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Hypertension (HTN or HT), also known as high blood pressure (HBP), is a
long-term Long-Term Capital Management L.P. (LTCM) was a hedge fund''A financial History of the United States Volume II: 1970–2001'', Jerry W. Markham, Chapter 5: "Bank Consolidation", M. E. Sharpe, Inc., 2002 based in Greenwich, Connecticut, Greenwich, Co ...
medical condition A disease is a particular abnormal condition that negatively affects the structure A structure is an arrangement and organization of interrelated elements in a material object or system A system is a group of Interaction, interactin ...
in which the
blood pressure Blood pressure (BP) is the pressure Pressure (symbol: ''p'' or ''P'') is the force In physics Physics is the natural science that studies matter, its Elementary particle, fundamental constituents, its Motion (physics), motio ...

blood pressure
in the
arteries An artery (plural arteries) () is a blood vessel that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pulmonary arteries, pulmonary ...

arteries
is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high blood pressure, however, is a major risk factor for
stroke A stroke is a medical condition A disease is a particular abnormal condition that negatively affects the structure or function (biology), function of all or part of an organism, and that is not due to any immediate external injury. Di ...

stroke
,
coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), or simply heart disease, involves the reduction of blood flow to the heart muscle Cardiac muscle (also called heart muscle or myocardium) i ...
,
heart failure Heart failure (HF), also known as congestive heart failure (CHF) and (congestive) cardiac failure (CCF), is a set of manifestations caused by the failure of the heart The heart is a cardiac muscle, muscular Organ (biology), organ in mo ...
,
atrial fibrillation Atrial fibrillation (AF or A-fib) is an abnormal heart rhythm (arrhythmia) characterized by the rapid and irregular beating of the atrial chambers of the heart. It often begins as short periods of abnormal beating, which become longer or cont ...

atrial fibrillation
,
peripheral arterial disease A peripheral or peripheral device is an auxiliary device used to put information into and get information out of a computer A computer is a machine that can be programmed to carry out sequences of arithmetic or logical operations automatica ...
,
vision loss Visual impairment, also known as vision impairment or vision loss, is a decreased ability to see to a degree that causes problems not fixable by usual means, such as glasses Glasses, also known as eyeglasses or spectacles, are vision eyew ...
,
chronic kidney disease Chronic kidney disease (CKD) is a type of kidney disease Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease A disease is a particular abnormal condition that negatively affects the str ...
, and
dementia Dementia manifests as a set of related symptoms, which usually surface when the brain is damaged by injury or disease. The symptoms Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or ...
. High blood pressure is classified as primary (essential) hypertension or
secondary hypertension Secondary hypertension (or, less commonly, inessential hypertension) is a type of hypertension Hypertension (HTN or HT), also known as high blood pressure (HBP), is a Chronic (medicine), long-term Disease, medical condition in which the blood ...
. About 90–95% of cases are primary, defined as high blood pressure due to nonspecific lifestyle and genetic factors. Lifestyle factors that increase the risk include excess
salt Salt is a mineral In geology and mineralogy, a mineral or mineral species is, broadly speaking, a solid chemical compound with a fairly well-defined chemical composition and a specific crystal structure that occurs naturally in pure fo ...

salt
in the diet, ,
smoking Smoking is a practice in which a substance is burned and the resulting smoke Smoke is a collection of airborne and es emitted when a material undergoes or , together with the quantity of air that is or otherwise mixed into the ma ...

smoking
, and
alcohol In chemistry, alcohol is an organic compound that carries at least one hydroxyl functional group (−OH) bound to a Saturated and unsaturated compounds, saturated carbon atom. The term alcohol originally referred to the primary alcohol ethan ...

alcohol
use. The remaining 5–10% of cases are categorized as secondary high blood pressure, defined as high blood pressure due to an identifiable cause, such as chronic kidney disease, narrowing of the kidney arteries, an
endocrine disorder Endocrine diseases are disorders of the endocrine system The endocrine system is a messenger system comprising feedback loops of the hormones released by internal glands of an organism directly into the circulatory system, regulating distant ta ...
, or the use of
birth control pillsOral contraceptives, abbreviated OCPs, also known as birth control pills, are medication A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to medical diagnosis, diagnose, cure, t ...

birth control pills
. Blood pressure is classified by two measurements, the
systolic to supply all body systems; 2) oxygen-depleted blood (blue arrow) in the right ventricle begins pulsing through the pulmonic (pulmonary) valve en route to the lungs for reoxygenation. depolarization is the start-point of the atrial stage of syst ...
and
diastolic Image:Heart diastole.png, upright=1.5, Heart performance during ventricular diastole: early diastole is a suction mechanism that draws blood 'down' from the left atrium (pink) and right atrium (blue) into each of the two ventricles. Then, in late ve ...
pressures, which are the maximum and minimum pressures, respectively. For most adults, normal blood pressure at rest is within the range of 100–130 millimeters mercury (mmHg) systolic and 60–80 mmHg diastolic. For most adults, high blood pressure is present if the resting blood pressure is persistently at or above 130/80 or 140/90 mmHg. Different numbers apply to children.
Ambulatory blood pressure monitoring Ambulatory blood pressure monitoring (ABPM) measures blood pressure Blood pressure (BP) is the pressure Pressure (symbol: ''p'' or ''P'') is the force In physics Physics (from grc, φυσική (ἐπιστήμη), physikḗ ...
over a 24-hour period appears more accurate than office-based
blood pressure measurement Digital blood pressure monitor in use Arterial blood pressure is most commonly measured via a sphygmomanometer, which historically used the height of a column of mercury to reflect the circulating pressure. Blood pressure values are generally rep ...

blood pressure measurement
. Lifestyle changes and medications can lower blood pressure and decrease the risk of health complications. Lifestyle changes include
weight loss Weight loss, in the context of medicine, health, or physical fitness Physical fitness is a state of health Health, according to the World Health Organization, is "a state of complete physical, Mental health, mental and social well-bein ...

weight loss
,
physical exercise Exercise is any bodily activity that enhances or maintains physical fitness Physical fitness is a state of health Health is a state of physical, mental and social well-being Well-being, also known as ''wellness'', ''prudential valu ...

