Hypertension

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This article is about arterial hypertension. For other forms of hypertension, see Hypertension (disambiguation). Hypertension (HTN) or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. It is the opposite of hypotension. Hypertension is classified as either primary (essential) hypertension or secondary hypertension; About 90–95% of cases are categorized as "primary hypertension," which means high blood pressure with no obvious medical cause.[1] The remaining 5–10% of cases (Secondary hypertension) are caused by other conditions that affect the kidneys, arteries, heart or endocrine system.[2] Persistent hypertension is one of the risk factors for stroke, myocardial infarction, heart failure and arterial aneurysm, and is a leading cause of chronic kidney failure.[3] Moderate elevation of arterial blood pressure leads to shortened life expectancy. Dietary and lifestyle changes can improve blood pressure control and decrease the risk of associated health complications, although drug treatment may prove necessary in patients for whom lifestyle changes prove ineffective or insufficient.[4]

[edit]Classification

The variation in pressure in the left ventricle (blue line) and the aorta (red line) over two cardiac cycles ("heart beats"), showing the definitions of systolic and diastolic pressure

Systolic pressure Diastolic pressure Classification mmHg kPa mmHg kPa

Normal

90–119

12–15.9

60–79

8.0–10.5

Prehypertension 120–139 16.0–18.5 80–89 10.7–11.9

Stage 1

140–159 18.7–21.2 90–99 12.0–13.2

nausea.[12] Hypertensive encephalopathy is caused by severe small blood vessel congestion and brain swelling. which is reversible if blood pressure is lowered. These classifications are made after averaging a patient's resting blood pressure readings taken on two or more office visits. Systolic blood pressure is the blood pressure in vessels during a heart beat. Diastolic blood pressure is the pressure between heartbeats. These symptoms are collectively called hypertensive encephalopathy. A systolic or the diastolic blood pressure measurement higher than the accepted normal values for the age of the individual is classified as prehypertension or hypertension.[5] Exercise hypertension is an excessively high elevation in blood pressure during exercise. drowsiness. confusion. Hypertension[6] has several sub-classifications.[5] Blood pressure is usually classified based on the systolic and diastolic blood pressures.Stage 2 ≥160 ≥21.[7][8][9] The range considered normal for systolic values during exercise is between 200 and 230 mm Hg.[13] [edit]Secondary hypertension .3 ≥100 ≥13. and isolated systolic hypertension.0 Source: American Heart Association (2003). Individuals older than 50 years are classified as having hypertension if their blood pressure is consistently at least 140 mmHg systolic or 90 mmHg diastolic. Isolated systolic hypertension refers to elevated systolic pressure with normal diastolic pressure and is common in the elderly.3 Isolated systolic hypertension ≥140 ≥18.[10] Exercise hypertension may indicate that an individual is at risk for developing hypertension at rest.[9][10] [edit]Signs and symptoms Mild to moderate essential hypertension is usually asymptomatic. vision disorders.[11] [edit]Accelerated hypertension Accelerated hypertension is associated with headache. Patients with blood pressures higher than 130/80 mmHg with concomitant presence of diabetes mellitus or kidney disease require further treatment. and vomiting.7 <90 <12.[5] Hypertension is also classified as resistant if medications do not reduce blood pressure to normal levels. including hypertension stage I. hypertension stage II.

