Essential hypertension

Answer 1

Definition

Essential hypertension refers to high blood pressure with no identifiable cause.

Alternative Names

Hypertension - essential

Causes, incidence, and risk factors

As blood is pumped through your body, it exerts pressure on the walls of your arteries. The systolic blood pressure is the pressure against these walls when the heart contracts, and the diastolic blood pressure is the pressure against these walls when the heart relaxes. When you get a blood pressure reading, you are told the systolic pressure/diastolic pressure.

For example, normal blood pressure is below 120/80.

High blood pressure, also called hypertension, occurs when the systolic pressure is consistently over 140 mm Hg, or the diastolic blood pressure is consistently over 90 mm Hg. Blood pressure is determined by the amount of blood pumped, by the actions of the heart, and by the size and condition of the arteries. Many factors affect blood pressure, including:

• The amount of water in the body
• The amoutn of salt in the body
• The condition of the kidneys, nervous system, and blood vessels
• Various hormone levels in the body

Prehypertension is when your systolic blood pressure is between 120 and 139 or your diastolic blood pressure is between 80 and 89. If you have prehypertension, you are more likely to develop high blood pressure at some point. Therefore, your doctor will recommend lifestyle changes to bring your blood pressure down to normal ranges.

African Americans of both sexes and Caucasian males have a higher rate of significant hypertension. While essential hypertension has no correctable cause, some genetic factors have been identified. Blood vessels become somewhat stiffer as you grow older. For this reason, the rate of high blood pressure increases with age.

Symptoms

Usually, high blood pressure has no symptoms at all. That is why it is often called the "silent killer." Millions of people have high blood pressure and many do not even know they have this serious condition.

Rarely, you may experience a mild headache when your blood pressure is elevated. If your headache is severe, or if you experience any of the symptoms below, you must be seen right away because these may be a sign of dangerously high blood pressure (called malignant hypertension) or a serious complication (like a heart attack).

• Fatigue
• Confusion
• Visual changes
• Nausea and vomiting
• Anxiety
• Perspiration
• Pale or red skin
• Angina-like pain, crushing chest pain

Note: There are usually no symptoms.

Signs and tests

Blood pressuremeasurements are repeated over time. Systolic blood pressure consistently over 140, or diastolic blood pressure consistently over 90, is considered hypertension. Your doctor will look for signs of complications to your heart, kidneys, eyes, and other organs in your body.

Multiple systolic blood pressure readings between 130 and 139 or diastolic blood pressure readings between 80 and 89 is called prehypertension. Your doctor will recommend and encourage lifestyle changes including weight loss, exercise, and nutritional changes.

Tests for suspected causes (called secondary hypertension) may be performed. Essential hypertension is diagnosed when NO causes can be found.

Treatment

You should have your blood pressure regularly checked by your doctor. Your doctor will tell you how often you need it checked.

You may want to consider a home blood pressure monitor as well. Bring the readings to your doctor when you go for your visits.

Lifestyle changes can help bring your blood pressure down. This includes regular exercise, including weight loss if you are overweight. You should follow a low fat diet rich in fish, chicken, whole grains, fruits and vegetables, and eat lower amounts of red meat and salt.

Do not smoke. If you have Diabetes, make sure you keep your blood sugars under control.

Many different medicines are used to control blood pressure. Some of them are listed below.

• Angiotensin converting enzyme (ACE) inhibitors
• Angiotensin receptor blockers (ARBs)
• Beta-blockers
• Calcium channel blockers
• Direct renin inhibitors, including aliskiren (Tekturna)
• Diuretics
• Vasodilators

Most people need two or more medications to control blood pressure.

Expectations (prognosis)

Essential hypertension is controllable with proper treatment. It requires lifelong monitoring, and treatment may require periodic adjustments.

Complications

Untreated hypertension can lead to:

• Aneurysms
• Blood vessel damage (atherosclerosis)
• Congestive heart failure
• Heart attacksand other heart damage
• Loss of vision
• Kidney damage
• Stroke

Calling your health care provider

Even if you have not been diagnosed with high blood pressure, it is important to have your blood pressure checked at annual exams, especially if you have a history of high blood pressure in your family.

If you have high blood pressure, you will have regularly scheduled appointments with your doctor.

In between appointments, if you have any of the following symptoms call your health care provider right away:

• Severe headache
• Excessive tiredness
• Confusion
• Visual changes
• Nausea and vomiting
• Chest pain
• Shortness of breath
• Significant sweating

Prevention

Prevention is based upon lifestyle changes that include:

• Weight loss, if you are overweight. Excess weight adds to heart strain. In some cases, weight loss may be the only treatment needed to lower your blood pressure.
• Exercise to improve cardiac fitness.
• Dietary adjustments to lower fat and modify sodium in your diet. Salt, MSG, and baking soda all contain sodium.

References

US Food and Drug Administration. FDA Approves New Drug Treatment for High Blood Pressure. Rockville, MD: National Press Office; March 6, 2007. Release P07-38.

Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Rockville, Md. National Heart, Lung, and Blood Institute, US Department of Health and Human Services; August 2004. National Institutes of Health Publication No. 04-5230.

Whelton PK, He J, Appel LJ, et al. Primary prevention of hypertension: Clinical and public health advisory from The National High Blood Pressure Education Program. JAMA.2002;288(15):1882-8.

Answer 2

Definition

Hypertension is the term used to describe high blood pressure. Essential hypertension means that the cause of high blood pressure is not known.

