Understanding High Blood Pressure and Hypertension

by Dr. William Gruss | 01/14/2021 5:15 PM
Understanding High Blood Pressure and Hypertension

Hypertension or high blood pressure is humanity’s real “Silent Killer.” Most people do not know that they have hypertension until it is usually diagnosed by chance when a person goes for a routine check-up or visits a doctor for some other health disorder.

The main reason for this ominous title is that there are no apparent signs or symptoms of the body condition. It can progress to an advanced stage before it is discovered, often with serious consequences.


It is important to understand at first what blood pressure is in reality. Blood pressure is the force that the blood exerts on the blood vessels’ walls (arteries) after being pumped by the heart. The increased blood pressure means that there is excess pressure or strain on the artery walls, which might lead to kidney damage, stroke, or even heart attack. We can measure blood pressure in millimeters of mercury (mm Hg) by using a medical instrument known as a sphygmomanometer, which is available in the form of a traditional manual device with a mercury column one with modern digital technology.

Typically, there are two numerical figures of blood pressure, i.e., the systolic pressure and the diastolic pressure. The systolic pressure indicates the higher or the upper number, which shows the arterial walls’ blood pressure when it leaves the heart. The diastolic pressure is the lower number and indicates blood pressure when the heart rests in between two beats. A healthy blood pressure level is usually around 120/80 mm Hg. The reading of blood pressure above the level of 140/90 mm Hg indicates high blood pressure.

The sphygmomanometer consists of an inflatable cuff that wraps around the upper arm. You can inflate the cuff with air to tighten the blood vessels. The dial on the device indicates the reading of pressure (when it goes up and down). Once the cuff pressure is higher than the pressure in the artery, then the blood flow in the upper arm’s main artery starts cutting off, thus indicating the absence of a pulse in the wrist. The person measuring the blood pressure releases the air using the dial’s valve. As the pressure starts dropping in the cuff, the blood rushes through the artery, and you can clearly hear the sound of blood rushing using a stethoscope.

The calibrated mercury column or the dial on the manual device shows the pressure of blood in the arteries when you hear the sound of blood rushing as we slowly release the air in the cuff. This is the reading of systolic pressure. The lower reading is judged by the person when the gushing sound stops, indicating that the blood flow is again streamlined. The digital automatic blood pressure monitor can skip the whole manual wrapping process and inflate the cuff, giving direct blood pressure readings in the form of digits. However, the readings of the digital device are not always accurate.

Having a family history of higher blood pressure must keep in check the blood pressure readings every month. More recurring checkups are a requirement for those with a family history of heart attack or stroke secondary to hypertension.

Hypertension Risk Factors

Hypertension more commonly runs in families of South Asian or Afro-Caribbean origins. This body condition is more common in older adults and in people who suffer from obesity or overweight issues. Moreover, the people who eat a diet higher in salt content, drink alcohol/smoke, lead a sedentary lifestyle, consume sugar-laden beverages, and have high blood cholesterol levels are more prone to developing hypertension.

The factors mentioned above can also significantly increase the chance of developing cardiovascular disease and strain the heart by pushing it to pump much harder. The heart muscle that now conditions to work extra hard due to higher blood pressure is more likely to frustrate - especially if the arteries supplying the heart muscles with the blood suffer from damage due to atherosclerosis.

Hypertension or high blood pressure can also be an issue for some females when pregnant. This is usually the start of the hypertension condition (called gestational hypertension) in women. There are numerous types of pregnancy-related hypertension and all of these types can affect the kidneys of the mother and other organs. Gestational hypertension can result in early delivery, premature birth and low birth weight.

Preeclampsia is a serious health condition of pregnancy and usually relates to increased blood pressure and increased protein in the mother’s urine due to abnormal kidney function. It affects the placenta and may damage the mother’s liver, brain and kidney. As preeclampsia progresses, the patient may develop seizures and another deadliest complication, known as the condition eclampsia. Eclampsia is a leading cause of fetal complications and maternal deaths worldwide. The fetal complication includes premature birth, stillbirth and low birth weight. Most women who develop preeclampsia signs need close monitoring to lessen or avoid health-related problems.

Hypertension Symptoms and Effects

High blood pressure or hypertension is known as the “Silent Killer” because there are very few or no symptoms during the disease’s initial stages in most patients. Some symptoms might appear when there is organ damage or the pressure reaches a very high level of almost 180/110 mm of Hg or higher.

