Hypertension or high blood pressure (BP) is a condition where the pressure on the blood vessel wall is increased from inside.

It is a common condition worldwide. We all know someone in the family or in our friends circle who have hypertension.The incidence is 25% in men and 20% in women worldwide. In India the incidence is higher – 30% in men and 27% in women. The incidence is higher in the urban population than in the rural population.

Blood pressure is written as two numbers. The first (systolic) number represents the pressure in blood vessels when the heart contracts or beats. The second (diastolic) number represents the pressure in the vessels when the heart rests between beats. People who have a blood pressure of 140/90 or higher are known to have hypertension. BP of 130-139/80-89 is defined as high normal, 120-129/<80 is defined as normal, and <120/<80 is defined as optimal.

Hypertension is a serious disease and it is known as a silent killer. Usually, it does not present with any symptoms in the early stage. Commonly known symptoms such as headaches are seen only when BP is very high > 180/110. Some people may have nose bleeds, fatigue, dizziness, nausea and vomiting, anxiety, or problems with vision.

The heart pumps blood into the blood vessels. So, high blood pressure can affect the heart. It can also increase the risk of stroke and peripheral arterial disease.

Lifestyle factors which increase the risk of getting hypertension are:

1. •Obesity (increased weight), particularly central obesity where the fat is disproportionately distributed inside your tummy and presents as increased waist circumference.
2. •Increased salt intake
3. •Not doing enough exercise
4. •Stress
5. •Smoking
6. •Excessive alcohol intake

Diabetes, family history of hypertension, high cholesterol land kidney disease also increase the risk of developing hypertension.

Hypertension is diagnosed by measuring the blood pressure either by using automated BP machines at home or by a health professional. Everyone should get their BP checked when they reach 40 years of age and then at least every 5 years or more frequently if they have risk factors. In-fact it is better to check BP at home as it gives a more correct value. Many people are tense when they see a doctor and can thus show a higher BP reading (White coat hypertension). A few readings should be taken at home setting and their average is taken to determine whether the person has hypertension. A person should not be diagnosed with hypertension on a single reading unless it is very high >180/110.

People with hypertension need to have their blood pressure controlled to prevent any long-term problems. High blood pressure can damage many organs. Let us look at them one by one.

Damage to the arteries: Healthy arteries are flexible, strong, and elastic. Their inner lining is smooth so that blood flows freely, supplying vital organs and tissues with nutrients and oxygen. Hypertension gradually increases the pressure of blood flowing through your arteries. As a result, you might have:

1. •Damaged and narrowed arteries:High blood pressure can damage the cells of the inner lining of arteries. When fats in food, enter the bloodstream, they can collect in the damaged arteries. Eventually, your artery walls become less elastic, limiting blood flow throughout your body.
2. •Aneurysm::Over time, the constant pressure of blood moving through a weakened artery can cause a section of its wall to enlarge and form a bulge (aneurysm). An aneurysm can potentially rupture and cause life-threatening internal bleeding. Aneurysms can form in any artery, but they're most common in the body's largest artery (aorta). Sometimes a longitudinal tear occurs along the wall of the artery and it is called dissecting aneurysm of the artery. They need emergency care and 20% die before they reach the hospital. Even if they have emergency surgery about 30% of patients die. These patients present with severe chest pain going to their back of the chest.

Damage to your heart:High blood pressure can cause many problems for the heart, including:

1. •Coronary artery disease:Arteries narrowed and damaged by high blood pressure have trouble supplying blood to the heart. When blood can't flow freely to your heart, you can have chest pain (angina), irregular heart rhythms (arrhythmias), or a heart attack. Patients with angina present with chest pain on exercising or when they are angry and is relieved on rest. In heart attack the chest pain persists and the patient may have breathlessness, dizziness, and palpitations.
2. •Enlarged left heart:High blood pressure forces your heart to work harder to pump blood to the rest of your body. This causes part of your heart (left ventricle) to thicken. A thickened left ventricle increases your risk of heart attack, heart failure, and sudden cardiac death.
3. •Heart failure:Over time, the strain on your heart caused by high blood pressure can cause the heart muscle to weaken and work less efficiently. Eventually, your overwhelmed heart begins to fail. Damage from heart attacks adds to this problem. These patients have breathlessness, cough and inability to lie flat due to fluid accumulating in the lungs. They can have swelling of their feet and ankles when sitting or standing for a long time which reduces when elevating their feet.

