Hypertension: symptoms, risk factors and prevention

By Cristiano Antonino On Oct 28, 2022

Hypertension is the elevation of blood pressure values within the arterial circulation above normal values. High blood pressure is a potentially dangerous condition for the body and an important cardiovascular risk factor

Hypertension can also cause serious diseases such as:

hypertensive retinopathy
nephropathy
cardiopathy
atrial fibrillation
myocardial infarction
aortic aneurysm.

Blood pressure is a value that depends on the ratio between the amount of blood the heart pumps per minute and the peripheral arterial resistance, i.e. the resistance of the artery walls to the passage of blood flow.

If either of these two values rises, the pressure will also increase, as during intense physical exertion or when the arteries become less elastic.

Blood pressure reaches a maximum value when the heart contracts (systole) and a minimum value when it relaxes by filling with blood (diastole).

Under ideal conditions, systolic (or Maximum) pressure should not exceed 120 mmHg and diastolic (or Minimum) pressure 80 mmHg.

When is Hypertension?

Blood pressure is not constant in the human body because it depends on the amount of blood and nutrients the tissues need at a specific time.

The human body is able to make pressure adjustments even within seconds and without any conscious control, through a complex interaction between the central nervous system, hormones and substances produced in the arterial circulation.

When blood pressure is outside normal ranges in a resting situation, we are dealing with a form of hypertension.

There are different forms and stages of hypertension

This can be distinguished into Essential Hypertension and Secondary Hypertension. It can also be classified according to the severity of the disorder into 4 stages: Prehypertension (or Normal – High Blood Pressure), Stage 1, Stage 2 and Stage 3 (ESC Guidelines – ESH 2018).

Essential Hypertension

Most hypertensive people suffer from a form of essential hypertension.

This is the result of increased vascular resistance, the cause of which is often not definable and depends on multiple pathophysiological factors.

This form of hypertension can involve both systolic and diastolic pressure.

In some cases, the increase in pressure only affects the systemic (also called maximal) pressure.

In this case we speak of Isolated Systolic Hypertension and it is the most common form of hypertension in the elderly.

With age, arteries tend to lose elasticity and their ability to adapt to changes in blood flow is reduced.

Values of this form of hypertension are above 140 mmHg for the maximum BP and are not accompanied by significant increases in the minimum BP (which remains below 90 mmHg).

Stages of hypertension

There are different stages of hypertension that are defined by how far blood pressure deviates from normal values (up to 129 mmHg for maximum BP and up to 84 mmHg for minimum BP according to the most recent 2018 European Guidelines).

They are recognised in:

normal/high BP (formerly referred to as prehypertension). A Normal/High BP is defined as if the systolic pressure is between 130 and 139 mmHg and the diastolic pressure is between 85 and 89 mmHg.
Stage 1 hypertension. Stage 1 hypertension occurs when systolic pressure values are between 140 and 159 and/or diastolic pressure values between 90 and 99. If there are no other cardiovascular diseases, diabetes mellitus or kidney disease, it is advisable to first change your lifestyle and eating habits. The doctor may also assess the need for blood pressure control medication.
Stage 2 hypertension. In this stage, the systolic pressure measures between 160 and 179 mmHg and/or the diastolic pressure is between 100 and 109 mmHg. In addition to changes in lifestyle habits, medication to lower blood pressure is almost always recommended in these cases.
Stage 3 hypertension. This is defined by Systolic Pressure values above 180 mmHg and/or Diastolic Pressure values above 110 mmH. At this point, it is necessary to emphasise that the cardiovascular risk (i.e. the possibility in statistical terms of encountering a cardiovascular event such as a myocardial infarction or cerebral stroke) starts to rise as soon as the pressure is above 120/70 mmHg and doubles with every 20-point increase in systemic pressure and every 10-point increase in diastolic pressure.

Secondary hypertension

Secondary hypertension emerges as a disorder related to other pathologies, such as renal artery stenosis, hyperaldosteronism, hyperthyroidism, Cushing’s syndrome, coarctation of the aorta, and sleep apnoea syndrome.

