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Encyclopedia > Hypertension
Hypertension
Classification and external resources
ICD-10 I10.,I11.,I12.,
I13.,I15.
ICD-9 401.x
OMIM 145500
DiseasesDB 6330
MedlinePlus 000468
eMedicine med/1106  ped/1097 emerg/267

Hypertension, most commonly referred to as "high blood pressure", HTN or HPN, is a medical condition in which the blood pressure is chronically elevated. It was previously referred to as arterial hypertension, but in current usage, the word "hypertension" without a qualifier normally refers to arterial hypertension. [1] The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Hypertension may refer to the following: Hypertension without a qualifier usually refers to arterial hypertension (high blood pressure of the arteries) Pregnancy-induced hypertension is newly diagnosed arterial hypertension in pregnant women. ... A sphygmomanometer, a device used for measuring arterial pressure. ... Section of an artery For other uses, see Artery (disambiguation). ...


Hypertension can be classified as either essential (primary) or secondary. Essential hypertension indicates that no specific medical cause can be found to explain a patient's condition. Secondary hypertension indicates that the high blood pressure is a result of (i.e. secondary to) another condition, such as kidney disease or tumors (pheochromocytoma and paraganglioma). Persistent hypertension is one of the risk factors for strokes, heart attacks, heart failure and arterial aneurysm, and is a leading cause of chronic renal failure. Even moderate elevation of arterial blood pressure leads to shortened life expectancy. At severely high pressures, defined as mean arterial pressures 50% or more above average, a person can expect to live no more than a few years unless appropriately treated.[2] While most forms of hypertension in humans have no known underlying cause (and are thus known as essential hypertension or primary hypertension), in about 10% of the cases, there is a known cause, and thus the hypertension is secondary hypertension (or, less commonly, inessential hypertension). ... See the article on the kidney for the anatomy and function of healthy kidneys and a list of diseases involving the kidney. ... For other uses, see Stroke (disambiguation). ... Heart attack redirects here. ... Post surgical photo of brain aneurysm survivor. ... Chronic renal failure (CRF, or chronic kidney failure, CKF, or chronic kidney disease, CKD) is a slowly progressive loss of renal function over a period of months or years and defined as an abnormally low glomerular filtration rate, which is usually determined indirectly by the creatinine level in blood serum. ... The mean arterial pressure (MAP) is a term used in medicine to describe a notional average blood pressure in an individual. ...


Hypertension is considered to be present when a person's systolic blood pressure is consistently 140 mmHg or greater, and/or their diastolic blood pressure is consistently 90 mmHg or greater.[3] Recently, as of 2003, the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure[4] has defined blood pressure 120/80 mmHg to 139/89 mmHg as "prehypertension." Prehypertension is not a disease category; rather, it is a designation chosen to identify individuals at high risk of developing hypertension. The Mayo Clinic website specifies blood pressure is "normal if it's below 120/80" but that "some data indicate that 115/75 mm Hg should be the gold standard." In patients with diabetes mellitus or kidney disease studies have shown that blood pressure over 130/80 mmHg should be considered high and warrants further treatment. Ventricular systole The parts of a QRS complex. ... The torr (symbol: Torr) or millimeter of mercury (mmHg) is a non-SI unit of pressure. ... Diastole is the period of time when the heart relaxes after contraction. ... Prehypertension is blood pressure that is elevated above normal but not to the level considered to be hypertension (high blood pressure). ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... Nephropathy refers to damage to or disease of the kidney. ...

Contents

Factors of essential hypertension

Although no specific medical cause can be determined in essential hypertension, the most common form has several contributing factors. These include salt sensitivity, renin homeostasis, insulin resistance, genetics, and age.


Liquorice (or 'licorice') toxicity

Consumption of liquorice (which can be of potent strength in candy) can lead to a surge in blood pressure. People with hypertension or history of cardio-vascular disease should avoid Liquorice raising their blood pressure to risky levels. Frequently, if liquorice is the cause of the high blood pressure, a low blood level of potassium will also be present. Binomial name L. Liquorice or licorice (see spelling differences) (IPA: , or ) is the root of Glycyrrhiza glabra, from which a sweet flavour can be extracted. ...


Liquorice extracts are present in many medicines (for example cough syrups, lozenges and peptic ulcer treatments).


Salt sensitivity

Sodium is an environmental factor that has received the greatest attention. Approximately 60% of the essential hypertensive population is responsive to sodium intake[citation needed]. This is due to the fact that increasing amounts of salt in a person's bloodstream causes cells to release water (due to osmotic pressure) to equilibrate concentration gradient of salt between the cells and the bloodstream; increasing the pressure on the blood vessel walls. This article is about common table salt. ...


The effects of excess amounts of salt in the body depend on how much excess salt (or salty food) is eaten in a specific time versus how well the kidneys functioned. When the salt content of the blood elevates, water is attracted from around the cells (in muscles and organs) and into the blood, in order to dilute blood salinity. There is salt as sodium outside every cell in the body. When the salt content of the fluid around the cells goes up, it attracts water from the blood and swelling occurs. The kidneys are responsible for regulating salt and water levels in the body. When salt and water levels increase around cells, the excess is drawn into the blood, which is filtered by the kidneys. The kidneys remove excess salt and water from the blood, both of which are excreted as urine. When the kidneys do not work well, fluid builds up around cells and in the blood. The heart is the pump that pushes the blood around. If there is more fluid in the blood, the heart has to work harder and the blood pressure can go up because there is more pressure on the walls of the blood vessels. The heart can get weaker or worn out from the extra work.


Salt has been blamed in the past as causing high blood pressure. New research suggests that too little calcium or potassium also has an impact on blood pressure.[citation needed]


Role of renin

Renin is an enzyme secreted by the juxtaglomerular apparatus of the kidney and linked with aldosterone in a negative feedback loop. The range of renin activity observed in hypertensive subjects tends to be broader than in normotensive individuals. In consequence, some hypertensive patients have been defined as having low-renin and others as having essential hypertension. Low-renin hypertension is more common in African Americans than white Americans, and may explain why they tend to respond better to diuretic therapy than drugs that interfere with the renin-angiotensin system. Not to be confused with rennin, the active enzyme in rennet. ... Ribbon diagram of the enzyme TIM, surrounded by the space-filling model of the protein. ... The juxtaglomerular apparatus is a renal structure consisting of the macula densa, mesangial cells, and juxtaglomerular cells. ... Aldosterone, is a steroid hormone (mineralocorticoid family) produced by the outer-section (zona glomerulosa) of the adrenal cortex in the adrenal gland, and acts on the kidney nephron to conserve sodium, secrete potassium,increase water retention, and increase blood pressure. ... An African American (also Afro-American, Black American, or simply black) is a member of an ethnic group in the United States whose ancestors, usually in predominant part, were indigenous to Africa. ... The term white American (often used interchangeably and incorrectly with Caucasian American[2] and within the United States simply white[3]) is an umbrella term that refers to people of European descent residing in the United States. ...


High Renin levels predispose to Hypertension: Increased Renin → Increased Angiotensin II → Increased Vasoconstriction, Thirst/ADH and Aldosterone → Increased Sodium Resorption in the Kidneys (DCT and CD) → Increased Blood Pressure. According to the Fifth Edition Annotated Instructor's Edition Nutrition Concepts & Controversies by authors, Eva May Nunnelley Hamilton, M.S., Eleanor Noss Whitney, Ph.d, R.D., Frances Sienkiewicz Sizer, M.S., R.D.published by West Publishing Company 1991 ISBN 0-314-81092-7 "Some authorities believe that potassium might both prevent and treat hypertension. It goes on to advise that salt avoidance may assist in lowering blood pressure in two ways, one of which is by replacing highly processed (salted foods) with natural foods which contain higher levels of potassium, and the other is by reducing salt intake. Angiotensinogen, angiotensin I and angiotensin II are peptides involved in maintenance of blood volume and pressure. ... The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... ADH is a three-letter abbreviation with multiple meanings, as described below: Antidiuretic hormone, a hormone that acts on the kidneys; Alcohol dehydrogenase, an enzyme involved in the break-down of alcohol; the IATA airport code for Ada Municipal Airport in Ada, Oklahoma; the IATA code for Aldan Airport in... Aldosterone, is a steroid hormone (mineralocorticoid family) produced by the outer-section (zona glomerulosa) of the adrenal cortex in the adrenal gland, and acts on the kidney nephron to conserve sodium, secrete potassium,increase water retention, and increase blood pressure. ... For sodium in the diet, see Salt. ... The kidneys are the organs that filter wastes (such as urea) from the blood and excrete them, along with water, as urine. ... A sphygmomanometer, a device used for measuring arterial pressure. ...


