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James, Paul A.; Oparil, Suzanne; Carter, Barry L.; Cushman, William C.; Dennison-Himmelfarb, Cheryl; Handler, Joel; Lackland, Daniel T.; Lefevre, Michael L.; MacKenzie, Thomas D.; Ogedegbe, Olugbenga; Smith, Sidney C.; Svetkey, Laura P.; Taler, Sandra J.; Townsend, Raymond R.; Wright, Jackson T.; Narva, Andrew S.; Ortiz, Eduardo (18 December 2013). "2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults". JAMA. 311 (5): 507–20. doi:10.1001/jama.2013.284427. PMID 24352797.
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).[5][7] Other thresholds are used (135 mmHg systolic or 85 mmHg diastolic) if measurements are derived from 24-hour ambulatory or home monitoring.[79] 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[27] 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)[86] and British Hypertension Society (BHS) IV (2004)[87] 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.[27] The ESH-ESC Guidelines (2007)[86] and BHS IV (2004)[87] 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.[27] In November 2017, the American Heart Association and American College of Cardiology published a joint guideline which updates the recommendations of the JNC7 report.[88]
You will work with your provider to come up with a treatment plan. It may include only the lifestyle changes. These changes, such as heart-healthy eating and exercise, can be very effective. But sometimes the changes do not control or lower your high blood pressure. Then you may need to take medicine. There are different types of blood pressure medicines. Some people need to take more than one type.
In an attempt to elucidate the genetic components of hypertension, multiple genome wide association studies (GWAS) have been conducted, revealing multiple gene loci in known pathways of hypertension as well as some novel genes with no known link to hypertension as of yet. [25] Further research into these novel genes, some of which are immune-related, will likely increase the understanding of hypertension's pathophysiology, allowing for increased risk stratification and individualized treatment.
The third group of pulmonary hypertension causes is lung diseases or hypoxia, which is the name for a shortage of oxygen in the body. The most common diseases that cause pulmonary hypertension are chronic obstructive pulmonary disease (COPD), interstitial lung disease , and sleep-disordered breathing, a group of disorders that affect the breathing during the sleep like obstructive sleep apnoea (OSA). To treat pulmonary hypertension in these patients, it is necessary to treat the primary disease first.
Hypertension is the most important modifiable risk factor for coronary heart disease (the leading cause of death in North America), stroke (the third leading cause), congestive heart failure, end-stage renal disease, and peripheral vascular disease. Therefore, health care professionals must not only identify and treat patients with hypertension but also promote a healthy lifestyle and preventive strategies to decrease the prevalence of hypertension in the general population. (See Treatment.)

Other studies have demonstrated that a reduction in blood pressure (BP) may result in improved renal function. Therefore, earlier detection of hypertensive nephrosclerosis (using means to detect microalbuminuria) and aggressive therapeutic interventions (particularly with angiotensin-converting enzyme inhibitor drugs [ACEIs]) may prevent progression to end-stage renal disease. [10]
In an attempt to elucidate the genetic components of hypertension, multiple genome wide association studies (GWAS) have been conducted, revealing multiple gene loci in known pathways of hypertension as well as some novel genes with no known link to hypertension as of yet. [25] Further research into these novel genes, some of which are immune-related, will likely increase the understanding of hypertension's pathophysiology, allowing for increased risk stratification and individualized treatment.
Whenever confronted with resistant hypertension, try to exclude any secondary causes of hypertension. A reevaluation of the patient’s history, physical examination, and laboratory results may provide clues to secondary hypertension (eg, renal artery stenosis, primary hyperaldosteronism, obstructive sleep apnea). Primary hyperaldosteronism is estimated to have a prevalence of 20% in this population. [110]
Hypertension may be primary, which may develop as a result of environmental or genetic causes, or secondary, which has multiple etiologies, including renal, vascular, and endocrine causes. Primary or essential hypertension accounts for 90-95% of adult cases, and a small percentage of patients (2-10%) have a secondary cause. Hypertensive emergencies are most often precipitated by inadequate medication or poor compliance.

