What Is Hypertension?


Hypertension is derived from two root words; Hyper meaning High and Tension  meaning Pressure. Hypertension simply means high blood pressure. Pressure is the  force generated when the heart contracts and pump blood through the blood  vessels that conduct the blood to various parts of the blood.  Although  hypertension does not mean or result from excessive emotional tension, but  evidence shows that stress and emotional tension do cause increase in blood  pressure, and if continuous, could be sustained. High blood pressure is  therefore generally defined as a blood pressure exceeding 140/90mmHg confirmed  on multiple occasions. The top number (140) is called the SYSTOLIC PRESSURE, and  it represents the pressure in the blood vessels (arteries) as the heart  contracts and pump blood into circulation. The bottom number (90) is called  DIASTOLIC PRESSURE, and it represents the pressure in the blood vessels as the  heart relaxes after contraction. These figures measured in millimeters of  Mercury (mmHg) reflect the highest and lowest pressures the heart and blood  vessels are exposed to during circulation. The generally accepted normal value  for blood pressure is 120/80mmHg. Above this value but less than 140/90mmHg is  not considered to be hypertensive yet but signals danger, it is therefore called  High normal.

An elevation of the blood pressure (Hypertension) increases the risk of  developing Heart (Cardiac) diseases such as Heart Failure and Heart attack,  Kidney diseases, Vascular diseases like athelosclerosis (hardening and narrowing  of blood vessels), Eye damage and Stroke (brain damage). These complications  called End organ damage arise as a result of long standing (chronic)  hypertension. But victims of hypertension are not aware, at an early stage, that  they have the disease, until these complications start appearing. This is  because hypertension shows virtually no signs/symptoms at the early stage. For  this reason, it is generally referred to as the ‘Silent Killer’.

The damage caused by hypertension increases in severity as the blood pressure  increases. Based on this hypertension can be classified as follows:

CATEGORY        SYSTOLIC(mmHg)   DIASTOLIC(mmHg) Normal Less than  130 Less than 85 High Normal 130 – 139 85 – 89 Mild  Hypertension 140 – 159 90 – 99  Moderate Hypertension 160 –  179 100 – 109 Severe Hypertension 180 – 209 110 – 119 Very  Severe Hypertension Greater than 210 Greater than 120


Borderline Hypertension is defined as mildly elevated blood pressure that is  found to be higher than 140/90mmHg at some times and lower than that at other  times.

Patients with borderline value need to have their blood pressure monitored  more frequently. They also need to assess end organ damage to be aware of the  significance of their hypertension.

It should, however, be emphasized that patients with borderline hypertension  have a higher tendency to develop a more sustained hypertension as they get  older. They stand a modest risk of having heart related diseases. A close  monitoring of their blood pressure and lifestyles could be very useful in this  regard.


A single elevated blood pressure reading in the doctor’s office could be  misleading, because the elevation might only be temporary. Evidence over the  years has shown that anxiety related to the stress of the examination and fear  of the result often result in blood pressure elevation noticed in the doctor’s  office only. Infact, it has been suggested that one out of every four persons  thought to have mild hypertension, actually may have normal blood pressure  outside the physician’s office. This sort of elevated blood pressure noticed in  the physician’s office is called ‘White Coat Hypertension’. Suggesting that the  white coat, symbolic of the physician, induces the patient’s anxiety and a  passing increase in blood pressure. Accordingly, monitoring of blood pressure at  home, when in a more relaxed state of mind, can provide a more reliable estimate  of the frequency and/or consistency of blood pressure changes.


The Blood pressure is determined by two major parameters; Cardiac output i.e.  the volume of blood pumped by the heart, and the Total peripheral resistance  i.e. the resistance of the blood vessels through which blood flows. Hypertension  is therefore an end result of either increased force of pumping by the heart, or  constriction/narrowing of blood vessels causing increased resistance to blood  flow or both. Using the cause of hypertension as a yardstick, two major  types of hypertension can be described;

Essential Hypertension

Secondary hypertension

The former also called Primary or Idiopathic hypertension is by far the most  prevalent type of hypertension. It accounts for over 90% of all hypertension  cases. No clear cut cause(s) can be identified for this type of accommodation,  hence the name Idiopathic.

The later accounts for less than 10% of all cases. In this case, the  hypertension is secondary to an existing abnormality in one or more systems or  organs of the body. The most common causes are related to kidney and hormonal  problems. The persistent uncontrolled use of contraceptives, especially in  females over 35years of age fall under hormonal causes of hypertension.

Since no clear-cut cause(s) can be adduce for the most common types of  hypertension, as with the case with most non-communicable diseases, we therefore  talk in terms of ‘Risk Factors’ and not causes. These Risk Factors are  actions/inactions that increases chances of getting a disease. Several  researches over the years have shown that some factors are directly or  indirectly related to the occurrence of hypertension. Some of the factors  include:

HEREDITARY: High blood pressure tends to run in some families and races. It  is believed that some inherited traits predispose some people to hypertension.  For example, high blood pressure tends to be more prevalent in blacks than  whites.

