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Hypertension
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{{short description| Long-term high blood pressure in the arteries}}{{cs1 config|name-list-style=vanc}}{{About|arterial hypertension|other forms of hypertension}}{{Use dmy dates|date=April 2023}}{{good article}}- the content below is remote from Wikipedia
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Signs and symptoms
Hypertension is rarely accompanied by symptoms, and its identification is usually through health screening, or when seeking healthcare for an unrelated problem. Some people with high blood pressure report headaches (particularly at the back of the head and in the morning), as well as lightheadedness, vertigo, tinnitus (buzzing or hissing in the ears), altered vision or fainting episodes.BOOK, Fisher ND, Williams GH, Kasper DL, Braunwald E, Fauci AS, Harrison’s Principles of Internal Medicine,archive.org/details/harrisonsprincip00kasp, limited, 16th, 2005, McGraw-Hill, New York, 978-0-07-139140-5, 1463–1481, Hypertensive vascular disease, etal, These symptoms, however, might be related to associated anxiety rather than the high blood pressure itself.JOURNAL, Marshall IJ, Wolfe CD, McKevitt C, Lay perspectives on hypertension and drug adherence: systematic review of qualitative research, The BMJ, 345, e3953, July 2012, 22777025, 3392078, 10.1136/bmj.e3953, On physical examination, hypertension may be associated with the presence of changes in the optic fundus seen by ophthalmoscopy.JOURNAL, Wong TY, Wong T, Mitchell P, The eye in hypertension, Lancet, 369, 9559, 425–435, February 2007, 17276782, 10.1016/S0140-6736(07)60198-6, 28579025, The severity of the changes typical of hypertensive retinopathy is graded from I to IV; grades I and II may be difficult to differentiate. The severity of the retinopathy correlates roughly with the duration or the severity of the hypertension.Secondary hypertension
Secondary hypertension is hypertension due to an identifiable cause, and may result in certain specific additional signs and symptoms. For example, as well as causing high blood pressure, Cushing’s syndrome frequently causes truncal obesity,WEB, Truncal obesity (Concept Id: C4551560) – MedGen – NCBI,www.ncbi.nlm.nih.gov/medgen/1637490#Definition, 2022-04-24, ncbi.nlm.nih.gov, en, glucose intolerance, moon face, a hump of fat behind the neck and shoulders (referred to as a buffalo hump), and purple abdominal stretch marks.BOOK, O’Brien E, Beevers DG, Lip GY, ABC of hypertension, BMJ Books, London, 2007, 978-1-4051-3061-5, Hyperthyroidism frequently causes weight loss with increased appetite, fast heart rate, bulging eyes, and tremor. Renal artery stenosis (RAS) may be associated with a localized abdominal bruit to the left or right of the midline (unilateral RAS), or in both locations (bilateral RAS). Coarctation of the aorta frequently causes a decreased blood pressure in the lower extremities relative to the arms, or delayed or absent femoral arterial pulses. Pheochromocytoma may cause abrupt episodes of hypertension accompanied by headache, palpitations, pale appearance, and excessive sweating.Hypertensive crisis
Severely elevated blood pressure (equal to or greater than a systolic 180 mmHg or diastolic of 120 mmHg) is referred to as a hypertensive crisis.WEB, Center for Drug Evaluation and Research, 2021-01-21, High Blood Pressure – Understanding the Silent Killer,www.fda.gov/drugs/special-features/high-blood-pressure-understanding-silent-killer, U.S. Food and Drug Administration, en, Hypertensive crisis is categorized as either hypertensive urgency or hypertensive emergency, according to the absence or presence of end organ damage, respectively.JOURNAL, Rodriguez MA, Kumar SK, De Caro M, Hypertensive crisis, Cardiology in Review, 18, 2, 102–107, 2010-04-01, 20160537, 10.1097/CRD.0b013e3181c307b7, 34137590, WEB, Hypertensive Crisis,www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Hypertensive-Crisis_UCM_301782_Article.jsp, heart.org, 2015-07-25, live,www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Hypertensive-Crisis_UCM_301782_Article.jsp," title="web.archive.org/web/20150725220209www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Hypertensive-Crisis_UCM_301782_Article.jsp,">web.archive.org/web/20150725220209www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/Hypertensive-Crisis_UCM_301782_Article.jsp, 25 July 2015, In hypertensive urgency, there is no evidence of end organ damage resulting from the elevated blood pressure. In these cases, oral medications are used to lower the BP gradually over 24 to 48 hours.JOURNAL, Marik PE, Varon J, Hypertensive crises: challenges and management, Chest, 131, 6, 1949–1962, June 2007, 17565029, 10.1378/chest.06-2490,chestjournal.chestpubs.org/content/131/6/1949.long, dead,chestjournal.chestpubs.org/content/131/6/1949.long," title="archive.today/20121204174126chestjournal.chestpubs.org/content/131/6/1949.long,">archive.today/20121204174126chestjournal.chestpubs.org/content/131/6/1949.long, 2012-12-04, In hypertensive emergency, there is evidence of direct damage to one or more organs.JOURNAL, Perez MI, Musini VM, Pharmacological interventions for hypertensive emergencies, The Cochrane Database of Systematic Reviews, 1, CD003653, January 2008, 2008, 18254026, 10.1002/14651858.CD003653.pub3, 6991936, The most affected organs include the brain, kidney, heart and lungs, producing symptoms which may include confusion, drowsiness, chest pain and breathlessness. In hypertensive emergency, the blood pressure must be reduced more rapidly to stop ongoing organ damage; however, there is a lack of randomized controlled trial evidence for this approach.Pregnancy
Hypertension occurs in approximately 8–10% of pregnancies. Two blood pressure measurements six hours apart of greater than 140/90 mmHg are diagnostic of hypertension in pregnancy.BOOK, Harrison’s principles of internal medicine., McGraw-Hill, New York, 978-0-07-174889-6, 2011, 55–61, 18th, High blood pressure in pregnancy can be classified as pre-existing hypertension, gestational hypertension, or pre-eclampsia.WEB, Management of hypertension in pregnant and postpartum women,www.uptodate.com/contents/management-of-hypertension-in-pregnant-and-postpartum-women, uptodate.com, 2015-07-30, live,www.uptodate.com/contents/management-of-hypertension-in-pregnant-and-postpartum-women," title="web.archive.org/web/20160304070333www.uptodate.com/contents/management-of-hypertension-in-pregnant-and-postpartum-women,">web.archive.org/web/20160304070333www.uptodate.com/contents/management-of-hypertension-in-pregnant-and-postpartum-women, 4 March 2016, Women who have chronic hypertension before their pregnancy are at increased risk of complications such as premature birth, low birthweight or stillbirth.JOURNAL, Al Khalaf SY, O’Reilly ÉJ, Barrett PM, B Leite DF, Pawley LC, McCarthy FP, Khashan AS, Impact of Chronic Hypertension and Antihypertensive Treatment on Adverse Perinatal Outcomes: Systematic Review and Meta-Analysis, Journal of the American Heart Association, 10, 9, e018494, May 2021, 33870708, 8200761, 10.1161/JAHA.120.018494, Women who have high blood pressure and had complications in their pregnancy have three times the risk of developing cardiovascular disease compared to women with normal blood pressure who had no complications in pregnancy.JOURNAL, 2023-11-21, Pregnancy complications increase the risk of heart attacks and stroke in women with high blood pressure,evidence.nihr.ac.uk/alert/pregnancy-complications-increase-the-risk-of-heart-attacks-and-stroke-in-women-with-high-blood-pressure/, NIHR Evidence, Plain English summary, National Institute for Health and Care Research, 10.3310/nihrevidence_60660, 265356623, JOURNAL, Al Khalaf S, Chappell LC, Khashan AS, McCarthy FP, O’Reilly ÉJ, Association Between Chronic Hypertension and the Risk of 12 Cardiovascular Diseases Among Parous Women: The Role of Adverse Pregnancy Outcomes, Hypertension, 80, 7, 1427–1438, July 2023, 37170819, 10.1161/HYPERTENSIONAHA.122.20628, free, Pre-eclampsia is a serious condition of the second half of pregnancy and following delivery characterised by increased blood pressure and the presence of protein in the urine. It occurs in about 5% of pregnancies and is responsible for approximately 16% of all maternal deaths globally. Pre-eclampsia also doubles the risk of death of the baby around the time of birth. Usually there are no symptoms in pre-eclampsia and it is detected by routine screening. When symptoms of pre-eclampsia occur the most common are headache, visual disturbance (often “flashing lights“), vomiting, pain over the stomach, and swelling. Pre-eclampsia can occasionally progress to a life-threatening condition called eclampsia, which is a hypertensive emergency and has several serious complications including vision loss, brain swelling, seizures, kidney failure, pulmonary edema, and disseminated intravascular coagulation (a blood clotting disorder).WEB,emedicine.medscape.com/article/261435-overview, Hypertension and Pregnancy, Gibson P, 30 July 2009, eMedicine Obstetrics and Gynecology, Medscape, 16 June 2009, live,emedicine.medscape.com/article/261435-overview," title="web.archive.org/web/20090724065747emedicine.medscape.com/article/261435-overview,">web.archive.org/web/20090724065747emedicine.medscape.com/article/261435-overview, 24 July 2009, In contrast, gestational hypertension is defined as new-onset hypertension during pregnancy without protein in the urine.Children
