Hypertension

Approximately 50 million people in America have hypertension. Based on JNC (Joint National Committee) VI, hypertension (high blood pressure) is defined as having a systolic blood pressure (the top number) of greater than 140 and a diastolic blood pressure (the bottom number) of greater than 90. Since this number can vary, you have to have 3 confirmed high readings before you can be diagnosed with hypertension. The percent of individuals who are hypertensive are greater in African Americans than in Caucasians (3). The major complication of heart disease is end-organ damage that can progress to end-organ failure. End-organ failure means that the organs in your body (e.g. heart, kidney, brain, etc.) fail as a result of hypertension. In general the deaths attributed to hypertension have declined over the last 20-30 years by approx. 40-60% but have now leveled off (14).

Although it has declined in general African Americans experience more rapid progression to end-organ damage from hypertension than do Caucasians (6). For example end-stage renal disease is when a person reaches the point where they need dialysis and/or a kidney transplant. African Americans make up roughly 12% of the American population but comprise a disproportionate 32% of all end-stage renal disease (9).

Majority of the people with hypertension are classified as primary or essential hypertension (approx. 95%). This means that no cause has been established. It occurs in approximately 10-15% of Caucasians and 20-30% of African Americans (approximately double) (14). The onset of essential hypertension is usually between the ages of 25 and 55 and is very uncommon to present before the age of 20. If hypertension does occur in a younger person, it is probably due to an identifiable cause that potentially can be cured.

Even though there is no established cause for majority of hypertensives there are identifiable factors that play a role in it. Some of these include genetics, renin-angiotensin system and salt. Some things that can make it worse include obesity, alcohol, and anti-inflammatory drugs such as aspirin.

Secondary causes for hypertension make up approximately 5% of all people with hypertension. Some of the causes of secondary hypertension include estrogen use (rare in those taking low dose estrogens), kidney disease, adrenal disease, and other endocrine diseases.

Some of the complications of hypertension were mentioned above. The major ones are heart disease including myocardial infarction (heart attack), stroke, kidney disease, and eye disease. Hypertension is called the "silent killer" because often times people have it and are unaware because they don't have any symptoms. This is why it is very important to get your blood pressure checked routinely. Mild to moderate hypertension usually have no symptoms for a long time. Headaches may occur and severe hypertension can be associated with confusion, vision changes, and nausea and vomiting. After hypertension has affected many of the end organs (kidney, heart, brain, etc.) you may get symptoms associated with those specific organs.

For example uncontrolled hypertension over a long time will cause your heart to enlarge and as a result can cause you to be short of breath. It may also lead to a myocardial infarction (heart attack), arrhythmias (irregular heart beats), and sudden death (14). There are also major risk factors that can make the effects of hypertension even worse. These risk factors include smoking, diabetes (sugar), dyslipidemia (high cholesterol), age greater than 60, males and postmenopausal women, and a family history of heart disease in first degree relatives (male 1st degree relatives with heart disease younger than 55 and women 1st degree relatives with heart disease younger than 65).

Everyone should have a primary care doctor and visit his or her doctor at least yearly. If you are found to be hypertensive there are many different medications to treat it. The Joint National Committee VI has divided people into different categories and recommends different treatment for those different groups. Consult your doctor for treatment options if you have hypertension. If you are currently being treated for hypertension and have side effects from the medication alert your doctor because there may be other medications that you may tolerate better.

Remember hypertension is a "silent killer". It can destroy your organs without you even knowing so it is important that you get regular check-ups and treatment if needed. This disease can be controlled with the proper treatment and add years to your life.