Medicipate! Conserve your knowledge 
Medicipate!
Conserve your knowledge
 
Write article
Please log in to edit this article.
Edit

Difference between revisions of "Hypertension"

 
 
(4 intermediate revisions by one other user not shown)
Line 1: Line 1:
''Synonym: High blood pressure
+
''Synonym: High blood pressure<br />
'''''German:''' Hypertonie, Hypertonus, Bluthochdruck''
+
'''''German:''' [[:de:Hypertonie|Hypertonie]] [[de:Hypertonie]], Hypertonus, Bluthochdruck''
  
 
There are three different forms of hypertension:
 
There are three different forms of hypertension:
  
*Arterial hypertension (increased blood pressure in body circulation)
+
*[[Arterial hypertension]] (increased blood pressure in body circulation)
*Pulmonary hypertension (increased blood pressure in lung circulation)
+
*[[Pulmonary hypertension]] (increased blood pressure in lung circulation)
*Portal hypertension (increased blood pressure in portal venous system)  
+
*[[Portal hypertension]] (increased blood pressure in portal venous system)  
  
For most, the term '''Hypertension''' generally denotes ''arterial hypertension'', which is the type discussed here.   
+
For most, the term '''Hypertension''' generally denotes '''arterial hypertension''', which is the type discussed here.   
Contents
+
 
+
==Definition==
+
According to the [[WHO]] criteria, a systolic [[blood pressure]] higher than 120 mmHg or a diastolic blood pressure higher than 80 mmHg are borderline values, and a [[systolic]] blood pressure higher than 140 mmHg or a [[diastolic]] blood pressure higher than 90 mmHg is defined as hypertension.  
+
 
+
==Epidemiology==
+
The [[prevalence]] of arterial hypertension is relatively high in the western industrial countries. The specifications of several epidemiological studies however partly clearly vary from one another. A study conducted in 2003 in 6 European countries, Canada and the USA stated the prevalence of hypertension among 44% of the population above 35 years of age in Europe. A prevalence of 28% is stated for the USA. As a rough approximation, it may be said that, of the population in Europe,
1. Definition2. Epidemiology3. Classification3.1. Classification according to cause3.2. Classification according to ESH3.3. Classification according to WHO3.4. Other classifications4. Pathogenesis5. Symptoms6. Diagnostics7. Links
+
*20-30% in the age group of 45-54 years,
+
*30-40% in the age group of 55-64 years, and
+
*40-50% in the age group of 65-74 years
DefinitionAccording to the WHO criteria, a systolic blood pressure higher than 120 mmHg or a diastolic blood pressure higher than 80 mmHg are borderline values, and a systolic blood pressure higher than 140 mmHg or a diastolic blood pressure higher than 90 mmHg is defined as hypertension. EpidemiologyThe prevalence of arterial hypertension is relatively high in the western industrial countries. The specifications of several epidemiological studies however partly clearly vary from one another. A study conducted in 2003 in 6 European countries, Canada and the USA stated the prevalence of hypertension among 44% of the population above 35 years of age in Europe. A prevalence of 28% is stated for the USA. As a rough approximation, it may be said that, of the population in Europe,· 20-30% in the age group of 45-54 years, · 30-40% in the age group of 55-64 years, and · 40-50% in the age group of 65-74 yearssuffer from high blood pressure. ClassificationThe arterial hypertension may be classified according to many different aspects, which are partly pathophysiological and partly clinically affected. Classification according to causePrimary hypertension: A hypertension that develops without any identifiable causes. It is also termed essential hypertension. It accounts for an overwhelming share of hypertension cases (approx. 85%). Secondary hypertension: A hypertension that occurs as a consequence of another primary disease and/or triggered by verifiable factors. The secondary hypertension accounts for the smaller share of cases (approx. 15%). Potential causes are: · Kidney diseases ("renal hypertension") · Endocrine disorders ("endocrine hypertension") o Hyperthyreosis o Hyperaldosteronism (Conn’s syndrome) o Hyperparathyroidism o Acromegaly o Cushing’s syndrome o Pheochromocytoma and many others. · Vascular diseaseso Aortic isthmus stenosis o Vasculitis o Collagenosis o Renal artery stenosis · Tumors (renin-producing tumors, brain tumors) Not classified as chronic arterial hypertension are temporary increases in blood pressure, which are triggered by, among others, the following causes: · Medicaments (corticosteroids, cyclosporin, erythropoietin, adrenalin) · Drugs (alcohol, cocaine, amphetamine) · Poisoning (carbon monoxide) · Pregnancy (see: Pregnancy-induced hypertension (PIH) Classification according to ESHThe ESH classifies the hypertension according to the extent of the blood pressure value:
+
 