Damage to your brain:The brain depends on nourishing blood supply to work properly. But high blood pressure can cause several problems, including:

1. •Transient ischemic attack (TIA):It is sometimes called a mini-stroke, a TIA is a brief, temporary disruption of blood supply to the brain. Hardened arteries or blood clots caused by high blood pressure can cause TIA. TIA is often a warning that you're at risk of a full-blown stroke. In a stroke the patients have one or more of the following symptoms – drooping of the face on one side with a deviation of the mouth to the opposite side when they smile, inability to move one side of the body or one arm or one leg, inability to articulate words and sudden loss of vision. If that happens they should seek urgent medical help from neurologists by going to the hospital. If the symptoms improve within 1 hr it is TIA. If symptoms persist more than 1 hr it is stroke.
2. •Stroke:A stroke occurs when part of the brain is deprived of oxygen and nutrients, causing brain cells to die. Blood vessels damaged by high blood pressure can narrow, rupture, or leak. High blood pressure can also cause blood clots to form in the arteries leading to your brain, blocking blood flow and potentially causing a stroke. Urgent treatment within 4hrs of onset of symptoms to dissolve the clot can help the patients recover with minimal persistent weakness. Before having the treatment, bleeding inside the brain needs to be ruled out which is done by an urgent CT scan of the brain.
3. •Dementia:Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain can also cause vascular dementia.
4. •Mild cognitive impairment:This condition is a transition stage between the changes in understanding and memory that generally come with aging and the more-serious problems caused by dementia. Studies suggest that high blood pressure can lead to mild cognitive impairment.

Damage to your kidneys:Kidneys filter excess fluid and waste from your blood — a process that requires healthy blood vessels. High blood pressure can damage the blood vessels in and leading to the kidneys. Having diabetes in addition to high blood pressure can worsen the damage. Kidney problems caused by high blood pressure include:

1. •Kidney scarring (glomerulosclerosis):This type of kidney damage occurs when tiny blood vessels within the kidney become scarred and unable to effectively filter fluid and waste from your blood. Glomerulosclerosis can lead to kidney failure.
2. •Kidney failure:High blood pressure is one of the most common causes of kidney failure. Damaged blood vessels prevent kidneys from effectively filtering waste from your blood, allowing dangerous levels of fluid and waste to accumulate. You might ultimately require dialysis or kidney transplantation.

Damage to your eyes:High blood pressure can damage the tiny, delicate blood vessels that supply blood to the eyes, causing:

1. •Damage to retina (retinopathy):Damage to the light-sensitive tissue at the back of your eye (retina) can lead to bleeding in the eye, blurred vision, and complete loss of vision. The risk is greater if you have diabetes in addition to high blood pressure.
2. •Fluid build-up under the retina (choroidopathy):Choroidopathy can result in distorted vision or sometimes scarring that impairs vision.
3. •Nerve damage (optic neuropathy):Blocked blood flow can damage the optic nerve, leading to bleeding within the eye or vision loss.

Sexual dysfunction:The inability to have and maintain an erection (erectile dysfunction) becomes increasingly common in men as they reach age 50. But men with high blood pressure are even more likely to experience erectile dysfunction. That's because limited blood flow caused by high blood pressure can block blood from flowing to your penis.

Women can also experience sexual dysfunction as a result of high blood pressure. Reduced blood flow to the vagina can lead to a decrease in sexual desire or arousal, vaginal dryness, or difficulty achieving orgasm.

It is best to prevent developing hypertension. One can do nothing about age and genetics. Diabetes is two types – Type 1 diabetes is due to less production of insulin by the body and most of these start in childhood or teenagers and early ’20s. These patients need to be rapidly started on insulin.

Type 2 diabetes is the one which is more common and usually starts in middle age or later. It is mainly caused by an unhealthy lifestyle and can be prevented by reducing weight by doing more exercise and reducing food intake especially unhealthy food with high carbohydrates and fat. These are also risk factors for the development of hypertension.

The risk factor can be controlled by a healthy lifestyle of reducing food with carbohydrates and fat and eating healthily with a lot of fiber such as vegetables and fruits. One should do plenty of exercises. Reducing salt intake helps reduce your risk. Smoking is another risk factor for developing hypertension. It also causes several other health problems and it is advisable not to smoke. If you are a smoker, you should try and stop. If you are finding it difficult to stop smoking, you can seek help from doctors. Doctors can help you by suggesting counseling or prescribing medication. Meditation and mindfulness can help reduce stress.

If you are diagnosed with hypertension, it is important not to panic and get stressed. Lifestyle can help reduce your blood pressure. Your doctor will do some tests to find out about how your heart, kidney, and liver are functioning before prescribing medication. Regular medications and check-up by doctor help reduce your chances of developing any of the complications.