Overview of High BP
High blood pressure (BP) or hypertension is a medical condition in which the BP is chronically elevated. Hypertension is the most important modifiable risk factor for coronary heart disease (CHD), stroke, congestive heart failure (CHF), end-stage renal disease and peripheral vascular disease.
High BP affects about 65 million adult Americans.1 Worldwide, hypertension is seen in about 1 billion people and the prevalence hasbeen estimated to increase by more than 29% by the year 2025.2 This condition is associated with increased obesity and aging population.Due to the associated morbidity, mortality and economical burden to the society, hypertension remains as a significant public health challenge.
As hypertension rarely causes specific symptoms, it is undetected until an individual’s BP is measured by a physician or until it had caused complications such as stroke or heart attack. The primary goal of treatment is to lower the BP to a normal level through appropriate combination of drugs that achieves this goal. Recommendations for pharmacologic treatment are based on the presence of symptomatic hypertension, evidence of end-organ damage and unresponsiveness to lifestyle modifications. Drug selection is largely determined by individual’s needs including the presence of any coexisting illness.
Classification of High BP
Hypertension is classified as primary hypertension and secondary hypertension. Primary or essential hypertension which accounts for more than 90% of cases of hypertension is
diagnosed in the absence of an identifiable
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Pathophysiology (How High BP Developes)
Essentially, BP is the outcome of cardiac output and peripheral vascular resistance (BP=cardiac output×peripheral vascular resistance). Therefore, maintenance of a normal BP is dependent on the balance between the cardiac output and peripheral vascular resistance.
Essential Hypertension
The pathogenesis of essential hypertension is multifactorial and highly complex. Many factors (and risk factors) have been implicated in the genesis of essential hypertension, which include the following:
- Increased sympathetic nervous system activity.
- Increased production of sodium-retaining hormones and vasoconstrictors.
- Deficiencies of vasodilators such as prostacyclin and nitric oxide.
- Inappropriate or increased renin secretion, resulting in increased production of angiotensin II and aldosterone.
- Genetic predisposition.
Secondary Hypertension
The common identifiable causes of hypertension are the following:
- Chronic kidney disease
- Renovascular disease
- Cushing’s syndrome (hypersecretion of the hormone cortisol)
- Pheochromocytoma (adrenal tumor)
- Drugs such as nonsteroidal antiinflammatory drugs (NSAIDs) and oral contraceptives
Risk Factors for High BP
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Clinical Features (symptoms of high blood pressure)
Although patients with isolated hypertension are usually asymptomatic, occasionally they have symptoms such as dizziness, headache (especially pulsating headaches behind the eyes that occur early in the morning), blurred
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Diagnosis of High BP
A complete history, physical examination and certain diagnostic tests are recommended, once the presence of hypertension has been confirmed. An accurate BP measurement is the key to diagnosis of hypertension. An average of three BP readings, each taken 2 min apart is preferable to ascertain the diagnosis. Blood pressure should be measured in both the supine and sitting positions. Patients should be encouraged to abstain from smoking and caffeine intake for at least 30 min before the measurement.
Once the diagnosis of hypertension has been established, it is necessary to identify the presence of any risk factors, secondary causes of hypertension and any evidence of end-organ damage.
Initial, screening tests should be simple. Detailed history, physical examination, measurement of body mass index, assessment of routine blood chemistry, blood sugar, lipid profile and urinalysis are required. Further investigations are carried out in order to outline other cardiovascular risk factors and to detect target organ damage with only limited screening for secondary hypertension.
The cardiovascular risk of hypertension can be determined from the evidence of the following:5
- Target organ damage to the eyes, heart and kidneys.
- Coexisting illness such as diabetes or hypercholesterolemia.
- Lifestyle risk factors such as obesity and smoking.
Treatment of High BP
The goal of treatment for most hypertensive patients is to lower the SBP below 140 mmHg and the DBP below 90 mmHg. In some patients, as those with diabetes, it is recommended that SBP maintained below 130 mmHg and
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FAQ and Answers
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