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Hypertension
Guide
by Jacqui
O'Connell, R.N
(4/21/99 HeartInfo) - It is
estimated that 1 out of 4 adults in the United States has elevated blood pressure and that
more than 30 percent of them are unaware of this fact. Since persons with hypertension may
not exhibit any symptoms, they often go undiagnosed until complications occur. Regular
blood pressure screening can facilitate early diagnosis and treatment and reduce the risk
of further complications associated with hypertension.
Part 1 of this guide explains the
science of hypertension, risk factors for and symptoms of hypertension, and the difference
between primary and secondary hypertension. It also includes a blood pressure chart issued by
the National Institutes of Health's Sixth Report of the Joint National Committee on
Prevention, Detection, Evaluation and Treatment of High Blood Pressure.
BLOOD PRESSURE
"Blood pressure" is actually the force that is exerted against the artery walls
as blood is carried through the circulatory system. It is recorded as a measurement of
this force in relation to the heart's pumping activity, and is measured in millimeters of
mercury (mmHg). The top number or systolic pressure is the measurement of the pressure
that occurs when the heart contracts or beats. The bottom number or diastolic pressure is
the measurement recorded between beats, while the heart is at rest. The systolic number is
placed over the diastolic number. An example would be 110/70 (read as 110 over 70). The
systolic number is always the higher of the two numbers.
ELEVATED LEVELS
Hypertension is an indicator that the force required for blood flow is greater than
normal. According to the new Sixth Report of the Joint National Committee on Detection,
Evaluation, and Treatment of High Blood Pressure (JNC VI), a blood pressure measurement of
less than 130/85 is considered "normal"; 130-140/85-90 is defined as "high
normal".
Blood pressure is considered to be elevated when repeated measurement is greater than
140/90 of either the systolic, diastolic, or both measurements. A diagnosis of
hypertension is made when a person has had 2 or more elevated readings after the initial
assessment.
JNC VI BLOOD PRESSURE CHART
The Sixth Report of the Joint National
Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure has
published the following chart to classify blood pressure. The chart applies to patients
who are 18 years and older, who have not already been diagnosed with hypertension, are not
on any medication for hypertension, and are not seriously ill.
| Category |
Systolic BP (mmHg) |
Diastolic BP (mmHg) |
Follow-up Recommendations |
| Optimal |
less than 120 |
less than 80 |
Recheck in 2 years |
| Normal |
less than 130 |
less than 85 |
Recheck in 2 years |
| High-normal |
130-139 |
85-89 |
Recheck in 1 year |
| Hypertension |
|
| Stage 1 |
140-159 |
90-99 |
Confirm within 2 months |
| Stage 2 |
160-179 |
100-109 |
Evaluate within 1 month |
| Stage 3 |
180 and above |
110 and above |
Evaluate immediately or within 1 week,
depending on the clinical situation |
(From the Sixth Report of the Joint National
Committee on Detection, Evaluation, and Treatment of High Blood Pressure.)
PRIMARY AND SECONDARY HYPERTENSION
Hypertension is classified as primary or
secondary. Primary or "essential" hypertension has no known cause, however
genetic and certain lifestyle factors such as body weight and salt intake are involved.
Ninety five percent of persons diagnosed with hypertension fall into this category. The
diagnosis is made when no other cause is found. Secondary hypertension is caused by some
other medical diagnosis or problem, such as kidney disease, Cushing's syndrome, pregnancy,
oral contraceptive use, chronic alcohol abuse or the use of certain medications.
RISK FACTORS
There are several factors that put people at risk for hypertension. Gender, age, heredity
and race are factors that cannot be controlled. As people age their chances of developing
hypertension increase. Men are generally at greater risk than women. However, as women
age, their risk increases with the onset of menopause and then -- later in life -- exceeds
that of men. Heredity can be a risk factor if one or more parents have been diagnosed with
hypertension. African Americans are at greater risk for developing hypertension than
Caucasians.
Risk factors that can be controlled are lifestyle related: obesity, diet, lack of
exercise, stress, the use of certain medications, smoking, and excessive alcohol
consumption.
SYMPTOMS
For many people hypertension often remains undiagnosed when they are asymptomatic (have no
symptoms). However, some persons may experience one or more of the following symptoms of
hypertension: headache, dizziness, irregular or rapid heartbeat, nosebleeds, fatigue, and
blurred vision.
PART 2
HYPERTENSION GUIDE
Sources
National Institutes of Health, "The Sixth Report of the Joint National Committee
on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure", Archives
of Internal Medicine 1997; 157:2413-2246.
Virtual Hospital: "Clinician's Handbook of Preventive Services, Chapter 27: Blood
Pressure",
Office of Disease Prevention and Health Promotion - Public Health Service, "How To
Keep Your Blood Pressure Under Control"
Internet Health Resources: "Hypertension: What is it?", Feminineheart.com
American Heart Association, "Stroke A to Z Guide"
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