So What Causes Our Blood Pressure To Be Elevated
Our blood pressure can rise transiently in response to a specific situation, or can be elevated more chronically secondary to certain diseases, diet, lifestyle, even aging. The latter is more important for long term health.
Temporary elevations in blood pressure can result from stressful life circumstances such as pain, an argument with a friend, pressure on the job, grief or depression, waiting for your coffee at Starbucks. You get the picture. This is normal, expected, and a part of life.
More sustained elevations in blood pressure can result from chronic conditions such as aging , a diet high in salt , a diet high in cholesterol , hormonal changes, diseases of the brain or kidney the list goes on. It is this long term hypertension, however, that can lead to disease.
The take-home point for our patients here is that, while we cant always control the day to day circumstances that lead to fluctuations in our blood pressure, the main goal is a relatively well-controlled blood pressure over time. It is also important to point out that as we age, and our blood vessels naturally get stiffer, it is normal to have a gradually increasing baseline pressure over time. In other words, healthy blood pressure for a 20-year-old is not the same number as healthy blood pressure for a 70-year-old, and so a healthy range is relative to the patient and their chronic medical conditions.
Pathophysiology Of Malignant Hypertension
what is malignant hypertension?
- When chronic hypertension is not treated, it may eventually reach a tipping point where the hypertension itself is causing progressive microvascular damage. This leads to a vicious spiral that, if untreated, will progress to death.
- The term malignant hypertension is somewhat outdated . Nonetheless, as a general concept this remains useful.
- Malignant hypertension is the purest form of primary hypertensive emergency.
pathophysiology of malignant hypertension
- The vicious spiral is shown above. The core of this spiral is that hypertension causes microcirculatory damage that impairs renal perfusion, leading to activation of the renin-angiotensin system . RAS activation, in turn, causes vasoconstriction which leads to worsening hypertension.
- Clinical implications of this pathophysiology include the following:
- The primary pathophysiological problem is excessive vasoconstriction. Thus, the optimal treatment may include a vasodilator . Alternatively, use of a beta-blocker will not address this underlying problem.
- Patients are sometimes intravascularly volume depleted . When vasoconstriction is treated, this may unmask underlying volume depletion which is best treated with IV crystalloid administration.
What Is A Hypertensive Crisis
A hypertensive crisis occurs when your blood pressure is so high that it can inflame your blood vessels and impair the ability of your cardiovascular system to work as it should, putting you at risk for stroke, heart attack, or other severe illness.
Hypertensive crises are divided into two categories: urgent and emergency. In an urgent crisis, your blood pressure is over 180 systolic or 110 diastolic . However, you usually arent experiencing any symptoms to indicate organ damage.
In an emergency crisis, your pressure is over 180 or 120 and you also have symptoms that indicate your organs are becoming damaged. Or, your blood pressure may be lower than 180/120, but its higher than its ever been and you are feeling symptoms possibly related to organ damage.
These serious symptoms can include:
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What Is The Quickest Way Of Controlling High Blood Pressure
It is not usually possible to lower blood pressure immediately without medical intervention. Doctors use intravenous antihypertensive medications for immediate treatment. This treatment needs to be given very carefully because reducing blood pressure immediately by a lot can cause other problems. Therefore, it is important to seek professional medical care to lower your blood pressure in an emergency.
Why Is Your Blood Pressure Important
Your blood pressure is important because if it is too high, it affects the blood flow to your organs. Over the years, this increases your chances of developing heart disease, stroke, chronic kidney disease, eye disease, erectile dysfunction and other conditions.
Very occasionally, people with very high blood pressure are at serious risk of problems and need urgent treatment in hospital to reduce the risk of a stroke or heart attack.
Current Australian guidelines recommend that if you have persistent raised blood pressure over 160/100 mmHg, but are at low risk of having a stroke or heart attack, you should talk to your doctor or specialist about taking medication to lower your blood pressure.
For further information, visit the Choosing Wisely Australia website.
If youre over 18, you should have your blood pressure checked by your doctor at least every 2 years, or more often if advised.
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Common Causes Of Extremely High Blood Pressure
Lifestyle choices
Being overweight, consuming a high-fat diet, smoking excessively and drinking alcohol, and specific medication can also raise the risk of hypertension.
