Hypertension ( HTN or HT ), also known as high blood pressure ( HBP ), is a long-term medical condition in which blood pressure in the arteries continues to increase. High blood pressure usually does not cause symptoms. Long-term high blood pressure, however, is a major risk factor for coronary artery disease, stroke, heart failure, atrial fibrillation, peripheral vascular disease, vision loss, chronic kidney disease, and dementia.
High blood pressure is classified as either primary high blood pressure (high blood pressure) or secondary high blood pressure. Approximately 90-95% of cases are primary, defined as high blood pressure due to non-specific lifestyle and genetic factors. Lifestyle factors that increase risk include excess salt in diet, overweight, smoking, and alcohol use. The remaining 5-10% of cases are categorized as secondary high blood pressure, defined as high blood pressure due to identifiable causes, such as chronic kidney disease, renal artery narrowing, endocrine disorders, or use of birth control pills..
Blood pressure is expressed by two measurements, systolic and diastolic pressure, which is the maximum and minimum pressure, respectively. For most adults, normal blood pressure at rest is in the 100-130 millimeter mercury (mmHg) systolic and 60-80 mmHg diastolic range. For most adults, high blood pressure is present if the blood pressure breaks continuously at or above 130/90 or 140/90 mmHg. Different numbers apply to children. Monitoring of ambulatory blood pressure for 24 hours is more accurate than the measurement of blood pressure in the office.
Lifestyle changes and medications can lower blood pressure and reduce the risk of health complications. Lifestyle changes include weight loss, decreased salt intake, physical exercise, and a healthy diet. If lifestyle changes are insufficient then blood pressure medication is used. Up to three drugs can control blood pressure in 90% of people. The treatment of arterial high blood pressure (defined as <160/100 mmHg) with drugs is associated with an increased life expectancy. The effects of blood pressure treatment between 130/80 mmHg and 160/100 mmHg are less clear, with some reviews finding benefits and others finding unclear benefits. High blood pressure affects between 16 and 37% of the population globally. In 2010, hypertension is believed to be a factor in 18% of all deaths (9.4 million globally).
Video Hypertension
Signs and symptoms
Hypertension is rarely accompanied by symptoms, and identification is usually through screening, or when seeking health care for unrelated problems. Some with reports of high blood pressure have headaches (especially in the back of the head and in the morning), and the head feels light, vertigo, tinnitus (buzzing or hissing in the ear), visual impairment or fainting. These symptoms, however, may be associated with an associated anxiety rather than high blood pressure itself.
On physical examination, hypertension may be associated with changes in the optic fundus seen by ophthalmoscopy. The severity of changes typical of hypertensive retinopathy is assessed from I-IV; values ​​of I and II may be difficult to distinguish. The severity of retinopathy correlates roughly with the duration or severity of hypertension.
Secondary hypertension
Hypertension with certain additional signs and symptoms may indicate secondary hypertension, ie, hypertension due to an identifiable cause. For example, Cushing's syndrome often causes trunkal obesity, glucose intolerance, lunar face, fatty stumps behind the neck/shoulder (referred to as buffalo hump), and a purple belly stretch mark. Hyperthyroidism often leads to weight loss with increased appetite, rapid heartbeat, prominent eyes, and tremors. Renal artery stenosis (RAS) may be associated with local abdominal bruits to the left or right of the midline (unilateral RAS), or in both sites (bilateral RAS). Coarctation of the aorta often causes a decrease in blood pressure in the lower limb relative to the arm, or delayed or absent femoral artery pulse. Pheochromocytoma may cause episodes of sudden hypertension ("paroxysmal") accompanied by headache, palpitations, pale appearance, and excessive sweating.
Hypertension crisis
High blood pressure (equal to or greater than systolic 180 or diastolic 110) is called a hypertensive crisis. Hypertension crisis is categorized as hypertensive urgency or hypertensive emergency, in accordance with the absence or presence of end-organ damage.
In the urgency of hypertension, there is no evidence of end-organ damage due to high blood pressure. In this case, oral medication is used to lower blood pressure gradually over 24 to 48 hours.
