Hypertension

Hypertension is a major risk factor in atherosclerosis, heart disease, hem­orrhagic and nonhemorrhagic stroke, and a principal cause of morbidity and mortality in developed nations throughout the world. In atherosclero­sis, hypertension contributes to intimal injury and permeability in the interactive process of lipoprotein uptake and plaque formation. In the etiology of hemorrhagic stroke (excluding ruptured congenital aneu­rysms), the pathogenesis is likely to be rupture of microaneurysms result­ing from arterionecrosis, which is characterized by infiltration into the intima of blood plasma with fibrin deposition, histolysis of the internal elastic lamina, and loss of medial smooth muscle cells.

incidence of hypertension

In the United States, almost 58 million people have high blood pressure, which is more common in black Americans (38% are hypertensive) than in whites (29%). Japan (Ueshima et al., 1980) and China (Li et al., 1985) have high morbidity and mortality from hypertension and stroke, but lower risks of coronary artery disease than in the United States and Europe. In other populations, especially in nonindustrialized societies such as the Tokelau, the condition is rare, but blood pressure levels may then be adversely influenced by migration and changes in weight, diet, exercise, and social factors. Thus, differences may be explained by genetic factors, environmental factors, or a genetic-environmental interaction. Advances in the management of hypertension make the search for specific causes of this disease important so that appropriate preventive and therapeutic mea­sures may be undertaken in a timely fashion. In 1972, the United States government launched a blood pressure awareness program. Since then, the annual rate of fatal strokes has been cut in half by identifying patients at risk and undertaking needed programs of prevention and treatment. In the same time frame the rate of fatal heart attacks has dropped by 34%—for a variety of reasons, including the assault on high blood pressure.

Blood pressure

Blood pressure is a continuously distributed metric trait the mainte­nance of which depends on the complex interaction of baroreceptors, renal transport systems for sodium and potassium, blood volume, vasoactive peptides, various hormones, myocardial contractility, vascular resistance, and the central and autonomic nervous systems. High blood pressure occurs as a primary condition (essential hypertension) or as a manifesta­tion of many known diseases, including a number of mendelizing condi­tions.

Factors causes hypertension

Environmental factors of hypertension

Salt (sodium) and stress are two environmental risk factors that have been studied in human populations and animal models. Many nonindustrialized societies exhibit a low prevalence of hypertension and little or no increase in blood pressure with age. However, some populations (e.g., Japan) that have high-salt diets also have an unusually high prevalence of hypertension. With exposure to an industrialized culture, the distribution of blood pressure within the popula­tion may change due to a variety of possible reasons, including diet (increased sodium, decreased po­tassium), obesity, exercise deficiency, stress, socioeconomic factors, and medications (e.g., birth control hormones). Ethnic comparisons of the incidence of hypertension and the distribution of blood pressure with age, as well as migration studies in which changes in the distribution of blood pressure have been documented following the relocation of a population to a different environment lend support to the importance of environmental factors in the etiology of hypertension.

symptoms of hypertension

symptoms of hypertension

That’s part of the problem. Hypertension usually causes no symptoms, so over time, damage to your arteries, heart, and brain can occur before the condition is diagnosed.

Hypertension Treatment

Hypertension Treatment
Won’t pills cure the problem?

Not really. Keep in mind that hypertension increases your risk of dying from cardiovascular-related disease, like heart attacks and strokes, by 300% and more. Diuretics – considered by many scientists to be the best drug treatment for most hypertensives – decreases your risk of dying by only 19%.

Pills as a treatment for hypertension have hardly solved the problem. Even if you’re taking pills, your risk of dying from cardiovascular disease is still at least two to three times higher than that of people whose blood pressure is optimal – 110/70 or less.

is there a cure for hypertension

Is there a cure for hypertension?

You cannot “cure” hypertension, but there’s a very good chance that with lifestyle treatment (the right diet, losing weight, regular exercise) you can get hypertension under control and significantly lower your risk of developing life-threatening diseases.

