Rheumatology
Living With Arthritis

Hypertension, commonly known as high blood pressure, is often called the "silent killer" because it typically has no symptoms until significant damage has occurred. A normal blood pressure reading is below 120/80 mmHg, while hypertension is defined as consistently measuring 130/80 mmHg or higher.
**Understanding the Numbers:**
- **Systolic pressure** (top number): Pressure when heart beats
- **Diastolic pressure** (bottom number): Pressure between beats
- Stage 1 hypertension: 130-139/80-89 mmHg
- Stage 2 hypertension: 140+/90+ mmHg
- Hypertensive crisis: 180+/120+ mmHg (requires immediate attention)
**Causes and Risk Factors:**
1. **Primary hypertension** (90-95% of cases):
- Develops gradually over years
- Related to lifestyle and genetic factors
- Risk increases with age
2. **Secondary hypertension** (5-10% of cases):
- Caused by underlying conditions:
* Kidney disease
* Thyroid problems
* Obstructive sleep apnea
* Certain medications (NSAIDs, decongestants)
* Illegal drugs (cocaine, amphetamines)
**Complications of Uncontrolled Hypertension:**
- Heart attack or stroke
- Aneurysm
- Heart failure
- Kidney damage
- Vision loss
- Metabolic syndrome
- Cognitive decline
**Comprehensive Management Strategies:**
1. **Dietary Approaches (DASH Diet):**
- Emphasizes fruits, vegetables, whole grains
- Includes low-fat dairy, lean proteins
- Limits saturated fats, cholesterol, sodium
- Recommended sodium: <1,500-2,300 mg/day
2. **Lifestyle Modifications:**
- Regular aerobic exercise (150 min/week)
- Weight loss (5-10% reduction helps significantly)
- Stress reduction techniques
- Smoking cessation
- Alcohol moderation (?1 drink/day women, ?2 men)
3. **Medications (when needed):**
- Thiazide diuretics
- ACE inhibitors
- ARBs
- Calcium channel blockers
- Beta blockers
- Often requires combination therapy
4. **Home Monitoring:**
- Use validated upper-arm monitors
- Take readings at consistent times
- Keep a log to share with your doctor
- Avoid caffeine, exercise, and smoking 30 mins before
**Emerging Treatments:**
- Renal denervation for resistant hypertension
- Newer combination medications with fewer side effects
- Digital therapeutics and mobile health monitoring
- Personalized medicine approaches based on genetics
Regular check-ups are crucial, as hypertension management often needs adjustment over time. Work closely with your healthcare provider to develop a personalized plan that works for your specific situation and risk factors.
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