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What is Hypertension?
Hypertension Aka high blood pressure is a common, long-term health condition which occurs when the force of your blood pushing against your arteries is elevated persistently. As of 2020, more than one billion adults or ~22% of people worldwide have hypertension. Blood pressure is determined by the amount of blood pumped by your heart as well as the resistance to the blood flow in the walls of your arteries. And when your heart pumps a lot of blood and if your arteries are narrow, the blood pressure tends to be on the higher side.
How do you know if you have hypertension?
You can have hypertension for years together without experiencing any symptoms. However, the damage that it does to your heart and blood vessels would continue to take place and that's when your hypertension would be detected. If left uncontrolled, high blood pressure can lead to health risks including heart attack and stroke. Hypertension generally develops over time and it affects almost everyone eventually. But needless to worry, hypertension can easily be detected and once you get aware of it, you can find ways to control it.
Although most of you with hypertension might not experience any signs or symptoms even if it is dangerously high, a few others might experience the following symptoms:
- Headache
- Shortness of breath
- nosebleeds
However, these aren't specific and doesn't usually happen until your blood pressure is so severe or life-threatening.
How can Hypertension be diagnosed?
Since the condition usually presents with no specific symptoms, you need to get your blood pressure checked on a regular basis.
You have hypertension if you have the following blood pressure readings:
- 140 or higher Systolic pressure
- 90 or higher diastolic pressure
And blood pressure readings above 180/120 are dangerously high and needs immediate medical attention.
What causes Hypertension?
To understand the causes of hypertension, you need to be aware of the types of it. There are two types- the Primary and the secondary. While the primary type is one with no identifiable cause and develops over time, the secondary kind is due to an underlying health condition like thyroid problems, kidney conditions, obstructive sleep apnea, birth defects or due to side effects from certain medication.
What are the risk factors of Hypertension?
Old age, family history, belonging to certain race (African heritage), unhealthy weight, physical inactivity, stress, Indulging in tobacco and/or alcohol, high sodium intake, and low potassium intake are the risk factors of high blood pressure.
What complications can Hypertension lead to?
High blood pressure can lead to the following health issues:
- Heart attack
- Stroke
- Aneurysm
- Heart Failure
- impaired kidney functioning
- Metabolic syndrome
- Vision loss
- The trouble with memory & understanding
- Dementia
Can Hypertension be Managed?
Lifestyle changes and medications can help manage hypertension and lower the chances of health complications.
What lifestyle modifications are effective?
- Eat a well, balanced healthy diet
- Lose weight and maintain a healthy weight
- Indulge in physical activity regularly
- reduce your intake of salt
- Cut down or reduce alcohol and smoking
- Manage stress through exercise, music, and meditation
Though you can prevent or reduce your chances of getting hypertension by making the above-mentioned lifestyle changes, when you already have high blood pressure, you require medical care and prescribed treatment.
Here's a list of medicines that can help you manage hypertension effectively:
- Thiazide diuretics like chlorthalidone, hydrochlorothiazide are drugs that act on your kidney to help eliminate sodium and water, thereby reducing blood volume.
- Angiotensin-converting enzyme (ACE) inhibitors like lisinopril (Zestril), benazepril (Lotensin), and captopril (Capoten) act by relaxing your blood vessels and block the chemical that causes narrowing of it.
- Angiotensin II receptor blockers like candesartan (Atacand) and Losartan (Cozaar) help your blood vessels to relax and prevent from narrowing.
- Calcium channel blockers such as amlodipine (Norvasc), diltiazem (Tiazac/Cardiazem) which helps relax your blood vessels and slow your heart rate.
- Alpha blockers like doxazosin and prazosin reduce your nerve impulses to your blood vessels and reduce the effects of chemicals that cause narrowing of it.
- Alpha-beta blockers like carvedilol and labetalol work by lowering your nerve impulses to your blood vessels and thereby slowing down your heartbeat to lower the amount of blood pumped through the vessels.
- Beta blockers such as acebutolol and atenolol reduce the workload on your heart and open up the blood vessels and making it beat slower and with lesser force.
- Aldosterone antagonists like spironolactone and eplerenone act by blocking the chemical responsible for fluid & salt retention that can cause high blood pressure.
- Renin inhibitors like Aliskiren act by reducing renin (the enzyme responsible for the increase in blood pressure) production.
- Vasodilators such as hydralazine and minoxidil work directly on your arteries and help prevent them from tightening or narrowing.
- Central-acting agents such as clonidine, methyldopa, and guanfacine prevent your brain from signaling your nervous system to up your heart rate and narrowing of your blood vessels.
- Alternative medicine: Even though supplements such as fiber, magnesium, calcium, potassium, folic acids, cocoa, coenzyme Q10, garlic, L-arginine, Omega-3 fatty acids, vitamin D, etc may help lower blood pressure, further research is needed to determine the potential benefits.
Currently, hypertension is treated predominantly using medications such as thiazide diuretics, Beta blockers, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and calcium-channel blockers (CCBs).
Upcoming trends in Hypertension Management
There is an emerging trend to empower hypertension patients to support hypertension screening and diagnosis via tele-monitoring and co-interventions. Novel technology includes smartphones and Bluetooth®-enabled telemonitoring devices that are evolving as key players in the management of high blood pressure and offer particular promise within pregnancy and developing countries. The most pressing need is for these new technologies to be properly assessed and clinically validated prior to widespread implementation in the general population.
Self-monitoring of Blood pressure:
Self-monitoring of BP can improve the management of hypertension and is well tolerated by patients. There are BP monitoring apps that can communicate between smartphones and your BP monitoring device and allow you to control the BP measurement procedure from the app and also lets you download automatically the older BP readings as well. Self-monitoring can also be combined with self-titration of medication, a process known as self-management.
Telemonitoring of Blood Pressure:
The treatment for high blood pressure based on the measurement of office BP once every few months is going to be a thing of the past. Home BP monitoring can be a cost-effective method that can assess for white coat hypertension, masked hypertension, and 24-hour BP control while increasing patient awareness and treatment adherence. Home Blood pressure telemonitoring combined with self-adjustment based on prespecified treatment algorithms has been shown to improve BP control. Currently, when considering the evidence and the cost-effectiveness, co-interventions, including teletransmission or health care professional co-management, should be limited to selected cases. However, technological advances are allowing for accurate measurement and telemonitoring of day-to-day home BP monitoring. Also, active intervention of medical personnel through the use of BP telemonitoring is helpful for improving drug compliance and achieving target BP. Although nothing can replace the tried and tested the doctor-patient relationship in the office, telemonitoring of home BP will be an important tool for treating hypertension in the future.
Artificial Intelligence in Hypertension Management:
By underpinning interfaces like Siri and Alexa which can update medication lists and set reminders wirelessly, the use of artificial intelligence can improve the management of hypertension. Incorporation of telemonitored data on blood pressure into digital healthcare programmes can now also allow combination with other physiological variables including blood glucose, heart rate and exercise allowing adaptation of management recommendations based on pre-determined variables including user demographics, indicated morbidities and comorbidities, self-identified barriers and actions recorded over the course of a program or set by a physician. Examples of this include the ‘WellDoc Hypertension and diabetes management platform’ and ‘Omada Health’s digital program’.
Sources: https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410 https://medlineplus.gov/bloodpressuremedicines.html https://en.wikipedia.org/wiki/Hypertension#Medications https://www.cdc.gov/bloodpressure/index.htm https://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/ https://www.ncbi.nlm.nih.gov/pubmed/28531239 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5052691/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483962/
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