HYPERTENSION AND ITS WOES

 

BY OFONMBUK SUNDAY UDOH AND SUNDAY OLAJIDE AWOFISAYO

 

CORRESPONDENCE

OFONMBUK SUNDAY UDOH

ABSTRACT

High blood pressure (HBP) is one of the most prevalent conditions seen today by clinicians,

affecting an estimated 73million or 1 in 3 adult Americans, only one third of who have achieved

control of their hypertension (HBP). Central to the management of this pervasive medical

condition are the issues of accurate diagnosis and maintaining control through appropriate

treatment. Accurate diagnosis depends primarily on reliable measurement.

Over the years, it has become increasingly recognized that blood pressure (BP) measurement

occurring in clinical settings produces far less accurate and reliable reading than do other

methods, notably 24 hour ambulatory BP monitoring and home BP measurement beyond

technique, there are additional challenges to obtaining accurate readings, having the potential to

mislead the clinician. The pharmacologic treatment with diuretic therapy, alpha blockers

conventional beta – blockers, calcium channel blockers, angiotensin – converting enzyme

inhibitors and angiotensin receptor blockers alongside therapeutic outcome are major topics of

discussions today. Trial outcomes shed light on the relative benefits and drawbacks of these

agents, often within the context of various patient characteristics such as age, co – morbidities

and risk status.

Successful management of HBP is a multifaceted and ongoing endeavor, in which developing

knowledge constantly tempered by new questions moves us toward the goal of improving the

lives of our patients.

INTRODUCTION

Each time the heart beats, blood is pumped through the arteries and veins in the blood vessels of

your circulatory system. Arterial blood pressure is created by the force exerted by the blood

against the artery walls, as they carry blood around the body.

 

Hypertension also known as high blood pressure is when the pressure of the blood being pumped through the art6eries is higher than it should be. High blood pressure or high pretension has been called ‘’silent killer’’, because it often has no warning signs or symptoms and many people do not even know they have it. Overtime, the constant pressure overload causes accumulating

damage that eventually becomes more than the circulating system can handle, often leading to serious health problems.

EPIDEMOLOGY

Hypertension is a worldwide epidemic accordingly; its epidemiology has been well studied. Data from National Health and Nutrition Examination Survey (NHANES) spanning 2011 -2014 in theUnited states found that in the population age 20years or older, an estimated 86million adults had hypertension with a prevalence of 34%.

Hypertension affects us men and women nearly equally, affecting an estimated 40.8 million men and 44.9million women. Globally, an estimated 26% of the world’s population (972million people) has hypertension and the prevalence is expected to increase to 29% by 2025, driven largely by increase in economically developing nations.

The high prevalence of hypertension exacts a tremendous public health burden. As a primary contributor to heart disease and stroke, the first and third leading cause of death worldwide, respectively, high blood pressure was the top modifiable risk factor for disability adjusted life years lost worldwide in 2013.

TYPES

Primary and secondary hypertension

Primary hypertension: also known as essential hypertension/ idiopathic hypertension is most common and complex type of hypertension population, by definition it has no direct cause but is a result of sedentary lifestyle and obesity.

Secondary hypertension: is a result of identifiable cause. It is very important to detect secondary hypertension as the treatment for secondary hypertension is associated with treating the cause. Secondary hypertension results from the interplay of several pathophysiological mechanisms, regulating plasma volume, peripheral vascular resistance and cardiac output, all of which may be increased.

COMPLICATIONS

When blood pressure stays high over long time, it can damage the different organs of the body and cause complications which include, Heart: left ventricular hypertrophy, angina previous myocardial infarction and heart failure brain: Stroke or Transient Ischemic attack, Dementia Chronic kidney disease, Peripheral arterial disease, aneurysms Retinopathy, Cognitive changes If hypertension is detected early, with adherence to medication and healthy behaviors, it is possible to minimize the risk of heart attack, heart failure, and stroke and kidney failure.

