UNIVERSITY OF RIJEKA

SCHOOL OF MEDICINE
MEDICINE

HYPERTENSION AND
HYPOTENSION

Rijeka, October 2019.

Contents

1. Introduction.................................................................................................................. 3
2. Blood pressure..............................................................................................................4
2.1. Systolic blood pressure..........................................................................................4
2.2. Diastolic blood pressure........................................................................................5
2.3. High blood pressure...............................................................................................6
2.3.1. Causes of high blood pressure........................................................................6
3. Hypertension................................................................................................................. 7
3.1. Risk factors.............................................................................................................7
3.2. Types of hypertension............................................................................................9
3.3. Complications.......................................................................................................10
3.4. Management and treatment................................................................................11
4. Hypotension................................................................................................................12
4.1. Causes of hypotension..........................................................................................12
4.2. Symptoms.............................................................................................................13
4.3. Treatment for hypotension..................................................................................13
5. Conclusion..................................................................................................................14
6. Summary..................................................................................................................... 15
7. References................................................................................................................... 16

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 1. Introduction

There are a lot of people in the world being affected by the high blood pressure, known as
hypertension. Sometimes, there are no symptoms, and that is what makes this disease dangerous.
It damages arteries and could lead to serious conditions such as heart attack, heart failure, heart
or brain aneurism, dementia.. It is a chronic disease that can not be cured, but it can be treated
and managed with medications and change of lifestyle which includes healthy diet, exercise, not
smoking and drinking a lot of alcohol. People with hypertension that is being treated can lead a
normal and long life. Another type of blood pressure is low blood pressure, known as
hypotension. It is not that common and dangerous as hypertension. It can be caused by other
conditions such as pregnancy, blood loss and infections. It can also be treated by medications.

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2. Blood pressure

Blood pressure (BP) is the pressure of circulating blood on the walls of blood vessels. Most of
this pressure is due to work done by the heart by pumping blood through the circulatory system.
Used without further specification, "blood pressure" usually refers to the pressure in large
arteries of the systemic circulation. Blood pressure is usually expressed in terms of the systolic
pressure (maximum during one heartbeat) over diastolic pressure (minimum in between two
heartbeats) and is measured in millimeters of mercury (mmHg), above the surrounding
atmospheric pressure. (1)

Blood pressure is one of the vital signs, along with respiratory rate, heart rate, oxygen saturation,
and body temperature. Normal resting blood pressure in an adult is approximately 120
millimetres of mercury (16 kPa) systolic, and 80 millimetres of mercury (11 kPa) diastolic,
abbreviated "120/80 mmHg". Globally, the average blood pressure, age standardized, has
remained about the same since 1975 to the present, at approx. 127/79 mmHg in men and 122/77
mmHg in women. (2)

Typically, more attention is given to systolic blood pressure (the first number) as a major risk
factor for cardiovascular disease for people over 50. In most people, systolic blood pressure rises
steadily with age due to the increasing stiffness of large arteries, long-term buildup of plaque and
an increased incidence of cardiac and vascular disease. (3)

However, either an elevated systolic or an elevated diastolic blood pressure reading may be used
to make a diagnosis of high blood pressure. According to recent studies, the risk of death from
ischemic heart disease and stroke doubles with every 20 mm Hg systolic or 10 mm Hg diastolic
increase among people from age 40 to 89. (3)

2.1. Systolic blood pressure

When your heart beats, it squeezes and pushes blood through your arteries to the rest of your
body. This force creates pressure on those blood vessels, and that's your systolic blood pressure.

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It indicates how much pressure your blood is exerting against your artery walls when the heart
beats. (3)

A normal systolic pressure is below 120. A reading of 140 or more means you have high blood
pressure (also called hypertension). (4)

2.2. Diastolic blood pressure

The diastolic reading, or the bottom number, is the pressure in the arteries when the heart rests
between beats. This is the time when the heart fills with blood and gets oxygen. It indicates how
much pressure your blood is exerting against your artery walls while the heart is resting between
beats. (3)

A normal diastolic blood pressure is lower than 80. A reading of 90 or higher means you have
high blood pressure. (4)

Picture 1. Chart for blood pressure categories

Available at: https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-
pressure-readings

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2.3. High blood pressure

An optimal blood pressure level is a reading under 120/80 mmHg. Readings over 120/80mmHg
and up to 139/89mmHg are in the normal to high range.

