Hypertension
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Hypertension: A Comprehensive Overview
Global Prevalence and Impact of Hypertension
Hypertension, or high blood pressure, is a leading cause of cardiovascular disease (CVD) and premature death worldwide. Despite the widespread use of antihypertensive medications, the global mean blood pressure has remained constant or slightly decreased over the past four decades. However, the prevalence of hypertension has increased, particularly in low- and middle-income countries (LMICs)3. In 2010, an estimated 31.1% of adults globally had hypertension, with higher prevalence in LMICs (31.5%) compared to high-income countries (28.5%)3. This condition is the most important modifiable risk factor for all-cause morbidity and mortality4.
Risk Factors and Pathogenesis
The development of hypertension involves a complex interplay of genetic, environmental, and pathophysiological factors. Major risk factors include high sodium intake, low potassium intake, obesity, alcohol consumption, physical inactivity, and unhealthy diet3 4. Genetic predisposition also plays a significant role, with hypertension often clustering in families due to inherited biochemical abnormalities8. Key pathophysiological mechanisms include activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system, endothelial dysfunction, and increased vascular stiffness8.
Diagnosis and Measurement
Accurate blood pressure (BP) measurement is crucial for diagnosing hypertension and assessing CVD risk. The 2017 American College of Cardiology (ACC)/American Heart Association (AHA) guidelines recommend using an average of at least two readings obtained on at least two separate occasions to categorize BP1. Out-of-office BP measurements, such as ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM), are recommended to confirm the diagnosis and detect conditions like white coat hypertension and masked hypertension1.
Treatment and Management
Pharmacologic Interventions
Pharmacologic treatment of hypertension includes various classes of antihypertensive medications such as thiazide-type diuretics, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin-receptor blockers (ARBs), calcium-channel blockers, and beta-blockers2. For adults aged 60 years or older, the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) recommend targeting a systolic BP (SBP) of less than 150 mm Hg to reduce the risk of stroke and cardiac events2.
Nonpharmacologic Interventions
Lifestyle modifications are essential for managing hypertension. Recommended changes include dietary modifications, increased physical activity, weight loss, and reduced alcohol consumption1 4. These interventions are particularly effective for individuals newly classified as having stage 1 hypertension (130-139/80-89 mm Hg)1.
Challenges and Future Directions
Despite current management strategies, many patients do not achieve adequate BP control, leading to rising hypertension-related cardiovascular mortality rates10. Improving BP control is critical and can be achieved by utilizing existing antihypertensive agents more effectively and exploring novel therapeutic agents that target alternative prohypertensive pathways10. Additionally, advancing knowledge of the human genome and molecular modification technology may pave the way for personalized medicine, potentially revolutionizing hypertension management10.
Conclusion
Hypertension remains a significant global health issue, contributing to the burden of cardiovascular disease and premature death. Effective management requires a combination of accurate diagnosis, appropriate pharmacologic and nonpharmacologic interventions, and ongoing research into novel treatment strategies. Addressing the global prevalence and improving BP control are essential steps toward reducing the impact of hypertension on public health.
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Most relevant research papers on this topic
Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Synopsis of the 2017 American College of Cardiology/American Heart Association Hypertension Guideline
The 2017 ACC/AHA Hypertension Guideline emphasizes the importance of lowering blood pressure in adults, reducing cardiovascular disease risk, and promoting self-directed monitoring and adherence to treatment.
Systematic Review
Rigorous Journal
Highly CitedPharmacologic Treatment of Hypertension in Adults Aged 60 Years or Older to Higher Versus Lower Blood Pressure Targets: A Clinical Practice Guideline From the American College of Physicians and the American Academy of Family Physicians
Higher systolic blood pressure targets (150 mm Hg) for adults aged 60 years or older may provide better benefits and harms than lower targets (140 mm Hg).
Systematic ReviewRigorous JournalHighly CitedThe global epidemiology of hypertension
Hypertension prevalence is rising globally, particularly in low- and middle-income countries, but awareness, treatment, and control are low, highlighting the need for multifaceted prevention and control strategies.
Literature ReviewHighly CitedHypertension
Lifestyle changes and medications effectively lower blood pressure and prevent cardiovascular disease in hypertensive patients.
Highly CitedAutomated Detection of Hypertension Using Physiological Signals: A Review
Machine learning and deep learning methods based on ECG and HRV signals are effective for automated detection of arterial hypertension, potentially benefiting wearable devices for remote blood pressure monitoring.
Systematic ReviewRigorous JournalHypertension and cardiovascular risk: General aspects
Hypertension is the strongest risk factor for most cardiovascular diseases, with a prevalence of 30-55% in the general population, increasing with age, and age-adjusted models are needed for estimating total cardiovascular risk.
Rigorous JournalHighly CitedHypertension
Hypertension is abnormally high blood pressure in the arteries, which are the blood vessels that carry blood from the heart to the rest of the body. As the heart beats, it forces blood through the arteries to deliver nutrients and oxygen to the rest of the body. The strength of the blood pushing against the artery walls is blood pressure, which is measured in units called millimeters of mercury (mmHg). The top number in a blood pressure reading is the pressure when the heart pumps (systolic blood pressure), and the bottom number is the pressure between heart beats (diastolic blood pressure). In adults, a normal blood pressure measurement is about 120/80 mmHg. Blood pressure is considered high when the measurement is 130/80 mmHg or greater.
Rigorous JournalPathogenesis of Hypertension
Hypertension is primarily caused by renal mechanisms, with other factors amplifying or buffering the effects of these mechanisms.
Highly CitedHypertension Prevalence and Control Among Adults: United States, 2011-2014.
Hypertension prevalence in the United States increased from 2011-2014, with a significant increase in individuals aged 50 and older with hypertension.
Highly CitedHypertension: Current trends and future perspectives
Improving blood pressure control is crucial, with novel therapeutic agents, co-existing condition treatments, and personalized medicine offering potential for a revolution in hypertension management.
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