Failure to thrive, seizures, irritability, lack of energy, and difficulty in breathingWEB,emedicine.medscape.com/article/889877-overview, Hypertension, Rodriguez-Cruz E, Ettinger LM, 6 April 2010, eMedicine Pediatrics: Cardiac Disease and Critical Care Medicine, Medscape, 16 June 2009, live,emedicine.medscape.com/article/889877-overview," title="web.archive.org/web/20090815113248emedicine.medscape.com/article/889877-overview,">web.archive.org/web/20090815113248emedicine.medscape.com/article/889877-overview, 15 August 2009, can be associated with hypertension in newborns and young infants. In older infants and children, hypertension can cause headache, unexplained irritability, fatigue, failure to thrive, blurred vision, nosebleeds, and facial paralysis.Causes
Primary hypertension
Hypertension results from a complex interaction of genes and environmental factors. Numerous common genetic variants with small effects on blood pressure have been identifiedJOURNAL, Ehret GB, Munroe PB, Rice KM, Bochud M, Johnson AD, Chasman DI, etal, Genetic variants in novel pathways influence blood pressure and cardiovascular disease risk, Nature, 478, 7367, 103–109, September 2011, 21909115, 3340926, 10.1038/nature10405, 2011Natur.478..103T, as well as some rare genetic variants with large effects on blood pressure.JOURNAL, Lifton RP, Gharavi AG, Geller DS, Molecular mechanisms of human hypertension, Cell, 104, 4, 545–556, February 2001, 11239411, 10.1016/S0092-8674(01)00241-0, free, Also, genome-wide association studies (GWAS) have identified 35 genetic loci related to blood pressure; 12 of these genetic loci influencing blood pressure were newly found.JOURNAL, Kato N, Loh M, Takeuchi F, Verweij N, Wang X, Zhang W, etal, Trans-ancestry genome-wide association study identifies 12 genetic loci influencing blood pressure and implicates a role for DNA methylation, Nature Genetics, 47, 11, 1282–1293, November 2015, 26390057, 4719169, 10.1038/ng.3405, Sentinel SNP for each new genetic locus identified has shown an association with DNA methylation at multiple nearby CpG sites. These sentinel SNP are located within genes related to vascular smooth muscle and renal function. DNA methylation might affect in some way linking common genetic variation to multiple phenotypes even though mechanisms underlying these associations are not understood. Single variant test performed in this study for the 35 sentinel SNP (known and new) showed that genetic variants singly or in aggregate contribute to risk of clinical phenotypes related to high blood pressure.Coronary artery ectasia: Coronary artery ectasia (CAE) is characterized by the enlargement of a coronary artery to 1.5 times or more than other non-ectasia parts of the vessel. The pooled unadjusted OR of CAE in subjects with Hypertension (HTN) in comparison by subjects without HTN was estimated 1.44.JOURNAL, Hypertension and coronary artery ectasia: a systematic review and meta-analysis study, Clinical Hypertension, 2021, 27, 10.1186/s40885-021-00170-6, free, Bahremand, Mostafa, Zereshki, Ehsan, Matin, Behzad Karami, Rezaei, Mansour, Omrani, Hamidreza, 1, 14, 34261539, 8281588, Blood pressure rises with aging when associated with a western diet and lifestyle and the risk of becoming hypertensive in later life is significant.JOURNAL, Vasan RS, Alexa Beiser, Beiser A, Seshadri S, Larson MG, Kannel WB, D’Agostino RB, Levy D, Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study, JAMA, 287, 8, 1003–1010, February 2002, 11866648, 10.1001/jama.287.8.1003, free, JOURNAL, Carrera-Bastos P, Fontes-Villalba M, O’Keefe JH, Lindeberg S, Cordain L, 2011-03-09, The western diet and lifestyle and diseases of civilization,www.dovepress.com/the-western-diet-and-lifestyle-and-diseases-of-civilization-peer-reviewed-article-RRCC, 2021-02-09, Research Reports in Clinical Cardiology, 2, 15–35, 10.2147/RRCC.S16919, 3231706, English, free, Several environmental factors influence blood pressure. High salt intake raises the blood pressure in salt sensitive individuals; lack of exercise and central obesity can play a role in individual cases. The possible roles of other factors such as caffeine consumption,JOURNAL, Mesas AE, Leon-Muñoz LM, Rodriguez-Artalejo F, Lopez-Garcia E, The effect of coffee on blood pressure and cardiovascular disease in hypertensive individuals: a systematic review and meta-analysis, The American Journal of Clinical Nutrition, 94, 4, 1113–1126, October 2011, 21880846, 10.3945/ajcn.111.016667, free, and vitamin D deficiencyJOURNAL, Vaidya A, Forman JP, Vitamin D and hypertension: current evidence and future directions, Hypertension, 56, 5, 774–779, November 2010, 20937970, 10.1161/HYPERTENSIONAHA.109.140160, free, are less clear. Insulin resistance, which is common in obesity and is a component of syndrome X (or the metabolic syndrome), also contributes to hypertension.JOURNAL, Sorof J, Daniels S, Obesity hypertension in children: a problem of epidemic proportions, Hypertension, 40, 4, 441–447, October 2002, 12364344, 10.1161/01.HYP.0000032940.33466.12, free, Events in early life, such as low birth weight, maternal smoking, and lack of breastfeeding may be risk factors for adult essential hypertension, although the mechanisms linking these exposures to adult hypertension remain unclear.JOURNAL, Lawlor DA, Smith GD, Early life determinants of adult blood pressure, Current Opinion in Nephrology and Hypertension, 14, 3, 259–264, May 2005, 15821420, 10.1097/01.mnh.0000165893.13620.2b, 10646150, An increased rate of high blood uric acid has been found in untreated people with hypertension in comparison with people with normal blood pressure, although it is uncertain whether the former plays a causal role or is subsidiary to poor kidney function.JOURNAL, Gois PH, Souza ER, Pharmacotherapy for hyperuricaemia in hypertensive patients, The Cochrane Database of Systematic Reviews, 2020, CD008652, September 2020, 9, 32877573, 10.1002/14651858.CD008652.pub4, 8094453, Average blood pressure may be higher in the winter than in the summer.JOURNAL, Fares A, Winter Hypertension: Potential mechanisms, International Journal of Health Sciences, 7, 2, 210–219, June 2013, 24421749, 3883610, 10.12816/0006044, Periodontal disease is also associated with high blood pressure.JOURNAL, Muñoz Aguilera E, Suvan J, Buti J, Czesnikiewicz-Guzik M, Barbosa Ribeiro A, Orlandi M, Guzik TJ, Hingorani AD, Nart J, D’Aiuto F, 6, Periodontitis is associated with hypertension: a systematic review and meta-analysis, Cardiovascular Research, 116, 1, 28–39, January 2020, 31549149, 10.1093/cvr/cvz201, free, Lembo G,Secondary hypertension