Classification according to ESH
+
suffer from high blood pressure.  
+
 
+
==Classification==
+
The arterial hypertension may be classified according to many different aspects, which are partly pathophysiological and partly clinically affected.  
Grade Systolic RR Diastolic RR
+
 
Grade 1 (mild) 140-159 mm Hg 90-99 mm Hg
+
===Classification according to cause===
Grade 2 (moderate) 160-179 mm Hg 100-109 mm Hg
+
'''Primary hypertension''': A hypertension that develops without any identifiable causes. It is also termed [[essential]] hypertension. It accounts for an overwhelming share of hypertension cases (approx. 85%).  
Grade 3 (severe) >180 mm Hg > 110 mm Hg
+
 
+
'''Secondary hypertension''': A hypertension that occurs as a consequence of another primary disease and/or triggered by verifiable factors. The secondary hypertension accounts for the smaller share of cases (approx. 15%). Potential causes are:
+
*Kidney diseases ("[[renal]] hypertension")
+
*[[Endocrine]] disorders ("endocrine hypertension")  
Classification according to WHOAccording to the recommendations of the WHO, hypertension is classified depending on the damages to blood vessels, eyes, heart, kidneys, etc.: · Grade I: Hypertension without damages to the end organ · Grade II: Hypertension with damages to the end organ (e.g.. fundus hypertonicus (Grade I and II), plaque formation in the larger blood vessels) · Grade III: Hypertension with manifest cardiovascular secondary diseases (e.g. angina pectoris, heart attack, stroke, PAVK) Other classifications· Form of blood pressure increase o Isolated systolic hypertension o Isolated diastolic hypertensiono Combined systolic-diastolic hypertension· Time-dependent hypertensiono Labile hypertension (borderline hypertension) o Stable hypertension (continuous hypertension) PathogenesisThe pathogenesis of primary hypertension is so complex that it could not be completely clarified so far. One reason is that the blood pressure is influenced by many diverse factors. Among others these are the circulating blood volume, the blood viscosity, the cardiac output, the blood vessel elasticity, the blood vessel width, and the hormonal (renin) and neuronal stimulation of the blood vessel tonus. SymptomsHypertension appears mostly asymptomatic and in case of moderately high blood pressure values often causes only uncharacteristic ailments: · Headaches (especially in the morning in bed) · Dizziness · Epistaxis (nosebleeds)· Abnormal fatigueIn case of very high blood pressure the following can appear: · Severe dyspnea · Angina pectoris · Palpitation· Nausea · Impaired vision If the hypertension is not diagnosed by a blood pressure checkup, it often becomes noticeable only by late damages. DiagnosticsThe diagnosis of “hypertensionâ€? is primarily conducted by the repeated blood pressure measurement in both arms.  The basic program for hypertension diagnosis further includes: · Anamnesis (general symptoms, medicaments, nicotine, coffee, alcohol, drugs) · Family anamnesis (heart attack, stroke) · Auscultation (heart, arteria carotis in particular, abdomen) · Ophthalmoscopy (ocular fundus) · Laboratory o Urine status o Serum electrolytes o Creatinine clearance o TSH o Screening of cardiovascular risk factors (e.g.. cholesterol, blood sugar) · ECG · Echocardiography Links
+
**[[Hyperthyreosis]]
 +
**[[Hyperaldosteronism]] (Conn’s syndrome)
 +
**[[Hyperparathyroidism]]
 +
**[[Acromegaly]]
 +
**[[Cushing’s syndrome]]
 +
**[[Pheochromocytoma]] and many others.  
 +
*Vascular diseaseso
 +
**[[Aortic isthmus stenosis]]
 +
**[[Vasculitis]]
 +
**[[Collagenosis]]
 +
**[[Renal artery stenosis]]
 +
*Tumors ([[renin]]-producing tumors, brain tumors)  
 +
 
