Hypertension is a chronic condition where blood pressure remains consistently elevated, increasing the risk of cardiovascular diseases. Hypertension is classified into primary and secondary hypertension, with further subtypes such as resistant, malignant, and gestational hypertension. Often called the “silent killer,” it may not show symptoms until complications arise. Common causes include high salt intake, kidney disease, obesity, and stress, with risk factors like aging, genetics, and smoking. If hypertension is left untreated, it can lead to severe health complications. Proper diagnosis, lifestyle modifications, and medical treatment are essential for effective hypertension management.
What is Hypertension (high blood pressure)?
Hypertension ( commonly known as high blood pressure) is a chronic health condition where the force of blood against artery walls remains consistently elevated, increasing the heart’s workload. Over time, this excessive pressure damages blood vessels, raising the risk of cardiovascular diseases like heart attack and stroke.
Blood pressure is measured in millimeters of mercury (mmHg), with a reading of 130/80 mmHg or higher classified as hypertension.
How common is Hypertension?
Approximately 44.7% of adults in the United States had hypertension, equating to an estimated 115.3 million individuals, according to the National Health and Nutrition Examination Survey (NHANES) conducted from 2017 to 2020. This prevalence increases with age, with more than 70% of adults aged 60 and older affected. Notably, about 1 in 4 adults with hypertension have their condition under control, and around 4 in 10 adults are unaware they have high blood pressure, highlighting the importance of regular monitoring.
Hypertension manifests in different forms, each categorized based on underlying causes and progression, requiring distinct diagnostic and management approaches.
What are the types of Hypertension?
Hypertension is classified into two primary types: Primary (Essential) Hypertension and Secondary Hypertension. The distinction is based on the underlying cause.
1- Primary (Essential) Hypertension
Primary (essential) Hypertension is the most common type of hypertension, developing gradually over time without a specific identifiable cause. Primary Hypertension causes can be genetic, environmental, and lifestyle factors like no physical activity.
Primary hypertension’s pathophysiology involves SNS overactivity, keeping blood vessels constricted, and RAAS dysfunction, causing fluid retention and vasoconstriction. Endothelial dysfunction reduces nitric oxide, impairing vessel relaxation, while kidney impairment increases blood volume. Over time, vascular stiffness raises resistance, leading to persistently high blood pressure.
2- Secondary Hypertension
Secondary hypertension is directly caused by an underlying medical condition. Unlike primary hypertension, which develops without a specific cause, secondary hypertension results from identifiable causes, including adrenal gland tumors, kidney disease, hormonal imbalances, obstructive sleep apnea, thyroid disorders, and certain medications like pain relievers and decongestants. Secondary hypertension accounts for about 5-10% of hypertension cases and often requires treating the root cause for effective management.
Secondary hypertension’s pathophysiology varies by cause; kidney disease leads to fluid retention and RAAS overactivation, endocrine disorders increase hormone levels that raise BP, sleep apnea triggers SNS overactivation and vasoconstriction, pregnancy causes fluid overload, and certain medications induce vessel constriction and fluid retention.
Secondary hypertension is classified based on the respective characteristics and clinical presentation of;
1- Resistant Hypertension
Resistant hypertension is a severe form of hypertension that remains uncontrolled despite the use of three or more antihypertensive medications. Resistant hypertension is often linked to underlying conditions like kidney disease, obesity, or secondary hypertension.
Resistant hypertension’s pathophysiology involves excessive RAAS activity, leading to persistent fluid retention and vasoconstriction. SNS hyperactivity keeps the body in a prolonged fight-or-flight state, maintaining high blood pressure. Over time, arterial stiffness develops due to sustained hypertension, causing irreversible vascular damage and further increasing resistance.
2- Malignant Hypertension
Malignant hypertension is a severe and rapidly progressing form of hypertension (>180/120 mmHg), often resulting in organ damage.
