Hypertension

INTRODUCTION
• Hypertension is one of the most important risk factors for cardiovascular

diseases (CVD), particularly ischemic heart disease and stroke
• High blood pressure, also called hypertension, is blood pressure that is
higher than normal. Your blood pressure changes throughout the day based
on your activities. Having blood pressure measures consistently above
normal may result in a diagnosis of high blood pressure (or hypertension).
• The higher your blood pressure levels, the more risk you have for other
health problems, such as heart disease, heart attack, and stroke.
DEFINATION
• In accordance with most major guidelines it is recommended that
hypertension be diagnosed when a person’s systolic blood pressure (SBP)
in the office or clinic is ≥140 mm Hg and/or their diastolic blood pressure
(DBP) is ≥90 mm Hg following repeated examination
• White coat hypertension: The use of office and out-of-office (home or
ambulatory) BP measurements identifies individuals with white coat
hypertension, who have elevated BP only in the office (nonelevated
ambulatory or home BP). These subjects are at intermediate
cardiovascular risk between normotensives and sustained hypertensives.
The diagnosis needs confirmation with repeated office and out-of-office
BP measurements.
• Masked hypertension: who have nonelevated BP in the office but
elevated BP out of the office (ambulatory or home). : These patients are
at similar risk of cardiovascular events as sustained hypertensives.
STATISTICAL OVERVIEW
• An estimated 1.28 billion adults aged 30–79 years worldwide have hypertension, most (two-thirds)
living in low- and middle-income countries
• An estimated 46% of adults with hypertension are unaware that they have the condition.
• Less than half of adults (42%) with hypertension are diagnosed and treated.
• Approximately 1 in 5 adults (21%) with hypertension have it under control.
• Hypertension is a major cause of premature death worldwide.
• One of the global targets for noncommunicable diseases is to reduce the prevalence of hypertension by
33% between 2010 and 2030.
• The World Health Organization target of a 25% relative reduction in the prevalence of high blood
pressure (BP) among persons aged 18 years and older by 2025 can only be achieved by a combination of
strategies that shift the population distribution of BP to the left and achieve good control of BP among
those with hypertension . A good understanding of the cascade of hypertension of “awareness,”
“treatment,” and “control” is useful to plan hypertension control strategy in a population as these have
different implications.
RISKFACTORS
• Personal history of CVD (myocardial infarction, heart failure [HF], stroke, transient ischemic attacks [TIA], diabetes,
dyslipidemia, chronic kidney disease [CKD], smoking status, diet, alcohol intake, physical activity, psychosocial
aspects, history of depression). Family history of hypertension, premature CVD, (familial) hypercholesterolemia,
diabetes.
• Other Risk Factors: Age (>65 years), sex (male>female), heart rate (>80 beats/min), increased body weight,
diabetes, high LDL-C/triglyceride, family history of CVD, family history of hypertension, early-onset menopause,
smoking habits, psychosocial or socioeconomic factors. HMOD: LVH (LVH with ECG), moderate-severe CKD (CKD;
eGFR <60 ml/min/1.73m2), any other available measure of organ damage. Disease: previous coronary heart disease
(CHD), HF, stroke, peripheral vascular disease, atrial fibrillation, CKD stage 3+.
• COMORBIDITIES INCLUDE:
• Coronary Artery Disease (CAD)
• Hypertension and Previous Stroke
• DIABETES
• Lipid disorders
• Inflammatory rheumatid arthritis

• Pysiachiatric diseases
• Ethnicity, Race and Hypertension
• Hypertension prevalence, treatment and control rates vary significantly according to ethnicity. Such differences are mainly
attributed to genetic differences, but lifestyle and socioeconomic status possibly filters through into health behaviors such as
diet – which appear to be major contributors.
• Populations From African Descent
• Black populations, whether residing in Africa, the Caribbean, United States, or Europe, develop hypertension and associated
organ damage at younger ages, have a higher frequency of resistant and nighttime hypertension, and a higher risk of kidney
disease,131 stroke, HF, and mortality,132 than other ethnic groups.
• This increased cardiovascular risk may be due to physiological differences including a suppressed RAAS, 133,134 altered renal
sodium handling,135 increased cardiovascular reactivity,136 and early vascular aging (large artery stiffness).137
• Populations From Asia
• Ethnic-specific characteristics are recognized for East Asian populations. Hypertensive patients have a greater likelihood of salt-
sensitivity accompanied with mild obesity. When compared to Western populations, East Asian people present a higher
prevalence of stroke (particularly hemorrhagic stroke) and nonischemic HF. 1
• Morning hypertension and nighttime hypertension140 are also more common in Asia, compared with European populations.
• South Asian populations originating from the Indian subcontinent have a particularly high risk for cardiovascular and metabolic
diseases, including CAD and type 2 DM. With large hypertensive populations residing in India and China, clinical trials in these
populations are required to advise whether current treatment approaches are ideal. 141,142
Prevention and control
• What can I do to prevent or manage high blood pressure?
• Many people with high blood pressure can lower their blood pressure into a healthy range or keep their
numbers in a healthy range by making lifestyle changes. Talk with your health care team about
• Getting at least 150 minutes of physical activity each week (about 30 minutes a day, 5 days a week)
• Not smoking
• Eating a healthy diet, including limiting sodium (salt) and alcohol
• Keeping a healthy weight
• Managing stress
• n addition to making positive lifestyle changes, some people with high blood pressure need to take
medicine to manage their blood pressure.
• Talk with your health care team right away if you think you have high blood pressure or if you’ve been
told you have high blood pressure but do not have it under control.
• By taking action to lower your blood pressure, you can help protect yourself against heart disease and
stroke, also sometimes called cardiovascular disease (CVD).
REFERENCES
• Hypertension treatment cascade in India: results from National
Noncommunicable Disease Monitoring Survey 2020
• International Society of Hypertension Global Hypertension Practice
Guidelines
• CDC

Hypertension

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INTRODUCTION

• Hypertension is one of the most important risk factors for cardiovascular

• Inflammatory rheumatid arthritis

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