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Author: Madison Burris

Hypertension is a condition of abnormally high blood pressure which exists when there is a force of blood against the artery walls, that when high enough, results in elevated health risks and may lead to eventual health problems, such as heart disease. Hypertension is the most common primary diagnosis in the United States, with an approximate 31% prevalence rate, which is still on the rise. In 2005 there were an estimated 35.3 million hypertensive men, and 38.3 million hypertensive women, with hypertension being more prevalent in African-Americans than Hispanic and non-Hispanic white people (Riaz).


One is diagnosed as hypertensive when the systolic blood pressure (SBP) is greater or equal to 140 mmHg, the diastolic blood pressure (DBP) is greater or equal to 90 mmHg, or when one is on antihypertensive medication. Systolic blood pressure is the maximum pressure that is within the arteries when the heart contracts and diastolic blood pressure is the minimum pressure within the arteries between each of the heart's contractions ("Hypertension"). There are several stages of hypertension as defined by the Seventh report of the Joint National Committee (JNC-7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, in 2003. One is said to be pre-hypertensive if the SBP is between 120-139 mmHg, or the DBP is between 80-89 mmHg. Stage one hypertension is described when one has a SBP between 140-159 mmHg or a DBP between 90-99 mmHg, while stage two hypertension is anything with a SBP of 160 mmHg or a DBP of 100 mmHg or greater (Iliades).


The risk of cardiovascular disease increases progressively with incremental increases in blood pressure. Studies have shown that beginning with a blood pressure of 115/75 mmHg, the risk for cardiovascular disease doubles with each 20 mmHg increment in SBP and with each 10 mmHg increment in DBP. High blood pressure can quietly damage an individual's body for years before any symptoms develop or are detected. Uncontrolled and prolonged elevations of blood pressure can result in a variety of changes in the "myocardial structure, coronary vasculature, and conduction system of the heart" (Riaz). These mal-adaptations can lead to the development of more serious complications and increase the risk for a variety of cardiovascular diseases including: stroke, atrial fibrillation, peripheral vascular disease, left coronary artery disease, coronary artery disease, various conduction system diseases, and systolic and diastolic dysfunction of the myocardium. These various cardiovascular diseases can manifest into angina (chest pain) or myocardial infarctions, cardiac arrhythmias, and congestive heart failure (Kaplan, Riaz). For all inclusive purposes, hypertensive heart disease is a term that is applied generally to heart diseases that are caused directly or indirectly by the consequences of hypertension.


However, there is no proof of exact causation since "increasing blood pressure could be a marker for other risk factors such as increasing body weight, which is associated with dyslipidemia, glucose intolerance, and the metabolic syndrome" (Kaplan). The etiology of hypertensive heart disease is a complex "interplay of various hemodynamic, structural, neuroendocrine, cellular, and molecular factors" (Riaz). All of these factors play important roles in the development of hypertension and its related complications, but an elevated blood pressure can, in itself, modulate these factors. Recently is has been emphasized that the absolute risk of cardiovascular events are from a combination of different things. Blood pressure is only one part, as the likelihood of an event is also influenced by age, gender, race, and the presence of other cardiovascular risk factors. For example, obesity has been linked to hypertension and left ventricular hypertrophy. Various epidemiological studies have reported that as many as 50% of obese patients also suffer from some degree of hypertension and as many as 60-70% of hypertensive patients are obese (Riaz).


For treatment, JNC-7 recommends lifestyle modifications for all pre-hypertensive and hypertensive individuals. Major lifestyle modifications that have proven to effectively reduce blood pressure include: weight reduction in those that are said to be overweight or obese, adoption of the Dietary Approaches to Stop Hypertension (DASH) eating plan, reduction of dietary sodium, an increase in physical activity, and moderation of alcohol consumption (Chobanian). Documented systolic and diastolic blood pressure reductions with lifestyle modifications vary among individuals and are dose and time dependent. However, if a person adopts all five of the recommended lifestyle modifications, they can theoretically lower their blood pressure by 21-55 mmHg and ultimately get down to their target blood pressure goal. Emerging data supports a target blood pressure goal of less than 140/90 mmHg for most people, 150/80 mmHg in patients over the age of 80, and less than 130/80 mmHg for those with established cardiovascular disease, type two diabetes, or renal disease (Chobanian, Riaz). Over the years the most effective forms of hypertension reduction have been found through the use of diet modification, exercise, and antihypertensive drug therapy.


For hypertension, as with many other chronic conditions that are asymptomatic in early stages, failure to adhere to drug or lifestyle modification recommendations is common and should be taken carefully into consideration by the medical care providers. The most effective therapy prescribed will control blood pressure and reduce hypertension only if the patients remain motivated. Levels of motivation improve when patients have positive experiences with and trust their medical provider. All diagnoses of hypertension are different and are case specific to each patient. As the symptoms vary, each treatment plan must be altered accordingly and ultimately the responsible medical care provider's judgment remains paramount.

References:

Chobanian AV, Bakris GL, Black HR. U.S. Department of Health and Human Services, comp. "JNC 7 Express." The Seventh Report on the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2003): 1-27. National Institutes of Health, Dec. 2003. Web. 14 Sept. 2017. http://www.nhlbi.nih.gov/files/docs/guidelines/express.pdf

"Hypertension." Cardiovascular Disease Risk Factors. World Heart Federation, 2014. Web. 16 Sept. 2017. http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/hypertension/

Iliades, Chris, and Pat F. Bass. "The Stages of Hypertension." EverydayHealth.com. Everyday Health Media, 2014. Web. 14 Sept. 2017. http://www.everydayhealth.com/hypertension/understanding/stages-of-hypertension.aspx

Kaplan, Norman. "Cardiovascular Risks of Hypertension." Cardiovascular Risks of Hypertension. UpToDate, 4 June 2017. Web. 14 Sept. 2017. http://www.uptodate.com/contents/cardiovascular-risks-of-hypertension.

Riaz, Kamran, and Yasmine Ali. "Hypertensive Heart Disease ." Hypertensive Heart Disease. MedScape, 5 Dec. 2013. Web. 15 Sept. 2017. http://emedicine.medscape.com/article/162449-overview