High Blood Pressure

The heart is the pump that circulates blood in the blood vessels throughout the body. Blood circulation in the body is largely divided into body circulation and pulmonary circulation.

1. Body circulation

The blood, which is pumped into the aorta by the contraction of the left ventricle, flows through the arteries into capillaries throughout the body, providing oxygen and nutrients to the tissues of the body, receiving carbon dioxide and waste, and then returning through the veins to the right atrium.

Left ventricle → Aorta → Arteries → Capillaries of each tissue in the body → Veins → right atrium

2. Pulmonary circulation

Blood flowing from the right atrium to the right ventricle passes through the alveolar capillaries along the pulmonary artery by the contraction of the right ventricle, releases carbon dioxide, receives oxygen, and returns to the left atrium along the pulmonary vein.

Right ventricle → Pulmonary arteries → Alveolar capillaries → Pulmonary veins → Left atrium

Structure of the circulatory system

Blood pressure is the pressure of blood flowing through blood vessels. Depending on the measurement site, there are various types such as arterial pressure, venous pressure, pulmonary artery pressure, and pulmonary vein pressure.

The unit for recording pressure uses mmHg, which is often used to measure air pressure. 1mmHg is the pressure that can push the column of mercury up to 1mm, which is called “millimeter mercury” when reading.

On the other hand, the pumping of the heart is caused by the contraction and relaxation of the heart, so the pressure in the arteries measured in the arm rises as the left ventricle contracts and decreases as it relaxes, forming a wave shape. The pressure at the highest moment due to contraction of the left ventricle is called “shrinkage blood pressure”, and the pressure at the lowest moment due to relaxation of the left ventricle is called “diastolic blood pressure.”

Hypertension is when the systolic blood pressure is greater than 140 mmHg or the diastolic blood pressure is greater than 90 mmHg in adults.

Hypertension causes a variety of complications throughout the body, including coronary artery disease, stroke, and kidney failure, directly threatening the patient’s life and health. However, in general, high blood pressure is not symptomatic, so it is not diagnosed until the blood pressure is measured.

Types of hypertension

Hypertension is divided into two categories according to its cause.

1) Primary hypertension

Also known as “essential hypertension”, which refers to high blood pressure whose cause is unclear. Most hypertensive patients in Korea correspond to primary hypertension. Primary hypertension accounts for over 90-95% of all people with high blood pressure.

It is not clear why essential hypertension develops, but it is thought that it occurs when the amount of salt intake is higher than necessary to increase the blood flow in the body or the resistance of peripheral hormones increases due to the imbalance of various hormones. Risk factors that cause high blood pressure include family history (genetic disposition) of high blood pressure, drinking, smoking, old age, lack of exercise, obesity, salty eating habits, and environmental or psychological factors such as stress.

2) Secondary hypertension

Secondary hypertension is when a blood pressure is high because of a disease. It is found in relatively young people, so if a young person is diagnosed with high blood pressure, it is necessary to look for the underlying disease. Various diseases can be caused by kidney disease, adrenal tumors, some congenital heart diseases, and some drugs can cause secondary hypertension. Kidney diseases (chronic renal failure and neovascular hypertension) are the most common causes of secondary hypertension.

It accounts for about 5-10% of all patients with hypertension, and hypertension tends to be sudden and blood pressure is relatively higher than primary hypertension. Severe hypertension with diastolic blood pressure greater than 120 mmHg or hypertension with retinal disease should be suspected and tested for secondary hypertension. Secondary hypertension treats high blood pressure by removing it when a causative disease is found.

• Chronic kidney disease
• Cushing’s syndrome
• Aortic coarctation
• Obstructive sleep apnea
• Parathyroid Disease
• Pheochromocytoma
• Primary aldosteroneism
• Neovascular disease
• Thyroid disease

Causes and Risks

Risk factors for high blood pressure can be divided into risk factors that are inevitable even if effort is made, and risk factors that can be controlled by effort. The reason for this distinction is that high blood pressure, like most chronic diseases such as diabetes, is a disease in which the patient must manage his / her own disease and physical condition.

1) Risk factors that patients cannot control

˚ Age: As age increases, the risk of developing high blood pressure increases.
˚ Family history: High blood pressure tends to be genetic. People with high blood pressure in the family have an increased risk of developing high blood pressure than people who do not.

2) Risk factors that can be controlled by the patient

• Obesity: As you gain weight, you are more likely to develop high blood pressure.
• Lack of activity: people with less physical activity is more likely to develop high blood pressure.
• Smoking: Smoking increases blood pressure by constricting blood vessels.
• Salt intake: Intake of salt more than necessary increases blood pressure.
• Stress: excessive stress increases blood pressure. Trying to relieve stress from overeating, smoking or drinking results in higher blood pressure.

