What Is Hypertension?

Hypertension affects approximately 70 million Americans each year, quadrupling the chance of a person dying from a stroke and tripling the chance of dying from heart disease. While the addition of lifestyle modifications offers several benefits to decreasing hypertension, many people are given only medications to lower blood pressure but with limited effect. Some people do not see the benefit, some may suffer unwanted side effects and others may hear stories about adverse effects that cause them to discontinue treatment. For many, it may be that the treatment is not targeting the underlying cause.

Over 90% of people with high blood pressure have primary hypertension. It can progress gradually over the years as a result of lifestyle factors such as inflammation levels, too much salt, lack of exercise, obesity, heavy alcohol consumption and hereditary factors. Hypertension that results from a medical condition, such as obstructive sleep apnea, adrenal gland tumors or thyroid problems, is called secondary hypertension. Secondary hypertension usually starts suddenly and causes higher blood pressure than primary hypertension. But there can also be neurological reasons that would account for increases and understanding the basics of physiology may help offer another tool for management.

Ask any person on a daily basis if they experience “stress” and you can get varying responses from only minor issues to being overwhelmed with it. When we are stressed, the sympathetic nervous system, sometimes called the "fight or flight," response system, kicks in. The adrenal glands produce more of the neurotransmitters epinephrine (adrenaline) and norepinephrine (noradrenaline), and extra blood is pumped to the muscles through the vessels, which delivers additional nutrients and oxygen until the crisis is over. The nervous system is connected via nerves to the heart and every blood vessel in your body. Through these nerves, it can increase heart rate and narrow blood vessel diameter. Both cause blood pressure to go up. This should be a transient response and clear as the stresses pass.

Therefore, neurogenic hypertension, which is related to excessive and abnormally high sympathetic activity from chronic and prolonged stress, can be another area of lifestyle that would need to be addressed. Research has also been done that demonstrated abnormally high amounts of norepinephrine and epinephrine in people with normal blood pressure but whose families had a history of hypertension. These "sympathetic bursts" have also been seen in patients with high BP and it was concluded that high BP can also result from a dysfunction in the autonomic nervous system.

If that is the case, then also being aware of family history is another item that can help someone assess whether they are at higher risk for a cardiovascular incident. In our office, we utilize The Boston Heart Study as a tool to screen for risk factors such as inflammation levels, genetic tendencies, lipid profile and blood sugar management. If there has been a family history of cardiovascular accidents and surgeries, diabetes and/or hypertension (or if you have experienced any of those first hand), you are a prime candidate to have this type of assessment performed. Not only will it help you understand where you are now, but it will also let you know about your risk level for those conditions in the future.

In Health, 

Dr. Brad Niewierowski