Secondary hypertension results from an identifiable cause. Kidney disease is the most common secondary cause of hypertension. Hypertension can also be caused by endocrine conditions, such as Cushing’s syndrome, hyperthyroidism, hypothyroidism, acromegaly, Conn’s syndrome or hyperaldosteronism, renal artery stenosis (from atherosclerosis or fibromuscular dysplasia), hyperparathyroidism, and pheochromocytoma.BOOK, Dluhy RG, Williams GH, Williams textbook of endocrinology, 1998, W.B. Saunders, Philadelphia; Montreal, 978-0-7216-6152-0, 9th, Endocrine hypertension, Wilson JD, Foster DW, Kronenberg HM, 729–749, registration,archive.org/details/williamstextbook00wils, Other causes of secondary hypertension include obesity, sleep apnea, pregnancy, coarctation of the aorta, excessive eating of liquorice, excessive drinking of alcohol, certain prescription medicines, herbal remedies, and stimulants such as coffee, cocaine and methamphetamine.JOURNAL, Grossman E, Messerli FH, Drug-induced hypertension: an unappreciated cause of secondary hypertension, The American Journal of Medicine, 125, 1, 14–22, January 2012, 22195528, 10.1016/j.amjmed.2011.05.024, Arsenic exposure through drinking water has been shown to correlate with elevated blood pressure.JOURNAL, Jiang J, Liu M, Parvez F, Wang B, Wu F, Eunus M, Bangalore S, Newman JD, Ahmed A, Islam T, Rakibuz-Zaman M, Hasan R, Sarwar G, Levy D, Slavkovich V, Argos M, Scannell Bryan M, Farzan SF, Hayes RB, Graziano JH, Ahsan H, Chen Y, Association between Arsenic Exposure from Drinking Water and Longitudinal Change in Blood Pressure among HEALS Cohort Participants, Environmental Health Perspectives, 123, 8, 806–812, August 2015, 25816368, 4529016, 10.1289/ehp.1409004, JOURNAL, Abhyankar LN, Jones MR, Guallar E, Navas-Acien A, Arsenic exposure and hypertension: a systematic review, Environmental Health Perspectives, 120, 4, 494–500, April 2012, 22138666, 3339454, 10.1289/ehp.1103988, Depression was also linked to hypertension.JOURNAL, Meng L, Chen D, Yang Y, Zheng Y, Hui R, Depression increases the risk of hypertension incidence: a meta-analysis of prospective cohort studies, Journal of Hypertension, 30, 5, 842–851, May 2012, 22343537, 10.1097/hjh.0b013e32835080b7, 32187480, Loneliness is also a risk factor.JOURNAL, Hawkley LC, Cacioppo JT, Loneliness matters: a theoretical and empirical review of consequences and mechanisms, Annals of Behavioral Medicine, 40, 2, 218–227, October 2010, 20652462, 3874845, 10.1007/s12160-010-9210-8, A 2018 review found that any alcohol increased blood pressure in males while over one or two drinks increased the risk in females.JOURNAL, Roerecke M, Tobe SW, Kaczorowski J, Bacon SL, Vafaei A, Hasan OS, Krishnan RJ, Raifu AO, Rehm J, Sex-Specific Associations Between Alcohol Consumption and Incidence of Hypertension: A Systematic Review and Meta-Analysis of Cohort Studies, Journal of the American Heart Association, 7, 13, e008202, June 2018, 29950485, 6064910, 10.1161/JAHA.117.008202,Pathophysiology
(File:Mean arterial pressure.png|thumb|upright=1.4|Determinants of mean arterial pressure)(File:Blausen 0486 HighBloodPressure 01.png|thumb|upright=1.4|Illustration depicting the effects of high blood pressure)In most people with established essential hypertension, increased resistance to blood flow (total peripheral resistance) accounts for the high pressure while cardiac output remains normal.JOURNAL, Conway J, Hemodynamic aspects of essential hypertension in humans, Physiological Reviews, 64, 2, 617–660, April 1984, 6369352, 10.1152/physrev.1984.64.2.617, There is evidence that some younger people with prehypertension or ‘borderline hypertension’ have high cardiac output, an elevated heart rate and normal peripheral resistance, termed hyperkinetic borderline hypertension.JOURNAL, Palatini P, Julius S, The role of cardiac autonomic function in hypertension and cardiovascular disease, Current Hypertension Reports, 11, 3, 199–205, June 2009, 19442329, 10.1007/s11906-009-0035-4, 11320300, These individuals develop the typical features of established essential hypertension in later life as their cardiac output falls and peripheral resistance rises with age. Whether this pattern is typical of all people who ultimately develop hypertension is disputed.JOURNAL, Andersson OK, Lingman M, Himmelmann A, Sivertsson R, Widgren BR, Prediction of future hypertension by casual blood pressure or invasive hemodynamics? A 30-year follow-up study, Blood Pressure, 13, 6, 350–354, 2004, 15771219, 10.1080/08037050410004819, 28992820, The increased peripheral resistance in established hypertension is mainly attributable to structural narrowing of small arteries and arterioles,JOURNAL, Folkow B, Physiological aspects of primary hypertension, Physiological Reviews, 62, 2, 347–504, April 1982, 6461865, 10.1152/physrev.1982.62.2.347, although a reduction in the number or density of capillaries may also contribute.JOURNAL, Struijker Boudier HA, le Noble JL, Messing MW, Huijberts MS, le Noble FA, van Essen H, The microcirculation and hypertension, Journal of Hypertension Supplement, 10, 7, S147–156, December 1992, 1291649, 10.1097/00004872-199212000-00016, It is not clear whether or not vasoconstriction of arteriolar blood vessels plays a role in hypertension.JOURNAL, Schiffrin EL, Reactivity of small blood vessels in hypertension: relation with structural changes. State of the art lecture, Hypertension, 19, 2 Suppl, II1-9, February 1992, 1735561, 10.1161/01.HYP.19.2_Suppl.II1-a, free, Hypertension is also associated with decreased peripheral venous compliance,JOURNAL, Safar ME, London GM, Arterial and venous compliance in sustained essential hypertension, Hypertension, 10, 2, 133–139, August 1987, 3301662, 10.1161/01.HYP.10.2.133, free, which may increase venous return, increase cardiac preload and, ultimately, cause diastolic dysfunction.For patients having hypertension, higher heart rate variability (HRV) is a risk factor for atrial fibrillation.JOURNAL, Kim SH, Lim KR, Chun KJ, Higher heart rate variability as a predictor of atrial fibrillation in patients with hypertensione, Scientific Reports, 12, 1, 3702, 2022, 10.1038/s41598-022-07783-3, 8904557, 35260686, Pulse pressure (the difference between systolic and diastolic blood pressure) is frequently increased in older people with hypertension.JOURNAL, Steppan J, Barodka V, Berkowitz DE, Nyhan D, Vascular stiffness and increased pulse pressure in the aging cardiovascular system, Cardiology Research and Practice, 2011, 263585, 2011-08-02, 21845218, 3154449, 10.4061/2011/263585, free, This can mean that systolic pressure is abnormally high, but diastolic pressure may be normal or low, a condition termed isolated systolic hypertension.JOURNAL, Chobanian AV, Clinical practice. Isolated systolic hypertension in the elderly, The New England Journal of Medicine, 357, 8, 789–796, August 2007, 17715411, 10.1056/NEJMcp071137, 42515260, The high pulse pressure in elderly people with hypertension or isolated systolic hypertension is explained by increased arterial stiffness, which typically accompanies aging and may be exacerbated by high blood pressure.JOURNAL, Zieman SJ, Melenovsky V, Kass DA, Mechanisms, pathophysiology, and therapy of arterial stiffness, Arteriosclerosis, Thrombosis, and Vascular Biology, 25, 5, 932–943, May 2005, 15731494, 10.1161/01.ATV.0000160548.78317.29, free, Many mechanisms have been proposed to account for the rise in peripheral resistance in hypertension. Most evidence implicates either disturbances in the kidneys’ salt and water handling (particularly abnormalities in the intrarenal renin–angiotensin system)JOURNAL, Navar LG, Counterpoint: Activation of the intrarenal renin-angiotensin system is the dominant contributor to systemic hypertension, Journal of Applied Physiology, 109, 6, 1998–2000; discussion 2015, December 2010, 21148349, 3006411, 10.1152/japplphysiol.00182.2010a, or abnormalities of the sympathetic nervous system.JOURNAL, Esler M, Lambert E, Schlaich M, Point: Chronic activation of the sympathetic nervous system is the dominant contributor to systemic hypertension, Journal of Applied Physiology, 109, 6, 1996–1998; discussion 2016, December 2010, 20185633, 10.1152/japplphysiol.00182.2010, 7685157, These mechanisms are not mutually exclusive and it is likely that both contribute to some extent in most cases of essential hypertension. It has also been suggested that endothelial dysfunction and vascular inflammation may also contribute to increased peripheral resistance and vascular damage in hypertension.JOURNAL, Versari D, Daghini E, Virdis A, Ghiadoni L, Taddei S, Endothelium-dependent contractions and endothelial dysfunction in human hypertension, British Journal of Pharmacology, 157, 4, 527–536, June 2009, 19630832, 2707964, 10.1111/j.1476-5381.2009.00240.x, JOURNAL, Marchesi C, Paradis P, Schiffrin EL, Role of the renin-angiotensin system in vascular inflammation, Trends in Pharmacological Sciences, 29, 7, 367–374, July 2008, 18579222, 10.1016/j.tips.2008.05.003, Interleukin 17 has garnered interest for its role in increasing the production of several other immune system chemical signals thought to be involved in hypertension such as tumor necrosis factor alpha, interleukin 1, interleukin 6, and interleukin 8.JOURNAL, Gooch JL, Sharma AC, Targeting the immune system to treat hypertension: where are we?, Current Opinion in Nephrology and Hypertension, 23, 5, 473–479, September 2014, 25036747, 10.1097/MNH.0000000000000052, 13383731, Excessive sodium or insufficient potassium in the diet leads to excessive intracellular sodium, which contracts vascular smooth muscle, restricting blood flow and so increases blood pressure.JOURNAL, Adrogué HJ, Madias NE, Sodium and potassium in the pathogenesis of hypertension, The New England Journal of Medicine, 356, 19, 1966–1978, May 2007, 17494929, 10.1056/NEJMra064486, 22345731, JOURNAL, Perez V, Chang ET, Sodium-to-potassium ratio and blood pressure, hypertension, and related factors, Advances in Nutrition, 5, 6, 712–741, November 2014, 25398734, 4224208, 10.3945/an.114.006783,Diagnosis
