Aftermaths of elevated blood pressure

There is a reason why hypertension was dubbed a ‘silent killer’. It does not manifest itself with any alarming symptoms that could give a pressing impulse to schedule a doctor’s appointment. As a result, nearly 1.13 billion world adult population suffers from elevated blood pressure [1]. Hypertension prevalence is estimated at approximately 50 % in the United States [2] and 55 % in Europe [3].

As many as 16 % hypertensive adults in the US remain unaware of their condition and thus do not undergo any form of medical treatment [4]. It is 22 % in low- and middle-income countries, where 80 % of total mortality is directly associated with cardiovascular disease [5]. The number is dramatically higher in the most poverty-stricken countries due to the poor quality of available healthcare services and their limited affordability.

Meanwhile, unaddressed elevated blood pressure wreaks havoc on the internal organs and blood vessels for years before any action is taken. This often leads to developing life-threatening conditions, some of which are listed below.

Circulatory system

Blood vessels are subjected to additional strain when blood is transported at an increased pressure. Their inner lining is gradually damaged, which is an underlying mechanism for developing a wide range of secondary medical conditions. In particular, hypertension promotes atherosclerosis, a process in which arteries lose their elasticity and become narrower until they can no longer provide sufficient flow of blood and delivery of nutrients and oxygen.

Constricted, clogged arteries tend to bulge and ultimately form aneurysms, bubble-like structures that are susceptible to bursting. A ruptured aneurysm may potentially pose a life threat depending on its location within the body. Uncontrolled bleeding is the final stage of pathogenesis and the first one to give noticeable symptoms. An aneurysm is especially dangerous when it forms in arteries that nourish the brain. The risk of death in patients with a ruptured brain aneurysm is 50 % and 15 % of such patients die before reaching the hospital.

Brain

Another way you brain can suffer from impaired, narrow and stiff blood vessels is through oxygen deprivation. Blood carries oxygen throughout the body and nourishes every organ, including the brain. Minutes after the oxygen supply is cut off, brain cells begin to die. Interrupted blood delivery to the brain may result in the so-called ischemic stroke. Another type of stroke is an internal bleeding into the brain, termed hemorrhagic stroke. This is commonly caused by a ruptured aneurysm, the formation of which is favored by elevated blood pressure.

Heart

Elevated blood pressure is a major risk factor for developing a range of heart conditions. These include:

  • Coronary heart disease – the most common cardiovascular disease, in which the buildup of fatty plaque, termed atherosclerosis, narrows down the coronary arteries and stiffens their walls. As a result, blood flow to the heart muscle is significantly diminished.
  • Heart attack - blood supply to the heart is dramatically reduced due to blocked coronary arteries, which causes oxygen starvation and death of heart muscle cells.
  • Heart failure – a long-term strain from high blood pressure weakens the heart to the point where it is unable to pump enough blood and oxygen through to other vital body organs.

Impaired sexual activity

Men with untreated high blood pressure are more likely to suffer from erectile dysfunction [6]. Penile blood flow velocity is lower in patients with elevated blood pressure due to structural damage to artery walls causing changes to sexual performance. Small blood vessels in penis are particularly prone to the loss of dilatation ability [7].

Similarly, women’s sexual functions are at risk in the case of elevated blood pressure. Studies show that hypertensive women are 1.7 times more likely to have sexual dysfunction [8]. Decreased blood flow to the vagina and clitoris lead to poorer relaxation response during sexual stimulation, vaginal dryness, pain and orgasmic dysfunction.

Other symptoms

Elevated blood pressure exerts adverse effects on virtually every part of the body, because all organs depend on a timely and uninterrupted supply of blood. This is just as much true for the heart as it is for kidneys or eyes. Monitoring your blood pressure is a tremendously beneficial routine, especially when you experience disconcerting non-specific symptoms such as headaches, nosebleeds, tremors, fatigue, nausea, chest pain, or breathlessness.

Recommended for reading/watching:

What Are the Risks of High Blood Pressure?

Under pressure: How blood pressure affects heart disease risk

References:

1. Future of Hypertension. Victor J. Dzau, Celynne A. Balatbat. Hypertension 2019, 74(3): 450–457.

2. Prevalence and control rates of hypertension in the USA: 2017–2018. Muchi Ditah Chobufo, Vijay Gayam, Jean Soluny, Ebad U. Rahman, Sostanie Enoru, Joyce Bei Foryoung, Valirie N. Agbor, Alix Dufresne, Tonga Nfor. International Journal of Cardiology Hypertension 2020, Vol. 6, 100044.

3. Status of hypertension in Europe. Hannes Reuter, Jens Jordan. Current Opinion in Cardiology 2019, 34(4):342-349.

4. Characteristics of U.S. Adults With Hypertension Who Are Unaware of Their Hypertension, 2011-2014. Ryne Paulose-Ram, Qiuping Gu, Brian Kit. NCHS Data Briefs 2017, (278):1-8.

5. Short-term trends in the prevalence, awareness, treatment, and control of arterial hypertension in Peru. David Villarreal-Zegarra, Rodrigo M. Carrillo-Larco, Antonio Bernabe-Ortiz. Journal of Human Hypertension 2020,

6. Blood Pressure, Sexual Activity, and Erectile Function in Hypertensive Men: Baseline Findings from the Systolic Blood Pressure Intervention Trial (SPRINT). Capri G. Foy, Jill C. Newman, Dan R. Berlowitz, Laurie P. Russell, Paul L. Kimmel, Virginia G. Wadley, Holly N. Thomas, Alan J. Lerner, William T. Riley. The Journal of Sexual Medicine 2019, 16(2): 235-247.

7. Review of the current information on erectile dysfunction in hypertensive males with 40 years of age or older. Elisabete Teixeira, Paula Soares. Porto Biomedical Journal 2020, 5(6): e107.

8. Hypertension as a risk factor for female sexual dysfunction: cross-sectional study. Rosana Pinheiro Lunelli, Maria Claudia Irigoyen, Silvia Goldmeier. Revista Brasileira de Enfermagem 2018, 71(5).

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