DIAGNOSIS

Blood pressure is usually measured using a pressure cuff or an electronic device placed on the upper arm. A blood pressure is written as two numbers representing the maximum pressure in the circulatory system when the heart pumps blood out(systolic pressure) and the minimum pressure when the heart refills (diastolic pressure). Blood pressure is measured in millimeters of mercury (mmHg). Normal resting blood pressure in an adult is approximately 120/80 mmHg. Blood pressure can fluctuate from minute to minute and readings are generally higher in the afternoon and lower at night.

Blood pressure is classified into four categories:

Normal blood pressure: the blood pressure is normal if it’s below mmHg

Elevated blood pressure: this is a systolic pressure ranging from mmHg. Elevated blood pressure tends to get worse over time unless steps are taken to control blood pressure.

Stage 1

Hypertension: this hypertension is has a systolic pressure ranging from mmHg

Stage 2

Hypertension: this is a systolic pressure of mmHg or higher

TREATMENT

Changing the lifestyle can go a long way toward controlling high blood pressure. The doctor may

recommend eating healthy diet with less salt, exercise regularly, quit smoking and maintain a healthy weight. But sometime lifestyle changes aren’t enough, the doctor may also recommend medication to lower the blood pressure. Examples are: Thiazide diuretics e.g. murduretic called water pill, the medication that act on your kidneys to help the body eliminate sodium and water,

reducing blood volume. Calcium channel blockers: e.g. Nifadipine, Amlodipine(Norvasc),

these help relax the muscles of the blood vessels. Some slow the heart rate. Calcium channel

blockers may work better for black and older people than do ACE inhibitors alone. Beta

blockers: e.g. Propanol (Inderal). These medications reduce the workload on the heart and open

the blood vessels, causing the heart6 to beat slower and with less force. Beta blockers also

include acebutolol(Sectral), atenolol (Tenomin) and others.

MODE OF ACTION

Many anti hypertensive drugs have their primary action on systemic vascular resistance. Some of these drugs produce vasodilation by interfering with sympathetic adrenergic vascular tone (Sympatholytics) or by blocking the formation of Aniotensin(ii) or its vascular receptors.

SIDE EFFECTS OF BLOOD PRESSURE MEDICINES

Most blood pressure medicines are easy to take, but all medicines have side effects. Most of these are mild and may go away overtime. Some common side effects are; Cough, Diarrhea or constipation, Dizziness or lightheadedness, Erection problems, Feeling nervous, Feeling tired, weak, drowsy or lack of energy, Headache, Nausea or vomiting, Skin rash, Weight loss or gain without trying.

REFERENCE

The Ministry of Health, Labour, and Welfare. Demographics in Japan in 2013. The Ministry of

Health, Labour, and Welfare. 2013. Japanese. E-III

 

Kubo M, Kiyohara Y, Kato I, Tanizaki Y, Arima H, Tanaka K, Nakamura H, Okubo K, Iida M.

Trends in the incidence, mortality, and survival rate of cardiovascular disease in a Japanese

community: the Hisayama study. Stroke 2003; 34: 2349–2354. E-III

 

Kitamura A, Sato S, Kiyama M, Imano H, Iso H, Okada T, Ohira T, Tanigawa T, Yamagishi K,

Nakamura M, Konishi M, Shimamoto T, Iida M, Komachi Y. Trends in the incidence of

coronary heart disease and stroke and their risk factors in Japan, 1964 to 2003: the Akita-Osaka

study. J Am Coll Cardiol 2008; 52: 71–79.

 

Ueshima H. Explanation for the Japanese paradox: prevention of increase in coronary heart

disease and reduction in stroke. J Atheroscler Thromb 2007; 14: 278–286. E-III

 

Kimura Y, Takishita S, Muratani H, Kinjo K, Shinzato Y, Muratani A, Fukiyama K.