Blood pressure over 140/90mmHg is generally considered to be high. When your blood pressure
is high your heart and arteries can become overloaded. High blood pressure can accelerate the
build-up of plaque on the artery walls (atherosclerosis), clogging blood flow to your heart
muscle, putting you at risk of heart attack. It also weakens the walls of arteries in your brain
which can cause stroke. It can affect arteries to other parts of your body too, such as the eyes,
kidneys and legs. Long term high blood pressure is known as hypertension and is one of the main
risk factors for heart disease. (5)

2.3.1. Causes of high blood pressure

Blood pressure goes up and down throughout the day. It depends on the time of day, the amount
of fluid in your body, the medicines in your system and what you are doing. Your blood pressure
can also be affected by things like your breathing, your emotions, exercise and sleep. These
temporary rises are completely natural and your blood pressure will generally return to normal
when you rest. (5)

The exact cause of high blood pressure is often not clear. However, various lifestyle conditions
and behaviours have been known to significantly contribute to high blood pressure (5):

 Being overweight
 Not getting enough physical activity
 Drinking more than 2 alcoholic drinks per day
 Stress
 Old age
 Smoking
 Family history of high blood pressure

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Prolonged high blood pressure is known as hypertension. Left undiagnosed, hypertension can
lead to several health issues, coronary heart disease (CHD) among them.

3. Hypertension

Hypertension is defined as blood pressure reading of 130/80 or higher.

Also known as high blood pressure, hypertension is when too much blood is being pumped into
your arteries which can cause life-threatening conditions like heart disease and stroke.
Hypertension is the most common cardiovascular disease, impacting nearly 75 million American
adults or one in every three American adults. However, people often don’t realize they have
hypertension because it rarely shows symptoms. High blood pressure is common in individuals
who are African-American, older than 55, overweight, inactive, heavy alcohol drinkers, and/or
smokers. (6)

You can have high blood pressure (hypertension) for years without any symptoms. Even without
symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled
high blood pressure increases your risk of serious health problems, including heart attack and
stroke. (7)

High blood pressure generally develops over many years, and it affects nearly everyone
eventually. Fortunately, high blood pressure can be easily detected. And once you know you
have high blood pressure, you can work with your doctor to control it. (7)

3.1. Risk factors

High blood pressure has many risk factors, including:

1. Age - The risk of high blood pressure increases as you age. Until about age 64, high
blood pressure is more common in men. Women are more likely to develop high blood
pressure after age 65.

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2. Race - High blood pressure is particularly common among people of African heritage,
often developing at an earlier age than it does in whites. Serious complications, such as
stroke, heart attack and kidney failure, also are more common in people of African
heritage.
3. Family history - High blood pressure tends to run in families.
4. Being overweight or obese - The more you weigh the more blood you need to supply
oxygen and nutrients to your tissues. As the volume of blood circulated through your
blood vessels increases, so does the pressure on your artery walls.
5. Not being physically active - People who are inactive tend to have higher heart rates.
The higher your heart rate, the harder your heart must work with each contraction and the
stronger the force on your arteries. Lack of physical activity also increases the risk of
being overweight.
6. Using tobacco - Not only does smoking or chewing tobacco immediately raise your
blood pressure temporarily, but the chemicals in tobacco can damage the lining of your
artery walls. This can cause your arteries to narrow and increase your risk of heart
disease. Secondhand smoke also can increase your heart disease risk.
7. Too much salt (sodium) in your diet - Too much sodium in your diet can cause your
body to retain fluid, which increases blood pressure.
8. Too little potassium in your diet - Potassium helps balance the amount of sodium in
your cells. If you don't get enough potassium in your diet or retain enough potassium, you
may accumulate too much sodium in your blood.
9. Drinking too much alcohol - Over time, heavy drinking can damage your heart. Having
more than one drink a day for women and more than two drinks a day for men may affect
your blood pressure.
10. Stress - High levels of stress can lead to a temporary increase in blood pressure. If you
try to relax by eating more, using tobacco or drinking alcohol, you may only increase
problems with high blood pressure.
11. Certain chronic conditions - Certain chronic conditions also may increase your risk of
high blood pressure, such as kidney disease, diabetes and sleep apnea.

