Overview of Hypertension (High Blood Pressure)

Hypertension (high blood pressure) is one of the most common chronic diseases worldwide, often called the "silent killer" because it usually presents with no obvious symptoms in its early stages. According to data from the World Health Organization, approximately 40% of adults globally are affected by this condition, with prevalence increasing with age. If not controlled promptly, it can lead to serious complications such as heart disease, stroke, kidney failure, and cause long-term damage to the entire vascular system.

This disease is classified into two main types: "Primary Hypertension" and "Secondary Hypertension." The former accounts for the vast majority, with complex and unclear causes; the latter is caused by specific diseases or medications, such as kidney disease or hormonal imbalances. Understanding its pathophysiology and risk factors is key to developing personalized prevention and treatment strategies.

Modern medicine has established comprehensive systems for diagnosis and treatment, but patients often delay treatment due to lack of symptoms. Regular blood pressure monitoring, lifestyle modifications, and medication are the core strategies for blood pressure control. This article will explore the causes, symptoms, diagnostic methods, and latest treatment trends of this disease.

Causes and Risk Factors

The etiology of primary hypertension involves multiple physiological mechanisms, including:

• Abnormal renal sodium excretion leading to excess body fluid
• Enhanced sympathetic nervous system activity
• Endothelial dysfunction causing arterial constriction

These factors collectively lead to increased vascular resistance and blood volume, ultimately raising blood pressure levels.

Common Causes of Secondary Hypertension

Approximately 5-10% of cases are caused by identifiable conditions, including:

• Kidney diseases (such as renal artery stenosis, chronic kidney disease)
• Endocrine disorders (such as adrenal tumors, thyroid dysfunction)
• Medication effects (such as oral contraceptives, steroids)
• Sleep apnea leading to nocturnal blood pressure fluctuations

These specific causes require detailed examinations for diagnosis.

Main Risk Factors

Genetic predisposition and environmental factors jointly influence disease development:

• Family history: increased risk if immediate relatives have hypertension
• Age: sharp increase after age 50
• Unhealthy lifestyle: high sodium diet, lack of exercise, excessive alcohol consumption, chronic stress
• Metabolic abnormalities: obesity, type 2 diabetes, hyperlipidemia

Excessive sodium intake directly stimulates renal water retention and is a key environmental risk factor.

Symptoms

The most dangerous feature of hypertension is its "asymptomatic" nature; most patients have no noticeable discomfort in early stages. Only when blood pressure rises sharply (such as hypertensive crisis) may symptoms appear:

• Severe headache with blurred vision
• Chest pain or shortness of breath
• Nausea, vomiting, and altered consciousness

These emergency symptoms require immediate medical attention.

Long-term Uncontrolled Symptoms

Chronic hypertension can cause systemic damage, potentially leading to:

• Cardiac hypertrophy and heart failure (palpitations, shortness of breath)
• Retinal changes (vision blurring)
• Renal function decline (nocturia, lower limb edema)
• Small cerebral hemorrhages causing dizziness or memory decline

These symptoms usually manifest only when the disease progresses to a severe stage.

Diagnosis

The diagnostic criterion considers a systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mmHg as abnormal, confirmed by measuring at least three times at different times. The diagnostic process includes:

1. Detailed medical history: assessing family history, medication use, and lifestyle
2. Basic tests: complete blood count, renal function, blood lipid profile
3. Ambulatory blood pressure monitoring: to exclude white coat hypertension
4. Additional tests such as renal artery ultrasound or thyroid function tests to rule out secondary causes

Special Diagnostic Considerations

Different standards apply for the elderly and special populations:

• For those over 80 years old, target blood pressure can be relaxed to below 140/90 mmHg
• Hypertensive disorders during pregnancy need to be distinguished from preeclampsia
• Patients with diabetes and hypertension require stricter control (target <130/80 mmHg)
Diagnostic plans should be tailored considering the overall health status of the patient.