Demographic study of first-ever stroke and acute myocardial infarction in Okinawa. Japan

Intern Med 1998; 37: 736–745. E-III

Imano H, Kitamura A, Sato S, Kiyama M, Ohira T, Yamagishi K, Noda H, Tanigawa T, Iso H,

Shimamoto T. Trends for blood pressure and its contribution to stroke incidence in the middle-

aged Japanese population: the Circulatory Risk in Communities Study

(CIRCS). Stroke 2009; 40: 1571–1577. E-Ib

Rumana N, Kita Y, Turin TC, Murakami Y, Sugihara H, Morita Y, Tomioka N, Okayama A,

Nakamura Y, Abbott RD, Ueshima H. Trend of increase in the incidence of acute myocardial

infarction in a Japanese population: Takashima AMI Registry, 1990–2001. Am J

Epidemiol 2008; 167: 1358–1364. E-III

Turin TC, Kokubo Y, Murakami Y, Higashiyama A, Rumana N, Watanabe M, Okamura T.

Lifetime risk of acute myocardial infarction in Japan. Circ Cardiovasc Qual Outcomes 2010; 3:

701–703. E-III

Turin TC, Kokubo Y, Murakami Y, Higashiyama A, Rumana N, Watanabe M, Okamura T.

Lifetime risk of stroke in Japan. Stroke 2010; 41: 1552–1554. E-III

Fujiyoshi A, Ohkubo T, Miura K, Murakami Y, Nagasawa SY, Okamura T, Ueshima H,

Observational Cohorts in Japan (EPOCH-JAPAN) Research Group. Blood pressure categories

and long-term risk of cardiovascular disease according to age group in Japanese men and

women. Hypertens Res 2012; 35: 947–953. E-Ia

Takashima N, Ohkubo T, Miura K, Okamura T, Murakami Y, Fujiyoshi A, Nagasawa SY,

Kadota A, Kita Y, Miyagawa N, Hisamatsu T, Hayakawa T, Okayama A, Ueshima H, NIPPON

DATA80 Research Group. Long-term risk of BP values above normal for cardiovascular

mortality: a 24-year observation of Japanese aged 30 to 92 years. J Hypertens 2012; 30:

2299–2306.

 

Ikeda A, Iso H, Yamagishi K, Inoue M, Tsugane S. Blood pressure and the risk of stroke,

cardiovascular disease, and all-cause mortality among Japanese: the JPHC Study. Am J

Hypertens 2009; 22: 273–280.

Arima H, Tanizaki Y, Yonemoto K, Doi Y, Ninomiya T, Hata J, Fukuhara M, Matsumura K,

Iida M, Kiyohara Y. Impact of blood pressure levels on different types of stroke: the Hisayama

study. J Hypertens 2009; 27: 2437–2443.

Lawes CM, Rodgers A, Bennett DA, Parag V, Suh I, Ueshima H, MacMahon S, Asia Pacific

Cohort Studies Collaboration. Blood pressure and cardiovascular disease in the Asia Pacific

region. J Hypertens 2003; 21: 707–716.

Nippon Data 80 Research Group. Impact of elevated blood pressure on mortality from all causes,

cardiovascular diseases, heart disease and stroke among Japanese: 14 year follow-up of

randomly selected population from Japanese—Nippon data 80. J Hum Hypertens 2003; 17:

851–857.

Tanizaki Y, Kiyohara Y, Kato I, Iwamoto H, Nakayama K, Shinohara N, Arima H, Tanaka K,

Ibayashi S, Fujishima M. Incidence and risk factors for subtypes of cerebral infarction in a

general population: the Hisayama study. Stroke 2000; 31: 2616–2622. E-Ib

Fukuhara M, Arima H, Ninomiya T, Hata J, Yonemoto K, Doi Y, Hirakawa Y, Matsumura K,

Kitazono T, Kiyohara Y. Impact of lower range of prehypertension on cardiovascular events in a

general population: the Hisayama Study. J Hypertens 2012; 30: 893–900.

Tozawa M, Iseki K, Iseki C, Kinjo K, Ikemiya Y, Takishita S. Blood pressure predicts risk of

developing end-stage renal disease in men and women. Hypertension 2003; 41: 1341–1345.