 +
Not classified as chronic arterial hypertension are temporary increases in blood pressure, which are triggered by, among others, the following causes:  
 +
*Medicaments ([[corticosteroid]]s, [[cyclosporin]], [[erythropoietin]], [[adrenalin]])  
 +
*Drugs ([[alcohol]], [[cocaine]], [[amphetamine]])  
 +
*Poisoning ([[carbon monoxide]])  
 +
*[[Pregnancy]] (see: [[Pregnancy-induced hypertension]] (PIH)  
 +
 
 +
===Classification according to ESH===
 +
The [[ESH]] classifies the hypertension according to the extent of the blood pressure value:
 +
<table title="Classification according to ESH" width = 100%>
 +
<tr>
 +
<th width="33%">Grade</th>
 +
<th width="33%">Systolic RR</th>
 +
<th width="33%">Diastolic RR</th>
 +
</tr>
 +
<tr>
 +
<td>Grad 1 (mild)</td>
 +
<td>140-159 mm Hg</td>
 +
<td>90-99 mm Hg</td>
 +
</tr>
 +
<tr>
 +
<td>Grad 2 (moderate)</td>
 +
<td>160-179 mm Hg</td>
 +
<td>100-109 mm Hg</td>
 +
</tr>
 +
<tr>
 +
<td>Grad 3 (severe)</td>
 +
<td>>180 mm Hg</td>
 +
<td>> 110 mm Hg</td>
 +
</tr>
 +
</table>
 +
 
 +
===Classification to WHO===
 +
According to the recommendations of the WHO hypertension is classified depending on the damages to blood vessels, [[eyes]], [[heart]], [[kidneys]], etc.:
 +
*Grade I: Hypertension without damages to the end organ
 +
*Grade II: Hypertension with damages to the end organ (e.g.. [[fundus hypertonicus]] (Grade I and II), [[plaque]] formation in the larger blood vessels)  
 +
*Grade III: Hypertension with manifest [[cardiovascular]] secondary diseases (e.g. [[angina pectoris]], [[heart attack]], [[stroke]], [[PAVK]])  
 +
 
 +
===Other classifications===
 +
*Form of blood pressure increase
 +
**Isolated systolic hypertension  
 +
**Isolated diastolic hypertension
 +
**Combined systolic-diastolic hypertension
 +
*Time-dependent hypertensiono
 +
**Labile hypertension ([[borderline hypertension]])  
 +
**Stable hypertension (continuous hypertension)  
 +
 
 +
==Pathogenesis==
 +
The [[pathogenesis]] of primary hypertension is so complex that it could not be completely clarified so far. One reason is that the blood pressure is influenced by many diverse factors. Among others these are the circulating [[blood volume]], the [[blood viscosity]], the cardiac output, the blood vessel elasticity, the blood vessel width, and the hormonal ([[renin]]) and neuronal stimulation of the blood vessel tonus.  
 +
 
 +
==Symptoms==
 +
Hypertension appears mostly [[asymptomatic]] and in case of moderately high blood pressure values often causes only uncharacteristic ailments:
 +
 
 +
*Headaches (especially in the morning in bed)
 +
*Dizziness  
 +
*[[Epistaxis]] (nosebleeds)
 +
*Abnormal fatigue
 +
 
 +
In case of very high blood pressure the following can appear:
 +
*[[Severe dyspnea]]
 +
*[[Angina pectoris]]
 +
*[[Palpitation]]
 +
*[[Nausea]]
 +
*Impaired vision  
 +
If the hypertension is not diagnosed by a blood pressure checkup, it often becomes noticeable only by late damages.  
 +
 
 +
==Diagnostics==
 +
The diagnosis of hypertension is primarily conducted by the repeated [[blood pressure measurement]] in both arms.  The basic program for hypertension diagnosis further includes:  
 +
*[[Anamnesis]] (general symptoms, medicaments, [[nicotine]], [[coffee]], [[alcohol]], drugs)
 +
*[[Family anamnesis]] (heart attack, stroke)
 +
*[[Auscultation]] (heart, [[arteria carotis]] in particular, [[abdomen]])
 +
*[[Ophthalmoscopy]] (ocular fundus)  
 +
*Laboratory
 +
**[[Urine status]]
 +
**[[Serum electrolytes]]
 +
**[[Creatinine clearance]]
 +
**[[TSH]]
 +
**Screening of [[cardiovascular risk factors]] (e.g.. [[cholesterol]], [[blood sugar]])
 +
*[[ECG]]
 +
*[[Echocardiography Links]]
 +
[[Specialty:Biology]]
 +
[[Tag:Blood]]
 +
[[Tag:Hypertension]]
 +
[[Tag:Pressure]]

