HYPERTENSION

Hypertension was defined as individuals with self-reported treated hypertension or with an

average of 2 blood pressure measurements of at least 140/90 mmHg. High blood pressure is risk

factor of CVD and leading cause of cardiovascular disease with at least 7.6 million deaths globally.

A lot of factors may influence the disease that may lead to its reduction towards normal or further

elevation. The considered risk factors include age, race, sex, alcohol intake, smoking, serum

cholesterol, glucose intolerance, weight, family history and physical activity). The Seventh Report

of the Joint National committee reported that prevalence of hypertension increases with advancing

age to the point where more than 50% of people 60–69 years of age and approximately 75% of

those 70 years of age and older are affected. The age related rise in SBP is primarily responsible

for an increase in both incidence and prevalence of hypertension with increasing age. However,

the younger the patient when hypertension first noted, the greater the life expectancy if the

hypertension is left untreated. In the United States urban blacks have about twice the prevalence

of hypertension as whites and more than four times the hypertension-induced morbidity rate. At

all ages and in both white and nonwhite populations, females with hypertension fare better than

males up to the age of 65, and the prevalence of hypertension in premenopausal females is

substantially less than that in age-matched males or postmenopausal women. Yet, compared with

their normotensive counterparts, females with hypertension run the same relative risk of a morbid

cardiovascular event as do males (Thomas JW, et. al, 2008). Cigarette smoking transiently increases

blood pressure, likely because the effect of nicotine on the autonomic ganglia, and a risk factor for

the development of sustained hypertension. In addition, the atherogenic effect of smoking may

contribute to the development of renovascular hypertension. Cigarette usage is associated with

many other health hazards, and all patients should be discouraged from smoking. The chronic

intake of alcoholic beverages correlates with high blood pressure. In people with hypertension,

who are obese or have type 2 diabetes there is impaired insulin independent transport of glucose

into many tissues termed insulin resistance. As a result serum glucose levels rise, stimulating the

pancreas to release additional insulin. Elevated insulin levels may contribute to hypertension via

increased sympathetic activation or by stimulation of vascular smooth cell hypertrophy, which

increases vascular resistance. Obesity itself has been directly associated with hypertension. The

current epidemic of obesity has led to a dramatic increase in the number of people with metabolic

syndrome. This condition represents a clustering of atherogenic risk factors, including

hypertension, hypertriglyceridemia, low serum HDL, a tendency toward glucose intolerance and

truncal obesity. About 90-95% of hypertension is idiopathic (no known cause) which appears to

be primary (essential hypertension), while the remaining 5-10% is mostly secondary. Essential

hypertension may be caused by generalized or functional abnormalities while secondary

hypertension may be either benign or malignant. The most dangerous of which is malignant or

accelerated hypertension that leads to death within a year or two in about 5% of hypertensive

persons that show a rapidly rising blood pressure when left untreated (Singh RB,, et.al , 1996).

The choice of treatment of hypertension is such that a satisfactory program to control

arterial pressure with minimal side effects can be developed for most patients..
References:

 Singh RB, Suh IL, Singh VP, Chaithiraphan S, Laothavorn P, Sy RG. Hypertension and

Stroke in Asia: Prevalence, Control and Strategies in Developing Countries for Prevention

journal of Human Hypertension 2010; 14(10/11),749-763.

 Thomas JW, Ramachandran SV. Epidemiology of Uncontrolled Hypertension in the United States.

Circulation 2005;112:1651-1662.