HYPERTENSION
Hypertension rates in rural areas are more
Hypertension is another name for high blood
pressure. It can lead to severe health
complications and increase the risk of heart
disease, stroke, and sometimes death.
Blood pressure is the force that a person’s
blood exerts against the walls of their blood
vessels. This pressure depends on the
resistance of the blood vessels and how hard
the heart has to work.
 is blood pressure that is higher than normal.
Your blood pressure changes throughout the
day based on your activities. Having blood
pressure measures consistently above normal
may result in a diagnosis of high blood
pressure (or hypertension).
Hypertension is a primary risk factor for
cardiovascular disease, including stroke, heart
attack, heart failure, and aneurysm. Keeping
blood pressure under control is vital for
preserving health and reducing the risk of
these dangerous conditions.
than 10% higher than in most urban areas,
according to a CDC survey.
Non-communicable diseases are increasing at
an alarming rate in rural India, with long-term
consequences on people's health and finances
A follow-up study on the causes of death in
rural India for the years 2010-13 showed that
NCDs accounted for 47% of all deaths while
communicable, maternal, peri-natal and
nutritional conditions together accounted for
30%, indicating that NCDs have unquestionably
become a healthcare priority.
High blood pressure, the biggest risk factor
for death worldwide, now affects one in five
adults in rural India
An analysis of data from the 2017 Behavioral
Risk Factor Surveillance System showed that
40% of participants in the most rural areas and
29.4% in the most urban areas reported having
a hypertension diagnosis.
Most counties in the predominantly rural
Southeast and in Appalachia had high
hypertension rates, many that topped 50%.
Management and treatment
Lifestyle adjustments are the standard, first-
line treatment for hypertension.
However, the study found little improvement
in the treatment and control of hypertension
in Nepal, Indonesia, and most countries in sub-
Saharan Africa and Oceania.
There were improvements in treatment and People should exercise on at least 5 days of
control in high income countries such as the week.
Germany, the United States, and Portugal.
Examples of suitable activities are walking,
The improvements were particularly jogging, cycling, or swimming.
impressive in Canada, Iceland, and South
Korea.

However, there was also major progress in the

treatment and control of hypertension in
some middle income countries, including
Costa Rica, Kazakhstan, South Africa, Brazil,
Turkey, and Iran.

The researchers attribute this progress to the Stress reduction

expansion of universal health coverage and
the strengthening of primary care in these Avoiding or learning to manage stress can
countries. help a person control blood pressure.

In these countries, less than a quarter of
women and a fifth of men with hypertension
received treatment for the condition in 2019.
Overall, fewer than 10% had well-controlled
blood pressure.
Meditation, warm baths, yoga, and simply
going on long walks are relaxation techniques
that can help relieve stress.
People should avoid consuming alcohol,
recreational drugs, tobacco, and junk food to

Regular physical exercise cope with stress, as these can contribute to

elevated blood pressure and the

Current guidelines recommend that all people, complications of hypertension.

including those with hypertension, engage in

at least 150 minutes of moderate intensity, Smoking can increase blood pressure.

aerobic exercise every week, or 75 minutes a Avoiding or quitting smoking reduces the risk

week of high intensity exercise.

of hypertension, serious heart conditions, and  vasodilators
other health issues.
 angiotensin-converting enzyme (ACE)
inhibitors

 angiotensin receptor blockers

Medication

Diet
People can use specific medications to treat
People can prevent high blood pressure by
hypertension. Doctors will often recommend a following a heart-healthy diet.
low dose at first. Antihypertensive
medications will usually only have minor side
effects.

Eventually, people with hypertension will

need to combine two or more drugs to
manage their blood pressure.

Moderating alcohol consumption

Medications for hypertension include:

Moderate to excessive alcohol consumption

 diuretics, including thiazides,
can increase blood pressure.
chlorthalidone, and indapamide

 beta-blockers and alpha-blockers The American Heart Association (AHA)

recommend a maximum of two alcoholic
 calcium-channel blockers
drinks a day for men, and one for women.
 central agonists

 peripheral adrenergic inhibitor The following would count as one drink:

  a 12-ounce (oz) bottle of beer

 4 oz of wine

 1.5 oz of 80-proof spirits

 1 oz of 100-proof spirits

Eating more fruit and vegetables and less fat

People who have high blood pressure or

people at high risk of developing high blood
pressure should eat as little saturated and
total fat as possible.

