BASICS FACT YOU NEED TO KNOW ABOUT HYPERTENSION.

High blood pressure can be divided into two main types based on its cause: primary hypertension and secondary hypertension.

Causes of Primary Hypertension

         Scientists aren’t sure exactly what causes this common form of high blood pressure, which makes up 90 to 95 percent of cases in adults. Primary hypertension isn’t directly attributable to any one underlying condition – it is caused by a combination of factors. However, changes in the arteries over the years are often associated with higher blood pressure. Such changes include:

1. Buildup of fatty deposits inside arteries (atherosclerosis)
2. Thickening of artery walls
3. Excessive contraction of small arteries (arterioles)

Causes of Secondary Hypertension

          This form of high blood pressure makes up five to 10 percent of cases in adults as well as most cases in children younger than 10. Secondary hypertension is the direct result of an underlying health condition that causes blood pressure to shoot up. It can have a number of causes.

Kidney disease

          Kidney disease is the most common cause of secondary hypertension. The kidneys regulate the amount of fluid in the body. When there is a kidney problem, the volume of blood may increase. The more blood that must be pumped through the arteries, the higher the force that is needed.
High blood pressure can be caused by several forms of kidney disease. Polycystic kidney disease is an inherited condition characterized by cysts in the kidneys. Diabetic nephropathy occurs when diabetes damages the kidneys’ filtering system. Glomerular disease is characterized by swelling of microscopic kidney filters called glomeruli. High blood pressure can also result from a blockage inside the kidneys (hydronephrosis) or narrowing of the arteries leading to them (renovascular hypertension).

Hormonal disorders

          The adrenal glands, which sit atop the kidneys, produce hormones that affect blood pressure. In Cushing’s disease, the adrenal glands release too much cortisol, which causes blood pressure to rise. In aldosteronism, they release too much aldosterone, which affects kidney function.
Other glands and their hormones can play a role, too. In hypothyroidism, the thyroid gland produces too little thyroid hormone, which can drive up blood pressure. In hyperthyroidism, the same gland releases too much thyroid hormone. Ironically, that can also raise blood pressure by increasing the activity of two other hormones, epinephrine and norepinephrine. In hyperparathyroidism, the parathyroid glands secrete too much parathyroid hormone, which increases calcium in the blood. That, in turn, can trigger a blood pressure increase.

Heart defect

           Some people are born with a narrowed aorta, the largest artery in the body. As a result, the heart has to pump harder to push blood through the aorta. The extra force required raises blood pressure, particularly in the arms. This condition is called “coarctation of the aorta.”

Sleep apnea

          Sleep apnea is a disorder characterized by repeated little pauses in breathing during sleep. This reduces the amount of oxygen in the body. Insufficient oxygen may damage the lining of blood vessel walls, making them less effective at regulating blood pressure.

Pregnancy

          High blood pressure problems occur in six to eight percent of U.S. pregnancies. Preeclampsia is a potentially serious condition that arises during the second half of pregnancy and is characterized by high blood pressure and excess protein in the urine. Gestational hypertension refers to high blood pressure that starts during pregnancy but isn’t accompanied by excess urinary protein.

Drugs and supplements

          Numerous prescription and over-the-counter (OTC) medicines can cause or worsen high blood pressure in certain individuals. These include birth control pills, hormone replacement therapy, cold-relief medicines, OTC and prescription pain relievers, antidepressants, asthma medications, and drugs used for organ transplants. Some herbal supplements, such as ginseng and Saint John’s Wort, also have this effect. In addition, many illicit drugs, such as cocaine and methamphetamine, raise blood pressure.

Obesity

          As a general rule of thumb, the more weight on a person’s body, the higher the amount of blood needed. More blood pumping through the body leads to additional pressure on the artery walls, which in turn increases blood pressure. Excess weight can also increase heart rate, which can also raise blood pressure.

Risk Factors That Can Be Changed

     Several risk factors for high blood pressure are wholly or partly under your control. By making changes in your lifestyle, you can lower your odds of developing high blood pressure—and that, in turn, reduces your risk of having a heart attack or stroke.