In an emergency hypertension, there is evidence of direct damage to one or more organs. The most affected organs including the brain, kidneys, heart and lungs, produce symptoms that may include confusion, drowsiness, chest pain and shortness of breath. In hypertensive emergencies, blood pressure should be reduced more quickly to stop ongoing organ damage, however, there is a lack of randomized controlled trial evidence for this approach.
Pregnancy
Hypertension occurs in about 8-10% of pregnancies. Two six-hour blood pressure measurements other than 140/90 mm Hg are diagnostic hypertension in pregnancy. High blood pressure in pregnancy can be classified as pre-existing hypertension, gestational hypertension, or pre-eclampsia.
Pre-eclampsia is a serious condition in the second half of pregnancy and after delivery is characterized by increased blood pressure and presence of protein in the urine. It occurs in about 5% of pregnancies and is responsible for about 16% of all maternal deaths globally. Pre-eclampsia also doubles the risk of infant mortality around the time of birth. There is usually no symptoms of preeclampsia and is detected by routine screening. When the symptoms of pre-eclampsia occur the most common are headache, visual disturbance (often "flashing light"), vomiting, abdominal pain, and swelling. Pre-eclampsia can sometimes develop into a life-threatening condition called eclampsia, which is an emergency hypertension and has several serious complications including vision loss, brain swelling, seizures, renal failure, pulmonary edema, and disseminated intravascular coagulation ).
In contrast, gestational hypertension is defined as new-onset hypertension during pregnancy without protein in the urine.
Children
Failure to develop, seizures, irritability, lack of energy, and difficulty breathing can be linked to hypertension in newborns and young infants. In infants and older children, hypertension can cause headaches, unexplained irritation, fatigue, failure to grow, blurred vision, nosebleeds, and facial paralysis.
Maps Hypertension
Cause
Primary hypertension
Hypertension results from complex interactions of genes and environmental factors. Many common genetic variants with small effects on blood pressure have been identified as well as some rare genetic variants with major effects on blood pressure. Also, genome association studies (GWAS) have identified 35 genetic loci associated with blood pressure; 12 genetic loci that affect new blood pressure is found. The SNP sentinel for each new genetic locus identified has shown association with DNA methylation at some nearby Cpg sites. This sentinel SNP is located within genes associated with vascular smooth muscle and renal function. DNA methylation may affect in some way linking common genetic variations to some phenotype even though the mechanisms underlying this association are not understood. The single variance test carried out in this study for 35 SNP (known and new) sentinels showed that single or aggregate genetic variants contributed to the risk of clinical phenotype associated with high blood pressure.
Blood pressure increases with aging and the risk of becoming hypertensive later in life is considerable. Some environmental factors affect blood pressure. High salt intake increases blood pressure in salt-sensitive individuals; lack of exercise, obesity, and depression can play a role in individual cases. Possible roles of other factors such as caffeine consumption, and vitamin D deficiency are less clear. Insulin resistance, which is common in obesity and is a component of the syndrome X (or metabolic syndrome), is also thought to contribute to hypertension. One review shows that sugar can play an important role in hypertension and salt is just an innocent person.
The incidence in early life, such as low birth weight, maternal smoking, and lack of breastfeeding may be a risk factor for essential mature hypertension, although the mechanisms linking this exposure to adult hypertension remain unclear. High levels of elevated blood urea have been found in people not treated with hypertension compared to people with normal blood pressure, although it is uncertain whether the former played a causal role or a subsidiary with poor kidney function. The average blood pressure may be higher in winter than in summer.
Secondary hypertension
Secondary hypertension results from an identifiable cause. Kidney disease is the second most common cause of hypertension. Hypertension can also be caused by endocrine conditions, such as Cushing's syndrome, hyperthyroidism, hypothyroidism, acromegaly, Conn syndrome or hyperaldosteronism, renal artery stenosis (from atherosclerosis or fibromuscular dysplasia), hyperparathyroidism, and pheochromocytoma. Other causes of secondary hypertension include obesity, sleep apnea, pregnancy, coarctation of the aorta, overeating of the roots, excessive alcohol drinking, and certain prescription medications, herbal remedies, and illegal drugs such as cocaine and methamphetamine. Exposure to arsenic through drinking water has been shown to correlate with an increase in blood pressure.
