Hypertension

Introduction

High blood pressure can be systolic, diastolic, or both, and the measurement varies depending on whether it was taken at a health center or at home.

Definitions:

• Systolic Hypertension:
  ≥140 mmHg at health centers.
  ≥135 mmHg at home.
• Diastolic Hypertension:
  ≥90 mmHg at health centers.
  ≥85 mmHg at home.

Types of Hypertension

• Essential Hypertension:
  Unknown cause (90–95% of cases).
• Secondary Hypertension:
  Due to chronic kidney disease, endocrine disorders, or use of birth control pills (5–10% of cases).

Special Cases of Hypertension

• Pregnancy-related Hypertension:
  Pre-eclampsia: A severe condition occurring in the second half of pregnancy.
• White Coat Syndrome:
  High blood pressure in the doctor's office but normal at home.
  Observed in 30–40% of people.
  Diagnosed through 24-hour blood pressure monitoring.

Classification of Blood Pressure

Causes of Hypertension

• Essential Hypertension:
  Influenced by genetic and environmental factors.
  Risk factors include high salt intake, physical inactivity, abdominal obesity, excessive coffee intake, and vitamin D deficiency.
• Secondary Hypertension:
  Chronic kidney disease (most common).
  Endocrine disorders (e.g., hyperthyroidism, Cushing's syndrome, adrenal tumors).
  Other factors: Sleep apnea, pregnancy, artery stenosis, and stimulant drugs.

Symptoms

Most patients with hypertension do not exhibit symptoms. Some symptoms may include:

• Nosebleeds.
• Heart palpitations.
• Ringing in the ears.
• Dizziness.
• Morning headaches (back of the head).

When to Measure Blood Pressure

• Ages 18+:
  Record a baseline measurement.
  Repeat every 3–5 years if normal.
  Repeat annually if at the upper limit.

How to Measure Blood Pressure Accurately

• Sit calmly for 5 minutes before measurement.
• Use an appropriate-sized cuff.
• Keep the upper arm at heart level.
• Take at least two readings during the same visit and use the average.

Diagnosis Confirmation

Diagnosis requires multiple readings on different occasions unless the patient has Stage 3 hypertension or organ damage.

Medical Tests

After diagnosis, routine tests include:

• Kidney function tests (creatinine).
• Cholesterol levels (HDL, LDL, triglycerides).
• Blood sugar levels.
• ECG.

Hypertension Treatment

• When to Start Treatment:
  Ages 18–65: Start if systolic ≥140 mmHg or diastolic ≥90 mmHg.
  Ages 65–79: Start if systolic ≥140 mmHg or diastolic ≥90 mmHg.
  Age 80+: Start if systolic ≥160 mmHg or diastolic ≥90 mmHg.
• Treatment Goals:
  Reduce systolic to 130–139 mmHg and diastolic to 70–79 mmHg.
• General Advice:
  Avoid maximum doses to minimize side effects.
  Use drug combinations if needed.
  Stick to prescribed schedules.

Prevention of Hypertension

• Engage in daily physical activity (e.g., brisk walking for 30+ minutes).
• Reduce salt intake (<2.4 g/day).
• Limit alcohol consumption (≤3 units/day for men; ≤2 units/day for women).
• Eat a diet rich in fruits and vegetables.
• Maintain a healthy weight (BMI 20–25 kg/m²).

Complications if Left Untreated

• Coronary artery hardening.
• Stroke.
• Heart failure.
• Chronic kidney disease.
• Atrial fibrillation (irregular heartbeat).
• Dementia.
• Retinal damage.