Symptoms and Complications

Most people with hypertension have no symptoms even when their blood pressure rises to severe levels. Dull headaches, dizziness, and nosebleeds are not symptoms of high blood pressure.

Long-term high blood pressure can cause various complications in different parts of the body and can sometimes be fatal, such as a heart attack or stroke. Most symptoms of high blood pressure are due to complications from high blood pressure, which means that the condition is already very advanced when symptoms appear. For this reason, high blood pressure is sometimes called the “silent killer.”

Complications that can occur if you do not control high blood pressure include:

• Hemorrhagic stroke
• Ischemic stroke
• Heart failure
• Myocardial infarction
• Arrhythmia
• Kidney failure
• Hypertensive retinopathy
• Aortic dissection

Diagnoses

If you have high blood pressure, it is a good idea to regularly check your blood pressure. In particular, high blood pressure does not have any other symptoms, so there is no way to determine whether high blood pressure has occurred except by measuring blood pressure.

Hypertension can be diagnosed as high blood pressure if you have visits to the hospital several times and have at least two consecutive blood pressures of 140/90 mmHg or higher.

Criteria for hypertension in adults. The table shows the criteria for hypertension in adults. Blood pressure is divided into normal, prehypertension, prehypertension, stage 1 hypertension, and stage 2 hypertension. In normal cases, the systolic is less than 120 and the diastolic is less than 80. For prehypertension, a prehypertension stage, the systolic is 120 to 139 or the diastolic is 80 to 89. For stage 1 hypertension, the systolic is 140 to 159 or the diastolic is 90 to 99. Stage 2 hypertension has more than 160 systolic or more than 100 diastolic.

1. Precautions when measuring blood pressure

Blood pressure can vary greatly depending on activity, food preferences, posture, etc. It is recommended that you read the following precautions for accurate measurement.

• Do not smoke or drink coffee 30 minutes before blood pressure measurement.
• If your bladder is full, your blood pressure will increase.
• Before you measure, keep your feet flat on the floor and sit comfortably on your chair for 5 minutes. Place your arms on a table about the height of your heart.
• It is recommended to wear short sleeves whenever possible so that the arms can be easily exposed. Take off the thick top.
• When a blood pressure is taken, the palpation of the forearm artery is promoted, and in irregular cases a manual blood pressure monitor is more accurate.
• If the difference between the stock of blood pressure on both arms, record the higher side. If the difference in blood pressure on both arms is more than 20mmHg, measure again.

2. White Coat Hypertension

Some people have high blood pressure only when they see the doctor, which is called white coat hypertension. If you suspect high blood pressure in your bag, you can diagnose it at home by measuring your blood pressure or using a 24-hour active blood pressure monitor that automatically checks your blood pressure every 15 to 30 minutes for 24 hours.

On the other hand, masked hypertension (hidden hypertension) is considered normal when the blood pressure is measured in the hospital, but when the blood pressure is measured in daily life, the average blood pressure is actually high and needs treatment.

[self-monitoring of BP at home, 24h-ambulatory BP monitoring]

In recent years, for the purpose of diagnosing hypertension and white blood pressure, and determining the treatment effect of hypertensive patients, a test for measuring 24-hour active blood pressure and a home blood pressure measurement for measuring blood pressure by the patient themselves are frequently used.

24-hour ambulatory blood pressure can help you see your average night and day blood pressure, which can help patients with large fluctuations in blood pressure or those who suspect certain symptoms related to blood pressure.
Home blood pressure is measured with a home electronic sphygmomanometer, and systolic blood pressure is quite accurate. However, electronic sphygmomanometers that are measured at the wrist or finger rather than at the upper arm are prone to errors. In addition, take home electronic sphygmomanometer to use after checking how much error occurs with blood pressure measured by mercury sphygmomanometer.
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1. Initial Evaluation of Patients with Hypertension

1) Lifestyles requiring risk assessment and correction

Among the risk factors that affect the development of high blood pressure, lifestyle therapy is the most important in the treatment and management of high blood pressure, identifying and educating patients to correct their lifestyle and mediating them to have the right lifestyle. Some lifestyle therapies that have been shown to be effective in lowering blood pressure include sobriety, smoking cessation, weight loss, regular exercise, low salt diet and proper diet.

2) Associated Disease Assessment

The ultimate reason for good blood pressure control is to prevent serious complications such as cardiovascular and cardiovascular disease. However, diabetes and hyperlipidemia also cause cardiovascular disease, so in order to ultimately prevent cardiovascular disease, these comorbidities must be managed together.

