Hypertension

Hypertension is defined in general term as a systolic blood pressure greater than 138 and/or diastolic blood pressure greater than 90.

Definition	Degree	Systolic	Diastolic
Normal	Normal	<138	<90
Hypertension	Mild	138-150	90-98
Hypertension	Moderate	150-170	100-110
Hypertension	Severe	>170	>110

Approximately 50 - 60 million Americans suffer from hypertension knowingly or unknowingly. Majority of African Americans are hypertensive or have families that are hyretensive. Correct measurement of blood pressure occurs over time. A one-time measurement of elevated blood pressure does not in itself constitute a diagnosis of hypertension. Sustained elevation of blood pressure on two or more measurements would be correctly classified as hypertension. Isolated elevation of systolic blood pressure especially in the elderly female patient has now been added to the definition of hypertension.

Approximately 85-90%of the hypertension cases have no known cause and are therefore termed essential hypertension. 5-10% of hypertensive cases are secondary to renal disease and only about 1% of hypertension cases are caused by a curable disease.

Even though the real causes of essential hypertension are unknown, many theories abound about its origin including, but not limited to:

• Aberrant sodium transport
• Sympathetic neurons system response
• Renin-angiotensin-aldosterone mechanism
• Lack of adequate vasodilator

Diseases Associated with Hypertension The effects of sustained elevated blood pressure are felt at specific organs sensitive to high blood pressure changes. These organs include:

• Heart
• Left ventricular enlargement
• Atherosclerotic heart disease
• Heart failure
• Brain
• Transient ischemic attacks "mild strokes"
Cerebrovascular accidents "strokes"
• Encephalopathy
• Kidney
• Kidney Failure
• Dialysis
• Eyes
• Glaucoma
• Bleeding inside the eye, Retinal Hemorrhage Papilledema

Treatment
The purpose of treatment of hypertension is not to cure the disease, but to modify the disease enough that the patient does not end up with one of the end-organ catastrophes mentioned above. Successful treatment for hypertension occurs in less than 30% of those treated with medication. Therefore, the first order of treatment is life style modification, followed by:

• Avoid stress
• Eat less salt
• Lose weight
• Drink less alcohol
• Get good night sleeps
• Go on vacation
• Drugs

There are groups of drugs currently available for hypertension. Within each group are different medications. Treatment has now become very specific that age, sex, race, and patient's medical history should be factored in prior to initiating one or more anti-hypertensive medications.