Insulin resistance

Insulin is a polypeptide hormone found in the islets of langerhans, secreted by the pancreas. Its main purpose is to regulate the levels of glucose in the body antagonistically with glucagon through negative feedback loops. Insulin also exhibits vasodilatory properties. In normotensive individuals, insulin may stimulate sympathetic activity without elevating mean arterial pressure. However, in more extreme conditions such as that of the metabolic syndrome, the increased sympathetic neural activity may over-ride the vasodilatory effects of insulin. Insulin resistance and/or hyperinsulinemia have been suggested as being responsible for the increased arterial pressure in some patients with hypertension. This feature is now widely recognized as part of syndrome X, or the metabolic syndrome. Not to be confused with inulin. ... For other uses, see Hormone (disambiguation). ... The pancreas is a gland organ in the digestive and endocrine systems of vertebrates. ... Glucose (Glc), a monosaccharide (or simple sugar), is an important carbohydrate in biology. ... Antagonistic Bending and straightening of the arm requires antagonistic muscle movement. ... Glucagon ball and stick model A microscopic image stained for glucagon. ... This article does not cite any references or sources. ... Hyperinsulinemia, present in people with Diabetes mellitus type 2 or insulin resistance where excess levels of circulating insulin in blood. ... Metabolic syndrome is a combination of medical disorders that increase ones risk for cardiovascular disease and diabetes. ... Metabolic syndrome is a combination of medical disorders that increase ones risk for cardiovascular disease and diabetes. ...


Sleep apnea

Sleep apnea is a common, under-recognized cause of hypertension.[5] It is often best treated with nocturnal nasal continuous positive airway pressure, but other approaches include the Mandibular advancement splint (MAS), UPPP, tonsilectomy, adenoidectomy, sinus surgery, or weight loss. Sleep apnea, sleep apnoea or sleep apnœa is a sleep disorder characterized by pauses in breathing during sleep. ... Continuous positive airway pressure (CPAP) is a method of respiratory ventilation used primarily in the treatment of sleep apnea and various lung diseases. ... -1... Uvulopalatopharyngoplasty (also known by the abbreviation UPPP) is a procedure used to decrease or remove the sound of snoring in human beings during sleep. ... A tonsillectomy is a surgical procedure, during which the tonsils are removed. ... Location of the adenoid Adenoidectomy is the surgical removal of the adenoids. ...


Genetics

Hypertension is one of the most common complex disorders, with genetic heritability averaging 30%.[citation needed] Data supporting this view emerge from animal studies as well as in population studies in humans. Most of these studies support the concept that the inheritance is probably multifactorial or that a number of different genetic defects each have an elevated blood pressure as one of their phenotypic expressions. In genetics, heritability is the proportion of phenotypic variation in a population that is attributable to genetic variation among individuals. ... The phenotype of an individual organism is either its total physical appearance and constitution, or a specific manifestation of a trait, such as size or eye color, that varies between individuals. ...


More than 50 genes have been examined in association studies with hypertension, and the number is constantly growing.


Age

Over time, the number of collagen fibers in artery and arteriole walls increases, making blood vessels stiffer. With the reduced elasticity comes a smaller cross-sectional area in systole, and so a raised mean arterial blood pressure. Tropocollagen triple helix. ...


Other etiologies

There are some anecdotal or transient causes of high blood pressure. These are not to be confused with the disease called hypertension in which there is an intrinsic physiopathological mechanism as described below.


Etiology of secondary hypertension

Only in a small minority of patients with elevated arterial pressure, can a specific cause be identified (in 90 percent to 95 percent of high blood pressure cases, the American Heart Association says there's no identifiable cause). These individuals will probably have an endocrine or renal defect that, if corrected, could bring blood pressure back to normal values. The endocrine system is a control system of ductless endocrine glands that secrete chemical messengers called hormones that circulate within the body via the bloodstream to affect distant organs. ...

Renal hypertension
Hypertension produced by diseases of the kidney. This includes diseases such as polycystic kidney disease or chronic glomerulonephritis. Hypertension can also be produced by diseases of the renal arteries supplying the kidney. This is known as renovascular hypertension; it is thought that decreased perfusion of renal tissue due to stenosis of a main or branch renal artery activates the renin-angiotensin system.
Adrenal hypertension
Hypertension is a feature of a variety of adrenal cortical abnormalities. In primary aldosteronism there is a clear relationship between the aldosterone-induced sodium retention and the hypertension.
Cushing's syndrome (hypersecretion of cortisol)
Both adrenal glands can overproduce the hormone cortisol or it can arise in a benign or malignant tumor. Hypertension results from the interplay of several pathophysiological mechanisms regulating plasma volume, peripheral vascular resistance and cardiac output, all of which may be increased. More than 80% of patients with Cushing's syndrome have hypertension.
In patients with pheochromocytoma increased secretion of catecholamines such as epinephrine and norepinephrine by a tumor (most often located in the adrenal medulla) causes excessive stimulation of [adrenergic receptors], which results in peripheral vasoconstriction and cardiac stimulation. This diagnosis is confirmed by demonstrating increased urinary excretion of epinephrine and norepinephrine and/or their metabolites (vanillylmandelic acid).
Genetic causes
Hypertension can be caused by mutations in single genes, inherited on a mendelian basis.[6]
Coarctation of the aorta
Drugs
Certain medications, especially NSAIDS (Motrin/ibuprofen) and steroids can cause hypertension. Licorice (Glycyrrhiza glabra) inhibits the 11-hydroxysteroid hydrogenase enzyme (catalyzes the reaction of cortisol to cortison) which allows cortisol to stimulate the Mineralocorticoid Receptor (MR) which will lead to effects similar to hyperaldosteronism, which itself is a cause of hypertension. [Reference: Harrisons Internal Medicine, online edition (2007-04-14)]
Spinal misalignment
A 2007 chiropractic pilot study indicated that some cases of hypertension may be caused by a misalignment of the atlas vertebra.[7]
Rebound hypertension
High blood pressure that is associated with the sudden withdrawal of various antihypertensive medications. The increases in blood pressure may result in blood pressures greater than when the medication was initiated. Depending on the severity of the increase in blood pressure, rebound hypertension may result in a hypertensive emergency. Rebound hypertension is avoided by gradually reducing the dose (also known as "dose tapering"), thereby giving the body enough time to adjust to reduction in dose.
Medications commonly associated with rebound hypertension include centrally-acting antihypertensive agents, such as clonidine and beta-blockers.

The kidneys are the organs that filter wastes (such as urea) from the blood and excrete them, along with water, as urine. ... Polycystic kidney disease (PKD) is a progressive, genetic disorder of the kidneys. ... Glomerulonephritis, also known as glomerular nephritis and abbreviated GN, is a primary or secondary immune-mediated renal disease characterized by inflammation of the glomeruli, or small blood vessels in the kidneys. ... Human kidneys viewed from behind with spine removed The renal arteries normally arise off the abdominal aorta and supply the kidneys with blood. ... Renovascular hypertension (or renal hypertension) is a form of secondary hypertension. ... A stenosis is an abnormal narrowing in a blood vessel or other tubular organ or structure. ... Hyperaldosteronism, also aldosteronism, is a medical condition where too much aldosterone is produced by the adrenal glands, which can lead to lowered levels of potassium in blood. ... A phaeochromocytoma (pheochromocytoma in the US) is a neuroendocrine tumor of the medulla of the adrenal glands originating in the chromaffin cells, which secretes excessive amounts of catecholamines, usually adrenaline and noradrenaline (epinephrine and norepinephrine in the US). ... Catecholamines are chemical compounds derived from the amino acid tyrosine that act as hormones or neurotransmitters. ... Adrenaline redirects here. ... Norepinephrine (INN)(abbr. ... Vanillyl mandelic acid (VMA) is a chemical end product of catecholamine metabolism. ... Aortic coarctation is narrowing of the aorta in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts. ... In anatomy, the atlas (C1) is the topmost (first) cervical vertebra of the spine. ... A diagram of a thoracic vertebra. ... Arterial hypertension, or high blood pressure is a medical condition where the blood pressure is chronically elevated. ... Withdrawal, also known as withdrawal syndrome, refers to the characteristic signs and symptoms that appear when a drug that causes physical dependence is regularly used for a long time and then suddenly discontinued or decreased in dosage. ... Antihypertensives are a class of drugs that are used in medicine and pharmacology to treat hypertension (high blood pressure). ... A hypertensive emergency is severe hypertension with acute impairment of an organ system (especially the central nervous system, cardiovascular system and/or the renal system) and the possibility of irreversible organ-damage. ... Clonidine is a direct-acting adrenergic agonist prescribed historically as an anti-hypertensive agent. ...