Pathophysiology
In most people with essential hypertension, increased resistance to blood flow (total peripheral resistance) contributes to high pressure while cardiac output remains normal. There is evidence that some younger people with prehypertension or 'borderline hypertension' have high cardiac output, elevated heart rate and normal peripheral resistance, called hyperkinetic hypertension. These individuals develop a characteristic feature of essential hypertension that has been established at a later date when their heart output decreases and peripheral resistance increases with age. Whether this pattern is typical of all those who ultimately develop debatable hypertension. Increased peripheral resistance in established hypertension is mainly due to structural narrowing of small arteries and arterioles, although a reduction in the amount or density of capillaries may also contribute.
It is not clear whether vasoconstriction of arteriolar blood vessels plays a role in hypertension. Hypertension is also associated with decreased peripheral venous compliance which can increase venous return, increase cardiac preload and, ultimately, cause diastolic dysfunction.
Pulse pressure (the difference between systolic and diastolic blood pressure) is often increased in older people with hypertension. This may mean that abnormally high systolic pressure, but diastolic pressure may be a normal or low condition called isolated systolic hypertension. High pulse pressure in older people with hypertension or isolated systolic hypertension is explained by increased arterial stiffness, which usually accompanies aging and may be aggravated by high blood pressure.
Many mechanisms have been proposed to explain increased peripheral resistance in hypertension. Most evidence implicates both impaired handling of salt and renal water (especially abnormalities in the intrarenal renin-angiotensin system) or sympathetic nervous system abnormalities. This mechanism is 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 to hypertension. Interleukin 17 has garnered interest for its role in increasing the production of several signals of other chemical immune systems suspected of involvement in hypertension such as tumor necrosis factor alpha, interleukin 1, interleukin 6, and interleukin 8.
Excessive consumption of sodium and/or insufficient potassium causes excessive intracellular sodium, which contracts with the vascular smooth muscle, limiting blood flow and thereby increasing blood pressure.
Diagnosis
Hypertension is diagnosed on the basis of persistently high blood pressure. Traditionally, the National Institute of Clinical Excellence recommends three separate sphygmomanometer break measurements at monthly intervals. The American Heart Association recommends at least three rest measures on at least two separate health care visits.
For accurate diagnosis of hypertension, it is important for proper blood pressure measurement techniques to be used. Improper blood pressure measurement is common and can change blood pressure readings by up to 10 mmHg, which can lead to misdiagnosis and misclassification of hypertension. The correct blood pressure measurement technique involves several steps. Appropriate blood pressure measurements require people whose blood pressure is measured to sit quietly for at least five minutes followed by the application of a properly attached blood pressure cuff to the bare upper arm. The man had to sit with his back supported, feet flat on the floor, and with their legs not crossed. People whose blood pressure is measured should avoid talking or moving during this process. The arm being measured should be supported on a flat surface at the heart level. Blood pressure measurements should be performed in a quiet room so that medical professionals who check blood pressure can hear Korotkoff sound while listening to the brachial artery with a stethoscope for accurate blood pressure measurement. Blood pressure cuff should be deflated slowly (2-3 mmHg per second) while listening to Korotkoff's voice. The bladder should be emptied before a person's blood pressure is measured as this can increase blood pressure up to 15/10 mmHg. A double blood pressure reading (at least two) within 1-2 minutes apart should be obtained to ensure accuracy. Monitoring of ambulatory blood pressure for 12 to 24 hours is the most accurate method to confirm the diagnosis.
Exceptions to this are people with very high blood pressure readings especially when there is poor organ function. Initial assessment of hypertensive people should include a complete history and physical examination. With the availability of a 24-hour ambulatory blood pressure monitor and home blood pressure machine, the importance of not misdiagnosing those with white-coat hypertension has led to changes in the protocol. In the UK, today's best practice is to follow up a single clinical reading with ambulatory measurements, or less than ideal with home blood pressure monitoring for 7 days. The United States Preventive Services Task Force also recommends measuring beyond the health care environment. Pseudohypertension in elderly or noncompressible arterial syndrome also requires consideration. This condition is believed to be due to arterial calcification resulting in an abnormally high blood pressure reading with cuff blood pressure while the measurement of intra-arterial blood pressure is normal. Orthostatic hypertension is when blood pressure increases when standing.
