Course of hypertension

If you have hypertension, your heart works harder than it should to pump blood to distant tissues and organs.

If this pressure isn’t controlled, your heart enlarges and your arteries become enlarged, scarred, and less flexible. Eventually, your overworked heart may not be able to pump and transport blood properly through stiff arteries.

These changes increase the risk of:

• Heart disease such as heart attacks (myocardial infarction, or the death of heart muscle).
• Heart failure (failure to pump enough blood to your body’s tissues and organs to meet their needs).
• Stroke
• Kidney failure. Kidney disease is silent and you must insist that your doctor check your kidneys with blood and urine tests.
• Peripheral vascular disease (any abnormal condition arising in the blood vessels outside the heart, especially in the legs). Peripheral vascular disease may cause cramps in the legs on walking and may even lead to amputation because of lack of blood.
• Dementia. The connection between hypertension and dementia is increasingly being recognised. Treatment of hypertension may delay or prevent dementia.

The risk of complications increases along with an increased BP, but there isn’t an abrupt cut-off point above which complications appear. Treatment and follow-up recommendations will depend on factors such as the severity of the hypertension and whether other organs, such as the kidneys, have been affected by it. Organ damage can occur if systolic, diastolic or both pressures are high.

Hypertension can damage the blood vessels that supply blood to the light-sensitive lining of the back of the eye (the retina). This damage, called retinopathy, can lead to vision loss or blindness if left untreated.

BUT: Hypertension doesn’t have to be deadly. It’s easy to diagnose and, once you know you have it, it can be controlled. Many experts believe that improved detection, treatment and control of hypertension is a major reason why there’s been a 50% decrease in death due to heart disease, and a 57% decrease in death caused by stroke, in America in the last 20 years.

Reviewed by Prof Brian Rayner, nephrologist and Director of the Hypertension Clinic, Groote Schuur Hospital. MBChB, FCP, MMed, PhD. May 2018.