Hypertension is diagnosed on the basis of a persistently high resting blood pressure. The American Heart Association (AHA) recommends at least three resting measurements on at least two separate health care visits.JOURNAL, Aronow WS, Fleg JL, Pepine CJ, Artinian NT, Bakris G, Brown AS, Ferdinand KC, Ann Forciea M, Frishman WH, Jaigobin C, Kostis JB, Mancia G, Oparil S, Ortiz E, Reisin E, Rich MW, Schocken DD, Weber MA, Wesley DJ, Harrington RA, Bates ER, Bhatt DL, Bridges CR, Eisenberg MJ, Ferrari VA, Fisher JD, Gardner TJ, Gentile F, Gilson MF, Hlatky MA, Jacobs AK, Kaul S, Moliterno DJ, Mukherjee D, Rosenson RS, Stein JH, Weitz HH, Wesley DJ, ACCF/AHA 2011 expert consensus document on hypertension in the elderly: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents developed in collaboration with the American Academy of Neurology, American Geriatrics Society, American Society for Preventive Cardiology, American Society of Hypertension, American Society of Nephrology, Association of Black Cardiologists, and European Society of Hypertension, Journal of the American Society of Hypertension, 5, 4, 259–352, 2011, 21771565, 10.1016/j.jash.2011.06.001, In Britain, ‘Blood Pressure UK’ states that a healthy blood pressure is any reading between 90/60 mmHg and 120/80 mmHg.WEB, Blood Pressure UK,www.bloodpressureuk.org/your-blood-pressure/understanding-your-blood-pressure/what-is-high-blood-pressure/, 2023-11-10, www.bloodpressureuk.org,Measurement technique
For an accurate diagnosis of hypertension to be made, it is essential for proper blood pressure measurement technique to be used.JOURNAL, Viera AJ, Screening for Hypertension and Lowering Blood Pressure for Prevention of Cardiovascular Disease Events, The Medical Clinics of North America, 101, 4, 701–712, July 2017, 28577621, 10.1016/j.mcna.2017.03.003, Review, Improper measurement of blood pressure is common and can change the blood pressure reading by up to 10 mmHg, which can lead to misdiagnosis and misclassification of hypertension. Correct blood pressure measurement technique involves several steps. Proper blood pressure measurement requires the person whose blood pressure is being measured to sit quietly for at least five minutes which is then followed by application of a properly fitted blood pressure cuff to a bare upper arm. The person should be seated with their back supported, feet flat on the floor, and with their legs uncrossed. The person whose blood pressure is being measured should avoid talking or moving during this process. The arm being measured should be supported on a flat surface at the level of the heart. Blood pressure measurement should be done in a quiet room so the medical professional checking the blood pressure can hear the Korotkoff sounds while listening to the brachial artery with a stethoscope for accurate blood pressure measurements.BOOK, Vischer AS, Burkard T, Hypertension: From basic research to clinical practice, Principles of Blood Pressure Measurement – Current Techniques, Office vs Ambulatory Blood Pressure Measurement, Advances in Experimental Medicine and Biology, 2017, 956, 85–96, 10.1007/5584_2016_49, 27417699, Review, 978-3-319-44250-1, The blood pressure cuff should be deflated slowly (2–3 mmHg per second) while listening for the Korotkoff sounds. The bladder should be emptied before a person’s blood pressure is measured since this can increase blood pressure by up to 15/10 mmHg. Multiple blood pressure readings (at least two) spaced 1–2 minutes apart should be obtained to ensure accuracy. Ambulatory blood pressure monitoring over 12 to 24 hours is the most accurate method to confirm the diagnosis.JOURNAL, Siu AL, Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement, Annals of Internal Medicine, 163, 10, 778–786, November 2015, 26458123, 10.7326/m15-2223, free, An exception to this is those with very high blood pressure readings especially when there is poor organ function.With the availability of 24-hour ambulatory blood pressure monitors and home blood pressure machines, the importance of not wrongly diagnosing those who have white coat hypertension has led to a change in protocols. In the United Kingdom, current best practice is to follow up a single raised clinic reading with ambulatory measurement, or less ideally with home blood pressure monitoring over the course of 7 days.BOOK, National Clinical Guidance Centre, Hypertension (NICE CG 127), National Institute for Health and Clinical Excellence, 7 Diagnosis of Hypertension, 7.5 Link from evidence to recommendations, 102, August 2011,www.nice.org.uk/nicemedia/live/13561/56007/56007.pdf, 22 December 2011, dead,www.nice.org.uk/nicemedia/live/13561/56007/56007.pdf," title="web.archive.org/web/20130723014309www.nice.org.uk/nicemedia/live/13561/56007/56007.pdf,">web.archive.org/web/20130723014309www.nice.org.uk/nicemedia/live/13561/56007/56007.pdf, 23 July 2013, The United States Preventive Services Task Force also recommends getting measurements outside of the healthcare environment. Pseudohypertension in the elderly or noncompressibility artery syndrome may also require consideration. This condition is believed to be due to calcification of the arteries resulting in abnormally high blood pressure readings with a blood pressure cuff while intra arterial measurements of blood pressure are normal.JOURNAL, Franklin SS, Wilkinson IB, McEniery CM, Unusual hypertensive phenotypes: what is their significance?, Hypertension, 59, 2, 173–178, February 2012, 22184330, 10.1161/HYPERTENSIONAHA.111.182956, free, Orthostatic hypertension is when blood pressure increases upon standing.JOURNAL, Kario K, Orthostatic hypertension: a measure of blood pressure variation for predicting cardiovascular risk, Circulation Journal, 73, 6, 1002–1007, June 2009, 19430163, 10.1253/circj.cj-09-0286, free,Other investigations
{{anchor|Laboratory tests}}{| class=“wikitable” style = “float: right; margin-left:15px; text-align:center”Classification in adults{| class“wikitable“|+ Blood pressure classifications
Lifestyle modifications
The first line of treatment for hypertension is lifestyle changes, including dietary changes, physical activity, and weight loss. Though these have all been recommended in scientific advisories,JOURNAL, Go AS, Bauman MA, Coleman King SM, Fonarow GC, Lawrence W, Williams KA, Sanchez E, An effective approach to high blood pressure control: a science advisory from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention, Hypertension, 63, 4, 878–885, April 2014, 24243703, 10.1161/HYP.0000000000000003, 10280688, free, a Cochrane systematic review found no evidence (due to lack of data) for effects of weight loss diets on death, long-term complications or adverse events in persons with hypertension.JOURNAL, Semlitsch T, Krenn C, Jeitler K, Berghold A, Horvath K, Siebenhofer A, Long-term effects of weight-reducing diets in people with hypertension, The Cochrane Database of Systematic Reviews, 2021, 2, CD008274, February 2021, 33555049, 8093137, 10.1002/14651858.CD008274.pub4, The review did find a decrease in body weight and blood pressure. Their potential effectiveness is similar to and at times exceeds a single medication. If hypertension is high enough to justify immediate use of medications, lifestyle changes are still recommended in conjunction with medication.Dietary changes shown to reduce blood pressure include diets with low sodium,JOURNAL, He FJ, Li J, Macgregor GA, Effect of longer-term modest salt reduction on blood pressure, The Cochrane Database of Systematic Reviews, 30, 4, CD004937, April 2013, 23633321, 10.1002/14651858.CD004937.pub2, Systematic Review & Meta-Analysis, 23522004, JOURNAL, Huang L, Trieu K, Yoshimura S, Neal B, Woodward M, Campbell NR, Li Q, Lackland DT, Leung AA, Anderson CA, MacGregor GA, He FJ, 6, Effect of dose and duration of reduction in dietary sodium on blood pressure levels: systematic review and meta-analysis of randomised trials, The BMJ, 368, m315, February 2020, 32094151, 7190039, 10.1136/bmj.m315, free, the DASH diet (Dietary Approaches to Stop Hypertension),JOURNAL, Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, Obarzanek E, Conlin PR, Miller ER, Simons-Morton DG, Karanja N, Lin PH, 6, Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group, The New England Journal of