Once a diagnosis of hypertension has been established, the healthcare provider should seek to identify underlying causes based on other risk factors and symptoms, if any. Secondary hypertension is more common in preteen children, with most cases caused by kidney disease. Primary or essential hypertension is more common in adolescents and has multiple risk factors, including obesity and family history of hypertension. Laboratory tests can also be performed to identify possible causes of secondary hypertension, and to determine if hypertension has caused damage to the heart, eyes, and kidneys. Additional tests for diabetes and high cholesterol levels are usually done because these conditions are additional risk factors for the development of heart disease and may require treatment.
Serum creatinine is measured to assess the presence of kidney disease, which can be the cause or outcome of hypertension. Serum creatinine alone may overestimate glomerular filtration rates and recent guidelines recommend the use of predictive equations such as the Dietary Modification formula in Kidney Disease (MDRD) to estimate glomerular filtration rate (eGFR). eGFR can also provide a baseline measurement of kidney function that can be used to monitor the side effects of certain anti-hypertensive drugs on kidney function. In addition, testing of urine samples for proteins was used as a secondary indicator of kidney disease. Electrocardiogram (ECG/ECG) tests are performed to check for evidence that the heart is under high blood pressure. It may also indicate whether there is a thickening of the heart muscle (left ventricular hypertrophy) or whether the heart has experienced a previous minor disorder such as a silent heart attack. Chest X-ray or echocardiogram can also be performed to look for signs of heart enlargement or damage to the heart.
Adult
In people 18 years of age or older, hypertension is defined as the measurement of systolic or diastolic blood pressure consistently higher than the normal value received (this is above 129 or 139 mmHg systolic, diastolic 89 mmHg depending on the guidelines). Another threshold is used (135 mmHg systolic or 85 mmHb diastolic) if the measurement comes from 24 hours of ambulatory or home monitoring. Recent international hypertension guidelines have also established categories under the hypertension range to show a higher-risk continuum with blood pressure within the normal range. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7) published in 2003 used the term prehypertension for blood pressure in the 120-139 mmHg systolic or 80 -89 mmHg diastolic, while the European Society of Hypertension Guidelines (2007) and British Hypertension Society (BHS) IV (2004) use normal, normal and high normal categories to divide the pressure below 140 mmHg systolic and 90 mmHg diastolic. Hypertension is also sub-classified: JNC7 differentiates stage I hypertension, second stage hypertension, and isolated systolic hypertension. Systolic isolated hypertension refers to an increase in systolic pressure with normal and common diastolic pressure in the elderly. The ESH-ESC Guidelines (2007) and BHS IV (2004) also determined the third stage (third stage hypertension) for people with systolic blood pressure exceeding 179 mmHg or diastolic pressure greater than 109 mmHg. Hypertension is classified as "resistant" if drugs do not reduce blood pressure to normal levels. In November 2017, the American Heart Association and the American College of Cardiology issued a joint guide that updated the recommendations of the JNC7 report.
Children
Hypertension occurs in about 0.2 to 3% of newborns; However, blood pressure is not measured regularly in healthy newborns. Hypertension is more common in high-risk newborns. Various factors, such as gestational age, postconception age and birth weight need to be considered when deciding whether normal blood pressure is in the newborn.
Hypertension defined as high blood pressure during multiple visits affects 1% to 5% of children and adolescents and is associated with long-term risk of poor health. Blood pressure increases with age in childhood and, in children, hypertension is defined as mean systolic or diastolic blood pressure at three or more times equal to or higher than the 95th percentile corresponding to gender, age and height of child. High blood pressure should be confirmed on repeat visits but before characterizing a child has hypertension. Prehypertension in children has been defined as mean systolic or diastolic blood pressures greater than or equal to the 90th percentile, but less than the 95th percentile. In adolescents, it has been proposed that hypertension and pre-hypertension are diagnosed and classified using the same criteria as in adults.
Routine screening values ​​for hypertension in children over 3 years of age are moot. In 2004 the National Blood Pressure Education Program recommends that children 3 years and older have blood pressure measurements at least once at each health care visit and National Heart, Lung, and Blood Institute and the American Academy of Pediatrics make similar recommendations. However, the American Academy of Family Physicians supports the US Prevention Task Force's view that available evidence is insufficient to determine the balance of benefits and screening hazards for hypertension in untreated children and adolescents.