physical exercise
, decreased salt intake, reducing alcohol intake, and a
healthy diet A healthy diet is a diet Diet may refer to: Food * Diet (nutrition) In nutrition, diet is the sum of food consumed by a person or other organism. The word diet often implies the use of specific intake of nutrition for #Health, health or #We ...
. If lifestyle changes are not sufficient, then
blood pressure medicationAntihypertensives are a class of medication, drugs that are used to treat hypertension (high blood pressure). Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction. Evidence sugge ...
s are used. Up to three medications taken concurrently can control blood pressure in 90% of people. The treatment of moderately high arterial blood pressure (defined as >160/100 mmHg) with medications is associated with an improved
life expectancy Life expectancy is a statistical measure of the average time an organism is expected to live, based on the year of its birth, its current age, and other demographic Demography (from prefix ''demo-'' from Ancient Greek Ancien ...

life expectancy
. The effect of treatment of blood pressure between 130/80 mmHg and 160/100 mmHg is less clear, with some reviews finding benefit and others finding unclear benefit. High blood pressure affects between 16 and 37% of the population globally. In 2010 hypertension was believed to have been a factor in 18% of all deaths (9.4 million globally).


Signs and symptoms

Hypertension is rarely accompanied by symptoms, and its identification is usually through screening, or when seeking healthcare for an unrelated problem. Some people with high blood pressure report
headache Headache is the symptom of pain Pain is a distressing feeling often caused by intense or damaging stimuli. The defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or ...

headache
s (particularly at the back of the head and in the morning), as well as
lightheadedness Lightheadedness is a common and typically unpleasant sensation of dizziness Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo, or lightheadedness. It can also refer to disequilibrium or a non-speci ...
,
vertigo Vertigo is a condition where a person has the sensation of movement or of surrounding objects moving when they are not. Often it feels like a spinning or swaying movement. This may be associated with nausea Nausea is a diffuse sensation of ...

vertigo
,
tinnitus Tinnitus is the perception of sound when no corresponding external sound is present. Nearly everyone will experience a faint "normal tinnitus" in a completely quiet room but it is only of concern if it is bothersome or interferes with normal h ...

tinnitus
(buzzing or hissing in the ears), altered vision or fainting episodes. These symptoms, however, might be related to associated
anxiety Anxiety is an emotion Emotions are mental state, psychological states brought on by neurophysiology, neurophysiological changes, variously associated with thoughts, feelings, behavioural responses, and a degree of pleasure or suffering, disp ...
rather than the high blood pressure itself. On
physical examination In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient A patient is any recipient of health care services that are performed by Health professional, healthcare professionals. The pati ...

physical examination
, hypertension may be associated with the presence of changes in the optic fundus seen by
ophthalmoscopy Ophthalmoscopy, also called funduscopy, is a test that allows a health professional to see inside the fundus of the eye and other structures using an ophthalmoscope (or funduscope). It is done as part of an eye examination An eye examination i ...
. 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 Cushing's syndrome is a collection of signs and symptoms due to prolonged exposure to glucocorticoids such as cortisol. Signs and symptoms may include hypertension, high blood pressure, abdominal obesity but with thin arms and legs, reddish str ...

Cushing's syndrome
frequently causes truncal obesity,
glucose intolerance Prediabetes is a component of the metabolic syndrome Metabolic syndrome is a clustering of at least three of the following five medical conditions: abdominal obesity, high blood pressure Hypertension (HTN or HT), also known as high blood p ...
,
moon face A Moon face is a medical sign Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood ...
, a hump of fat behind the neck and shoulders (referred to as a buffalo hump), and purple abdominal
stretch marks :''"Striae :''" Striae" is also a general term referring to thin, narrow grooves or channels, or a thin line or band especially if several of them are parallel or close together.'' Stretch marks, also known as Striae or Striae distensae, are ...
.
Hyperthyroidism Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormone File:Thyroid_system.svg, upright=1.5, The thyroid The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans it is in the neck ...
frequently causes weight loss with increased appetite,
fast heart rate Tachycardia, also called tachyarrhythmia, is a heart rateHeart rate is the speed of the heartbeat measured by the number of contractions (beats) of the heart The heart is a muscle, muscular Organ (anatomy), organ in most animals, which pu ...
, bulging eyes, and tremor.
Renal artery stenosis Renal artery stenosis (RAS) is the narrowing of one or both of the renal arteries The renal arteries are paired arteries that supply the kidneys with blood. Each is directed across the crus of the diaphragm, so as to form nearly a right angle. T ...
(RAS) may be associated with a localized abdominal
bruit Bruit, also called vascular murmur, is the abnormal sound generated by turbulent flow of blood in an artery due to either an area of partial obstruction or a localized high rate of blood flow through an unobstructed artery. The bruit may be heard ...
to the left or right of the midline (unilateral RAS), or in both locations (bilateral RAS).
Coarctation of the aorta Coarctation of the aorta (CoA or CoAo), also called aortic narrowing, is a congenital condition whereby the aorta The aorta ( ) is the main and largest artery An artery (plural arteries) () is a blood vessel that takes blood away from th ...
frequently causes a decreased blood pressure in the lower extremities relative to the arms, or delayed or absent femoral arterial pulses.
Pheochromocytoma Pheochromocytoma (PHEO or PCC) is a rare tumor of the adrenal medulla composed of chromaffin cells, also known as pheochromocytes. When a tumor composed of the same cells as a pheochromocytoma develops outside the adrenal gland, it is referred t ...

Pheochromocytoma
may cause abrupt episodes of hypertension accompanied by headache,
palpitation Palpitations are perceived abnormalities of the heartbeat characterized by awareness of cardiac muscle contractions in the chest, which is further characterized by the hard, fast and/or irregular beatings of the heart. Symptoms include a rapid ...
s, pale appearance, and excessive sweating.


