Overview
Hypertension is the medical term for chronic high blood pressure. There are two types of hypertension: primary hypertension (also known as essential hypertension) and secondary hypertension. Primary hypertension means that the cause of the high blood pressure is undefined; the majority of hypertension cases (95%) are classified as primary hypertension.
Around 5% of cases of hypertension are cases of secondary hypertension, which is when the patient’s high blood pressure is caused by an underlying disease.
There are a number of forms of hypertension. These include: white coat hypertension, meaning that blood pressure is high in clinical settings but not at other times; malignant hypertension or hypertensive emergency, when the patient’s organs may be damaged as a result of the high blood pressure; and resistant hypertension, which is when the patient’s blood pressure does not respond to therapeutic lifestyle changes and at least two other anti-hypertensive drugs.
Symptoms
In most patients, hypertension does not cause any specific symptoms and so the condition is only identified when a doctor physically examines them.
When hypertension does cause symptoms, the symptoms fall into one of the following categories: related to the high blood pressure itself; caused by hypertensive vascular disease; or caused by the underlying disease, if the patient has secondary hypertension.
Although headaches are often thought of as a symptom of high blood pressure, a headache is in fact a symptom of severe hypertension only, and patients tend to experience headaches upon waking up. Other symptoms include light-headedness, vertigo, tinnitus, altered vision and fainting episodes. You may also experience dizziness, palpitations, easy fatigability and impotence. Malignant hypertension and untreated hypertension may cause acute or chronic damage to the brain, heart, arteries (such as aortic dissection), kidneys and eyes.
Diagnosis
In order for your doctor to confirm that you have hypertension, you will need to provide your medical history as well as undergoing a physical examination and laboratory tests. These tests are also used to rule out any of the possible causes of secondary hypertension. Your blood pressure should be measured at least twice and on two separate occasions.
If you have a strong family history of hypertension and have had high blood pressure in the past, you are likely to have primary hypertension. If there is a possibility that you have white coat hypertension, you may be diagnosed using a 24-hour blood pressure device which can be used at home.
Secondary hypertension often develops in patients under 35 years old or over 55 years old. If you do have secondary hypertension, you will need other tests to establish the underlying cause, such as an ultrasound or other imaging tests.
Treatment
If you have primary hypertension, your first treatment option will include dietary changes, physical exercise and weight loss. If this treatment is ineffective or unsuitable for you, you may be given anti-hypertensive drugs to treat the hypertension.
If you have secondary hypertension, your treatment will depend on the underlying condition which causes the hypertension. If you have an endocrine disease, your treatment will be tailored to the specific condition affecting your hormones.
If the underlying condition is caused by a narrowing of the blood vessels in your kidney, you will undergo an imaging test (called a transarterial angiography) to confirm the location of the narrowed area and a doctor will insert a stent (a tiny metal mesh tube) into the vessel to support it and ensure it stays open. This restores the normal blood flow to the kidney.
If you have resistant hypertension, you may be given medication to lower your blood pressure. New drugs are currently being investigated, so there may be a medication suitable for you. Alternatively, you may undergo a more invasive method, such as renal denervation, a minimally invasive procedure in which a doctor deliberately damages specific nerves in the renal artery to lower the patient’s blood pressure.