Hypertension: What it is, Causes, Symptoms, Treatment & Types

What is Hypertension?

Hypertension, or high BP, is a medical condition in which the blood pressure pushing against the artery walls remains consistently higher than normal. A person is generally considered to have hypertension when their blood pressure readings remain high over time.

Blood pressure is measured in mmHg and is recorded as:

• Pressure: The pressure when the heart contracts and pumps blood.

• Diastolic Pressure: The pressure when the heart relaxes between beats.

In India, a normal blood pressure reading is usually below 120/80 mmHg. A person is generally considered to have hypertension when their blood pressure readings are 140/90 mmHg or higher on repeated measurements. Since hypertension often develops without noticeable symptoms, many people may not realise they have it until it is detected during a routine health check-up.

What are the Types of Hypertension?

The two main types of hypertension are as follows:

Stages of Hypertension

Blood pressure is generally classified into stages based on systolic (upper) and diastolic (lower) readings.

How Common is Hypertension in India?

Hypertension is one of the most common medical conditions affecting adults in India, and, it is turning into a major public health concern. Often referred to as the 'silent killer,' it can develop gradually without causing noticeable symptoms, while increasing serious complications like heart disease, stroke, and kidney failure.

According to the National Family Health Survey (NFHS-6), 19.4% of women and 22.1% of men aged 15 years and above in India have elevated blood pressure or are already on medication to manage it. So overall, this means that millions of Indians are living with high blood pressure right now, and for many of them, they may not even realise they have it until problems show up later on.

The survey also found that hypertension is slightly more common in urban areas. Among women, 23.5% in urban areas had elevated blood pressure compared to 17.8% in rural areas. Similarly, 26.2% of urban men were affected, compared to 20.4% of rural men. As lifestyles continue to change, the prevalence of high blood pressure is rising throughout the country.

Symptoms of Hypertension

Hypertension is often called a silent condition because many people do not notice any symptoms, especially in the early stages. Most people get to know that they have high blood pressure during a routine health check-up. However, when blood pressure becomes very high or remains uncontrolled for a long time, certain symptoms may develop and require prompt medical attention.

Related Diseases Comparison

Hypertension has symptoms and risk factors which are common to many other cardiovascular diseases. However, each disease is caused by a different factor and has a unique diagnosis and treatment. Here’s the tabular comparison for better understanding.

Hypertension vs Coronary Artery Disease vs Heart Failure

Medicines Used to Treat Hypertension

There are various medicines that can be prescribed in India for the treatment of high blood pressure. This is based on parameters such as age, blood pressure readings, kidney function, presence of diabetes and pregnancy, among others. Most people need a combination of two or more medicines to achieve satisfactory blood pressure control.

• ACE Inhibitors: Enalapril, Ramipril, and Lisinopril

• ARBs (Angiotensin II Receptor Blockers): Telmisartan, Losartan, Olmesartan, and Valsartan

• Calcium Channel Blockers: Amlodipine, Cilnidipine, and Nifedipine

• Thiazide and Thiazide-like Diuretics: Hydrochlorothiazide, Chlorthalidone, and Indapamide

• Beta Blockers: Metoprolol, Atenolol, Bisoprolol, and Nebivolol

• Mineralocorticoid Receptor Antagonists: Spironolactone and Eplerenone

• Alpha Blockers: Prazosin and Doxazosin

Note: These medicines should only be taken under the guidance of a qualified healthcare professional. The appropriate medicine and dose vary from person to person.

Living with Hypertension in India: Daily Challenges, Caregiving

Living with hypertension involves continuous management instead of temporary medication. Through proper management and a healthy lifestyle, most individuals can effectively manage their condition and minimise risk factors.

Hypertension Treatment Cost in India

The cost breakdown of treating hypertension in India is highlighted in the table below:

Note: These costs are approximate and may vary depending on the hospital, city, doctor's fees, diagnostic requirements, and more such factors.

What Causes Hypertension?

A list of factors can lead to the development of hypertension. The most common causes include the following:

• Excess Body Weight: Being overweight increases the workload on the heart and blood vessels, which can raise blood pressure over time.

• High Salt Intake: Eating too much salt causes your body to retain extra fluids, which boosts pressure against blood vessel walls.

• Lack of Physical Activity: An inactive lifestyle can cause weight gain and poor heart health, both of which increase the risk of hypertension.

• Family History: People with close relatives who have high blood pressure are more likely to develop the condition themselves.

• Ageing: Blood vessels naturally become less flexible with age, making high blood pressure more common in older adults.

• Smoking and Tobacco Use: Smoking and tobacco use narrow blood vessels and raise blood pressure temporarily. Long-term tobacco use damages the cardiovascular system.

• Excessive Alcohol Consumption: Consuming excessive alcohol can increase BP and reduce the effectiveness of blood pressure medications.

• Chronic Stress: Ongoing stress may contribute to temporary spikes in blood pressure and can encourage unhealthy habits such as overeating, smoking, or excessive alcohol use.

• Kidney Disease: The kidneys help in regulating blood pressure. When they do not function properly, blood pressure can rise.

• Sleep Disorders: Problems such as obstructive sleep apnea can disrupt normal breathing during sleep and increase the risk of hypertension.

In many cases, hypertension develops as a result of a combination of these factors rather than a single cause.

What are the Complications of Hypertension?