A poor diet often is built around high calorie foods low in essential nutrients, including ones containing saturated fat, trans fat, and added sugar. This type of diet is detrimental to overall health. It also makes it easier to become overweight. Beyond that, for some individuals, eating too much salt (sodium) can cause the body to retain fluid, which drives up blood pressure. Getting too little potassium, a mineral that helps balance the amount of sodium in cells, adds to the risk.

Physical inactivity

          Lack of physical activity increases the risk of blood vessel disease, heart disease, and stroke. It also makes it easier to put on unwanted pounds. In addition, when you are out of shape, it takes more effort for your heart to pump blood. This increases the force exerted on arteries, which can lead to high blood pressure.

Overweight or obesity

          About two-thirds of adults in the United States are overweight or obese. Excess weight places added strain on the heart and raises cholesterol and triglyceride levels. In addition, the more you weigh, the more blood is needed to supply oxygen and nutrients to your body. The extra blood volume puts increased pressure on artery walls.

Excessive alcohol

          Long-term heavy drinking can lead to irregular heartbeats, heart failure and stroke. It can also contribute to high triglycerides. In addition, having more than two or three drinks at a time triggers the release of hormones that increase blood flow and heart rate. This, in turn, can raise blood pressure as well as reduce the effectiveness of high blood pressure medication.

Smoking

          Smoking is one of the leading causes of preventable death in the United States, and it increases the risk of having a heart attack or stroke. With each cigarette you smoke, blood pressure also shoots up by as much as 10 points and stays higher for up to an hour. If you constantly have a cigarette in your hand, that could keep your blood pressure elevated for much of the day. High amounts of secondhand smoke, environmental smoke, and passive smoking can also contribute to high blood pressure; it is best to avoid cigarette smoke as much as possible.

Stress

          Severe stress can lead to a temporary but dramatic spike in blood pressure. Over time, this might contribute to high blood pressure, although that has never been conclusively proved. In addition, some people cope with stress by overeating, drinking too much, or smoking.

Caffeine

          Even if you're healthy, caffeine can cause a short-lived but dramatic rise in blood pressure. The amount of caffeine in two to three cups of coffee can raise systolic pressure (the top number in your blood pressure reading) 3 to 14 millimeters of mercury (mm Hg). Your diastolic pressure (the bottom number) can be increased 4 to 13 mm Hg. However, this transient rise in blood pressure due to caffeine has not been shown to increase your risk of hypertension.  The cause of essential hypertension remains unknown.

Prehypertension

           Prehypertension is slightly elevated blood pressure that isn't yet high enough to be considered high blood pressure. About 25 percent of adults in the United States have blood pressure in this range. If prehypertension isn't addressed by changing the lifestyle factors mentioned above, blood pressure is likely to keep rising.

Risk Factors That Cannot Be Changed

           Learning about risk factors that are beyond your control can also be beneficial. If you know you're at high risk, you and your doctor can keep close tabs on your blood pressure and start treatment at the earliest signs of trouble.

Age

          High blood pressure can occur in people of all ages, including teens, children, and even babies. However, the risk rises as you get older, in part because blood vessels become less flexible with age. More than half of adults in the United States age 60 and older have high blood pressure.

Gender

          Men and women are about equally likely to develop high blood pressure at some point in their lives. However, the comparative risk varies by age. For those under age 45 men are more likely to have high blood pressure than women. The proportion evens out in middle age. By age 60 and older, women are just as likely as men to have the condition.

Ethnicity

          High blood pressure affects people from all ethnic groups. However, African Americans develop high blood pressure more often and at an earlier age, on average, than their white or Mexican American counterparts. In addition, compared to white Americans, African Americans are more likely to die prematurely from high-blood-pressure­-related diseases, such as coronary heart disease, stroke, and kidney failure.