Treatment Options

Treatment strategies are divided into lifestyle modifications and pharmacotherapy based on severity. The World Health Organization recommends that all patients initially adopt:

• Low-sodium diet (less than 2300 mg of sodium daily)
• Increased intake of fruits, vegetables, and whole grains
• Regular aerobic exercise (150 minutes of moderate-intensity activity per week)
• Maintaining a healthy BMI <24

Pharmacological Treatment Choices

When lifestyle adjustments are insufficient, physicians select medications based on patient characteristics:

• Calcium channel blockers (e.g., amlodipine)
• ACE inhibitors / ARBs (e.g., benazepril)
• Diuretics (e.g., hydrochlorothiazide)
• Beta-blockers and alpha-blockers
Often, two or more drugs are combined to achieve target blood pressure.

Emerging Treatment Technologies

Recent developments include:

• Renal nerve ablation: destroying renal nerves via catheter to lower blood pressure
• New drug classes such as selective sodium channel inhibitors
• Digital health tools: smart blood pressure monitors and app tracking systems
These innovations offer new directions for treating resistant hypertension.

Prevention

Primary prevention should start from adolescence, with recommendations including:

• Daily sodium intake limited to 1500-2300 mg
• Reducing refined sugars and saturated fats
• Maintaining moderate weight (waist circumference <90cm for men, <80cm for women)
• Quitting smoking and limiting alcohol (less than 2 standard drinks per day for men)
Regular blood pressure screening is key to early detection.

Targeted Preventive Measures

Specific populations should strengthen prevention:

• High-risk groups (family history, obesity) should measure blood pressure every 3 months
• Postmenopausal women need enhanced blood pressure monitoring
• Chronic disease patients (diabetes, kidney disease) require stricter control
Community health education and workplace health promotion are vital strategies for population-wide prevention.

When Should You See a Doctor?

Seek immediate medical attention if you experience:

• Persistent blood pressure over 180/120 mmHg with headache or visual disturbances
• Chest pain or difficulty breathing
• Weakness on one side or speech difficulties
• Unexplained dizziness with abnormal blood pressure
These may be warning signs of hypertensive emergencies or complications.

Regular Check-up Recommendations

Normal adults are advised to check blood pressure every 2 years, while high-risk groups should be screened every 6 months. Immediate medical attention is needed if:

• Blood pressure remains elevated outside of stress
• Symptoms like dizziness or tinnitus occur
• Other metabolic abnormalities (such as high blood sugar) are present
Early diagnosis can reduce the risk of cardiovascular events by 30-50%.

 

Frequently Asked Questions

What is an appropriate daily salt intake for hypertensive patients?

The World Health Organization recommends that the general population consume less than 5 grams of salt daily, while hypertensive patients should aim for below 3 grams. Excessive salt increases sodium in the blood, leading to water retention and increased vascular resistance. It is advised to replace salt with herbs, spices, or lemon for flavor.

What types of exercise are suitable for hypertensive patients?

Aerobic exercises such as brisk walking, swimming, or cycling are suitable, with a recommended minimum of 150 minutes of moderate-intensity activity per week. Avoid intense competitive sports or breath-holding activities. Consult a doctor before starting and monitor blood pressure regularly.

Can antihypertensive medications be used during pregnancy?

Some antihypertensive drugs may affect fetal development, but uncontrolled hypertension increases the risk of preeclampsia. Doctors may prescribe pregnancy-safe medications like labetalol, with regular monitoring and close coordination with the healthcare team.

What are common mistakes when measuring blood pressure at home?

Avoid caffeine or exercise 30 minutes before measurement, sit quietly for 5 minutes, keep the arm at heart level, and ensure the cuff fits snugly but not too tight. Measure twice daily (morning and evening) and record the readings for assessment.

Why is hypertension called the "silent killer"?

Because early hypertension often has no obvious symptoms, patients may only discover the problem when complications such as dizziness, chest pain, or other issues occur. Long-term uncontrolled hypertension damages the heart, brain, and kidneys, making regular check-ups and early intervention crucial.