Genetics
One major cause of hypertension is genetic predisposition. The probability of developing hypertension is higher in adults with a family history of high blood pressure or diabetes, for those with kidney disease, lupus, hyper or hypothyroidism, and obstructive sleep apnea.
Special situations
High blood pressure may occur in pregnancy. There are special considerations for children with high blood pressure.
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Hypertensive Crisis: When To Go To The Er For High Blood Pressure
If you are one of the 75 million Americans dealing with high blood pressure, you may have heard about a hypertensive crisis. Hypertension begins at a blood pressure reading of 140/90, and it becomes increasingly more severe after that. Because blood pressure spikes affect us all in different ways, its hard to know when should you go to the ER. One of Advance ERs experienced physicians, Dr. Joseph Meier, takes time to answer your hypertension questions so you know exactly when to go to get medical help.
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What Is Hypertension Urgency
A hypertensive crisis can be classified as either urgent or emergency. They are identified according to evidence of end-organ damage. Urgent hypertensive crisis is blood pressure that is extremely high without apparent end-organ damage yet, according to Dr. Huot. The condition does not require hospitalization.
According to the American Heart Association, if your numbers are 180/120 or greater with no symptoms, wait about five minutes and retake your blood pressure. If the readings are still high, talk to your doctor about the appropriate steps you have to take.
How To Manage High Blood Pressure At Home
The best way to manage high blood pressure at home is to adjust your lifestyle. Here are some recommendations:
Regular physical exercise
People with hypertension are advised to engage in moderate-intensity exercise for at least 150 minutes every week or 75 minutes of high-intensity exercise weekly. Some suitable activities include cycling, jogging, walking, aerobics, and swimming. Strength training is also recommended at least twice a week.
Diet
People with high blood pressure should implement a healthy heart diet:
Stress reduction
Learn to manage or avoid stress, so that it doesnt impact your blood pressure. A great way to do this would be to adopt a few relaxation skills such as meditation, yoga, warm baths, or taking long walks. You should avoid consuming alcohol, smoking, and taking recreational drugs to cope with stress, which can contribute to elevated blood pressure.
Medication
Doctors often recommend specific medication to manage high blood pressure levels. The type of medication you will take depends on the individual and your underlying medical conditions. Ensure you carefully read the labels and only use medication prescribed by a medical practitioner.
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What Is A Hypertensive Emergency
A high blood pressure reading of 180/120 millimeters of mercury , or higher, that comes with chest pain, back pain, numbness or weakness, or vision changes, might indicate a hypertensive emergency.
According to Dr. Huot, these symptoms may indicate end-organ damage, where the blood vessels in the brain, heart, kidneys, and aorta are injured due to untreated high blood pressure. It can cause stroke, heart attack, and kidney failure.
End-organ damage due to a hypertensive emergency has the following symptoms:
- Chronic kidney disease
- Medication interactions
These emergencies usually happen when a person stops taking their medicines for blood pressure, says Dr. Huot.
How Is High Blood Pressure Diagnosed
Your blood pressure varies from day to day, even from moment to moment. Generally, if a person has a blood pressure reading taken on 3 separate occasions that is greater than 140/90 mmHg, they have high blood pressure. Your doctor may ask you to monitor your blood pressure at home, or wear a monitor over a 24-hour period, to see how it varies and to make sure they get an accurate reading.
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Why Do Care So Much About Blood Pressure
At the end of the day, our blood vessels are the critical plumbing system of the body that keeps blood flowing to all our organs. We will spare you a trip back to physics class, but some of you may remember how the resistance in a pipe affects how effectively fluid can flow through those pipes. A blood pressure that is too high or too low will affect how well our vessels can deliver blood to the rest of our body.
Most patients are familiar with the way chronically elevated blood pressure can be detrimental to our health. Our critical organs are all affected when our blood pressure is persistently elevated over time. This can lead to a spectrum of diseases coronary artery disease, congestive heart failure, stroke, kidney disease the list goes on. This is why doctors want to pay close attention to helping their patients maintain a healthy range of blood pressures.
What Kind Of Organ Damage Might Occur From A Hypertensive Crisis
The heart can be damaged, the kidneys may fail, the aorta may be compromised, the eyes could be damaged, there could be fluid in the lungs and even memory loss, says Dr. Meier. Thats why its so important to get fast medical intervention to try to minimize the damage of the hypertensive crisis.
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