Pathophysiology

Most of the secondary mechanisms associated with hypertension are generally fully understood, and are outlined at secondary hypertension. However, those associated with essential (primary) hypertension are far less understood. What is known is that cardiac output is raised early in the disease course, with total peripheral resistance (TPR) normal; over time cardiac output drops to normal levels but TPR is increased. Three theories have been proposed to explain this: While most forms of hypertension in humans have no known underlying cause (and are thus known as essential hypertension or primary hypertension), in about 10% of the cases, there is a known cause, and thus the hypertension is secondary hypertension (or, less commonly, inessential hypertension). ... Cardiac output (CO) is the volume of blood being pumped by the heart, in particular by a ventricle in a minute. ... Total peripheral resistance refers the cumulative resistance of the thousands of arterioles in the body, or the lungs, respectively. ...

It is also known that hypertension is highly heritable and polygenic (caused by more than one gene) and a few candidate genes have been postulated in the etiology of this condition.[8][9][10] Atrial natriuretic factor (ANF), atrial natriuretic peptide (ANP) or atriopeptin, is a peptide hormone involved in the homeostatic control of body water and sodium. ... Atrial natriuretic factor (ANF), atrial natriuretic peptide (ANP) or atriopeptin, is a peptide hormone involved in the homeostatic control of body water and sodium. ... The renin-angiotensin system (RAS) or the renin-angiotensin-aldosterone system is a hormone system that helps regulate long-term blood pressure and blood volume in the body. ... The blood vessels are part of the circulatory system and function to transport blood throughout the body. ... The Sympathetic Nervous System (SNS) is a branch of the autonomic nervous system. ... A genetic disorder, or genetic disease is a disease caused, at least in part, by the genes of the person with the disease. ... This stylistic schematic diagram shows a gene in relation to the double helix structure of DNA and to a chromosome (right). ...


Signs and symptoms

Hypertension is usually found incidentally - "case finding" - by healthcare professionals during a routine checkup. The only test for hypertension is a blood pressure measurement. Hypertension in isolation usually produces no symptoms although some people report headaches, fatigue, dizziness, blurred vision, facial flushing, transient insomnia or difficulty sleeping due to feeling hot or flushed, and tinnitus [11] during beginning onset or prior to hypertention diagnosis. Tinnitus (pronounced or ,[1] from the Latin word for ringing[2]) is the perception of sound in the human ear in the absence of corresponding external sound(s). ...


Malignant hypertension (or accelerated hypertension) is distinct as a late phase in the condition, and may present with headaches, blurred vision and end-organ damage. Malignant hypertension is a complication of hypertension characterized by very elevated blood pressure, and organ damage in the eyes, brain, lung and/or kidneys. ...


Hypertension is often confused with mental tension, stress and anxiety. While chronic anxiety and/or irritability is associated with poor outcomes in people with hypertension, it alone does not cause it. Accelerated hypertension is associated with somnolence, confusion, visual disturbances, and nausea and vomiting (hypertensive encephalopathy). [12]


Hypertensive urgencies and emergencies

Hypertension is rarely severe enough to cause symptoms. These typically only surface with a systolic blood pressure over 240 mmHg and/or a diastolic blood pressure over 120 mmHg. These pressures without signs of end-organ damage (such as renal failure) are termed "accelerated" hypertension. When end-organ damage is possible or already ongoing, but in absence of raised intracranial pressure, it is called hypertensive emergency. Hypertension under this circumstance needs to be controlled, but prolonged hospitalization is not necessarily required. When hypertension causes increased intracranial pressure, it is called malignant hypertension. Increased intracranial pressure causes papilledema, which is visible on ophthalmoscopic examination of the retina. Blood pressure is the pressure exerted by the blood on the walls of the blood vessels. ... Blood pressure is the pressure exerted by the blood on the walls of the blood vessels. ... Intracranial pressure, (ICP), is the pressure exerted by the cranium on the brain tissue, cerebrospinal fluid (CSF), and the brains circulating blood volume. ... A hypertensive emergency is severe hypertension with acute impairment of an organ system (especially the central nervous system, cardiovascular system and/or the renal system) and the possibility of irreversible organ-damage. ... Malignant hypertension is a complication of hypertension characterized by very elevated blood pressure, and organ damage in the eyes, brain, lung and/or kidneys. ... Papilledema is optic disc swelling that is caused by increased intracranial pressure. ... In medicine the ophthalmoscope was invented by Hermann von Helmholtz and is an instrument that is used to look into the human eye. ... Human eye cross-sectional view. ...


Complications

While elevated blood pressure alone is not an illness, it often requires treatment due to its short- and long-term effects on many organs. The risk is increased for:

A stroke or cerebrovascular accident (CVA) occurs when the blood supply to a part of the brain is suddenly interrupted by occlusion (an ischemic stroke- approximately 90% of strokes), by hemorrhage (a hemorrhagic stroke - less than 10% of strokes) or other causes. ... Heart attack redirects here. ... Hypertensive heart disease is any of a number of complications of arterial hypertension that affect the heart. ... Hypertension, or high blood pressure that does not respond to treatment, has several ocular manifestations. ... Human eye cross-sectional view. ... In kidney, as a result of benign arterial hypertension, hyaline (pink, amorphous, homogeneous material) accumulates in the wall of small arteries and arterioles, producing the thickening of their walls and the narrowing of the lumens - hyaline arteriolosclerosis. ... Chronic renal failure (CRF, or chronic kidney failure, CKF, or chronic kidney disease, CKD) is a slowly progressive loss of renal function over a period of months or years and defined as an abnormally low glomerular filtration rate, which is usually determined indirectly by the creatinine level in blood serum. ...

Pregnancy

Although few women of childbearing age have high blood pressure, up to 10% develop hypertension of pregnancy. While generally benign, it may herald three complications of pregnancy: pre-eclampsia, HELLP syndrome and eclampsia. Follow-up and control with medication is therefore often necessary. Pregnancy-induced hypertension (PIH) is the accepted name for what was previously called gestational hypertension or hypertension of pregnancy. ... Pregnancy-induced hypertension (PIH) is the accepted name for what was previously called gestational hypertension or hypertension of pregnancy. ... Pre-eclampsia (US: preeclampsia) is a medical condition where hypertension arises in pregnancy (pregnancy-induced hypertension) in association with significant amounts of protein in the urine. ... HELLP syndrome is a life-threatening obstetric complication considered by many to be a variant of pre-eclampsia. ...


Children and adolescents

As with adults, blood pressure is a variable parameter in children. It varies between individuals and within individuals from day to day and at various times of the day. The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early development of atherosclerosis in children would make the detection of and intervention in childhood hypertension important to reduce long-term health risks; however, supporting data are lacking. These children vary in their proportion of body fat. ...


Most childhood hypertension, particularly in preadolescents, is secondary to an underlying disorder. Renal parenchymal disease is the most common (60 to 70%) cause of hypertension. Adolescents usually have primary or essential hypertension, making up 85 to 95% of cases. [13]


Diagnosis

Measuring blood pressure

Diagnosis of hypertension is generally on the basis of a persistently high blood pressure. Usually this requires three separate measurements at least one week apart. Exceptionally, if the elevation is extreme, or end-organ damage is present then the diagnosis may be applied and treatment commenced immediately.


Obtaining reliable blood pressure measurements relies on following several rules and understanding the many factors that influence blood pressure reading[14].


For instance, measurements in control of hypertension should be at least 1 hour after caffeine, 30 minutes after smoking or strenuous exercise and without any stress. Cuff size is also important. The bladder should encircle and cover two-thirds of the length of the arm. The patient should be sitting upright in a chair with both feet flat on the floor for a minimum of five minutes prior to taking a reading. The patient should not be on any adrenergic stimulants, such as those found in many cold medications.


