Hypertension, defined as blood pressure that is elevated and higher than normal, is one of the most common medical conditions in the world. With several resulting conditions and significant healthcare expenses, the societal impact of hypertension is tremendous. Measures to prevent and treat hypertension have one common goal: to minimize the risk of complications stemming from high blood pressure.
Atherosclerosis
Hypertension is one of the major risk factors of atherosclerosis. In combination with other factors such as high cholesterol and diabetes mellitus, hypertension accelerates the process by which plaques form in the walls of the arteries. Complications result depending on which arteries are affected and, consequently, which organs receive inadequate delivery of blood and oxygen. Of these complications, two are especially common and associated with morbidity and mortality: heart attack and stroke.
Congestive Heart Failure
Hypertension can lead to a heart attack, which can result in congestive heart failure over time because of impaired heart muscle contraction. However, hypertension can also lead to congestive heart failure in a different way. If the blood pressure is consistently high, the heart has to constantly pump against a high level of resistance. This causes the heart muscle of the left ventricle to thicken (left ventricular hypertrophy, or LVH). If it continues, the thickening can be so great that it reduces the space within the ventricle, limiting the amount of blood that gets pumped out.
Kidney Failure
Another effect of untreated high blood pressure is kidney failure. Along with diabetes mellitus, hypertension is a major risk factor for this condition because of damage to the filtering portions of the kidney (glomeruli). Additionally, such kidney disease, in turn, can increase blood pressure. Between 80% and 90% of patients with chronic kidney failure have hypertension.
Aortic Dissection
Hypertension can cause aortic dissection in which the layers of the wall of the aorta separate from each other. This generally occurs when the blood pressure remains consistently at a moderate to severe level. Inherent weakness of the aortic wall, as with Marfan's syndrome, may also play a role.
Malignant Hypertension
The problems of atherosclerosis, congestive heart failure, and kidney failure do not require hypertension to be extreme. However, if the blood pressure becomes severely high, then hypertension becomes malignant and requires quick and immediate treatment.
If a patient exhibits no symptoms but the blood pressure has a systolic value greater than 220 mmHg or a diastolic value greater than 120 mmHg, the condition is termed hypertensive urgency. However, in severely high blood pressure with symptoms, including but not limited to chest pain, visual changes, headache, or vomiting, the condition is known as a hypertensive emergency. This involves damage to organs, which must be addressed with drastic blood pressure control within minutes to hours.
Importance of Prevention
High blood pressure is more than just a set of two elevated numbers. It's an ongoing condition that can have serious consequences. As silent as hypertension can be, taking measures to keep one's blood pressure under control can mean the difference between life and death.
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