Hypertension

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Hypertension

NIH - Medical Encyclopedia: Essential hypertension "Essential hypertension refers to high blood pressure with no identifiable cause. ...Usually, high blood pressure has no symptoms at all. That is why it is often called the 'silent killer.' "

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.”

Natural antioxidants from tomato extract reduce blood pressure in patients with grade-1 hypertension: a double-blind, placebo-controlled pilot study. (Am Heart J. 2006)"A short-term treatment with antioxidant-rich tomato extract can reduce blood pressure in patients with grade-1 HT, naive to drug therapy."

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Hypertension

Diagnosis, Imaging, and Screening

NEWS:

24-Hour Ambulatory Blood Pressure Monitoring in Primary Care (JABFP 2001)

Ambulatory blood pressure characteristics in normotensive and treated hypertensive older people (Journal of Human Hypertension (2002))

Blood Pressure Differences Between Arms Could Signal Heart Risk “People whose systolic blood pressure -- the upper number in their reading -- is different in their left and right arms may be suffering from a vascular disease that could increase their risk of death, British researchers report. The arteries under the collarbone supply blood to the arms, legs and brain. Blockage can lead to stroke and other problems, the researchers noted, and measuring blood pressure in both arms should be routine.”

Get the most out of home blood pressure monitoring

Prognostic value of the morning blood pressure surge in 5645 subjects from 8 populations. (Hypertension. 2010) “Our study established the prognostic value of the morning surge in blood pressure in general populations. An exaggerated morning surge, exceeding the 90th percentile of the population, is an independent risk factor for mortality and cardiovascular and cardiac events, especially in smokers. Conversely, a sleep-through or preawakening morning surge in systolic blood pressure <20 mm Hg is probably not associated with an increased risk of death or cardiovascular events.”

ARTICLES:

Differences in Blood Pressure Between Arms May Signal Blood Vessel Problems

Get the most out of home blood pressure monitoring “Encourage better control. Taking your own blood pressure measurements can result in better blood pressure control. You gain a stronger sense of responsibility for your health, and you may be even more motivated to control your blood pressure with an improved diet, physical activity and proper medication use.”

How Does Exercise & Position Affect Blood Pressure?

Hypertension: Tackling challenges in the diagnosis and management of hypertension in 2012

Normal Blood Pressure Increase During Treadmill Tests “Under normal circumstances, you can expect systolic blood pressure to increase to about 200 at the peak of the test and diastolic blood pressure to remain steady or fall only slightly. Heart disease is a likely if your systolic pressure does not rise above 120, if it falls, or if your diastolic pressure rises above 90 to 100. … During the test, says HeartSite.com, an unblocked coronary artery will dilate, or become larger to provide increased blood flow to your heart. Blood pressure will rise as your heart begins pumping faster to accommodate the muscles need for additional blood. If, however, your arteries cannot dilate enough to accommodate this increased need for blood due to coronary artery blockage, blood pressure will not increase sufficiently and your heart, as well as your muscles will not get the extra blood they require. If the test continues, reduced blood flow to muscles can cause symptoms such as chest pain or extreme shortness of breath.”

Treadmill Stress Test

Treadmill Stress Testing

When and how to use self (home) and ambulatory blood pressure monitoring (JASH 2008) “The accurate measurement of blood pressure (BP) remains the most important technique for evaluating hypertension and its consequences, and there is increasing evidence that the traditional office BP measurement procedure may yield inadequate or misleading estimates of a patient's true BP status. The limitations of office BP measurement arise from at least four sources: 1) the inherent variability of BP coupled with the small number of readings that are typically taken in the doctor's office, 2) poor technique (e.g., terminal digit preference, rapid cuff deflation, improper cuff, and bladder size), 3) the white coat effect (the increase of BP that occurs in the medical care environment), and 4) the masked effect (a decrease of BP that occurs in the medical care environment that may lead to under treatment; in the case of ‘masked’ hypertension, the out-of-office BP is hypertensive while the resting, in-office BP is normotensive, or substantially lower than the out-of-office BP). Nearly 70 years ago there were observations made that office BP can vary by as much as 25 mm Hg between visits.1 The solution to this dilemma is potentially two-fold: by improving the office BP technique (e.g., using accurate validated automated monitors that can take multiple readings), and by using out-of-office monitoring to supplement the BP values taken in the clinical environment.”