and facial paralysis. similar studies have not been performed thoroughly to link any adverse effects with the increase in blood pressure. [edit]In pregnancy Hypertension in pregnant women is one symptom of pre-eclampsia. tremors. Other hormone disorders like hyperaldosteronism may cause less specific symptoms such asnumbness.Main article: Secondary hypertension Some additional signs and symptoms suggest that the hypertension is caused by disorders in hormone regulation.[17] and also cause mental pressure.[20] Even with the above clinical symptoms. protrusion of the lower jaw. vomiting. the prevalence of pediatric hypertension remains unknown due to the lack of scientific knowledge. Therefore. fatigue. or the recent onset of diabetes suggests that an individual has a hormone disorder known as Cushing's syndrome. Hypertension combined with obesity distributed on the trunk of the body. enlargement of the tongue. or growth hormone excess will be accompanied by additional symptoms specific to these disorders. Hypertension caused by other hormone disorders such as hyperthyroidism. For example. In adults.[21] [edit]Causes [edit]Essential hypertension . lack of energy. electrolyte imbalances and dehydration.[15]excessive hair growth. and difficulty breathing. darkening of the skin color. Pre-eclampsia can progress to a lifethreatening condition called eclampsia.[14] Signs and symptoms associated with growth hormone excess include coarsening of facial features.[18] In addition. reddening of the palms. the true incidence of pediatric hypertension is not known. and severe seizures. accumulated fat on the back of the neck ('buffalo hump'). irritability. and increased sweating. and vision loss.[19] [edit]In children Some signs and symptoms are especially important in newborns and infants such as failure to thrive. generalized swelling. wide purple marks on the abdomen (abdominal striae). However. hypertension has been defined due to the adverse effects caused by hypertension. Other symptoms indicating that brain function is becoming impaired may precede these seizures such as nausea. heart rate abnormalities. the systemic vascular resistance and blood pressure decrease during pregnancy. nosebleeds. seizures. excessive sweating.[20] In children. blurred vision. which is the development of protein in the urine. The body must compensate by increasing cardiac output and blood volume to provide sufficient circulation in the uteroplacental arterial bed. hypothyroidism. headaches. hypertension can cause headache. in children.[16]:499. and elevated blood alkalinity. and excessive sweating. excessive urination. hyperthyrodism can cause weight loss.

[36] Hypertension is also caused by other conditions that cause hormone changes. Hypertension results in the compromise or imbalance of the pathophysiological mechanisms.. pre-eclampsia during pregnancy.[30] and having a family history of hypertension. such as the hormone-regulating endocrinesystem. affecting 90–95% of hypertensive patients.[22] smoking. Other common causes of secondary hypertension include kidney disease. that regulate blood plasma volume and heart function. stress.[25] alcohol intake. Some are common. [33] Insulin resistance. is another risk factor.g.[32] as is sympatheticnervous system overactivity.[27][28] Risk also increases with aging.[35] [edit]Secondary hypertension Main article: Secondary hypertension Secondary hypertension by definition results from an identifiable cause. a hormone secreted by the kidney.Main article: Essential hypertension Essential hypertension is the most prevalent hypertension type. is also thought to contribute to hypertension. which is a component of syndrome X (or the metabolic syndrome).[24] salt (sodium) sensitivity. pheochromocytoma).[22] obesity[23] (more than 85% of cases occur in those with a body mass index greater than 25).[26] and vitamin D deficiency that increase the risk of developing hypertension. potassium deficiency (hypokalemia). visceral obesity. [1] Although no direct cause has been identified. This type is important to recognize since it's treated differently to essential hypertension.[31] An elevated level of renin. [edit]Pathophysiology Main article: Pathophysiology of hypertension . Many conditions cause hypertension. obesity/metabolic disorder.[29] some inherited genetic mutations. and certain prescription and illegal drugs. there are many factors such as sedentary lifestyle.[32][34] Recent studies have implicated low birth weight as a risk factor for adult essential hypertension. hypothyroidism (citation needed). well-recognized secondary causes such as renovascular hypertension and Cushing's syndrome. such as hyperthyroidism. and certain tumors of the adrenal medulla (e.[36] which is a condition where the adrenal glands overproduce the hormone cortisol. by treating the underlying cause of the elevated blood pressure. the congenital defect known as coarctation of the aorta.

