Hypertension and Correlation to Cerebrovascular Change: A Brief Overview
Ayman El-Baz, Jasjit S. Suri in Cardiovascular Imaging and Image Analysis, 2018
High blood pressure (hypertension) is a clinical condition in which the pressure and force of the blood against the arterial walls is elevated. Blood pressure is often reported as systolic and diastolic blood pressures in millimeters of mercury (mmHg), which correspond to the peak aortic pressure during ventricular ejection (systolic) and the lowest pressure in the aorta during ventricular relaxation (diastolic). The mean arterial pressure (MAP) is the average aortic blood pressure during the entire cardiac cycle. A normal blood pressure reading is a systolic measurement of less than 120 mmHg, a diastolic measurement of less than 80 mmHg, and a MAP of approximately 95 mmHg (Table 16.1). Hypertension was traditionally defined as systolic blood pressure >160 mmHg, diastolic blood pressure >100 mmHg, or MAP >120 mmHg. Hypertension can be classified as primary (or essential or idiopathic), secondary, accelerated, hypertension urgency, or as malignant hypertension. Essential hypertension develops over years, even decades, with no single identified lifestyle or genetic cause. Approximately 90–95% of patients diagnosed with hypertension are classified as primary hypertension [1]. Secondary hypertension is a secondary disease which can develop due to conditions including adrenal and thyroid problems, obstructive sleep apnea, drugs and medications, chronic alcohol abuse, etc. [2]. An example of secondary hypertension is renal (or renovascular) hypertension, where hormones released by the kidneys increase blood pressure throughout the systemic circulation in response to narrowing of the arteries that supply blood to the kidneys.
Hypertension in Indo-Asians
Partha Ghosh, Shahid Anis Khan in Transcultural Geriatrics, 2018
The risks of cardiovascular complications secondary to hypertension increase with age. Hypertension is silent in the majority of patients and this could predispose to suboptimal treatment, leading to serious consequences. The main determinants of hypertension-related risks include level of blood pressure, presence of other cardiovascular risk factors, age and target organ damage. Wide pulse pressure has been shown to be a risk marker in elderly patients. There is sufficient evidence to show the benefits of treating systolic and diastolic blood pressure, one of which is a reduction in cardiovascular complications. The most common cardiovascular complications secondary to hypertension include ischaemic heart disease, heart failure, left ventricular hypertrophy and left ventricular diastolic dysfunction. Ischaemic or haemor-rhagic stroke, transient ischaemic attack, dementia, retinopathy, renal failure and peripheral vascular disease are some of the other common complications related to long-standing hypertension. Although antihypertensive treatment reduces the risk for first stroke, information is scarce on the protective effect of antihypertensive treatment on recurrent strokes.
Lifestyle Management and Prevention of Hypertension
James M. Rippe in Lifestyle Medicine, 2019
Primary or essential hypertension, the most common type of hypertension in the United States (90–95%) has no specific known underlying cause, while secondary hypertension results from medical conditions such as chronic kidney disease, renal artery stenosis, or adrenal tumors (e.g., pheochromocytoma, primary aldosteronism, and Cushing’s disease). Essential hypertension cannot be cured, but it can be controlled with therapeutic lifestyle changes (TLC) and/or pharmacotherapy. Non-modifiable risk factors for essential hypertension include a positive family history (generally via a polygenic mode of inheritance), age (>30 years old in men), sex (more common in men than women), and ethnicity (more common in blacks than in non-blacks). Modifiable risk factors are excess weight (BMI > 25 kg/m ); excess alcohol consumption; a sodium-rich diet low in calcium, potassium, and magnesium; and physical inactivity. Any physiological factor that increases cardiac output or total peripheral vascular resistance can result in an elevation of blood pressure, since blood pressure level is determined hemodynamically by the product of these two variables. Other contributing factors to an increase in blood pressure levels include endothelial dysfunction, increased sympathetic nervous system activation, and renin-angiotensin-aldosterone system (R-A-A) activity. It is postulated that a sustained elevation in blood pressure from any of these physiological disturbances results in a resetting of the baroreceptors, hypertrophy of the arteriolar smooth muscle, and an increase in peripheral vascular resistance, the principal hemodynamic disturbances associated with essential hypertension. Hypertension-induced LVH (a major cardiac consequence of hypertension) is postulated to be related to both an increase in pre-load and after-load (i.e., chronic volume and pressure overload), resulting in eccentric or concentric volumetric ventricular changes associated with dysfunctional systolic contraction. The reader is referred to a review on the topic by Rosendorff et al.