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Although high blood pressure is most common in adults, children may be at risk, too. For some
children, high blood pressure is caused by problems with the kidneys or heart. But for a growing
number of kids, poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise,
contribute to high blood pressure. (8)

3.2. Types of hypertension

There are two types of high blood pressure:

1. Primary (essential) hypertension

For most adults, there's no identifiable cause of high blood pressure. This type of high blood
pressure, called primary (essential) hypertension, tends to develop gradually over many years.
(8)

2. Secondary hypertension

Some people have high blood pressure caused by an underlying condition. This type of high
blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood
pressure than does primary hypertension. Various conditions and medications can lead to
secondary hypertension, including:

 Obstructive sleep apnea

 Kidney problems
 Adrenal gland tumors
 Thyroid problems
 Certain defects you're born with (congenital) in blood vessels
 Certain medications, such as birth control pills, cold remedies, decongestants, over-the-
counter pain relievers and some prescription drugs
 Illegal drugs, such as cocaine and amphetamines (8)

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3.3. Complications

The excessive pressure on your artery walls caused by high blood pressure can damage your
blood vessels, as well as organs in your body. The higher your blood pressure and the longer it
goes uncontrolled, the greater the damage. (8)

Uncontrolled high blood pressure can lead to complications including:

 Heart attack or stroke - High blood pressure can cause hardening and thickening of the
arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
 Aneurysm - Increased blood pressure can cause your blood vessels to weaken and bulge,
forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
 Heart failure - To pump blood against the higher pressure in your vessels, the heart has
to work harder. This causes the walls of the heart's pumping chamber to thicken (left
ventricular hypertrophy). Eventually, the thickened muscle may have a hard time
pumping enough blood to meet your body's needs, which can lead to heart failure.
 Weakened and narrowed blood vessels in your kidneys - This can prevent these
organs from functioning normally.
 Thickened, narrowed or torn blood vessels in the eyes - This can result in vision loss.
 Metabolic syndrome - This syndrome is a cluster of disorders of your body's
metabolism, including increased waist circumference; high triglycerides; low high-
density lipoprotein (HDL) cholesterol, the "good" cholesterol; high blood pressure and
high insulin levels. These conditions make you more likely to develop diabetes, heart
disease and stroke.
 Trouble with memory or understanding - Uncontrolled high blood pressure may also
affect your ability to think, remember and learn. Trouble with memory or understanding
concepts is more common in people with high blood pressure.
 Dementia - Narrowed or blocked arteries can limit blood flow to the brain, leading to a
certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the
brain also can cause vascular dementia. (8)

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3.4. Management and treatment

Lifestyle adjustments are the standard, first-line treatment for hypertension.

1. Regular physical exercise - People should exercise for 30 minutes a day for at least 5
days of the week. Examples of suitable activities are walking, jogging, cycling, or
swimming.
2. Stress reduction - Avoiding or learning to manage stress can help a person control blood
pressure. Meditation, warm baths, yoga, and simply going on long walks are relaxation
techniques that can help relieve stress.
3. Medication - People can use specific medications to treat hypertension. Medications for
hypertension include:
 diuretics, including thiazides, chlorthalidone, and indapamide
 beta-blockers and alpha-blockers
 calcium-channel blockers
 central agonists
 peripheral adrenergic inhibitor
 vasodilators
 angiotensin-converting enzyme (ACE) inhibitors
 angiotensin receptor blockers
4. Diet - people can prevent high blood pressure by following a heart-healthy diet. (8)

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 4. Hypotension

Hypotension is the medical term for low blood pressure (less than 90/60). Having a lower blood
pressure is good in most cases (less than 120/80). But low blood pressure can sometimes make
you feel tired or dizzy. In those cases, hypotension can be a sign of an underlying condition that
should be treated. (9)

4.1. Causes of hypotension

Everyone’s blood pressure drops at one time or another. And, it often doesn’t cause any
noticeable symptoms. Certain conditions can cause prolonged periods of hypotension that can
become dangerous if left untreated. These conditions include:

 pregnancy, due to an increase in demand for blood from both mother and the growing
fetus
 large amounts of blood loss through injury
 impaired circulation caused by heart attacks or faulty heart valves
 weakness and a state of shock that sometimes accompanies dehydration
 anaphylactic shock, a severe form of allergic reaction
 infections of the bloodstream
 endocrine disorders such as diabetes, adrenal insufficiency, and thyroid disease (9)

Medications might also cause blood pressure to drop. Beta-blockers and nitroglycerin, used to
treat heart disease, are common culprits. Diuretics, tricyclic antidepressants, and erectile
dysfunction drugs can also cause hypotension.

