Why is high blood pressure so dangerous?

High blood pressure - the technical term is hypertension - is a very common, long-term, medical condition.  It does not usually have noticeable symptoms, but if left untreated or uncontrolled, it can become dangerous by increasing your risk of serious illness.

Blood pressure is divided into systolic (top number) over diastolic (bottom number).  The systolic pressure is the pressure generated when the heart muscle contracts to fill the arteries.  The diastolic pressure is the pressure in the arteries while the heart muscle relaxes.  If your heart is pumping harder, and your arteries are narrower, you will have higher blood pressure.

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High blood pressure takes years to develop but can be easily diagnosed.  Checking your blood pressure involves a simple test that can be carried out by your doctor, or even by yourself if you have access to a blood pressure cuff.  

HIgh blood pressure can be present for years without symptoms, but this does not mean it is not causing any damage.  This is why checking your blood pressure routinely is recommended.  The long-term strain that high blood pressure puts on the artery walls can eventually lead to serious medical somplications, such as kidney damage, heart attack or stroke.  If you know you have high blood pressure, you can work with your doctor to treat and control it.

The normal range of blood pressure is between 120/80 mmHg (systolic, or top number) and 90/60 mmHg (diastolic, or bottom number).  High blood pressure is present if your top number is consistently over 140 mmHg or your bottom number is consistently over 90 mmHg.  

Risk factors

There are many risk factors that are associated with high blood pressure:

• Age - Your risk of high blood pressure increases with age.
• Race - High blood pressure is more prevalent in African Americans, who often develop it at an earlier age.
• Family history - High blood pressure can be hereditary.
• Overweight - As your weight increases, the likelihood of developing high blood pressure increases as well.
• Smoking - Not only does smoking raise blood pressure, but it also damages the lining of the arteries irrespective of the blood pressue itself.
• Salt - Too much salt intake causes your body to retain fluid leading to increased blood pressure
• Stress - Stress causes a temporary spike in blood pressure.  Persistent, long-term stress can cause a highly elevated blood pressure.
• Chronic conditions - Some chronic conditions such as kidney disease, diabetes, and sleep apnea are also linked to high blood pressure. 

Dangers

High blood pressure can cause damage to a number of organs: arteries, heart, brain, kidneys, and eyes can be adversely affected.

Arteries 

Arteries are strong, flexible, and elastic in nature, They have a smooth inner lining so blood can flow freely to vital organs and provide oxygen and nutrients.  High blood pressure increases the pressure of the blood flowing in the arteries. This may then result in:

• Damaged and narrow arteries: The increased pressure of the blood can cause damage to the cell lining in the inner arteries. Fat can collect in these damaged arteries making the arteries less elastic. This limits the amount of blood flowing through the body.
• Aneurysm: When blood is flowing through a weakened artery at constant high pressure, a section or the artery wall can become enlarged and form a bulge called an aneurysm. If the aneurysm ruptures it can cause internal bleeding which is life-threatening.

Heart

The problems high blood pressure can cause to the heart include: 

• Coronary artery disease: The damaged and narrow arteries have trouble supplying the heart with blood. This prevents the free flow of blood to the heart muscles, resulting in symptoms such as angina (chest pain) and irregular heart beats.  A decreased blood supply deprives the heart muscle of oxygen and can eventually lead to a heart attack.
• Enlarged left heart: Blood is pumped to the rest of the body via the left ventricle of the heart.  With high blood pressure, the left ventricle needs to work harder and the muscles start to thicken.  This increases the risk of heart attack, heart failure or sudden cardiac death.
• Heart failure: Over the course of time, the strain of high blood pressure weakens the hearts muscles. Eventually, the heart does not function sufficiently and heart failure ensues.

Brain

The brain requires a healthy blood supply in order to function properly. High blood pressure can lead to several problems:

• TIA (transient ischemic attack): This is sometimes referred to as a mini-stroke.  Damage to the blood vessels leading to the brain can cause a disruption in blood, which in the case of a TIA is temporary.  However, TIA is a risk factor for getting a proper stroke. 
• Stroke: When the brain is deprived of oxygen and nutrients, it can cause brain cells to die.  High blood pressure may also result in blood clots forming in the arteries leading to the brain, blocking blood flow, and resulting in a stroke. 
• Dementia: Narrowing or blockage of the blood vessels can lead to a specific type of dementia called vascular dementia.  People who have had TIAs or strokes are more prone to vascular dementia.

Kidneys

The 2 kidneys in the body are responsible for filtering excess fluid and waste from the blood. In order to do this, the kidney needs healthy blood vessels.  High blood pressure damages the vessels that lead to the kidney.  If you have diabetes, in addition to high blood pressure, this can worsen the damage to the kidney.  Kidney damage can eventually lead to kidney failure, which can cause waste to accumulate in the blood at dangerous levels.  Ultimately, individuals may require dialysis to compensate for a lack of kidney function.

Eyes

The eyes contain tiny blood vessels that supply blood to the eye. High blood pressure damages these delicate vessels. This can then cause:

• Ooptiv nerve damage (optic neuropathy): The blood vessels in the eyes become blocked, limiting blood to the optic nerve.  Optic nerve damage can then lead to hemorrhage and vision loss.
• Fluid buildup under the retina (choroidopathy): This can lead to scarring and ijmpaired vision.
• Damage to the retina (retinopathy): The retina is composed of light-sensitive tissue at the back of the eye.  Retinal damage can lead to bleeding within the eye, blurred vision or total vision loss. Those with diabetes as well as high blood pressure are at a higher risk of developing this.

Sexual dysfunction

Erectile dysfunction becomes more likely in men with high blood pressure, as the blood vessels supplying the penis are damaged, disrupting the blood flow needed for an erectioon.  

Women may experience sexual dysfunction as well due to reduced blood flow to the vagina, which can lead to vaginal dryness, and trouble having an orgasm. 

Emergency

Individuals with high blood pressure may experience a hypertensive emergency. This happens when your blood pressure is severely elevated and may constitutes a medical emergency. Hospitalization is often neeeded.  Some of the symptoms of hypertensive crisis include:

• Blindness 
• Heart attack 
• Memory loss, changes in personality, difficulty concentrating, irritability, slow loss of consciousness
• Stroke 
• Aortic dissection
• Loss of kidney function 

If you do have high blood pressure, make sure it is well controlled.  There are many lifestyle changes and medications that can help you control high blood pressure.

References:

Mayo Clinic, “How high blood pressure can affect your body.” in Mayo Clinic, , 2019, <https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20045868>.
‌NHS Choices, “Overview - High Blood Pressure (hypertension).” in NHS, , 2019, <https://www.nhs.uk/conditions/high-blood-pressure-hypertension/>.
Mayo Clinic, “High blood pressure (hypertension) - Symptoms and causes.” in Mayo Clinic, , 2018, <https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410>.

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