The condition of the organs that cause the complications of hypertension, such as the heart, kidneys, and cerebrovascular vessels, is damaged by hypertension, which is an important criterion for determining the treatment method and target blood pressure.

2. Non-Drug Treatment of Hypertension

Life therapy such as smoking cessation, sobriety, diet, and regular exercise are recommended for the prevention of hypertension, even for adults with prehypertension or normal blood pressure if necessary for the treatment of hypertension.

Recommendations

• Maintain a normal weight.
• Eat lots of fruits and vegetables and low-fat dairy products and avoid saturated fatty and fatty foods.
• Eat less than 6 grams of salt per day or consult your doctor.
• Do at least 30 minutes of cardio exercise each day.
• Limit drinking to 2 drinks per day for men and 1 drink per day.

1) Weight loss

Obese people are about five times more likely to have high blood pressure, and a 10% increase in body fat increases systolic blood pressure by 6 mm Hg and diastolic blood pressure by 4 mm Hg. Therefore, if an obese person loses 10% of their weight, their blood pressure decreases by 5-20 mmHg.

2) Exercise therapy

You may want to exercise three times a week for 30 minutes at a time. If you exercise regularly, even if you do not lose weight, the effect of the exercise itself will lower the systolic and diastolic blood pressure by 5 mm Hg each.

When exercising, it’s best to start slowly to reduce the risk of damage. And make sure to warm up well before your workout and lightly clean up after your workout. Exercise intensity should gradually increase.

(1) If a test is necessary before starting exercise

Excessive exercise in your physical condition can lead to heart attacks, strokes, and arthritis, which can threaten your health. In particular, it is advisable for the following people to be prescribed appropriate exercises through consultation and consultation with a doctor before starting exercise.

• 40 years old or older, 50 years old or older
• Smoker
• Overweight or obese
• Chronic diseases such as hypertension or hyperlipidemia
• Heart disease
• Family history of heart disease before age 55
• Experience chest pain or dizziness during exercise
• Unsure of their health

(2) If you feel any of the following symptoms during exercise, stop exercising immediately and visit a hospital.

• Chest pain, tightness or tightness in the chest
• Dizziness, fainting
• Pain in the arm or jaw
• Shortness of breath, shortness of breath
• Irregular heartbeat
• Severe fatigue

3) Diet

(1) low salt type

In patients with mild hypertension, reducing their salt intake to 3 grams per day for four weeks reported a reduction in systolic blood pressure by 16 mmHg and diastolic blood pressure by 9 mm Hg compared to 12 g of salt per day. Since our country consumes more than 12 g of salt on average, it will be very difficult to properly carry out low-salt diets, as in foreign countries. However, you can expect a significant blood pressure treatment just by reducing your salt intake, so keep a low salt diet.

(2) potassium and calcium intake

Eating potassium and calcium can help lower blood pressure. However, people with poor kidney function may have fatal side effects such as hyperkalemia, so be sure to consult with your doctor. Fresh vegetables and fruits are high in potassium, so eating them without warming or pickling will help lower your blood pressure.

(3) reduced fat intake

Reducing fat intake does not have a direct effect on blood pressure reduction, but it helps to reduce overall cardiovascular disease. However, hyperlipidemia in Koreans is more importantly influenced by other factors, such as genetic factors than intake of fatty foods, so it is more important to maintain standard weight through exercise and diet.

Foods Restricted to Hypertensive Patients

• Salty foods: baking powder, soda, miso, red pepper paste, soy sauce, canned food, boiled meat and fish, bacon, ham, cooked food, cheese, diced, pickles, salted seafood, seaweed, butter, margarine, mayonnaise, chemical seasoning, Shellfish, shrimp, crab, sea cucumber
• Fast food: ramen and udon soups, canned food, dry snacks, popcorn, fries, fried peanuts, processed cheese, pizza, and many other processed foods
• Fatty foods: red beans, sweets, beer, ice cream, fried foods, cakes, donuts, chocolate, pork scaffolding
• Cholesterol-rich foods: butter, cheese, egg yolks, crayfish, squid

Recommended for hypertensive patients.