Prevention
Most of the burden of high blood pressure disease is experienced by people who are not labeled hypertension. As a result, population strategies are needed to reduce the consequences of high blood pressure and reduce the need for antihypertensive drugs. Lifestyle changes are recommended to lower blood pressure, before starting treatment. The 2003 British Hypertension Society guidelines propose lifestyle changes consistent with those outlined by the US National Higher Education Program in 2002 for primary prevention of hypertension:
- keep normal weight for adults (eg body mass index 20-25 kg/m 2 )
- reduce dietary sodium intake to & lt; 100 mmol/day (& lt; 6 g sodium chloride or & lt; 2.4 g sodium per day)
- engage in regular aerobic physical activity such as brisk walking (> = 30 minutes per day, most days of the week)
- limit alcohol consumption to no more than 3 units/day in men and no more than 2 units/day in women
- eat foods rich in fruits and vegetables (eg at least five servings per day);
Effective lifestyle modification can lower blood pressure as much as individual antihypertensive drugs. The combination of two or more lifestyle modifications can achieve better results. There is ample evidence that reducing dietary salt intake lowers blood pressure, but whether this means decreased mortality and cardiovascular disease remains uncertain. Sodium intake is estimated> = 6g/day and & lt; 3g/day are both associated with a high risk of death or major cardiovascular disease, but the relationship between high sodium intake and poor outcomes is only observed in people with hypertension. Consequently, in the absence of results from randomized controlled trials, the wisdom of reducing dietary salt intake levels below 3g/day has been questioned.
Management
According to a review published in 2003, a reduction in blood pressure of 5 mmHg could reduce the risk of stroke by 34%, ischemic heart disease by 21%, and reduce the likelihood of dementia, heart failure, and death from cardiovascular disease.
Target blood pressure
Various expert groups have produced guidelines on how low the target blood pressure should be when a person is treated for hypertension. These groups recommend targets below the range of 140-160/90-100 mmHg for the general population. Cochrane reviews recommend similar targets for subgroups such as people with diabetes and people with previous cardiovascular disease.
Many expert groups recommend targets that are slightly higher than 150/90 mmHg for those aged between 60 and 80 years. JNC-8 and the American College of Physicians recommend target 150/90 mmHg for those over the age of 60, but some experts in this group disagree with this recommendation. Some expert groups have also recommended slightly lower targets in those with diabetes or chronic kidney disease with protein loss in urine, but others recommend the same target as for the general population. The issue of what the best target is and whether the target should be different for high-risk individuals is unsolved, although some experts suggest more intensive blood pressure reduction than is recommended in some guidelines.
Lifestyle modification
First-line treatment for hypertension is lifestyle changes, including dietary changes, physical exercise, and weight loss. Although all of this has been recommended in scientific advisors, Cochrane's systematic review found no evidence for the effects of weight loss diets on mortality, long-term complications or side effects in people with hypertension. The review found a drop in blood pressure. Their potential effectiveness is similar to and sometimes exceeds a single drug. If hypertension is high enough to justify the immediate use of drugs, lifestyle changes are still recommended in relation to drugs.
Dietary changes shown to reduce blood pressure include low-sodium diet, DASH diet, vegetarian diet, and green tea consumption.
Increasing potassium diet has the potential benefit to reduce the risk of hypertension. The 2015 Dietary Guidance Advisory Committee (DGAC) states that potassium is one of the underutilized nutritional deficiencies in the United States.
Physical exercise regimens proven to reduce blood pressure include isometric resistance exercises, aerobic exercise, resistance training, and device-guided breathing.
Stress reduction techniques such as biofeedback or transcendental meditation can be considered as an adjunct to other treatments to reduce hypertension, but have no evidence to prevent cardiovascular disease alone. Self-monitoring and appointment reminders may support the use of other strategies to improve blood pressure control, but need further evaluation.
Drugs
Some classes of drugs, collectively referred to as antihypertensive drugs, are available to treat hypertension.
