Hypertension: Understanding Causes, Symptoms, Diagnosis, and Treatment

Hypertension (hypertensive disorder) is one of the most common chronic diseases worldwide, often referred to as the "silent killer" due to its lack of obvious symptoms in the early stages. According to data from the World Health Organization, approximately 40% of the adult population globally suffers from this condition, with incidence rates increasing with age. If not controlled in a timely manner, it can lead to serious complications such as heart disease, stroke, and kidney failure, causing long-term damage to the entire vascular system.

This disease is divided into two main types: "primary hypertension" and "secondary hypertension." The former accounts for the vast majority, with complex and unclear causes; the latter is induced by specific diseases or medications, such as kidney disease or hormonal disorders. Understanding its pathological mechanisms and risk factors is key to developing personalized prevention and treatment strategies.

Modern medicine has established a comprehensive diagnosis and treatment system, but patients often delay treatment due to a lack of symptoms. Regular blood pressure monitoring, lifestyle adjustments, and medication therapy are core strategies for controlling blood pressure. This article will delve into the causes, symptoms, diagnostic methods, and latest treatment trends of this disease.

Causes and Risk Factors

The causes of primary hypertension involve various physiological mechanisms, including:

• Abnormal sodium excretion by the kidneys leading to excess fluid volume
• Increased sympathetic nervous system activity
• Endothelial dysfunction causing arterial constriction

These factors collectively lead to increased vascular resistance and blood volume, ultimately raising blood pressure levels.

Common Causes of Secondary Hypertension

About 5-10% of cases are triggered by identifiable causes, including:

• Kidney diseases (such as renal artery stenosis, chronic kidney disease)
• Endocrine disorders (such as adrenal tumors, thyroid dysfunction)
• Medication effects (such as oral contraceptives, steroids)
• Obstructive sleep apnea leading to nighttime blood pressure fluctuations

These specific causes require detailed examination for diagnosis.

Main Risk Factors

Genetic predisposition and environmental factors jointly influence disease development:

• Family history: Increased risk if first-degree relatives have hypertension
• Age: Incidence sharply rises after age 50
• Unhealthy lifestyle habits: High sodium diet, lack of exercise, excessive alcohol consumption, chronic stress
• Metabolic abnormalities: Obesity, type 2 diabetes, hyperlipidemia

Among these, excessive sodium intake directly stimulates the kidneys to retain water, making it a key environmental risk factor.

Symptoms

The most dangerous characteristic of hypertension is its "asymptomatic" nature, with most patients experiencing no discomfort in the early stages. Only when blood pressure rises sharply (such as in hypertensive crises) may symptoms appear:

• Severe headache accompanied by blurred vision
• Chest pain or difficulty breathing
• Nausea, vomiting, and altered consciousness

These acute symptoms require immediate medical attention.

Long-term Uncontrolled Symptoms

Long-term hypertension can cause systemic damage, potentially leading to:

• Cardiac hypertrophy and heart failure (palpitations, shortness of breath)
• Retinopathy (blurred vision)
• Declining kidney function (increased nighttime urination, lower limb edema)
• Small cerebral hemorrhages leading to dizziness or memory decline

These symptoms typically manifest only when the disease progresses to a severe stage.

Diagnosis

The diagnostic criteria define abnormal indicators as "systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mmHg," requiring confirmation through measurements taken at different times on three or more occasions. The diagnostic process includes:

1. Detailed medical history: Assessing family history, medication history, and lifestyle habits
2. Basic examinations: Complete blood count, kidney function tests, lipid profile
3. Ambulatory blood pressure monitoring: To rule out "white coat hypertension" interference
4. If necessary, renal artery ultrasound or thyroid function tests to exclude secondary causes

Special Diagnostic Considerations

Older adults and special populations require different standards:

• For individuals over 80 years old, target blood pressure may be relaxed to below 140/90 mmHg
• Pregnancy-related hypertension must be distinguished from preeclampsia
• Diabetic patients with hypertension require stricter control (target <130/80 mmHg)

Diagnosis must consider the overall health status of the patient to formulate a treatment plan.