Lifestyle treatment reduces blood pressure more than drugs and dramatically lowers the risk of diabetes, heart attacks, cancer, and stroke.

symptoms of pregnancy induced hypertension

symptoms of pregnancy-induced hypertension

Rapid or sudden weight gain, high blood pressure, protein in the urine, as well as swelling* in the hands, feet and face are all signs of PIH Other symptoms include abdominal pain, severe headaches, a change in reflexes, reduced output of urine or no urine, blood in the urine, dizziness or excessive vomiting and nausea.

*Note: Some swelling is normal during pregnancy. However, if the swelling doesn't go away and is accompanied by some of the above symptoms, be sure to see your doctor right away.

pregnancy-induced hypertension diagnosing

How is pregnancy-induced hypertension diagnosed?

During routine prenatal tests, your weight gain, blood pressure and urine protein are monitored. If you have symptoms of PIH, as listed above, additional blood tests may be ordered, which would show abnormal results if PIH is present.

If PIH is suspected, a non-stress test may be performed. During the non-stress test, an ultrasound transducer records the baby's heart rate and a pressure transducer (called the toco transducer) records uterine activity. Each time you feel the baby move, you make a mark on a graph paper which displays the fetal heart rate and uterine activity.

Usually the fetal heart rate increases when the fetus moves, just as your heart beats faster when you exercise. Certain changes in the fetal heart rate are considered a sign of good health.

pregnancy-induced hypertension treatment

How is pregnancy-induced hypertension treated?

If PIH is mild, it can be treated at home. If you have been diagnosed with PIH and your doctor recommends home treatment, you will need to maintain a quiet, restful environment with limited activity or bed rest.

It is important that you follow the diet and fluid intake guidelines from your health care provider and maintain your scheduled Clinic appointments. Your constant perception of fetal movement is also important. Any changes need to be reported to your health care provider immediately.

If PIH becomes worse, you will need to be admitted to the hospital where you can be closely monitored. Your health care provider will work with you to maintain the health of you and your baby. In severe cases, the baby may have to be delivered.

risk factors for hypertension

Who is at risk of developing pregnancy-induced hypertension?

A woman is more likely to develop PIH if she:

  • Is under age 20 or over age 35
  • Has a history of chronic hypertension
  • Has a previous history of PIH
  • Has a female relative with a history of PIH
  • Is underweight or overweight
  • Has diabetes before becoming pregnant
  • Has an immune system disorder, such as lupus or rheumatoid arthritis
  • Has kidney disease
  • Has a history of alcohol, drug or tobacco use
  • Is expecting twins or triplets

Pulmonary hypertension

Pulmonary hypertension

Measuring levels of a hormone called brain natriuretic peptide in individuals with serious lung disease can predict the presence of pulmonary hypertension and a patient's potential death or survival, regardless of clinical severity or the cause of illness.

These results appear in the first issue for April 2006 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.

Juergen Behr, M.D., of the Division of Pulmonary Diseases in the Department of Internal Medicine at Ludwig Maximillians University in Munich, Germany, and six associates studied brain natriuretic peptide (BNP) in the circulation of 176 consecutive adult patients with a variety of pulmonary diseases. These patients also underwent right heart catheterization, lung function testing, and a 6-minute walk test.

BNP, a hormone produced by the heart, is activated by different cardiovascular diseases. Normally, the level of BNP in the blood is low. However, if the heart has to work harder over a longer period of time due to disease, the level of BNP rises.

The investigators noted that the purpose of their research was to uncover a safe, easy-to-perform method of identifying patients with increased probability of clinically significant pulmonary hypertension.

"In the absence of significant left heart disease, BNP serves as a marker of an increased workload in the right heart originating from idiopathic pulmonary arterial hypertension," Dr. Behr said.

During the 10 months following the study, 31 participants (18 percent) died of cardiopulmonary causes. "Patients who died during the follow-up period more frequently had elevated BNP levels and prominent pulmonary hypertension with significantly impaired right heart function," Dr. Behr continued.

The authors identified a pulmonary artery pressure greater than 35 mm Hg as a degree of significant pulmonary hypertension. Such measurements led to decreased 6-minute walk test distances and increased mortality. More than one-fourth of the patients in the study cohort showed pulmonary hypertension readings above that level.

"Despite the mixed nature of the study population, our data allows an estimation of the prevalence of pulmonary hypertension in a 'real life' setting of patients with advanced lung disease, because all participants underwent right heart catheterization as the reference diagnostic tool," said Dr. Behr.

