Hypertension

Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated. This requires the heart to work harder than normal to circulate blood through the blood vessels. Blood pressure involves two measurements, systolic and diastolic, which depend on whether the heart muscle is contracting (systole) or relaxed between beats (diastole). Normal blood pressure at rest is within the range of 100-140mmHg systolic and 60-90mmHg diastolic. High blood pressure is said to be present if it is persistently at or above 140/90 mmHg.

Hypertension is classified as either primary (essential) hypertension or secondary hypertension; about 90–95% of cases are categorized as "primary hypertension" which means high blood pressure with no obvious underlying medical cause. The remaining 5–10% of cases (secondary hypertension) are caused by other conditions that affect the kidneys, arteries, heart or endocrine system.

Signs and Symptoms:

Hypertension is rarely accompanied by any symptoms, and its identification is usually through screening, or when seeking healthcare for an unrelated problem. A proportion of people with high blood pressure reports 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.

On physical examination, hypertension may be suspected on the basis of the presence of hypertensive retinopathy detected by examination of the optic fundus found in the back of the eye using ophthalmoscopy. Classically, the severity of the hypertensive retinopathy changes is graded from grade I–IV, although the milder types may be difficult to distinguish from each other. Ophthalmoscopy findings may also indicate how long a person has been hypertensive.

Causes:

Primary (essential) hypertension is the most common form of hypertension, accounting for 90–95% of all cases of hypertension. In almost all contemporary societies, blood pressure rises with aging and the risk of becoming hypertensive in later life is considerable. Hypertension results from a complex interaction of genes and environmental factors. Numerous common genes with small effects on blood pressure have been identified as well as some rare genes with large effects on blood pressure but the genetic basis of hypertension is still poorly understood. Several environmental factors influence blood pressure. Lifestyle factors that lower blood pressure, include reduced dietary salt intake, increased consumption of fruits and low fat products (Dietary Approaches to Stop Hypertension (DASH diet), exercise, weight loss and reduced alcohol intake. The possible role of other factors such as stress, caffeine consumption, and vitamin D deficiency are less clear cut. Insulin resistance, which is common in obesity and is a component of syndrome X (or the metabolic syndrome), is also thought to contribute to hypertension. Recent studies have also implicated events in early life (for example low birth weight, maternal smoking and lack of breast feeding) as risk factors for adult essential hypertension, although the mechanisms linking these exposures to adult hypertension remain obscure.

Diagnosis:

Hypertension is diagnosed on the basis of a persistently high blood pressure. Traditionally, this requires three separate sphygmomanometer measurements at one monthly intervals. Initial assessment of the hypertensive people should include a complete history and physical examination. 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.

Treatment:

• Losing weight if you are overweight or obese.
• Quitting smoking.
• Eating a healthy diet, including the DASH diet (eating more fruits, vegetables, and low fat dairy products, less saturated and total fat).
• Reducing the amount of sodium in your diet to less than 1,500 milligrams a day if you have high blood pressure. Healthy adults need to limit their sodium intake to no more 2,300 milligrams a day (about 1 teaspoon of salt).
• Getting regular aerobic exercise (such as brisk walking at least 30 minutes a day, several days a week).
• Limiting alcohol to two drinks a day for men, one drink a day for women.

There are several types of drugs used to treat high blood pressure, including:

• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin II receptor blockers (ARBs)
• Diuretics
• Beta-blockers
• Calcium channel blockers
• Alpha-blockers
• Alpha-agonists
• Renin inhibitors
• Combination medications

Mortality Rate:

The relationship between blood pressure and risk of cardiovascular disease (CVD) is continuous, consistent and independent of other risk factors. For persons normotensive at 55 years of age have a 90% lifetime risk of developing hypertension. A70 After 40 years of age, each increment of 20 mmHg in systolic or 10 mm / Hg diastolic pressure doubles the risk of CVD in the entire range of 115/75 185/115 mmHg.1

In Mexico, the HAS for 2002 ranked the 9 th leading cause of death in the general population, with a total of 10, 696 deaths, with a rate of 10.38 deaths per 100, 000 habitantes.3 According to the Census of Population and Housing 2000, Mexico had 49.7 million between 20 and 69 years, of which 15.16 million (30.05%) were hypertensive. Taking the lowest rate of mortality from SAH (1.5%), meant that in 2000 there were 227.400 deaths attributable to hypertension and therefore potentially preventable. In other words, a death every 2 minutes. While this number of potential deaths subtract 14.6% of hypertensive patients, the figure would be reduced to 194.199, that is one death every 3 minutes.

More Information about Hypertension:

http://www.nlm.nih.gov/medlineplus/ency/article/000468.htm

http://www.medicinenet.com/high_blood_pressure/article.htm

http://www.medicalnewstoday.com/articles/150109.php

http://www.nhs.uk/Conditions/Blood-pressure-(high)/Pages/Introduction.aspx