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Hypertension, also called high blood pressure, condition that arises when the blood

pressure is abnormally high. Hypertension occurs when the bodys smaller blood
vessels (the arterioles) narrow, causing the blood to exert excessive pressure against
the vessel walls and forcing the heart to work harder to maintain the pressure. Although
the heart and blood vessels can tolerate increased blood pressure for months and even
years, eventually the heart may enlarge (a condition called hypertrophy) and be
weakened to the point of failure. Injury to blood vessels in the kidneys, brain, and eyes
also may occur.
Blood pressure is actually a measure of two pressures, the systolic and the diastolic.
The systolic pressure (the higher pressure and the first number recorded) is the force
that blood exerts on theartery walls as the heart contracts to pump the blood to the
peripheral organs and tissues. The diastolic pressure (the lower pressure and the
second number recorded) is residual pressure exerted on the arteries as the heart
relaxes between beats. A diagnosis of hypertension is made when blood pressure
reaches or exceeds 140/90 mmHg (read as 140 over 90 millimetres of mercury).
When there is no demonstrable underlying cause of hypertension, the condition is
classified asessential hypertension. (Essential hypertension is also called primary or
idiopathic hypertension.) This is by far the most common type of high blood pressure,
occurring in 90 to 95 percent of patients. Genetic factors appear to play a major role in
the occurrence of essential hypertension. Secondary hypertension is associated with an
underlying disease, which may be renal, neurologic, or endocrine in origin; examples of
such diseases include Bright disease (glomerulonephritis; inflammation of the urineproducing structures in the kidney), atherosclerosis of blood vessels in the brain,
and Cushing syndrome (hyperactivity of the adrenal glands). In cases of secondary
hypertension, correction of the underlying cause may cure the hypertension. Various
external agents also can raise blood pressure. These include cocaine, amphetamines,
cold remedies, thyroid supplements, corticosteroids, nonsteroidal anti-inflammatory
drugs (NSAIDs), and oral contraceptives.
Malignant hypertension is present when there is a sustained or sudden rise in diastolic
blood pressure exceeding 120 mmHg, with accompanying evidence of damage to

organs such as the eyes, brain, heart, and kidneys. Malignant hypertension is a medical
emergency and requires immediate therapy and hospitalization.
Elevated arterial pressure is one of the most important public health problems in
developed countries. In the United States, for instance, nearly 30 percent of the adult
population is hypertensive. High blood pressure is significantly more prevalent and
serious among African Americans. Age, race, sex, smoking, alcohol intake, elevated
serum cholesterol,

salt

intake, glucose intolerance, obesity,

and

stress

all

may

contribute to the degree and prognosis of the disease. In both men and women, the risk
of developing high blood pressure increases with age.
Hypertension has been called the silent killer because it usually produces no
symptoms. It is important, therefore, for anyone with risk factors to have their blood
pressure checked regularly and to make appropriate lifestyle changes.
The most common immediate cause of hypertension-related death is heart disease, but
death fromstroke or renal (kidney) failure is also frequent. Complications result directly
from the increased pressure (cerebral hemorrhage, retinopathy, left ventricular
hypertrophy, congestive heart failure, arterial aneurysm, and

vascular rupture),

from atherosclerosis (increased coronary, cerebral, and renal vascular resistance), and
from decreased blood flow and ischemia (myocardial infarction, cerebral thrombosis and
infarction, and renal nephrosclerosis).
Effective treatment will reduce overall cardiovascular morbidity and mortality. Nondrug
therapy consists of: (1) relief of stress, (2) dietary management (restricted intake of salt,
calories, cholesterol, and saturated fats; sufficient intake of potassium, magnesium,
calcium, and vitamin C), (3) regular aerobic exercise, (4) weight reduction, (5) smoking
cessation, and (6) reduced intake of alcohol and caffeine.
Mild to moderate hypertension may be controlled by a single-drug regimen, although
more severe cases often require a combination of two or more drugs. Diuretics are a
common medication; these agents lower blood pressure primarily by reducing body
fluids and thereby reducing peripheral resistance to blood flow. However, they deplete
the bodys supply of potassium, so it is recommended that potassium supplements be
added or that potassium-sparing diuretics be used. Beta-adrenergic blockers (beta-

blockers) block the effects of epinephrine (adrenaline), thus easing the hearts pumping
action and widening blood vessels. Vasodilators act by relaxing smooth muscle in the
walls of blood vessels, allowing small arteries to dilate and thereby decreasing total
peripheral resistance. Calcium channel blockers promote peripheral vasodilation and
reduce vascular resistance. Angiotensin-converting enzyme (ACE) inhibitors inhibit the
generation of a potent vasoconstriction agent (angiotensin II), and they also may retard
the degradation of a potent vasodilator (bradykinin) and involve the synthesis of
vasodilatory prostaglandins. Angiotensin receptor antagonists are similar to ACE
inhibitors in utility and tolerability, but instead of blocking the production of angiotensin
II, they completely inhibit its binding to the angiotensin II receptor. Statins, best known
for their use as cholesterol-lowering agents, have shown promise as antihypertensive
drugs because of their ability to lower both diastolic and systolic blood pressure. The
mechanism by which statins act to reduce blood pressure is unknown; however,
scientists suspect that these drugs activate substances involved in vasodilation.