Initial assessment of the hypertensive patient should include a complete history and physical examination. Three theories have been proposed to explain this:  Inability of the kidneys to excrete sodium. The increase inblood volume plus vasoconstriction leads to hypertension. those associated with essential (primary) hypertension are far less understood. What is known is that cardiac output is raised early in the disease course. and kidneys.  An overactive Renin-angiotensin system leads to vasoconstriction and retention of sodium and water. leading to increased stress responses.[39] Recently. whether endothelial changes precede the development of hypertension or whether such changes are mainly due to longstanding elevated blood pressures. It remains unclear. [edit]Diagnosis Hypertension is generally diagnosed on the basis of a persistently high blood pressure.[38] It is also known that hypertension is highly heritable and polygenic (caused by more than one gene) and a few candidategenes have been postulated in the etiology of this condition. with total peripheral resistance (TPR) normal. and to determine whether hypertension has caused damage to the heart.[37]  An overactive sympathetic nervous system. work related to the association between essential hypertension and sustained endothelial damage has gained popularity among hypertension scientists. physicians will attempt to identify the underlying cause based on risk factors and other symptoms. Additional tests for diabetes and high cholesterol levels are usually performed because these conditions are additional risk factors for the development of heart disease and require treatment. Exceptionally. if present. resulting in natriuretic factors such as Atrial Natriuretic Factor being secreted to promote salt excretion with the side effect of raising total peripheral resistance. [31] Laboratory tests can also be performed to identify possible causes of secondary hypertension.[1] Typical tests are classified as follows: System Tests . eyes. Usually this requires three separate sphygmomanometer measurements at least one week apart (see figure). Primary or essential hypertension is more common in adolescents and has multiple risk factors.A diagram explaining factors affecting arterial pressure Most of the mechanisms associated with secondary hypertension are generally fully understood. with most cases caused by renal disease. however. if the elevation is extreme. However. then a diagnosis may be made and treatment started immediately. including obesity and a family history of hypertension. over time cardiac output drops to normal levels but TPR is increased. or if symptoms of organ damage are present. Once the diagnosis of hypertension has been made. Secondary hypertension is more common in preadolescent children. Diagnosis often entails three separate visits to the physician's office.

calcium. proteinuria. detection and omission of environmental toxins. total cholesterol. In addition. HDL and LDL cholesterol. and chest radiograph Sources: Harrison's principles of internal medicine[40] others[41][42][43][44][45][46] Creatinine (renal function) testing is done to assess the presence of kidney disease. serum BUN (blood urea nitrogen) and/or creatinine Endocrin Serum sodium. sodium/potassium balance. potassium. Electrocardiogram (EKG/ECG) testing is done to check for evidence that the heart is under strain from high blood pressure. Following this. A chest X-ray may be performed to look for signs of heart enlargement or damage to heart tissue. TSH (thyroid-stimulating hormone). [edit]Prevention The degree to which hypertension can be prevented depends on a number of features including current blood pressure level. before the initiation of prescription drug therapy. among others). triglycerides Other Hematocrit. Glucose testing is done to determine if diabetes mellitus is present. heart. lifestyle changes are recommended to lower blood pressure. risk factors for cardiovascular diseases and the age at diagnosis of prehypertension or at risk for hypertension. kidney. The process of managing prehypertension according the guidelines of the British Hypertension Society suggest the following lifestyle changes: . creatinine testing provides a baseline measurement of kidney function that can be used to monitor for side effects of certain antihypertensive drugs on kidney function. A prolonged assessment that involves repeated blood pressure measurements provides the most accurate blood pressure level assessment. electrocardiogram. It may also show whether there is thickening of the heart muscle (left ventricular hypertrophy) or whether the heart has experienced a prior minor disturbance such as a silent heart attack.Renal Microscopic urinalysis. Additionally. testing of urine samples for proteinis used as a secondary indicator of kidney disease. e Metabolic Fasting blood glucose. which can be either the cause or the result of hypertension. changes in end/target organs (retina.