Medicine, 344, 1, 3–10, January 2001, 11136953, 10.1056/NEJM200101043440101, free, which was the best against 11 other diet in an umbrella review,JOURNAL, Sukhato K, Akksilp K, Dellow A, Vathesatogkit P, Anothaisintawee T, Efficacy of different dietary patterns on lowering of blood pressure level: an umbrella review, The American Journal of Clinical Nutrition, 112, 6, 1584–1598, December 2020, 33022695, 10.1093/ajcn/nqaa252, free, and plant-based diets.JOURNAL, Joshi S, Ettinger L, Liebman SE, Plant-Based Diets and Hypertension, American Journal of Lifestyle Medicine, 14, 4, 397–405, 2020, 33281520, 7692016, 10.1177/1559827619875411, There is some evidence green tea consumption may help lower blood pressure, but this is insufficient for it to be recommended as a treatment.JOURNAL, Xu R, Yang K, Ding J, Chen G, Effect of green tea supplementation on blood pressure: A systematic review and meta-analysis of randomized controlled trials, Medicine, 99, 6, e19047, February 2020, 32028419, 7015560, 10.1097/MD.0000000000019047, There is evidence from randomized, double-blind, placebo-controlled clinical trials that Hibiscus tea consumption significantly reduces systolic blood pressure (-4.71 mmHg, 95% CI [-7.87, -1.55]) and diastolic blood pressure (−4.08 mmHg, 95% CI [-6.48, −1.67]).JOURNAL, Najafpour Boushehri S, Karimbeiki R, Ghasempour S, Ghalishourani SS, Pourmasoumi M, Hadi A, Mbabazi M, Pour ZK, Assarroudi M, Mahmoodi M, Khosravi A, Mansour-Ghanaei F, Joukar F, 6, The efficacy of sour tea (Hibiscus sabdariffa L.) on selected cardiovascular disease risk factors: A systematic review and meta-analysis of randomized clinical trials, Phytotherapy Research, 34, 2, 329–339, February 2020, 31943427, 10.1002/ptr.6541, 210333560,onlinelibrary.wiley.com/doi/abs/10.1002/ptr.6541, JOURNAL, McKay DL, Chen CY, Saltzman E, Blumberg JB, Hibiscus sabdariffa L. tea (tisane) lowers blood pressure in prehypertensive and mildly hypertensive adults, The Journal of Nutrition, 140, 2, 298–303, February 2010, 20018807, 10.3945/jn.109.115097, free, Beetroot juice consumption also significantly lowers the blood pressure of people with high blood pressure.WEB, Beetroot juice lowers high blood pressure, suggests research,www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2015/january/beetroot-and-blood-pressure, British Heart Foundation, JOURNAL, Siervo M, Lara J, Ogbonmwan I, Mathers JC, Inorganic nitrate and beetroot juice supplementation reduces blood pressure in adults: a systematic review and meta-analysis, The Journal of Nutrition, 143, 6, 818–826, June 2013, 23596162, 10.3945/jn.112.170233, free, JOURNAL, Bahadoran Z, Mirmiran P, Kabir A, Azizi F, Ghasemi A, The Nitrate-Independent Blood Pressure-Lowering Effect of Beetroot Juice: A Systematic Review and Meta-Analysis, Advances in Nutrition, 8, 6, 830–838, November 2017, 29141968, 5683004, 10.3945/an.117.016717,doi.org/10.3945/an.117.016717, Increasing dietary potassium has a potential benefit for lowering the risk of hypertension.JOURNAL, Aburto NJ, Hanson S, Gutierrez H, Hooper L, Elliott P, Cappuccio FP, Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses, The BMJ, 346, f1378, April 2013, 23558164, 4816263, 10.1136/bmj.f1378, JOURNAL, Stone MS, Martyn L, Weaver CM, Potassium Intake, Bioavailability, Hypertension, and Glucose Control, Nutrients, 8, 7, 444, July 2016, 27455317, 4963920, 10.3390/nu8070444, free, The 2015 Dietary Guidelines Advisory Committee (DGAC) stated that potassium is one of the shortfall nutrients which is under-consumed in the United States.WEB, Scientific Report of the 2015 Dietary Guidelines Advisory Committee,health.gov/dietaryguidelines/2015-scientific-report/, 2017-04-26, live,web.archive.org/web/20170426153317/https://health.gov/dietaryguidelines/2015-scientific-report/, 26 April 2017, However, people who take certain antihypertensive medications (such as ACE-inhibitors or ARBs) should not take potassium supplements or potassium-enriched salts due to the risk of high levels of potassium.JOURNAL, Raebel MA, Hyperkalemia associated with use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, Cardiovascular Therapeutics, 30, 3, e156–166, June 2012, 21883995, 10.1111/j.1755-5922.2010.00258.x, free, Physical exercise regimens which are shown to reduce blood pressure include isometric resistance exercise, aerobic exercise, resistance exercise, and device-guided breathing.JOURNAL, Brook RD, Appel LJ, Rubenfire M, Ogedegbe G, Bisognano JD, Elliott WJ, Fuchs FD, Hughes JW, Lackland DT, Staffileno BA, Townsend RR, Rajagopalan S, Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the american heart association, Hypertension, 61, 6, 1360–1383, June 2013, 23608661, 10.1161/HYP.0b013e318293645f, free, Stress reduction techniques such as biofeedback or transcendental meditation may be considered as an add-on to other treatments to reduce hypertension, but do not have evidence for preventing cardiovascular disease on their own.JOURNAL, Nagele E, Jeitler K, Horvath K, Semlitsch T, Posch N, Herrmann KH, Grouven U, Hermanns T, Hemkens LG, Siebenhofer A, Clinical effectiveness of stress-reduction techniques in patients with hypertension: systematic review and meta-analysis, Journal of Hypertension, 32, 10, 1936–1944; discussion 1944, October 2014, 25084308, 10.1097/HJH.0000000000000298, 20098894, JOURNAL, Dickinson HO, Campbell F, Beyer FR, Nicolson DJ, Cook JV, Ford GA, Mason JM, Relaxation therapies for the management of primary hypertension in adults, The Cochrane Database of Systematic Reviews, 1, CD004935, January 2008, 18254065, 10.1002/14651858.CD004935.pub2, Self-monitoring and appointment reminders might support the use of other strategies to improve blood pressure control, but need further evaluation.JOURNAL, Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T, Interventions used to improve control of blood pressure in patients with hypertension, The Cochrane Database of Systematic Reviews, 3, CD005182, March 2010, 20238338, 10.1002/14651858.cd005182.pub4,researchonline.lshtm.ac.uk/10814/1/Fahey_et_al-2006-The_Cochrane_library.pdf, 11 February 2019,researchonline.lshtm.ac.uk/10814/1/Fahey_et_al-2006-The_Cochrane_library.pdf," title="web.archive.org/web/20190412075644researchonline.lshtm.ac.uk/10814/1/Fahey_et_al-2006-The_Cochrane_library.pdf,">web.archive.org/web/20190412075644researchonline.lshtm.ac.uk/10814/1/Fahey_et_al-2006-The_Cochrane_library.pdf, 12 April 2019, live, 10344/9179, free,Medications
Several classes of medications, collectively referred to as antihypertensive medications, are available for treating hypertension.First-line medications for hypertension include thiazide-diuretics, calcium channel blockers, angiotensin converting enzyme inhibitors (ACE inhibitors), and angiotensin receptor blockers (ARBs).JOURNAL, Wright JM, Musini VM, Gill R, First-line drugs for hypertension, The Cochrane Database of Systematic Reviews, 2018, 4, CD001841, April 2018, 29667175, 6513559, 10.1002/14651858.CD001841.pub3, These medications may be used alone or in combination (ACE inhibitors and ARBs are not recommended for use together); the latter option may serve to minimize counter-regulatory mechanisms that act to restore blood pressure values to pre-treatment levels,JOURNAL, Chen JM, Heran BS, Wright JM, Blood pressure lowering efficacy of diuretics as second-line therapy for primary hypertension, The Cochrane Database of Systematic Reviews, 4, CD007187, October 2009, 19821398, 10.1002/14651858.CD007187.pub2, 73993182, although the evidence for first-line combination therapy is not strong enough.JOURNAL, Garjón J, Saiz LC, Azparren A, Gaminde I, Ariz MJ, Erviti J, First-line combination therapy versus first-line monotherapy for primary hypertension, The Cochrane Database of Systematic Reviews, 2, 2, CD010316, February 2020, 32026465, 7002970, 10.1002/14651858.CD010316.pub3, Cochrane Hypertension Group, Most people require more than one medication to control their hypertension. Medications for blood pressure control should be implemented by a stepped care approach when target levels are not reached. Withdrawal of such medications in the elderly can be considered by healthcare professionals, because there is no strong evidence of an effect on mortality, myocardial infarction, or stroke.JOURNAL, Reeve E, Jordan V, Thompson W, Sawan M, Todd A, Gammie TM, Hopper I, Hilmer SN, Gnjidic D, 6, Withdrawal of antihypertensive drugs in older people, The Cochrane Database of Systematic Reviews, 2020, 6, CD012572, June 2020, 32519776, 7387859, 10.1002/14651858.CD012572.pub2, Cochrane Hypertension Group, Previously, beta-blockers such as atenolol were thought to have similar beneficial effects when used as first-line therapy for hypertension. However, a Cochrane review that included 13 trials found that the effects of beta-blockers are inferior to that of other antihypertensive medications in preventing cardiovascular disease.JOURNAL, Wiysonge CS, Bradley HA, Volmink J, Mayosi BM, Opie LH, Beta-blockers for hypertension, The Cochrane Database of Systematic Reviews, 1, CD002003, January 2017, 1, 28107561, 5369873, 10.1002/14651858.CD002003.pub5, The prescription of antihypertensive medication for children with hypertension has limited evidence. There is limited evidence which compare it with placebo and shows modest effect to blood pressure in short term. Administration of higher dose did not make the reduction of blood pressure greater.JOURNAL, Chaturvedi S, Lipszyc DH, Licht C, Craig JC, Parekh R, Pharmacological interventions for hypertension in children, The Cochrane Database of Systematic Reviews, 2, CD008117, February 2014, 24488616, 10.1002/14651858.CD008117.pub2, Cochrane Hypertension Group, 11056235,Resistant hypertension
