Most experts like Cardiologist in Karachi consider hypertension to be the ‘silent killer’ as more often than not it is accidently discovered after it has done significant damage to the body. There are four stages of hypertension, and the treatment of hypertension depends on which stage it is. Without proper management, hypertension can prove dangerous. Read on to know more about hypertension and its stages:

What is hypertension?

The medical term for higher than normal blood pressure is hypertension. Blood pressure is a measure of force of blood against the wall of blood vessels and is measured through an instrument called sphygmomanometer. The top number in the blood pressure measures the systolic pressure or the pressure when the heart is contracting. The bottom number is the diastolic pressure or the pressure in the vessels when the heart is resting and the chambers of the heart are filling with blood. Normal blood pressure is around 120/80 mm Hg.

Consistently high blood pressure forces the wall of the blood vessels to expand beyond their normal limits which can put them at risk for stroke, heart attack and kidney disease. Persistently high blood pressure can present with symptoms of:

• Nausea and vomiting
• Facial redness
• Fatigue
• Pounding headache
• Shortness of breath
• Nosebleeds
• Heart palpitations
• Subconjunctival hemorrhage
• Double vision

The risk of hypertension is higher in certain ethnicities, individuals with family history of disease and in men up to the age of 65 years. After 65 years, women are more likely to develop hypertension than men. The risk of hypertension is also higher in people who lead a sedentary lifestyle, consume diet rich in sodium, sugars and trans fats. Stress and poor control of diabetes are other risk factors that increase the chances of hypertension.  

What are the types of hypertension?

The types of hypertension include:

• Primary hypertension: also known as essential hypertension, this is the condition whereby a specific cause of hypertension is not known. A combination of age, lifestyle changes and family history are the supposed culprits of primary hypertension. Most adult cases belongs to the category of essential hypertension. Lifestyle changes, dietary changes and exercise can help lower primary hypertension.
• Secondary hypertension: if the cause of hypertension is identifiable, it is called secondary hypertension. This is potentially reversible as the cause is known. Of all the cases of hypertension, only about 5 to 10 percent belong to this category. This type of high blood pressure is more common in younger individuals within the age group of 18 to 40 years.  
• Resistant hypertension: when hypertension is not controllable with multiple medications, it is called resistant hypertension. By definition, if the blood pressure is not controllable with three different types of antihypertensives including a diuretic, it is termed resistant hypertension. About 10 percent of all hypertensive cases belong to this category.  
• Malignant hypertension: this is the type of dangerously high hypertension with end organ damage, that is an emergency condition. The blood pressure readings are usually higher than 180 mmHg systolic and 120-130 mmHg diastolic. The symptoms of malignant hypertension include: shortness of breath, dizziness, chest pain, headache and visual changes.
• Isolated systolic hypertension: is when the systolic blood pressure alone is higher than 140 mmHg while the diastolic blood pressure is under 90 mmHg. The prevalence of this type of hypertension is around 15 percent.

What are the stages of hypertension?

There are four stages of hypertension according to the new 2017 guidelines of American College of Cardiology and the American Heart Association. These include:

• Normal blood pressure: the normal range of blood pressure is below 120/80 mmHg.  
• Elevated blood pressure: is defined as systolic blood pressure between 120-129 mmHg systolic and diastolic pressure less than 80 mmHg. According to recent studies, even this range of blood pressure can result in long-term problems, including heart disease and stroke. Without managing the hypertension at this stage, it can progress to the next stage of hypertension.
• Stage I hypertension: this is when the range of blood pressure is between 130-139/ 80-89 mmHg.
• Stage II hypertension: is when the blood pressure is higher than 140/90 mmHg and healthcare providers at Fauji Foundation Hospital treat with multiple anti-hypertensives.