When taking manual measurements, the person taking the measurement should be careful to inflate the cuff suitably above anticipated systolic pressure. The person should inflate the cuff to 200 mmHg and then slowly release the air while palpating the radial pulse. After one minute, the cuff should be reinflated to 30 mmHg higher than the pressure at which the radial pulse was no longer palpable. A stethoscope should be placed lightly over the brachial artery. The cuff should be at the level of the heart and the cuff should be deflated at a rate of 2 to 3 mmHg/s. Systolic pressure is the pressure reading at the onset of the sounds described by Korotkoff (Phase one). Diastolic pressure is then recorded as the pressure at which the sounds disappear (K5) or sometimes the K4 point, where the sound is abruptly muffled. Two measurements should be made at least 5 minutes apart, and, if there is a discrepancy of more than 5 mmHg, a third reading should be done. The readings should then be averaged. An initial measurement should include both arms. In elderly patients who particularly when treated may show orthostatic hypotension, measuring lying sitting and standing BP may be useful. The BP should at some time have been measured in each arm, and the higher pressure arm preferred for subsequent measurements. One way of defining pressure is in terms of the height of a column of fluid that may be supported by that pressure; or the height of a column of fluid that exerts that pressure at its base. ... Korotkoff sounds are the sounds that medical personnel listen for when they are taking blood pressure using a non-invasive procedure. ... Nikolai Sergeievich Korotkov (also Korotkoff) (February 13, 1874–1920) was a pioneer of 20th century vascular surgery and developed a technique for measuring blood pressure in 1905. ... Orthostatic hypotension (also known as postural hypotension, orthostatic intolerance and, colloquially, as head rush or a dizzy spell) is a sudden fall in blood pressure, typically greater than 20/10 mm Hg, that occurs when a person assumes a standing position, usually after a prolonged period of rest. ...


BP varies with time of day, as may the effectiveness of treatment, and archetypes used to record the data should include the time taken. Analysis of this is rare at present. Electronic patient chart of a HIS Medical Informatics is the name given to the discipline that exists at the intersection of information technology and medicine. ...


Automated machines are commonly used and reduce the variability in manually collected readings [15]. Routine measurements done in medical offices of patients with known hypertension may incorrectly diagnose 20% of patients with uncontrolled hypertension [16]


Home blood pressure monitoring can provide a measurement of a person's blood pressure at different times throughout the day and in different environments, such as at home and at work. Home monitoring may assist in the diagnosis of high or low blood pressure. It may also be used to monitor the effects of medication or lifestyle changes taken to lower or regulate blood pressure levels. An editor has expressed a concern that the subject of the article does not satisfy the notability guideline or one of the following guidelines for inclusion on Wikipedia: Biographies, Books, Companies, Fiction, Music, Neologisms, Numbers, Web content, or several proposals for new guidelines. ...


Home monitoring of blood pressure can also assist in the diagnosis of white coat hypertension. The American Heart Association[17] states, "You may have what's called 'white coat hypertension'; that means your blood pressure goes up when you're at the doctor's office. Monitoring at home will help you measure your true blood pressure and can provide your doctor with a log of blood pressure measurements over time. This is helpful in diagnosing and preventing potential health problems." Arterial hypertension, or high blood pressure is a medical condition where the blood pressure is chronically elevated. ... The American Heart Association (AHA) is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke American Stroke Association Web site. ...


Those using home blood pressure monitoring devices are increasingly also making use of blood pressure charting software.[18] These charting methods provide print outs for the patients physician and reminders to take a blood pressure reading.


Distinguishing primary vs. secondary hypertension

Once the diagnosis of hypertension has been made it is important to attempt to exclude or identify reversible (secondary) causes.

Metabolic syndrome is a combination of medical disorders that increase ones risk for cardiovascular disease and diabetes. ... Insulin resistance is the condition in which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells. ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... In medicine, combined hyperlipidemia (or -aemia) is a commonly occurring form of hypercholesterolemia (elevated cholesterol levels) characterised by increased LDL and triglyceride concentrations, often accompanied by decreased HDL. On lipoprotein electrophoresis (a test now rarely performed) is shows as a hyperlipoproteinemia type IIB. The elevated triglyceride levels (>5 mmol/l... Central obesity (or apple-shaped or masculine obesity) occurs when the main deposits of body fat are localised around the abdomen and the upper body. ... While most forms of hypertension in humans have no known underlying cause (and are thus known as essential hypertension or primary hypertension), in about 10% of the cases, there is a known cause, and thus the hypertension is secondary hypertension (or, less commonly, inessential hypertension). ... Kidneys viewed from behind with spine removed The kidneys are bean-shaped excretory organs in vertebrates. ... Essential hypertension is a subtype of arterial hypertension in which no one specific etiology can be isolated as the cause of increased blood pressure. ...

Investigations commonly performed in newly diagnosed hypertension

Tests are undertaken to identify possible causes of secondary hypertension, and seek evidence for end-organ damage to the heart itself or the eyes (retina) and kidneys. Diabetes and raised cholesterol levels being additional risk factors for the development of cardiovascular disease are also tested for as they will also require management.


Blood tests commonly performed include: Blood tests are laboratory tests done on blood to gain an appreciation of disease states and the function of organs. ...

Additional tests often include: Creatinine is a breakdown product of creatine phosphate in muscle, and is usually produced at a fairly constant rate by the body (depending on muscle mass). ... In medicine (nephrology) renal function is an indication of the state of the kidney and its role in physiology. ... An electrolyte is any substance containing free ions that behaves as an electrically conductive medium. ... For sodium in the diet, see Salt. ... General Name, symbol, number potassium, K, 19 Chemical series alkali metals Group, period, block 1, 4, s Appearance silvery white Standard atomic weight 39. ... Glucose (Glc), a monosaccharide (or simple sugar), is an important carbohydrate in biology. ... For the disease characterized by excretion of large amounts of very dilute urine, see diabetes insipidus. ... Cholesterol is a sterol (a combination steroid and alcohol). ...

  • Testing of urine samples for proteinuria - again to pick up underlying kidney disease or evidence of hypertensive renal damage.
  • Electrocardiogram (EKG/ECG) - for evidence of the heart being under strain from working against a high blood pressure. Also may show resulting thickening of the heart muscle (left ventricular hypertrophy) or of the occurrence of previous silent cardiac disease (either subtle electrical conduction disruption or even a myocardial infarction).
  • Chest X-ray - again for signs of cardiac enlargement or evidence of cardiac failure.

Proteinuria (from protein and urine) means the presence of an excess of serum proteins in the urine. ... “QRS” redirects here. ... Left ventricular hypertrophy (LVH) is the thickening of the myocardium (muscle) of the left ventricle of the heart. ... Frontal chest X-ray. ... Congestive heart failure (CHF), also called congestive cardiac failure (CCF) or just heart failure, is a condition that can result from any structural or functional cardiac disorder that impairs the ability of the heart to fill with or pump a sufficient amount of blood throughout the body. ...

Epidemiology

The level of blood pressure regarded as deleterious has been revised down during years of epidemiological studies. A widely quoted and important series of such studies is the Framingham Heart Study carried out in an American town: Framingham, Massachusetts. The results from Framingham and of similar work in Busselton, Western Australia have been widely applied. To the extent that people are similar this seems reasonable, but there are known to be genetic variations in the most effective drugs for particular sub-populations. Recently (2004), the Framingham figures have been found to overestimate risks for the UK population considerably. The reasons are unclear. Nevertheless the Framingham work has been an important element of UK health policy. The Framingham Heart Study is a cardiovascular study based in Framingham, Massachusetts. ... Location in Massachusetts Coordinates: , Country United States State Massachusetts County Middlesex County Settled 1650 Incorporated 1700 Government  - Type Representative town meeting Area  - Town  26. ... Busselton foreshore at sunset Busselton foreshore Busselton is a town in the South West region of Western Australia. ... Year 2004 (MMIV) was a leap year starting on Thursday of the Gregorian calendar. ...


Treatment

Lifestyle modification (nonpharmacologic treatment)

  • Weight reduction and regular aerobic exercise (e.g. jogging) are recommended as the first steps in treating mild to moderate hypertension. Regular mild exercise improves blood flow and helps to reduce resting heart rate and blood pressure. These steps are highly effective in reducing blood pressure, although drug therapy is still necessary for many patients with moderate or severe hypertension to bring their blood pressure down to a safe level.
  • Reducing sodium (salt) diet is proven very effective: it decreases blood pressure in about 60% of people (see above). Many people choose to use a salt substitute to reduce their salt intake.
  • Additional dietary changes beneficial to reducing blood pressure includes the DASH diet (Dietary Approaches to Stop Hypertension), which is rich in fruits and vegetables and low fat or fat-free dairy foods. This diet is shown effective based on National Institutes of Health sponsored research. In addition, an increase in daily calcium intake has the benefit of increasing dietary potassium, which theoretically can offset the effect of sodium and act on the kidney to decrease blood pressure. This has also been shown to be highly effective in reducing blood pressure.
  • Discontinuing tobacco use and alcohol consumption has been shown to lower blood pressure. The exact mechanisms are not fully understood, but blood pressure (especially systolic) always transiently increases following alcohol and/or nicotine consumption. Besides, abstention from cigarette smoking is important for people with hypertension because it reduces the risk of many dangerous outcomes of hypertension, such as stroke and heart attack. Note that coffee drinking (caffeine ingestion) also increases blood pressure transiently, but does not produce chronic hypertension.