Family history

          Like height and eye color, a tendency toward high blood pressure can run in families. If your parents or siblings have high blood pressure, you're more likely to develop it, too

Risk Factors for Children and Teens

          The risk factors for older children and teens are similar to those for adults. Boys are at greater risk than girls, and African American and Mexican American youth are more likely to develop prehypertension or high blood pressure than their white American peers. Other contributing factors in this age group include overweight or obesity, physical inactivity, and an unhealthy diet containing too much salt (sodium).
In young children and babies, high blood pressure is usually caused by another condition, such as a heart defect, kidney disease, hormonal disorder, or drug side effect. Premature birth and low birth weight also increase risk

High Blood Pressure Treatments

          Treatment for high blood pressure typically involves a combination of medication and lifestyle changes to help control the condition and prevent or delay related health problems. The goal is to get blood pressure below the high range.
A normal blood pressure is 120/80 or lower.  When the systolic blood pressure (the top number) is between 121-139 and the diastolic blood pressure (the lower number) is between 81-89, this is a condition known as prehypertension. While prehypertension doesn’t necessarily raise your risk for heart attack or stroke, without attention, it will usually progress to full high blood pressure, which definitely does raise those risks.
High blood pressure, also known as hypertension, is present once the blood pressure is 140/90 and above.

Lifestyle Changes

A healthy lifestyle is the first line of defense against high blood pressure. Habits that help control blood pressure include:

1. eating a healthy diet
2. staying physically active
3. maintaining a healthy weight
4. avoiding excessive alcohol
5. quitting smoking and avoiding secondhand smoke
6. managing stress
7. eating less salt
8. limiting caffeine
9. monitoring blood pressure at home
10. getting support from family and friends

High Blood Pressure Drugs

          Some people find that lifestyle changes alone are enough to tame their high blood pressure. Many also take medication to treat their condition. There are numerous different types of blood pressure medication with different modes of action. If one doesn’t lower blood pressure enough, another might do the job. For some people, a combination of two or more drugs may be needed in order to keep blood pressure under control.
High blood pressure medications can be divided into 11 categories based on how they work. The example drugs in each section are just a sampling of what’s available.

Diuretics

          Diuretics, sometimes called water pills, help the kidneys get rid of excess water and salt (sodium). This reduces the volume of blood that needs to pass through the blood vessels, and as a result, blood pressure goes down. There are three major types of diuretics defined by how they work. They include:

1. thiazide diuretics (Hygroton, Diuril, Lasix, etc.)
2. potassium-sparing diuretics (Midamor, Aldactone, Durenium)
3. loop diuretics (bumetanide, furosemide)
4. combination diuretics which include more than one variety used together

Diuretics in the thiazide group generally have fewer side effects than the others, particularly when used at the low doses that are generally used in treating early high blood pressure.

Beta Blockers

       Beta blockers help the heart beat with less speed and force. The heart pumps less blood through the blood vessels and blood pressure decreases. There are many drugs within this classification, including:

1. acebutolol (Sectral)
2. betaxolol (Kerlone)
3. metoprolol tartrate (Lopressor)
4. metoprolol succinate (Toprol-XL)
5. penbutolol sulfate (Levatol)

Angiotensin-Converting Enzyme (ACE) Inhibitors

        ACE inhibitors keep the body from making a hormone (angiotensin II) that causes blood vessels to narrow. These medications decrease blood pressure by helping blood vessels expand and let more blood through. Some ACE inhibitors include:

1. benazepril hydrochloride (Lotensin)
2. captopril (Capoten)
3. enalapril maleate (Vasotec)
4. fosinopril sodium (Monopril)
5. lisinopril (Prinivil, Zestril)

Angiotensin II Receptor Blockers

        This class of drugs also protects the blood vessels from angiotensin II. To tighten blood vessels, the hormone must bind with a receptor site on the blood vessels. These medications keep that from happening. Consequently, blood pressure falls. These include:

1. candesartan (Atacand)
2. eprosartan mesylate (Teveten)
3. irbesartan (Avapro)
4. losartan potassium (Cozaar)
5. telmisartan (Micardis)
6. valsartan (Diovan)

Calcium Channel Blockers

         Movement of calcium into and out of muscle cells is necessary for all muscle contractions.  These drugs keep calcium from entering the smooth muscle cells of the heart and blood vessels. This makes the heart beat less forcefully and helps blood vessels relax. As a result, blood pressure decreases. Examples of these include:

1. amlodipine besylate (Norvasc, Lotrel)
2. felodipine (Plendil)
3. isradipine (DynaCirc, DynaCirc CR)
4. verapamil hydrochloride (Calan SR, Covera HS, Isoptin SR, Verelan)

Alpha Blockers
          Your body produces a type of hormone called a catecholamine when under stress, or chronically in some disease states. These hormones, including norepinephrine and epinephrine, cause the heart to beat faster and with more force and they constrict blood vessels. These effects raise blood pressure, and occur when these hormones attach to a receptor. The muscles around some blood vessels have what are known as alpha adrenergic receptors. When a catecholamine binds to an alpha receptor, the muscle contracts, the blood vessel narrows, and blood pressure rises. These drugs block binding to alpha receptors, so blood is able to flow through the blood vessels more freely, and blood pressure falls. These drugs include doxazosin mesylate (Cardura), prazosin hydrochloride (Minipress), and terazosin hydrochloride (Hytrin).
Alpha-Beta Blockers
Alpha-beta blockers have a combined effect. They block the binding of catecholamine hormones to both alpha and beta receptors.  Therefore, they can decrease the constriction of blood vessels like alpha blockers, and slow down the rate and force of the heartbeat like beta blockers. Carvedilol (Coreg) and labetalol hydrochloride (Normodyne) are common alpha-beta blockers.
Alpha-2 Receptor Agonists
Like other alpha blockers, these drugs reduce activity in the sympathetic nervous system, which decreases blood pressure. The main biologic difference between them and other alpha blockers is they target only one type of alpha receptor. They are a first-choice treatment during pregnancy, because they generally pose few risks for the mother or fetus. Methyldopa (Aldomet) is a common form of this type of drug.

Central Agonists

          These medications keep the brain from sending messages to the nervous system that would release catecholamines and thus speed up heart rate and tighten blood vessels. The heart doesn’t pump as hard and blood flows more easily, so blood pressure decreases.These include:

1. alpha methyldopa (Aldomet) 
2. clonidine hydrochloride (Catapres) 
3. guanabenz acetate (Wytensin) 
4. guanfacine hydrochloride (Tenex)

Peripheral Adrenergic Inhibitors

          This group of drugs works to block certain chemical messengers inside the brain, which keeps the smooth muscles from getting the message to constrict. These medications are generally used only if other medications aren’t effective. They include:

1. guanadrel (Hylorel)
2. guanethidine monosulfate (Ismelin)
3. reserpine (Serpasil)

Vasodilators

          Vasodilators relax the muscles in the walls of blood vessels, especially small arteries (arterioles). This widens the blood vessels and allows blood to flow through them more easily. Blood pressure falls as a result. Hydralazine hydrochloride (Apresoline) and minoxidil (Loniten) are examples of these.

Ongoing Medical Care

          To make the most of your treatment, it’s vital to get regular medical checkups and blood pressure tests. Regular checkups allow your doctor to monitor how well treatment is going and make any necessary adjustments to your treatment plan. If your blood pressure starts inching back up, your doctor can respond promptly. Doctor visits also give you an opportunity to ask questions and bring up any concerns.

Treatment for Specific Situations

          Additional treatment options may be needed in certain situations like resistant hypertension or secondary hypertension.
Resistant hypertension refers to blood pressure that remains high after trying at least three different types of blood pressure medication. Someone whose high blood pressure is controlled by taking four different kinds of medication is also considered to have resistant hypertension. Even such hard-to-treat cases can often be managed successfully in time. The doctor might prescribe a different medication, dose, or drug combination. Or the doctor might recommend more aggressive lifestyle changes.
Secondary hypertension is high blood pressure that is directly caused by another health problem or drug side effect. Blood pressure often drops substantially or even goes back to normal once the root cause is diagnosed and treated.

Treatment Options for Children and Teens

           The first-line treatment for children and teens with high blood pressure is a healthy lifestyle. This includes a balanced diet, regular exercise, and weight loss for those who are overweight or obese. Children may also take the same blood pressure medications as adults when necessary. For children with secondary hypertension, blood pressure often returns to normal once the underlying condition is treated.

SOURCE: healthline.com