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Hypertension (High Blood Pressure)

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Updated June 04, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

African American doctor checking senior man's blood pressure
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Hypertension, or high blood pressure, is one of the most common medical problems in the developed world. Unfortunately hypertension often goes undiagnosed; and when it is diagnosed it is often inadequately treated, despite the fact that it is usually fairly easy to treat. So hypertension remains a leading cause of heart attack, stroke, kidney disease and other serious medical problems.

Hypertension is an insidious disease. Most people who have hypertension never develop any symptoms from the high blood pressure itself, and often seem and feel completely healthy for many years, until it has caused irreversible damage to a vital organ.

For these reasons, it is important for you to have your blood pressure checked periodically. And if you have hypertension, it is important to work closely with your doctor to find the treatment that is right for you.

What Is Hypertension?

Hypertension is when the blood pressure in your arteries is higher than what's considered normal.

Your blood pressure is determined by several factors, including the force of your heartbeat, and the "tone" (that is, the relative tightness or elasticity) of your blood vessels. A blood pressure that is chronically elevated places extra stress on both your heart and your arteries, and over time can lead to disease in the blood vessels themselves, and in the organs supplied by the diseased blood vessels.

How Is Hypertension Diagnosed?

Hypertension is diagnosed when your blood pressure at rest is found to be persistently elevated.

It is important to measure the blood pressure correctly, so as not to over-diagnose or under-diagnose hypertension. In today's typically harried medical office, the correct procedures for accurately measuring blood pressure are too often overlooked. Since you are the one who has to live with the diagnosis (or with the consequences of a missed diagnosis), you ought to have some idea of the proper way to diagnose hypertension.

What Are The Symptoms and the Consequences of Hypertension?

Hypertension itself does not usually cause any symptoms, which is why it has been called a "silent killer."

It does, however, cause several very undesirable medical consequences. Over a period of years (or over shorter periods of time if the hypertension is severe) it can accelerate coronary artery disease, leading to heart attacks; it can cause cardiomyopathy and heart failure; it is the leading risk factor for stroke; and it can produce kidney failure. Because hypertension can produce so many life-altering (and life-ending) medical conditions, diagnosing and treating hypertension is critical.

What Are the Risk Factors for Hypertension?

While hypertension is a strong risk factor for cardiovascular, cerebrovascular and kidney disease, there are also several risk factors that make hypertension itself more likely to occur.

Hypertension is more common and more severe in black individuals, or if there is a family history of hypertension. Excess salt intake is an important factor in developing hypertension for many individuals. High alcohol intake (greater than two drinks per day) is associated with hypertension. Elevated blood-lipid levels (fatty acids and cholesterol in your blood) and obesity are also associated with an increased incidence of hypertension.

What Causes Hypertension?

Hypertension is usually divided into two general categories: essential (or primary) hypertension, and secondary hypertension. The vast majority of people with hypertension have essential hypertension, which means, simply, that no specific underlying cause can be identified. While a lot of research has been done to try to pinpoint the cause (or causes) of essential hypertension, so far the cause remains elusive.

Much less commonly, hypertension is secondary to some identifiable -- and often treatable and/or reversible -- underlying disorder. Conditions that can produce secondary hypertension include kidney disease; sleep apnea; coarctation of the aorta; disease of the blood vessels supplying the kidneys; various endocrine gland disorders; and the use of oral contraceptives, excessive alcohol, chronic use of non-steroidal anti-inflammatory drugs (NSAIDs), or antidepressants.

A careful medical history, physical examination, and an evaluation of routine blood work should tip off your physician as to whether further steps ought to be taken to look for a potential cause of secondary hypertension.

How Is Hypertension Treated?

If you have hypertension, the good news is that there is a huge array of therapies to choose from. The bad news is also that there is a huge array of therapies to choose from -- and that can make selecting the "right" treatment a little complicated.

But if you and your doctor take a logical, step-wise approach, there is an excellent chance that you will arrive at a highly effective and well-tolerated treatment regimen.

Sources:

Chobanian, AV, Bakris, GL, Black, HR, Cushman, WC. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report. JAMA 2003; 289:2560.

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