Weight loss, in the context of medicine or health or physical fitness, is a reduction of the total body weight, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue. ... Aerobic exercise refers to exercise that is of moderate intensity, undertaken for a long duration. ... Jogging is a form of trotting or running at a slow or leisurely pace. ... R-phrases 36 S-phrases none Flash point Non-flammable Related Compounds Other anions NaF, NaBr, NaI Other cations LiCl, KCl, RbCl, CsCl, MgCl2, CaCl2 Related salts Sodium acetate Supplementary data page Structure and properties n, εr, etc. ... Measuring body weight on a scale Dieting is the practice of ingesting food in a regulated fashion to achieve a particular objective. ... Salt substitutes are edible products designed to taste similar to table salt, which is mostly sodium chloride. ... DASH diet in full-form is Dietary Approaches to Stop Hypertension. It is a diet which encourages the consumption of nuts, whole grains, fish, poultry, fruits and vegetables while lowering the consumption of red meats, sweets, salt and sugar. ... General Name, symbol, number potassium, K, 19 Chemical series alkali metals Group, period, block 1, 4, s Appearance silvery white Standard atomic weight 39. ... The relationship between alcohol consumption and health has been the subject of formal scientific research since at least 1926, when Dr. Raymond Pearl published his book, Alcohol and Longevity, in which he reported his finding that drinking alcohol in moderation was associated with greater longevity than either abstaining or drinking... For other senses of this word, see Meditation (disambiguation). ... Roadway noise is the main source of exposure Noise health effects, the collection of health consequences of elevated sound levels, constitute one of the most widespread public health threats in industrialized countries. ... This cosmetics store has lighting levels over twice recommended levels and sufficient to trigger headaches and other health effects Over-illumination is the presence of lighting intensity (illuminance) beyond that required for a specified activity. ... Progressive muscle relaxation is a technique of stress management developed by American physician Edmund Jacobson in the early 1920s. ... Biofeedback mechanism. ...

Medications

Main article: Antihypertensive

There are many classes of medications for treating hypertension, together called antihypertensives, which — by varying means — act by lowering blood pressure. Evidence suggests that reduction of the blood pressure by 5-6 mmHg can decrease the risk of stroke by 40%, of coronary heart disease by 15-20%, and reduces the likelihood of dementia, heart failure, and mortality from vascular disease. Antihypertensives are a class of drugs that are used in medicine and pharmacology to treat hypertension (high blood pressure). ... Antihypertensives are a class of drugs that are used in medicine and pharmacology to treat hypertension (high blood pressure). ...


The aim of treatment should be blood pressure control to <140/90 mmHg for most patients, and lower in certain contexts such as diabetes or kidney disease (some medical professionals recommend keeping levels below 120/80 mmHg).[4] Each added drug may reduce the systolic blood pressure by 5-10 mmHg, so often multiple drugs are necessary to achieve blood pressure control.


Commonly used drugs include:

Captopril, the first ACE inhibitor ACE inhibitors, or inhibitors of Angiotensin-Converting Enzyme, are a group of pharmaceuticals that are used primarily in treatment of hypertension and congestive heart failure, in most cases as the drugs of first choice. ... For the use of creatine to enhance athletic performance, please see Creatine supplements. ... Captopril is an Angiotensin-Converting Enzyme inhibitor (ACE inhibitor) used for the treatment of hypertension and some types of chronic heart failure. ... Enalapril is an angiotensin converting enzyme (ACE) inhibitor used in the treatment of hypertension and some types of chronic heart failure. ... Fosinopril is an angiotensin converting enzyme (ACE) inhibitor used for the treatment of hypertension and some types of chronic heart failure. ... Lisinopril (lye-SIH-no-pril, is a drug of the angiotensin converting enzyme (ACE) inhibitor class that is primarily used in treatment of hypertension, congestive heart failure, heart attacks and also in preventing renal and retinal complications of diabetes. ... Quinapril (or Accupril ®) is an ACE inhibitor used to control blood pressure. ... Ramipril (marketed as Tritace or Altace) is an angiotensin-converting enzyme (ACE) inhibitor, used to treat hypertension and congestive heart failure. ... Losartan, the first ARB Angiotensin II receptor antagonists, also known as angiotensin receptor blockers (ARBs), AT1-receptor antagonists or sartans, are a group of pharmaceuticals which modulate the renin-angiotensin-aldosterone system. ... Chemical structure of telmisartan Telmisartan is an antihypertensive drug categorized as an angiotensin II receptor blocker (ARB). ... Irbesartan (INN) (IPA: ) is an angiotensin II receptor antagonist used mainly for the treatment of hypertension. ... Losartan (rINN) (IPA: ) is an angiotensin II receptor antagonist drug used mainly to treat high blood pressure (hypertension). ... Valsartan (trade name Diovan®) is an angiotensin II receptor antagonist, acting on the AT1 subtype. ... Candesartan (kan-de-SAR-tan) belongs to the class of medicines called angiotensin II inhibitors. ... Alpha blockers (also called alpha-adrenergic blocking agents) constitute a variety of drugs which block α1-adrenergic receptors in arteries and smooth muscles. ... Doxazosin mesylate, a quinazoline compound sold by Pfizer under the brand name Cardura®, is an alpha blocker used to treat high blood pressure and benign prostatic hyperplasia. ... Prazosin, brand name Minipress®, is a medication used to treat high blood pressure (hypertension). ... Terazosin (Hytrin) is an alpha blocker used for treatment of symptoms of prostate enlargement (BPH). ... Beta blockers or beta-adrenergic blocking agents are a class of drugs used to treat a variety of cardiovascular conditions and some other diseases. ... Atenolol is a drug belonging to the group of beta blockers, a class of drugs used primarily in cardiovascular diseases. ... Labetalol (Normodyne, Trandate, fixed combination with hydrochlorothiazide: Normozyde) is an alpha-1 and beta adrenergic blocker used to treat high blood pressure. ... “Minax” redirects here. ... Propranolol (INN) (IPA: ) is a non-selective beta blocker mainly used in the treatment of hypertension. ... Calcium channel blockers are a class of drugs and natural substances with effects on many excitable cells of the body, like the muscle of the heart, smooth muscles of the vessels or neuron cells. ... Amlodipine (as besylate or malleate) is a long-acting calcium channel blocker used as an anti-hypertensive and in the treatment of angina. ... Diltiazem is a member of the group of drugs known as Benzothiapines , which are a class of calcium channel blockers, used in the treatment of hypertension, angina pectoris, and some types of arrhythmia. ... Verapamil (brand names: Isoptin®, Verelan®, Calan®) is a medical drug that acts as an L-type calcium channel blocker. ... Aliskiren (INN) is a renin inhibitor marketed under the trade name Tekturna by the Swiss pharmaceutical company Novartis. ... This illustration shows where some types of diuretics act, and what they do. ... Bendroflumethiazide, (formerly known as bendrofluazide), is a thiazide diuretic, used to treat hypertension. ... Chlortalidone (formerly spelt chlorthalidone in the UK) is a thiazide diuretic, used to treat hypertension. ... Hydrochlorothiazide (Apo-Hydro®, Aquazide H®, Microzide®, Oretic®), sometimes abbreviated HCT, HCTZ, or HZT is a popular diuretic drug that acts by inhibiting the kidneys ability to retain water. ...

Choice of initial medication

Which type of many medications should be used initially for hypertension has been the subject of several large studies and various national guidelines.


Regarding cardiovascular outcomes, the ALLHAT study showed a slightly better outcome and cost-effectiveness for the thiazide diuretic chlortalidone compared to other anti-hypertensives in an ethnically mixed population.[21] Whilst a subsequent smaller study (ANBP2) did not show this small difference in outcome and actually showed a slightly better outcome for ACE-inhibitors in older white male patients.[22] Thiazides are a class of drug that promote water loss from the body ((diuretics)). They inhibit Na+/Cl- reabsorption from the distal convoluted tubules in the kidneys. ... Chlortalidone (formerly spelt chlorthalidone in the UK) is a thiazide diuretic, used to treat hypertension. ...


Whilst thiazides are cheap, effective, and recommended as the best first-line drug for hypertension by many experts, they are not prescribed as often as some newer drugs. Arguably, this is because they are off-patent and thus rarely promoted by the drug industry.[23]


Due to their metabolic impact (hypercholesterinemia, impairment of glucose tolerance, increased risk of developing Diabetes mellitus type 2), the use of thiazides as first line treatment for essential hypertension has been repeatedly questioned and strongly discouraged.[24] [25] [26] Diabetes mellitus type 2 or Type 2 Diabetes (formerly called non-insulin-dependent diabetes (NIDDM), obesity-related diabetes, or adult-onset diabetes) is a metabolic disorder that is primarily characterized by insulin resistance, relative insulin deficiency, and hyperglycemia. ...


