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Essential Hypertension - a Hidden Threat


High blood pressure

Essential hypertension, also called primary or idiopathic hypertension, is elevated blood pressure that does not have a well-known cause. About 95% of all cases of hypertension fall into this category. Another kind of hypertension is secondary hypertension where there is an observable cause such as kidney problems, hormonal imbalances, etc.  

When the heart pushes the blood across the entire body, there is power exerted against the walls of the arteries, this is known as blood pressure. It differs all through the day, hence only one reading of elevated blood pressure does not mean you have hypertension.  

Risk Factors for Primary Hypertension

The exact basis of essential hypertension is still unknown. There is strong evidence that the genetic component has a huge part in primary hypertension. Several elements are responsible for an increase in blood pressure:
  • Obesity
  • Increased alcohol intake
  • Insulin resistance as in diabetes
  • Taking more salt
  • Increase in age
  • Inactive lifestyle
  • Stress 

The presence of two or more of the above-mentioned risk factors also plays a key role in developing high blood pressure such as drinking alcohol and obesity. 

Signs and Symptoms of Ideopathic Hypertension

The majority of individuals with high blood pressure do not have symptoms until it gives rise to a problem like a heart attack or stroke. One finds he/she has high blood pressure while they seek consultation for another medical problem or if they check the blood pressure regularly. 

Sometimes, when blood pressure is extremely high, you might get headaches, less frequently dizziness, or blurring of vision. 

Complications of Essential Hypertension

The enormous force on the walls of arteries caused by increased blood pressure can harm the blood vessels and body organs. The damage is further significant if the pressure is very high for a long time and when it is not controlled timely. Some complications that can arise are as follows:
  • Heart attack
  • Stroke
  • Failing heart
  • Life-threatening aneurysm 
  • Damaged blood vessels of organs such as kidneys, eyes causing deterioration of organ functions
  • Problems with memory and understanding

Knowing More about Your Blood Pressure

The best way to find if there is hypertension is through checking blood pressure regularly when the person is not stressed. It varies throughout the day. 

Blood pressure is commonly mentioned by two numbers: systolic and diastolic. Systolic pressure is the pressure in the arterial wall when the heart pumps the blood to other parts of the body and diastolic pressure is the force in the wall of the arteries when the heart is relaxed and is being filled by the blood. It is commonly written as systolic pressure value over diastole pressure value in millimeters of mercury (mm Hg). 

Normal Blood Pressure and Abnormal Blood Pressure

Blood pressure can be classified into the below-mentioned categories:
  • Normal blood pressure: less than 120/80mm Hg
  • Elevated blood pressure: sometimes referred to as prehypertension is a systolic pressure between 120 to 129mm Hg and a diastolic pressure below 80mm Hg. 
  • Stage 1 hypertension: systolic pressure of 130 to 139mm Hg, or a diastolic pressure of 80 to 89 mm Hg
  • Stage 2 hypertension: systolic pressure of 140mm Hg or higher or a diastolic pressure of 90mm Hg or higher, treatment is usually started 
  • Hypertensive crisis: It is an emergency condition in which a blood pressure reading is more than 180/120mm Hg on separate occasions. Urgent hospital admission is needed. 

Diagnosing High Blood Pressure

After taking a routine medical history, one of the vital signs taken by the doctors, nurse or other medical assistant is taking blood pressure. A blood pressure monitor is used for this purpose. Blood pressure is taken at the clinic and also at home regularly. 

Blood pressure might get elevated when visiting a doctor, also known as white coat hypertension, hence home blood pressure readings are necessary. These readings are noted by the patients and brought to the doctors on the next visit. The seriousness of the elevated blood pressure is discovered after taking the average of those blood pressure readings noted at various times. 

The doctor also does a thorough physical assessment to determine the presence of heart problems. The doctor might also request some tests to determine heart and kidney diseases. Such as cholesterol levels, electrocardiogram (EKG), Echocardiogram, kidney function tests as well as other tests such as blood examination, urine examination, ultrasounds, etc. 

Hypertension is diagnosed when there are two or more readings of raised blood pressures in different situations. 

Treatment of Primary Hypertension

Primary hypertension can’t be cured, but some treatments assist to lower blood pressure. Treatment is based on seriousness and feedback to interventions. 

Sometimes physicians use risk calculators to determine the risk of getting a stroke or heart attack or dying because of diseases of the heart or blood vessels in the upcoming 10 years or throughout the lifespan. These details aid the doctors to select the top therapy to halt complications. One such example is the Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator .

Healthy Lifestyle Modifications

These are the first and foremost pieces of advice the doctor recommends for controlling elevated blood pressure. A mild rise in blood pressure is usually manageable by adopting healthy lifestyle changes such as:
  • Eating a heart-fit diet that is full of potassium (except when there are kidney problems) and fiber.
  • Taking less salt 
  • Exercising regularly for at least 30 minutes daily
  • Maintaining healthy body weight 
  • Giving up smoking
  • Restricting the quantity of alcohol intake
  • Controlling stress and getting adequate good-quality sleep

Occasionally lifestyle modifications aren’t sufficient hence the doctor may advise and start drugs to control or lower the blood pressure. 

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Medications for Essential Hypertension

The kind of medicines prescribed by the doctors relies on blood pressure readings and general well-being. One or combination of two or more antihypertensive drugs might be prescribed by the doctor. Commonly prescribed antihypertensive medications are:
  • Angiotensin-converting enzyme (ACE) inhibitors, examples: enalapril, captopril, ramipril
  • Angiotensin II receptor blockers (ARBs), examples: losartan, valsartan, telmisartan
  • Beta-blockers, examples: metoprolol, bisoprolol, atenolol
  • Calcium channel blockers (CCBs), examples: amlodipine, nifedipine
  • Diuretics, examples: hydrochlorothiazide, furosemide, spironolactone 
  • Renin-inhibitors, example: aliskiren

Healthy lifestyle changes combined with medications can aid control and decrease high blood pressure and complications. 

Clinical Trials Investigate New Drugs for Treatment of Idiopathic Hypertension

There were many clinical trials done with one goal, finding the best drug with minimal side effects and high efficacy to reduce high blood pressure. Some of them used a single drug while some of them used a combination of drugs. Many studies such as ALLHAT, LIFE, and ASCOT showed combinations of antihypertensive drugs are required for a vast number of patients to control their increased blood pressure. The combinations have also shown to reduce incidences of heart attacks and strokes. 

Some newer drugs are undergoing clinical trials in various regions of the world, which are mentioned below:
  • Dual-action vasopeptidase inhibitors: These drugs enhance the vein dilatation, excretion of sodium, decrease the chance of abnormal growth of the heart by inhibiting angiotensin 2.  
  • Dual ACE-neprilysin inhibitors- omapatrilat, ilepatril (AVE 7688)
  • Dual Endothelin Converting Enzyme-neprilysin inhibitor- daglutril (SLV 306)
  • Dual Angiotensin receptor-neprilysin inhibitor- valsartan/sacubitril (LCZ 696)
  • Angiotensin II receptor agonists: Compound 21. It specifically stimulates angiotensin receptor 2, which has shown to promote tissue protection in animal models. 
  • Aldosterone synthase inhibitors: osilodrostat (LCI 699). This drug suppresses the effect of excess aldosterone which is known to play a role in inflammation, blood vessel renovation, and scarring of heart tissue. It has shown to lower both systolic and diastolic pressure. 
  • Endothelium antagonists: Bosentan, ambrisentan, and macitentan. These drugs block the endothelin receptors and are mainly used for treating high blood pressure within the arteries of the lungs.  
  • Granulate cyclase activators: Riociguat, phosphodiesterase-5 inhibitors. These drugs activate nitric oxide-guanylate cyclase-cyclic GMP pathway, which plays a vital role in vein dilatation and lowering blood pressure. This pathway is the target of new antihypertensive drug development. 
  • Agents decreasing arterial stiffness: These classes of drugs have extra benefits that contribute to de-stiffening of the arteries. 
  • nitric oxide donors
  • collagen cross-link breakers
  • anti-inflammatory drugs
  • drugs influencing calcium metabolism 
  • Aminopeptidase A inhibitor- Firibastat. It prevents the production of angiotensin 3 in the brain. Clinical trials have shown it helps to reduce blood pressure in some specific populations who do not or poorly respond to monotherapy of ACE inhibitors or ARBs. There is an ongoing phase 3 trial titled Firibastat in treatment-resistant hypertension (FRESH)

Currently accessible antihypertensive medicines are successful in controlling the increased blood pressure in almost all hypertensive patients especially those who are on combination treatment. But there is still room for improvement in antihypertensive drugs to protect target organ damage and prevent complications.

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