Yamagata K, Ishida K, Sairenchi T, Takahashi H, Ohba S, Shiigai T, Narita M, Koyama A. Risk

factors for chronic kidney disease in a community-based population: a 10-year follow-up

study. Kidney Int 2007; 71: 159–166.

Kanno A, Kikuya M, Ohkubo T, Hashimoto T, Satoh M, Hirose T, Obara T, Metoki H, Inoue R,

Asayama K, Shishido Y, Hoshi H, Nakayama M, Totsune K, Satoh H, Sato H, Imai Y. Pre-

hypertension as a significant predictor of chronic kidney disease in a general population: the

HYPERTENSION AND ITS WOES
BY OFONMBUK SUNDAY UDOH AND SUNDAY OLAJIDE AWOFISAYO

CORRESPONDENCE
OFONMBUK SUNDAY UDOH
Email; Telephone

ABSTRACT
High blood pressure (HBP) is one of the most prevalent conditions seen today by clinicians,
affecting an estimated 73million or 1 in 3 adult Americans, only one third of who have achieved
control of their hypertension (HBP). Central to the management of this pervasive medical
condition are the issues of accurate diagnosis and maintaining control through appropriate
treatment. Accurate diagnosis depends primarily on reliable measurement.
Over the years, it has become increasingly recognized that blood pressure (BP) measurement
occurring in clinical settings produces far less accurate and reliable reading than do other
methods, notably 24 hour ambulatory BP monitoring and home BP measurement beyond
technique, there are additional challenges to obtaining accurate readings, having the potential to
mislead the clinician. The pharmacologic treatment with diuretic therapy, alpha blockers
conventional beta – blockers, calcium channel blockers, angiotensin – converting enzyme
inhibitors and angiotensin receptor blockers alongside therapeutic outcome are major topics of
discussions today. Trial outcomes shed light on the relative benefits and drawbacks of these
agents, often within the context of various patient characteristics such as age, co – morbidities
and risk status.
Successful management of HBP is a multifaceted and ongoing endeavor, in which developing
knowledge constantly tempered by new questions moves us toward the goal of improving the
lives of our patients.
INTRODUCTION
Each time the heart beats, blood is pumped through the arteries and veins in the blood vessels of
your circulatory system. Arterial blood pressure is created by the force exerted by the blood
against the artery walls, as they carry blood around the body.

Hypertension also known as high blood pressure is when the pressure of the blood being pumped
through the art6eries is higher than it should be. High blood pressure or high pretension has been
called ‘’silent killer’’, because it often has no warning signs or symptoms and many people do
not even know they have it. Overtime, the constant pressure overload causes accumulating
damage that eventually becomes more than the circulating system can handle, often leading to
serious health problems.
EPIDEMOLOGY
Hypertension is a worldwide epidemic accordingly; its epidemiology has been well studied. Data
from National Health and Nutrition Examination Survey (NHANES) spanning 2011 -2014 in the
United states found that in the population age 20years or older, an estimated 86million adults had
hypertension with a prevalence of 34%.
Hypertension affects us men and women nearly equally, affecting an estimated 40.8 million men
and 44.9million women. Globally, an estimated 26% of the world’s population (972million
people) has hypertension and the prevalence is expected to increase to 29% by 2025, driven
largely by increase in economically developing nations.
The high prevalence of hypertension exacts a tremendous public health burden. As a primary
contributor to heart disease and stroke, the first and third leading cause of death worldwide,
respectively, high blood pressure was the top modifiable risk factor for disability adjusted life
years lost worldwide in 2013.
TYPES
Primary and secondary hypertension
Primary hypertension: also known as essential hypertension/ idiopathic hypertension is most
common and complex type of hypertension population, by definition it has no direct cause but is
a result of sedentary lifestyle and obesity.
Secondary hypertension: is a result of identifiable cause. It is very important to detect
secondary hypertension as the treatment for secondary hypertension is associated with treating
the cause. Secondary hypertension results from the interplay of several pathophysiological

