Definition:

Hypertension is a long-term medical condition in which the blood

pressure in the arteries is persistently elevated. Long-term high blood
pressure, however, is a major risk factor for coronary artery
disease, stroke, heart failure, atrial fibrillation, peripheral vascular
disease, vision loss, chronic kidney disease, and dementia.

Signs and Symptoms

 Hypertension is rarely accompanied by symptoms, and its
identification is usually through screening.
 Some people with high blood pressure
report headaches (particularly at the back of the head and in the
morning), as well as light headedness, vertigo, tinnitus (buzzing or
hissing in the ears), altered vision or fainting episodes
 On physical examination, hypertension may be associated with the
presence of changes in the optic fundus seen by ophthalmoscopy.
The severity of the changes typical of hypertensive retinopathy is
graded from I to IV.
 The severity of the retinopathy correlates roughly with the duration
or the severity of the hypertension.

Causes
Primary hypertension
 Hypertension results from a complex interaction of genes and
environmental factors.
 Genome-wide association studies (GWAS) have identified 35
genetic loci related to blood pressure; 12 of these genetic loci
influencing blood pressure were newly found
 Several environmental factors influence blood pressure. High salt
intake raises the blood pressure in salt sensitive individuals; lack of
exercise, obesity, and depression can play a role in individual
cases.
  The possible roles of other factors such as caffeine
consumption, and vitamin D deficiency are less clear.
 Insulin resistance, which is common in obesity and is a component
of syndrome X(or the metabolic syndrome), is also thought to
contribute to hypertension.
 Events in early life, such as low birth weight, maternal smoking,
and lack of breastfeeding may be risk factors for adult essential
hypertension
Secondary hypertension
 Secondary hypertension results from an identifiable cause.
 Kidney disease is the most common secondary cause of
hypertension.
 Hypertension can also be caused by endocrine conditions, such
as hyperthyroidism, Cushing’s syndrome, acromegaly, renal artery
stenosis hyperparathyroidism, and pheochromocytoma. Other
causes of secondary hypertension include obesity, sleep
apnoea, pregnancy, coarctation of the aorta, etc

Risk Factors
 Age - Blood pressure tends to rise with age
 Race/Ethnicity - High blood pressure is more common in African
American adults
 Weight - People who are overweight or have obesity are more
likely to develop prehypertension or high blood pressure
 Gender - Before age 55, men are more likely than women to
develop high blood pressure. After age 55, women are more likely
than men to develop it.
 Lifestyle - Certain lifestyle habits can raise your risk for high blood
pressure, such as eating too much sodium or not enough
potassium, lack of exercise, drinking too much alcohol, and
smoking.
 Family history - A family history of high blood pressure raises the
risk of developing prehypertension or high blood pressure
Diagnosis

Hypertension categories according to the new guidelines given by

American Heart Association (AHA)
 Normal: Less than 120/80 mm Hg;
 Elevated: Systolic between 120-129 and diastolic less than 80;
 Stage 1: Systolic between 130-139 or diastolic between 80-89;
 Stage 2: Systolic at least 140 or diastolic at least 90 mm Hg;
  Hypertensive crisis: Systolic over 180 and/or diastolic over 120,
with patients needing prompt changes in medication if there are no
other indications of problems, or immediate hospitalization if there
are signs of organ damage.

The guidelines eliminate the category of prehypertension, categorizing

patients as having either Elevated (120-129 and less than 80) or Stage I
hypertension (130-139 or 80-89). While previous guidelines classified
140/90 mm Hg as Stage 1 hypertension, this level is classified as Stage
2 hypertension under the new guidelines.

Prevention

 Eating a healthy diet. To help manage your blood pressure, you

should limit the amount of sodium (salt) that you eat, and increase
the amount of potassium in your diet. It is also important to eat
foods that are lower in fat, as well as plenty of fruits, vegetables,
and whole grains. The DASH diet is an example of an eating plan
that can help you to lower your blood pressure.
 Getting regular exercise. Exercise can help you maintain a
healthy weight and lower your blood pressure. You should try to
get moderate-intensity aerobic exercise at least 2 and a half hours
per week, or vigorous-intensity aerobic exercise for 1 hour and 15
minutes per week. Aerobic exercise, such as brisk walking, is any
exercise in which your heart beats harder and you use more
oxygen than usual.
 Being at a healthy weight. Being overweight or
having obesity increases your risk for high blood pressure.
Maintaining a healthy weight can help you control high blood
pressure and reduce your risk for other health problems.
 Limiting alcohol. Drinking too much alcohol can raise your blood
pressure. It also adds extra calories, which may cause weight gain.
Men should have no more than two drinks per day, and women
only one.
 Not smoking. Cigarette smoking raises your blood pressure and
puts you at higher risk for heart attack and stroke. If you do not
smoke, do not start. If you do smoke, talk to your health care
provider for help in finding the best way for you to quit.
 Managing stress. Learning how to relax and manage stress can
improve your emotional and physical health and lower high blood
 pressure. Stress management techniques include exercising,
listening to music, focusing on something calm or peaceful, and
meditating.

Management
Drugs to Treat High Blood Pressure

 Angiotensin-converting enzyme (ACE) inhibitors

 Angiotensin II receptor blockers (ARBs)

 Diuretics

 Beta-blockers

 Calcium channel blockers

 Alpha-blockers

 Alpha-agonists

 Renin inhibitors

 Combination medication
Treatment Guidelines for Adults
References
 WHO Factsheet: https://www.who.int/topics/hypertension/en/
 American College of Cardiology: https://www.acc.org/latest-in-
cardiology/articles/2017/11/08/11/47/mon-5pm-bp-guideline-aha-
2017
 Medline Plus article:
https://medlineplus.gov/howtopreventhighbloodpressure.html
 NICE guidelines: https://www.nice.org.uk/

Warm Regards,
Rtr. Simran Shah
President 2018-19
Rtr. Medha Shah & Rtr. Parth Doshi
International Service Directors, 2018-19
Rotaract Club of The Caduceus Zone 3, RID 3141
Website: http://www.rccaduceus.tk
Mail: rotaractclubofthecaduceus18@gmail.com; is.rccad@gmail.com