A family history of hypertension increases one chances of high blood  pressure. Regular monitoring of blood pressure becomes very vital. HIGH SALT  INTAKE: High intake of Sodium Chloride (table salt) has being linked to high  blood pressure. The condition develops mostly in societies or communities that  have a fairly high intake of salt, exceeding 5.8grams daily. In fact, salt  intake may be a particularly important factor in relation to essential  hypertension that is associated with advancing age, black racial background,  hereditary susceptibility, obesity and kidney failure.  Research has shown  that:

a. Rise in blood pressure with age is directly related to increase level of  sat intake, especially in blacks.

b. People who consume little sodium chloride develop no high blood pressure  when they consume more, hypertension appears.

c. Increased Sodium is found in the blood vessels and blood of most  hypertensives.

Cutting down on salt intake is therefore a reasonable step in preventing  hypertension


A close relationship exists between hypertension and obesity. In fact it is  believed that most hypertensives are more than 10% overweight. Fat accumulation  in the trunk or abdomen is not only related to hypertension but also to diabetes  and hyperlipideamia (excess fat in the body). Obesity can contribute to  hypertension in several ways. For one thing, obesity leads to a greater output  of blood, because the heart has to pump more blood to supply the excess tissues.  The increased cardiac output then can raise the blood pressure. For another  thing, obese hypertensive individuals have a greater stiffness (resistance) in  the peripheral arteries throughout the body. Finally, obesity may be associated  with a tendency for the kidneys to retain salt in the body. Weight loss may help  reverse problems related to obesity while also lowering blood pressure. It has  been estimated that the blood pressure can be decreased 0.32mmHg for every 1kg  (2.2pounds) of weight loss.

The International standard for measuring overweight and obesity is based on a  value called BODY MASS INDEX (BMI). This value is derived by dividing the body  weight (in Kilograms) by the square of height (in Metres).

i.e. BMI = Body weight (Kg)

Height2 (Metres). Note: 1ft = 0.305metres. For adults, a BMI less  than 25kg/m2  is preferred. 25 – 29kg/m2 is considered overweight and above  30kg/m2 is Obesity.


Sedentary normal individuals have a 20 – 50% higher risk of developing  hypertension when compared to very active individuals. Exercise lowers both  systolic and diastolic blood pressures.  For example dynamic exercises such as  brisk walking or jogging, swimming or bicycle ridding for 30 – 45mins daily or  3-5times a week may lower blood pressure by as much as 5 – 15mmHg. Moreover,  there appears to be a relationship between the amount of exercise and the degree  to which blood pressure is lowered. Thus, to a point, the more you exercise, the  more you lower your blood pressure. Provided you do not over strain yourself.  Normally, a particularly type of exercise is started, and gradually built up to  a satisfactory level over time. Regular exercise reduces blood pressure, burn  out unnecessarily fat and also makes the body healthier.


These two constitute the social factors most related to high blood pressure.  People who drink alcohol excessively (over two drinks per day) have a one and  half to two times increase in the frequency of hypertension. The association  between alcohol and high blood pressure becomes particularly noticeable when the  alcohol intake exceeds the above per day. Moreover, the connection is a dose  related phenomenon. In other words, the more alcohol consumed, the stronger the  chances of hypertension. This, probably will explain the prevalence of  hypertension in populations where alcohol consumption is a habit.

Although smoking increases the risk of vascular complications (for example,  heart diseases and stroke) in people who already have hypertension, it cannot be  directly linked with increase in the development of hypertension. Nevertheless,  smoking a cigarette can repeatedly produce an immediate, temporary rise in blood  pressure of 5 – 10mmHg, but a permanent increase cannot be established. However,  it is known that some substances in cigarette, e.g. nicotine, alters the  composition of the blood and also affects the blood vessels.

Smoking and alcohol control are integral part of any effort towards the  primary control of cardiovascular diseases in any population. STRESS:  Although the role of stress and other emotional factors in hypertension is  difficult to define. However, it is known that stress causes a physiological  rise in blood pressure and this could be sustained if the stress becomes chronic  (prolonged).


Since lifestyle components such as dietary patterns, obesity, physical  activity, alcohol and smoking have been recognized as important risk factors,  steps to reduce the occurrence of hypertension or to alleviate the condition   (for those who are hypertensives) should involve lifestyle modification.

Dietary modifications include restricting salt intake cutting down or cutting  out alcohol, reduced fat consumption, and reducing weight if overweight. The  American Heart Association recommends a daily consumption of less than 6grams of  table salt for normal individuals, and less than 4grams for hypertensives.

A regular exercise program such as brisk walking, jogging, swimming, cycling  e.t.c.  for 30 – 45mins daily or 3-5 times a week could be very helpful.

Conclusively, it is very important to remember that the only way to know if  one’s blood pressure is on the high side is by taking your blood pressure  frequently. Normally, your doctor would do that for you. But for a more  consistent and reliable monitor of blood pressure, a self-operated blood  pressure monitor is crucial. Being very handy and always around, it allows you  to follow up your blood pressure regularly and report an increase  immediately.

Finally, always remember the WHO slogan “Know your Blood Pressure, if it’s  high have it treated”. A healthy Heart adds life to years. A stitch in time,  they say, saves nine.


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