• Grains such as barley, rice, brown rice, buckwheat, barley, sake tea, ginseng tea, corn, sweet potato, unsalted grains, bread
• Unsalted soup
• Beef, Pork, Fresh Fish, Salted and Dried Fish
• Food made from eggs not added with salt
• Tofu and legumes, green and yellow vegetables, vegetable salad, seaweed, skim milk, garlic, leek, green onion, fresh fruit
• Vegetable oil
• Brown sugar, jam, jelly, custard, pudding
• Milk, juice, barley tea, black tea, coffee

4) Other

(1) no smoking

When smoking, systolic blood pressure rises by 4.8 mm Hg, diastolic blood pressure by 3.9 mm Hg, the effect of which is greater in elderly patients. And smoking promotes atherosclerosis, which greatly increases the risk of coronary artery disease, cerebrovascular disease, and peripheral vascular disease. Therefore, high blood pressure patients must quit smoking.

(2) no drinking

Drinking reduces blood pressure slightly at the time of drinking, but has the effect of raising blood pressure shortly afterwards and chronically. The allowable alcohol intake for an adult male is less than 28g per day, which is equivalent to two drinks of shochu (50cc) or beer (350cc) (less than 1 drink per day for older men and women). It is also recommended that you do it twice a week, and drinking more alcohol may adversely affect your health.

(3) stress, sleep disorder control

Much of adult hypertension is associated with stress. When stress is severe, sympathetic nerves increase and blood pressure rises. Simple stretching, relaxation and meditation in less than 10 minutes will help reduce stress. In addition, if you have severe insomnia or sleep apnea, you may have high blood pressure and need to see a doctor.

3. Drug treatment of hypertension

Continuous lifestyle therapy is the most important for blood pressure control. However, most people develop arteriosclerosis, which causes the arteries to become less elastic and calcify with age. For this reason, people with high blood pressure may not be able to lower their blood pressure enough by lifestyle therapy alone, so they need medication to reach their target blood pressure. Because the effects and side effects on medications vary from patient to patient, multiple attempts may be necessary to find the best prescription.

The following is basic information about antihypertensive drugs used to treat high blood pressure.

1) Angiotensin-converting enzyme (ACE) inhibitor

It is a widely used blood pressure medicine because it blocks the formation of substances with vasoconstriction (angio: vascular + tensin: contraction) and helps relax blood vessels and inhibits left ventricular hypertrophy and arteriosclerosis. There may be hypotension early in the course of administration, so dehydration or use with caution in older people. Relatively common side effects may include dry cough, redness of the skin and loss of taste.

2) Angiotensin II Receptor Blocker

A drug that has a similar effect to angiotensin converting enzyme inhibitors and has fewer side effects such as dry cough. It is the preferred drug for reducing proteinuria and preventing kidney complications in patients with high blood pressure with diabetes. A common side effect is dizziness.

3) Beta blocker

Beta blockers reduce the load on the heart by suppressing the release of renin and slowing the heart rate. It is a popular drug in people with heart failure who have a fast pulse arrhythmia or after myocardial infarction.

4) Calcium channel blocker

The drug relaxes smooth muscle in the walls of blood vessels and slows some heart rates. If you take grapefruit juice with some calcium channel blockers, it is not recommended to take them with calcium channel blockers, as there is a risk of the drug’s side effects resulting from elevated blood levels of the drug. Common side effects can include heart palpitations, palpitations, constipation, and headaches.

5) Diuretics

The drug acts on the kidneys, sending sodium and water from food through the urine to lower blood pressure and dilate blood vessels. Thiazide diuretics play an important role in the treatment of hypertension as well as in preventing heart failure associated with hypertension. Side effects can include increased blood sugar levels in diabetics and erectile dysfunction in a small number of patients. Leg cramps, fatigue, and so on can be caused by eating foods that contain potassium. Diuretics can be very helpful when blood pressure is not controlled.

6) Other hypertension drugs

If the combination of drugs described above does not reduce your blood pressure to your target, you may also prescribe the following drugs.

(1) Alpha blocker

Alpha blockers reduce the effects of vasoconstrictors by reducing nerve impulses on the blood vessels.

(2) Alpha-beta blocker

In addition to reducing nerve stimulation to blood vessels, it also reduces heart rate, which reduces the amount of blood that must pass through blood vessels when contracted.

(3) Vasodilator

Vasodilators act directly on the muscles of the artery walls, preventing their contraction of blood vessels.

Any drug has side effects, but antihypertensive drugs have proven their effectiveness and safety for a long time, and the benefits of drug use are far greater than the risk of side effects. In fact, among a large number of patients, side effects from taking medications are very rare. Therefore, if you suspect side effects, it is advisable to consult and evaluate your doctor first.

4. Treatment of hypertension step by step

1) Pre-hypertension (120/80 ~ 139/89mmHg)

This stage is the time to develop high blood pressure. Therefore, it is advisable to reduce the likelihood of developing high blood pressure by making appropriate lifestyle corrections such as:

• Quit smoking.
• Have a healthy diet. That means eating fruits and vegetables, low-fat dairy products, and eating low-salt meals.
• Keep your weight.
• Exercise 30 minutes of moderate intensity each day.
• You should drink less than twice a week.

