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About Hypertension

Secondary hypertension
Main article: Secondary hypertension

Some additional signs and symptoms may suggest secondary hypertension, i.e. hypertension due to an identifiable cause such as kidney diseases or endocrine diseases. For example, truncal obesity, glucose intolerance, moon face, a "buffalo hump" and purple stretch marks suggest Cushing's syndrome. Thyroid disease and acromegaly can also cause hypertension and have characteristic symptoms and signs.

Hypertensive crisis
Main article: Hypertensive emergency

Severely elevated blood pressure (equal to or greater than a systolic 180 or diastolic of 110—sometimes termed malignant or accelerated hypertension) is referred to as a "hypertensive crisis", as blood pressure at this level confers a high risk of complications. People with blood pressures in this range may have no symptoms, but are more likely to report headaches (22% of cases)and dizziness than the general population. Other symptoms accompanying a hypertensive crisis may include visual deterioration or breathlessness due to heart failure or a general feeling of malaise due to renal failure. Most people with a hypertensive crisis are known to have elevated blood pressure, but additional triggers may have led to a sudden rise.

Pathophysiology

In most people with established essential (primary) hypertension, increased resistance to blood flow (total peripheral resistance) accounts for the high pressure while cardiac output remains normal.There is evidence that some younger people with prehypertension or 'borderline hypertension' have high cardiac output, an elevated heart rate and normal peripheral resistance, termed hyperkinetic borderline hypertension.

Epidemiology

As of 2000, nearly one billion people or ~26% of the adult population of the world had hypertension. It was common in both developed (333 million) and undeveloped (639 million) countries. However rates vary markedly in different regions with rates as low as 3.4% (men) and 6.8% (women) in rural India and as high as 68.9% (men) and 72.5% (women) in Poland. In Europe hypertension occurs in about 30-45% of people as of 2013.

Prognosis

Hypertension is the most important preventable risk factor for premature death worldwide. It increases the risk of ischemic heart disease strokes. peripheral vascular disease, and other cardiovascular diseases, including heart failure, aortic aneurysms, diffuse atherosclerosis, and pulmonary embolismHypertension is also a risk factor for cognitive impairment and dementia, and chronic kidney disease. Other complications include hypertensive retinopathy and hypertensive nephropathy.

History

Modern understanding of the cardiovascular system began with the work of physician William Harvey (1578–1657), who described the circulation of blood in his book "De motu cordis". The English clergyman Stephen Hales made the first published measurement of blood pressure in 1733. Descriptions of hypertension as a disease came among others from Thomas Young in 1808 and especially Richard Bright in 1836.

Economics

High blood pressure is the most common chronic medical problem prompting visits to primary health care providers in USA. The American Heart Association estimated the direct and indirect costs of high blood pressure in 2010 as $76.6 billion.

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