High blood pressure is a condition that occurs when blood pressure on the artery walls exceeds the threshold values of 90 mmHg (minimum) and 140 mmHg (maximum). In this article, we will give you a complete guide about what causes high blood pressure? Arterial hypertension is a condition that constitutes a risk factor for other cardiovascular diseases ( heart attack and stroke ) and of other organs such as the kidneys and retina.
About a quarter of Italians are hypertensive (about 15 million), but only half are aware of it, and more than 60%, despite the therapy, do not reach adequate blood pressure. Yet returning to normal values could reduce the risk of mortality from cardiovascular disease, given that 40% of deaths from stroke and 25% from coronary heart disease, including heart attacks, are attributable to hypertension.
Hypertension: reference values
The blood pressure is the value that the blood flow exerted on the walls of the arteries. It depends on the relationship between the amount of blood that the heart pumps per minute and its resistance in the arteries. When one of these two values rises, the pressure also increases, as during intense physical exertion or when the arteries are not flexible or elastic ( arteriosclerosis ). The blood pressure has a maximum value when the heart contracts ( systolic ) and a minimum when it relaxes blood filling ( diastolic ).
While it is quite clear that a person is hypertensive when the maximum blood pressure is above 140 mmHg and the minimum is 90 mmHg, it is not easy to establish normal blood pressure values for the entire population. In fact, the pressure changes based on sex, age, weight, and ethnicity.
Other factors influence the pressure:
- The apparatus used to measure it;
- The time of day;
- Who takes the measurement;
- The psychophysical state.
Considering all these factors, there is agreement among experts in believing that, in an adult subject, the ideal pressure is contained:
- Between 115-130 mmHg in the maximum values (systolic pressure);
- Between 75-85 mmHg in the minimum values (diastolic pressure).
When these thresholds are exceeded, one is still in a normal condition but must be periodically checked. According to lines IHS 2020 guide, written by ‘ International Society of Hypertension, people with the highest pressure within the normal range (130-139 / 85-89 mmHg) may benefit from interventions on lifestyle and in some cases take medication, while subjects with confirmed hypertension must receive adequate pharmacological treatment.
Symptoms of hypertension
Hypertension has no specific symptoms (asymptomatic): it is no coincidence that this condition is known as a silent killer. Many patients can live with what causes high blood pressure for a long time without knowing it. Only rarely does hypertension manifest itself with:
- Palpitations ;
- Dizziness ;
- Headache ;
- Nervousness ;
- Fatigue ;
- Ronnie ;
- Phosphenes (flashes of light) and other visual disturbances.
Other signs of high blood pressure can be:
- The headaches behind the neck, in the morning, when you wake up, and it disappears spontaneously after a few hours.
- The bleeding from the nose (epistaxis).
- L ‘ helplessness.
- The most dramatic alarm bells are.
- The cardiac arrhythmias.
- Transient attacks of cerebral ischemia (TIA).
- Subconjunctival hemorrhage.
What causes high blood pressure
High blood pressure is classified as primary and secondary. Essential hypertension (or primary) represents about 95% of cases of hypertension. It is defined as essential because there is no precise cause that triggers this condition, but rather an alteration of a series of complex mechanisms that regulate blood pressure: the autonomic nervous system, circulating substances that affect the pressure.
The other 5% of cases are classified as secondary hypertension because it results from other diseases, genetic or acquired, affecting the kidneys, adrenal glands, vessels, and heart. So in these cases, it is possible, once the underlying disease is cured, the blood pressure values are normalized. In some cases, the increase in blood pressure values depends on drugs such as nasal sprays, cortisone, birth control pills, and drug abuse: cocaine and amphetamines. By stopping the intake of these substances, blood pressure values return to normal.
However, there are conditions or risk factors that can predispose to the development of hypertension, including:
- The age.
- The cigarette smoke.
- Excess body weight.
- The sedentary lifestyle.
- Hypercholesterolemia (high levels of fat in the blood).
- Lo stress.
- The familiar.