Most individuals diagnosed with hypertension will have increasing blood pressure (BP) as they age. Untreated hypertension is notorious for increasing the risk of mortality and is often described as a silent killer. Mild to moderate hypertension, if left untreated, may be associated with a risk of atherosclerotic disease in 30% of people and organ damage in 50% of people within 8-10 years after onset.
The renin-angiotensin-aldosterone system helps regulate blood volume and therefore blood pressure. Renin, an enzyme formed in the juxtaglomerular apparatus, catalyzes conversion of angiotensinogen to angiotensin I. This inactive product is cleaved by ACE, mainly in the lungs but also in the kidneys and brain, to angiotensin II, a potent vasoconstrictor that also stimulates autonomic centers in the brain to increase sympathetic discharge and stimulates release of aldosterone and vasopressin. Aldosterone and vasopressin cause sodium and water retention, elevating BP. Aldosterone also enhances potassium excretion; low plasma potassium (< 3.5 mEq/L) increases vasoconstriction through closure of potassium channels. Angiotensin III, present in the circulation, stimulates aldosterone release as actively as angiotensin II but has much less pressor activity. Because chymase enzymes also convert angiotensin I to angiotensin II, drugs that inhibit ACE do not fully suppress angiotensin II production.
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
How do you check your own blood pressure? It is common to have your blood pressure checked at the doctor's office, but there are many cases where it is important to monitor it at home. It is easy to check blood pressure with an automated machine, but it can also be done manually at home. Learn how to check your own blood pressure and what the results mean. Read now
High blood pressure (for example, 180/110 or higher) may indicate an emergency situation. If this high blood pressure is associated with chest pain, shortness of breath, headache, dizziness, or back or abdominal pain, seek medical care immediately. If you are experiencing no associated symptoms with a high blood pressure reading such as this, re-check it again within a few minutes and contact your doctor or go to an emergency room if it is still high.

^ Saiz, Luis Carlos; Gorricho, Javier; Garjón, Javier; Celaya, Mª Concepción; Muruzábal, Lourdes; Malón, Mª del Mar; Montoya, Rodolfo; López, Antonio (2017-10-11). "Blood pressure targets for the treatment of people with hypertension and cardiovascular disease". Cochrane Database of Systematic Reviews. 10: CD010315. doi:10.1002/14651858.cd010315.pub2. PMID 29020435.

Dr Jacomien de Villiers qualified as a specialist physician at the University of Pretoria in 1995. She worked at various clinics at the Department of Internal Medicine, Steve Biko Hospital, these include General Internal Medicine, Hypertension, Diabetes and Cardiology. She has run a private practice since 2001, as well as a consultant post at the Endocrine Clinic of Steve Biko Hospital.
High blood pressure is extremely common in adults, and it is estimated as many as 30% of individuals have varying degrees of high blood pressure.  High blood pressure can be present for years without hypertension symptoms, but can still damage your heart and blood vessels. In fact, most people have no symptoms. For those who do show signs or have severe enough hypertension, high blood pressure signs may include:
To control or lower high blood pressure, your doctor may recommend that you adopt heart-healthy lifestyle changes, such as heart-healthy eating patterns like the DASH eating plan, alone or with medicines. Controlling or lowering blood pressure can also help prevent or delay high blood pressure complications, such as chronic kidney disease, heart attack, heart failure, stroke, and possibly vascular dementia.
140. Krum H, Schlaich M, Whitbourn R, Sobotka PA, Sadowski J, Bartus K, Kapelak B, Walton A, Sievert H, Thambar S, Abraham WT, Esler M. Catheter-based renal sympathetic denervation for resistant hypertension: a multicentre safety and proof-of-principle cohort study.Lancet. 2009;373:1275–1281. doi: 10.1016/S0140-6736(09)60566-3.CrossrefMedlineGoogle Scholar
Ambulatory blood pressure monitoring can be done by using at-home devices that measure your blood pressure at periodic increments throughout a 24-hour or 48-hour time period. This provides your medical team with an average blood pressure reading that is believed to be more accurate than one taken at the doctor's office. Accumulating evidence supports the reliability of this approach.
* Some examples of agents that induce hypertension include nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors; illicit drugs; sympathomimetic agents; oral contraceptive or adrenal steroid hormones; cyclosporine and tacrolimus; licorice; erythropoietin; and certain over-the-counter dietary supplements and medicines, such as ephedra, ma huang, and bitter orange. Drug-related causes of hypertension may be due to nonadherence, inadequate doses, and inappropriate combinations.
The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

