Hypertension can be defined as systolic blood pressure higher than 130 millimeters of mercury (mmHg) and/or diastolic blood pressure higher than 80 mmHg. This condition is more commonly known as high blood pressure, and it’s one of the most common chronic illnesses in the country. In fact, the Centers for Disease Control and Prevention (CDC) says that almost half of American adults have hypertension, and it causes or contributes to more than 690,000 deaths every year.
Failure to control high blood pressure with lifestyle changes, medication, or both leads to uncontrolled hypertension. According to Million Hearts, a national organization committed to preventing one million heart attacks and strokes by 2027, only one in four Americans have their high blood pressure under control. Learning more about hypertension, its causes, and the potential impact it can have on your long-term health is an important first step in reaching your health goals.
Causes of Uncontrolled Hypertension
There are several causes of uncontrolled hypertension, and some occur far more frequently than others.
Data from Million Hearts also revealed that about four in five adults who have been diagnosed with hypertension are prescribed medication designed to control their blood pressure. Sadly, almost 35 million Americans do not take their medication as prescribed, and about 30% have what is known as resistant hypertension. Despite taking their medications, their blood pressure remains high.
Surveys from the CDC found that the prevalence of obesity in America rose from 30.5% to 41.9% between 2017 and 2020 – and the number continues to rise. Obesity is one of the most prevalent contributing factors to uncontrolled hypertension. The larger the body, the harder the heart must work to pump oxygenated, nutrient-rich blood to the organs and extremeties. According to the Mayo Clinic, losing one kilogram of weight can reduce blood pressure by about one millimeter of mercury.
Excessive Alcohol Consumption
Numerous studies have shown a strong link between the overconsumption of alcohol and hypertension. One study published in the medical journal Hypertension showed that consuming alcohol without food raised blood pressure even more. To combat uncontrolled hypertension, the American Heart Association recommends limiting alcohol consumption to no more than two drinks per day for men and one drink per day for women
Certain over-the-counter and prescription medications can raise blood pressure or make it difficult to control. Some of the most common culprits include pain medications that cause water retention, such as aspirin and ibuprofen, common cold medications containing the decongestants pseudoephedrine or phenlyephrine, antidepressant medications, and birth control containing hormones. Caffeine and many herbal supplements can also lead to high blood pressure.
High Sodium Intake
Excessive sodium consumption causes the body to retain fluid, which makes the heart work harder and raises blood pressure. American Dietary Guidelines recommend less than 2,300 milligrams of salt per day, which is equal to about a teaspoon. Individuals who have been diagnosed with hypertension should work to reduce their intake even further.
Symptoms of Hypertension
Many people who have uncontrolled hypertension do not experience any symptoms, even when their blood pressure is dangerously high. Of those who do experience symptoms, the most common are headaches, shortness of breath, and nosebleeds. A few people may also experience a pulsating feeling in the neck or head, and some may even experience severe anxiety.
Effects of Uncontrolled Hypertension
The effects of uncontrolled hypertension are many. Sadly, many people who have high blood pressure succumb to heart attack or stroke, which can lead to disability or even death. Prolonged high blood pressure can also cause the following:
- Persistent shortness of breath caused by fluid buildup in the lungs (pulmonary edema)
- Vision loss due to reduced blood flow to the optic nerve
- Kidney damage due to damaged blood vessels in and around the kidneys
- Erectile dysfunction due to damaged blood vessels
- Memory loss caused by brain damage resulting from lack of oxygenated blood
- Metabolic issues and syndromes, including diabetes and high cholesterol
How to Diagnose Uncontrolled Hypertension
Hypertension is typically diagnosed with a simple blood pressure test. A healthcare professional wraps a cuff around the arm, then uses a stethoscope and a gauge known as a sphygmomonometer to measure pressure inside the blood vessels in a unit known as millimeters of mercury, or mmHg. If the number is higher than 120\80 (read as one hundred and twenty over eighty), it is considered high.
There are two stages of hypertension. Stage 1 is defined as a top (diastolic) reading between 130 and 139 mmHg, a bottom (systolic) reading between 80 and 89 mmHg, or both. Stage 2 is defined a diastolic pressure higher than 140 mmHg, a systolic pressure higher than 90 mmHg, or both.