A Clinical Follow-Up Study of 260 Women with Hypertension in Pregnancy
Published in Clinical and Experimental Hypertension. Part B: Hypertension in Pregnancy, 1983
Anders Svensson, Björn Andersen, Lennart Hansson
In 1969–73, 260 women had pre-eclampsia or hypertension in pregnancy. 237 were examined 7–12 years later. 172 were found to be normotensive, 24 were classified as having borderline hypertension while 62 had hypertension (antihypertensive treatment or BP ×160/100 mm Hg). Late hypertension was more often found after severe pre-eclampsia and gestational hypertension than after mild pre-eclampsia. Hypertension preceding pregnancy was more common with severe pre-eclampsia. A family history of hypertension and repeated hypertensive pregnancies seem to predispose for later hypertension.
Physicians, patients, and public knowledge and perception regarding hypertension and stroke: a review of survey studies
Published in Current Medical Research and Opinion, 2006
Massimo Volpe, Seema D. Dedhiya
ABSTRACT Background: Hypertension is the most common treatable risk factor for stroke. Efforts have been made to raise the awareness of both hypertension and stroke. There is a lack of clear understanding of the current state of knowledge, attitudes, and perceptions about hypertension and stroke among patients, the public, and physicians. Objectives: To understand the level of knowledge, attitudes, and perceptions regarding hypertension and stroke among patients, the public, and physicians and to highlight the practices of physicians in managing hypertension given current hypertension guideline recommendations. Methods: Current Contents, Embase, and Medline databases were searched to identify manuscripts published between January 1994 and December 2004 reporting surveys concerning the knowledge and perceptions of patients, the public, and physicians regarding hypertension and stroke. Studies were summarized and collated into a spreadsheet. Results: Of a total of 85 manuscripts identified, only 43 contained information meeting the study objectives. Based on the reported results, it was observed that patients and public alike are generally aware that hypertension is one of the risk factors of stroke, and that stroke could be a consequence of hypertension, but do not consider hypertension to be a serious health concern. Physicians appreciate the importance of managing hypertension to avoid future complications such as stroke. However, they do not conform to the recommendations made in various hypertension guidelines. They have higher thresholds than guideline recommendations for defining and categorizing hypertension, for starting antihypertensive therapy, and for target blood pressure goals. They do not aggressively manage hypertension in older people, considering that the elderly are at greater risk for developing stroke. Conclusions: Patients and public are aware of the link between hypertension and stroke but do not appreciate the consequences of uncontrolled hypertension. Physicians worldwide need to engage in patient communication regarding hypertension, stroke, and the dangers of uncontrolled hypertension, and need to implement guideline recommendations for hypertension diagnosis and management.
Prevalence, pathophysiology and treatment of isolated systolic hypertension in the elderly
Published in Expert Review of Cardiovascular Therapy, 2004
Lutgarde Thijs, Elly Den Hond, Tim Nawrot, Jan A Staessen
Isolated systolic hypertension is the predominant type of hypertension in the elderly and is associated with cardiovascular complications such as stroke, coronary heart disease and heart failure. In this review, the role of arterial stiffness, endothelial function, atherosclerosis and oxidative stress in the pathogenesis of isolated systolic hypertension is extensively discussed. Placebo-controlled intervention trials such as the Systolic Hypertension in Europe Trial and the Systolic Hypertension in the Elderly Program have clearly shown that pharmacological treatment of isolated systolic hypertension improves outcome in the elderly. Nevertheless, isolated systolic hypertension remains the major subtype of untreated and uncontrolled hypertension.