If you are a healthy adult with no specific medical conditions, you do not need to take any medications prior to high blood pressure. However, if your blood pressure is more than 130/85 mmHg, you are about to double your chances of developing high blood pressure complications. Also, if your blood pressure is more than 130/85 mmHg, it is highly likely that you have masked hypertension, and masked hypertension requires medication.

2) Stage 1 hypertension (140/90 ~ 159/99mmHg)

If your systolic blood pressure (highest blood pressure) is above 140mmHg, or your diastolic blood pressure (lowest blood pressure) is above 90mmHg, you will be diagnosed as stage 1 hypertension. Of course, both systolic and diastolic blood pressure are in this range of stage 1 hypertension. From this stage, drug therapy is needed, and lifestyle therapy should be combined with it.

3) Stage 2 hypertension (more than 160/100mmHg)

If your systolic blood pressure is 160 mmHg or higher, or your diastolic blood pressure is 100 mmHg or higher (or both numbers are beyond this range), you will be diagnosed with stage 2 hypertension. At this stage, it is important to stop or slow the development of complications from high blood pressure as soon as possible, so medication should be taken immediately to lower your blood pressure to your target.

4) Isolated systolic hypertension

Often, only systolic, or systolic, blood pressure is increased, which is called isolated systolic hypertension, especially in older people over 60, and medication is very important.

5) High blood pressure with other health problems

Hypertension is often accompanied by other diseases, such as: In this case, tighter blood pressure control is necessary.

• Heart failure
• Coronary artery
• Left ventricular hypertrophy
  diabetes
• Chronic kidney disease
  stroke

Hypertension itself is also a risk factor for the diseases listed above, and if you have one or more of these diseases and have high blood pressure, you are at higher risk for fatal complications. Therefore, more rigorous and thorough blood pressure treatment is needed.

Frequently Asked Questions

1. The blood pressure is high, but there are no special symptoms and I am physically confident in my health. Should I still be treated?

Hypertension is called the “silent killer.” High blood pressure has few signs or symptoms. But if they are left without symptoms, the burden on the heart and blood vessels increases.

If left untreated, your blood pressure will be higher and you will be at higher risk for fatal complications such as stroke, heart failure, and kidney failure (decrease in kidney function) that can be caused by high blood pressure. Even without symptoms, hypertension is progressing. Therefore, be sure to start treatment for hypertension.

2. Sometimes I get tired or have headaches in the back of my head, is it because of high blood pressure?

The likelihood of symptoms caused by high blood pressure is very low. High blood pressure is called a “silent killer” because high blood pressure causes no symptoms, and one day suddenly causes complications such as stroke and myocardial infarction. Stroke due to cerebral hemorrhage or cerebral infarction can be caused by a sudden rise in blood pressure, but people who have high blood pressure usually become dull with pain and can’t feel headaches.

Headaches due to high blood pressure are rare, but they are characterized by morning sickness and improve over time, and the headaches we often complain about are often contracted or muscle contractions around the head if the stress and fatigue from work are not adequately relieved. Due to tension headaches that occur mainly in the afternoon.

3. I am taking high blood pressure medication, and my blood pressure is almost normal. How long do I have to take my blood pressure medicine?

The root cause of high blood pressure has not yet been identified, and there are many genetic factors that should be taken for almost a lifetime. However, if long-term normal blood pressure is maintained due to long-term use of anti-hypertensives, the drug may be stopped by reducing the amount of the drug. The decision to continue taking or stopping blood pressure-lowering medications should be determined by your doctor, taking into account your health and blood pressure levels.

4. I have no energy and feel dizzy since I started taking blood pressure medications. Can I take it only when my blood pressure goes up?

If you are diagnosed with high blood pressure and are taking prescription blood pressure medications from a specialist, you should take them as prescribed. However, if you are having difficulty taking your medicine due to symptoms such as your Mac falling out after you take it, you may want to talk to your doctor about it and change it to another drug or take another. Do not take medications arbitrarily.

5. Will measuring blood pressure at home help my blood pressure?

Blood pressure measurements outside the office provide valuable information for continuously monitoring the initial evaluation of hypertensive patients and their response to treatment.

Self-measurement has four major advantages. The first white can distinguish between hypertension and persistent hypertension, the second can evaluate the therapeutic effect of the blood pressure medication, and the third can increase the patient’s compliance with the treatment. Finally, you can reduce your medical bills.