Reducing salt intake Instead, experts recommend:

People’s average salt intake is between 9  whole grain, high fiber foods

grams (g) and 12 g per day in most countries  a variety of fruit and vegetables
around the world.
 beans, pulses, and nuts

 fish rich in omega-3 twice a week

The World Health Organization (WHO)
recommend reducing intake to under 5  nontropical vegetable oils, for
gTrusted Source a day to help decrease the example, olive oil
risk of hypertension and related health
 skinless poultry and fish
problems.
 low fat dairy products

Lowering salt intake can benefit people both

It is important to avoid trans fats,
with and without hypertension.
hydrogenated vegetable oils, and animal fats,
as well as large portion sizes.

Some fats, such as those in oily fish and olive

oil, have protective effects on the heart.
However, these are still fats. While they are
typically healthful, people with a risk of
hypertension should still include them in their
total fat intake.
Managing body weight
Excess body weight can contribute to
hypertension. A fall in blood pressure usually
follows weight loss, as the heart does not
have to work so hard to pump blood around
the body.
A balanced diet with a calorie intake that
matches the individual’s size, sex, and activity
level will help.
The U.S. National Heart, Lung, and Blood
Institute (NHLBI) recommend the DASH
diet for people with high blood pressure.
DASH stands for “Dietary Approaches to Stop
Hypertension.”
DASH is a flexible and balanced eating plan
with a firm grounding in research by the
NHLBI who advise that the diet:
 lowers high blood pressure
 improves levels of fats in the
bloodstream
 reduces the risk of cardiovascular
disease
Causes
The cause of hypertension is often not known.
In many cases, it is the result of an underlying
condition.
Doctors call high blood pressure that is not
due to another condition or disease primary or
essential hypertension.
If an underlying condition is the cause of
increasing blood pressure, doctors call this
secondary hypertension.
 Chronic kidney disease (CKD) is a common
cause of high blood pressure - as the kidneys
no longer filter out fluid. This excess fluid
leads to hypertension.

Conditions that can lead to hypertension

include:

 diabetes- due to kidney problems and

Primary hypertension can result from multiple nerve damage

factors, including:  kidney disease-

 pheochromocytoma- a rare cancer of
 blood plasma volume- An increase in
an adrenal gland
blood volume increases central
venous pressure.   Cushing syndrome- that corticosteroid
drugs can cause
Blood pressure increases with
 congenital adrenal hyperplasia- a
increased cardiac output, peripheral
disorder of the cortisol-secreting
vascular resistance, volume of blood,
adrenal glands
viscosity of blood and rigidity of vessel
 hyperthyroidism- or an overactive
walls.
thyroid gland
 hormone activity in people who
 Hyperparathyroidism- which
manage blood volume and pressure
affects calcium and phosphorous
using medication
levels
 environmental factors- such as stress
 pregnancy
and lack of exercise
 sleep apnea- is the most common
sleep-related breathing disorder.
Secondary hypertension has specific causes
and is a complication of another health  obesity
problem.
Risk factors
A number of factors increase the risk of
hypertension.
 Age- Hypertension is more common in
people who are more than 60 years of
age. Blood pressure can increase
steadily with age as the arteries stiffen
and narrow due to plaque buildup.
 Ethnicity- Some ethnic groups are
more prone to hypertension than
others. African Americans have a
higher riskTrusted Source than other
ethnic groups, for example. · Size and
weight: Being overweight or obese is a
primary risk factor.
 Alcohol and tobacco use- Regularly
consuming large quantities of alcohol
or tobacco can increase blood
pressure.
 Sex- According to a 2018
reviewTrusted Source, males have a
higher risk of developing hypertension
than females. However, this is only
until after women reach menopause.
 Existing health conditions-
Cardiovascular disease, diabetes,
chronic kidney disease, and
high cholesterol levels can lead to
hypertension, especially as people
age.
Other risk factors include:
 sedentary lifestyle
 salt rich, high fat diet
 low potassium intake
Poorly managed stress and a family history of
high blood pressure can also contribute to the
risk of developing hypertension.
Symptoms
A person with hypertension may not notice
any symptoms, and so people often call it the
“silent killer.” 
More than half of all people with hypertension
in 2019, or 720 million individuals, were
receiving no treatment for the condition
because many of them were unaware that
they had it.
New research by an international team of
scientists has discovered that in 2019, close to
41% of women and 51% of men with high blood
pressure were unaware that they had the
condition.
The same study found that, in total, about 53%
of women and 62% of men with hypertension
were not receiving appropriate treatment, as
most of them were not aware that they had
the condition.
Without detection, hypertension can damage
the heart, blood vessels, and other organs,
such as the kidneys.
Hypertension-related atherosclerosis can lead
to:
 heart failure and heart attacks
 aneurysm, or abnormal bulge in the
wall of an artery that can burst
 kidney failure
 stroke