Resistant hypertension is defined as high blood pressure that remains above a target level, in spite of being prescribed three or more antihypertensive drugs simultaneously with different mechanisms of action.JOURNAL, Giacona JM, Kositanurit W, Vongpatanasin W, Management of Resistant Hypertension-An Update, JAMA Intern Med, 184, 4, 433–434, April 2024, 38372970, 10.1001/jamainternmed.2023.8555, Failing to take prescribed medications as directed is an important cause of resistant hypertension.JOURNAL, Santschi V, Chiolero A, Burnier M, Electronic monitors of drug adherence: tools to make rational therapeutic decisions, Journal of Hypertension, 27, 11, 2294–2295; author reply 2295, November 2009, 20724871, 10.1097/hjh.0b013e328332a501, Resistant hypertension may also result from chronically high activity of the autonomic nervous system, an effect known as neurogenic hypertension.JOURNAL, Zubcevic J, Waki H, Raizada MK, Paton JF, Autonomic-immune-vascular interaction: an emerging concept for neurogenic hypertension, Hypertension, 57, 6, 1026–1033, June 2011, 21536990, 3105900, 10.1161/HYPERTENSIONAHA.111.169748, Electrical therapies that stimulate the baroreflex are being studied as an option for lowering blood pressure in people in this situation.JOURNAL, Wallbach M, Koziolek MJ, Baroreceptors in the carotid and hypertension-systematic review and meta-analysis of the effects of baroreflex activation therapy on blood pressure, Nephrology, Dialysis, Transplantation, 33, 9, 1485–1493, September 2018, 29136223, 10.1093/ndt/gfx279, free, Some common secondary causes of resistant hypertension include obstructive sleep apnea, pheochromocytoma, renal artery stenosis, coarctation of the aorta, and primary aldosteronism.JOURNAL, Sarwar MS, Islam MS, Al Baker SM, Hasnat A, Resistant hypertension: underlying causes and treatment, Drug Research, 63, 5, 217–223, May 2013, 23526242, 10.1055/s-0033-1337930, 8247941, As many as one in five people with resistant hypertension have primary aldosteronism, which is a treatable and sometimes curable condition.JOURNAL, Young WF, Diagnosis and treatment of primary aldosteronism: practical clinical perspectives, Journal of Internal Medicine, 285, 2, 126–148, February 2019, 30255616, 10.1111/joim.12831, 52824356, free,Refractory hypertension
Refractory hypertension is characterized by uncontrolled elevated blood pressure unmitigated by five or more antihypertensive agents of different classes, including a long-acting thiazide-like diuretic, a calcium channel blocker, and a blocker of the renin-angiotensin system.JOURNAL, Acelajado MC, Hughes ZH, Oparil S, Calhoun DA, Treatment of resistant and refractory hypertension, Circulation Research, 124, 7, 1061–1070, March 2019, 30920924, 6469348, 10.1161/CIRCRESAHA.118.312156, People with refractory hypertension typically have increased sympathetic nervous system activity, and are at high risk for more severe cardiovascular diseases and all-cause mortality.JOURNAL, Dudenbostel T, Siddiqui M, Oparil S, Calhoun DA, Refractory hypertension: A novel phenotype of antihypertensive treatment failure, Hypertension, 67, 6, 1085–1092, June 2016, 27091893, 5425297, 10.1161/HYPERTENSIONAHA.116.06587,Non-modulating
Non-modulating essential hypertension is a form of salt-sensitive hypertension, where sodium intake does not modulate either adrenal or renal vascular responses to angiotensin II. Individuals with this subset have been termed non-modulators.JOURNAL, Williams GH, Hollenberg NK, Non-modulating essential hypertension: a subset particularly responsive to converting enzyme inhibitors, Journal of Hypertension Supplement, 3, 2, S81–S87, November 1985, 3003304, They make up 25–30% of the hypertensive population.BOOK, Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, Harrison’s Principles of Internal Medicine, 16th, 2005, McGraw-Hill, New York, {{Page needed|date=June 2011}}Epidemiology
(File:Hypertension World Map Men 2014.png|thumb|upright=1.5|Rates of hypertension in adult men in 2014WEB, Blood Pressure,www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence/en/, World Health Organization, 22 April 2017, live,www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence/en/," title="web.archive.org/web/20170418053459www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence/en/,">web.archive.org/web/20170418053459www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence/en/, 18 April 2017, )File:Hypertensive heart disease world map - DALY - WHO2004.svg|thumb|upright=1.5|Disability-adjusted life year for (hypertensive heart disease]] per 100,000 inhabitants in 2004:WEB,www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html, WHO Disease and injury country estimates, 2009, World Health Organization, 11 November 2009, live,www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html," title="web.archive.org/web/20091111101009www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html,">web.archive.org/web/20091111101009www.who.int/healthinfo/global_burden_disease/estimates_country/en/index.html, 11 November 2009, {{Col-begin}}{{Col-break}}{{legend|#b3b3b3|no data}}{{legend|#ffff65|1600}}{{col-end}})Adults
{{As of|2019}}, at least 1 billion 278 million adults aged 30–79 worldwide (over 16% of world population), including 626 million women and 652 million men, were estimated to have hypertension.JOURNAL, Zhou, Bin, Carrillo-Larco, Rodrigo M, Danaei, Goodarz, Riley, Leanne M, Paciorek, Christopher J, Stevens, Gretchen A, Gregg, Edward W, Bennett, James E, Solomon, Bethlehem, Singleton, Rosie K, Sophiea, Marisa K, Iurilli, Maria LC, Lhoste, Victor PF, Cowan, Melanie J, Savin, Stefan, 2021-09-11, Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants, The Lancet, en, 398, 10304, 957–980, 10.1016/S0140-6736(21)01330-1, 0140-6736, 8446938, 34450083, 237286310, free, This is approximately 278 million up from 2014WEB,www.who.int/gho/ncd/risk_factors/blood_pressure_text/en/, Raised blood pressure, World Health Organization. Global Health Observatory (GHO) data, live,www.who.int/gho/ncd/risk_factors/blood_pressure_text/en/," title="web.archive.org/web/20160808122609www.who.int/gho/ncd/risk_factors/blood_pressure_text/en/,">web.archive.org/web/20160808122609www.who.int/gho/ncd/risk_factors/blood_pressure_text/en/, 8 August 2016, and almost double compared to year 1990, when there were estimated 648 million adults in the same age group living with the condition worldwide.Hypertension is slightly more frequent in men, in those of low socioeconomic status, and it becomes more common with age. It is common in high, medium, and low-income countries.JOURNAL, Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J, Global burden of hypertension: analysis of worldwide data, Lancet, 365, 9455, 217–223, 2005, 15652604, 10.1016/S0140-6736(05)17741-1, 7244386,www.med-sovet.pro/jour/article/view/2588, Submitted manuscript, 3 November 2018,web.archive.org/web/20181103213519/https://www.med-sovet.pro/jour/article/view/2588, 3 November 2018, live, In 2004, rates of high blood pressure were highest in Africa (30% for both sexes), and lowest in the Americas (18% for both sexes). Rates also vary markedly within regions with country-level rates as low as 22.8% (men) and 18.4% (women) in Peru and as high as 61.6% (men) and 50.9% (women) in Paraguay. Rates in Africa were about 45% in 2016.NEWS, Social divide,www.dandc.eu/en/article/nigeria-poor-tend-ignore-early-symptoms-hypertension-must-be-taken-seriously, Oyedele D, D+C, development and cooperation, 20 February 2018, 5 March 