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). 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%). This condition is the most important modifiable risk factor for all-cause morbidity and mortality.

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 diet . Genetic predisposition also plays a significant role, with hypertension often clustering in families due to inherited biochemical abnormalities. Key pathophysiological mechanisms include activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system, endothelial dysfunction, and increased vascular stiffness.

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 BP. 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 hypertension.

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-blockers. 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 events.

Nonpharmacologic Interventions

Lifestyle modifications are essential for managing hypertension. Recommended changes include dietary modifications, increased physical activity, weight loss, and reduced alcohol consumption . These interventions are particularly effective for individuals newly classified as having stage 1 hypertension (130-139/80-89 mm Hg).

Challenges and Future Directions

Despite current management strategies, many patients do not achieve adequate BP control, leading to rising hypertension-related cardiovascular mortality rates. 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 pathways. Additionally, advancing knowledge of the human genome and molecular modification technology may pave the way for personalized medicine, potentially revolutionizing hypertension management.

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.