Understanding Hypertension: Taking Control of Your Blood Pressure
- jennifernavarro292
- Feb 28
- 6 min read
By Jennifer Navarro MSN, RN, NPD-BC
Hypertension
High blood pressure, also called hypertension (HTN), is a very common health issue in the United States, affecting both men and women about equally. The reasons people develop high blood pressure are complicated, and it can happen to anyone, but it tends to be more severe and starts at a younger age in African American communities, often leading to more health problems. According to the Centers for Disease Control and Prevention (CDC), about 45% of Americans have high blood pressure, which means their top blood pressure number is over 130, or their bottom number is over 80.
Pathophysiology (How High Blood Pressure Develops)
Blood pressure is the force of blood pushing against the walls of your arteries. It's determined by how much blood your heart pumps and how hard it is for blood to flow through your blood vessels. If your heart beats faster or pushes out more blood with each beat, or if your blood vessels are narrow or your blood is thicker, your blood pressure goes up. If any of these factors change, it can lead to high or low blood pressure.
There are many reasons someone might develop high blood pressure. Sometimes, the cause is unknown, but other times it can be linked to your genes, your environment, or other health problems that affect how your heart and blood vessels function.
High blood pressure usually happens when your heart is working harder than normal, your blood vessels are constricted (narrowed), or your blood is thicker. Things like genetics, being overweight, stress, and eating too much salt can all play a part. For some people, their bodies hold on to more salt and water, raising the amount of blood in their vessels and increasing pressure. Hormones and the nervous system can also cause blood vessels to tighten, making the pressure higher.
When high blood pressure sticks around for a long time, it forces the heart to work overtime, causing the heart muscle to get thicker and less efficient. This can eventually lead to heart problems like irregular heartbeat or even heart failure. Chronic high blood pressure also damages the kidneys because it makes the tiny blood vessels in the kidneys stiff and inflamed, which can lead to kidney failure over time.
Sometimes, high blood pressure is caused by another health issue, like kidney disease, hormone problems, certain blood vessel disorders, pregnancy, stress, or even certain medications. All these things can increase blood pressure by making blood vessels tighten or causing the body to hold on to too much salt and water.
The tricky thing is, most people with high blood pressure don’t feel any symptoms at first, which is why it's often called the "silent killer." The only way to know for sure is to check your blood pressure. Over time, if high blood pressure isn't treated, it can damage important organs like the heart and kidneys, and cause problems such as thickening of the heart muscle, chest pain, bulging blood vessels (aneurysms), swelling, mini-strokes, vision problems, leg pain, blood clots, trouble thinking clearly, and headaches or migraines.
Diagnostic Testing
High blood pressure (HTN) is checked by listening to your heartbeat and using a blood pressure cuff. To find out if someone really has high blood pressure, doctors need to see higher readings at least twice, on different days. It’s important that the patient doesn’t have nicotine or caffeine for at least 30 minutes before the test since these can affect the results. Sometimes, people get nervous at the doctor’s office, and their blood pressure goes up (“white coat hypertension”). Other times, their blood pressure seems normal at the doctor’s but is high at home (“masked hypertension”). That’s why doctors may ask patients to check their blood pressure at home too.
The doctor will also ask about your medical history and do a physical exam to look for things that could increase your risk, like family history, environment, or lifestyle habits. If high blood pressure is confirmed, the doctor will focus on three main goals: finding out if you have any habits or risks that affect your heart, checking for causes that can be treated, and seeing if your organs (like your heart or kidneys) are already affected.
To check if high blood pressure has caused damage, doctors might do several tests:
· 12-lead electrocardiogram (EKG): Looks for heart problems caused by high blood pressure.
· Urinalysis: Checks your urine for protein, which can show if your kidneys are being damaged.
· Blood sugar tests (like A1C): Helps see if you might have diabetes or issues with how your body handles sugar, since these can go along with high blood pressure.
· Complete metabolic panel: Measures how well your kidneys are working and checks your body’s salt and mineral levels.
Treatment Options for High Blood Pressure (HTN)
How your high blood pressure is treated depends on what type you have and whether it’s starting to affect other parts of your body. Experts agree that the first step in treating high blood pressure is to make healthy changes to your lifestyle. This means:
· Losing extra weight if you need to
· Eating a healthy diet, like the DASH diet, which focuses on fruits, vegetables, and low-fat foods
· Cutting back on salt
· Getting regular exercise, like walking or other activities every day
· Limiting how much alcohol you drink
· Keeping your cholesterol at a healthy level
Let’s focus on treating "primary stage one" high blood pressure, which is a common, early stage. If lifestyle changes aren’t enough, your doctor may prescribe medicine. The type of medicine depends on whether you have other health problems, like heart disease.
· If you don’t have other major health issues, you’ll likely start with a water pill (diuretic) like hydrochlorothiazide. This helps your body get rid of extra salt and water.
· If that’s not enough, your doctor might add other medicines, like ACE inhibitors, ARBs, beta-blockers, or calcium channel blockers. Sometimes, you may take a combination of these. All medicines are started at a low dose and slowly increased if needed.
· If you have other conditions, like heart disease, your doctor may choose medicine like an ACE inhibitor, ARB, or an aldosterone blocker because these specifically help protect your heart and lower your blood pressure.
Your healthcare provider will spend time explaining what’s causing your high blood pressure and how making healthy choices can really help. If you need to start medicine, you’ll learn what the medicine does and what side effects to watch out for.
Because some people’s blood pressure goes up just from being at the doctor’s office (“white coat hypertension”), you’ll also learn how to check your blood pressure at home and keep a record to share with your doctor.
It’s important to understand your treatment plan and the goals for your health. Sticking to your treatment can be tough, so involving your family, using community support, and working with a team of healthcare experts can help you succeed.
Over time, high blood pressure can change the way your body senses and controls blood pressure and can damage the lining of your blood vessels. Medicines can help control your blood pressure but can’t undo any damage that’s already happened. That’s why it’s crucial to have regular checkups and screenings—to catch any problems early, protect your heart and kidneys, and lower your risk for serious health issues. High blood pressure is a leading cause of kidney failure, just behind diabetes.
Safety Concerns for People with High Blood Pressure
If you have high blood pressure, you’re at higher risk for heart problems and serious complications like stroke. In fact, not treating high blood pressure can make your chance of having a type of stroke called a hemorrhagic stroke about five times greater. A lot of people don’t know they have high blood pressure, and even among those who do, many aren’t getting treated for it. High blood pressure can also cause lasting harm to important organs, including your brain, eyes, kidneys, and heart.
Besides that, if you take medicine for high blood pressure, be careful when using other medicines, including ones you buy without a prescription or when having surgery. Some blood pressure medicines, like beta-blockers, can cause heart-related issues, so it’s important to let your doctor or surgeon know about all the medicines you’re taking.
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