High blood pressure
Pro Research Analysisby 
Searched over 200M research papers
Consensus Meter
High Blood Pressure: A Comprehensive Overview
Introduction to High Blood Pressure
High blood pressure, also known as hypertension, is a prevalent chronic condition affecting millions globally. It is a significant risk factor for cardiovascular diseases (CVD), stroke, chronic kidney disease, and dementia . In the United States alone, approximately one in three adults suffers from hypertension.
Classification and Diagnosis of Hypertension
Blood Pressure Categories
The 2017 American College of Cardiology (ACC) and American Heart Association (AHA) guidelines redefined blood pressure categories. Normal blood pressure is classified as systolic BP (SBP) less than 120 mm Hg and diastolic BP (DBP) less than 80 mm Hg. Elevated BP is defined as SBP of 120-129 mm Hg and DBP less than 80 mm Hg. Stage 1 hypertension is SBP of 130-139 mm Hg or DBP of 80-89 mm Hg, and stage 2 hypertension is SBP of at least 140 mm Hg or DBP of at least 90 mm Hg.
Measurement Techniques
Accurate BP measurement is crucial for diagnosis and management. The guidelines recommend using an average of at least two readings obtained on two separate occasions. Out-of-office measurements, such as ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM), are encouraged to detect white coat hypertension and masked hypertension.
Global Epidemiology and Health Burden
Hypertension is more prevalent in low- and middle-income countries compared to high-income countries. In 2015, an estimated 8.5 million deaths were attributable to high BP, with 88% occurring in low- and middle-income countries. The prevalence of hypertension has declined in high-income regions since the 1970s but has risen in East, South, and Southeast Asia, Oceania, and sub-Saharan Africa.
Risk Factors and Prevention
Lifestyle and Dietary Factors
Several lifestyle factors contribute to the development of hypertension, including high salt intake, obesity, high alcohol consumption, and a high sodium/potassium dietary ratio. Preventive measures include increasing the availability and affordability of fresh fruits and vegetables, reducing the sodium content in packaged foods, and promoting dietary salt substitutes.
Nonpharmacologic Interventions
For individuals newly classified with stage 1 hypertension, lifestyle changes such as diet modification, increased physical activity, and weight loss are recommended. These interventions can significantly reduce BP and lower the risk of CVD.
Pharmacologic Treatment
Drug Classes and Treatment Strategies
For uncomplicated hypertension, thiazide diuretics are often recommended as the first-line treatment, either alone or in combination with other antihypertensive drugs such as ACE inhibitors, angiotensin-receptor blockers, beta-blockers, and calcium channel blockers. The 2017 guidelines also suggest that initiating treatment with two antihypertensive drugs may be more beneficial for patients with significantly elevated BP.
Treatment Goals
The goal of antihypertensive therapy is to achieve a BP of less than 140/90 mm Hg, or less than 130/80 mm Hg for patients with diabetes or chronic kidney disease. Intensive BP-lowering therapies are particularly directed toward patients with the highest atherosclerotic cardiovascular disease (ASCVD) risk.
Special Populations
Pediatric Hypertension
The 2017 guidelines also address pediatric hypertension, replacing the term "prehypertension" with "elevated blood pressure" and providing new normative BP tables based on normal-weight children. The guidelines emphasize the importance of early detection and management to prevent long-term health complications .
Cognitive Implications
High BP has been associated with an increased risk of cognitive decline. Managing BP early, even in the absence of clinical hypertension, can help prevent cognitive impairment typically associated with aging.
Conclusion
High blood pressure is a critical public health issue with significant implications for cardiovascular and overall health. Accurate diagnosis, effective management, and preventive measures are essential to reduce the global burden of hypertension. Implementing lifestyle changes and appropriate pharmacologic treatments can significantly lower BP and reduce the risk of associated health complications.
Sources and full results
Most relevant research papers on this topic