Hypertensive crisis

Severely elevated blood pressure (equal to or greater than a systolic 180 or diastolic of 110) is referred to as a hypertensive crisis. Hypertensive crisis is categorized as either hypertensive urgency or
hypertensive emergency A hypertensive emergency is high blood pressure Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term Disease, medical condition in which the blood pressure in the artery, arteries is persistently elevated. High ...
, according to the absence or presence of end organ damage, respectively. 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. In hypertensive emergency, there is evidence of direct damage to one or more organs. 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 A randomized controlled trial (or randomized control trial; RCT) is a form of scientific experiment An experiment is a procedure carried out to support, refute, or validate a hypothesis. Experiments provide insight into Causality, cause-and- ...
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 mm Hg are diagnostic of hypertension in pregnancy. High blood pressure in pregnancy can be classified as pre-existing hypertension,
gestational hypertension Gestational hypertension or pregnancy-induced hypertension (PIH) is the development of new hypertension in a pregnant woman after 20 weeks' gestation without the presence of protein in the urine or other signs of pre-eclampsia. Gestational hyper ...
, or
pre-eclampsia Pre-eclampsia is a disorder of pregnancy Pregnancy, also known as gestation, is the time during which one or more offspring In biology, offspring are the young creation of living organisms, produced either by a Asexual reproduction, si ...
. 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 death Maternal death or maternal mortality is defined by the World Health Organization (WHO) as "the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause ...
s 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 . Pre-eclampsia can occasionally progress to a life-threatening condition called
eclampsia Eclampsia is the onset of seizures An epileptic seizure, formally known as a seizure, is a period of symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for ...
, which is a
hypertensive emergency A hypertensive emergency is high blood pressure Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term Disease, medical condition in which the blood pressure in the artery, arteries is persistently elevated. High ...
and has several serious complications including
vision loss Visual impairment, also known as vision impairment or vision loss, is a decreased ability to see to a degree that causes problems not fixable by usual means, such as glasses Glasses, also known as eyeglasses or spectacles, are vision eyew ...
, brain swelling,
seizures An epileptic seizure, formally known as a seizure, is a period of symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower tem ...
,
kidney failure Kidney failure, also known as end-stage kidney disease, is a medical condition in which the kidneys are functioning at less than 15% of normal levels. Kidney failure is classified as either acute kidney failure, which develops rapidly and may res ...
,
pulmonary edema Pulmonary edema (PE), also known as pulmonary congestion, is liquid accumulation in the tissue Tissue may refer to: Biology * Tissue (biology), an ensemble of similar cells that together carry out a specific function * ''Triphosa haesitata'', a ...

pulmonary edema
, and
disseminated intravascular coagulation Disseminated intravascular coagulation (DIC) is a condition in which blood clots form throughout the body, blocking Microvessel, small blood vessels. Symptoms may include chest pain, shortness of breath, leg pain, problems speaking, or problems mov ...
(a blood clotting disorder). In contrast,
gestational hypertension Gestational hypertension or pregnancy-induced hypertension (PIH) is the development of new hypertension in a pregnant woman after 20 weeks' gestation without the presence of protein in the urine or other signs of pre-eclampsia. Gestational hyper ...
is defined as new-onset hypertension during pregnancy without protein in the urine.


Children

Failure to thrive Failure to thrive (FTT) indicates insufficient weight gain or inappropriate weight loss in Pediatrics, pediatric patients unless the term is more precisely defined. In children, it is usually defined in terms of weight, and can be evaluated either ...
,
seizures An epileptic seizure, formally known as a seizure, is a period of symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower tem ...
,
irritability Irritability is the excitatory ability that living organisms In biology Biology is the natural science that studies life and living organisms, including their anatomy, physical structure, Biochemistry, chemical processes, Molecular bi ...
, lack of energy, and difficulty in breathing can be associated with hypertension in newborns and young infants. In older infants and children, hypertension can cause headache, unexplained irritability,
fatigue Fatigue describes a state of tiredness that does not resolve with rest or sleep. In general usage, fatigue is synonymous with extreme tiredness or exhaustion that normally follows prolonged physical or mental activity. When it does not resolve ...
, failure to thrive,
blurred vision Blurred vision is an ocular Eyes are organs An organ is a group of tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given organ's tissues can be broadly categorized as p ...

blurred vision
,
nosebleeds A nosebleed, also known as epistaxis, is bleeding from the human nose, nose. Blood can also flow down into the stomach and cause nausea and vomiting. In more severe cases, blood may come out of both nostrils. Rarely, bleeding may be so significa ...
, 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 identified as well as some rare genetic variants with large effects on blood pressure. 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. Sentinel SNP for each new genetic locus identified has shown an association with
DNA methylation DNA methylation is a biological process by which methyl group A methyl group is an alkyl derived from methane, containing one carbon atom chemical bond, bonded to three hydrogen atoms — CH3. In chemical formula, formulas, the ...

DNA methylation
at multiple nearby
CpG site The CpG sites or CG sites are regions of DNA Deoxyribonucleic acid (; DNA) is a molecule File:Pentacene on Ni(111) STM.jpg, A scanning tunneling microscopy image of pentacene molecules, which consist of linear chains of five carbon ...
s. 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. Blood pressure rises with
aging Ageing or aging (see spelling differences Despite the various English dialects Dialect The term dialect (from Latin , , from the Ancient Greek word , , "discourse", from , , "through" and , , "I speak") is used in two distinct ways ...

aging
when associated with a
western diet The Western pattern diet (WPD) is a modern dietary pattern that is generally characterized by high intakes of red meat In gastronomy 200px, Fine food, the principal study of gastronomy Gastronomy is a compound word that derives from t ...
and lifestyle and the risk of becoming hypertensive in later life is significant. Several environmental factors influence blood pressure. High salt intake raises the blood pressure in salt sensitive individuals; lack of exercise, central obesity can play a role in individual cases. The possible roles of other factors such as caffeine consumption, and
vitamin D deficiency Vitamin D deficiency, or hypovitaminosis D is defined as a vitamin D level that is below normal. It most commonly occurs in people when they have inadequate sunlight exposure (in particular sunlight with adequate ultraviolet B rays (UVB)). Vita ...
are less clear.
Insulin resistance Insulin resistance (IR) is a pathological condition in which cell (biology), cells fail to respond normally to the hormone insulin. Insulin is a hormone that allows glucose to enter cells which also reduces blood glucose (blood sugar). Insulin is ...
, which is common in obesity and is a component of syndrome X (or the
metabolic syndrome Metabolic syndrome is a clustering of at least three of the following five medical conditions: abdominal obesity, hypertension, high blood pressure, hyperglycemia, high blood sugar, Hypertriglyceridemia, high serum triglycerides, and ''low'' seru ...
), also contributes to hypertension. Events in early life, such as
low birth weight Low birth weight (LBW) is defined by the World Health Organization as a birth weight of an infant of or less, regardless of gestational age. Infants born with LBW have added health risks which require close management, often in a neonatal intensive ...
, , and lack of
breastfeeding Breastfeeding, also called nursing, is the process of feeding a mother's breast milk to her infant, either directly from the breast or by expressing (pumping out) the milk from the breast and bottle-feeding it to the infant. The World Healt ...