Limiting alcohol intake to less than 2 standard drinks per day can reduce systolic blood pressure by between 2-4mmHg.[52]   Vasodialators such as niacin. Research sponsored by the National Heart.[51]  Discontinuing tobacco use and alcohol consumption has been shown to lower blood pressure.[59] [edit]Treatment [edit]Lifestyle modifications The first line of treatment for hypertension—which are the same as the recommended preventative lifestyle changes[53]— include:    Dietary changes Physical exercise Weight loss . which offsets the effect of sodium has been shown highly effective in reducing blood pressure.[56][57]although meta-analysis suggests it is not effective unless combined with other relaxation techniques. but blood pressure (especially systolic) always transiently increases following alcohol or nicotine consumption. The fish oil may increase sodium and water excretion.[49]  Additional dietary changes beneficial to reducing blood pressure include the DASH diet (dietary approaches to stop hypertension) which is rich in fruits and vegetables and low-fat or fat-free dairy products.. Lung. In addition.[55] such as device-guided paced breathing. and Blood Institute. Many people usepotassium chloride[48]salt substitute to reduce their salt intake. Weight reduction and regular aerobic exercise (e.[54] by reducing environmental stress such as high sound levelsand overillumination can also lower blood pressure. walking): Regular exercise improves blood flow and helps to reduce the resting heart rate and blood pressure.g. Fish oil is shown to lower blood pressure in hypertensive individuals. such as meditation and other mindbody relaxation techniques.[50] showed this diet to be effective.[53]  Reducing stress.[47]   Reduce dietary sugar Reduce sodium (salt) in the body by disuse of condiment sodium and the adoption of a high potassium diet which rids the renal system of excess sodium. Abstaining from cigarette smoking reduces the risks of stroke and heart attack associated with hypertension. The exact mechanisms are not fully understood. Jacobson's Progressive Muscle Relaxation and biofeedback are also beneficial. for example with relaxation therapy.[58]  Increasing omega 3 fatty acids can help lower hypertension. an increase in dietary potassium.

[66] The aim of treatment should be to reduce blood pressure to <140/90 mmHg for most individuals. are currently available for treating hypertension.[67] If the blood pressure goal is not met. of ischaemic heart disease by 21%.[61][62][63] Regarding dietary changes.g. with lower BP targets applying to patients with end-organ damage or proteinuria. both in people with hypertension and in people with normal blood pressure. the DASH diet (Dietary Approaches to Stop Hypertension) is adiet promoted by the National Heart. Reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34%. in general claims of efficacy are not supported by scientific studies. hydrochlorothiazide).[4] The first line antihypertensive supported by the best evidence is a low dose thiazide-based diuretic. as well as protein". and sugar. and reduce the likelihood of dementia. Commonly used prescription drugs include:[70]ACE inhibitors. beta blockers . and calcium.These have all been shown to significantly reduce blood pressure in people with hypertension. relaxation or meditation are advertised to reduce hypertension.[65] and it also generally encourages the consumption of nuts. fruits and vegetables while lowering the consumption of red meats. which have been in general of low quality. and lower for individuals with diabetes or kidney disease (some medical professionals recommend keeping levels below 120/80 mmHg). Some examples of common combined prescription drug treatments include: . and Blood Institute (part of the NIH. A Cochrane review published in 2008 concluded that a long term (more than 4 weeks) low sodium diet in Caucasians has a useful effect to reduce blood pressure. [edit]Medications Several classes of medications. calcium channel blockers.[60] If hypertension is high enough to justify immediate use of medications. Drug prescription should take into account the patient's absolute cardiovascular risk (including risk of myocardial infarction and stroke) as well as blood pressure readings. direct renin inhibitors. lifestyle changes are still recommended in conjunction with medication. alpha blockers. sweets. in order to gain a more accurate picture of the patient's cardiovascular profile. diuretics (e. A major feature of the plan is limiting intake of sodium. magnesium.[4] Different programs aimed to reduce psychological stress such as biofeedback. angiotensin II receptor antagonists . It is also "rich in potassium. a United States government organization) to control hypertension. [68] Comorbidity also plays a role in determining target blood pressure. fish. heart failure. Lung. However. poultry. a change in treatment should be made as therapeutic inertia is a clear impediment to blood pressure control.[64] Also.[69] Often multiple medications are needed to be combined to achieve the goal blood pressure. collectively referred to as antihypertensive drugs. and mortality from cardiovascular disease. a low sodium diet is beneficial. whole grains.