Some of the symptoms of high blood pressure or hypertension include:

  • Flushing and feeling hot
  • Dizziness
  • Pain in the back of the neck
  • Drowsiness
  • Irregular heartbeat
  • Nausea and sometimes vomiting
  • Shortness of breath

Long term high blood pressure might also lead to blurred or double vision and eye damage. Some people with high blood pressure might experience headaches, but headaches often do not occur unless the pressure increases significantly. Severe hypertension might cause sudden and severe nosebleeds

Effects of high blood pressure or hypertension

Chronic hypertension eventually damages and strains the blood vessels due to the excess strain against them. The long term condition might lead to several health complications - the most well-known is atherosclerosis. Atherosclerosis is a body condition described as a buildup of fatty plaques or deposits in the arteries’ walls. As the fatty deposits in the walls thicken with time, they start calcifying and become brittle with a narrow lumen. The development of a narrow lumen restricts the blood flow in the arteries.

Alt : (Atherosclerosis illustration)

Atherosclerosis is mainly responsible for a host of cardiovascular diseases - such as heart attacks, pulmonary embolism, kidney failure, and stroke. The development of a blood clot at the plaque site might permanently block the artery. The complete blockage of arteries might lead to ischemia or a lack of blood supply to the heart muscles, a common cause of heart attack.

Hypertension Treatment

High blood pressure or hypertension rarely gets the diagnosis early on in the course of the disease because the condition at an early stage is usually free of symptoms. However, for this reason, hypertension is known as the silent killer. The symptoms typically occur when the condition progresses. It is usually because the blood pressure reaches a higher level and starts damaging the organs, such as the eyes or kidneys. In several cases, high blood pressure is detected and diagnosed by chance on a routine visit to the doctor or other healthcare professional for unlinked reasons.

Treatment of hypertension

Let’s start with lifestyle changes that can help reduce the likelihood of hypertension by modifying routine life. Lifestyle modifications and changes can also reduce the complications of hypertension. Some of the lifestyle changes include:

  • Reduction of alcohol intake
  • Cessation of smoking
  • Reduce the consumption of caffeine in your diet.
  • Employ stress relief techniques such as meditation in practice.
  • Perform physical exercise regularly with at least 30 minutes of some aerobic exercise such as jogging, brisk walking, cycling or swimming every day.
  • Weight reduction

Diet is a big issue!

Diet must contain lesser saturated fats and trans-fats. Include more of the polyunsaturated fats and foods containing omega-three fatty acids in your diet, such as nuts, seeds and oily fish. The inclusion of omega-three fatty acids is beneficial to cardiovascular health.

The diet must also include higher amounts of whole grains and fiber. One of the most important dietary habits to prevent hypertension complications includes reducing salt intake (avoiding salty foods such as processed, cured and tinned meats or foods that contain salt as a preservative).

Eating a balanced and healthy diet with at least five portions of fresh vegetables and fruits each day produces excellent assistance. 


There is an extensive range of medications that help lower blood pressure. While a few of these medications are diuretics, which increase urine output and decrease blood volume, other medications relax the blood vessels’ smooth muscles and heart muscles, allowing the blood to pass smoothly through the blood vessels.

Most hypertensive patients begin treatment by taking a single medication for a few weeks and if the blood pressure is not getting under control, the dose might be increased. The drug with a different action mechanism might be later added to the treatment regimen to control the hypertension symptoms.

Some patients might stop taking medications for hypertension after a few months - if the blood pressure comes under control. However, in most cases, the medications continue for life to manage hypertension symptoms.

Hypertension is a significant health risk that can be controlled.

Margaret Kinninmont was not in a good mood when she arrived at work one morning in December 2013 because the graffiti painting was on the garages near her home in Glasgow City, Scotland. According to the 58-year-old executive secretary, “I was in a right temper.” Her boss, Professor Rhian Touyz, director of the institute of cardiovascular and medical sciences, university of Glasgow, took a look at Margaret, red in the face as she states the ugly art scenario. The boss said, “Let’s take the reading of your blood pressure.”

Touyz is a world-renowned hypertension expert and the existing president of the international society of hypertension (ISH). One of the key parts of her job is to educate the public about the serious consequences of uncontrolled hypertension condition. She states that “high blood pressure is the major risk factor for a number of diseases and deaths in the world.” “Hypertension causes kidney failure, strokes, heart disease and the evidence also reveals that it now causes vascular dementia.”