First-line drugs for hypertension include thiazide-diuretics, calcium channel blockers, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers. These drugs may be used alone or in combination (ACE inhibitors and ARBs are not recommended for use in combination); the latter option may serve to minimize the counter-regulatory mechanisms that act to restore the value of blood pressure to the pre-treatment level. Previous beta-blockers were thought to have the same beneficial effect when used as first-line therapy for hypertension. However, a Cochrane review that included 13 trials found that the beta-blocker effect was lower than other antihypertensive drugs. Most people need more than one drug to control their hypertension. Drugs for blood pressure control should be implemented with a stepwise treatment approach when the target level is not reached.
Resistant hypertension
Resistant hypertension is defined as high blood pressure that remains above the target level, although prescribed three or more antihypertensive drugs simultaneously with different mechanisms of action. Failure to take prescribed medications is an important cause of resistant hypertension. Resistant hypertension can also be caused by the chronic high activity of the autonomic nervous system, an effect known as "neurogenic hypertension". Electrical therapy that stimulates baroreflex is being studied as an option to lower blood pressure in people in this situation.
Epidemiology
Adult
In 2014, about one billion adults or ~ 22% of the world's population have hypertension. It is slightly more frequent in men, in those with low socioeconomic status, and it becomes more common with age. This is common in high, middle, and low income countries. In 2004 high blood pressure was highest in Africa, (30% for both sexes) and lowest in the United States (18% for both sexes). Rates also vary greatly in areas with rates as low as 3.4% (male) and 6.8% (female) in rural India and as high as 68.9% (male) and 72.5% (women) in Poland. Rates at the 2016 level in Africa are around 45%.
In Europe, hypertension occurs in about 30-45% of people by 2013. In 1995 it was estimated that 43 million people (24% of the population) in the United States had hypertension or were taking antihypertensive drugs. In 2004 this has increased to 29% and further to 32% (76 million US adults) by 2017. By 2017, with a change in definition for hypertension, 46% of people in the United States are affected. African-American adults in the United States have the highest rates of hypertension in the world that is 44%. It is also more common in Filipino-Americans and less common in the whites of US and Mexican Americans.
Children
High blood pressure levels in children and adolescents have increased in the last 20 years in the United States. Child hypertension, especially in pre-teens, is more often secondary to underlying disorders than in adults. Kidney disease is the second most common cause of hypertension in children and adolescents. However, primary or essential hypertension accounts for the majority of cases.
Results
Hypertension is the most preventable risk factor for premature death worldwide. It increases the risk of ischemic heart disease, stroke, peripheral vascular disease, and other cardiovascular diseases, including heart failure, aortic aneurysm, diffuse atherosclerosis, chronic kidney disease, atrial fibrillation, and pulmonary embolism. Hypertension is also a risk factor for cognitive and dementia disorders. Other complications include hypertensive retinopathy and hypertension of nephropathy.
History
Measurement
The modern understanding of the cardiovascular system begins with the work of physician William Harvey (1578-1657), which describes the blood circulation in his book " De motu cordis ". The British priest Stephen Hales made the first blood pressure measurements published in 1733. However, hypertension as a clinical entity came on its own with the invention of a cuff-based sphygmomanometer by Scipione Riva-Rocci in 1896. This allowed easy systolic measurement. pressure in the clinic. In 1905, Nikolai Korotkoff refined the technique by describing Korotkoff sounds that were heard when the arteries were counted with a stethoscope while the sphygmomanometer cuff deflated. This allowed systolic and diastolic pressure can be measured.
Identify
Symptoms similar to the symptoms of patients with hypertensive crisis are discussed in medieval Persian medical texts in the chapter "disease of fullness". Symptoms include headache, headache, slow movement, general redness and warmth to feel the touch of the body, prominent, distended and tense veins, fullness of pulse, skin distension, colored and dense urine, loss of appetite, weak vision, thinking, yawning, drowsiness, rupture of the blood vessels, and hemorrhagic stroke. The fullness of the disease is thought to be caused by excessive amounts of blood in the blood vessels.
Description 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).
Treatment
Historically the treatment for so-called "hard pulse" consists in reducing the amount of blood by bloodshed or the application of leeches. This was advocated by the Chinese Yellow Emperor, Cornelius Celsus, Galen, and Hippocrates. Therapeutic approaches to the treatment of pulmonary disease include lifestyle changes (away from anger and intercourse) and diet programs for patients (avoiding the consumption of grapes, meat and pastries, reducing the volume of food in foods, maintaining low-energy diets and using dietary spinach and vinegar ).