breastfeeding
may be risk factors for adult essential hypertension, although the mechanisms linking these exposures to adult hypertension remain unclear. 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. Average blood pressure may be higher in the winter than in the summer.
Periodontal disease Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis Gingivitis is a non-destructive disease that causes inflammation Inflam ...
is also associated with high blood pressure.


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 Cushing's syndrome is a collection of signs and symptoms due to prolonged exposure to glucocorticoids such as cortisol. Signs and symptoms may include hypertension, high blood pressure, abdominal obesity but with thin arms and legs, reddish str ...

Cushing's syndrome
,
hyperthyroidism Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormone File:Thyroid_system.svg, upright=1.5, The thyroid The thyroid, or thyroid gland, is an endocrine gland in vertebrates. In humans it is in the neck ...
,
hypothyroidism Hypothyroidism (also called ''underactive thyroid'', ''low thyroid'' or ''hypothyreosis'') is a disorder of the endocrine system in which the thyroid gland The thyroid, or thyroid gland, is an endocrine gland in the neck consisting of two ...

hypothyroidism
,
acromegaly Acromegaly is a disorder that results from excess growth hormone Growth hormone (GH) or somatotropin, also known as human growth hormone (hGH or HGH) in its human form, is a peptide hormonePeptide hormones or protein hormones are hormones ...

acromegaly
,
Conn's syndrome Primary aldosteronism (PA)'','' also known as primary hyperaldosteronism or Conn's syndrome, refers to the excess production of the hormone aldosterone from the adrenal glands, resulting in low renin levels and high blood pressure. This abnormality ...
or
hyperaldosteronism Hyperaldosteronism is a medical condition wherein too much aldosterone is produced by the adrenal glands, which can lead to lowered levels of potassium in the blood (hypokalemia) and increased hydrogen ion excretion (alkalosis). This cause of mine ...
,
renal artery stenosis Renal artery stenosis (RAS) is the narrowing of one or both of the renal arteries The renal arteries are paired arteries that supply the kidneys with blood. Each is directed across the crus of the diaphragm, so as to form nearly a right angle. T ...
(from
atherosclerosis Atherosclerosis is a disease in which the wall of the artery An artery (plural arteries) () is a blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels tr ...

atherosclerosis
or
fibromuscular dysplasia Fibromuscular dysplasia (FMD) is a non-atherosclerotic Atherosclerosis is a disease in which the wall of the artery An artery (plural arteries) () is a blood vessel that takes blood away from the heart to one or more parts of the body (ti ...
),
hyperparathyroidism Hyperparathyroidism is an increase in parathyroid hormone (PTH) levels in the blood. This occurs from a disorder either within the parathyroid glands (primary hyperparathyroidism) or outside the parathyroid glands (secondary hyperparathyroidism). ...
, and
pheochromocytoma Pheochromocytoma (PHEO or PCC) is a rare tumor of the adrenal medulla composed of chromaffin cells, also known as pheochromocytes. When a tumor composed of the same cells as a pheochromocytoma develops outside the adrenal gland, it is referred t ...

pheochromocytoma
. Other causes of secondary hypertension include
obesity Obesity is a medical condition A disease is a particular abnormal condition that negatively affects the structure or function (biology), function of all or part of an organism, and that is not due to any immediate external injury. ...

obesity
,
sleep apnea Sleep apnea, also spelled sleep apnoea, is a sleep disorder A sleep disorder, or somnipathy, is a medical disorder of an individual's sleep patterns. Some sleep disorders are severe enough to interfere with normal physical, mental, social and ...
,
pregnancy Pregnancy, also known as gestation, is the time during which one or more offspring In biology, offspring are the young creation of living organisms, produced either by a Asexual reproduction, single organism or, in the case of sexual repr ...

pregnancy
,
coarctation of the aorta Coarctation of the aorta (CoA or CoAo), also called aortic narrowing, is a congenital condition whereby the aorta The aorta ( ) is the main and largest artery An artery (plural arteries) () is a blood vessel that takes blood away from th ...
, excessive eating of
liquorice Liquorice ( UK) or licorice ( US) ( ; also ) is the common name Common may refer to: Places * Common, a townland in County Tyrone, Northern Ireland * Boston Common Boston Common (also known as the Common) is a central public park in dow ...

liquorice
, excessive drinking of alcohol, certain prescription medicines, herbal remedies, and
stimulants Stimulants (also often referred to as psychostimulants or colloquially as uppers) is an overarching term that covers many drug Uncoated tablets, consisting of about 90% acetylsalicylic acid, along with a minor amount of inert fillers and b ...

stimulants
such as
cocaine Cocaine (from , from , ultimately from Quechuan languages, Quechua: ''kúka'') is a tropane alkaloid and stimulant drug obtained primarily from the leaves of two coca species native to South America, ''Erythroxylum coca'' and ''Erythroxylu ...

cocaine
and
methamphetamine Methamphetamine (contracted from ) is a potent central nervous system (CNS) stimulant that is mainly used as a recreational drug use, recreational drug and less commonly as a second-line treatment for attention deficit hyperactivity disord ...

methamphetamine
.
Arsenic Arsenic is a chemical element Image:Simple Periodic Table Chart-blocks.svg, 400px, Periodic table, The periodic table of the chemical elements In chemistry, an element is a pure substance consisting only of atoms that all have the same num ...