The investigators concluded that BNP is a prognostic marker and a screening parameter for significant pulmonary hypertension in chronic lung disease.

Drugs For Treating Hypertension

Drugs For Treating Hypertension

Diuretics Is Better Than Other Drugs For Treating Hypertension

Use of calcium-channel blockers, alpha-blockers or angiotensin-converting enzyme (ACE) inhibitors appears to offer no advantages in improving clinical outcomes compared with use of diuretics when treating hypertension among individuals with metabolic syndrome. This appears particularly true for black patients.

Patients with hypertension (high blood pressure) and metabolic syndrome are at high risk for the complications of cardiovascular disease, according to background information in the article. The metabolic syndrome was defined as hypertension plus at least two of the following factors: diabetes or pre-diabetes; a body mass index (BMI) of at least 30; high triglyceride levels; or low levels of high-density lipoprotein ("good" cholesterol). Because some medications for high blood pressure (including alpha-blockers, ACE inhibitors and calcium channel blockers) have a favorable metabolic profile—for instance, have more favorable short-term effects on blood glucose or blood cholesterol levels—they have been advocated over other drugs (beta-blockers and diuretics) for the treatment of patients with metabolic syndrome.

Jackson T. Wright Jr., M.D., Ph.D., of University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, and colleagues analyzed data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). A total of 42,418 participants with hypertension and at least one other risk factor for cardiovascular disease were randomly assigned to take a diuretic (chlorthalidone, 15,255 patients), a calcium channel blocker (amlodipine besylate, 9,048 patients), an alpha-blocker (doxazosin mesylate, 9,061 patients) or an ACE inhibitor (lisinopril, 9,054 patients).

Each drug was used to start treatment and other drugs could be added if necessary to control blood pressure. Patients were followed for an average of 4.9 years for all drugs except the alpha-blocker; that arm of the trial was discontinued after an average 3.2 years of follow-up in light of increased rates of cardiovascular disease, including a near two-fold increased rates of heart failure, when compared with the diuretic arm. A total of 23,077 ALLHAT participants (54.4 percent) met criteria for metabolic syndrome.

"No differences were noted among the four treatment groups, regardless of race or metabolic syndrome status for the primary end point (non-fatal myocardial infarction [heart attack] and fatal coronary heart disease)," the authors write. Among patients with the metabolic syndrome (7,327 black and 15,750 white patients), the calcium channel blocker, ACE inhibitor and alpha-blocker had higher rates of heart failure compared with the diuretic; the ACE inhibitor and the alpha-blocker also had an increased risk of combined cardiovascular disease.

"The lack of benefit of the agents with the most favorable metabolic profile (i.e., ACE inhibitors and alpha-blockers) was especially marked in the black participants with metabolic syndrome," the authors write. "The magnitude of the excess risk of end-stage renal [kidney] disease (70 percent), heart failure (49 percent) and stroke (37 percent) and the increased risk of combined cardiovascular disease and combined coronary heart disease strongly argue against the preference of ACE inhibitors over diuretics as the initial therapy in black patients with metabolic syndrome. Similar higher risk was noted for those randomized to the alpha-blocker vs. the diuretic."

"These findings fail to provide support for the selection of alpha-blockers, ACE inhibitors, or calcium channel blockers over thiazide-type diuretics to prevent cardiovascular or renal outcomes in patients with metabolic syndrome, despite their more favorable metabolic profiles," the authors conclude.

Pregnancy-induced hypertension

What is pregnancy-induced hypertension?

Pregnancy-induced hypertension (which may also be called preeclampsia, toxemia or toxemia of pregnancy) is a pregnancy complication characterized by high blood pressure, swelling due to fluid retention and protein in the urine.

symptoms of pregnancy-induced hypertension

Rapid or sudden weight gain, high blood pressure, protein in the urine, as well as swelling* in the hands, feet and face are all signs of PIH Other symptoms include abdominal pain, severe headaches, a change in reflexes, reduced output of urine or no urine, blood in the urine, dizziness or excessive vomiting and nausea.

*Note: Some swelling is normal during pregnancy. However, if the swelling doesn't go away and is accompanied by some of the above symptoms, be sure to see your doctor right away.