Causes- Effects and Impacts of Hypertension

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Hypertension (HTN) also known as high blood pressure, is diagnosed when the force of systolic pressure which is defined as the force of blood being pumped out of the heart into arteries and the pressure exerted by blood against the artery walls and diastolic pressure, defined as the time the heart rests between beats and the force of blood being exerted against the artery walls, is measured as a numerical reading and is determined to be above normal. Normal range is considered when the systolic (top number) is less than 120mm and the diastolic (lower number) is less than 80mm.   When the force of blood pushing against the walls of the blood vessels is consistently registered as high over a period of time, a diagnosis of hypertension is given. It is recommended that an individual have their blood pressure taken in both arms to accurately determine their numbers.  There are two stages before an individual is considered in to be in hypertensive crisis. Hypertension Stage 1 is determined when blood pressure has a systolic reading between 130-139mm and diastolic reading between 80-89mm. Hypertension Stage 2 is determined when systolic numbers are 140mm or higher and diastolic numbers are 90mm or higher. An individual is considered in a state of hypertensive crisis when the systolic numbers are over 180mm and diastolic numbers are over 120mm. (AHA, 2019).  According to the American Heart Association, individuals from age 40-89 will doubled their increased risk of death from ischemic heart disease and stroke with every 20mm systolic or 10mm diastolic increase. (AHA, 2019).

Hypertension is also known as the silent killer because it has no real symptoms. High blood pressure may develop over many years. Symptoms when they do exhibit are usually present when an individual’s BP has reached a severe and possibly life-threatening level and may include headaches, nosebleeds and shortness of breath, dizziness, and occasionally blood spots in the eyes along with blurred or double vision but initially these symptoms are often mistaken as having other causes. An individual who smokes, consumes a diet high in sodium and fats, is overweight and leads a sedentary life should understand that these are signs and often are the contributing causes of high blood pressure. Women may experience these symptoms but may also have signs and symptoms specific to women including chest pain, blood in the urine, pounding in the ears, neck and/or chest, fatigue and/or confusion and irregular heartbeat. These signs and symptoms should not be ignored.

Hypertension will affect nearly everyone eventually. As mentioned, this is a disease that usually develops over many years. A high fat, high cholesterol diet will cause plaque to build up in the blood and arteries. Blood vessels carry blood to and from the major arteries. As the pressure the blood travels under increases, the force of the blood pushing against these walls causes damage to them in the form of small tears where bad cholesterol begins to attach and collect at the tears causing a narrowing of the arteries creating a situation where there is less blood flow passing through. When blood flow is restricted to tissues and organs, damage results. With a narrowing of the arteries, the heart has to work harder to pump the blood and with each pump the heart is less effective at achieving proper blood flow. Additionally, as individuals age, their heart muscle changes along with other organs and tissues in the body. Body functions slow and become less efficient sometimes causing organs and systems to work harder.  There has long been a theory that a reduction in sodium intake can help to lower blood pressure. Recent studies have discovered the opposite is true. A reduction in sodium seems to cause an increase in blood cholesterol and in women who are overweight, blood cholesterol may become even more elevated due to insulin resistance. There are many risk factors that can contribute to developing this disease including excessive smoking, alcohol abuse, high cholesterol and/or a high sodium diet such as from fast food, lack of exercise, obesity and stress. These are some of the factors that may be within an individual’s control. Other contributing factors that may be beyond and individuals control include age, genetics, stress (beyond one’s control), family history of hypertension, adrenal disease, thyroid disease, chronic kidney disease and diabetes. African American women are more salt sensitive than Caucasian women contributing to higher sodium levels in the body.  Women who are taking oral birth control are more at risk of having hypertension and this risk multiplies if they are taking oral birth control and are a smoker. While hypertension is easier to diagnose in women, the symptoms are often mistaken for other diseases. Racial differences play a part in hypertension as well with African Americans being at a greater risk than Caucasians. According to the National Institutes of Health, the life expectancy for African American men and women is significantly less than for Caucasians. African Americans are more likely to develop hypertension at an earlier age and have a higher rate of diagnosed cases of hypertension associated illnesses. (NIH, 2014).

“Stroke mortality risks are two-fold greater for African Americans. End-stage renal disease is five times more common for African American men and women. In addition, the age of onset of disease such as stroke is considerably earlier for African Americans. While high blood pressure affects all segments of the population, high blood pressure rates are more prevalent among African American men and women.”