If poorly managed, hypertension can damage blood vessels and vital organs throughout the body. Over time, this increases the risk of several serious health complications, such as:

• Heart Attack: High BP can damage and narrow the arteries that supply blood to the heart, increasing the risk of a heart attack.

• Stroke: Hypertension can weaken or block blood vessels in the brain, leading to a stroke.

• Heart Failure: In case of hypertension, the heart has to work a little harder to pump blood against increased pressure, which can eventually weaken the heart muscle and cause heart failure.

• Kidney Damage: High blood pressure can damage the blood vessels in the kidneys, affecting their ability to filter waste adequately.

• Vision Loss: Hypertension can damage the blood vessels in the eyes, causing blurred vision, reduced vision, or even blindness in severe cases.

• Peripheral Artery Disease (PAD): Hypertension can narrow arteries in the legs and other parts of the body, leading to pain and decreased blood flow.

• Aneurysm: Constant pressure on arterial walls can weaken them, causing them to bulge and form an aneurysm that may rupture and become life-threatening.

• Cognitive Decline and Dementia: Lowered blood flow to the brain over time can affect memory, thinking, and mental abilities.

• Sexual Dysfunction: High blood pressure may impair blood flow, causing erectile dysfunction in men and reduced sexual function in women.

When Should I See My Healthcare Provider?

In case of hypertension, you should see a healthcare provider if:

• Your blood pressure readings are consistently more than the normal range.

• You have a family history of hypertension, heart disease, or stroke.

• You are overweight, have diabetes, kidney disease, or other conditions that increase your risk of high blood pressure.

• You experience frequent headaches, dizziness, blurred vision, or shortness of breath.

• Lifestyle changes are not helping you to lower your blood pressure.

• You have been prescribed blood pressure medication and notice side effects or difficulty managing your condition.

How is Hypertension Diagnosed?

To diagnose hypertension, your healthcare provider may:

• Measure Your Blood Pressure: Readings are taken using an inflatable cuff placed around your upper arm. Blood pressure is recorded as systolic pressure and diastolic pressure.

• Review Your Medical History: Your healthcare provider may ask about your symptoms, lifestyle habits, family history, and any existing health conditions.

• Perform a Physical Examination: This helps identify signs of conditions that may be causing high blood pressure.

• Blood and Urine Tests: These tests can help assess kidney function, blood sugar and cholesterol levels, and other factors associated with hypertension.

• Additional Tests: Depending on your condition, your doctor may suggest tests such as an electrocardiogram (ECG), echocardiogram, or ambulatory blood pressure monitoring to evaluate heart health and monitor blood pressure over a longer period.

How is Hypertension Managed?

The management of hypertension focuses on lowering blood pressure and reducing the risk of complications:

Hypertension During Pregnancy

Hypertension in pregnancy can raise the chance of complications for both the mother and the baby, like preeclampsia, early delivery, and low birth weight. Regular prenatal examinations are essential because they help track blood pressure and detect problems early. Women with high blood pressure during pregnancy need to stick with their doctor's recommendations, take medicines on time, eat healthy, cut back on salt, and stay active. They should also avoid smoking and drinking. Immediate medical attention is important if symptoms such as severe headaches, vision changes, sudden swelling, or shortness of breath occur.

Can Hypertension Be Reversed?

In some cases, hypertension can be reduced or even return to normal particularly if detected early and tied to lifestyle factors like being overweight, poor diet, or smoking. By adopting healthy habits, sticking to a balanced diet, and managing stress, people can often lower their blood pressure. This might mean they need less medication too. Still, not every case can be fully reversed, especially if genes, ageing, or other health issues play a role. Even when a cure is not possible, proper treatment and lifestyle changes can effectively control blood pressure and reduce the risk of complications.

How Can I Prevent Hypertension?

While hypertension cannot always be prevented, adopting healthy lifestyle habits can considerably lower your risk of developing high blood pressure and its complications. Here are some of the common tips that you must follow:

• Keep a healthy weight.

• Follow a balanced eating pattern and reduce salt intake.

• Engage in regular physical activity.

• Stay away from smoking and drinking alcohol.

• Manage stress through relaxation techniques, such as exercise or meditation.

• Get enough quality sleep at night.

• Check your BP regularly, especially if you have risk factors.

• Manage underlying medical conditions such as diabetes, kidney disease, or high cholesterol.

Does Health Insurance Cover Hypertension?

Yes, health insurance provides coverage for hypertension. Most plans cover expenses related to hospitalisation costs, doctor consultations, prescribed medications, and diagnostic tests. If hypertension is diagnosed after you purchase a health insurance policy, it is generally covered according to the policy terms. However, if you already have hypertension at the time of buying the policy, it is considered a pre-existing condition. In such cases, many health insurance companies apply a waiting period of up to 4 years before coverage becomes available. In fact, some plans cover pre-existing hypertension from day 1 of the policy. Since coverage terms, waiting periods, and exclusions vary between insurers, it is important to review the policy details carefully before buying a plan.

How Much Health Insurance Coverage is Needed for Hypertension Treatment?

The amount of health insurance you need for hypertension depends on various factors like your age, overall health, existing medical conditions, and the risk of complications. Since managing hypertension involves regular doctor visits, diagnostic tests, medications, and, in some cases, hospitalisation, having coverage of around ₹10-15 lakh is recommended. Moreover, those with additional health complications or a family history of cardiovascular disease may benefit from a higher coverage amount of ₹15-20 lakh.