Essential hypertension

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 pressure measurements 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.

Support Groups

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 attacks and 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.

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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.