Hypertension: High Blood Pressure
Hypertension: High Blood Pressure
Hypertension: High Blood Pressure
Blood pressure is a measurement of the force against the walls of your arteries as the heart pumps blood through the body.
Blood pressure readings are measured in millimeters of mercury (mmHg) and usually given as two numbers -- for example, 120 over 80
(written as 120/80 mmHg). One or both of these numbers can be too high.
Top number (systolic blood pressure) is between 120 and 139 most of the time, or
Bottom number (diastolic blood pressure) is between 80 and 89 most of the time
If you have pre-hypertension, you are more likely to develop high blood pressure.
If you have heart or kidney problems, or if you had a stroke, your doctor may want your blood pressure to be even lower than that of
people who do not have these conditions.
Causes
You are more likely to be told your blood pressure is too high as you get older. This is because your blood vessels become stiffer as
you age. When that happens, your blood pressure goes up. High blood pressureincreases your chance of having a stroke, heart attack,
heart failure, kidney disease, and early death.
High blood pressure that is caused by another medical condition or medication is called secondary hypertension. Secondary
hypertension may be due to:
Alcohol abuse Coarctation of the aorta
Atherosclerosis Cocaine use
Autoimmune disorders such as periarteritis nodosa Diabetes (if it causes kidney damage)
Chronic kidney disease
Endocrine disorders, such as adrenal tumors (pheochromocytoma, aldosteronism), thyroid disorders, andCushing syndrome
Medications
o Appetite suppressants
o Birth control pills
o Certain cold medications
o Corticosteroids
o Migraine medications
Renal artery stenosis
Symptoms
Most of the time, there are no symptoms. Symptoms that may occur include:
If you have a severe headache or any of the symptoms above, see your doctor right away. These may be signs of a complication or
dangerously high blood pressure called malignant hypertension.
Your health care provider will perform a physical exam and check your blood pressure. If the measurement is high, your health care
provider may think you have high blood pressure. The measurements need to be repeated over time, so that the diagnosis can be
confirmed.
If you monitor your blood pressure at home, you may be asked the following questions:
Other tests may be done to look for blood in the urine or heart failure. Your doctor will look for signs of complications in your heart,
kidneys, eyes, and other organs in your body.
Treatment
The goal of treatment is to reduce blood pressure so that you have a lower risk of complications. You and your health care provider
should set a blood pressure goal for you.
There are many different medicines that can be used to treat high blood pressure, including:
Your health care provider may also tell you to exercise, lose weight, and follow a healthier diet. If you have pre-hypertension, your
health care provider will recommend the same lifestyle changes to bring your blood pressure down to a normal range.
Often, a single blood pressure drug may not be enough to control your blood pressure, and you may need to take two or more drugs. It
is very important that you take the medications prescribed to you. If you have side effects, your health care provider can substitute a
different medication.
In addition to taking medicine, you can do many things to help control your blood pressure, including:
Eat a heart-healthy diet, including potassium and fiber, and drink plenty of water.
Exercise regularly -- at least 30 minutes a day.
If you smoke, quit -- find a program that will help you stop.
Limit how much alcohol you drink -- 1 drink a day for women, 2 a day for men.
Limit the amount of sodium (salt) you eat -- aim for less than 1,500 mg per day.
Reduce stress -- try to avoid things that cause stress for you. You can also try meditation or yoga.
Stay at a healthy body weight -- find a weight-loss program to help you, if you need it.
Your health care provider can help you find programs for losing weight, stopping smoking, and exercising. You can also get a referral
from your doctor to a dietitian, who can help you plan a diet that is healthy for you.
Your health care provider may ask you to keep track of your blood pressure at home. Make sure you get a good quality, well-fitting
home device. It will probably have a cuff with a stethoscope or a digital readout. Practice with your health care provider or nurse to
make sure you are taking your blood pressure correctly.
Outlook (Prognosis)
Most of the time, high blood pressure can be controlled with medicine and lifestyle changes.
Possible Complications
Prevention
Hypertension (HTN) or high blood pressure is a chronic medical condition in which the systemic arterial blood pressure is elevated. It
is the opposite of hypotension. It is classified as either primary (essential) or secondary. About 90–95% of cases are termed "primary
hypertension", which refers to high blood pressure for which no medical cause can be found.[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 failureand 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.[
Classification
Isolated systolic
≥140 ≥18.7 <90 <12.0
hypertension
Pathophysiology
Most of the mechanisms associated with secondary hypertension are generally fully understood. However, those associated
with essential (primary) hypertension are far less understood. What is known is thatcardiac output is raised early in the disease course,
with total peripheral resistance (TPR) normal; over time cardiac output drops to normal levels but TPR is increased. Three theories
promote salt excretion with the side effect of raising total peripheral resistance.
An overactive Renin-angiotensin system leads to vasoconstriction and retention of sodium and water. The increase in blood
volume leads to hypertension.[37]
It is also known that hypertension is highly heritable and polygenic (caused by more than one gene) and a few candidate genes have
Recently, work related to the association between essential hypertension and sustained endothelial damage has gained popularity
among hypertension scientists. It remains unclear however whether endothelial changes precede the development of hypertension or
whether such changes are mainly due to long standing elevated blood pressures.
Diagnosis
Hypertension is generally diagnosed on the basis of a persistently high blood pressure. Usually this requires three
separate sphygmomanometer (see figure) measurements at least one week apart. Often, this entails three separate visits
to the physician's office. Initial assessment of the hypertensive patient should include a complete history and physical
examination. Exceptionally, if the elevation is extreme, or if symptoms of organ damage are present then the diagnosis
may be given and treatment started immediately.
Once the diagnosis of hypertension has been made, physicians will attempt to identify the underlying cause based on risk
factors and other symptoms, if present. Secondary hypertension is more common in preadolescent children, with most
cases caused by renal disease. Primary or essential hypertension is more common in adolescents and has multiple risk
factors, including obesity and a family history of hypertension. [31] Laboratory tests can also be performed to identify
possible causes of secondary hypertension, and determine if hypertension has caused damage to the heart, eyes,
and kidneys. Additional tests for Diabetes and high cholesterol levels are also usually performed because they are
additional risk factors for the development of heart disease require treatment.[1] Tests typically performed are classified as
follows:
System Tests
Creatinine (renal function) testing is done to determine if kidney disease is present, which can be either the cause or
result of hypertension. In addition, it provides a baseline measurement of kidney function that can be used to monitor for
side-effects of certain antihypertensive drugs on kidney function. Additionally, testing of urine samples for protein is used
as a secondary indicator of kidney disease. Glucosetesting is done to determine if diabetes mellitus is
present. Electrocardiogram (EKG/ECG) testing is done to check for evidence of the heart being under strain from high
blood pressure. It may also show if there is thickening of the heart muscle (left ventricular hypertrophy) or has
experienced a prior minor heart distubance such as a silent heart attack. A chest X-ray may be performed to look for signs
of heart enlargement or damage to heart tissue.
Complications
Hypertension is the most important risk factor for death in industrialized countries.[74] It increaseshardening of the
arteries[75] thus predisposes individuals to heart disease,[76] peripheral vascular disease,[77] and strokes.[78] Types of heart
disease that may occur include: myocardial infarction,[78] heart failure,[79] and left ventricular hypertrophy[80] Other
complications include:
Hypertensive retinopathy[81]
Hypertensive nephropathy[82]
If blood pressure is very high hypertensive encephalopathy may result.