JOURNAL ARTICLES:

An epidemiological approach to ambulatory blood pressure monitoring:the Belgian Population Study. (Blood Press Monit. 1996) “These boundaries were not materially altered when we considered only the 275 participants who had been normotensive both at home and at the clinic (127/79, 135/87 and 118/72 mmHg, respectively). When, in addition to the Belgian data, other reports on large cohorts were also analysed, the transition from normotension to hypertension on ambulatory measurement was likely to be within the ranges of 130-135/80-85, 135-140/85-90 and 120-125/70-75 mmHg for 24 h, daytime and night-time pressures, respectively.”

Blood Pressure Response During Treadmill Testing as a Risk Factor for New-Onset Hypertension (Circulation. 1999) “In normotensive men and women, an exaggerated diastolic BP response to exercise was associated with a 2- to 4-fold risk for new-onset hypertension. A diminished recovery systolic BP response was also predictive of hypertension in men. Although previous work has shown exercise-induced hypertension to be predictive of incident hypertension,4 6 10 this is the first prospective population-based study to examine the exercise BP response during treadmill testing as a predictor of new-onset hypertension separately in middle-aged men and women. … Several definitions of exaggerated BP response have been reported, including some based solely on systolic BP and others on systolic and diastolic BP together.4 5 6 7 8 9 10 Scant information is available regarding the examination of each separately. In this study, the exercise diastolic response was predictive of the development of hypertension and was the strongest exercise predictor of hypertension in both men and women. This finding is consistent with an earlier report describing diastolic BP changes with exercise in borderline hypertensives who subsequently went on to develop hypertension.10 … suggesting that exercise systolic response was a weaker predictor of hypertension than the diastolic response. This finding is at odds with several other studies that have reported exercise systolic BP as a strong predictor of hypertension.5 6 10 23 Those studies included small numbers of female subjects, did not adjust for confounding variables, and used different cutoff points for exaggerated BP responses. The CARDIA study, which observed a weak association between exercise systolic BP response and hypertension, was restricted to younger subjects and did not separately examine the diastolic BP or recovery-phase responses.4 … We observed a stronger association between resting BP and risk for subsequent hypertension than with exercise BP. Although this finding is supported by some studies,4 19 several others have suggested that BP during exercise is a better predictor of hypertension than resting BP.6 10 29 This discrepancy probably arises from differences in methodology, characteristics of the study sample, and clinical covariates considered in the analyses. In this study, we have shown the additional value of exercise and recovery BP responses as predictors of hypertension after adjustment for baseline systolic and diastolic BP. In a subset analysis of subjects with high-normal resting BP (subjects at high risk of developing hypertension), we have shown the additional and incremental value of exercise systolic and diastolic BP responses above resting measurements. Subjects with high-normal resting BP who exhibit an exercise BP response in the top quartile are more likely to develop resting hypertension in the future.”

Diagnostic accuracy of home vs. ambulatory blood pressure monitoring in untreated and treated hypertension. (Hypertens Res. 2012) “HBP appears to be a reliable alternative to ABP in the diagnosis of hypertension and the detection of WCP and MH in both untreated and treated subjects.

Effectiveness of Self-Measured Blood Pressure Monitoring in Adults With Hypertension. (AHRQ Comparative Effectiveness Reviews. 2012)

Evaluation of Blood Pressure Measurement and Agreement in an Academic Health Sciences Center (The Journal of Clinical Hypertension 2012) “Overall, 41% of patients had a =10-mm Hg difference in SBP between measurements. Similarly, 54% had differences of =5 mm Hg in DBP between measurements. Inaccurate BP measurement and poor technique may lead to misclassification, misdiagnosis, and inappropriate medical decisions. Concordance of measured SBP between our site personnel and trained observer was less than optimal.”

Home versus ambulatory and office blood pressure in predicting target organ damage in hypertension: a systematic review and meta-analysis. (J Hypertens. 2012)

Significance of White-Coat Hypertension in Older Persons With Isolated Systolic Hypertension (Hypertension 2012)

The Deep-Breath Test as a Diagnostic Maneuver for White-Coat Effect in Hypertensive Patients (J Am Board Fam Med. 2004) “The deep-breath test reduced SBP by 15 mm Hg and DBP by about 6 mm Hg ( Table 2 ). … “

The exercise treadmill test: Estimating cardiovascular prognosis (Cleveland Clinic Journal of Medicine 2008) “Of the prognostic factors, exercise duration is the one most strongly associated with risk of coronary events and death, independent of age, sex, or known presence and severity of coronary artery disease. A decrease in blood pressure with exercise can reflect severe coronary artery disease or left ventricular systolic dysfunction. A heart rate that does not increase adequately during exercise or does not recover rapidly after exercise is associated with an increased risk of death. Exercise training may help to improve the prognosis of patients with an abnormal hemodynamic response to exercise caused by poor general health.”

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