Hypertension

Hypertension

Definition:

A disorder characterized by high blood pressure; generally this includes systolic blood pressure (the "top" number of your blood pressure measurement, which represents the pressure generated when the heart beats) consistently higher than 140, or diastolic blood pressure (the "bottom" number of your blood pressure measurement, which represents the pressure in the vessels when the heart is at rest) consistently over 90.

Causes, incidence, and risk factors:

Blood pressure is determined by the amount of blood pumped by the heart, and the size and condition of the arteries. Many other factors can affect blood pressure, including volume of water in the body; salt content of the body; condition of the kidneys, nervous system, or blood vessels; and levels of various hormones in the body.

"Essential" hypertension has no identifiable cause. It may have genetic factors and environmental factors, such as salt intake or others. Essential hypertension comprises over 95% of all hypertension.

"Secondary" hypertension is hypertension caused by another disorder. This may include:

adrenal gland tumors
Cushing's syndrome
kidney disorders
- glomerulonephritis (inflammation of kidneys)
- renal vascular obstruction or narrowing
- renal failure
use of medications, drugs, or other chemicals
oral contraceptives
hemolytic-uremic syndrome
Henoch-Schonlein purpura
periarteritis nodosa
radiation enteritis
retroperitoneal fibrosis
Wilms' tumor
other disorders

Symptoms:

headache (occasionally)

If hypertension is severe, may have:

tiredness
confusion
vision changes
nausea, vomiting
excessive perspiration
muscle tremors
angina-like pain: crushing substernal chest pain
heart failure
blood in urine

Note: Often no symptoms are present.

Additional symptoms that may be associated with this disease:

Signs and tests:

Hypertension may be suspected when the blood pressure is high. It is confirmed through blood pressure measurements that are repeated over time. Blood pressure consistently elevated over 140 systolic (which indicates the pressure generated when the heart beats) or 90 diastolic (which indicates the pressure when the heart is at rest). The person may show signs of complications.

Tests for suspected causes and complications may be performed. These are guided by the symptoms presented, history, and results of examination.

This disease may also alter the results of the following tests:

Treatment:

The goal of treatment is to reduce blood pressure to a level where there is decreased risk of complications. Treatment may occur at home with close supervision by the health care provider, or may occur in the hospital.

Medications may include diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or alpha blockers. Medications such as hydralazine, minoxidil, diazoxide, or nitroprusside may be required if the blood pressure is very high.

Have your blood pressure checked at regular intervals (as often as recommended by the provider).

Lifestyle changes may reduce high blood pressure, including weight loss, exercise, and dietary adjustments (see "Prevention").

Expectations (prognosis):

Hypertension is controllable with treatment. It requires lifelong monitoring, and the treatment may require adjustments periodically.

Complications:

Calling your health care provider:

Call for an appointment with your health care provider if:

you think you may have hypertension.
your blood pressure remains high even with treatment, or if other symptoms develop.

Prevention:

Lifestyle changes may be helpful to control high blood pressure. Lose weight, if overweight. Excess weight adds to strain on the heart. In some cases, weight loss may be the only treatment needed. Exercise to improve cardiac fitness. Dietary adjustments may be beneficial, especially a decrease of sodium in diet. Modify intake (sodium intake may have little effect in persons without hypertension but may have a profound effect in those with hypertension). Salt, MSG, and baking soda all contain sodium.

Follow the health care provider's recommendations to modify, treat, or control possible causes of secondary hypertension.

Review Date: 11/29/2001
Reviewed By: Andrew Koren, MD, Department of Nephrology, NYU-Mount Sinai Medical Center, New York, NY. Review provided by VeriMed Healthcare Network

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