Malignant hypertension’s pathophysiology involves endothelial injury and inflammation, causing rapid blood vessel damage that can lead to organ failure. Microvascular thrombosis develops as tiny clots form, obstructing blood flow to vital organs. As a result, ischemic organ damage occurs, depriving the heart, brain, and kidneys of oxygen, which can lead to severe complications such as heart failure, stroke, or kidney failure.
3- Isolated Systolic Hypertension (ISH)
Isolated systolic hypertension (ISH) occurs when only systolic blood pressure is elevated (>130 mmHg) while diastolic pressure remains normal, commonly due to arterial stiffness and aging.
ISH’s pathophysiology involves reduced arterial compliance, limiting the ability of blood vessels to expand with each heartbeat. Endothelial dysfunction further impairs relaxation, keeping systolic pressure elevated. Overactivation of the RAAS and SNS increases vascular resistance and fluid retention, worsening hypertension and increasing the risk of cardiovascular complications.
4- White Coat Hypertension
White coat hypertension is a temporary increase in blood pressure observed in clinical settings due to stress or anxiety, while readings remain normal outside.
White coat hypertension’s pathophysiology is driven by acute SNS activation, leading to transient vasoconstriction and increased heart rate. Unlike persistent hypertension, it does not involve sustained endothelial dysfunction or renal impairment, and blood pressure normalizes once the stressor is removed.
5- Masked Hypertension
Masked hypertension presents as normal blood pressure in clinical settings but elevated readings in daily life, increasing the risk of cardiovascular disease.
Masked hypertension’s pathophysiology is linked to heightened SNS and RAAS activity, causing intermittent vasoconstriction and fluid retention. Endothelial dysfunction and arterial stiffness further contribute to sustained high blood pressure outside clinical settings, making early detection crucial.
6- Gestational Hypertension
Gestational hypertension develops after 20 weeks of pregnancy, leading to high blood pressure without proteinuria or organ damage.
Gestational hypertension’s pathophysiology involves increased RAAS activity, causing excessive fluid retention and elevated blood volume. Endothelial dysfunction reduces nitric oxide availability, leading to vasoconstriction. Placental factors contribute to vascular resistance, and impaired kidney function further exacerbates blood pressure elevation, posing risks to both mother and fetus.
7- Nocturnal Hypertension
Nocturnal hypertension refers to elevated blood pressure during sleep, often linked to disrupted circadian regulation of blood pressure control.
Nocturnal hypertension’s pathophysiology involves impaired autonomic function, leading to insufficient nighttime BP reduction. Increased SNS activity and RAAS dysregulation promote vasoconstriction and fluid retention. Endothelial dysfunction and kidney impairment further contribute to sustained high blood pressure levels overnight, increasing cardiovascular risk.
What are the Symptoms of Hypertension?
Hypertension is often called the “silent killer” because symptoms may not be noticeable until severe complications occur. The symptoms of hypertension are;
- Headache (especially in the morning) – Dizziness
- Confusion – Blurred vision
- Vertigo – Chest pain
- Palpitations – Shortness of breath
- Double vision – Visual disturbances
- Swelling (edema) in legs – Frequent urination)
- Fatigue Nosebleeds – Anxiety Facial flushing
What are the causes of Hypertension?
The causes of hypertension include;
- High salt intake: Consuming excessive sodium disrupts the body’s fluid balance, causing the kidneys to retain more water, which increases blood volume and raises arterial pressure.
- Excess alcohol consumption: Chronic alcohol intake affects the autonomic nervous system, leading to vasoconstriction and increased cardiac output, which raises blood pressure.
- Kidney disease: Impaired kidney function disrupts the regulation of sodium and fluid balance, leading to increased blood volume and blood pressure.
- Diabetes: High blood sugar damages blood vessel walls, leading to endothelial dysfunction and reduced nitric oxide availability, which causes hypertension.
