Spanish HIPERTENSION, PRESION SANGUINEA ALTA, Presión sanguínea alta, HTA, Hipertensión NEOM, Hipertensión arterial, HT, HIPERTENSION ARTERIAL, enfermedad hipertensiva, SAI, [X]enfermedades hipertensivas (trastorno), enfermedad hipertensiva, SAI (trastorno), [X]enfermedades hipertensivas, Hypertensive disease NOS, degeneración vascular hipertensiva, enfermedad hipertensiva, enfermedad vascular hipertensiva, hiperpiesia, hiperpiesis, hipertensión arterial (trastorno), hipertensión arterial, presión arterial alta, tensión arterial alta, tensión arterial elevada, Hipertensión, Presión Sanguínea Alta
The results of the Second Australian National Blood Pressure Study (ANBP2) followed soon after ALLHAT results were published. This was a randomized, open-label, blinded end point study of 6083 hypertensive patients aged 65–84 years, who otherwise had a relatively low cardiovascular risk profile, with a median follow-up of 4.1 years (31). Initial treatment options included ACE-I or a diuretics-based regimen (HCTZ and Enalapril were the recommended agents). The key findings from the study were:
Elevated arterial pressure is one of the most important public health problems in developed countries. In the United States, for instance, nearly 30 percent of the adult population is hypertensive. High blood pressure is significantly more prevalent and serious among African Americans. Age, race, sex, smoking, alcohol intake, elevated serum cholesterol, salt intake, glucose intolerance, obesity, and stress all may contribute to the degree and prognosis of the disease. In both men and women, the risk of developing high blood pressure increases with age.
The NHLBI is part of the U.S. Department of Health and Human Services’ National Institutes of Health (NIH)—the Nation’s biomedical research agency that makes important scientific discovery to improve health and save lives. We are committed to advancing science and translating discoveries into clinical practice to promote the prevention and treatment of heart, lung, blood, and sleep disorders, including high blood pressure. Learn about the current and future NHLBI efforts to improve health through research and scientific discovery.
Sun X, Li C, Liu Y, Du L, Zeng M, Zheng X, Zhang W, Liu Y, Zhu M, Kong D, Zhou L, Lu L, Shen Z, Yi Y, Du L, Qin M, Liu X, Hua Z, Sun S, Yin H, Zhou B, Yu Y, Zhang Z and Duan S (2018) T-Cell Mineralocorticoid Receptor Controls Blood Pressure by Regulating Interferon-Gamma, Circulation Research, 120:10, (1584-1597), Online publication date: 12-May-2017.
While there have been a number of short-term (4–24 weeks’ duration) placebo-controlled trials that have shown beneficial effects of spironolactone in TRH 17, the strongest evidence for the use of spironolactone in TRH has recently been obtained from the PATHWAY-2 trial 19. All patients who were already receiving A+C+D medications were randomised to receive 12-week sequential treatments of placebo, spironolactone, the α 1-adrenoceptor antagonist doxazosin, and the β 1-adrenoceptor antagonist bisoprolol. In this study, spironolactone reduced home blood pressure recordings by approximately double that of other active treatment arms and showed for the first time a direct drug comparison in the same TRH patients. There was also a significant inverse correlation between plasma renin and blood pressure reduction by spironolactone, suggesting that sodium retention contributed to TRH. In this study 19 and earlier studies 17, there was a low incidence of adverse effects. While it has been argued that these results should influence treatment guidelines 19, it will be of great interest to determine long-term TRH outcomes in this particular cohort, including potential adverse outcomes, given the combined use of an ACE inhibitor or an AT 1 receptor antagonist together with mineralocorticoid receptor blockade. Of interest, newer nonsteroidal mineralocorticoid receptor antagonists, such as finerenone, have been developed to target the heart and are being trialled in heart failure 20.
Secondary hypertension can be caused by kidney disease; sleep apnea; coarctation of the aorta; disease of the blood vessels supplying the kidneys; various endocrine gland disorders; the use of oral contraceptives; smoking; alcohol intake of more than two drinks per day; chronic use of non-steroidal anti-inflammatory drugs (NSAIDs); and antidepressant use.
Gary Edward Sander, MD, PhD, FACC, FAHA, FACP, FASH Professor of Medicine, Director of CME Programs, Team Leader, Root Cause Analysis, Tulane University Heart and Vascular Institute; Director of In-Patient Cardiology, Tulane Service, University Hospital; Visiting Physician, Medical Center of Louisiana at New Orleans; Faculty, Pennington Biomedical Research Institute, Louisiana State University; Professor, Tulane University School of Medicine
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 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.
All of these lucky developments eventually produced the first multi-center hypertension treatment trial (the first VA Co-operative research study on hypertension), which was published in JAMA in 1967. The major findings of these and other landmark studies that followed in the subsequent 50 years are highlighted in this timeline. Considering the importance of the topic, there had been very few attempts to detail the history of hypertension treatment. Noteworthy are Dr. Moser’s personal account and a more detailed timeline created by Theodore Kotchen (14).
Hypertension does not usually cause any noticeable symptoms. When it does, you might experience dizziness, shortness of breath, headaches, and nosebleeds, which could indicate that your blood pressure is rising. Complications such as heart disease, stroke, and kidney failure can occur if long-term hypertension is not adequately treated. A hypertensive emergency, which is an uncommon and dangerous event, may cause blurry vision, nausea, chest pain and anxiety.
If lifestyle modifications are insufficient to achieve the goal blood pressure (BP), there are several drug options for the treatment and management of hypertension. Based on the Seventh Report of the Joint National Committee of Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) and the 2010 Institute for Clinical Systems Improvement (ICSI) guideline on the diagnosis and treatment of hypertension recommendations, thiazide diuretics were the preferred initial agents in the absence of compelling indications. 
Blood pressure often increases in stages. A person in her thirties may have mild to moderately elevated blood pressure readings. As she ages, blood pressure may continue to slowly rise. If someone develops high blood pressure before the age of 50, the risk of heart attack and stroke is greatly increased. If untreated, high blood pressure can reduce life expectancy by 10 or more years.
Calcium channel blockers are drugs that reduce the movement of calcium into cells of the heart and vessels. This reduces the strength of heart contractions and relaxes the arteries, allowing them to remain more open, lowering blood pressure. Side effects of calcium channel blockers can include heart palpitations, dizziness, swollen ankles, and constipation. Calcium channel blockers can be taken alone or with other blood pressure medications. They should be taken with food or milk. Because of potential interactions, those taking calcium channel blockers should avoid alcohol and grapefruit juice.
There have been two mineralocorticoid receptor antagonists available for many decades. The second-generation compound eplerenone has reduced affinity for androgen and progesterone receptors compared with the first-generation antagonist spironolactone, but it is also less potent than spironolactone at blocking aldosterone receptors, hence the greater anti-hypertensive potency exhibited by spironolactone 17. Just as the RALES trial 18 led to a resurgence in the use of spironolactone and later eplerenone for the treatment of severe heart failure, there is renewed interest in the use of mineralocorticoid receptor antagonists for treatment-resistant hypertension (TRH), if this is caused by aldosterone breakthrough in patients already being treated with an ACE inhibitor or an AT 1 receptor antagonist, leading to sodium retention 17.
Because some medications, such as over-the-counter cold medicines, pain medications, antidepressants, birth control pills and others, can raise your blood pressure, it might be a good idea to bring a list of medications and supplements you take to your doctor's appointment. Don't stop taking any prescription medications that you think may affect your blood pressure without your doctor's advice.