Treatment Options

Treatment strategies are divided into lifestyle adjustments and medication therapy based on severity. The World Health Organization recommends that all patients first implement:

• Low sodium diet (daily sodium intake <2300 mg)
• Increased intake of fruits and vegetables
• Regular aerobic exercise (at least 150 minutes of moderate-intensity exercise per week)
• Maintaining a healthy weight with BMI <24

Medication Treatment Options

When lifestyle adjustments are insufficient for control, physicians will choose medications based on patient characteristics:

• Calcium channel blockers (such as amlodipine)
• ACEI/ARB medications (such as benazepril)
• Diuretics (such as hydrochlorothiazide)
• β-blockers and α-blockers

Often, two or more medications are needed in combination to achieve target blood pressure.

Emerging Treatment Technologies

Recent developments include:

• Renal denervation: Using catheters to disrupt renal nerves to lower blood pressure
• New classes of medications such as selective sodium channel inhibitors
• Digital health tools: Smart blood pressure monitors and APP tracking systems

These new technologies provide new directions for treating resistant hypertension.

Prevention

Primary prevention should begin in adolescence, with recommendations including:

• Daily sodium intake controlled at 1500-2300 mg
• Limiting refined sugars and saturated fat intake
• Maintaining a moderate weight (waist circumference <90 cm for men, <80 cm for women)
• Quitting smoking and limiting alcohol (men <2 standard drinking units per day)

Regular blood pressure screenings are key for early detection.

Targeted Preventive Measures

Specific populations need enhanced prevention:

• High-risk groups (family history, obese individuals) should measure blood pressure every 3 months
• Post-menopausal women need increased blood pressure monitoring
• Patients with chronic diseases (diabetes, kidney disease) require stricter control

Community health education and workplace health promotion are important strategies for group prevention.

When Should You See a Doctor?

Seek immediate medical attention if the following occurs:

• Blood pressure consistently exceeds 180/120 mmHg accompanied by headache or visual disturbances
• Chest pain or difficulty breathing
• Unilateral limb weakness or speech difficulties
• Unexplained dizziness with abnormal blood pressure

These may be warning signs of hypertensive crises or complications.

Regular Check-up Recommendations

Normal adults should have their blood pressure checked every 2 years, while high-risk groups should be screened every 6 months. Seek immediate medical attention if:

• Blood pressure remains elevated in non-stressful situations
• Dizziness, tinnitus, or other nonspecific symptoms occur
• Other metabolic abnormalities (such as elevated blood sugar) are present

Early diagnosis can reduce the risk of cardiovascular events by 30-50%.

 

Frequently Asked Questions

What is the appropriate daily salt intake for hypertension patients?

The World Health Organization recommends that the general population's daily salt intake should be less than 5 grams, while hypertension patients should further limit it to below 3 grams. Excessive salt can increase sodium ions in the blood, leading to water retention and increased vascular resistance. It is recommended to use herbs, spices, or lemon to enhance flavor instead of salt.

What types of exercise are suitable for hypertension patients?

Aerobic exercises such as brisk walking, swimming, or cycling are good choices for hypertension patients, with a recommendation of at least 150 minutes of moderate-intensity exercise per week. However, vigorous competitive sports or sudden breath-holding actions should be avoided. Patients should consult their physician and monitor blood pressure before exercising.

Can hypertension medications be taken during pregnancy?

Some hypertension medications may affect fetal development, but uncontrolled blood pressure can increase the risk of preeclampsia. Physicians will prescribe pregnancy-safe medications such as labetalol based on the situation, and regular monitoring and close cooperation with the healthcare team are necessary during pregnancy.

What common mistakes occur when measuring blood pressure at home?

Avoid consuming caffeine or exercising 30 minutes before measurement, and remain seated for 5 minutes. The arm should be at heart level, and the cuff should fit snugly but not constrict. It is recommended to measure twice daily and record the data to assist the physician in assessing blood pressure control.

Why is hypertension called the "silent killer"?

Hypertension often has no obvious symptoms in its early stages, and patients may only realize there is a problem when complications such as dizziness or chest pain occur. Long-term uncontrolled hypertension can damage the heart, blood vessels in the brain, and kidneys, making regular check-ups and early intervention crucial.