Following a high blood pressure reading, doctors and other healthcare providers sometimes order additional tests. These can include the following:
- Ambulatory Monotoring: This involves checking the blood pressure routinely over a 24-hour period. Many patients use their own blood pressure measurement equipment at home during this time and report back to their healthcare team.
- Laboratory Testing: Common lab tests may look at blood sugar and cholesterol. In some cases, kidney, liver, and/or thyroid function may also be measured.
- Electrocardiogram (ECG or EKG): These tests provide a measurement of the electrical activity in the heart, which can provide healthcare professionals with vital information about the heart’s condition.
- Echocardiogram: This test is an ultrasound of the heart muscle. It shows the blood movement in and out of the heart, which can also be used to diagnose uncontrolled hypertension.
How to Treat Uncontrolled Hypertension
Numerous studies have found that a combination of medication and lifestyle changes is the very best way to reduce high blood pressure and keep it under control.
Some of the most common medications used to treat hypertension include the following:
- Diuretics: Diuretics are medications that remove excess fluid and sodium from the body to reduce the pressure on the blood vessel walls.
- ACE Inhibitors: Angiotensin-converting enzyme (ACE) stops the production of angiotensin, which is a chemical that narrows the blood vessels and increases pressure.
- ARBs: Angiotensin 2 receptor blockers (ARBs) are different in that they block the action of the angiotensin rather than preventing its production.
- Calcium Channel Blockers: Calcium can restrict the movement and relaxation of the arteries. These drugs are designed to prevent calciumf rom entering the cells, which allows the blood vessels and heart to remain relaxed and open.
- Beta Blockers: These drugs stop the effects of adrenaline (or epinephrine), which causes the heart to beat faster and harder – especially during exercise or stressful situations.
- Renin Inhibitors: Renin is naturally produced in the kidneys, and it can trigger a series of events that leads to high blood pressure. These drugs slow the production renin in an effort to reduce high blood pressure before it starts.
It is entirely possible for many Americans to reduce uncontrolled hypertension with lifestyle changes alone. Eating more fruits and vegetables, quitting smoking, managing stress, exercising for 30 minutes a day, avoiding or limiting alcohol, maintaining a healthy weight, and reducing sodium intake all have a significant impact on blood pressure.
Uncontrolled hypertension despite lifestyle changes and medications is referred to as resistant hypertension. People who are over the age of 55, African-American individuals, people who have chronic kidney disease, and people who have diabetes are at the greatest risk for resistant hypertension. These individuals are often asked to take a very carefully designed cocktail of medications, work toward a healthier lifestyle, and monitor their blood pressure very closely by checking it several times every day.
When to Take Blood Pressure Medications
Most blood pressure medications must be prescribed by a doctor, and it is vital to take them as prescribed. It is important for anyone with uncontrolled hypertension to tell their doctors about any medications or supplements they are already taking, as well. Depending on the severity of the condition, many doctors will ask their patients to impelment lifestyle changes before taking medications. If these changes do not lead to a reduction in blood pressure, medications are typically the next step.
Over the Counter Medications for High Blood Pressure
Individuals who have been diagnosed with high blood pressure or uncontrolled blood pressure should never rely solely on over-the-counter (OTC) medications. In fact, many OTC medications can raise blood pressure, so it is important to discuss these with a doctor before using them. A few studies have shown that supplements like potassium and magnesium can help to reduce blood pressure in those who have deficiencies.
Blood Pressure Medications and Ibuprofen
Ibuprofen is the most common non-steroidal anti-inflammatory drug (NSAID) in the United States. It helps to control pain and fever by reducing inflammation, which makes it quite powerful and very useful. However, individuals who are taking blood pressure medications may find that ibuprofen actually reduces the pressure-lowering effect of their medications, rendering them mostly useless. Furthermore, taking ibuprofen with many blood pressure medications can lead to severe kidney damage, especially when used in combination with a diuretic.
Uncontrolled hypertension is a serious issue in the United States, and roughly 46% of those who have high blood pressure are undiagnosed.
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