Arsenic
exposure through drinking water has been shown to correlate with elevated blood pressure.
Depression Depression may refer to: Mental health * Depression (mood), a state of low mood and aversion to activity * Mood disorders characterized by depression are commonly referred to as simply ''depression'', including: ** Dysthymia ** Major depressive ...
was also linked to hypertension.
Loneliness Loneliness is an unpleasant emotion Emotions are psychological state A mental state is a state of mind that an agent is in. Most simplistically, a mental state is a mental condition. It is a relation that connects the agent with a propo ...

Loneliness
is also a risk factor. A 2018 review found that any alcohol increased blood pressure in males while over one or two drinks increased the risk in females.


Pathophysiology

In most people with established
essential hypertension Essential hypertension (also called primary hypertension, or idiopathic hypertension) is the form of hypertension that by definition has no identifiable secondary cause. It is the most common type affecting 85% of those with high blood pressure. T ...
, increased resistance to blood flow (
total peripheral resistance Vascular resistance is the resistance that must be overcome to push blood Blood is a body fluid Body fluids, bodily fluids, or biofluids are liquid A liquid is a nearly incompressible In fluid mechanics or more generally continuum ...
) accounts for the high pressure while
cardiac output Cardiac output (CO), also known as heart output denoted by the symbols Q, or \dot Q_ , is a term used in cardiac physiologyCardiac physiology or heart function is the study of healthy, unimpaired function of the heart: involving blood flow; Ca ...
remains normal. 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. 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. The increased peripheral resistance in established hypertension is mainly attributable to structural narrowing of small arteries and
arteriole An arteriole is a small-diameter blood vessel in the microcirculation that extends and branches out from an artery and leads to capillary, capillaries. Arterioles have muscle, muscular walls (usually only one to two layers of smooth muscle) and a ...

arteriole
s, although a reduction in the number or density of capillaries may also contribute. It is not clear whether or not
vasoconstriction Vasoconstriction is the narrowing of the blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of th ...

vasoconstriction
of arteriolar blood vessels plays a role in hypertension. Hypertension is also associated with decreased peripheral venous compliance which may increase venous return, increase cardiac preload and, ultimately, cause
diastolic dysfunction Heart failure with preserved ejection fraction (HFpEF) is a form of heart failure in which the ejection fraction – the percentage of the volume of blood ejected from the left ventricle with each heartbeat divided by the volume of blood when the le ...
.
Pulse pressure Pulse pressure is the difference between systolic and diastolic blood pressure Blood pressure (BP) is the pressure Pressure (symbol: ''p'' or ''P'') is the force In physics Physics (from grc, φυσική (ἐπιστήμ ...
(the difference between systolic and diastolic blood pressure) is frequently increased in older people with hypertension. This can mean that systolic pressure is abnormally high, but diastolic pressure may be normal or low, a condition termed isolated systolic hypertension. The high pulse pressure in elderly people with hypertension or isolated systolic hypertension is explained by increased
arterial stiffness Arterial stiffness occurs as a consequence of biological aging and arteriosclerosis. Inflammation plays a major role in arteriosclerosis development, and consequently it is a major contributor in large arteries stiffening. Increased arterial stiff ...
, which typically accompanies aging and may be exacerbated by high blood pressure. 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 The renin–angiotensin system (RAS), or renin–angiotensin–aldosterone system (RAAS), is a hormone system that regulates blood pressure Blood pressure (BP) is the pressure Pressure (symbol: ''p'' or ''P'') is the force In phy ...
) or abnormalities of the
sympathetic nervous system The sympathetic nervous system (SNS) is one of two divisions of the autonomic nervous system The autonomic nervous system (ANS), formerly the vegetative nervous system, is a division of the peripheral nervous system that supplies smooth muscle ...
. 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 In vascular diseases, endothelial dysfunction is a systemic pathological state of the endothelium. Along with acting as a semi-permeable membrane, the endothelium is responsible for maintaining vascular tone and regulating oxidative stress ( ...
and vascular
inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogen In biology Biology is the natural science that studies life and living organisms, including their anato ...
may also contribute to increased peripheral resistance and vascular damage in hypertension.
Interleukin 17 Interleukin 17 family (IL17 family) is a family of pro-inflammatory cystine knot cytokines. They are produced by a group of T helper cell known as T helper 17 cell in response to their stimulation with IL-23. Originally, Th17 was identifi ...
has garnered interest for its role in increasing the production of several other thought to be involved in hypertension such as
tumor necrosis factor alpha Tumor necrosis factor (TNF, cachexin, or cachectin; often called tumor necrosis factor alpha or TNF-α) is an adipokine The adipokines, or adipocytokines (Greek ''adipo-'', fat; ''cytos-'', cell; and ''-kinos'', movement) are cytokines (cell si ...
,
interleukin 1 The Interleukin-1 family (IL-1 family) is a group of 11 cytokines Cytokines are a broad and loose category of small proteins (~5–25 kDa) important in cell signaling. Cytokines are peptides and cannot cross the lipid bilayer of cells to ente ...
,
interleukin 6 Interleukin 6 (IL-6) is an interleukin that acts as both a pro-inflammatory cytokine and an anti-inflammatory myokine. In humans, it is encoded by the ''IL6'' gene. In addition, osteoblasts secrete IL-6 to stimulate osteoclast formation. Smooth ...
, and
interleukin 8 Interleukin 8 (IL-8 or chemokine (C-X-C motif) ligand 8, CXCL8) is a chemokine Chemokines (Greek ''-kinos'', movement) are a family of small cytokines, or signaling protein Proteins are large biomolecules or macromolecules that are comprised ...
. Excessive sodium or insufficient
potassium Potassium is a chemical element In chemistry Chemistry is the study of the properties and behavior of . It is a that covers the that make up matter to the composed of s, s and s: their composition, structure, properties, b ...

potassium
in the diet leads to excessive intracellular sodium, which contracts vascular smooth muscle, restricting blood flow and so increases blood pressure.