mechanisms, regulating plasma volume, peripheral vascular resistance and cardiac output, all of
which may be increased.
COMPLICATIONS
When blood pressure stays high over long time, it can damage the different organs of the body
and cause complications which include, Heart: left ventricular hypertrophy, angina previous
myocardial infarction and heart failure brain: Stroke or Transient Ischemic attack, Dementia
Chronic kidney disease, Peripheral arterial disease, aneurysms Retinopathy, Cognitive changes
If hypertension is detected early, with adherence to medication and healthy behaviors, it is
possible to minimize the risk of heart attack, heart failure, and stroke and kidney failure.
DIAGNOSIS
Blood pressure is usually measured using a pressure cuff or an electronic device placed on the
upper arm. A blood pressure is written as two numbers representing the maximum pressure in the
circulatory system when the heart pumps blood out(systolic pressure) and the minimum pressure
when the heart refills (diastolic pressure). Blood pressure is measured in millimeters of mercury
(mmHg). Normal resting blood pressure in an adult is approximately 120/80 mmHg. Blood
pressure can fluctuate from minute to minute and readings are generally higher in the afternoon
and lower at night.
Blood pressure is classified into four categories:
Normal blood pressure: the blood pressure is normal if it’s below mmHg
Elevated blood pressure: this is a systolic pressure ranging from mmHg. Elevated blood
pressure tends to get worse over time unless steps are taken to control blood pressure. Stage 1
Hypertension: this hypertension is has a systolic pressure ranging from mmHg Stage 2
Hypertension: this is a systolic pressure of mmHg or higher
TREATMENT
Changing the lifestyle can go a long way toward controlling high blood pressure. The doctor may
recommend eating healthy diet with less salt, exercise regularly, quit smoking and maintain a

healthy weight. But sometime lifestyle changes aren’t enough, the doctor may also recommend
medication to lower the blood pressure. Examples are: Thiazide diuretics e.g. murduretic called
water pill, the medication that act on your kidneys to help the body eliminate sodium and water,
reducing blood volume. Calcium channel blockers: e.g. Nifadipine, Amlodipine(Norvasc),
these help relax the muscles of the blood vessels. Some slow the heart rate. Calcium channel
blockers may work better for black and older people than do ACE inhibitors alone. Beta
blockers: e.g. Propanol (Inderal). These medications reduce the workload on the heart and open
the blood vessels, causing the heart6 to beat slower and with less force. Beta blockers also
include acebutolol(Sectral), atenolol (Tenomin) and others.
MODE OF ACTION
Many anti hypertensive drugs have their primary action on systemic vascular resistance. Some of
these drugs produce vasodilation by interfering with sympathetic adrenergic vascular tone
(Sympatholytics) or by blocking the formation of Aniotensin(ii) or its vascular receptors.
SIDE EFFECTS OF BLOOD PRESSURE MEDICINES
Most blood pressure medicines are easy to take, but all medicines have side effects. Most of
these are mild and may go away overtime. Some common side effects are;
Cough, Diarrhea or constipation, Dizziness or lightheadedness, Erection problems, Feeling
nervous, Feeling tired, weak, drowsy or lack of energy, Headache, Nausea or vomiting, Skin rash
Weight loss or gain without trying.
REFERENCE
The Ministry of Health, Labour, and Welfare. Demographics in Japan in 2013. The Ministry of
Health, Labour, and Welfare. 2013. Japanese. E-III

Kubo M, Kiyohara Y, Kato I, Tanizaki Y, Arima H, Tanaka K, Nakamura H, Okubo K, Iida M.
Trends in the incidence, mortality, and survival rate of cardiovascular disease in a Japanese
community: the Hisayama study. Stroke 2003; 34: 2349–2354. E-III

Kitamura A, Sato S, Kiyama M, Imano H, Iso H, Okada T, Ohira T, Tanigawa T, Yamagishi K,
Nakamura M, Konishi M, Shimamoto T, Iida M, Komachi Y. Trends in the incidence of
coronary heart disease and stroke and their risk factors in Japan, 1964 to 2003: the Akita-Osaka
study. J Am Coll Cardiol 2008; 52: 71–79.

