Hypertension can be described as, the level of blood pressure reached when treatment is advantageous to an individual. Ideal blood pressure is seen to be between 90/60mmHg and 120/80mmHg1. Within the population, it is described as normally distributed2. People are not classified into subgroups of normotensive and hypertensive as many factors come into play2. There are two main types of hypertension and these are classified as primary (essential) and secondary. Essential hypertension is a condition in which there are no specific causes, genetics and environmental factors each play a significant role. When a specific cause can be found, the condition is called secondary hypertension. For example, these causes could be underlying renal or adrenal diseases3.
Many factors are to be considered when deliberating the cause of essential hypertension. Genetics contribute as high blood pressure can run in families. This is not due to one gene, but a combination of 27, however this only changes blood pressure by 1-2mmHg4. Some environmental factors that could lead to an increased blood pressure include salt, potassium, calcium and magnesium intake, weight, alcohol consumption, stress levels, exercise and other dietary factors such as a vegetarian diet5.
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High blood pressure can directly or indirectly damage the kidneys, heart and brain. Some life-threatening conditions hypertension can lead to include heart disease, heart attacks, strokes, heart failure, peripheral arterial disease, aortic aneurysms, kidney disease and vascular dementia1. Strokes and cardiovascular diseases, account for more deaths than any other common medical conditions6.
There are many non-pharmacological ways to decrease blood pressure, which are specifically advised when a patient’s blood pressure is between 120/80mmHg and 140/90mmHg, as they could be at risk of hypertension1, however any patient with a high blood pressure, at any stage of hypertension should be advised this too7. These non-pharmacological treatments are life style changes, including: weight reduction, salt restriction, monitoring alcohol consumption, exercising more and maintaining a healthy diet8. These lifestyle changes have been proved to decrease blood pressure as seen in various studies9.
It is generally considered that patients with a blood pressure of >160/100mmHg, or have conditions such as renal disease or diabetes will benefit from drugs that reduce blood pressure10, 11 . It is advised by the NICE guidelines12 if aged under 55 an ACE inhibitor or low-cost angiotensin II receptor blocker should be used and if over 55 or black person of African or Caribbean family origin of any age, calcium-channel blockers should be used, this is treatment for stage 1 hypertension. When following the flow chart of the NICE guidelines12 the next step should be offered if the previous hasn’t controlled blood pressure levels. As you progress down the flow chart previous treatments become combined, then thiazide-like diuretic becomes introduced. Resistant hypertension, step 4 in the NICE flow chart12, is a stage at which blood pressure remains at or above 140/90mmHg after maximum possible treatment13 at this stage there are 2 treatments to consider, stated by the NICE guidelines14. Patients should then refer to an expert if the blood pressure is still uncontrolled13.
In conclusion hypertension has many causes. These can be treated in a number of ways including both pharmacological and non-pharmacological methods.
References
- NHS Choices. High blood pressure (Hypertension). Available from: https://www.nhs.uk/conditions/blood-pressure-(high)/pages/introduction.aspx [Accessed 20th October 2017)
- MacGregor GA, KM Norman. Fast Facts: Hypertension. 3rd ed. Oxford: Health Press Limited; 2006. p.10
- Beevers DG, Lip GYH, O’Brien E. ABC of Hypertension. 6th ed. Chichester: John Wiley & Sons; 2015. p.5.
- 4Beevers DG, Lip GYH, O’Brien E. ABC of Hypertension. 6th ed. Chichester: John Wiley & Sons; 2015. p.1.
- Beevers DG, Lip GYH, O’Brien E. ABC of Hypertension. 6th ed. Chichester: John Wiley & Sons; 2015. p.5-8.
- Beevers DG, Lip GYH, O’Brien E. ABC of Hypertension. 6th ed. Chichester: John Wiley & Sons; 2015. p.2.
- Williams H. Hypertension: Management. 2015. p.2.
- Beevers DG, Lip GYH, O’Brien E. ABC of Hypertension. 6th ed. Chichester: John Wiley & Sons; 2015. p.63-66.
- Beevers DG, Lip GYH, O’Brien E. ABC of Hypertension. 6th ed. Chichester: John Wiley & Sons; 2015. p.64-66, figures 8.1, 8.2, 8.3, 8.4.
- Williams H. Hypertension: Management. 2015. p.1.
- Beevers DG, Lip GYH, O’Brien E. ABC of Hypertension. 6th ed. Chichester: John Wiley & Sons; 2015. p.68.
- NICE. Treatment steps for hypertension. Available from: https://pathways.nice.org.uk/pathways/hypertension#content=view-index&path=view%3A/pathways/hypertension/treatment-steps-for-hypertension.xml [Accessed 21st October 2017].
- Williams H. Hypertension: Management. 2015. p.6.
- NICE. Treatment steps for hypertension. Available from: https://pathways.nice.org.uk/pathways/hypertension#content=view-node%3Anodes-step-4-resistant-hypertension&path=view%3A/pathways/hypertension/treatment-steps-for-hypertension.xml [Accessed 21st October 2017].
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