Diagnosis

Hypertension is diagnosed on the basis of a persistently high resting blood pressure. The
American Heart Association The American Heart Association (AHA) is a nonprofit organization A nonprofit organization (NPO), also known as a non-business entity, not-for-profit organization, or nonprofit institution, is a legal entity organized and operated for a collectiv ...
recommends at least three resting measurements on at least two separate health care visits. The UK
National Institute for Health and Care Excellence The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body In the United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or B ...

National Institute for Health and Care Excellence
recommends
ambulatory blood pressure monitoring Ambulatory blood pressure monitoring (ABPM) measures blood pressure Blood pressure (BP) is the pressure Pressure (symbol: ''p'' or ''P'') is the force In physics Physics (from grc, φυσική (ἐπιστήμη), physikḗ ...
to confirm the diagnosis of hypertension if a clinic blood pressure is 140/90 mmHg or higher.


Measurement technique

For an accurate diagnosis of hypertension to be made, it is essential for proper
blood pressure measurement Digital blood pressure monitor in use Arterial blood pressure is most commonly measured via a sphygmomanometer, which historically used the height of a column of mercury to reflect the circulating pressure. Blood pressure values are generally rep ...

blood pressure measurement
technique to be used. 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 The brachial artery is the major blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels transport blood cells, nutrients, and oxygen to the tissues of the bo ...
with a
stethoscope The stethoscope is an acoustic medical Medicine is the science and Praxis (process) , practice of caring for a patient, managing the diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care , palliation o ...

stethoscope
for accurate blood pressure measurements. The blood pressure cuff should be deflated slowly (2-3 mmHg per second) while listening for the Korotkoff sounds. The
bladder The urinary bladder, or simply bladder, is a hollow muscular organ in humans and other vertebrates that stores urine Urine is a liquid by-product of metabolism in humans and in many other animals. Urine flows from the kidneys through the ure ...
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. An exception to this is those with very high blood pressure readings especially when there is poor
organ Organ may refer to: Biology * Organ (anatomy) An organ is a group of Tissue (biology), tissues with similar functions. Plant life and animal life rely on many organs that co-exist in organ systems. A given organ's tissues can be broadly cate ...
function. With the availability of 24-hour
ambulatory blood pressure Ambulatory blood pressure monitoring (ABPM) measures blood pressure Blood pressure (BP) is the pressure Pressure (symbol: ''p'' or ''P'') is the force In physics Physics (from grc, φυσική (ἐπιστήμη), physikḗ ...
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. 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. Orthostatic hypertension is when blood pressure increases upon standing.


Other investigations

Once the diagnosis of hypertension has been made, healthcare providers should attempt to identify the underlying cause based on risk factors and other symptoms, if present. Secondary hypertension is more common in preadolescent children, with most cases caused by kidney disease. Primary or essential hypertension is more common in adolescents and adults and has multiple risk factors, including obesity and a family history of hypertension. Laboratory tests can also be performed to identify possible causes of secondary hypertension, and to determine whether hypertension has caused damage to the Human heart, heart, Human eyes, eyes, and kidneys. Additional tests for diabetes and high cholesterol levels are usually performed because these conditions are additional risk factors for the development of heart disease and may require treatment. Initial assessment of the hypertensive people should include a complete Medical history, history and
physical examination In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient A patient is any recipient of health care services that are performed by Health professional, healthcare professionals. The pati ...

physical examination
. Serum creatinine is measured to assess for the presence of kidney disease, which can be either the cause or the result of hypertension. Serum creatinine alone may overestimate glomerular filtration rate and recent guidelines advocate the use of predictive equations such as the Modification of Diet in Renal Disease (MDRD) formula to estimate glomerular filtration rate (eGFR). eGFR can also provide a baseline measurement of kidney function that can be used to monitor for side effects of certain Antihypertensive drug, anti-hypertensive drugs on kidney function. Additionally, testing of urine samples for proteinuria, protein is used as a secondary indicator of kidney disease. Electrocardiogram (EKG/ECG) testing is done to check for evidence that the heart is under strain from high blood pressure. It may also show whether there is thickening of the heart muscle (left ventricular hypertrophy) or whether the heart has experienced a prior minor disturbance such as a silent heart attack. A chest X-ray or an echocardiogram may also be performed to look for signs of heart enlargement or damage to the heart.


Classification in adults

In people aged 18 years or older hypertension is defined as either a systolic or a diastolic blood pressure measurement consistently higher than an accepted normal value (this is above 129 or 139 mmHg systolic, 89 mmHg diastolic depending on the guideline). Other thresholds are used (135 mmHg systolic or 85 mmHg diastolic) if measurements are derived from 24-hour ambulatory or home monitoring. Recent international hypertension guidelines have also created categories below the hypertensive range to indicate a continuum of risk with higher blood pressures in 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 uses the term prehypertension for blood pressure in the range 120–139 mmHg systolic or 80–89 mmHg diastolic, while European Society of Hypertension Guidelines (2007) and British Hypertension Society (BHS) IV (2004) use optimal, normal and high normal categories to subdivide pressures below 140 mmHg systolic and 90 mmHg diastolic. Hypertension is also sub-classified: JNC7 distinguishes hypertension stage I, hypertension stage II, and isolated systolic hypertension. Isolated systolic hypertension refers to elevated systolic pressure with normal diastolic pressure and is common in the elderly. The ESH-ESC Guidelines (2007) and BHS IV (2004) additionally define a third stage (stage III hypertension) for people with systolic blood pressure exceeding 179 mmHg or a diastolic pressure over 109 mmHg. Hypertension is classified as "resistant" if Pharmaceutical drug, medications do not reduce blood pressure to normal levels. In November 2017, the American Heart Association and American College of Cardiology published a joint guideline which updates the recommendations of the JNC7 report. The 2020 International Society of Hypertension guidelines define hypertension based on office blood pressure ≥140/90 mmHg or home monitoring blood pressure ≥135/85 mmHg, or 24-hour ambulatory blood pressure average ≥130/80 mmHg (daytime average ≥135/85 mmHg or nighttime average BP ≥120/70 mmHg).


