Definition

Essential hypertension is an increase in blood pressure not caused by another disease or medical condition. Essential hypertension is also known as primary hypertension. Hypertension is more commonly known as high blood pressure among the general public.

Blood pressure is the force of blood against the artery walls as the heart pumps blood throughout the body. Hypertension occurs when the force of the blood is stronger than it should be. Most cases of high blood pressure are classified as essential hypertension.

Another type of hypertension is secondary hypertension, which is high blood pressure with a known cause, such as kidney disease.

Causes

Unhealthy lifestyles and certain circumstances contribute to the onset of essential hypertension, such as:

• Being 65 years old and above
• High salt diet
• Excessive coffee consumption
• Family history of high blood pressure
• Overweight
• Excessive alcohol consumption
• A sedentary lifestyle or lack of physical activity
• Having sleep problems, such as insomnia

Risk Factor

The following factors increase the risk of essential hypertension:

• Genetic or hereditary
• High salt diet
• Stress
• Lack of physical activity
• Excess body weight

Symptoms

Most people with essential hypertension experience no symptoms at first. High blood pressure is usually discovered during routine medical check-ups. Essential hypertension can start at any age. However, it is most common to first occur in mid-age.

Diagnosis

Blood pressure tests are the most effective method for detecting high blood pressure. It is very important to understand how to measure blood pressure and read the results.

Blood pressure readings have two numbers. The first number is systolic pressure, which measures the force of blood against the walls of arteries as the heart pumps blood throughout the body. The second number measures diastolic pressure, which is the force of blood against the artery walls when the heart muscle relaxes and receives blood from the rest of the body.

Blood pressure can vary up or down throughout the day. Blood pressure fluctuates after exercise, at rest, during pain, and even when stressed or angry. Occasional high blood pressure does not necessarily mean you have hypertension. A diagnosis of hypertension is made if blood pressure is elevated on at least 2-3 measurements at different times.

Normal blood pressure vs. abnormal blood pressure

Normal blood pressure is below 120/80 mmHg. While hypertension is a condition when blood pressure is above 130/80.

Some stages of increased blood pressure are as follows:

1. Pre-hypertension

Occurs when blood pressure is higher than normal but does not yet meet the criteria for hypertension. The criteria for prehypertension are:

• Systolic pressure 120-129 mmHg
• Diastolic pressure <80 mmHg

2. Stage 1 hypertension

• Systolic pressure 130-139 mmHg, or
• Diastolic pressure 80-89 mmHg

3. Stage 2 hypertension

• Systolic pressure ≥140 mmHg, or
• Diastolic pressure ≥90 mmHg

The doctor will use a sphygmomanometer or tensimeter to measure your blood pressure. If you have high blood pressure, they will advise you to check it at home on a regular basis. If your doctor instructs you to measure your blood pressure at home, he or she will teach you how to use the tensimeter. You should take your blood pressure every day and report it to your doctor at the next control session. The severity of high blood pressure is determined by the average of several blood pressure readings taken at different times.

The doctor will also conduct a physical exam to look for signs of other comorbidities. This includes checking the eyes, heart, lungs, and blood flow in the neck. Small blood vessels at the back of the eyes may show damage due to high blood pressure. This damage could indicate similar damage elsewhere.

Doctors may also perform the following tests to detect heart and kidney problems:

• Cholesterol test
• Echocardiography, that uses sound waves to display images of the heart
• Electrocardiogram (ECG), which records the electrical activity of the heart
• Kidney and other organ function tests. These tests include blood tests, urine tests, or ultrasounds to check the function of the kidneys and other organs

Management

As of now, hypertension cannot be cured, but it can be controlled so that blood pressure levels stabilize. Some ways to control blood pressure are:

1. Lifestyle Modifications

If you have hypertension, your doctor will suggest lifestyle changes to help you lower it. The recommended lifestyle changes are:

• Exercise at least 30 minutes a day
• Lose weight if you are overweight
• Quit smoking
• Limit alcohol intake to no more than one drink a day if you are a woman and two drinks a day if you are a man
• Reduce stress levels
• Eat a diet low in salt and high in potassium and fiber, which is good for heart health
• If you have kidney problems, do not increase your potassium intake without your doctor's permission

2. Medications

If lifestyle changes are ineffective at lowering blood pressure, your doctor may prescribe one or more antihypertensive medications. The most commonly prescribed hypertension medications are:

• Beta-blockers, such as metoprolol 
• Calcium channel blockers, such as amlodipine
• Duretics, such as hydrochlorothiazide/HCTZ
• Angiotensin-converting enzyme (ACE) inhibitors, such as captopril
• Angiotensin II receptor blockers (ARBs), such as losartan
• Renin inhibitors, such as aliskiren

Complications

Higher blood pressure causes the heart to work harder. Increased blood pressure can harm the organs, blood vessels, and heart muscle. This eventually leads to reduced blood flow throughout the body, which can result in:

• Hypertensive Crisis
• Heart failure
• Heart attack
• Atherosclerosis or hardening of the arteries due to cholesterol buildup, can lead to heart attack
• Stroke
• Eye damage
• Kidney damage
• Nerve damage
• Brain aneurysms, or weakened protrusions of the walls of the brain's blood vessels. If the aneurysm ruptures, it can be life-threatening
• Dementia

Prevention

A comprehensive strategy to reduce hypertension-related mortality and morbidity should include prevention, early detection, and appropriate treatment options. More serious efforts are required to lower blood pressure in high-risk populations, such as those with a family history of hypertension, black ancestry, obesity, high salt consumption, physical inactivity, and/or alcohol consumption.

Even a slight decrease in blood pressure will provide significant health benefits. A 2 mmHg reduction in diastolic blood pressure is estimated to reduce stroke risk by 15% and coronary heart disease risk by 6%.

To prevent high blood pressure from worsening, you can take the following steps:

• Follow your doctor's medication instructions, such as taking the correct dose of medication every day
• Consult with your doctor if other medications you are currently taking may affect your blood pressure
• Routinely check your blood pressure and consult with your doctor about adjusting the type and dose of your medication
• Consistently live a healthy lifestyle, such as quitting smoking and having a healthy diet
• Maintaining an ideal body weight
• Increased physical activity or exercise
• Low salt consumption
• Increased potassium intake
• A diet rich in fruits, vegetables, low-fat meat, fish, and dairy products

When to See a Doctor?

If you meet the above criteria for high blood pressure, consult with a doctor immediately. Proper diagnosis and treatment can prevent worsening of the disease and prevent complications