EMPTY
Essential Hypertension
High Blood Pressure
WHAT IS IT?
Hypertension is high blood pressure. Hypertension affects over 50 million Americans between the ages of 25 and 55. Untreated, hypertension affects the heart, the brain and the kidneys. Individuals with hypertension often die prematurely.A specific cause can rarely be found, though family history is often a precursor. Obesity, high alcohol consumption, cigarette smoking, a high-stress occupation or environment, and the use of certain anti-inflammatory drugs can precipitate or worsen high blood pressure in predisposed individuals. An estimated ten to fifteen percent of white adults and twenty to thirty percent of black adults develop high blood pressure, which is a known contributor to the risk of stroke and heart disease.
HOW IS IT DIAGNOSED?
History: A family history is often present. Individuals can have mild to moderately high blood pressure without being aware of it. As it worsens, high blood pressure can cause headaches, fatigue, confusion, blurred vision, and occasionally nausea and vomiting.
Physical exam: Upper (systolic) and lower (diastolic) blood pressure readings may be elevated. Two blood pressure readings will often be taken in a single visit, one while the individual is standing and the second while the individual is lying down. Other findings may include retinal changes, irregular heartbeats or sounds, irregular pulse, blurred vision.
Tests: Basic laboratory tests for a diagnosis of hypertension typically include a blood count, urinalysis, renal function test and measurement of blood sugar after fasting. Further tests are usually used to rule out possible underlying causes of hypertension. If hypertensive cardiovascular disease is suspected, an echocardiogram or a chest x-ray to closely examine the left ventricle of the heart may be ordered.
HOW IS IT TREATED?
Treatment varies according to the readings obtained in a blood pressure evaluation and whether any risk factors are present. Individuals with high normal or elevated blood pressures can often be treated successfully with individual lifestyle modifications such as weight loss, exercise, decrease in salt intake and alcohol consumption, and stopping smoking.
More severe hypertension with accompanying risk factors typically calls for drug therapy (such as diuretics and beta-blockers, and occasionally calcium channel blockers, ACE inhibitors, and alpha-blockers) to reduce readings to lower, safer levels. The choice of the drug or drugs is usually based on the individual's age, race, sex and lifestyle, and the presence of any other illness or disorder.
COMPLICATIONS
Complications include heart attack, stroke or renal failure.
PREDICTED OUTCOME
Untreated, hypertension can result in death and is known to shorten lives by ten to twenty years. Approximately 95% of individuals are able to lower their blood pressure at least moderately by making certain lifestyle changes, and often dramatically with drug therapy. If treatment is successful, the individual may be able to lower the drug dosage to maintain a healthy blood pressure.
ALTERNATIVES
Treatable causes of hypertension such as pheochromocytoma, primary aldosteronism, severe cases of Cushing's syndrome and acromegaly should be ruled out.
APPROPRIATE SPECIALISTS
Internist, cardiologist, dietitian, and endocrinologist.
MEDICATIONS
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