Thank you for consulting with us at Doctor spring. Since you say that you have been suffering from hypertension from the past ten years, I assume you were diagnosed as having hypertension from the age of 21.

The first thing in the evaluation of hypertension is to obtain reliable measurements of blood pressure measured by a doctor or in a hospital. Blood pressure apparatus for home use may not be calibrated accurately and show falsely high or low values. The doctor may also want to obtain the following details:

• Duration of hypertension
• Previous therapies, response and side effects
• Family history of hypertension and cardiac disease
• Dietary history
• Other risk factors for cardiac disease: Elevated lipid profiles, smoking, diabetes, physical inactivity
• Evidence of secondary causes of hypertension
• Evidence of damage to body organs as a result of hypertension

At present, hypertension is defined based on the JNC recommendations. A level of systolic blood pressure between 120-140 and a diastolic pressure between 80 and 90 is considered pre hypertension (the normal blood pressure is recorded as an average of atleast two recordings and is taken as a systolic BP of 120 and a diastolic BP of 80). Any level of BP above 140 systolic and 90 diastolic is considered as hypertension.

There are two types of hypertension:

• Primary hypertension or Essential hypertension: In which there is no obvious cause for the hypertension
• Secondary hypertension: In which there is a more specific mechanism for blood pressure elevation

Essential Hypertension tends to be familial, but there is no single gene that pin points as to being the cause for hypertension. Instead, essential hypertension is said to have a familial inheritance where there is an interaction between environmental and genetic factors ultimately resulting in hypertension. There is also a phenomenon called tracking of BP in which individuals with higher BP at a young age also tend to have higher BP later in life. Essential hypertension is not curable. But the BP should be controlled with medication in order to reduce pressures on the organs of the body from damage due to exposure to high BP. At you age, although secondary causes of hypertension are more common, it is possible that you are suffering from primary hypertension.

Another important emerging cause of hypertension is Metabolic syndrome. This is a term used for insulin resistance, hypertension and abnormal blood cholesterol levels occurring in a person. Although this may also have a polygenic inheritance as described for secondary hypertension, the actual occurrence of the syndrome is modifiable by environmental factors, such as degree of physical inactivity and diet. For example, several studies have shown that insulin sensitivity increases and BP decreases in response to weight loss. So, introduction of life style modification strategies and drug therapies should address overall risk and not simply focus on hypertension.

Other important secondary causes of hypertension are:

• Renal diseases
• Diseases of arteries or veins in the kidneys
• Diseases of the adrenal glands
• Coarctation of the aorta
• Pregnancy related Hypertension
• Neurogenic causes
• Hormonal abnormalities
• Some drugs
• Rare directly inheritable forms of hypertension

Among the list mentioned above, each needs careful evaluation in your case and some of them are curable if the underlying cause is identified and eliminated while others can only be kept under control with anti hypertensive medication. The important thing is to visit your doctor who will be able to explain to you your condition and help you to keep your BP under control. Hope this inforamtion was of use to you.