Ueshima H. Explanation for the Japanese paradox: prevention of increase in coronary heart
disease and reduction in stroke. J Atheroscler Thromb 2007; 14: 278–286. E-III

Kimura Y, Takishita S, Muratani H, Kinjo K, Shinzato Y, Muratani A, Fukiyama K.
Demographic study of first-ever stroke and acute myocardial infarction in Okinawa. Japan
Intern Med 1998; 37: 736–745. E-III
Imano H, Kitamura A, Sato S, Kiyama M, Ohira T, Yamagishi K, Noda H, Tanigawa T, Iso H,
Shimamoto T. Trends for blood pressure and its contribution to stroke incidence in the middle-
aged Japanese population: the Circulatory Risk in Communities Study
(CIRCS). Stroke 2009; 40: 1571–1577. E-Ib
Rumana N, Kita Y, Turin TC, Murakami Y, Sugihara H, Morita Y, Tomioka N, Okayama A,
Nakamura Y, Abbott RD, Ueshima H. Trend of increase in the incidence of acute myocardial
infarction in a Japanese population: Takashima AMI Registry, 1990–2001. Am J
Epidemiol 2008; 167: 1358–1364. E-III
Turin TC, Kokubo Y, Murakami Y, Higashiyama A, Rumana N, Watanabe M, Okamura T.
Lifetime risk of acute myocardial infarction in Japan. Circ Cardiovasc Qual Outcomes 2010; 3:
701–703. E-III
Turin TC, Kokubo Y, Murakami Y, Higashiyama A, Rumana N, Watanabe M, Okamura T.
Lifetime risk of stroke in Japan. Stroke 2010; 41: 1552–1554. E-III
Fujiyoshi A, Ohkubo T, Miura K, Murakami Y, Nagasawa SY, Okamura T, Ueshima H,
Observational Cohorts in Japan (EPOCH-JAPAN) Research Group. Blood pressure categories
and long-term risk of cardiovascular disease according to age group in Japanese men and
women. Hypertens Res 2012; 35: 947–953. E-Ia
Takashima N, Ohkubo T, Miura K, Okamura T, Murakami Y, Fujiyoshi A, Nagasawa SY,
Kadota A, Kita Y, Miyagawa N, Hisamatsu T, Hayakawa T, Okayama A, Ueshima H, NIPPON
DATA80 Research Group. Long-term risk of BP values above normal for cardiovascular
mortality: a 24-year observation of Japanese aged 30 to 92 years. J Hypertens 2012; 30:
2299–2306.