the efficacy of which has been demonstrated in individuals with glucose intolerance or metabolic syndrome.[71]  A fixed combination of a diuretic and an ARB.[80] and left ventricular hypertrophy[81] Other complications include:  Hypertensive retinopathy[82] .[53] [edit]In the elderly Treating moderate to severe high blood pressure decreases death rates in those under 80 years of age.[72] The recommended BP goal is <140/90 mm Hg with thiazide diuretics being the first line medication. Hypertension is the most important risk factor for death in industrialized countries.[74] [edit]Complications Main article: Complications of hypertension Diagram illustrating the main complications of persistent high blood pressure.[79] heart failure. Combinations of an ACE inhibitor or angiotensin II–receptor antagonist.[77] peripheral vascular disease.[72] In those over 80 years old there was a decrease in morbidity but no decrease in mortality. One example of this is the combination of perindopril and amlodipine.[75] It increases hardening of the arteries[76] thus predisposes individuals to heart disease.[78] and strokes.[73] [edit]Resistant Guidelines for treating resistant hypertension have been published in the UK[70] and US. A fixed combination of an ACE inhibitor and a calcium channel blocker. The combination is known colloquially as a "triple whammy" in the Australian health industry. [79] Types of heart disease that may occur include: myocardial infarction. a diuretic and an NSAID (including selective COX-2 inhibitors and non-prescribed drugs such as ibuprofen) should be avoided whenever possible due to a high documented risk of acute renal failure.

is secondary to an underlying disorder.[91] [edit]History . and is greater in the southeastern United States.[42] The incidence of exercise hypertension is reported to range from 1– 10%.5% (women) in Poland.   Hypertensive nephropathy[83] If blood pressure is very high hypertensive encephalopathy may result.4% (men) and 6. Hypertension is the major treatable risk factor associated with silent stokes. Despite not causing identifiable symptoms a silent stroke still causes damage to the brain.[86] In 1995 it is estimated that 43 million people in the United States had hypertension or were taking antihypertensive medication. Adolescents usually have primary or essential hypertension. particularly in preadolescents.[85] It was common in both developed (333 million ) and undeveloped (639 million) countries. Hypertension is more prevalent in men (though menopause tends to decrease this difference) and those of lowsocioeconomic status. and places the patient at increased risk for a major stroke in the future.8% (women) in rural India and as high as 68.[90] Most childhood hypertension. almost 24% of the adult population.[1] Over 90–95% of adult hypertension is essential hypertension. which accounts for 85–95% of cases. Kidney disease is the most common (60–70%) cause of hypertension in children.[84] [edit]Epidemiology In the year 2000 it is estimated that nearly one billion people or ~26% of the adult population had hypertension worldwide.[1] The most common cause of secondary hypertension is primary aldosteronism. Silent stroke is a type of stroke (infarct) that does not have any outward symptoms (asymptomatic). and the patient is typically unaware they have suffered a stroke.[87] The prevalence of hypertension in the United States is increasing and reached 29% in 2004. [85] However rates vary markedly in different regions with rates as low as 3. rates increase with age.[88][89] It is more common in blacks and native Americans and less in whites and Mexican Americans.[10] [edit]In children The prevalence of high blood pressure in the young is increasing.9% (men) and 72.

[93] Studies in the 1920s demonstrated the public health impact of untreated high blood pressure. was used in 1900 but had many side effects and was unpopular. and deaths from malignant hypertension and its complications were common.[93] Our modern understanding of hypertension began with the work of physician William Harvey (1578–1657).[95] Before pharmacological treatment for hypertension became possible.[93] The first ever elevated blood pressure in a patient without kidney disease was reported by Frederick Mahomed (1849–1884). The National Institutes of Health also sponsored other population studies. A randomized controlled trial sponsored by the Veterans Administration using these drugs had to be stopped early because those not receiving treatment were developing more complications and it was deemed unethical to withhold treatment from them.sympathectomy (surgical ablation of parts of the sympathetic nervous system).[94] It was not until 1904 that sodium restriction was advocated while a rice diet was popularized around 1940.[92] Others propose even earlier descriptions dating as far as 2600 BCE. hydralazine and reserpine (derived from the medicinal plant Rauwolfia serpentina). sodium thiocyanate. These studies prompted public health campaigns to increase public awareness of hypertension and the advice to get blood pressure measured and treated. A prominent victim of severe hypertension leading to cerebral hemorrhage was Franklin D. the most popular and reasonably effective of which were tetramethylammonium chloride and its derivative hexamethonium.[95] . which additionally showed that African Americans had a higher burden of hypertension and its complications. who was the first to describe correctly the systemic circulation of blood being pumped around the body by the heart in his book "De motu cordis".Image of veins from Harvey's Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus Some cite the writings of Sushruta in the 6th century BC as being the first mention of symptoms like those of hypertension. Roosevelt (1882– 1945). treatment options were limited at the time. Cornelius Celsus. and pyrogen therapy (injection of substances that caused a fever. The Framingham Heart Study added to the epidemiological understanding of hypertension and its relationship with coronary artery disease.[93] Several other agents were developed after the Second World War. and Hipocrates advocated such treatments. The basis for measuring blood pressure were established by Stephen Hales in 1733.[93] Initial descriptions of hypertension as a disease came among others fromThomas Young in 1808 and specially Richard Bright in 1836.[93] Well known individuals such as The Yellow Emperor of China. Galen. Main treatment for what was called the "hard pulse disease" consisted in reducing the quantity of blood in a subject by the sectioning of veins or the application of leeches. indirectly reducing blood pressure). three treatment modalities were used. These measures appear to have contributed at least in part of the observed 50% fall in stroke and ischemic heart disease between 1972 and 1994. all with numerous side-effects: strict sodium restriction.[93][95] The first chemical for hypertension.