2018,web.archive.org/web/20180517230312/https://www.dandc.eu/en/article/nigeria-poor-tend-ignore-early-symptoms-hypertension-must-be-taken-seriously, 17 May 2018, live, In Europe, hypertension occurs in about 30–45% of people {{as of|2013|lc=y}}. In 1995 it was estimated that 43 million people (24% of the population) in the United States had hypertension or were taking antihypertensive medication.JOURNAL, Burt VL, Whelton P, Roccella EJ, Brown C, Cutler JA, Higgins M, Horan MJ, Labarthe D, Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988–1991, Hypertension, 25, 3, 305–313, March 1995, 7875754, 10.1161/01.HYP.25.3.305, 23660820, By 2004 this had increased to 29%JOURNAL, Ostchega Y, Dillon CF, Hughes JP, Carroll M, Yoon S, Trends in hypertension prevalence, awareness, treatment, and control in older U.S. adults: data from the National Health and Nutrition Examination Survey 1988 to 2004, Journal of the American Geriatrics Society, 55, 7, 1056–1065, July 2007, 17608879, 10.1111/j.1532-5415.2007.01215.x, 27522876,zenodo.org/record/1230667, and further to 32% (76 million US adults) by 2017. In 2017, with the change in definitions for hypertension, 46% of people in the United States are affected. African-American adults in the United States have among the highest rates of hypertension in the world at 44%. It is also more common in Filipino Americans and less common in US whites and Mexican Americans.WEB, Culture-Specific of Health Risk Health Status: Morbidity and Mortality,geriatrics.stanford.edu/ethnomed/filipino/health_risk_patterns.html, Stanford, 12 April 2016, live,web.archive.org/web/20160215101224/https://geriatrics.stanford.edu/ethnomed/filipino/health_risk_patterns.html, 15 February 2016, 2014-03-16, Differences in hypertension rates are multifactorial and under study.JOURNAL, Frohlich ED, Epidemiological issues are not simply black and white, Hypertension, 58, 4, 546–547, October 2011, 21911712, 10.1161/HYPERTENSIONAHA.111.178541, free,Children
Rates of high blood pressure in children and adolescents have increased in the last 20 years in the United States.JOURNAL, Falkner B, Hypertension in children and adolescents: epidemiology and natural history, Pediatric Nephrology, 25, 7, 1219–1224, July 2010, 19421783, 2874036, 10.1007/s00467-009-1200-3, Childhood hypertension, particularly in pre-adolescents, is more often secondary to an underlying disorder than in adults. Kidney disease is the most common secondary cause of hypertension in children and adolescents. Nevertheless, primary or essential hypertension accounts for most cases.JOURNAL, Luma GB, Spiotta RT, Hypertension in children and adolescents, American Family Physician, 73, 9, 1558–1568, May 2006, 16719248,www.aafp.org/afp/20060501/1558.html,www.aafp.org/afp/20060501/1558.html," title="web.archive.org/web/20070926230038www.aafp.org/afp/20060501/1558.html,">web.archive.org/web/20070926230038www.aafp.org/afp/20060501/1558.html, live, 26 September 2007,Prognosis
(File:Main complications of persistent high blood pressure.svg|thumb|upright=1.4|Diagram illustrating the main complications of persistent high blood pressure)Hypertension is the most important preventable risk factor for premature death worldwide.WEB, Global health risks: mortality and burden of disease attributable to selected major risks,www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf, World Health Organization, 2009, 10 February 2012, live,www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf," title="web.archive.org/web/20120214111235www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf,">web.archive.org/web/20120214111235www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf, 14 February 2012, It increases the risk of ischemic heart disease,JOURNAL, Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies, Lancet, 360, 9349, 1903–1913, December 2002, 12493255, 10.1016/S0140-6736(02)11911-8, 54363452, strokes, peripheral vascular disease,JOURNAL, Singer DR, Kite A, Management of hypertension in peripheral arterial disease: does the choice of drugs matter?, European Journal of Vascular and Endovascular Surgery, 35, 6, 701–708, June 2008, 18375152, 10.1016/j.ejvs.2008.01.007, free, and other cardiovascular diseases, including heart failure, aortic aneurysms, diffuse atherosclerosis, chronic kidney disease, atrial fibrillation, cancers, leukemia and pulmonary embolism. Hypertension is also a risk factor for cognitive impairment and dementia. Other complications include hypertensive retinopathy and hypertensive nephropathy.History
(File:William Harvey ( 1578-1657) Venenbild.jpg|Image of veins from Harvey’s Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus|left|thumb)Measurement
Modern understanding of the cardiovascular system began with the work of physician William Harvey (1578–1657), who described the circulation of blood in his book ”De motu cordis”. The English clergyman Stephen Hales made the first published measurement of blood pressure in 1733.JOURNAL, Kotchen TA, Historical trends and milestones in hypertension research: a model of the process of translational research, Hypertension, 58, 4, 522–38, October 2011, 21859967, 10.1161/HYPERTENSIONAHA.111.177766, free, However, hypertension as a clinical entity came into its own with the invention of the cuff-based sphygmomanometer by Scipione Riva-Rocci in 1896.BOOK, A century of arterial hypertension 1896–1996, Postel-Vinay N, 213, Chichester, Wiley, 1996, 978-0-471-96788-0, This allowed easy measurement of systolic pressure in the clinic. In 1905, Nikolai Korotkoff improved the technique by describing the Korotkoff sounds that are heard when the artery is ausculted with a stethoscope while the sphygmomanometer cuff is deflated. This permitted systolic and diastolic pressure to be measured.Identification
The symptoms similar to symptoms of patients with hypertensive crisis are discussed in medieval Persian medical texts in the chapter of “fullness disease”.JOURNAL, Heydari M, Dalfardi B, Golzari SE, Habibi H, Zarshenas MM, The medieval origins of the concept of hypertension, Heart Views, 15, 3, 96–98, July 2014, 25538828, 4268622, 10.4103/1995-705X.144807, free, The symptoms include headache, heaviness in the head, sluggish movements, general redness and warm to touch feel of the body, prominent, distended and tense vessels, fullness of the pulse, distension of the skin, coloured and dense urine, loss of appetite, weak eyesight, impairment of thinking, yawning, drowsiness, vascular rupture, and hemorrhagic stroke.JOURNAL, Emtiazy M, Choopani R, Khodadoost M, Tansaz M, Dehghan S, Ghahremani Z, Avicenna’s doctrine about arterial hypertension, Acta medico-historica Adriatica, 12, 1, 157–162, 2014, 25310615, Fullness disease was presumed to be due to an excessive amount of blood within the blood vessels.Descriptions of hypertension as a disease came among others from Thomas Young in 1808 and especially Richard Bright in 1836. The first report of elevated blood pressure in a person without evidence of kidney disease was made by Frederick Akbar Mahomed (1849–1884).BOOK, Swales JD, Manual of hypertension, Blackwell Science, Oxford, 1995, xiii, 978-0-86542-861-4, Until the 1990s, systolic hypertension was defined as systolic blood pressure of 160 mm Hg or greater.JOURNAL, Wilking, Spencer Van B., 1988-12-16, Determinants of Isolated Systolic Hypertension,jama.jamanetwork.com/article.aspx?doi=10.1001/jama.1988.03410230069030, JAMA: The Journal of the American Medical Association, en, 260, 23, 3451–3455, 10.1001/jama.1988.03410230069030, 3210285, 0098-7484, In 1993, the WHO/ISH guidelines defined 140 mmHg as the threshold for hypertension.JOURNAL, 1993, 1993 guidelines for the management of mild hypertension: memorandum from a WHO/ISH meeting., Bulletin of the World Health Organization, 71, 5, 503–517, 0042-9686, 2393474, 8261554,Treatment
Historically the treatment for what was called the “hard pulse disease” consisted in reducing the quantity of blood by bloodletting or the application of leeches.JOURNAL, Esunge PM, From blood pressure to hypertension: the history of research, Journal of the Royal Society of Medicine, 84, 10, 621, October 1991, 10.1177/014107689108401019, 1744849, 1295564,
This was advocated by The Yellow Emperor of China, Cornelius Celsus, Galen, and Hippocrates. The therapeutic approach for the treatment of hard pulse disease included changes in lifestyle (staying away from anger and sexual intercourse) and dietary program for patients (avoiding the consumption of wine, meat, and pastries, reducing the volume of food in a meal, maintaining a low-energy diet and the dietary usage of spinach and vinegar).
