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Hypertension

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Hypertension

NIH - High blood pressure (Hypertension) (Medical Encyclopedia) “Blood pressure readings are measured in millimeters of mercury (mmHg) and usually given as 2 numbers. For example, 140 over 90 (written as 140/90). • The top number is your systolic pressure, the pressure created when your heart beats. It is considered high if it is consistently over 140. • The bottom number is your diastolic pressure, the pressure inside blood vessels when the heart is at rest. It is considered high if it is consistently over 90. Either or both of these numbers may be too high. Pre-hypertension is when your systolic blood pressure is between 120 and 139 or your diastolic blood pressure is between 80 and 89 on multiple readings. If you have pre-hypertension, you are more likely to develop high blood pressure at some point. … Most of the time, no cause is identified. This is called essential hypertension. High blood pressure that results from a specific condition, habit, or medication is called secondary hypertension. Too much salt in your diet can lead to high blood pressure. Secondary hypertension may also be due to: • Adrenal gland tumor • Alcohol poisoning • Anxiety and stress • Appetite suppressants • Arteriosclerosis • Birth control pills • Certain cold medicines • Coarctation of the aorta • Cocaine use • Cushing syndrome • Diabetes • Kidney disease, including: o Glomerulonephritis (inflammation of kidneys) o Kidney failure o Renal artery stenosis o Renal vascular obstruction or narrowing • Migraine medicines • Hemolytic-uremic syndrome • Henoch-Schonlein purpura • Obesity • Pain • Periarteritis nodosa • Pregnancy (called gestational hypertension) • Radiation enteritis • Renal artery stenosis • Retroperitoneal fibrosis • Wilms' tumor “

NHS - Blood pressure (high) “Causes of high blood pressure There are two types of high blood pressure: • essential (or primary) high blood pressure - where there is no identifiable cause, and • secondary high blood pressure - where high blood pressure is the result of an underlying cause, such as kidney disease, or a particular type of medication that you are taking. Essential high blood pressure While the cause of essential high blood pressure remains unknown, there is compelling evidence to show that there are number of risk factors which increase your chances of developing the condition. These risk factors include: • age - the risk of developing high blood pressure increases as you get older, • a family history of high blood pressure - the condition seems to run in families, • being of Afro-Caribbean or South Asian origin, • obesity, • lack of exercise, • smoking, • excessive alcohol consumption, • high amount of salt in your diet, • high fat diet, and • stress. A number of other medical conditions have also been linked to an increase chance in developing essential high blood pressure, such as diabetes and kidney disease. Secondary high blood pressure A small amount of cases of high blood pressure (approximately 5%) are the result of an underlying condition or cause. These include: • kidney conditions, such as a kidney infection, or kidney disease, • narrowing of the arteries, • hormonal conditions, such as Cushing's syndrome (a condition where your body produces an excess of steroid hormones), • conditions affecting the tissue of the body, such as lupus (a condition where your immune system attacks healthy tissue), • medicines, such as the oral contraceptive pill, or the type of painkillers known as nonsteriodal anti-inflammatory drugs (NSAIDs), such as ibuprofen, • excessive alcohol consumption, and • illegal stimulants, such as cocaine, amphetamine and crystal meth”

Highlighted Articles

Prognostic Significance of Between-Arm Blood Pressure Differences (Hypertension. 2008) “Every 10-mm Hg difference in systolic BP between the arms conferred a mortality hazard of 1.24 (95% CI: 1.01 to 1.52) after adjusting for average systolic BP and chronic kidney disease. BP differences between arms are reproducible and carry prognostic information. Patients should have evaluation of BP in both arms at the screening visit.”

Salt intake, blood pressure and clinical outcomes. (Current Opinion in Nephrology & Hypertension. 2008) “Summary: Average sodium consumption in the US population is excessively high, and well above recommended limits. Because most sodium derives from processed and restaurant foods, a reduction of sodium in these sources, as recently called for by the American Medical Association, is necessary to reduce exposure.”

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Hypertension

Diagnosis, Imaging, and Screening

NEWS:

ACCOMPLISH: Systolic Blood Pressure With 24-Hour Monitoring No Different in Treatment Arms

Wolves in Sheep's Clothing: Don't Ignore White-Coat and Masked Hypertension “White-coat hypertension and masked hypertension should not be regarded as benign, say the authors of a new study [1]. Dr Giuseppe Mancia (University Milan-Bicocca, Monza, Italy ) and colleagues show in their 10-year trial, published online June 29, 2009 in Hypertension, that the risk of developing sustained hypertension is significantly higher in people with one of the above two conditions than in those who have normal blood pressure. There has been much debate about whether white-coat or masked hypertension is harmless or not, the researchers explain. "Earlier studies, all with shorter follow-up than this one, have been inconclusive," says Mancia in an AHA statement [2]. "This study is the first demonstration that white-coat hypertension and masked hypertension result in greater long-term risk of developing sustained hypertension, a major risk factor for heart attack and stroke. This means that these conditions are by no means clinically innocent, as they have often been thought to be." “

ARTICLES:

JOURNAL ARTICLES:

Office blood pressure and 24-hour ambulatory blood pressure measurements: high proportion of disagreement in resistant hypertension (Journal of Clinical Epidemiology 2009) “The office BP is still an important tool to monitor BP control of patients with TR hypertension, whereas the monitoring of patients with WCR hypertension requires ambulatory BP.”

The optimal home blood pressure monitoring schedule based on the Didima outcome study (Journal of Human Hypertension 2009) “In conclusion, by averaging more readings the average HBP and its variability are reduced and the prognostic ability improved. Any aspect of HBP monitoring (first or second readings, morning or evening) has similar prognostic ability. The first day gives higher and unstable values with lower prognostic ability and should be better discarded. These data validate the HBP monitoring schedule proposed by the European Society of Hypertension.”

Use of automated office blood pressure measurement to reduce the white coat response. (J Hypertens. 2009) “CONCLUSION: The white coat response associated with office BP measurements can be virtually eliminated by recording BP with the automated BpTRU device with patients resting alone in a quiet examining room.”

 

 

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