including resistance to taking multiple medications to reach blood pressure goals. which became available in 1958.[95] [edit]Society and culture [edit]Economics The National Heart. Black developed beta blockers in the early 1960s.[99] High blood pressure is the most common chronic medical problem prompting visits to primary health care providers. and most importantly.[102][103] [edit]Awareness .2 billion. and the cost associated with advanced medical care.[95] ACE inhibitors were developed through rational drug design. The medical. Lung. the development of other debilitating conditions.A major breakthrough was achieved with the discovery of the first well-tolerated orally available agents.. treatment. was described. Adequate management of hypertension can be hampered by inadequacies in the diagnosis. but turned out to lower blood pressure.[100] Thus. The first member was verapamil. economic. Patients also face the challenges of adhering to medicine schedules and making lifestyle changes.[93][96] it increased salt excretion while preventing fluid accumulation. an orally active agent. In 1975.[95] The next class of antihypertensives to be discovered was that of the calcium channel blockers. the achievement of blood pressure goals is possible. The first was chlorothiazide. yet it is estimated that only 34% of the 50 million American adults with hypertension have their blood pressure controlled to a level of <140/90 mm Hg. In 1977 captopril. about two thirds of Americans with hypertension are at increased risk for heart disease. and Blood Institute (NHLBI) estimated in 2002 that hypertension cost the United States $47.[97] these were initially used for angina. the first thiazide and developed from the antibioticsulfanilamide.[101] Health care providers face many obstacles to achieving blood pressure control from their patients. and/or control of high blood pressure.[95] The British physician James W. and snake venom from Bothrops jararaca could lower blood pressure through inhibition of ACE. and human costs of untreated and inadequately controlled high blood pressure are enormous. lowering blood pressure significantly reduces the risk of death due to heart disease. a derivative of papaverine that was initially thought to be a beta blocker and used for angina. Black received the 1976 Lasker Award and in 1988 the Nobel Prize in Physiology or Medicine for his discovery. but then turned out to have a different mode of action and was shown to lower blood pressure. the Lasker Special Public Health Award was awarded to the team that developed chlorothiazide. Nonetheless. the reninangiotensin system was known to play an important role in blood pressure regulation.[98] this led to the development of a number of other ACE inhibitors.