- Certain medications: Certain medications can cause fluid retention, increased sodium levels, and vasoconstriction, all of which contribute to elevated blood pressure.
- Hormonal imbalances: Conditions such as hyperthyroidism and Cushing’s syndrome increase heart rate, blood volume, and vascular resistance, all of which elevate blood pressure.
- Sleep apnea: Repeated episodes of oxygen deprivation during sleep trigger the sympathetic nervous system, causing increased heart rate and blood vessel constriction.
- Pregnancy: Pregnancy alters vascular function, which causes temporary high blood pressure, which may persist postpartum.
What are the risk factors for Hypertension?
The hypertension risk factors include;
- Genetic predisposition: A family history of hypertension increases susceptibility due to inherited traits affecting vascular tone, sodium regulation, and cardiac function.
- Obesity: Excess body fat increases the workload on the heart by raising cardiac output and vascular resistance, leading to higher blood pressure.
- Physical inactivity: Lack of exercise weakens the heart and blood vessels, contributing to elevated blood pressure.
- Chronic stress: Persistent psychological stress activates the sympathetic nervous system, causing prolonged vasoconstriction and increased heart rate.
- Smoking: Chemicals in tobacco damage the endothelial lining of blood vessels, reducing nitric oxide availability and leading to arterial stiffness, which increases blood pressure.
- Aging: As the body ages, arteries lose their elasticity, making them stiffer and less able to accommodate blood flow efficiently. This leads to increased peripheral resistance, requiring the heart to pump harder, ultimately causing hypertension.
- Unhealthy diet: A High intake of processed foods, trans fats, and low potassium can contribute to high blood pressure.
What are the complications (Long-Term Health Effects) of Hypertension?
The complications (Long-Term Health Effects) of Hypertension are;
- Heart Disease
- Stroke
- Kidney Damage (Chronic Kidney Disease)
- Eye Problems (Hypertensive Retinopathy)
- Aneurysm Formation (Weakening and bulging of arteries)
- Cognitive Issues (Dementia & Memory Loss)
- Peripheral Artery Disease (PAD)
How to diagnose Hypertension?
Hypertension is diagnosed through primary diagnostic methods, medical history, Physical examination, laboratory tests, and imaging tests to identify underlying causes and assess cardiovascular health. For a detailed breakdown of each hypertension diagnosis, visit the hypertension diagnosis and treatment page.
What are the treatments for Hypertension?
Hypertension treatment focuses on managing blood pressure through lifestyle modifications, medications, and weight loss programs. Hypertension treatment aims to reduce cardiovascular risks and prevent complications with personalized treatment plans. For a detailed breakdown of each hypertension treatment, visit the hypertension diagnosis and treatment page.
What is self-care in Hypertension?
Hypertension self-care involves proactive measures like regular blood pressure monitoring, medication adherence, healthy lifestyle choices, and stress management. It helps individuals control their condition, prevent complications, and maintain overall cardiovascular health. For a detailed breakdown of each hypertension self-care, visit the hypertension diagnosis and treatment page.
Where can you find hypertension treatment in North Carolina?
You can receive hypertension treatment at the FMRC, Family Medicine, Rehab, and Med Spa clinic in North Carolina, which offers a comprehensive approach to managing high blood pressure, including lifestyle modifications, medication management, and cardiovascular care. The clinic provides specialized treatment tailored to each patient’s needs, combining medical interventions with personalized strategies to maintain optimal blood pressure levels. Additionally, FMRC’s Medical Weight Management Program plays an important role in hypertension management, as maintaining a healthy weight is essential for reducing cardiovascular strain. Led by Meredith Frazier, MSN, RN, FNP, this program integrates medical weight management techniques to help patients achieve long-term blood pressure control by addressing both metabolic and lifestyle factors.
Disclaimer: This is for informational purposes only. For medical advice or diagnosis, consult a Primary Care Provider and Nurse Practitioner at FRMC.