How to deal with High Blood Pressure?

High Blood Pressure

High blood pressure (BP) is the most common risk factor for cardiovascular disease in developed and developing countries. Since the late 1960s, in Europe and the United States, there has been a dramatic decline in the mortality rate from hypertensive heart disease, primarily due to the development of several classes of antihypertensive drugs. At least 43 million Americans have hypertension, and an additional large number have BPs at the upper level of the normal range, which puts them at greater risk for development of hypertension than people with lower BPs.

High BP is also known as hypertension. The National High Blood Pressure Program since its inception in 1972 has intentionally used the phrase high blood pressure instead of the word hypertension. This choice was made because of the misconceptions that occur when the word hypertension is used. People think that because they are neither “tense” nor “hyper” that they will be unlikely to have hypertension. Among health care professionals, it is useful to use the word hypertension, but it is important to remember that because this word can be confusing, high blood pressure is a better term to use when communicating with the public.

High BP can be considered as a sign, a risk factor, and a disease. Because BP is a continuous variable, one of the challenging aspects is deciding the boundaries between normal and abnormal for the two components of BP: systolic and diastolic BP.


Causes pf High Blood pressure

Despite years of research and countless publications, the underlying cause of most cases of high BP is unknown. To distinguish between hypertension with a known cause and that whose cause is unknown, the terminology of primary and secondary hypertension or high BP is used. Primary or idiopathic high BP is the term used to indicate those cases of hypertension for which no cause can be identified. Approximately 90% to 95% of cases of hypertension fall in this category.The term secondary hypertension describes the 5% to 10% of cases of high BP for which a cause can be identified

Blood Pressure Measurement

The diagnosis of hypertension cannot be made from a single measurement because BP can vary markedly over weeks, days, and even minutes. In both hypertensive and normotensive people, there is diurnal variation in BP, with the highest pressures occurring between 8:00 and 11:00 AM, and lowest during sleep between 2:00 and 6:00 AM. There can be a marked variation in BP during rapid eye movement sleep and a substantial elevation when a person first awakens. Furthermore, a person's BP can be elevated during an office visit because of apprehension, pain, or preexisting illness. In view of the normal lability and biologic variations in BP, JNC VI has established guidelines for the detection and follow-up of high BP. A diagnosis can be established only on the basis of an average of two or more BPs taken on two or more subsequent occasions. The reliability and accuracy of BP readings depend on good technique and standardization of the procedure. The American Heart Association's Recommendations for Human BP Determination by Sphygmomanometers and the American Society of Hypertension's Recommendations for Routine BP Measurement by Indirect Cuff Sphygmomanometry contain current national standards for BP measurement.

Treatment Options

Answers to a series of questions outline progress in the treatment of high BP. In the 1950s, the initial question was whether any treatment would reduce morbidity and mortality. Once clinical trials revealed that treatment was beneficial in reducing both morbid and mortal events, the following questions became relevant.

The goal of therapy for patients with hypertension is the prevention of morbidity and mortality related to the elevated pressure, specifically the prevention of target organ damage and progression of atherosclerotic cardiovascular disease. In recognition of this goal, the JNC VI report has developed a table to guide clinicians in their choice of therapy. Other factors to consider in making treatment choices are any comorbid conditions, cost of treatment, client preference, and potential impacts on the client's quality of life.

An important tool in the management of high BP is the concept of setting a “goal BP” for each client. This pressure is usually less than 140/90 mm Hg, although for patients with diabetes mellitus or renal disease a lower goal is recommended. (See section on special populations for specific information on people with renal disease and diabetes mellitus.) The clinician may choose lower or higher goals depending on the individual client.