Children

Hypertension occurs in around 0.2 to 3% of newborns; however, blood pressure is not measured routinely in healthy newborns. Hypertension is more common in high risk newborns. A variety of factors, such as gestational age, postconceptional age and birth weight needs to be taken into account when deciding if a blood pressure is normal in a newborn. Hypertension defined as elevated blood pressure over several visits affects 1% to 5% of children and adolescents and is associated with long term risks of ill-health. Blood pressure rises with age in childhood and, in children, hypertension is defined as an average systolic or diastolic blood pressure on three or more occasions equal or higher than the 95th percentile appropriate for the sex, age and height of the child. High blood pressure must be confirmed on repeated visits however before characterizing a child as having hypertension. Prehypertension in children has been defined as average systolic or diastolic blood pressure that is 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. The value of routine screening for hypertension in children over the age of 3 years is debated. In 2004 the National High Blood Pressure Education Program recommended that children aged 3 years and older have blood pressure measurement at least once at every health care visit and the National Heart, Lung, and Blood Institute and American Academy of Pediatrics made a similar recommendation. However, the American Academy of Family Physicians supports the view of the United States Preventive Services Task Force, U.S. Preventive Services Task Force that the available evidence is insufficient to determine the balance of benefits and harms of screening for hypertension in children and adolescents who do not have symptoms.


Prevention

Much of the disease burden of high blood pressure is experienced by people who are not labeled as hypertensive. Consequently, population strategies are required to reduce the consequences of high blood pressure and reduce the need for antihypertensive medications. Lifestyle changes are recommended to lower blood pressure, before starting medications. The 2004 British Hypertension Society guidelines proposed lifestyle changes consistent with those outlined by the US National High BP Education Program in 2002 for the primary prevention of hypertension: * maintain normal body weight for adults (e.g. body mass index 20–25 kg/m2) * reduce dietary sodium intake to <100 mmol/ day (<6 g of sodium chloride or <2.4 g of sodium per day) * engage in regular aerobic physical activity such as brisk walking (≥30 min 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 * consume a diet rich in fruit and vegetables (e.g. at least five portions per day); Effective lifestyle modification may lower blood pressure as much as an individual antihypertensive medication. Combinations of two or more lifestyle modifications can achieve even better results. There is considerable evidence that reducing dietary salt intake lowers blood pressure, but whether this translates into a reduction in mortality and cardiovascular disease remains uncertain. Estimated sodium intake ≥6g/day and <3g/day are both associated with high risk of death or major cardiovascular disease, but the association between high sodium intake and adverse outcomes is only observed in people with hypertension. Consequently, in the absence of results from randomized controlled trials, the wisdom of reducing levels of dietary salt intake below 3g/day has been questioned. ESC guidelines mention periodontitis is associated with poor cardiovascular health status.


Management

According to one review published in 2003, reduction of the
blood pressure Blood pressure (BP) is the pressure Pressure (symbol: ''p'' or ''P'') is the force In physics Physics is the natural science that studies matter, its Elementary particle, fundamental constituents, its Motion (physics), motio ...

blood pressure
by 5 mmHg can decrease the risk of stroke by 34%, of ischemic heart disease by 21%, and reduce the likelihood of
dementia Dementia manifests as a set of related symptoms, which usually surface when the brain is damaged by injury or disease. The symptoms Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or ...
,
heart failure Heart failure (HF), also known as congestive heart failure (CHF) and (congestive) cardiac failure (CCF), is a set of manifestations caused by the failure of the heart The heart is a cardiac muscle, muscular Organ (biology), organ in mo ...
, and death, mortality from cardiovascular disease.


Target blood pressure

Various expert groups have produced guidelines regarding how low the blood pressure target should be when a person is treated for hypertension. These groups recommend a target below the range 140–160 / 90–100 mmHg for the general population. Cochrane reviews recommend similar targets for subgroups such as people with diabetes and people with prior cardiovascular disease. Additionally, Cochrane reviews have found that for older individuals with moderate to high cardiovascular risk, the benefits of trying to achieve a lower than standard blood pressure target (at or below 140/90 mmHg) are outweighed by the risk associated with the intervention. These findings may not be applicable to other populations. Many expert groups recommend a slightly higher target of 150/90 mmHg for those over somewhere between 60 and 80 years of age. The JNC-8 and American College of Physicians recommend the target of 150/90 mmHg for those over 60 years of age, but some experts within these groups disagree with this recommendation. Some expert groups have also recommended slightly lower targets in those with diabetes or chronic kidney disease with proteinuria, protein loss in the urine, but others recommend the same target as for the general population. The issue of what is the best target and whether targets should differ for high risk individuals is unresolved, although some experts propose more intensive blood pressure lowering than advocated in some guidelines. For people who have never experienced cardiovascular disease who are at a 10-year risk of cardiovascular disease of less than 10%, the 2017 American Heart Association guidelines recommend medications if the systolic blood pressure is >140 mmHg or if the diastolic BP is >90 mmHg. For people who have experienced cardiovascular disease or those who are at a 10-year risk of cardiovascular disease of greater than 10%, it recommends medications if the systolic blood pressure is >130 mmHg or if the diastolic BP is >80 mmHg.


Lifestyle modifications

The first line of treatment for hypertension is lifestyle changes, including dietary changes, physical exercise, and weight loss. Though these have all been recommended in scientific advisories, a Cochrane (organisation), Cochrane systematic review found no evidence for effects of weight loss diets on death, long-term complications or adverse events in persons with hypertension. 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, the DASH diet (Dietary Approaches to Stop Hypertension), and plant-based diets. There is some evidence green tea consumption may help lower blood pressure, but this is insufficient for it to be recommended as a treatment. 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]). Beetroot, Beetroot juice consumption also significantly lowers the blood pressure of people with high blood pressure. Increasing Potassium#Nutrition, dietary potassium has a potential benefit for lowering the risk of hypertension. The 2015 Dietary Guidelines Advisory Committee (DGAC) stated that potassium is one of the shortfall nutrients which is under-consumed in the United States. 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. Physical exercise regimens which are shown to reduce blood pressure include isometric exercise, isometric resistance exercise, aerobic exercise, resistance exercise, and device-guided breathing. 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. Self-monitoring and appointment reminders might support the use of other strategies to improve blood pressure control, but need further evaluation.


