension can cause harmful consequences. The thickening of the walls of the blood vessels leads to reduced blood flow to different organs of the body. Hypertension can increase the risk of developing:

• Coronary artery disease
• Heart failure
• Stroke
• Aortic aneurysm (bleeding from large blood vessels)
• Nephropathy (kidney damage)
• Retinopathy (vision loss)

Many people with hypertension also have other health risk factors such as smoking, obesity, high cholesterol, and diabetes, which increase their odds of complications.

1. Coronary Artery Disease

The damaged blood vessels of the heart can reduce the efficiency of the heart and increase its workload. This can cause angina (chest pain) and left ventricular hypertrophy (thickening of the heart muscle wall), eventually leading to heart failure.

2. Stroke

Uncontrolled hypertension damages and weakens the small vessels in the brain, causing them to rupture and leak. It can also lead to the formation of blood clots in the vessels, blocking blood flow and potentially causing a stroke.

3. Dementia

Hypertension in midlife is a major risk factor for dementia. Chronically elevated blood pressure causes thickening of the blood vessel wall, narrowing the tiny blood vessels. Plaque accumulation also leads to the narrowing of the larger arteries of the brain. These plaques may rupture, completely blocking blood passage and resulting in the death of tissue in areas of the brain responsible for memory and executive function.

4. Aortic Aneurysm/Dissection

Hypertension weakens the wall of the blood vessels and may cause it to bulge over time. This forms an aneurysm (a pouch-like structure) in the blood vessel wall, which can be fatal when ruptured.

5. Hypertensive Nephropathy/CKD

Damaged small vessels in the kidney reduce its blood supply, leading to reduced kidney function and eventually kidney failure.

6. Hypertensive Retinopathy

The retina, choroid, and optic nerve of the eye are affected. Blood vessels in the retina are narrowed, impairing vision and leading to retinopathy and eventually blindness.

These complications can be prevented by controlling blood pressure and known risk factors. Reduction of blood pressure to <130/80 mmHg has been shown to reduce heart complications by 25%.

According to Ayurveda, hypertension can be attributed to two types of causes:

• Diet-related Causes (Aharaj-nidana): These include excessive salt intake (atilavana), alcohol consumption (atimadyapana), and meat consumption (mansa-sewan).
• Lifestyle-related Causes (Viharaj-nidana): These causes chiefly include staying awake at night (ratrijagarana), sleeping during the day (divasvapna), holding on to natural urges like urination (vegavidharana), sedentary lifestyle (avyayama), overexertion (ativyayam), and stress and anxiety (manashetu).

Ayurveda Herbs: Individual drugs such as Gokshura, Guggulu, Gomutra (cow urine), Arjuna, Punarnava, Ashwagandha, and Triphala can be used for the treatment of hypertension.

Garlic powder in a dosage of 600-900 mg per day is a useful remedy for high blood pressure.

Arjuna bark powder, when taken in a dosage of 4 gm twice daily, causes significant improvement in hypertension.

Two tablets of Sarpagandha vati (250 mg) taken twice daily have shown good results in reducing blood pressure.

Having Ashwagandha powder (2 gm) with milk also helps to reduce blood pressure.

Here are more Ayurvedic herbs that are effective in regulating blood pressure and managing your condition at home.

Panchakarma: The procedure of full body massage (Sarvanga Abhyanga) with medicated oils, followed by induced vomiting and purgative therapy (Vaman and Virechan) or medicated enema (basti), may be administered depending upon the vitiated dosha and the condition of the patient.

Yoga: Meditation and other relaxing techniques can help reduce stress. If practiced regularly and appropriately, you can also benefit from:

• Pranayama
• Shavasana
• Vajrasana
• Makarasana
• Dhanurasana
• Sukhasana

Hypertension is a lifelong disease that requires ongoing management. To effectively manage your condition, you will need to make necessary dietary and lifestyle changes. Key strategies include:

• Eating healthy
• Exercising regularly
• Reducing weight
• Limiting alcohol intake
• Quitting smoking

While lifestyle changes and medication may help you feel fine, it is essential to prevent health complications that may arise from hypertension. Additionally, managing your condition can take a toll on you both physically and emotionally.

1. Invest in a digital blood pressure monitor and use it regularly to check your blood pressure at home. Consult tips on how to choose a blood pressure monitor. Additionally, have your blood pressure tested at a hospital by an expert or qualified professional at least once a year or during your regular health check-ups.
2. Seek immediate medical attention if your blood pressure exceeds 180/120 mm Hg, as this indicates a hypertensive crisis. Also, consult your doctor if you experience symptoms of low blood pressure such as fainting, headaches, dizziness, or fatigue.
3. Consume a healthy diet low in sodium and fats to help control your blood pressure, along with regular medication and timely health check-ups. Incorporate plenty of fresh fruits and vegetables into your diet while avoiding sweetened beverages and processed foods.
4. Engage in physical activity for 30 to 45 minutes at least five times a week, which may include brisk walking and strenuous workouts. For older individuals, it is recommended to perform physical activities at least twice a week. This not only improves blood circulation but also helps control blood pressure and lowers the risk of heart disease.
5. Limit alcohol intake, as excessive drinking can increase the risk of hypertension. Quitting smoking also reduces the overall risk of cardiovascular diseases, which are complications associated with high blood pressure.
6. If stress contributes to your high blood pressure, consider stress management as an effective intervention. Techniques that can help calm your mind and body include engaging in hobbies, playing sports, joining swim or dance classes, or practicing yoga and meditation.
7. Joining support groups for hypertension can assist you in managing your condition. These groups can increase your awareness of your condition and its associated complications. You may find one, either in person or online, where you can share your story and gain support in managing hypertension.