Advice in the United Kingdom

The risk of beta-blockers provoking type 2 diabetes led to their downgrading to fourth-line therapy in the United Kingdom in June 2006[27], in the revised national guidelines.[28] Skeletal formula of propranolol, the first clinically successful beta blocker Beta blockers (sometimes written as β-blockers) are a class of drugs used for various indications, but particularly for the management of cardiac arrhythmias and cardioprotection after myocardial infarction. ... See diabetes mellitus for further general information on diabetes. ...


Advice in the United States

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) in the United States recommends starting with a thiazide diuretic if single therapy is being initiated and another medication is not indicated.[4] Thiazides are diuretics, a class of drug that promote water loss from the body. ...


Chiropractic

Chiropractic, which treats disorders by diagnosing and treating mechanical disorders of the spine, has shown positive results in the treatment of hypertension. The Journal of Human Hypertension published the results of a chiropractic trial in which patients with hypertension and a misaligned atlas vertebra were chosen to undergo chiropractic treatment. The study showed a significant lowering of blood pressure in hypertensive patients after only one chiropractic adjustment of the atlas vertebra. The study showed a decrease in blood pressure immediately following the adjustment as well as a full eight weeks following the adjustment. Blood pressure in the group receiving chiropractic was lowered by an average of 17mmHg BP systolic and 10mmHg diastolic BP. The decrease in blood pressure was equal to taking two antihypertensive drugs at once. [7] Chiropractic (from Greek chiros and praktikos meaning done by hand) is a health care profession whose purpose is to diagnose and treat mechanical disorders of the spine and musculoskeletal system with the intention of affecting the nervous system and improving health. ... Antihypertensives are a class of drugs that are used in medicine and pharmacology to treat hypertension (high blood pressure). ... Many drugs are provided in tablet form. ...


Systolic hypertension

For more details on this topic, see Systolic hypertension.

Systolic hypertension is defined as an elevated systolic blood pressure with a normal diastolic blood pressure. ...

See also

Antihypertensives are a class of drugs that are used in medicine and pharmacology to treat hypertension (high blood pressure). ... Edible salt is mostly sodium chloride (NaCl). ... A hypertensive emergency is severe hypertension with acute impairment of an organ system (especially the central nervous system, cardiovascular system and/or the renal system) and the possibility of irreversible organ-damage. ... Malignant hypertension is a complication of hypertension characterized by very elevated blood pressure, and organ damage in the eyes, brain, lung and/or kidneys. ... Exercise hypertension is an excessive rise in blood pressure during exercise. ... Arterial hypertension, or high blood pressure is a medical condition where the blood pressure is chronically elevated. ... An editor has expressed a concern that the subject of the article does not satisfy the notability guideline or one of the following guidelines for inclusion on Wikipedia: Biographies, Books, Companies, Fiction, Music, Neologisms, Numbers, Web content, or several proposals for new guidelines. ...

References

  1. ^ Maton, Anthea; Jean Hopkins, Charles William McLaughlin, Susan Johnson, Maryanna Quon Warner, David LaHart, Jill D. Wright (1993). Human Biology and Health. Englewood Cliffs, New Jersey, USA: Prentice Hall. ISBN 0-13-981176-1. 
  2. ^ Guyton & Hall. Textbook of Medical Physiology, 7th Ed., Elsevier-Saunders, p220. ISBN 0-7216-0240-1. 
  3. ^ Hypertension - MeSH
  4. ^ a b Chobanian AV et al (2003). "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.". JAMA 289: 2560-72. PMID 12748199. 
  5. ^ Silverberg DS, Iaina A and Oksenberg A (January 2002). "Treating Obstructive Sleep Apnea Improves Essential Hypertension and Quality of Life". American Family Physicians 65 (2): 229-36. PMID 11820487. 
  6. ^ Hypertension Etiology & Classification - Secondary Hypertension. Armenian Medical Network (2006). Retrieved on 2007-12-02.
  7. ^ a b Bakris G, Dickholtz M, Meyer PM, et al. (2007). "Atlas vertebra realignment and achievement of arterial pressure goal in hypertensive patients: a pilot study". J Hum Hypertens 21 (5): 347–52. doi:10.1038/sj.jhh.1002133. PMID 17252032. 
  8. ^ Sagnella GA, Swift PA (June 2006). "The Renal Epithelial Sodium Channel: Genetic Heterogeneity and Implications for the Treatment of High Blood Pressure". Current Pharmaceutical Design 12 (14): 2221-2234. PMID 16787251. 
  9. ^ Johnson JA, Turner ST (June 2005). "Hypertension pharmacogenomics: current status and future directions.". Current Opinion in Molecular Therapy 7 (3): 218-225. PMID 15977418. 
  10. ^ Hideo Izawa; Yoshiji Yamada et al (May 2003). "Prediction of Genetic Risk for Hypertension". Hypertension 41 (5): 1035-1040. PMID 12654703. 
  11. ^ Symptoms of High Blood Pressure.
  12. ^ Hypertension symptoms and signs. Systemic Hypertension - Hypertension Health Center. Armenian Medical Network (2006). Retrieved on 2007-07-24.
  13. ^ Hypertension in Children and Adolescents. Hypertension in Children and Adolescents. American Academy of Family Physicians (2006). Retrieved on 2007-07-24.
  14. ^ Reeves R (1995). "The rational clinical examination. Does this patient have hypertension? How to measure blood pressure.". JAMA 273 (15): 1211-8. PMID 7707630. 
  15. ^ White W, Lund-Johansen P, Omvik P (1990). "Assessment of four ambulatory blood pressure monitors and measurements by clinicians versus intraarterial blood pressure at rest and during exercise.". Am J Cardiol 65 (1): 60-6. PMID 2294682. 
  16. ^ Kim J, Bosworth H, Voils C, Olsen M, Dudley T, Gribbin M, Adams M, Oddone E (2005). "How well do clinic-based blood pressure measurements agree with the mercury standard?". J Gen Intern Med 20 (7): 647-9. PMID 16050862. 
  17. ^ The American Heart Association. Home Monitoring of High Blood Pressure.
  18. ^ Blood pressure charting software.
  19. ^ Luma GB, Spiotta RT (may 2006). "Hypertension in children and adolescents.". Am Fam Physician 73 (9): 1558-68. PMID 16719248. 
  20. ^ Kragten JA, Dunselman PHJM. Nifedipine gastrointestinal therapeutic system (GITS) in the treatment of coronary heart disease and hypertension. Expert Rev Cardiovasc Ther 5 (2007):643-653. FULL TEXT!
  21. ^ ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group (Dec 18 2002). "Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)". JAMA 288 (23): 2981-97. PMID 12479763. 
  22. ^ Wing LM, Reid CM, Ryan P et al (Feb 13 2003). "A comparison of outcomes with angiotensin-converting--enzyme inhibitors and diuretics for hypertension in the elderly". NEJM 348 (7): 583-92. PMID 12584366. 
  23. ^ Wang TJ, Ausiello JC, Stafford RS (1999). "Trends in Antihypertensive Drug Advertising, 1985–1996". Circulation 99: 2055-2057. PMID 10209012. 
  24. ^ Lewis PJ, Kohner EM, Petrie A, Dollery CT (1976). "Deterioration of glucose tolerance in hypertensive patients on prolonged diuretic treatment". Lancet 307 (7959): 564 - 566. PMID 55840. 
  25. ^ Murphy MB, Lewis PJ, Kohner E, Schumer B, Dollery CT (1982). "Glucose intolerance in hypertensive patients treated with diuretics; a fourteen-year follow-up". Lancet 320 (8311): 1293 - 1295. PMID 6128594. 
  26. ^ Messerli FH, Williams B,Ritz E (2007). "Essential hypertension". Lancet 370 (9587): 591-603. PMID. 
  27. ^ Sheetal Ladva (28/06/2006). NICE and BHS launch updated hypertension guideline. National Institute for Health and Clinical Excellence. Retrieved on 2006-09-30.
  28. ^ Hypertension: management of hypertension in adults in primary care (PDF). National Institute for Health and Clinical Excellence. Retrieved on 2006-09-30.

Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... JAMA, published continuously since in 1883, is an international peer-reviewed general medical journal published 48 times per year. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 336th day of the year (337th in leap years) in the Gregorian calendar. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 205th day of the year (206th in leap years) in the Gregorian calendar. ... Year 2007 (MMVII) was a common year starting on Monday of the Gregorian calendar in the 21st century. ... is the 205th day of the year (206th in leap years) in the Gregorian calendar. ... JAMA, published continuously since in 1883, is an international peer-reviewed general medical journal published 48 times per year. ... The New England Journal of Medicine (NEJM) is a peer-reviewed medical journal published by the Massachusetts Medical Society. ... The National Institute for Health and Clinical Excellence or NICE is an agency of the National Health Service in the United Kingdom. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 273rd day of the year (274th in leap years) in the Gregorian calendar. ... The National Institute for Health and Clinical Excellence or NICE is an agency of the National Health Service in the United Kingdom. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... is the 273rd day of the year (274th in leap years) in the Gregorian calendar. ...

External links

The Open Directory Project (ODP), also known as dmoz (from , its original domain name), is a multilingual open content directory of World Wide Web links owned by Netscape that is constructed and maintained by a community of volunteer editors. ... MedlinePlus (medlineplus. ...

Major studies

For transport in plants, see Vascular tissue. ... A renal cell carcinoma (chromophobe type) viewed on a hematoxylin & eosin stained slide Pathologist redirects here. ... In kidney, as a result of benign arterial hypertension, hyaline (pink, amorphous, homogeneous material) accumulates in the wall of small arteries and arterioles, producing the thickening of their walls and the narrowing of the lumens - hyaline arteriolosclerosis. ... While most forms of hypertension in humans have no known underlying cause (and are thus known as essential hypertension or primary hypertension), in about 10% of the cases, there is a known cause, and thus the hypertension is secondary hypertension (or, less commonly, inessential hypertension). ... Renovascular hypertension (or renal hypertension) is a form of secondary hypertension. ... Ischaemic (or ischemic) heart disease is a disease characterized by reduced blood supply to the heart. ... Prinzmetals angina, also known as variant angina or angina inversa, is a syndrome typically consisting of angina (cardiac chest pain) at rest that occurs in cycles. ... Heart attack redirects here. ... Dresslers syndrome is a form of pericarditis that occurs in the setting of injury to the heart or the pericardium (the outer lining of the heart). ... Pulmonary circulation is the portion of the cardiovascular system which carries oxygen-depleted blood away from the heart, to the lungs, and returns oxygenated blood back to the heart. ... Cor pulmonale is a medical term used to describe a change in structure and function of the right ventricle of the heart as a result of a respiratory disorder. ... The pericardium is a double-walled sac that contains the heart and the roots of the great vessels. ... Pericarditis is inflammation of the sac surrounding the heart, the pericardium. ... Pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. ... Cardiac tamponade, also known as pericardial tamponade, is a medical emergency condition where liquid accumulates in the pericardium in a relatively short time. ... In the heart, the endocardium is the innermost layer of tissue that lines the chambers of the heart. ... Grays Fig. ... Endocarditis is an inflammation of the inner layer of the heart, the endocardium. ... The mitral valve (also known as the bicuspid valve or left atrioventricular valve), is a dual flap (bi = 2) valve in the heart that lies between the left atrium (LA) and the left ventricle (LV). ... Mitral regurgitation (MR), also known as mitral insufficiency, is the abnormal leaking of blood through the mitral valve, from the left ventricle into the left atrium of the heart. ... Mitral valve prolapse (MVP) is a heart valve condition marked by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. ... Mitral stenosis is a narrowing of the orifice of the mitral valve of the heart. ... The aortic valve is one of the valves of the heart. ... Aortic valve stenosis (AS) is a heart condition caused by the incomplete opening of the aortic valve. ... Aortic insufficiency (AI), also known as aortic regurgitation (AR), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. ... The pulmonary valve, also known as pulmonic valve, is the semilunar valve of the heart that lies between the right ventricle and the pulmonary artery and has three cusps. ... Pulmonary valve stenosis is a medical condition in which outflow of blood from the right ventricle of the heart is obstructed at the level of the pulmonic valve. ... Pulmonary valve insufficiency (or incompetence, or regurgitation) is a condition where the pulmonary valve is not strong enough to prevent backflow into the right ventricle. ... The tricuspid valve is on the right side of the heart, between the right atrium and the right ventricle. ... Tricuspid valve stenosis is a valvular heart disease which results in the narrowing of the orifice of the tricuspid valve of the heart. ... Tricuspid insufficiency, also termed Tricuspid regurgitation, refers to the failure of the hearts tricuspid valve to close properly during systole. ... Myocardium is the muscular tissue of the heart. ... In medicine (cardiology), myocarditis is inflammation of the myocardium, the muscular part of the heart. ... Dilated cardiomyopathy or DCM (also known as congestive cardiomyopathy), is a disease of the myocardium (the muscle of the heart) in which a portion of the myocardium is dilated, often without any obvious cause. ... Hypertrophic cardiomyopathy, or HCM, is a disease of the myocardium (the muscle of the heart) in which a portion of the myocardium is hypertrophied (thickened) without any obvious cause. ... This article is considered orphaned, since there are very few or no other articles that link to this one. ... Restrictive cardiomyopathy (RCM) is the least common cardiomyopathy. ... Arrhythmogenic right ventricular dysplasia (ARVD, also known as arrhythmogenic right ventricular cardiomyopathy or ARVC) is a type of nonischemic cardiomyopathy that involves primarily the right ventricle. ... The normal electrical conduction in the heart allows the impulse that is generated by the sinoatrial node (SA node) of the heart to be propagated to (and stimulate) the myocardium (Cardiac muscle). ... A heart block is a disease in the electrical system of the heart. ... A heart block denotes a disease in the electrical system of the heart. ... First degree AV block or PR prolongation is a disease of the electrical conduction system of the heart in which the PR interval is lengthened. ... Second degree AV block is a disease of the electrical conduction system of the heart. ... Third degree AV block, also known as complete heart block, is a defect of the electrical system of the heart, in which the impulse generated in the atria (typically the SA node on top of the right atrium) does not propagate to the ventricles. ... Bundle branch block refers to a disorder of the hearts electrical conducting system. ... ECG characteristics of a typical LBBB showing wide QRS complexes with abnormal morphology in leads V1 and V6. ... Right bundle branch block (RBBB) is a cardiac conduction abnormality seen on electrocardiogram (EKG). ... Bifascicular block is a conduction abnormality in the heart where two of the three main fascicles of the His/Purkinje system are blocked. ... Trifascicular heart block is the triad of first degree heart block, right bundle branch block, and either left anterior or left posterior hemi block seen on an electrocardiogram (EKG). ... Pre-excitation syndrome is a condition where the the ventricles of the heart become depolarized too early, which leads to their premature contraction, causing arrhythmia. ... Wolff-Parkinson-White syndrome (WPW) is a syndrome of pre-excitation of the ventricles of the heart due to an accessory pathway known as the Bundle of Kent. ... Lown-Ganong-Levine syndrome (LGL) is a syndrome of pre-excitation of the ventricles due to an accessory pathway providing an abnormal electrical communication from the atria to the ventricles. ... The long QT syndrome (LQTS) is a heart disease in which there is an abnormally long delay between the electrical excitation (or depolarization) and relaxation (repolarization) of the ventricles of the heart. ... The term Stokes-Adams Attack refers to a sudden, transient episode of syncope, occasionally featuring seizures. ... A cardiac arrest is the cessation of normal circulation of the blood due to failure of the ventricles of the heart to contract effectively during systole. ... Cardiac arrhythmia is any of a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. ... A supraventricular tachycardia (SVT) is a rapid rhythm of the heart in which the origin of the electrical signal is either the atria or the AV node. ... AV nodal reentrant tachycardia (AVNRT) is a type of reentrant tachycardia (fast rhythm) of the heart. ... Ventricular tachycardia (V-tach or VT) is a fast rhythm that originates in one of the ventricles of the heart. ... Atrial flutter is an abnormal fast heart rhythm that occurs in the atria of the heart. ... Atrial fibrillation (AF or afib) is a cardiac arrhythmia (abnormal heart rhythm) that involves the two upper chambers (atria) of the heart. ... Ventricular fibrillation (V-fib or VF) is a cardiac condition which consists of a lack of coordination of the contraction of the muscle tissue of the large chambers of the heart that eventually leads to the heart stopping altogether. ... pac This