Not Smoking While smoking is a proven risk factor for heart problems like heart attack and stroke, researchers are still trying to understand its connection to high blood pressure. Both smoking and secondhand exposure to tobacco smoke increases the risk of plaque inside the arteries, a condition known as atherosclerosis, which high blood pressure accelerates.
To control or lower high blood pressure, your doctor may recommend that you adopt heart-healthy lifestyle changes, such as heart-healthy eating patterns like the DASH eating plan, alone or with medicines. Controlling or lowering blood pressure can also help prevent or delay high blood pressure complications, such as chronic kidney disease, heart attack, heart failure, stroke, and possibly vascular dementia.
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 mechanisms of action.[131] Failing to take the prescribed drugs, is an important cause of resistant hypertension.[132] Resistant hypertension may also result from chronically high activity of the autonomic nervous system, an effect known as "neurogenic hypertension".[133] Electrical therapies that stimulate the baroreflex are being studied as an option for lowering blood pressure in people in this situation.[134]

The differences may reflect the design of the trials. Results from non-randomised studies are more likely to be favourable to the drug of interest than those of randomised trials. Within randomised trials, less weight should be given to the results if allocation to treatment or control arms was not concealed. The populations included in the trials may not be comparable (for example, the ALLHAT and the ANBP2 studies4). Patient outcomes may be expressed in different ways (incidence of stroke, of coronary disease, 'all-cause' cardiovascular morbidity or mortality) that render comparison difficult or impossible. Undeclared conflict of interest may impinge, if not on the results of a study, then at least on its interpretation. Finally, all studies work with samples of the total patient population and the simple play of chance influences the result of any one trial. This is why greater reliance should be placed on the results of trials with larger patient numbers or on systematic reviews or meta-analyses of several studies.

Hypertension, or high blood pressure, is dangerous because it can lead to strokes, heart attacks, heart failure, or kidney disease. The goal of hypertension treatment is to lower high blood pressure and protect important organs, like the brain, heart, and kidneys from damage. Treatment for hypertension has been associated with reductions in stroke (reduced an average of 35%-40%), heart attack (20%-25%), and heart failure (more than 50%), according to research.