Moreover, according to rough estimates, one in every three people over 18 in Europe suffer from high blood pressure; the readings are higher than 140/90 mm Hg. Most of the people do not know that they have hypertension, and of those who know, around 50 percent do not control it. Professor Robert Fagard, a hypertension expert from Leuven, Belgium, states that “Hypertension is a silent killer.” The first time that many people get to know about the hypertension condition, it becomes debilitating or even fatal for their cardiovascular health.  For this reason, it is essential that people regularly monitor their blood pressure and that they work with their doctors or healthcare professionals to treat the condition of hypertension.

Until that day of December, Margaret Kinninmont never knowingly suffered from hypertension herself. However, her blood pressure readings were dangerously higher: 180/100 mm Hg. Margaret tried to breathe deeply and relax. The blood pressure reading was retaken and it was still much higher. A little while later, a third reading indicated higher blood pressure. The higher readings were the beginning of a year-long journey to bring the blood pressure back to the normal range. The treatment incorporated a prescription for medication and frequent readings for over a month ahead. Margaret bought a blood pressure monitor for home and started monitoring her blood pressure by herself. The first medication results in the swelling of her ankles, so she changed to another medication. The doctor adjusted the dosage and the time of the day to take the medication to keep her blood pressure under 120 mm Hg with no visible side effects.

Moreover, she focused on eating more vegetables and fruits and became more physically active. More than a year later, Margaret has shed more than 12 kilograms (26 pounds), her blood pressure readings are back in the healthy range of 115/79 mm Hg. Margaret no longer feels breathless while climbing the stairs with her young granddaughter. She says, “I feel better than I have in years.”

Margaret’s story indicates that every individual diagnosed with hypertension of blood pressure must deal positively with the condition, notes Professor Touyz. Not only she received the right treatment, but she does a fantastic job of taking control of her health. Better patient engagement and education when it comes to keeping in check hypertension is a huge need, particularly in Europe. Several research studies state that Europeans have poorer blood pressure control than patients in North America. Professor Thomas Kahan, chief of cardiology at Danderyd university hospital, Stockholm, says that 35 percent of patients initially starting the hypertension medications discontinue them within two years. And many patients who suffer from treatment-resistant hypertension are not taking their medications at all.

Hypertension experts in Europe are very vigilant. In recent years the European society of hypertension, the European Society of Cardiology (ISH) and the UK National Institute for Health and Care Excellence came up with highly detailed guidelines to improve the diagnosis, long-term control, and treatment of hypertension. Professor Fagard says that “Physicians must convince patients about the benefits of good blood pressure control for the long run.” Here are ten facts that you must know about hypertension:

How does hypertension cause damage and health complications?

Like a garden hose that is under a lot of strain can develop bulges and eventually blow out, blood flowing through the blood vessels having higher blood pressure can weaken them. The weakened blood vessels develop ruptures and bulges and damage the delicate organs that receive the flow. For this reason, hypertension has a link to strokes, eye, heart attacks, aneurysms and kidney damage.

Alt : (Heart Attack Illustration)

What causes high blood pressure?

In almost 95 percent of cases, there is no direct cause known as essential hypertension. However, lack of exercise, obesity, family history, stress, high salt consumption, and high alcohol consumption are all risk factors. Moreover, with the increasing age, there is a slight increase in blood pressure due to decreased blood vessels’ elasticity, making them thinner and stiffer.

In almost five percent of hypertension cases, high blood pressure results from another illness or secondary to some medication - known as secondary hypertension. Adrenal gland problems, thyroid diseases and polycystic kidneys are also known to cause hypertension. Medications like cold and migraine medications, oral contraceptives and non-steroidal anti-inflammatory drugs for pain relief can also result in causing high blood pressure.

How to measure hypertension?

A device known as a sphygmomanometer with the arm supported cuff helps measure blood pressure. The doctor pumps the cuff up for the manual device until the blood flow in the arm stops. The doctor watches the dial and then releases the cuff pressure until he hears the blood pressure sound through the stethoscope. The “Kototkoff sounds” represents the top number, i.e., systolic pressure. The blood’s re-flowing in the arterial system gives the lower reading or diastolic pressure.

What do the two numbers mean?

