Hypertension:‘t think about how our blood flows through our veins. It is one of the many bodily functions we take for granted. But for nearly 93 million adults in the U.S., uncontrolled high blood pressure is a primary concern, as it affects their overall health and well-being.
Understanding what uncontrolled high blood pressure is—its causes and how it affects the body—can help you determine whether you have this condition and how to talk to your doctor about managing it.
What Is Uncontrolled Hypertension?
High blood pressure typically presents no obvious symptoms, as it silently damages your blood vessels, your heart, and other organs. When your blood pressure remains above normal levels despite medical treatment, it is mentioned to as uncontrolled high blood pressure.
“When symptoms do occur, they may contain chest pain, headache, blurred vision, shortness of breath, or nosebleeds,” states Dr Kevin Hwang, MD, MPH, National Volunteer Chair of the American Heart Association’s Ambulatory Care Quality Improvement Advisory Committee, and Professor and Director of General Internal Medicine at UTHealth Houston. “But the absence of these symptoms does not mean that your blood pressure is normal.”
Testing for Uncontrolled Hypertension
Measuring your blood pressure using the correct method over several different days—whether at home or in a clinic, and preferably in both settings—can provide the data your doctor needs to determine if you have uncontrolled high blood pressure.
Here is what your doctor will look for based on the average of those readings:
Stage 1 hypertension falls between 130 and 139 mmHg for the top number, which corresponds to systolic pressure (the pressure when the heart pumps). As for the lower number—diastolic pressure (the moment when the heart relaxes)—a reading of 80 to 89 mmHg indicates Stage 1 hypertension.
Stage 2 hypertension is defined as 140 or higher for systolic pressure, or 90 or higher for diastolic pressure. It is considered severe hypertension if the systolic pressure exceeds 180 or the diastolic pressure exceeds 120.
Simply put, uncontrolled hypertension means that your blood pressure readings are consistently higher than your treatment target—generally 130/80 or higher—even when you are taking blood pressure medication and following healthy habits.
It is important to distinguish this from “resistant hypertension,” a specific type of uncontrolled blood pressure. This remains elevated even when the person is taking three or more different types of blood pressure medications.
Addressing the root of the problem is crucial, as uncontrolled hypertension can lead to a variety of severe health risks, such as heart attack, stroke, heart failure, arrhythmias, kidney disease, dementia, and peripheral arterial disease. Nevertheless, it is a treatable condition.
“Broadly speaking, uncontrolled hypertension is the leading preventable cause of cardiovascular disease worldwide and reduces life expectancy if left untreated,” stated Hwang. “Controlling blood pressure can reduce these risks.”
Why It Impacts the Body
When your blood pressure remains too high for a prolonged period, it can damage the walls of your blood vessels. In an effort to repair the damage, your body sends specialised cells—think of them as reinforcements—to patch the breach; however, the weakened wall is then left vulnerable to the buildup of cholesterol and other fats. This buildup, known as plaque, obstructs the healthy blood flow on which your body relies to receive essential nutrients, such as oxygen.
Over time, persistently high blood pressure leads to the hardening and narrowing of the arteries (a process known as atherosclerosis), which reduces blood flow to vital organs and tissues. This triggers nervous and hormonal responses that lead to increased sodium and fluid retention, making blood pressure control even more difficult. This process harms the heart, brain, kidneys, and eyes. It can also damage the veins in the legs, as well as the aorta—the main artery responsible for distributing blood throughout the body. Hwang noted that these physical effects may also donate to the onset of mental health issues, such as dementia and cognitive decline.
Common Causes
If you are taking your medication but your blood pressure readings remain elevated, the situation can be frustrating. Often, multiple factors work together to keep your blood pressure high.
Lifestyle Factors
Various lifestyle factors can influence high blood pressure and your overall health, even if you are taking medication to manage your hypertension.
Consuming processed foods—which typically have a high salt (sodium) content—causes the body to retain fluids, which, in turn, increases pressure within the arteries.
A lack of regular, consistent aerobic exercise can also contribute to a decline in the heart’s ability to pump blood, which can keep your blood pressure elevated. Excessive alcohol consumption (more than one alcoholic drink per day for women, and more than two drinks per day for men) can significantly raise blood pressure and interfere with the effectiveness of medications.
Finally, the use of tobacco products can lead to an increase in blood pressure and cause damage to the arteries.
Unrelated Medical Conditions
There may also be less obvious causes of uncontrolled high blood pressure, manifesting as an apparently unrelated medical condition known as “secondary hypertension.” Common causes include sleep apnea, kidney disease, thyroid problems, pregnancy, the use of birth control pills, and alcohol abuse.
Medication and Supplement Interactions
Furthermore, certain commonly used medications and supplements can interfere with your blood pressure, such as:
- Over-the-counter pain reliefs (NSAIDs, such as ibuprofen or naproxen).
- Decongestants are found in cold or flu medications containing pseudoephedrine or phenylephrine.
- Birth control pills and hormone-containing devices.
- Herbal supplements, such as arnica, ephedra, ginseng, guarana, and liquorice.
- High doses of caffeine.
- Certain biologics and immunosuppressants.
- Some types of antidepressants.
- Stimulants such as methylphenidate are often used to treat attention-deficit/hyperactivity disorder (ADHD).
- Recreational drugs such as amphetamines—including methamphetamine, cocaine, and ecstasy (MDMA).
Genetic Factors
Hypertension tends to run in families and may be linked to specific abnormal genes or caused by hundreds of DNA variations. Having a parent or grandparent with high blood pressure increases your risk; this is due, in part, to inherited genes, but also to shared exposure to stress and common habits related to diet, tobacco use, and physical activity.
Improving Uncontrolled Hypertension
According to Hwang, managing uncontrolled high blood pressure typically begins with adopting healthy lifestyle habits, which generally include a healthy diet, physical activity, adequate sleep, and managing body weight. “A healthy eating plan for controlling blood pressure includes fruits, vegetables, whole grains, low-fat dairy products, fish, skinless poultry, beans, and nuts,” he states. “Custom plant-based oils, such as olive oil or avocado oil.” General guidelines for attempting to control high blood pressure through diet are:
Limit Na (to less than 1,500 milligrams per day).
Reduce saturated fats (found in fatty meats, full-fat dairy foods, and tropical oils such as palm and coconut oil).
- Limit the eating of sugary foods and beverages.
- Reduce or eliminate alcohol consumption.
- Consume foods rich in potassium.
- Your primary care physician can monitor high blood pressure.
If necessary, they may refer you to a cardiologist (heart specialist) or a nephrologist (kidney specialist). When a hormonal disorder is suspected as the cause of high blood pressure, it may be helpful to include an endocrinologist in your medical team.
“If your risk is high enough to warrant the use of blood pressure medication, there are several options your healthcare provider can discuss with you,” notes Hwang. “Most of these drugs are available in generic versions that can be taken once daily. Measure your blood pressure at home using an accurate monitor to track your progress. Consult your healthcare provider regularly to determine if any adjustments are needed.”
Despite its name, uncontrolled high blood pressure can be managed—though this may require more than one approach. Making lifestyle changes and being mindful of potential interactions between medications or supplements are fundamental aspects. “The good news is that healthy life habits and blood pressure medications—when their use is appropriate—can contribute significantly to keeping blood pressure under control,” states Hwang, “even in people with a family history of uncontrolled high blood pressure.”