Hypertension: A Comprehensive Approach.


Introduction.

Hypertension, or high blood pressure, is a chronic condition characterized by a sustained increase in blood pressure in the arteries. It is one of the major risk factors for cardiovascular diseases, including myocardial infarction, stroke, and chronic kidney disease. Globally, hypertension affects over one billion people and is responsible for approximately 7.5 million deaths annually.


Pathophysiology.

Hypertension is classified into two types: primary (essential) and secondary. Primary hypertension, which accounts for about 90-95% of cases, has no identifiable cause and is believed to result from a combination of genetic and environmental factors. Secondary hypertension is due to an underlying condition, such as kidney disease, endocrine disorders, or the use of certain medications.

Blood pressure is measured in millimeters of mercury (mmHg) and is expressed as two values: systolic pressure (when the heart contracts) and diastolic pressure (when the heart relaxes). Normal blood pressure is considered to be below 120/80 mmHg. Hypertension is diagnosed when the values are consistently equal to or greater than 140/90 mmHg.


Risk Factors.

Risk factors for hypertension include:

  • Age: The risk increases with age.
  • Gender: Men are at higher risk before age 55, while women are at higher risk after menopause.
  • Family history: Hypertension has a significant genetic component.
  • Lifestyle: High sodium diet, excessive alcohol consumption, smoking, and sedentary lifestyle.
  • Obesity: Excess weight contributes to peripheral vascular resistance.
  • Stress: Can cause temporary increases in blood pressure.

Diagnosis.

The diagnosis of hypertension is made through repeated blood pressure measurements. These measurements should be taken at different times and under resting conditions. It is also important to rule out white coat hypertension, where blood pressure is elevated only in a clinical setting.


Treatment.

Management of hypertension includes lifestyle modifications and, when necessary, the use of antihypertensive medications. Lifestyle modifications include:

  • Diet: Adopting a diet rich in fruits, vegetables, whole grains, and low in sodium, such as the DASH diet.
  • Exercise: Engaging in regular physical activity, at least 150 minutes of moderate exercise per week.
  • Weight control: Maintaining a healthy weight.
  • Stress reduction: Relaxation techniques and stress management.


Antihypertensive Medications.

Pharmacological treatment of hypertension includes several classes of medications, each with different mechanisms of action. The most commonly used medications in the United States are:

  1. Thiazide diuretics: Hydrochlorothiazide, Chlorthalidone
  2. Angiotensin-converting enzyme inhibitors (ACE inhibitors): Enalapril, Lisinopril
  3. Angiotensin II receptor blockers (ARBs): Losartan, Valsartan
  4. Beta-blockers: Metoprolol, Atenolol
  5. Calcium channel blockers: Amlodipine, Nifedipine
  6. Alpha-blockers: Doxazosin, Prazosin
  7. Direct renin inhibitors: Aliskiren


Conclusion.

Hypertension is a common and potentially serious condition that requires a comprehensive approach for its management. Combining lifestyle changes and pharmacological treatment can help control blood pressure and reduce the risk of complications. It is essential for patients to work closely with their healthcare professionals to develop an individualized treatment plan.

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