Ikeda A, Iso H, Yamagishi K, Inoue M, Tsugane S. Blood pressure and the risk of stroke,
cardiovascular disease, and all-cause mortality among Japanese: the JPHC Study. Am J
Hypertens 2009; 22: 273–280.
Arima H, Tanizaki Y, Yonemoto K, Doi Y, Ninomiya T, Hata J, Fukuhara M, Matsumura K,
Iida M, Kiyohara Y. Impact of blood pressure levels on different types of stroke: the Hisayama
study. J Hypertens 2009; 27: 2437–2443.
Lawes CM, Rodgers A, Bennett DA, Parag V, Suh I, Ueshima H, MacMahon S, Asia Pacific
Cohort Studies Collaboration. Blood pressure and cardiovascular disease in the Asia Pacific
region. J Hypertens 2003; 21: 707–716.
Nippon Data 80 Research Group. Impact of elevated blood pressure on mortality from all causes,
cardiovascular diseases, heart disease and stroke among Japanese: 14 year follow-up of
randomly selected population from Japanese—Nippon data 80. J Hum Hypertens 2003; 17:
851–857.
Tanizaki Y, Kiyohara Y, Kato I, Iwamoto H, Nakayama K, Shinohara N, Arima H, Tanaka K,
Ibayashi S, Fujishima M. Incidence and risk factors for subtypes of cerebral infarction in a
general population: the Hisayama study. Stroke 2000; 31: 2616–2622. E-Ib
Fukuhara M, Arima H, Ninomiya T, Hata J, Yonemoto K, Doi Y, Hirakawa Y, Matsumura K,
Kitazono T, Kiyohara Y. Impact of lower range of prehypertension on cardiovascular events in a
general population: the Hisayama Study. J Hypertens 2012; 30: 893–900.
Tozawa M, Iseki K, Iseki C, Kinjo K, Ikemiya Y, Takishita S. Blood pressure predicts risk of
developing end-stage renal disease in men and women. Hypertension 2003; 41: 1341–1345.
Yamagata K, Ishida K, Sairenchi T, Takahashi H, Ohba S, Shiigai T, Narita M, Koyama A. Risk
factors for chronic kidney disease in a community-based population: a 10-year follow-up
study. Kidney Int 2007; 71: 159–166.
Kanno A, Kikuya M, Ohkubo T, Hashimoto T, Satoh M, Hirose T, Obara T, Metoki H, Inoue R,
Asayama K, Shishido Y, Hoshi H, Nakayama M, Totsune K, Satoh H, Sato H, Imai Y. Pre-
hypertension as a significant predictor of chronic kidney disease in a general population: the
Ohasama Study. Nephrol Dial Transplant 2012; 27: 3218–3223.

HYPERTENSION AND ITS WOES
BY OFONMBUK SUNDAY UDOH AND SUNDAY OLAJIDE AWOFISAYO

CORRESPONDENCE
OFONMBUK SUNDAY UDOH
Email; Telephone

ABSTRACT
High blood pressure (HBP) is one of the most prevalent conditions seen today by clinicians,
affecting an estimated 73million or 1 in 3 adult Americans, only one third of who have achieved
control of their hypertension (HBP). Central to the management of this pervasive medical
condition are the issues of accurate diagnosis and maintaining control through appropriate
treatment. Accurate diagnosis depends primarily on reliable measurement.
Over the years, it has become increasingly recognized that blood pressure (BP) measurement
occurring in clinical settings produces far less accurate and reliable reading than do other
methods, notably 24 hour ambulatory BP monitoring and home BP measurement beyond
technique, there are additional challenges to obtaining accurate readings, having the potential to
mislead the clinician. The pharmacologic treatment with diuretic therapy, alpha blockers
conventional beta – blockers, calcium channel blockers, angiotensin – converting enzyme
inhibitors and angiotensin receptor blockers alongside therapeutic outcome are major topics of
discussions today. Trial outcomes shed light on the relative benefits and drawbacks of these
agents, often within the context of various patient characteristics such as age, co – morbidities
and risk status.
Successful management of HBP is a multifaceted and ongoing endeavor, in which developing
knowledge constantly tempered by new questions moves us toward the goal of improving the
lives of our patients.
INTRODUCTION
Each time the heart beats, blood is pumped through the arteries and veins in the blood vessels of
your circulatory system. Arterial blood pressure is created by the force exerted by the blood
against the artery walls, as they carry blood around the body.

Hypertension also known as high blood pressure is when the pressure of the blood being pumped
through the art6eries is higher than it should be. High blood pressure or high pretension has been
called ‘’silent killer’’, because it often has no warning signs or symptoms and many people do
not even know they have it. Overtime, the constant pressure overload causes accumulating
damage that eventually becomes more than the circulating system can handle, often leading to
serious health problems.
EPIDEMOLOGY
Hypertension is a worldwide epidemic accordingly; its epidemiology has been well studied. Data
from National Health and Nutrition Examination Survey (NHANES) spanning 2011 -2014 in the
United states found that in the population age 20years or older, an estimated 86million adults had
hypertension with a prevalence of 34%.
Hypertension affects us men and women nearly equally, affecting an estimated 40.8 million men
and 44.9million women. Globally, an estimated 26% of the world’s population (972million
people) has hypertension and the prevalence is expected to increase to 29% by 2025, driven
largely by increase in economically developing nations.
The high prevalence of hypertension exacts a tremendous public health burden. As a primary
contributor to heart disease and stroke, the first and third leading cause of death worldwide,
respectively, high blood pressure was the top modifiable risk factor for disability adjusted life
years lost worldwide in 2013.
TYPES
Primary and secondary hypertension
Primary hypertension: also known as essential hypertension/ idiopathic hypertension is most
common and complex type of hypertension population, by definition it has no direct cause but is
a result of sedentary lifestyle and obesity.
Secondary hypertension: is a result of identifiable cause. It is very important to detect
secondary hypertension as the treatment for secondary hypertension is associated with treating
the cause. Secondary hypertension results from the interplay of several pathophysiological