page meets Wikipedias criteria for speedy deletion. ... This article does not cite any references or sources. ... An ectopic pacemaker or ectopic focus is an excitable group of cells that causes a premature heart beat outside the normally functioning SA node of the human heart. ... Sick sinus syndrome, also called Bradycardia-tachycardia syndrome is a group of abnormal heartbeats (arrhythmias) presumably caused by a malfunction of the sinus node, the hearts natural pacemaker. ... Cardiovascular disease refers to the class of diseases that involve the heart or blood vessels (arteries and veins). ... Cardiomegaly is a medical condition wherein the heart is enlarged. ... Although ventricular hypertrophy may occur in either the left or right or both ventricles of the heart , left ventricular hypertrophy (LVH) is more commonly encountered. ... Left ventricular hypertrophy (LVH) is the thickening of the myocardium (muscle) of the left ventricle of the heart. ... Right ventricular hypertrophy (RVH) is a form of ventricular hypertrophy affecting the right ventricle. ... Cerebrovascular disease is damage to the blood vessels in the brain, resulting in a stroke. ... For other uses, see Stroke (disambiguation). ... A transient ischemic attack (TIA, often colloquially referred to as mini stroke) is caused by the temporary disturbance of blood supply to a restricted area of the brain, resulting in brief neurologic dysfunction that usually persists for less than 24 hours. ... This article needs cleanup. ... A intracranial hemorrhage is a bleed into the substance of the cerebrum. ... Extra-axial hematoma, or extra-axial hemorrhage is a subtype of intracranial hemorrhage, or bleeding within the intracranial space, that occurs within the skull but outside of the brain tissue itself. ... Nontraumatic epidural hematoma in a young woman. ... A subdural hematoma (SDH) is a form of traumatic brain injury in which blood collects between the dura (the outer protective covering of the brain) and the arachnoid (the middle layer of the meninges). ... Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space surrounding the brain, i. ... Intra-axial hemorrhages, or intra-axial hematomas, are a subtype of intracranial hemorrhage that occur within the brain tissue itself. ... Intraventricular hemorrhage (or IVH) is a bleeding of the ventricles, where the cerebrospinal fluid is produced and circulates through towards the subarachnoid space. ... Intra-axial hemorrhages, or intra-axial hematomas, are a subtype of intracranial hemorrhage that occur within the brain tissue itself. ... Ischemia or infarction of the spinal cord in the distribution of the anterior spinal artery, which supplies the ventral two-thirds of the spinal cord and Medulla. ... Binswangers disease is a rare form of multi-infarct dementia caused by damage to deep white brain matter. ... Moyamoya disease is an extremely rare disorder in most parts of the world except in Japan. ... Section of an artery An artery or arterial is also a class of highway. ... An arteriole is a blood vessel that extends and branchs out from an artery and leads to capillaries. ... The word capillary is used to describe any very narrow tube or channel through which a fluid can pass. ... Renal artery stenosis is the narrowing of the renal artery. ... Aortic dissection is a tear in the wall of the aorta (the largest artery of the body). ... An aortic aneurysm is a general term for any swelling (dilatation or aneurysm) of the aorta, usually representing an underlying weakness in the wall of the aorta at that location. ... A plate from Grays Anatomy with yellow lines depicting the most common infrarenal location of the AAA. Abdominal aortic aneurysm, also written as AAA and often pronounced triple-A, is a localized dilatation of the abdominal aorta, that exceeds the normal diameter by more than 50%. The normal diameter... Post surgical photo of brain aneurysm survivor. ... Raynauds phenomenon (RAY-noz), in medicine, is a vasospastic disorder causing discoloration of the fingers, toes, and occasionally other extremities, named for French physician Maurice Raynaud (1834 - 1881). ... Raynauds disease (RAY-noz) is a condition that affects blood flow to the extremities which include the fingers, toes, nose and ears when exposed to temperature changes or stress. ... Buergers disease (also known as thromboangiitis obliterans) is an acute inflammation and thrombosis (clotting) of arteries and veins of the hands and feet. ... In medicine, vasculitis (plural: vasculitides) is a group of diseases featuring inflammation of the wall of blood vessels due to leukocyte migration and resultant damage. ... Arteritis is inflammation of the walls of arteries, usually as a result of infection or auto-immune response. ... Aortitis is the inflammation of the aorta. ... Intermittent claudication is a cramping sensation in the legs that is present during exercise or walking and occurs as a result of decreased oxygen supply. ... An arteriovenous fistula is an abnormal connection or passageway between an artery and a vein. ... In medicine, hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber syndrome, is a genetic disorder that leads to vascular malformations. ... A spider angioma (also known as a nevus araneus, spider nevus, or vascular spider) is a type of angioma found slightly below the skins surface, often containing a central red spot and reddish extensions which radiate outwards like a spiders web. ... Carotid artery dissection is an important cause of stroke in young patients. ... In medical contexts, dissection refers to a tear in the wall of a blood vessel. ... In the circulatory system, a vein is a blood vessel that carries blood toward the heart. ... Lymph originates as blood plasma lost from the circulatory system, which leaks out into the surrounding tissues. ... Lymph nodes are components of the lymphatic system. ... Thrombosis is the formation of a clot or thrombus inside a blood vessel, obstructing the flow of blood through the circulatory system. ... Phlebitis is an inflammation of a vein, usually in the legs. ... It has been suggested that this article or section be merged into deep vein thrombosis. ... This article is about Deep-vein thrombosis. ... May-Thurner syndrome is deep vein thrombosis of the iliofemoral vein due to compression of the left common iliac vein by overlying right common iliac artery. ... A venous thrombosis is a blood clot that forms within a vein. ... In medicine (gastroenterology and hepatology), Budd-Chiari syndrome is the clinical picture caused by occlusion of the hepatic vein. ... Renal vein thrombosis (RVT) is the formation of a clot or thrombus obstructing the renal vein, leading to a reduction in drainage of the kidney. ... Paget-Schroetter disease (also Paget-von Schrötter disease) refers to deep vein thrombosis of an upper extremity vein, including the axillary vein or subclavian vein. ... Vein gymnastics in the barefoot park Dornstetten, Germany. ... A portacaval anastomosis is a specific type of anastomosis that occurs between the veins of portal circulation and those of systemic circulation. ... Hemorrhoids (AmE), haemorrhoids (BrE), emerods, or piles are varicosities or swelling and inflammation of veins in the rectum and anus. ... In medicine (gastroenterology), esophageal varices are extreme dilations of sub mucosal veins in the mucosa of the esophagus in diseases featuring portal hypertension, secondary to cirrhosis primarily. ... Cross section showing the pampiniform plexus Varicocele is an abnormal enlargement of the veins in the scrotum draining the testicles. ... Gastric varices are dilated submucosal veins in the stomach. ... Caput medusae means dilated veins around the umbilicus. ... Superior vena cava syndrome (SVCS) is a result of obstruction of the superior vena cava. ... Lymphadenopathy is a term meaning disease of the lymph nodes. ... Azskeptic 17:34, 10 July 2007 (UTC) Lymphedema, also spelled lymphoedema, also known as lymphatic obstruction, is a condition of localized fluid retention caused by a compromised lymphatic system. ... Lymphadenopathy is swelling of one or more lymph nodes. ... In physiology and medicine, hypotension refers to an abnormally low blood pressure. ... Orthostatic hypotension (also known as postural hypotension, orthostatic intolerance and, colloquially, as head rush or a dizzy spell) is a sudden fall in blood pressure, typically greater than 20/10 mm Hg, that occurs when a person assumes a standing position, usually after a prolonged period of rest. ... Rheumatic fever is an inflammatory disease which may develop after a Group A streptococcal infection (such as strep throat or scarlet fever) and can involve the heart, joints, skin, and brain. ...

  Results from FactBites:
 
Hypertension - Wikipedia, the free encyclopedia (2497 words)
Persistent hypertension is one of the risk factors for strokes, heart attacks, heart failure and arterial aneurysm, and is a leading cause of chronic renal failure.
Hypertension produced by renal disease.A simple explanation for renal vascular hypertension is that decreased perfusion of renal tissue due to stenosis of a main or branch renal artery activates the renin-angiotensin system.
Malignant hypertension (or accelerated hypertension) is distinct as a late phase in the condition, and may present with headaches, blurred vision and end-organ damage.
hypertension - Columbia Encyclopedia article about hypertension (820 words)
hypertension or high blood pressure, elevated blood pressure blood pressure, force exerted by the blood upon the walls of the arteries.
Hypertension is generally defined as a blood pressure reading greater than 140 over 90; presssures of 120–139 over 80–89 are now considered prehypertension.
Known as the "silent killer," hypertension often produces few overt symptoms; it may, however, result in damage to the heart, eyes, kidneys, or brain and ultimately lead to congestive heart failure congestive heart failure, inability of the heart to expel sufficient blood to keep pace with the metabolic demands of the body.
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