What is high blood pressure (hypertension)?

High blood pressure, also known as hypertension, is a medical condition where the pressure of blood in the arteries is consistently higher than normal. Hypertension is considered a long-term condition.

There are multiple stages of hypertension according to the American College of Cardiology and the European Society of Hypertension (ESH), displayed in the table below:

Other types of ​​hypertension

• Essential hypertension (also known as primary hypertension or idiopathic hypertension) is classed as someone with hypertension with no identifiable secondary cause, and the majority of hypertensive patients fall under this category.
• There is also secondary hypertension  where the cause is another medical condition..
• Malignant hypertension is classified as severe HTN, usually grade 3, with clear ongoing detrimental effects to organ systems. This only affects around 1% of hypertensive patients in the US.
• Resistant hypertension is when a patient’s blood pressure cannot be brought to the target level despite optimal lifestyle changes and 3 or more medications.

White coat hypertension is a phenomenon where a patient exhibits higher blood pressure in a medical environment (i.e. a doctor’s office or hospital) during a blood pressure reading. The term “white coat” refers to the signature attire of a doctor.

What are the symptoms?

Most hypertensive patients don’t display any symptoms, however some exhibit the following with severe hypertension:

• Headaches
• Nosebleeds
• Shortness of breath
• Dizziness
• Nausea
• Blurry vision

Causes

The known causes of high blood pressure (secondary hypertension) fall into 3 general categories::

• Medical conditions
• Medication
• Genetic causes

According to the NHS, these primary categories account for about 5% of all high blood pressure cases.

Medical conditions that can contribute to high blood pressure

• Acute or chronic kidney disease
• Renovascular diseases (narrowing of the arteries that feed the kidneys)
• Sleep apnea
• Chronic obstructive pulmonary disease (COPD)
• Hormone-related conditions such as hyper/hypothyroidism, Cushing’s syndrome, Conn’s syndrome, hyperparathyroidism, and pheochromocytoma
• Coarctation of the aorta

Medication that can cause high blood pressure

• Steroids
• Contraceptive pills
• Anti-inflammatories
• Cold and cough medicine with certain decongestants
• Recreational stimulant drugs such as cocaine, amphetamines, ecstasy, nicotine, and certain alcohols
• Antidepressants such as venlafaxine
• Anabolic steroids
• Certain chemotherapeutic agents
• Traditional hard black licorice

Genetic causes:

There are several rare genetic enzyme defects that can cause an overproduction of steroid hormones, which in turn, can cause hypertension.
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Treatments and management

The primary forms of treatment for high blood pressure can be split into two categories:

• Lifestyle changes
• Medication

Lifestyle changes

There are different things you can change in your day-to-day life that can help manage high blood pressure. These include:

• Eat a balanced diet containing fruit and veggies, low-fat and low-sodium foods.
• Regular blood pressure monitoring
• Regular physical exercise
• Eliminate recreational drug use
• Maintain a healthy weight 

Please note: These lifestyle changes can vary in the time it takes to reduce hypertension so always speak to a doctor about your options.

Read more: How to Lower Blood Pressure

Medication that can reduce high blood pressure

The most commonly used 5 categories of medication people take to reduce their hypertension are:

• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin-2 receptor blockers (ARBs)
• Calcium channel blockers
• Diuretics
• Beta blockers

Consult your doctor on the different medications you can take to reduce your blood pressure.

Additional questions

Is high blood pressure hereditary?

Hypertension can run in families and most often, there is no genetic test applicable for the vast majority of hypertensive people. 

Hypertension can be caused by some rare genetic conditions. However, a family history of high blood pressure could be attributed to other factors which a medical professional would need to diagnose. 

The following rare genetic conditions carry high blood pressure as a symptom:

• Familial hyperaldosteronism
• Pseudohyperaldosteronism
• Pseudohypoaldosteronism type 2
• Liddle syndrome
• Apparent mineralocorticoid excess (AME)
• Congenital Adrenal Hyperplasia (CAH)
• Paragangliomas

Is it safe to take cough medicine if you have high blood pressure?

It is advised to avoid cough and cold remedies that contain non-steroidal anti-inflammatory drugs (NSAIDs) or decongestants such as phenylephrine or pseudoephedrine.

That is because NSAIDs and these types of decongestants can increase your blood pressure and prevent blood pressure medication from working correctly.

Speak to your doctor about alternative treatments for viruses like the common cold, flu, and any sinus infections.

How can salt cause high blood pressure?

Regular table salt, kosher salt and other forms of cooking salts can cause blood pressure to increase by provoking water retention and increasing blood flow in your blood vessels.

Studies also show links between high sodium intake and increased blood pressure levels due to changes in vascular resistance, the resistance against blood flow through the circulatory system, although other factors may contribute to this.

For more information, please read this medical journal entry on sodium intake and hypertension.

 Further reading

• Blood Pressure UK
• Cardiac and vascular pathophysiology in hypertension
• Vascular Resistance – an overview