The history of hypertension goes back a long way (1). In ancient Chinese and Indian Ayurvedic medicine, the quality of an individual’s pulse, as felt by gentle palpation by the trained physician, was a window into the condition of the cardiovascular system. What was called “hard pulse” possibly would qualify for the modern term of hypertension. Any article on the history of hypertension, however, is incomplete without a mention of Akbar Mahomed’s contribution in developing the modern concept of hypertension. In the late nineteenth century, Frederick Akbar Mahomed (1849–1884), an Irish-Indian physician working at Guy’s hospital in London, first described conditions that later came to be known as “essential hypertension,” separating it from the similar vascular changes seen in chronic glomerulonephritis such as Bright’s disease. Some of the noteworthy contributions of Akbar Mahomed were the demonstration that high BP could exist in apparently healthy individuals, that high BP was more likely in older populations, and that the heart, kidneys, and brain could be affected by high arterial tension (Interested readers may read about Akbar’s life in a detailed account written by Cameron in Kidney international) (2, 3). However, only with the advent of the mercury sphygmomanometer in the early twentieth century and defining of the systolic and diastolic BP by appearance/disappearance of Korotkoff sounds as heard via the stethoscope, the modern quantitative concept of hypertension – broken into systolic and diastolic categories – came into existence. By the middle of the twentieth century, checking BP by sphygmomanometer became part of the routine physical examination in hospitals and clinics (4).
The appropriate therapy depends on the cause of excessive aldosterone production. A CT scan with dynamic protocol may help localize an adrenal mass, indicating adrenal adenoma, which may be a nonsecreting incidentaloma or a hypersecreting adenoma. If the results of the CT scan are inconclusive, adrenal venous sampling for aldosterone and cortisol levels should be performed.
The CAFE study (33) was a large sub study of the ASCOT trial. The CAFE trial was primarily designed to investigate differences in central aortic pressures vs. cuff BP in the two groups in ASCOT participants. The secondary aim of the trial was to examine if a relationship existed between central aortic pressures and cardiovascular outcomes. The central aortic BP was measured by use of applanation tonometry (Sphygmocore).
This is a substudy of the ASCOT and this is the only large study that examined the variable effect of different class of drugs on reducing central aortic pressure (as measured by the new non-invasive technique of applanation tonometry) vs. usual peripheral blood pressures(brachial pressure). This study gave answer to the lingering question why beta blocker like atenolol was not very effective in reducing stroke in hypertensive patients.
Malignant hypertension is the sudden development of extremely high blood pressure and should be treated as a hypertensive crisis or medical emergency. Typically a person would jump to 180/120 blood pressure. This can be caused by untreated high blood pressure, missing high blood pressure medication, kidney disease, tumors, spinal cord injuries, or illegal drugs. It is very rare, where only 1% of individuals develop this condition, but it is life threatening. The main symptoms are:
Hypertension may be primary, which may develop as a result of environmental or genetic causes, or secondary, which has multiple etiologies, including renal, vascular, and endocrine causes. Primary or essential hypertension accounts for 90-95% of adult cases, and a small percentage of patients (2-10%) have a secondary cause. Hypertensive emergencies are most often precipitated by inadequate medication or poor compliance.
If we combine the evidence from each of the selection criteria, it is difficult to escape the conclusion that treatment of patients with uncomplicated hypertension should be started with low-dose thiazide-type diuretics. Failure to respond adequately will probably require the addition of another drug, while the emergence of unacceptable adverse effects is a reason for changing to an alternative class of drug.
93. Parvanova A, van der Meer IM, Iliev I, Perna A, Gaspari F, Trevisan R, Bossi A, Remuzzi G, Benigni A, Ruggenenti P; Daglutril in Diabetic Nephropathy Study Group. Effect on blood pressure of combined inhibition of endothelin-converting enzyme and neutral endopeptidase with daglutril in patients with type 2 diabetes who have albuminuria: a randomised, crossover, double-blind, placebo-controlled trial.Lancet Diabetes Endocrinol. 2013;1:19–27. doi: 10.1016/S2213-8587(13)70029-9.CrossrefMedlineGoogle Scholar