Over the past three years. During the week of WHD. an umbrella organization of 85 national hypertension societies and leagues. and a blood pressure of 140/90 or above is considered high. High blood pressure does not mean excessive emotional tension. The diastolic pressure reflects the lowest pressure to which the arteries are exposed. The bottom number. The top number. Using mass media such as Internet and television. The World Hypertension League (WHL). As the momentum picks up year after year.Graph showing. Arteries are vessels that carry blood from the pumping heart to all the tissues and organs of the body. as the leading cause of cardiovascular mortality. represents the pressure in the arteries as the heart relaxes after the contraction. Normal blood pressure is below 120/80. In 2007. corresponds to the pressure in the arteries as the heart contracts and pumps blood forward into the arteries. recognized that more than 50% of the hypertensive population worldwide are unaware of their condition. treatment and control of hypertension compared between the four studies of NHANES[88] The World Health Organization attributes hypertension. more national societies have been engaging in WHD and have been innovative in their activities to get the message to the public. the WHL is confident that almost all the estimated 1. . [105] What is high blood pressure? High blood pressure (HBP) or hypertension means high pressure (tension) in the arteries. prevalence of awareness. the WHL initiated a global awareness campaign on hypertension in 2005 and dedicated May 17 of each year as World Hypertension Day (WHD). blood pressure between 120/80 and 139/89 is called "pre-hypertension". all these countries – in partnership with their local governments. the systolic blood pressure. or high blood pressure. professional societies.5 billion people affected by elevated blood pressure can be reached. the diastolic pressure. there was record participation from 47 member countries of the WHL. nongovernmental organizations and private industries – promoted hypertension awareness among the public through several media and public rallies. the message reached more than 250 million people.[104] To address this problem. although emotional tension and stress can temporarily increase blood pressure.

but it is now known that in people 50 years or older systolic hypertension represents a greater risk. It was previously thought that rises in diastolic blood pressure were a more important risk factor than systolic elevations. the diagnosis of high blood pressure is important so efforts can be made to normalize blood pressure and prevent complications. High blood pressure is also estimated to affect about two million Americanteens and children. . and the Journal of the American Medical Association reports that many are under-diagnosed. kidney (renal) disease.An elevation of the systolic and/or diastolic blood pressure increases the risk of developing heart (cardiac) disease. and stroke(brain damage). Hypertension is clearly a major public health problem.73 million people. hardening of the arteries (atherosclerosis or arteriosclerosis). For that reason. The American Heart Association estimates high blood pressure affects approximately one in three adults in the United States . eye damage. These complications of hypertension are often referred to as end-organ damage because damage to these organs is the end result of chronic (long duration) high blood pressure.

What causes high blood pressure? .

(Secondary hypertension is discussed further in a separate section later. Salt intake may be a particularly important factor in relation to essential hypertension in several situations. that is. (Genes are tiny portions of chromosomes that produce theproteins that determine the characteristics of individuals. (These identified genetic disorders are considered secondary hypertension. in individuals who have one or two parents with hypertension. obesity. certain unusual genetic disorders affecting the hormones of the adrenal glands may lead to hypertension. yet its basic causes or underlying defects are not always known. this increased peripheral arteriolar stiffness is present in those individuals whose essential hypertension is associated with genetic factors. there are several factors whose combined effects produce hypertension.) The vast majority of patients with essential hypertension have in common a particular abnormality of the arteries: an increased resistance (stiffness or lack of elasticity) in the tiny arteries that are most distant from the heart (peripheral arteries or arterioles).) The current research in this area is focused on the genetic factors that affect the renin-angiotensinaldosterone system.) Essential hypertension affects approximately 72 million Americans. and excess salt may be involved in the hypertension that is associated with advancing age. Also. Inflammation also may play a role in hypertension since a predictor of the development of hypertension is the presence of an elevated C reactive protein level (a blood test marker of inflammation) in some individuals. lack of exercise. which accounts for 5% of hypertension. high blood pressure is twice as common as in the general population. . the genes for hypertension have not yet been identified. For example. hereditary (genetic) susceptibility. Just what makes the peripheral arteries become stiff is not known.8 grams daily. essential hypertension develops only in groups or societies that have a fairly high intake of salt. Yet. The arterioles supply oxygen-containing blood and nutrients to all of the tissues of the body. Nevertheless. The Institute of Medicine of the National Academies recommends healthy 19 to 50-year-old adults consume only 3. For example. the incidence of high blood pressure is greater among African Americans than among Caucasians or Asians. and aging. and kidney failure(renal insufficiency). Essential hypertension is a far more common condition and accounts for 95% of hypertension. African American background. certain associations have been recognized in people with essential hypertension. In secondary hypertension. The arterioles are connected by capillaries in the tissues to the veins (the venous system). However. This system helps to regulate blood pressure by controlling salt balance and the tone (state of elasticity) of the arteries.Two forms of high blood pressure have been described: essential (or primary) hypertension and secondary hypertension. which returns the blood to the heart and lungs. obesity. Genetic factors are thought to play a prominent role in the development of essential hypertension. in the United States. Approximately 30% of cases of essential hypertension are attributable to genetic factors. exceeding 5.8 grams of salt to replace the average amount lost daily through perspiration and toachieve a diet that provides sufficient amounts of other essential nutrients. overuse of salt. Rarely. The cause of essential hypertension is multifactorial. the high blood pressure is secondary to (caused by) a specific abnormality in one of the organs or systems of the body.

