Hypertension (HTN)

1. Definition:

Hypertension (HTN) is a condition in which the blood pressure in the arteries is chronically elevated. It is generally defined as a systolic blood pressure (the pressure when the heart beats) of 140 mmHg or higher, and/or a diastolic blood pressure (the pressure when the heart relaxes) of 90 mmHg or higher.

2. Classification:

HTN is classified based on its cause and severity:

• Primary HTN (Essential HTN): The cause is unknown, and it accounts for the majority of cases.

• Secondary HTN: It is caused by other underlying medical conditions, such as:

• Endocrine HTN:

• Hyperthyroidism-induced HTN: Due to an overactive thyroid gland, leading to increased production of thyroid hormones.

• Pheochromocytoma-induced HTN: Caused by a tumor that secretes hormones like adrenaline and noradrenaline.

• Adrenal medullary tumor-induced HTN: Due to a tumor in the adrenal medulla that secretes hormones like adrenaline and noradrenaline.

• Adrenal cortical tumor-induced HTN: Caused by a tumor in the adrenal cortex that secretes the hormone aldosterone, leading to sodium and water retention.

• Neurogenic HTN: Caused by stress, anxiety, or strong stimulation.

• Mechanical HTN:

• Coarctation of the aorta-induced HTN: Caused by a narrowing of the aorta, leading to increased pressure in the aorta above the narrowed area.

• Renal artery stenosis-induced HTN: Caused by narrowing of the renal artery, which increases blood pressure in the kidneys, leading to hypertension.

• Medication-induced HTN: Caused by the use of certain medications, such as birth control pills, pain relievers, and anti-inflammatory drugs.

• Chronic kidney disease-induced HTN: Caused by kidney damage, leading to decreased blood filtration and increased blood pressure.

• Heart disease-induced HTN: Caused by heart conditions, leading to increased pressure on the aorta.

• Acute HTN: Sudden onset, often caused by:

• Acute hyperthyroidism-induced HTN: Due to a sudden surge in thyroid hormone production.

• Acute adrenal medullary tumor-induced HTN: Due to a sudden release of adrenaline and noradrenaline from a tumor in the adrenal medulla.

• Drug-induced HTN: Caused by the use of drugs or toxins that increase blood pressure.

• Chronic HTN: Gradual onset, lasting over time, often caused by:

• Essential HTN: The cause is unknown, and it accounts for the majority of cases.

• Chronic kidney disease-induced HTN: Caused by kidney damage, leading to decreased blood filtration and increased blood pressure.

• Heart disease-induced HTN: Caused by heart conditions, leading to increased pressure on the aorta.

3. Symptoms:

• Mild HTN: Often no noticeable symptoms.

• Severe HTN:

• Severe headache, throbbing headache.

• Dizziness, lightheadedness, feeling faint when changing positions.

• Fatigue, shortness of breath, discomfort.

• Chest pain.

• Nosebleeds.

• Blurred vision, decreased vision.

• Swelling in the legs and hands, edema.

• Frequent nighttime urination.

• Sleep disturbances.

4. Diagnosis:

• Blood pressure measurement:

• Blood pressure measured using a blood pressure monitor at home or in a healthcare facility.

• Measure blood pressure multiple times throughout the day and in various positions to accurately assess blood pressure levels.

• Ensure measurements are taken in a calm state, avoiding tobacco, caffeine, or alcohol before measurement.

• Be aware of white coat hypertension: High blood pressure readings in a clinic setting but normal at home.

• Blood tests:

• Kidney function tests, liver function tests.

• Blood sugar tests, lipid tests.

• Thyroid hormone tests.

• Electrocardiogram (ECG):

• Evaluates heart activity, detects any heart rhythm abnormalities.

• Echocardiogram: Evaluates the structure and function of the heart.

• Chest X-ray: Evaluates heart size and lung conditions.

5. Treatment:

• Lifestyle modifications:

• Weight loss if overweight or obese.

• Reducing salt intake and lowering sodium in the diet.

• Eating plenty of fruits and vegetables.

• Engaging in regular physical activity and exercise.

• Quitting smoking and alcohol.

• Reducing stress and improving sleep quality.

• Medications:

• Diuretics: Help the body eliminate excess water and salt.

• Beta-blockers: Reduce heart rate and the force of heart contractions.

• Calcium channel blockers: Reduce the force of heart contractions and dilate blood vessels.

• Angiotensin-converting enzyme inhibitors (ACEIs): Block the production of angiotensin II, which dilates blood vessels and lowers blood pressure.

• Angiotensin II receptor blockers (ARBs): Reduce the effects of angiotensin II, which dilates blood vessels and lowers blood pressure.

• Surgery:

• For HTN caused by coarctation of the aorta or renal artery stenosis.

• For HTN caused by adrenal medullary tumors or adrenal cortical tumors.

6. Complications:

• Cardiovascular disease:

• Heart attack.

• Heart failure.

• Arrhythmias.

• Stroke.

• Kidney disease:

• Kidney failure.

• Diabetic nephropathy.

• Eye disease:

• Blindness.

• Neurological disorders:

• Alzheimer’s disease.

• Cognitive impairment.

• Blood vessel disease:

• Arterial thrombosis.

• Peripheral vascular disease.

Note:

• HTN is a serious condition that can lead to numerous severe complications.

• HTN treatment should be followed under the guidance of a doctor. Do not self-medicate or alter medication dosages without consulting a healthcare professional.

• Regular blood pressure checks are recommended, at least once a year.

• A healthy diet and exercise are crucial for blood pressure control.

Additional information:

• HTN is one of the most prevalent medical conditions worldwide.

• HTN is a major risk factor for cardiovascular disease, stroke, and kidney disease.

• Statistically, approximately one in three adults worldwide has HTN.

• HTN is often symptomless in its early stages, making many unaware they have the condition.

• Effective blood pressure control significantly reduces the risk of heart-related, kidney-related, and other complications.

• Collaboration between patients and their doctors is essential for successful HTN management.