Latest revision as of 00:24, 11 July 2012

Synonym: High blood pressure
German: Hypertonie, Hypertonus, Bluthochdruck

There are three different forms of hypertension:

For most, the term Hypertension generally denotes arterial hypertension, which is the type discussed here.

1 Definition

According to the WHO criteria, a systolic blood pressure higher than 120 mmHg or a diastolic blood pressure higher than 80 mmHg are borderline values, and a systolic blood pressure higher than 140 mmHg or a diastolic blood pressure higher than 90 mmHg is defined as hypertension.

2 Epidemiology

The prevalence of arterial hypertension is relatively high in the western industrial countries. The specifications of several epidemiological studies however partly clearly vary from one another. A study conducted in 2003 in 6 European countries, Canada and the USA stated the prevalence of hypertension among 44% of the population above 35 years of age in Europe. A prevalence of 28% is stated for the USA. As a rough approximation, it may be said that, of the population in Europe,

  • 20-30% in the age group of 45-54 years,
  • 30-40% in the age group of 55-64 years, and
  • 40-50% in the age group of 65-74 years

suffer from high blood pressure.

3 Classification

The arterial hypertension may be classified according to many different aspects, which are partly pathophysiological and partly clinically affected.

3.1 Classification according to cause

Primary hypertension: A hypertension that develops without any identifiable causes. It is also termed essential hypertension. It accounts for an overwhelming share of hypertension cases (approx. 85%).

Secondary hypertension: A hypertension that occurs as a consequence of another primary disease and/or triggered by verifiable factors. The secondary hypertension accounts for the smaller share of cases (approx. 15%). Potential causes are:

Not classified as chronic arterial hypertension are temporary increases in blood pressure, which are triggered by, among others, the following causes:

3.2 Classification according to ESH

The ESH classifies the hypertension according to the extent of the blood pressure value:

Grade Systolic RR Diastolic RR
Grad 1 (mild) 140-159 mm Hg 90-99 mm Hg
Grad 2 (moderate) 160-179 mm Hg 100-109 mm Hg
Grad 3 (severe) >180 mm Hg > 110 mm Hg

3.3 Classification to WHO

According to the recommendations of the WHO hypertension is classified depending on the damages to blood vessels, eyes, heart, kidneys, etc.:

3.4 Other classifications

  • Form of blood pressure increase
    • Isolated systolic hypertension
    • Isolated diastolic hypertension
    • Combined systolic-diastolic hypertension
  • Time-dependent hypertensiono

4 Pathogenesis

The pathogenesis of primary hypertension is so complex that it could not be completely clarified so far. One reason is that the blood pressure is influenced by many diverse factors. Among others these are the circulating blood volume, the blood viscosity, the cardiac output, the blood vessel elasticity, the blood vessel width, and the hormonal (renin) and neuronal stimulation of the blood vessel tonus.

5 Symptoms

Hypertension appears mostly asymptomatic and in case of moderately high blood pressure values often causes only uncharacteristic ailments:

  • Headaches (especially in the morning in bed)
  • Dizziness
  • Epistaxis (nosebleeds)
  • Abnormal fatigue

In case of very high blood pressure the following can appear:

If the hypertension is not diagnosed by a blood pressure checkup, it often becomes noticeable only by late damages.

6 Diagnostics

The diagnosis of hypertension is primarily conducted by the repeated blood pressure measurement in both arms. The basic program for hypertension diagnosis further includes:

Specialties: Biology

This page was last edited on 7 October 2005, at 16:42.

To comment on this article, please login..

Click here for creating a new article in the DocCheck Flexikon.

Last authors:

2 rating(s) (4 ø)

You have any questions?
Copyright ©2022 DocCheck Medical Services GmbH | Switch to mobile version
Language:
Follow DocCheck: