What You Need To Know About Chronic Hypertension — Living With High Blood Pressure

Around 1.28 billion adults¹ around the world between the ages of 30 and 79 have hypertension. Approximately 46% of adults with hypertension aren't even aware that they have it, and only 42% have received a diagnosis and treatment.

What is chronic hypertension?

Hypertension is when your blood pressure is regularly too high over a longer period. When your blood pressure remains elevated, it causes your heart to work a great deal harder than it normally would. This can lead to heart, blood vessel, and organ damage. However, even if you've been dealing with hypertension for years (chronic), you can still help manage it with medications, lifestyle changes, or both.

Blood pressure is the force your blood puts on your artery walls. Doctors measure it in millimeters of mercury (mm Hg). They do this through the use of a gauge that is connected to a blood pressure cuff.

The ideal blood pressure measurement² is 120/80mm Hg or less. This measurement means that every time your heart contracts, your blood is ejected into the arteries with a force of 120 mm Hg (pressure in millimeters of mercury). As your heart relaxes to refill, it causes a pressure drop to 80 mm Hg.

When your blood pressure is chronically above 120/80mm Hg, your heart is forced to work harder to push blood throughout your body because the resistance it faces while moving through the vessels is greater. You are considered to have hypertension if your blood pressure gets to 130/80 mm Hg.³ This increases your risk of cardiovascular events exponentially. You may require one or more medications to lower your blood pressure and reduce the risk of damage to your vessels.

Your doctor may initially recommend you try and bring it down with certain lifestyle changes, including:

• Exercise

• Weight loss

• Cutting back on dietary salt and fats 

• Quitting smoking

• Reducing alcohol use

There's a link between chronically high blood pressure and cardiovascular disease, especially in older adults.⁴ And the higher your blood pressure, the higher your risk of other health issues, such as stroke, heart attack, and heart disease.

What is chronic hypertension in pregnancy?

Some women develop high blood pressure during pregnancy, putting themselves and their babies at risk of medical issues during the pregnancy and after delivery.

Chronic hypertension in pregnancy is when women who already have high blood pressure become pregnant, and it continues throughout the pregnancy and beyond. It's estimated that chronic hypertension is present in around 3% to 5% of pregnancies.⁵ Fortunately, high blood pressure is treatable and preventable.

How is blood pressure categorized?

According to the new 2017 American Heart Association guidelines, there are four blood pressure categories.² These include:

Normal blood pressure

This is a 119/79 mm Hg reading or lower. If your blood pressure stays at this normal level, your doctor may only check your blood pressure once a year.

Elevated blood pressure

This is when the systolic number is between 120 and 129mm Hg, and the diastolic number is 79mm Hg or less. Sometimes, this is referred to as prehypertension. The doctor may recommend you make some lifestyle changes to help bring your blood pressure back down to a normal level. They may check your blood pressure again in three to six months.

Stage 1 hypertension 

This is when your systolic measurements are between 130 and 139mm Hg and your diastolics are 80-89mm Hg. The doctor may suggest you make some lifestyle changes along with taking medication. They may check your blood pressure every three to six months until your blood pressure is under control.

Stage 2 hypertension

This is a 140/90mm Hg or higher reading. The doctor will usually have you take two types of hypertension medication along with making some lifestyle changes. You'll also need monthly blood pressure checks until it's under control.

What causes chronic hypertension?

The exact causes of chronic hypertension are unknown, though it’s often due to an underlying condition that leads to elevated blood pressure. When this occurs, it’s called secondary hypertension. When no underlying cause can be determined, it’s called primary hypertension.

Primary hypertension, though its cause may be unknown, can be impacted by various factors, including:

• High salt intake

• Being overweight or obese

• Smoking tobacco

• Excessive alcohol intake

• Insulin resistance

• Sedentary lifestyle

Secondary hypertension is the complication of another health issue and has specific causes. For instance, chronic kidney disease affects your kidneys’ ability to filter fluid out of the body. The excess fluid builds up and causes increased pressure, making the heart work harder to pump blood through the vessels.

Other medical conditions that can cause high blood pressure include:

• Cushing’s syndrome

• Diabetes

• Pregnancy

• Pheochromocytoma, a rare adrenal gland cancer

• Sleep apnea

• Hyperparathyroidism 

• Obesity

• Hyperthyroidism

• Congenital adrenal hyperplasia

What is the difference between acute hypertension and chronic hypertension?

The terms hypertension, acute hypertension, and chronic hypertension are often used interchangeably. Their differences come down to how long the high blood pressure lasts and the underlying cause.

Hypertension is a general term that just means elevated blood pressure. It doesn’t really differentiate whether that is a one-time thing or ongoing.

Acute hypertension is when a person has elevated blood pressures for a short period, and this would typically have a triggering event such as pain, trauma, or extreme stress that initiates the “fight or flight” mechanism. A surge of hormones within the body causes a stress response with increases in heart rate and blood pressure. This would be expected to return to normal when the situation is over.

Some people have acute hypertensive episodes that require emergency care to lower their blood pressure. These mostly occur in people already diagnosed with hypertension.

However, when people talk about chronic hypertension, it means the disease has been ongoing for a longer period and is expected to be a lifelong condition; it may be the result of an underlying medical condition. When there is no underlying cause, it is called primary hypertension (also known as essential hypertension).

Either way, it is almost always a condition that will need to be monitored and, in most cases, treated for life.

How hypertension can damage internal organs

Hypertension can lead to internal organ damage, such as:

• Left ventricular hypertrophy

• Coronary artery disease from blood vessel thickening

• Heart attacks

• Arrhythmias

• Vision loss from eye vessel damage 

• Kidney failure from vessel damage in kidneys 

• Dementia and stroke from blood vessel damage in the brain

What can you do to help chronic hypertension?

Lifestyle changes play a significant role in the treatment of chronic hypertension. If you're able to control your blood pressure successfully with a healthy lifestyle, you may delay, avoid, or reduce your need for medicine.

To help lower and manage your blood pressure, here are nine lifestyle changes you can try:

1. Losing the extra pounds

As body weight increases, blood pressure tends to increase because it makes your heart pump harder and adds strain on your arteries. This causes your arteries to become stiffer and resist the blood flow, leading to a rise in blood pressure.

When you're overweight, it can also lead to disrupted breathing while you're sleeping (sleep apnea), and this can further raise your blood pressure.

2. Eating a healthy diet

You can lower your blood pressure by following a diet rich in fruits, vegetables, whole grains, and low-fat dairy products and avoiding cholesterol and saturated fat. This is referred to as the Dietary Approaches to Stop Hypertension (DASH) diet.⁶

Changing your eating habits may not be simple, but these tips can help you create a healthy diet eating plan:

Maintain a food diary

Write down everything you eat. Even if it's only for a week, it can help you evaluate your real eating habits. You'll want to monitor not only what you eat but when, how much, and why.

Shop smart 

Make sure you read all the labels on the food items you're thinking about buying, reviewing the levels of fat, sugar, and salt. Stick to your healthy meal plan—even when dining out.

Boost potassium

Potassium lessens sodium's effects on blood pressure. Food is your best source of potassium, such as vegetables and fruits, instead of supplements. Your doctor will inform you if any medications you are taking might impact your potassium levels.

Cut back on your salt intake 

As you age, your blood pressure and body become more sensitive to sodium. Sodium (salt) is typically added in large amounts to a variety of foods during preparation and processing, so it is necessary to cut processed foods out of your diet. Consider the DASH diet, which is low-sodium. It has the added benefit of helping you lose weight and keep off the excess pounds.

3. Exercising regularly

Moving your body regularly, around 30 minutes several days a week or 150 minutes a week, can help reduce elevated blood pressures by around 5 to 8mm Hg.⁷ If you stop exercising, your blood pressure can begin to rise again, so it’s essential to remain consistent.

If your blood pressure is normal or mildly elevated, physical activity can help prevent you from progressing into hypertension. If your blood pressure is already high, regular physical activity can help lower it to safer levels.

Aerobic exercise is good for lowering your blood pressure and includes things like:

• Jogging

• Walking

• Dancing

• Swimming

• Cycling

4. Quit smoking

Smoking raises your risk for hypertension, stroke, heart disease, lung disease, cancer, and other health issues. If you currently smoke, quit.

Smoking and secondhand smoke both increase your risk for an accumulation of plaque (fatty substances) inside your arteries that leads to heart attacks. High blood pressure accelerates this process. When you smoke, it also causes a temporary rise in blood pressure.

5. Limiting your alcohol

Alcoholic beverages can negatively affect your blood pressure. For individuals who drink, having no more than two alcoholic beverages a day for men and no more than one a day for women can help lower their risk of hypertension.

6. Getting quality sleep

Let your doctor know if a partner or someone else has told you that you snore or that your breathing pauses for a few moments while you sleep, which could indicate sleep apnea. Sleep apnea treatment and regularly getting a decent night's sleep may help lower your blood pressure.

7. Managing stress levels

Stress is a big part of life and, though you can work to reduce it, you cannot get rid of it completely. Learning stress management techniques can help you deal with life’s issues and lower your blood pressure.

Exercise is excellent for managing stress, along with meditation, laughter, healthy social relationships, and a positive attitude. Additional skills to learn and incorporate into your life include biofeedback, relaxation and guided imagery, mindfulness, and special breathing techniques.

8. Taking your prescribed medication

Along with lifestyle changes, medications are frequently used for managing hypertension. There are a few different types of medication doctors prescribe, depending on the range of your blood pressures and other factors. Each type has its own benefits and risks that you'll need to carefully weigh up with your doctor. Many individuals end up taking more than one medicine to keep their blood pressure within the normal range.

Doctors will frequently suggest a low dose first. There are typically only minor side effects of antihypertensive medicines.

Hypertension medications include:

• Calcium-channel blockers

• Diuretics

• Vasodilators

• Central agonists

• Beta-blockers and alpha-blockers

• Angiotensin receptor blockers

• Angiotensin-converting enzyme (ACE) inhibitors

• Peripheral adrenergic inhibitors

The medication the doctor prescribes will depend on the patient and whether or not they have an underlying medical condition that could be contributing to their chronic hypertension.

If you’re taking antihypertensive medicines, it's important to read the labels on all over-the-counter drugs you may be taking, such as decongestants; these can interact with blood pressure medications. Speak with your doctor about any potential conflicts with your blood pressure medicine.

Your chronic hypertension medication should start working within days. But, since chronic hypertension is a long-term medical problem that frequently produces little to no symptoms, it can be a challenge to remember to take it every day. Combination drugs, whether once-a-day or long-acting, may be used to reduce the burden of having to take a number of medications and help ensure you take them regularly.

Once you begin hypertension medication, you'll want to continue taking it until your doctor informs you to stop. Discontinuing it abruptly can make your blood pressure rise to dangerous levels, so don’t change your dose or stop it without conferring with your prescriber.

9. Monitoring your blood pressure levels

It's essential to keep up with routine visits to your doctor's office to monitor your blood pressure and keep it under control. Your doctor will let you know how often you should have it checked. They may even recommend you check it at home through home monitoring, once daily or less frequently. Home monitoring can help you:

• Determine if any lifestyle changes you have made are working

• Keep tabs on your blood pressure levels at different times of the day

• Alert your doctor of any related health problems

If you're making any medication changes, your doctor may ask you to start checking your blood pressure at a certain frequency until your next appointment to see the effects of these changes.

The lowdown

Consult with your doctor immediately if you suspect you have high blood pressure or know you have chronic hypertension and don't have it controlled.

Taking action immediately to reduce your blood pressure can help you protect yourself against cardiovascular disease, like stroke or heart disease.

Keeping your blood pressure under control should be a lifelong task and a part of your everyday healthy living plan. When left untreated, chronic hypertension can cause damage to your internal organs that won't produce any symptoms until the damage is severe. You can help manage and keep this "silent killer” under control by taking charge of your own health.