^ Jump up to: a b Brook RD, Appel LJ, Rubenfire M, Ogedegbe G, Bisognano JD, Elliott WJ, Fuchs FD, Hughes JW, Lackland DT, Staffileno BA, Townsend RR, Rajagopalan S, American Heart Association Professional Education Committee of the Council for High Blood Pressure Research, Council on Cardiovascular and Stroke Nursing, Council on Epidemiology and Prevention, and Council on Nutrition, Physical, Activity (Jun 2013). "Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the American Heart Association". Hypertension. 61 (6): 1360–83. doi:10.1161/HYP.0b013e318293645f. PMID 23608661.
According to the Centers for Disease Control and Prevention, more than 50% of people age 50 and older have high blood pressure. Women are about as likely as men to develop high blood pressure, though this varies somewhat by age. For people younger than age 45, more men than women are affected, while for those age 65 and older, more women than men are affected. Americans of African descent develop high blood pressure more often and at an earlier age than those of European and Hispanic descent.
30. Parvanova A, van der Meer IM, Iliev I, et al. : Effect on blood pressure of combined inhibition of endothelin-converting enzyme and neutral endopeptidase with daglutril in patients with type 2 diabetes who have albuminuria: a randomised, crossover, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol. 2013;1(1):19–27. 10.1016/S2213-8587(13)70029-9 [PubMed] [CrossRef]
^ Martin-Cabezas, Rodrigo; Seelam, Narendra; Petit, Catherine; Agossa, Kévimy; Gaertner, Sébastien; Tenenbaum, Henri; Davideau, Jean-Luc; Huck, Olivier (2016-10). "Association between periodontitis and arterial hypertension: A systematic review and meta-analysis". American Heart Journal. 180: 98–112. doi:10.1016/j.ahj.2016.07.018. ISSN 1097-6744. PMID 27659888. Check date values in: |date= (help)
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.[87] 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.[96] 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.[97] 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.[96]
Several situations demand the addition of a second drug, because 2 drugs may be used at lower doses to avoid the adverse effects that may occur with higher doses of a single agent. Diuretics generally potentiate the effects of other antihypertensive drugs by minimizing volume expansion. Specifically, the use of a thiazide diuretic in conjunction with a beta-blocker or an ACEI has an additive effect, controlling BP in up to 85% of patients.
Everyone age 3 or older should have their blood pressure checked by a healthcare provider at least once a year. Your doctor will use a blood pressure test to see if you have consistently high blood pressure readings. Even small increases in systolic blood pressure can weaken and damage your blood vessels. Your doctor will recommend heart-healthy lifestyle changes to help control your blood pressure and prevent you from developing high blood pressure.
The United Kingdom Prospective Diabetes Study (27, 28) was set up to find answers for several key questions related to diabetes management. Two key questions that the study aimed to answer in relation to hypertension were (1) did tight control of blood pressure in diabetics have an effect on complications and (2) was there any specific advantage or disadvantage of using a beta blocker or angiotensin converting enzyme inhibitor in treating hypertension in this population.
In the absence of major differences in efficacy, safety and convenience, comparative cost may become the final discriminator. In a Pharmaceutical Benefits Scheme (PBS) which is continually under threat, small differences in cost (to the taxpayer) in treating a condition which affects 10-15% of the population can add up to substantial sums, particularly as treatment is usually lifelong.
Acceptable techniques for obtaining the necessary proof are presently not available. We believe that critical techniques designed for a more precise and scientific answer to the problem under discussion will appear much sooner in an atmosphere of less enthusiasm and more caution in interpreting the results and implication of this form of therapy (8).
We may perform a cardiac catheterization, which is the gold standard to provide a definitive diagnosis of PH, to determine the severity of PH and guide our treatment. Because cardiac catheterization is an invasive procedure we require the assistance of our cardiac anesthesiologists and often a night’s stay in our Evelyn and Daniel M. Tabas Cardiac Intensive Care Unit. Because we perform hundreds of catheterizations in children with PH, we can identify and minimize the risks of this procedure. During the procedure, a catheter is threaded through blood vessels into the right side of the heart to the pulmonary artery. With this catheter, we measure the pressures in the pulmonary vessels and the blood flow into the lungs to help us determine the severity of the condition and confirm the diagnosis. We may give your child medications during the catheterization so that we can see how treatment will affect the pressure in the pulmonary artery. Catheterization can help us predict disease progression.
Pregnant women with pre-eclampsia or toxemia require rest and close monitoring by their healthcare practitioner. The only cure for pre-eclampsia is delivery of the baby. In deciding when to deliver, the healthcare practitioner will try to minimize the risk to mother and baby from pre-eclampsia while allowing the baby the maximum time to mature. The time delay must be balanced against the increasing danger of seizures and organ damage in the mother, emergency conditions that can be lethal to both the baby and the mother.
With the advent of noninvasive techniques, aortal renal bypass using a saphenous vein or hypogastric artery is not commonly employed for revascularization. PTRA can be an effective treatment for hypertension and the preservation of renal function in a subset of patients. PTRA may be the initial choice in younger patients with fibromuscular lesions amenable to balloon angioplasty. Renal artery stenting of osteal lesions has been associated with improved long-term patency.
Obstructive sleep apnea (OSA) is a common but frequently undiagnosed sleep-related breathing disorder defined as an average of at least 10 apneic and hypopenic episodes per sleep hour, which leads to excessive daytime sleepiness. Multiple studies have shown OSA to be an independent risk factor for the development of essential hypertension, even after adjusting for age, gender, and degree of obesity.
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.
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