Hypertension (Part I)

Happy Monday, and welcome to Medical Mondays!

February is American Heart Month, so I thought I’d start off with Hypertension!

…and since hypertension (HTN) is such an important topic (one of the “big 3!”), it’s getting two posts! :O Today’s post will focus more on the diagnosis, risk factors, and screening, and Part II, which will focus more on prevention, will roll out later on this week, so keep your eyes peeled! :]

In the United States, the treatment of hypertension is the most common reason for office visits in non-pregnant adults and for use of prescription drugs.

Despite the fact that hypertension awareness, treatment, and control have all improved over the last few decades, a 2005-2008 National Health & Nutrition Examination Survey revealed that only ~50% of persons with hypertension had their blood pressure under control (< 140/90 mmHg).

Hypertension is associated with a number of serious adverse effects, and is one of the major modifiable risk factors for premature cardiovascular disease.

A patient with hypertension has increased risk of:

• Heart failure
• Ischemic stroke or heart disease
• Intracerebral hemorrhage
• Chronic kidney disease + end-stage renal disease

Diagnosis

For simplicity’s sake, your systolic blood pressure is the top (higher) number, and your diastolic blood pressure is the bottom (lower) number. For instance, if your blood pressure is 120/80, 120 is your systolic blood pressure (SBP) and 80 is your diastolic blood pressure (DBP)

The diagnosis of hypertension can be made after two or more office visits of elevated blood pressure (see table below) after an initial screen:

 

 

Risk Factors

There are a number of risk factors that increase an individual’s chances of having hypertension. Although some are not modifiable (e.g. age, family history, race), there are many that can be changed and improved upon by the patient (e.g. diet, activity, nutrition).

• Age: Advancing age is associated with increased blood pressure (especially systolic) + incidence of HTN
• Obesity + weight gain
• Family history: 2x more common in individuals who have 1 or 2 hypertensive parents
• Race: tends to be more common, more severe, with earlier onset and greater target-organ damage in blacks
• Reduced nephron number
• High-sodium diet
• Excessive alcohol consumption
• Physical inactivity
• Diabetes + dyslipidemia
• Personality traits + depression: may be more common in individuals with certain personality traits (e.g. hostile attitudes, time urgency/impatience, depression)
• Hypovitaminosis D

Screening

The current guidelines on screening for high blood pressure in adults is as follows:

• Every 2 years for persons with systolic + diastolic pressures below 120 and 80 mmHg, respectively
• Every year for persons with a systolic pressure of 120-139 mmHg or a diastolic pressure of 80-89 mmHg

 

Stay tuned for Part II, where I’ll be going into more detail about its methods for prevention, later on this week! :]

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Disclaimer: The information in this post was gleaned from UpToDate articles and other med school resources. This is where I also reiterate that I am merely a medical student struggling through the world that is her clinical rotations. The statements made on this blog should not be taken as medical advice to treat, cure or prevent any disease. Please contact your own physician or health care provider before starting a health or fitness/wellness program. (See full disclaimer here.)