High blood pressure Diagnosis
Since there are no warning symptoms, the most effective way to diagnose hypertension early is to measure it regularly. A person usually discovers that they are hypertensive following a measurement made by the doctor. The pressure can be measured using various manual equipment: From the most modern and compact digital meters ( semi-automatic oscillometers ) that allow pressure measurement.
To the aneroid sphygmomanometer, which replaced the mercury one created a century ago by the Italian Riva-Rocci. The blood pressure monitor requires another person to take the measurement. This instrument consists of a rubber bracelet connected on one side to a small hand pump and on the other to a pressure gauge. Usually, before making a diagnosis, the doctor asks the patient to take measurements at home since the clinic’s pressure is often higher due to the motion effect, such as white coat hypertension. In this case, they are useful for automatic equipment, allowing self-measurement by the patient himself at home.
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How pressure is measured
It is a good idea to sit for a few minutes before the measurement. The optimal position is to stand with both feet on the floor and arms in a resting position, preferably resting on the table. For self-measurement, the cuff is positioned on the wrist, and the device is activated. If the measurement is carried out with an aneroid sphygmomanometer, the cuff on the arm’s skin at the heart’s height and the maximum and minimum pressure is measured, defined respectively by the appearance and disappearance of a beat detectable with a phonendoscope.
The first time you take a measurement, both arms should be taken to identify peripheral circulation disorders. In the case of different values, the highest will be considered. To obtain reliable values, it is advisable not to consume caffeine and not smoke within 30 minutes before the test.
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When to measure high blood pressure
If you are not being treated with antihypertensive drugs, two distance measurements are enough :
- At least one to two minutes in the morning (from 6 to 9, before breakfast);
- Two measurements in the evening (from 6 to 9 pm, before dinner);
- During the week before the visit to the doctor.
If you start treatment with anti-hypertensive drugs, take two measurements in the morning (before taking the medication) and two measurements in the evening (6 to 9 pm) during the week before visiting the doctor.
Once the blood pressure has stabilized with therapy for two blood pressure measurements once a week, before a follow-up medical examination, it is advisable to measure it again for seven consecutive working days with two measurements in the morning and two measurements in the evening.
A quarter of Italians suffer from hypertension, including children.
Data from the Italian Society of Arterial Hypertension (Siena) estimate that:
- 25% of the population is hypertensive, but only half knew about it.
- The most disturbing data concerns the people who are in therapy: more than 60% do not reach adequate blood pressure values, despite the treatment.
- What causes high blood pressure should be remembered because 40% of deaths from stroke, and 25% are from a heart attack.
- A survey conducted between 2008 and 2012 in all Italian regions found that, between 35 and 79 years, the average systemic pressure (Pas) is 134mmHg in men and 129 mmHg in women. Diastolic pressure (Pad) shows a similar trend.
Although hypertension occurs with age, 9% of children and young people range between 0 and 18 years and suffer from pediatric hypertension. This is a phenomenon that has been occurring in recent years. The main causes concern eating habits, characterized by high consumption of fatty foods and low physical activity.
Types of hypertension
Essential or Primary Hypertension
Almost all hypertensive people have some form of primary hypertension because a certain cause is not known. It is usually due to an increase in vascular resistance, the causes of which are often unknown. Sometimes the pressure increases only in the maximum values. This condition, called isolated systolic hypertension, is typical of older people. In fact, with age, the arteries tend to lose elasticity and lose the ability to adapt to blood flow changes (arteriosclerosis). This form of hypertension is higher than 140 mmHg for the maximum and 89 mmHg, or lower, for the minimum.
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Secondary hypertension: What Causes High Blood Pressure
Only a small number of subjects receive the diagnosis of secondary hypertension, a condition that manifests itself as a disorder connected to other diseases or metabolic disorders such as:
- Renal artery stenosis.
- I am hyperaldosteronism.
- The peraldosteroidismo (in detail see: ” Thyroid: what is its function? Symptoms, Causes, and Cures “).
- Cushing’s syndrome.
- Sleep apnea.
Even some medications commonly used can make the pressure go up:
- Non-steroidal anti-inflammatories (NSAIDs).