adrenal gland. thickening of the heart muscle and heart attacks. . and smoking may all adversely affect the outlook for the health of an individual with hypertension. • High salt intake. • The goal of therapy for hypertension is to bring the blood pressure down to 140/85 in the general population and to even lower levels in diabetics. even decades. • In essential hypertension (95% of people with hypertension). such as in the kidney. kidney failure. • Heightened public awareness and screening of the population are necessary to detect hypertension early enough so it can be treated before critical organs are damaged. obesity.High Blood Pressure (Hypertension) At A Glance • High blood pressure (hypertension) is designated as either essential (primary) hypertension or secondary hypertension and is defined as a consistently elevated blood pressure exceeding 140/90 mm Hg. until it finally damages certain critical organs. and people with certain chronic kidney diseases. some are preferred over others in certain specific medical situations. and controlling hypertension early in its course can significantly reduce the risk of developing strokes. treating. ARB drugs. • Poorly controlled hypertension ultimately can cause damage to blood vessels in the eye. and some are not to be used (contraindicated) in other situations. • Essential hypertension may run in some families and occurs more often in the African American population. no specific cause is found. alpha-blockers. • High blood pressure is called "the silent killer" because it often causes no symptoms for many years. lack of regular exercise. heart attacks. and strokes. although the genes for essential hypertension have not yet been identified. • Screening. hardening of the arteries (arteriosclerosis). • Most antihypertensive medications can be used alone or in combination: some are used only in combination. and peripheral vasodilators. including ACE inhibitors. calcium channel blockers. or kidney failure. diagnosing. or aortic artery. beta-blockers. • Several classes of anti-hypertensive medications are available. excessive alcohol or coffee intake. while secondary hypertension (5% of people with hypertension) is caused by an abnormality somewhere in the body. • Lifestyle adjustments in diet and exercise and compliance with medication regimes are important factors in determining the outcome for people with hypertension. diuretics. African Americans.

Hypertension (high blood pressure) is a disease of vascular regulation resulting from malfunction of arterial pressure control mechanisms (central nervous system.) the cause is unknown. Either of these conditions may give rise to accelerated hypertension – a medical emergency . rennin-angiotensinaldosterone system. and coarctation of the aorta.which results primarily from renal disease. extracellular fluid volume. in which diastrolic pressure is 90 mm Hg or higher and systolic pressure is 140 mm Hg or higher in absence of other causes of hypertension (approximately 95 % of patients). endocrine disorders. and Secondary hypertension. The basic explanation is that blood pressure is elevated when there is increased cardiac output plus increased peripheral vascular resistance. and there is no cure. The two major types of hypertension are primary (essential) hypertension.

kidney. Hypertension in children is defined as the average systolic or diastolic blood pressure greater than or equal to the 95th percentile for age and sex with measurement on at lease three occasions. renal failure. or inadequately treated. or the heart. and young children with secondary causes. overweight. cigarette smoking. family history. Because hypertension presents no over symptoms.” The untreated disease may progress to retinopathy. untreated. . Risk factors for hypertension are age between 30 and 70. but it is increasingly being recognized in adolescents. however. infants. heart failure. black. Hypertension is one of the most prevalent chronic diseases for which treatment is available. The incidence of hypertension in children is low. sedentary lifestyle. most patients with hypertension are unaware. and diabetes mellitus. and stroke. it is termed the “silent killer. sleep apnea.– in which blood pressure elevates very rapidly to threaten one or more of the target organs: the brain. and it may occur in neonates. coronary artery disease.

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