Systolic pressure is the pressure that the blood exerts on blood vessel walls when the heart beats and pumps out the blood. The diastolic pressure indicates the pressure which blood exerts on blood vessels between the two heartbeats, i.e., when the heart relaxes. The optimal blood pressure is 120/80 mm Hg or under this level.

How often should we test blood pressure?

The guidelines recommend at least once every two years. In most cases, patients got their hypertension detected when they see a doctor for something else. General check-ups are very important and the doctors also believe that accurate public monitors must be more available in Europe as they are in North America.

How many readings should one take?

According to the guidelines, the doctors recommend that the patients sit peacefully for the first reading and then take two or one more readings by one or two minutes apart. Then, try to take the average out of these measurements, especially if the readings are higher. About 20 percent of people have abnormally high readings when the doctor takes the blood pressure reading, known as white coat hypertension. At the same time, about 10 percent have normal readings at the doctor’s office but are actually hypertensive at home, known as masked hypertension.

What else should be done if the readings are higher?

Any hypertension readings might trigger a careful history of medical and tests to detect further other risk factors, such as urine or blood tests for diabetes, gout, cardiovascular disease, arthritis, and kidney damage. Also, a watchful medical history of family members is a lot helpful. The higher your risk factors for developing cardiovascular diseases are, the more important it is for you to get frequent checkups for blood pressure.

What lifestyle changes make a difference?

The following important lifestyle modifications can have a huge impact on blood pressure:

  • Lowering down your consumption of alcohol
  • Exercising four or five times a week
  • Cutting out salt consumption (especially in processed foods)
  • Increasing fruit and vegetable intake
  • Maintaining a healthy weight
  • Maintaining adequate hydration by drinking plenty of water
  • Managing stress
  • Smoking cessation

Recent studies recommend that cutting out sugar intake can improve blood pressure even without losing weight. According to Dr. Hanley, “Anything that you can achieve through lifestyle is going to have useful effects on other health conditions too, such as cancer.”

Is it ever too late to make lifestyle changes?

No. Karen Smith, a 59-year-old from Lincolnshire, UK, tried several changes during the past year when retiring from teaching. She joined weight watchers and avoided cakes, bread, pasta, cookies, and excess amounts of sugar. She avoided alcohol during the weekdays. She ate more vegetables, fruits and lean proteins. She became more active physically and started walking daily. She not only lost 16 kilograms but also improved her sleep. Moreover, her mood and energy also increased. And best of all things, her medication dose starts dropping on the lowest dose possible.

Karen states that “My doctor thinks that if I keep up the lifestyle, he might be able to cut off my blood pressure drugs completely.” But it is important to understand unless you imply a major change in your lifestyle, you will need the medication for life.

An expert like Professor Touyz says that “Patients become pathetic to take medication daily for life. And for this reason, it is integral to have regular contact with the doctor and regular motivation by health care professionals.” According to 2012 statistics by the European society of cardiology, stroke is the second leading factor leading to death in Europe, accounting for around 1.1 million deaths annually. Almost one in every seven women (15 percent) and one in every ten men (10 percent) die from hypertension.

If I take medication, will there be any side effects?

A number of medications are now available, which controls the blood pressure with minimal or zero side effects, states Professor Fagard. Some of the hypertension drugs might cause diarrhea or other gastrointestinal tract problems. Medication that controls blood pressure is olmesartan (an angiotensin receptor blocker, or ARB, comes under the trade name of Benicar, Azor or Tribenzor associates with celiac-like modifications to the intestine. Tell the doctor about any side effects that you are suffering from and she or he will work with you to find the best-suited medication. Sometimes it takes a lot of work.

A 42-year-old Finnish kindergarten teacher, Minna Ilonen, having slight hypertension during each of her seven pregnancies, purchased herself a home monitor for blood pressure. In September 2013, she started noticing an increase and went to the doctor and found out that the blood pressure was 170/108, dangerously high. The doctor recommended an ARB, but she started developing an unlinked cluster of blood vessels in her brain. The cluster in her brain started bleeding slowly, making it imperative further treatment was required immediately. After hospitalization, dosage adjustments, and drug switches, she got the blood pressure down to 130/80 mm Hg. Since December 2013, she took beta-blockers and a combination medication that includes an ARB, calcium channel blocker and a diuretic. Professor Kahan says, “We are progressing in controlling high blood pressure in Europe, but we still have a long way to go.” He further states that “With more motivated and educated patients, we can greatly lower down chronic diseases and deaths.”




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