What are the causes and effects of hypertension (high blood pressure) and hypotension (low blood pressure)?

From the Guidelines

Hypertension is defined as a blood pressure consistently at or above 130/80 mmHg, while hypotension is defined as a blood pressure below 90/60 mmHg. The causes of hypertension include lifestyle factors such as high sodium intake, physical inactivity, and excessive alcohol consumption, as well as underlying medical conditions like kidney disease, sleep apnea, and certain medications 1. Hypotension, on the other hand, can be caused by dehydration, blood loss, certain medications, and underlying medical conditions like heart failure or thyroid disorders.

Effects of Hypertension and Hypotension

The effects of hypertension can be severe and include:

• Increased risk of coronary artery disease, heart failure, stroke, and peripheral vascular disease
• Kidney damage and chronic kidney disease
• Vision loss and blindness
• Cognitive decline and dementia

The effects of hypotension can also be significant and include:

• Dizziness and lightheadedness
• Fainting and falls
• Fatigue and weakness
• Decreased cognitive function and productivity

Treatment and Management

Lifestyle modifications are the first line of treatment for hypertension, including reducing sodium intake, regular exercise, limiting alcohol, maintaining a healthy weight, and managing stress. If medication is needed, common options include ACE inhibitors, ARBs, calcium channel blockers, and thiazide diuretics 1. For hypotension, treatment typically involves addressing the underlying cause, and may include measures such as:

• Adequate hydration
• Increasing salt intake (if appropriate)
• Wearing compression stockings
• Medications like fludrocortisone or midodrine in severe cases

Key Considerations

Regular monitoring of blood pressure is essential to prevent and manage both hypertension and hypotension. Healthcare providers should also consider the patient's overall health, medical history, and lifestyle when developing a treatment plan. By prioritizing lifestyle modifications and addressing underlying causes, individuals can reduce their risk of complications and improve their overall quality of life 1.

From the FDA Drug Label

Lisinopril tablets USP are indicated for the treatment of hypertension in adult patients and pediatric patients 6 years of age and older to lower blood pressure. Lowering blood pressure lowers the risk of fatal and non-fatal cardiovascular events, primarily strokes and myocardial infarctions Elevated systolic or diastolic pressure causes increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures, so that even modest reductions of severe hypertension can provide substantial benefit Lisinopril can cause symptomatic hypotension, sometimes complicated by oliguria, progressive azotemia, acute renal failure or death Patients at risk of excessive hypotension include those with the following conditions or characteristics: heart failure with systolic blood pressure below 100 mmHg, ischemic heart disease, cerebrovascular disease, hyponatremia, high dose diuretic therapy, renal dialysis, or severe volume and/or salt depletion of any etiology

The causes of hypertension (high blood pressure) are not explicitly stated in the provided drug labels. The effects of hypertension include increased cardiovascular risk, and the absolute risk increase per mmHg is greater at higher blood pressures. The causes of hypotension (low blood pressure) include:

• Heart failure with systolic blood pressure below 100 mmHg
• Ischemic heart disease
• Cerebrovascular disease
• Hyponatremia
• High dose diuretic therapy
• Renal dialysis
• Severe volume and/or salt depletion of any etiology The effects of hypotension include:
• Oliguria
• Progressive azotemia
• Acute renal failure
• Death 2 2

From the Research

Causes of Hypertension

• Hypertension is associated with increased risk of cardiovascular disease (CVD) events and death 3
• Factors that contribute to hypertension include:
  • Obesity
  • Physical inactivity
  • High sodium intake
  • Low potassium intake
  • Excessive alcohol consumption
  • Stress 4, 5

Effects of Hypertension

• Hypertension increases the risk of:
  • Cardiovascular disease (CVD) events (coronary heart disease, heart failure, and stroke) 3, 6
  • Death 3
• Uncontrolled hypertension can lead to target organ damage and adverse clinical events 7

Causes of Hypotension

• No direct evidence is provided in the given studies to discuss the causes of hypotension

Effects of Hypotension

• No direct evidence is provided in the given studies to discuss the effects of hypotension

Lifestyle Modifications for Hypertension

• Lifestyle modifications that can help prevent and control hypertension include:
  • Weight loss or maintenance of healthy body weight 4, 6, 7, 5
  • Regular physical exercise 4, 6, 7, 5
  • Healthy dietary patterns (e.g. low sodium, high potassium intake) 4, 6, 5
  • Moderation or elimination of alcohol consumption 4, 6
  • Stress management 4, 5
• These lifestyle modifications can help reduce blood pressure and improve cardiovascular risk biomarkers 7, 5

Treatment of Hypertension

• First-line therapy for hypertension is lifestyle modification, followed by pharmacologic therapy if necessary 3
• First-line drug therapy for hypertension includes:
  • Thiazide or thiazide-like diuretics
  • Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers
  • Calcium channel blockers 3, 6