Some people have low blood pressure for unknown reasons. This form of hypotension, called
chronic asymptomatic hypotension, isn’t usually harmful. (9)

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4.2. Symptoms

People with hypotension may experience symptoms when their blood pressure drops below
90/60. Symptoms of hypotension can include:

 fatigue
 lightheadedness
 dizziness
 nausea
 clammy skin
 depression
 loss of consciousness
 blurry vision

Symptoms can range in severity. Some people may be slightly uncomfortable, while others may
feel quite ill. (9)

4.3. Treatment for hypotension

Your treatment will depend on the underlying cause of your hypotension. Treatment could
include medications for heart disease, diabetes, or infection. Drink plenty of water to avoid
hypotension due to dehydration, especially if you are vomiting or have diarrhea. Staying
hydrated can also help treat and prevent the symptoms of neurally mediated hypotension. If you
experience low blood pressure when standing for long periods, be sure to take a break to sit
down. And try to reduce your stress levels to avoid emotional trauma. Treat orthostatic
hypotension with slow, gradual movements. Instead of standing up quickly, work your way into
a sitting or standing position using small movements. You can also avoid orthostatic hypotension
by not crossing your legs when you sit. Shock-induced hypotension is the most serious form of
the condition. Severe hypotension must be treated immediately. Emergency personnel will give
you fluids and possibly blood products to increase your blood pressure and stabilize your vital
signs. (9)

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 5. Conclusion

To sum up, there are 3 types of blood pressure: normal, which is 120/80, high blood pressure or
hypertension which is over 140/90 and low blood pressure or hypotension where blood pressure
falls below 90/60.

High blood pressure is affecting high number of people in the world, many of whom are unaware
of their condition due to lack of symptoms. Prolonged and untreated hypertension causes damage
to arteries which can lead to serious complications as heart attack, heart failure, aneurism.. That
is why the right treatment is necessary for hypertension which includes medications but also
change of diet, stop smoking, more physical activity.

Although, hypotension is not that dangerous as hypertension, it also has to be monitored and
treated. Low blood pressure can be just a short-term condition resulting from other conditions or
diseases such as pregnancy, blood loss, diabetes. Symptoms of low blood pressure are fatigue,
dizziness, lightheaded and pale skin. It can be treated also with medications, but it is important to
stay hydrated and to calm down and avoid stress when feeling symptoms that suit hypotension.

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 6. Summary

Blood pressure is one of the vital signs, along with respiratory rate, heart rate, oxygen saturation,
and body temperature. Normal blood pressure is 120 systolic and 80 diastolic. Blood pressure
over 140/90 is called high blood pressure or hypertension and blood pressure below 90/60 is low
blood pressure or hypotension. Hypertension is a chronic disease that causes damage to arteries
and could lead to heart attack and heart failure. It can be treated and managed with right
medications, change of diet and lifestyle which includes enough of physical activity.
Hypotension is not as dangerous as high blood pressure, but symptoms include fatigue, dizziness
and vomiting so it also has to be treated. It can be treated also by medications and diet, but when
the symptoms appear it is necessary to stay hydrated.

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7. References

1. https://en.wikipedia.org/wiki/Blood_pressure (7.10.2019.)
2. Lewington S., Clarke R., Qizilbash N., Peto R., Collins R. Prospective Studies
Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a
meta-analysis of individual data for one million adults in 61 prospective studies. Lancet.
2002; 360: 1903-1913
3. https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-
pressure-readings (7.10.2019.)
4. https://www.webmd.com/hypertension-high-blood-pressure/qa/what-does-the-systolic-
blood-pressure-number-mean (7.10.2019.)
5. https://www.heartfoundation.org.au/your-heart/know-your-risks/blood-pressure/is-my-
blood-pressure-normal (7.10.2019.)
6. https://www.mibluesperspectives.com/2018/05/04/hypertension-hypotension-highs-lows-
blood-pressure/ (8.10.2019.)
7. Martha Grogan, M.D. Mayo Clinic Healthy Heart for Life. A plan for preventing and
conquering heart disease. Rochester: Time, Inc., 2012.; 1-60320-204-8
8. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-
causes/syc-20373410 (8.10.2019.)
9. https://www.healthline.com/health/hypotension (8.10.2019.)

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