In the 19th and 20th centuries, before effective pharmacological treatment for hypertension became possible, three treatment modalities were used, all with numerous side-effects: strict sodium restriction (for example the rice diet), sympathectomy (surgical ablation of parts of the sympathetic nervous system), and pyrogen therapy (injection of substances that caused a fever, indirectly reducing blood pressure).JOURNAL, Dustan HP, Roccella EJ, Garrison HH, Controlling hypertension. A research success story, Archives of Internal Medicine, 156, 17, 1926–1935, September 1996, 8823146, 10.1001/archinte.156.17.1926, The first chemical for hypertension, sodium thiocyanate, was used in 1900 but had many side effects and was unpopular. Several other agents were developed after the Second World War, the most popular and reasonably effective of which were tetramethylammonium chloride, hexamethonium, hydralazine, and reserpine (derived from the medicinal plant Rauvolfia serpentina). None of these were well tolerated.JOURNAL, Lyons HH, Hoobler SW, Experiences with tetraethylammonium chloride in hypertension, Journal of the American Medical Association, 136, 9, 608–613, February 1948, 18899127, 10.1001/jama.1948.02890260016005, JOURNAL, Bakris GL, Frohlich ED, The evolution of antihypertensive therapy: an overview of four decades of experience, Journal of the American College of Cardiology, 14, 7, 1595–1608, December 1989, 2685075, 10.1016/0735-1097(89)90002-8, free, A major breakthrough was achieved with the discovery of the first well-tolerated orally available agents. The first was chlorothiazide, the first thiazide diuretic and developed from the antibiotic sulfanilamide, which became available in 1958.JOURNAL, Novello FC, Sprague JM, Benzothiadiazine dioxides as novel diuretics, J. Am. Chem. Soc., 1957, 79, 2028–2029, 10.1021/ja01565a079, 8, Subsequently, beta blockers, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers, and renin inhibitors were developed as antihypertensive agents.Society and culture
Awareness
File:HTNstudyupd.png|thumb|upright=1.4|Graph showing prevalence of awareness, treatment and control of hypertension compared between the four studies of NHANESJOURNAL, Burt VL, Cutler JA, Higgins M, Horan MJ, Labarthe D, Whelton P, Brown C, Roccella EJ, Trends in the prevalence, awareness, treatment, and control of hypertension in the adult US population. Data from the health examination surveys, 1960 to 1991, Hypertension, 26, 1, 60–69, July 1995, 7607734, 10.1161/01.HYP.26.1.60,hyper.ahajournals.org/cgi/pmidlookup?view=long&pmid=7607734, dead,hyper.ahajournals.org/cgi/pmidlookup?view=long&pmid=7607734," title="archive.today/20121220113643hyper.ahajournals.org/cgi/pmidlookup?view=long&pmid=7607734,">archive.today/20121220113643hyper.ahajournals.org/cgi/pmidlookup?view=long&pmid=7607734, 2012-12-20, ]]The World Health Organization has identified hypertension, or high blood pressure, as the leading cause of cardiovascular mortality. The World Hypertension League (WHL), an umbrella organization of 85 national hypertension societies and leagues, recognized that more than 50% of the hypertensive population worldwide are unaware of their condition.JOURNAL, Chockalingam A, Impact of World Hypertension Day, The Canadian Journal of Cardiology, 23, 7, 517–519, May 2007, 17534457, 2650754, 10.1016/S0828-282X(07)70795-X, To address this problem, the WHL initiated a global awareness campaign on hypertension in 2005 and dedicated 17 May of each year as World Hypertension Day (WHD). Over the past three years, more national societies have been engaging in WHD and have been innovative in their activities to get the message to the public. In 2007, there was record participation from 47 member countries of the WHL. During the week of WHD, all these countries – in partnership with their local governments, professional societies, nongovernmental organizations and private industries – promoted hypertension awareness among the public through several media and public rallies. Using mass media such as Internet and television, the message reached more than 250 million people. As the momentum picks up year after year, the WHL is confident that almost all the estimated 1.5 billion people affected by elevated blood pressure can be reached.JOURNAL, Chockalingam A, World Hypertension Day and global awareness, The Canadian Journal of Cardiology, 24, 6, 441–444, June 2008, 18548140, 2643187, 10.1016/S0828-282X(08)70617-2,Economics
High blood pressure is the most common chronic medical problem prompting visits to primary health care providers in US. The American Heart Association estimated the direct and indirect costs of high blood pressure in 2010 as $76.6 billion.JOURNAL, Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, etal, Heart disease and stroke statistics – 2010 update: a report from the American Heart Association, Circulation, 121, 7, e46–e215, February 2010, 20019324, 10.1161/CIRCULATIONAHA.109.192667, free, In the US 80% of people with hypertension are aware of their condition, 71% take some antihypertensive medication, but only 48% of people aware that they have hypertension adequately control it. Adequate management of hypertension can be hampered by inadequacies in the diagnosis, treatment, or control of high blood pressure.JOURNAL, Alcocer L, Cueto L, Hypertension, a health economics perspective, Therapeutic Advances in Cardiovascular Disease, 2, 3, 147–155, June 2008, 19124418, 10.1177/1753944708090572, 31053059, Health care providers face many obstacles to achieving blood pressure control, including resistance to taking multiple medications to reach blood pressure goals. People also face the challenges of adhering to medicine schedules and making lifestyle changes. Nonetheless, the achievement of blood pressure goals is possible, and most importantly, lowering blood pressure significantly reduces the risk of death due to heart disease and stroke, the development of other debilitating conditions, and the cost associated with advanced medical care.JOURNAL, Elliott WJ, The economic impact of hypertension, Journal of Clinical Hypertension, 5, 3 Suppl 2, 3–13, October 2003, 12826765, 10.1111/j.1524-6175.2003.02463.x, 8099256, 26799038, free, JOURNAL, Coca A, Economic benefits of treating high-risk hypertension with angiotensin II receptor antagonists (blockers), Clinical Drug Investigation, 28, 4, 211–220, 2008, 18345711, 10.2165/00044011-200828040-00002, 8294060,Other animals
Hypertension in cats is indicated with a systolic blood pressure greater than 150 mmHg, with amlodipine the usual first-line treatment. A cat with a systolic blood pressure above 170 mmHg is considered hypertensive. If a cat has other problems such as any kidney disease or retina detachment then a blood pressure below 160 mmHg may also need to be monitored.JOURNAL, Taylor SS, Sparkes AH, Briscoe K, Carter J, Sala SC, Jepson RE, Reynolds BS, Scansen BA, ISFM Consensus Guidelines on the Diagnosis and Management of Hypertension in Cats, Journal of Feline Medicine and Surgery, 19, 3, 288–303, March 2017, 28245741, 10.1177/1098612X17693500, free, Normal blood pressure in dogs can differ substantially between breeds but hypertension is often diagnosed if systolic blood pressure is above 160 mmHg particularly if this is associated with target organ damage.JOURNAL, Acierno MJ, Brown S, Coleman AE, Jepson RE, Papich M, Stepien RL, Syme HM, ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats, Journal of Veterinary Internal Medicine, 32, 6, 1803–1822, November 2018, 30353952, 6271319, 10.1111/jvim.15331, Inhibitors of the renin-angiotensin system and calcium channel blockers are often used to treat hypertension in dogs, although other drugs may be indicated for specific conditions causing high blood pressure.See also
References
{{Reflist}}Further reading
- JOURNAL, James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, etal, 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8), JAMA, 311, 5, 507–20, February 2014, 24352797, 10.1001/jama.2013.284427, free,
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