- Nasal decongestants.
- Some weight loss supplements.
- The same effect may also be due to medicines used in autoimmune diseases such as cortisone and cyclosporine, which cause narrowing of the arteries.
- Hypertension can be a side effect of some antidepressants.
- The contraceptive pill can also increase blood pressure even in patients who usually have normal values.
On the other hand, hormone replacement therapy (TOS) in menopause can cause the values’ instability but not always. Therefore the evaluation is case by case.
Then there are physiological conditions such as pregnancy that can lead to an increase in blood pressure. In these women, the symptom appears around the twentieth week. Within six months of giving birth, in most cases, the pressure returns to normal. Depending on how far the values differ from the defined normal limits (120/80 mmHg), three stages of the disease can be recognized: prehypertension, stage 1 hypertension, and stage 2 hypertension.
It is defined when the maximum pressure is between 120 and 139, while the minimum is maintained between 80 and 89 mmHg. The cardiovascular risk begins to rise when the pressure is above 115/75 mmHg values: it doubles every 20 points of increase of the maximum and every 10 of the minimum. At this stage, lifestyle changes are sufficient to restore optimal pressure conditions.
Stage 1 hypertension (mild hypertension)
At this level, the pressure has values between 140 and 159 and, for the minimum, between 90 and 99. If there are other cardiovascular diseases, diabetes, or kidney disease, you should first change their lifestyle and eating habits. The doctor can also assess the need for a drug.
Stage 2 hypertension
The maximum pressure is above 160 mmHg, while the minimum is at least 100 mmHg. In addition to lifestyle changes, it is almost always recommended to take drug therapy to lower blood pressure in these cases.
Pressure jump and unstable hypertension
The pressure fluctuations are physiological during the day: it increases in the morning and decreases at night. Frequent pressure changes make hypertension unstable, and this condition is more dangerous than high but constant pressure. Whenever the pressure increases, the arteries suffer, and if this occurs too often, the risk of stroke increases. At the origin of pressure changes, various factors depend on genetics, but also from advancing age.
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Resistant hypertension: What Causes High Blood Pressure
When blood pressure is not controlled even by the combination of three drugs, it is in the presence of resistant hypertension.
- Drug-resistant hypertension is frequent and often underestimated, depending on the reference population, affects about 5-30% of hypertensive people.
- It is often associated with a high risk of cardiovascular and renal complications.
Resistant hypertension can be:
A frequent cause of spurious resistant hypertension is a failure to adhere to the prescribed pharmacological treatment due to the low blood pressure control rate. True resistant hypertension can result from an incorrect lifestyle, obesity, or excessive alcohol consumption, which contrasts with therapy’s antihypertensive effects. Other factors include the presence of sleep apnea syndrome or unrecognized forms of secondary hypertension.
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At night, the pressure naturally drops, but the pressure rises during the night in some people. A retrospective study conducted in Japan on the data of over 6,000 patients recently highlighted how nocturnal hypertension peaks could increase the risk of cardiovascular events and heart failure. “During sleep, the supine position increases venous return, resulting in increased cardiac preload,” the study reads. “The rise in nocturnal systolic pressure has a major impact on the tension of the heart wall, increasing both preload and afterload” and increasing the risk of heart problems.
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Transient hypertension: What Causes High Blood Pressure
Anxiety may cause transient hypertension. A typical example of this benign phenomenon is white coat hypertension, i.e., higher pressure values , because the doctor carries out the measurement precisely for this reason. Before making a diagnosis of hypertension, the doctor recommends taking measurements at home, in a normal living environment.
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Acute hypertension and hypertensive urgency
In an acute hypertensive episode, the pressure is less than 220/120 mmHg and is not accompanied by signs or symptoms attributable to it. We talk about hypertensive urgency when blood pressure (BP) levels are generally higher than 220/120 mmHg because they can increase the risk of damage to organs such as the heart, brain, kidneys, eye.
In these cases, it is necessary to reduce within the shortest possible time, a maximum of one hour. To avoid more serious complications, which fortunately occur in 1% of cases.