 amputation
It is vital to check blood pressure regularly.
 hypertensive retinopathies in the eye,
which can lead to blindness
In rare and severe cases, high blood pressure
causes sweating, anxiety, sleeping problems,
and blushing. However, most people with
hypertension will experience no symptoms at Signs
all.
A sphygmomanometer, or blood pressure
If high blood pressure becomes a monitor, can help people keep track of their
hypertensive crisis, a person may blood pressure.
experience headaches and nosebleeds.

Complications

Long term hypertension can cause

complications through atherosclerosis where
plaque develops on the walls of blood vessels,
causing them to narrow.

This narrowing makes hypertension worse, as

the heart must pump harder to circulate the
blood.
A doctor’s visit is not always necessary for 130 and
hypertension 80 and 89
blood pressure monitoring. Home blood 139

pressure monitors are available for purchase Stage 2 At least At least

hypertension 140 90
online.
Hypertensive
Over 180 Over 120
crisis
For this reason, a diagnosis of hypertension
requires several readings that show sustained
high blood pressure over time. Medications

The AHA issued guidelines in November 2017
that define hypertension as blood pressure
that is consistently higher than 130 over 80
millimeters of mercury (mmHg).
The systolic reading of 130 mmHg refers to the
The type of medication your doctor prescribes
for high blood pressure depends on your
blood pressure measurements and overall
health. Two or more blood pressure drugs
often work better than one. Sometimes
finding the most effective medication or

pressure as the heart pumps blood around the combination of drugs is a matter of trial and
error.
body. The diastolic reading of 80 mmHg refers
to the pressure as the heart relaxes and refills
with blood.

The AHA 2017 guidelines define the following

ranges of blood pressure:

Systolic Diastolic
(mmHg) (mmHg) You should aim for a blood pressure
treatment goal of less than 130/80 mm Hg if:
Normal blood Less than Less than
pressure 120 80
 You're a healthy adult age 65 or
Between older
Less than
Elevated 120 and
80
129  You're a healthy adult younger
Stage 1 Between Between than age 65 with a 10% or higher
 risk of developing cardiovascular
disease in the next 10 years
 You have chronic kidney disease,
diabetes or coronary artery
disease
Ask your doctor what your blood
pressure treatment goal should be.
Also, the ideal blood pressure
treatment goal can vary with age
and health conditions, particularly if
you're older than age 65.
Medications used to treat high blood pressure
include:
Diuretics. - Diuretics, sometimes called water
pills, are medications that help your kidneys
eliminate sodium and water from the body.
These drugs are often the first medications
tried to treat high blood pressure.
There are different classes of diuretics,
including thiazide, loop and potassium
sparing. Which one your doctor recommends
depends on your blood pressure
measurements and other health conditions,
such a kidney disease or heart failure.
Diuretics commonly used to treat blood
pressure include chlorthalidone,
hydrochlorothiazide (Microzide) and others.
A common side effect of diuretics is increased
urination, which could reduce potassium
levels. If you have a low potassium level, your
doctor may add a potassium-sparing diuretic
— such as triamterene (Dyazide, Maxide) or
spironolactone (Aldactone) — to your
treatment.
Angiotensin-converting enzyme (ACE)
inhibitors. - These medications — such as
lisinopril (Prinivil, Zestril), benazepril
(Lotensin), captopril and others — help relax
blood vessels by blocking the formation of a
natural chemical that narrows blood vessels.
Angiotensin II receptor blockers (ARBs). -
These medications relax blood vessels by
blocking the action, not the formation, of a
natural chemical that narrows blood
vessels. ARBs include candesartan (Atacand),
losartan (Cozaar) and others.
Calcium channel blockers. - These medications
— including amlodipine (Norvasc), diltiazem
(Cardizem, Tiazac, others) and others — help
relax the muscles of your blood vessels. Some
slow your heart rate. Calcium channel blockers
may work better for older people and people
of African heritage than do ACE inhibitors
alone.
Don't eat or drink grapefruit products when
taking calcium channel blockers. Grapefruit
increases blood levels of certain calcium
channel blockers, which can be dangerous.
Talk to your doctor or pharmacist if you're
concerned about interactions.