mechanisms, regulating plasma volume, peripheral vascular resistance and cardiac output, all of
which may be increased.
COMPLICATIONS
When blood pressure stays high over long time, it can damage the different organs of the body
and cause complications which include, Heart: left ventricular hypertrophy, angina previous
myocardial infarction and heart failure brain: Stroke or Transient Ischemic attack, Dementia
Chronic kidney disease, Peripheral arterial disease, aneurysms Retinopathy, Cognitive changes
If hypertension is detected early, with adherence to medication and healthy behaviors, it is
possible to minimize the risk of heart attack, heart failure, and stroke and kidney failure.
DIAGNOSIS
Blood pressure is usually measured using a pressure cuff or an electronic device placed on the
upper arm. A blood pressure is written as two numbers representing the maximum pressure in the
circulatory system when the heart pumps blood out(systolic pressure) and the minimum pressure
when the heart refills (diastolic pressure). Blood pressure is measured in millimeters of mercury
(mmHg). Normal resting blood pressure in an adult is approximately 120/80 mmHg. Blood
pressure can fluctuate from minute to minute and readings are generally higher in the afternoon
and lower at night.
Blood pressure is classified into four categories:
Normal blood pressure: the blood pressure is normal if it’s below mmHg
Elevated blood pressure: this is a systolic pressure ranging from mmHg. Elevated blood
pressure tends to get worse over time unless steps are taken to control blood pressure. Stage 1
Hypertension: this hypertension is has a systolic pressure ranging from mmHg Stage 2
Hypertension: this is a systolic pressure of mmHg or higher
TREATMENT
Changing the lifestyle can go a long way toward controlling high blood pressure. The doctor may
recommend eating healthy diet with less salt, exercise regularly, quit smoking and maintain a

healthy weight. But sometime lifestyle changes aren’t enough, the doctor may also recommend
medication to lower the blood pressure. Examples are: Thiazide diuretics e.g. murduretic called
water pill, the medication that act on your kidneys to help the body eliminate sodium and water,
reducing blood volume. Calcium channel blockers: e.g. Nifadipine, Amlodipine(Norvasc),
these help relax the muscles of the blood vessels. Some slow the heart rate. Calcium channel
blockers may work better for black and older people than do ACE inhibitors alone. Beta
blockers: e.g. Propanol (Inderal). These medications reduce the workload on the heart and open
the blood vessels, causing the heart6 to beat slower and with less force. Beta blockers also
include acebutolol(Sectral), atenolol (Tenomin) and others.
MODE OF ACTION
Many anti hypertensive drugs have their primary action on systemic vascular resistance. Some of
these drugs produce vasodilation by interfering with sympathetic adrenergic vascular tone
(Sympatholytics) or by blocking the formation of Aniotensin(ii) or its vascular receptors.
SIDE EFFECTS OF BLOOD PRESSURE MEDICINES
Most blood pressure medicines are easy to take, but all medicines have side effects. Most of
these are mild and may go away overtime. Some common side effects are;
Cough, Diarrhea or constipation, Dizziness or lightheadedness, Erection problems, Feeling
nervous, Feeling tired, weak, drowsy or lack of energy, Headache, Nausea or vomiting, Skin rash
Weight loss or gain without trying.
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