In addition, secondary hypertension can be caused by taking certain medications, including self-medication drugs such as non-steroidal anti-inflammatory drugs, nasal decongestants and some weight loss supplements.

Medications for autoimmune diseases such as glucocorticoids and cyclosporine, which cause narrowing of the arteries, can also lead to high blood pressure.

Hypertension can also be a side effect of certain drugs used to treat depression.

Finally, a rise in blood pressure can occur in pregnant women around the 20th week.

When the rise in blood pressure is accompanied by an excess of protein in the urine, this condition is called pre-eclampsia.

In most cases, the pressure returns to normal within six months after delivery.

The symptoms of high blood pressure

Most hypertensives have no specific symptoms, which is why hypertension has been nicknamed the ‘silent killer’.

Some signs of uncontrolled hypertension may be:

a localised headache in the back of the neck or the top of the head that disappears spontaneously after a few hours
dizziness
palpitations
fatigue
nosebleeds (nosebleeds)
visual disturbances
impotence.

The most dramatic alarm bells are cardiac arrhythmias, transient cerebral ischaemia attacks (TIA), and subconjunctival haemorrhages.

Diagnosis of hypertension: how to measure blood pressure

Measuring blood pressure regularly is the most effective method of diagnosing hypertension at an early stage.

Blood pressure is measured using a mercury or aneroid sphygmomanometer or a semi-automatic oscillometer.

Before measurement, the patient must remain seated for a few minutes.

The cuff is placed on the arm, with the lower edge of the cuff coinciding with the bend in the elbow, keeping the meter at heart height, and the maximum and minimum pressures are measured, defined respectively by the appearance and disappearance of a pulse detectable with a phonendoscope.

The optimal position is that of the patient sitting with both feet on the floor and the arms in a resting position, preferably resting on the table.

The first time it is advisable to measure the blood pressure in both arms to identify any disturbances in the peripheral circulation.

In the event of different values, the higher one will be considered; the arm with the higher reading (dominant arm) should be used for subsequent measurements.

To obtain reliable values, it is a good idea not to take caffeine or smoke in the 30 minutes before the test.

Good practice, especially when using automatic measuring devices, is to repeat the measurement 3 times consecutively and to take an average of the 3 measurements.

Should the first of the measurements be significantly higher than the subsequent ones, this should be considered the result of an alarm reaction and can be excluded from the average.

If the pressure is below 120/80 mmHg, it is called hypotension.

Overall, more than 50% of men and more than 40% of women are hypertensive; only women in central Italy (38%) deviate from these values.

With regard to antihypertensive treatment, the picture also appears better for women: men are more treated because the prevalence of hypertension is higher, but there are fewer untreated hypertensive women (33%) than untreated hypertensive men (43%).

Risk factors and prevention of high blood pressure

Increased awareness of which factors expose one to the risk of hypertension is important in order to prevent cardiovascular diseases.

The factors that make an individual more prone to developing hypertension are:

familiarity
advancing age
sex
obesity.

Women, in fact, while up to around 55 years of age are less likely to develop hypertensive disease, after the menopause they are at greater risk due to hormonal changes.

Other risk factors are:

an unhealthy lifestyle
a diet rich in fat
excess salt in food
a sedentary lifestyle
alcohol
smoking
lack of regular physical activity
stress.

Tense situations are also absolutely to be avoided to prevent high blood pressure

These, in fact, provoke a hormonal response that prepares the body for action: the heartbeat increases and more blood is pumped from the heart.

If this condition is prolonged over time, it causes harmful effects including increased blood pressure.

For these reasons, it is essential to learn stress management strategies, doing relaxation exercises and getting enough rest.

In general, a healthy lifestyle is essential to keep blood pressure under control and prevent the risk of cardiovascular disease: avoid smoking, eat foods rich in vitamins and fibre, eat little salt, exercise regularly, avoid stress and control weight.

According to several clinical studies, lifestyle changes actually help to control blood pressure, both in combination with drug therapy and without it.

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