(NIH, 2014).

Individuals diagnosed with hypertension have a myriad of changes and issues that will occur within their body.  Hypertension causes harm to the heart and blood vessels by making these systems work harder and less efficiently.  The first system that is damaged is the circulatory system. As stated earlier, blood vessels carry blood to and from the major arteries. As the pressure the blood travels under increases, the force of the blood pushing against these walls causes damage to them in the form of small tears where bad cholesterol begins to attach and collect at the tears causing a narrowing of the arteries creating a situation where there is less blood flow passing through. When blood flow is restricted to tissues and organs, damage results. With a narrowing of the arteries, the heart has to work harder to pump the blood and with each pump the heart is less effective at achieving proper blood flow. This extra work can cause enlargement of the left ventricle which is the side responsible for pumping blood throughout the body. This increases the risk of a heart attack and/or heart failure. A damaged artery may also be susceptible to an aneurysm which can go undetected until it bursts and may be life threatening. Hypertension may also be linked to dementia by contributing to a reduction in the blood flow to the brain. This condition can lead to memory loss, difficulty understanding concepts and possibly even a stroke. Damage to the blood vessels in the eyes may also occur. Hypertension can also impact the skeletal system by increasing the amount of calcium lost during urination leading to osteoporosis. Within the lungs, hypertension can cause a pulmonary embolism as well as an aneurysm. Reproductive organs are also impacted by hypertension since there is extra blood flow to these organs during arousal. Sexual dysfunction may take the form of men being unable to achieve an erection and women may experience less desire, problems with orgasm and vaginal dryness. Our kidneys play a major role in regulating blood volume and pressure, remove waste from the blood and filter waste from the body in the form of urine. When an individual has hypertension, the large and small blood vessels leading to and within the kidneys become damaged and impact kidney function leading to kidney disease and possibly kidney failure. The result is that the kidneys are no longer able to remove waste from the body and the individual will require dialysis and/or a transplant. Hypertension impacts every aspect of the body from system function to cells and tissue.

Hypertension is manageable if caught in time reducing the risk for many of the diseases associated with the condition. The NIH states that

“African Americans demonstrated poorer blood pressure compared with Caucasians.”

(NIH, 2014). Societal awareness of hypertension and treatments are the same for African American and Caucasians however, the response to medications have been different. According to studies, African Americans respond better to calcium channel blockers and diuretics while Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB’s) have been shown to be less effective.

The economic impact of hypertension is staggering.  The costs are incurred at both ends of the spectrum, from the range of treatments necessary for those who are diagnosed with the disease and the associated illnesses such as medications, rehabilitation and loss of productivity, and treatment of those who go undiagnosed or treated and the associated illnesses that result in the form of multiple organs  being affected, medication, rehabilitative care, increased medical costs and loss of productivity. According to HSR, of people diagnosed with hypertension only 68% report taking medication to control the disease. (HSR, 2011). The Milken Institute study discusses the issue of chronic illnesses on the U.S. economy.  The study reports that the chronic diseases are preventable and impact not only the health of our nation’s individuals but also the economic health of our nation in the form of lost productivity. stating that “…

the annual economic impact on the U.S. economy of the most common chronic diseases is calculated to be more than $1 trillion, which could balloon to nearly $6 trillion by the middle of the century”,

and, “

According to the study, seven chronic diseases-cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions and mental illness-have a total impact on the economy of $1.3 trillion annually. Of this amount, $1.1 trillion represents the cost of lost productivity”.

(Fight Chronic Disease, 2019). The study goes on to state that any funding spent on preventing chronic diseases will be worth the investment over the long term. With improvements in detection and early intervention, by 2023 40 million cases of chronic diseases can be avoided reducing the economic impact by 27% resulting in a savings of $1.1 trillion annually. Regarding the impact on healthcare costs, HSR reports that reducing the number of individuals with high blood pressure would save $37 per person annually in follow-up visits to the physician, declines in hospitalization related to high BP would be reduced by $92 per person annually. (HSR, 2011).

The bottom line is that any chronic illness impacts  every aspect of a person’s life as well as that of their families in the form of loss of productivity, increase in insurance rates, increase in treatment costs,  increase in cost of medications, strains on facilities in the form of long term care and chronic care required and lifespan.

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