In 2000, 972 million (26%) adults had hypertension (high blood pressure) worldwide. In 2025 about 1.5 billion people (29%) are projected to have hypertension, with a significant increase in India and China.1 In established countries, such as the United States, many go untreated as only 69% of the population is aware of hypertension. In addition, among those that undergo treatment many have uncontrolled hypertension.
Blood pressure is force of blood against your artery walls as it circulates through your body. Blood pressure normally rises and falls throughout the day. A normal blood pressure reading is 120/80 mm Hg with the systolic (top number) showing pressure when the heart beats and diastolic pressure (lower number) at rest between heartbeats, when the heart refills with blood.
High blood pressure is a silent killer that often has no warning signs or symptoms, making it essential to have your blood pressure checked regularly. High blood pressure may lead to some of these symptoms:
- Severe headache
- Difficulty breathing
- Fatigue or confusion
- Irregular heartbeat
- Vision problems
- Blood in the urine
- Chest pain
- Pounding in your chest, neck, or ears
Untreated hypertension can lead to serious diseases including stroke, heart disease, kidney failure and eye problems.
How your heart and kidneys are affected by high blood pressure
Kidneys also play a crucial role in regulating the blood pressure (Learn more at Sympathetic Nervous System). Persistent high blood pressure leads to nephrosclerosis, a renal disease that starts with proteinuria progresses to renal insufficiency, and finally to end-stage renal disease requiring dialysis.
renal denervation persistent hypertension
Uncontrolled blood pressure and a stiff heart (LVH)
As the heart thickens, it cannot efficiently contract or relax normally. Diastolic dysfunction, inability of the heart to relax normally, leads to inefficient pumping of deoxygenated blood and subsequently may cause heart failure. With the progression of LVH, patients may suffer from arrhythmia and stroke. Persistent hypertension can lead to hardening of the arteries and atherosclerosis (building of plaque in the arteries), which may cause heart attacks and angina.
How you can help your body
By controlling your blood pressure, you delay the effects of HTN on your organs to much later in your life. For every increase in 20/10 mm Hg of blood pressure, there is 2-fold increase mortality and even a small reduction in blood pressure translates in to a benefit. Below are some suggestions to help you control your blood pressure.
- Simple lifestyle and dietary changes can help reduce blood pressure (See Healthy Lifestyle)
- Take your blood pressure medications on time and as prescribed
- Properly treated high blood pressure should not interfere with daily living
- Remember: Failure to control your blood pressure can lead to serious health problems and sometimes even death
Treatment for Hypertension
Pre-hypertension is readings that are consistently just above the normal level, anywhere between 120 and 139 for systolic pressure or 80 to 89 for diastolic pressure. People in this range have twice the risk of developing heart disease than those with a lower reading. Your doctor may recommend lifestyle changes to help lower your blood pressure. High blood pressure is defined as continuous readings averaging 140/90 or higher for either number.
Categories for Blood Pressure Levels in Adults (Age 18 and Older)2
|Blood Pressure Level (mmHg)|
|High Blood pressure|
|Stage 1 Hypertension||140-159||Or||90-99|
|Stage 2 Hypertension||≤160||Or||≤160|
Diuretics along with lifestyle changes can be the first line of therapy for hypertension. If one drug doesn’t work or is disagreeable, other types of drugs are available. ACE inhibitors are often a choice for a people with diabetes.
If your blood pressure is more than 20 points higher than it should be, your doctor may consider starting you on 2 drugs or combination therapy.
- Angiotensin-converting enzyme inhibitors (ACE)
- Angiotensin II receptor blockers (ARBs)
- Combination medications
- Calcium channel blockers
- Renin inhibitors
Along with medication, life-style change in both diet and exercise is essential for patients with high blood pressure.
Medications to treat high blood pressure
- Thiazide diuretics.Diuretics (water pills) act on kidneys and excrete sodium and water, reducing blood volume and blood pressure. Thiazide diuretics are often the first choice. It is also considered the most effective antihypertensive medication.
- Beta blockers. These medications reduce the workload on the heart,dilate blood vessels and decrease the heart rate and force of contraction of the heart muscle. Beta blockers are also considered cardioprotective.
- Angiotensin-converting enzyme (ACE) inhibitors. These medications inhibit formation of a protein (Angiotensin II) which causes the blood vessel to constrict, and thus help relax blood vessels. The most common side effect of this medication is dry cough and angioedema.
- Angiotensin II receptor blockers (ARBs). These medications help relax blood vessels by blocking the action of the protein Angiotensin II. Side effects may include headache and dizziness.
- Calcium channel blockers. These medications help relax the muscles of your blood vessels. Some slow your heart rate. The common side effect is leg edema.
- Renin inhibitor. Aliskiren slows down the production of a hormone secreted from kidneys called renin. Renin starts a chain of chemical reaction that increases blood pressure. (Read more on sympathetic nervous system) Due to a risk of serious complications, including stroke, you shouldn’t take aliskiren with ACE inhibitors or ARBs.
The following medications are prescribed in combination with the above medications for patients unable to reach their blood pressure goal:
- Alpha blockers. These medications help relax small blood vessels by blocking the hormone norepinephrine from tightening the muscles in the small arteries and veins. The common side effect is postural dizziness.
- Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels. These medications have improved survival in patients with systolic heart failure.
- Central-acting agents. These medications prevent your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels.
- Vasodilators. These medications work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.
The general goal is to start one medication and gradually increase the dose to maximum tolerated dose. A combination of low-dose medications is prescribed to avoid side effects of high dose medications and have the beneficial effects of different co-existing clinical conditions. In fact in clinical trials, 2 or more blood pressure drugs often work better than one. Sometimes finding the most effective medication combination takes several attempts, as each human body responds to the medication differently.
- Kearney PM, et al. Global burden of hypertension: analysis worldwide data. Lancet. 2005;365:217-223.
- Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903-1913.