In the 19th and 20th centuries, before effective pharmacological treatment for hypertension became possible, three treatment modalities were used, all with many side effects: tight sodium restriction (eg diet of rice), sympathectomy (sympathetic nervous system surgical ablation), and therapy pyrogens (injection of a substance that causes fever, indirectly lowers blood pressure).
The first chemicals for hypertension, sodium thiocyanate, were used in 1900 but have many side effects and are not popular. Several other agents developed after the Second World War, the most popular and quite effective of which are tetramethylammonium chloride, hexamethonium, hydralazine, and reserpine (derived from medicinal plants Rauwolfia serpentina ). None of this is well tolerated. A major breakthrough was achieved with the discovery of the first agent to be orally tolerated. The first was chlorothiazide, the first thiazide diuretic and developed from sulfanilamide antibiotics, which became available in 1958. Furthermore, beta blockers, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers, and renin inhibitors were developed as antihypertensives. agent.
Society and culture
Awareness
The World Health Organization has identified hypertension, or high blood pressure, as the leading cause of cardiovascular death. The World Hypertension League (WHL), an umbrella organization of 85 national hypertension communities and the league, recognizes that over 50% of hypertensive populations worldwide are unaware of their condition. To address this problem, WHL initiated a global awareness campaign on hypertension in 2005 and dedicates May 17 of each year as World Hypertension Day (WHD). Over the past three years, more national societies have been involved in the WHD and have been innovative in their activities to deliver the message to the public. In 2007, there was a record of participation of 47 WHL member states. During the WHD week, all these countries - in partnership with local governments, professional societies, nongovernmental organizations and private industry - raise the awareness of hypertension among communities through several media and rallies. Using mass media such as the Internet and television, the message reaches more than 250 million people. As the momentum increases year by year, the WHL believes that almost all estimates of 1.5 billion people who are exposed to high blood pressure can be achieved.
Economy
High blood pressure is the most common chronic medical problem that drives visits to primary health care providers in the United States. The American Heart Association estimates the direct and indirect costs of high blood pressure in 2010 of $ 76.6 billion. In the US, 80% of people with hypertension are aware of their condition, 71% use antihypertensive drugs, but only 48% of people are aware that they have sufficiently controlled hypertension. Adequate hypertension management may be inhibited by insufficiency in diagnosis, treatment, or control of high blood pressure. Healthcare providers face many obstacles to achieving blood pressure control, including resistance to taking some medication to achieve blood pressure goals. People also face the challenge of following a treatment schedule and changing lifestyles. Nevertheless, achievement of blood pressure goals is possible, and most importantly, lowering blood pressure significantly reduces the risk of death from heart disease and stroke, the development of other debilitating conditions, and the costs associated with advanced medical care.
Research
A 2015 review of some studies found that restoring blood vitamin D levels by supplementation (more than 1,000 IU per day) reduced blood pressure in hypertensive individuals when they were deficient in vitamin D. The results also showed a correlation of low chronic vitamin D levels with the possibility higher to hypertension. Supplementation with vitamin D for 18 months in normotensive individuals with vitamin D deficiency did not significantly affect blood pressure.
There is tentative evidence that increased calcium intake may help prevent hypertension. However, further research is needed to assess the optimal dosage and possible side effects.
References
Further reading
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James, Paul A.; Oparil, Suzanne; Carter, Barry L.; Cushman, William C.; Dennison-Himmelfarb, Cheryl; Handler, Joel; Lackland, Daniel T.; Lefevre, Michael L.; MacKenzie, Thomas D.; Ogedegbe, Olugbenga; Smith, Sidney C.; Svetkey, Laura P.; Taler, Sandra J.; Townsend, Raymond R.; Wright, Jackson T.; Narva, Andrew S.; Ortiz, Eduardo (December 18, 2013). "2014 Evidence-Based Guidelines for High Blood Pressure Management in Adults". JAMA . 311 (5): 507-20. doi: 10.1001/jama.2013.284427. PMID 24352797.
External links
- Hypertension in Curlie (based on DMOZ)
Source of the article : Wikipedia
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