Blood pressure measures the force against the walls of your arteries as your heart pumps blood through your body.

Blood pressure readings are usually given as two numbers -- for example, 120 over 80 (written as 120/80 mmHg). One or both of these numbers can be too high.

The top number is called the systolic blood pressure, and the bottom number is called the diastolic blood pressure.

• Normal blood pressure is when your blood pressure is 120/80 mmHg or lower most of the time.
• High blood pressure (hypertension) is when your blood pressure is 140/90 mmHg most of the time.
• If your blood pressure numbers fall between 120/80 and 140/90, it is called pre-hypertension.

If you have pre-hypertension, you are more likely to develop high blood pressure.

If you have heart or kidney problems, or if you had a stroke, your doctor may want your blood pressure to be even lower than that of people who do not have these conditions.

Alternative Names

Hypertension - essential

Causes, incidence, and risk factors

Many factors can affect blood pressure, including:

• How much water and salt you have in your body
• The condition of your kidneys, nervous system, or blood vessels
• The levels of different body hormones

You are more likely to be told your blood pressure is too high as you get older. This is because your blood vessels become stiffer as you age. When that happens, your blood pressure goes up. High blood pressureincreases your chance of having a stroke, heart attack, heart failure, kidney disease, and early death.

You have a higher risk of high blood pressure if you:

• Are African American
• Are obese
• Are often stressed or anxious
• Drink too much alcohol (more than one drink per day for women and more than two drinks per day for men)
• Eat too much salt in your diet
• Have a family history of high blood pressure
• Have diabetes
• Smoke

Most of the time, no cause is identified. This is called essential hypertension.

High blood pressure that is caused by another medical condition or medication is called secondary hypertension. See also: Hypertension

Symptoms

Most of the time, there are no symptoms. In most people, high blood pressure is found when they visit their health care provider and have it measured.

Because there are no symptoms, people can develop Heart disease and kidney problems without knowing they have high blood pressure.

If you have a severe headache, nausea or vomiting, confusion, changes in vision, or nosebleeds you may have a severe and dangerous form of high blood pressure called malignant hypertension.

Signs and tests

Your health care provider will check your blood pressure several times. It is normal for your blood pressure to be different at different times of the day.

Blood pressure readings that you take at home may be a better measure of your current blood pressure than those taken at your doctor's office. Make sure you get a good quality, well-fitting home device. It will probably have a cuff with a stethoscope or a digital readout. Practice with your health care provider or nurse to make sure you are taking your blood pressure correctly.

See also: Blood pressure monitors for home

Your doctor will perform a physical exam to look for signs of heart disease, damage to the eyes, and other changes in your body.

Tests may be done to look for:

• Heart disease (echocardiogram or electrocardiogram)
• High cholesterol levels
• Kidney disease (basic metabolic panel, urinalysis, or ultrasound of the kidneys)

Treatment

The goal of treatment is to reduce blood pressure so that you have a lower risk of complications. You and your health care provider should set a blood pressure goal for you.

Your health care provider may also recommend that you exercise, lose weight, and follow a healthier diet. If you have pre-hypertension, your health care provider will recommend the same lifestyle changes to bring your blood pressure down to a normal range.

You can do many things to help control your blood pressure, including:

• Eat a heart-healthy diet, including potassium and fiber, and drink plenty of water. See: High blood pressure and diet
• Exercise regularly -- at least 30 minutes a day.
• If you smoke, quit -- find a program that will help you stop.
• Limit how much alcohol you drink -- one drink a day for women, two a day for men.
• Limit the amount of sodium (salt) you eat -- aim for less than 1,500 mg per day.
• Reduce stress -- try to avoid things that cause you stress. You can also try meditation or yoga.
• Stay at a healthy body weight -- find a weight-loss program to help you, if you need it.

Your health care provider can help you find programs for losing weight, stopping smoking, and exercising. You can also get a referral from your doctor to a dietitian, who can help you plan a diet that is healthy for you.

Many different medicines can be used to treat high blood pressure. See: High blood pressure medicines.

Often, a single blood pressure drug may not be enough to control your blood pressure. You may need to take two or more drugs. It is very important that you take the medications you were prescribed. If you have side effects, your health care provider can substitute a different medication.

Expectations (prognosis)

Most of the time, high blood pressure can be controlled with medicine and lifestyle changes.

Complications

If your blood pressure is not well controlled, you are at risk for:

• Bleeding from the aorta, the large blood vessel that supplies blood to the abdomen, pelvis, and legs
• Chronic kidney disease
• Heart attack or heart failure
• Poor blood supply to the legs
• Problems with your vision
• Stroke

Calling your health care provider

If you have essential hypertension, you will have regular appointments with your doctor.

Even if you have not been diagnosed with high blood pressure, it is important to have your blood pressure checked during your yearly check-up, especially if someone in your family has or had high blood pressure.

Call your health care provider right away if home monitoring shows that your blood pressure is still high.

Prevention

Adults over 18 should have their blood pressure checked regularly.

Lifestyle changes may help control your blood pressure.

Follow your health care provider's recommendations to treat your essential hypertension.

References

Goldstein LB, Bushnell CD, Adams RJ, Appel LJ, Braun LT, Chaturvedi S, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42:517-584.

Kaplan NM. Systemic Hypertension: Treatment. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 46.

Victor RG. Systemic hypertension: Mechanisms and diagnosis. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 45.

Reviewed By

Review Date: 06/10/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.