Medications

Several classes of medications, collectively referred to as antihypertensive drug, antihypertensive medications, are available for treating hypertension. First-line medications for hypertension include Thiazide, thiazide-diuretics, calcium channel blockers, angiotensin converting enzyme inhibitors (ACE inhibitors), and Angiotensin II receptor antagonist, angiotensin receptor blockers (ARBs). These medications 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 counter-regulatory mechanisms that act to restore blood pressure values to pre-treatment levels. 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. 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.


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 mechanism of action, mechanisms of action. Adherence (medicine), Failing to take prescribed medications as directed is an important cause of resistant hypertension. Resistant hypertension may also result from chronically high activity of the autonomic nervous system, an effect known as "neurogenic hypertension". Electrical therapies that stimulate the baroreflex are being studied as an option for lowering blood pressure in people in this situation. Some common secondary causes of resistant hypertension include obstructive sleep apnea,
pheochromocytoma Pheochromocytoma (PHEO or PCC) is a rare tumor of the adrenal medulla composed of chromaffin cells, also known as pheochromocytes. When a tumor composed of the same cells as a pheochromocytoma develops outside the adrenal gland, it is referred t ...

pheochromocytoma
,
renal artery stenosis Renal artery stenosis (RAS) is the narrowing of one or both of the renal arteries The renal arteries are paired arteries that supply the kidneys with blood. Each is directed across the crus of the diaphragm, so as to form nearly a right angle. T ...
,
coarctation of the aorta Coarctation of the aorta (CoA or CoAo), also called aortic narrowing, is a congenital condition whereby the aorta The aorta ( ) is the main and largest artery An artery (plural arteries) () is a blood vessel that takes blood away from th ...
, and primary aldosteronism.


Refractory hypertension

Refractory hypertension is characterized by uncontrolled elevated
blood pressure Blood pressure (BP) is the pressure Pressure (symbol: ''p'' or ''P'') is the force In physics Physics is the natural science that studies matter, its Elementary particle, fundamental constituents, its Motion (physics), motio ...

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. 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.


Epidemiology


Adults

, approximately one billion adults or ~22% of the population of the world have hypertension. It 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. 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 rates as low as 3.4% (men) and 6.8% (women) in rural India and as high as 68.9% (men) and 72.5% (women) in Poland. Rates in Africa were about 45% in 2016. In Europe hypertension occurs in about 30-45% of people . In 1995 it was estimated that 43 million people (24% of the population) in the United States had hypertension or were taking antihypertensive medication. By 2004 this had increased to 29% 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 European Americans, whites and Mexican Americans. Differences in hypertension rates are multifactorial and under study.


Children

Rates of high blood pressure in children and adolescents have increased in the last 20 years in the United States. 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.


Prognosis

Hypertension is the most important List of preventable causes of death, preventable risk factor for premature death worldwide. It increases the risk of ischemic heart disease, strokes, peripheral vascular disease, and other cardiovascular diseases, including
heart failure Heart failure (HF), also known as congestive heart failure (CHF) and (congestive) cardiac failure (CCF), is a set of manifestations caused by the failure of the heart The heart is a cardiac muscle, muscular Organ (biology), organ in mo ...
, aortic aneurysms, diffuse
atherosclerosis Atherosclerosis is a disease in which the wall of the artery An artery (plural arteries) () is a blood vessel The blood vessels are the components of the circulatory system that transport blood throughout the human body. These vessels tr ...

atherosclerosis
,
chronic kidney disease Chronic kidney disease (CKD) is a type of kidney disease Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease A disease is a particular abnormal condition that negatively affects the str ...
,
atrial fibrillation Atrial fibrillation (AF or A-fib) is an abnormal heart rhythm (arrhythmia) characterized by the rapid and irregular beating of the atrial chambers of the heart. It often begins as short periods of abnormal beating, which become longer or cont ...

atrial fibrillation
, cancers, leukemia and pulmonary embolism. Hypertension is also a risk factor for cognitive impairment and
dementia Dementia manifests as a set of related symptoms, which usually surface when the brain is damaged by injury or disease. The symptoms Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or ...
. Other complications include hypertensive retinopathy and hypertensive nephropathy.


History


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. However, hypertension as a clinical entity came into its own with the invention of the cuff-based sphygmomanometer by Scipione Riva-Rocci in 1896. 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". 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. 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 (scientist), Thomas Young in 1808 and especially Richard Bright (physician), 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 what was called the "hard pulse disease" consisted in reducing the quantity of blood by bloodletting or the application of leeches. This was advocated by The Yellow Emperor of China, Aulus Cornelius Celsus, 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 The sympathetic nervous system (SNS) is one of two divisions of the autonomic nervous system The autonomic nervous system (ANS), formerly the vegetative nervous system, is a division of the peripheral nervous system that supplies smooth muscle ...
), and pyrogen therapy (injection of substances that caused a fever, indirectly reducing blood pressure). 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 World War II, 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. 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. 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

The World Health Organization has identified hypertension, or high blood pressure, as the leading cause of cardiovascular Mortality rate, mortality. The World Hypertension League (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. To address this problem, the WHL initiated a global awareness campaign on hypertension in 2005 and dedicated May 17 of each year as World Hypertension Day (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 Mass media, 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.


Economics

High blood pressure is the most common chronic medical problem prompting visits to primary health care providers in USA. The American Heart Association estimated the direct and indirect costs of high blood pressure in 2010 as $76.6 billion. 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. 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.


Other animals

Hypertension in cats is indicated with a systolic blood pressure greater than 150 mm Hg, with amlodipine the usual first-line treatment. Normal blood pressure in dogs can differ substantially between breeds but hypertension is often diagnosed if systolic blood pressure is above 160 mm Hg particularly if this is associated with target organ damage. 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.


References


Further reading

* *


External links

* {{Authority control Hypertension, Blood pressure Medical conditions related to obesity Aging-associated diseases Wikipedia medicine articles ready to translate (full) Wikipedia neurology articles ready to translate Articles containing video clips