Prevalence And Temporal Trends Of Hypertension In Europe
Due to the difficulty of obtaining comparable results among countries, the World Health Organization Global Health Observatory represents an important source of data on the prevalence of hypertension and the mean SBP values among 51 European national populations. The first striking feature of these data is the similarity of the pattern of the association between blood pressure and age as well as between BP and sex in different countries. SBP progressively increases throughout life, with a difference of 2030 mmHg between early and late adulthood.6,7 DBP increases to a lower extent until the fifth decade, and then average DBP tends to remain constant or, more frequently, to decline slightly.6,8 For both SBP and DBP, the mean levels are higher in men than in women in early adulthood, although this difference narrows progressively and is either non-existent or reversed by the sixth or seventh decade.9,10
Figure 44.1.1 Prevalence of raised blood pressure in Europe in 2014. In males aged over 18 years in females aged over 18 years.
Adapted from11 with permission.
Blood Pressure And Primary Prevention Of Cardiovascular Disease And Stroke
There is robust evidence that screening and treatment of hypertension prevents cardiovascular disease and reduces mortality in the middle-aged population . Even in older adults, lowering BP is likely to be beneficial provided that treatment is well tolerated, despite a lack of studies to support this. However, there is a lack of high-quality evidence for a favourable harmbenefit balance of antihypertensive treatment among older adults, especially among the oldest age groups .
There has been a debate about how far BP should be lowered. The American Guidelines for Management of Hypertension, influenced by the results of the Systolic Blood Pressure Intervention Trial recommends a reduction of the treatment target from 140/90 mmHg to 130/80 mmHg, including for the very old. However, some authors emphasised that there is a greater potential for harm to exceed benefit when BP targets are lowered.
How To Measure Blood Pressure At Home
The American Heart Association recommends home monitoring for all people with high blood pressure to help the healthcare provider determine whether treatments are working.
Home monitoring is not a substitute for regular visits to your health care professional but can be very useful in managing high blood pressure.
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How Is High Blood Pressure Treated
Many people can lower their blood pressure by making changes to their lifestyle. If you are overweight, losing some weight can make a big difference. Doing some more exercise, eating healthier food, and reducing alcohol can also cause a big improvement in blood pressure levels.
You may be advised to take medication, especially if you have some additional risk factors.
To help you make a decision about medication, your doctor will assess your personal risk of developing stroke or heart disease in future. They look at whether your high blood pressure has caused problems in the body already. You may have a blood test, a urine test, and an electrocardiogram to check for heart problems.
If your blood pressure is consistently above 140/90 mmHg and your risk of stroke is high, you’ll be offered medication to lower your blood pressure and advice about making lifestyle changes.
If your blood pressure is consistently above 160/100mmHg, you’ll be offered medication to lower your blood pressure, even if your risk of a stroke is low, as well as advice on making lifestyle changes.
If you’ve had a stroke or heart attack, the aim will often be to reduce your blood pressure to below 130/80mmHg.
High Blood Pressure And Women
A common misconception is that high blood pressure rarely affects women. However, nearly half of all adults with high blood pressure are women. In fact, women that are just 20 pounds or more overweight, have a family history of HBP or have reached menopause are known to increase a womans risk.
While high blood pressure isn’t directly related to gender, throughout a womans life, health issues like pregnancy, pregnancy prevention and menopause can increase the risk of developing high blood pressure.
Women represent almost 52% of deaths from high blood pressure.
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High Blood Pressure And High Cholesterol
High blood pressure is a major risk factor for heart disease and stroke because it damages the lining of the arteries, making them more susceptible to the buildup of plaque, which narrows the arteries leading to the heart and brain. About 108 million US adults have high blood pressure. Only about half of these people have their high blood pressure under control. About 7 in 10 people who have a first heart attack and 8 in 10 people who have a first stroke have high blood pressure.
Eating too much sodium can lead to high blood pressure. Americans aged 2 years or older consume an average of about 3,400 mg of sodium each day, well over the 2,300 mg recommended by the Dietary Guidelines for Americans. More than 70% of the sodium Americans consume is added outside the home , not added as salt at the table or during home cooking.
High LDL cholesterol can also double a persons risk of heart disease. Thats because excess cholesterol can build up in the walls of arteries and limit blood flow to a persons heart, brain, kidneys, other organs, and legs. Although nearly 86 million US adults could benefit from taking medicine to manage their high LDL cholesterol, only about half are doing so.
People can improve their blood pressure and cholesterol levels by eating a healthy diet that is low in sodium, being physically active, maintaining a healthy weight, and taking medications as recommended.
In the United States,
in health care system costs.
Keeping An Eye On Blood Pressure Levels
High blood pressure ultimately leads to several negative conditions and diseases. The earlier you can recognize and get treatment for hypertension, the better chances you have at preventing your hypertension, turning into a stroke or heart disease.
Unfortunately, hypertension is strongly linked to stroke and heart disease. According to the CDC, 80% of Americans who have had a stroke and 70% of Americans with heart disease also suffer from hypertension.
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High Blood Pressure In Pregnancy
If you have high blood pressure during pregnancy, your blood pressure will be monitored during pregnancy, labour and after the birth. If its very high you may need to stay in hospital until it improves.
The most commonly used drug for high blood pressure in pregnancy is labetalol. If you cant take labetalol, methyldopa and nifedipine are possible alternatives. These are not licensed for use in pregnancy, but they can be offered along with advice about the risks and the reasons for using it.
If you are on blood pressure medication before becoming pregnant, you might need to change to a different type as some types are not safe to use in pregnancy. You should speak to your doctor to discuss the best way to manage your blood pressure during pregnancy.
Combined Effect On The Risk Of Cvd
The cumulative incidence rates of CVD among the four subgroups were 3.21%, 3.96%, 14.13% and 15.90%, respectively . Hypertension and heart rate were both associated with the development of CVD. Compared with the normotensives with a heart rate < 80b.p.m., the multivariable adjusted HRs of CVD for hypertensives with a heart rate < 80b.p.m. and hypertensives with a heart rate 80b.p.m. were statistically significant . The hypertensives with a heart rate 80b.p.m. were at the highest risk of CVD. No significant interaction was detected between hypertension and heart rate on the development of CVD . The AUC for the model including hypertension and heart rate 80b.p.m., and other conventional risk factors was larger than for the model including only other conventional risk factors .
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Stroke And Brain Problems
High blood pressure can cause the arteries that supply blood and oxygen to the brain to burst or be blocked, causing a stroke. Brain cells die during a stroke because they do not get enough oxygen. Stroke can cause serious disabilities in speech, movement, and other basic activities. A stroke can also kill you.
Having high blood pressure, especially in midlife, is linked to having poorer cognitive function and dementia later in life. Learn more about the link between high blood pressure and dementia from the National Institutes of Healths Mind Your Risks®external icon campaign.
Heart Disease High Blood Pressure And Menopause
While you may have had normal blood pressure most of your life, your chances of developing high blood pressure increase considerably after menopause.
Heart disease risk rises for everyone as they age, but for women symptoms can become more evident after the onset of menopause.
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Reducing Sodium And Reducing Cardiovascular Disease Burden
- Lowering high blood pressure reduces the risk of heart disease and stroke.13 Adults with elevated and high blood pressure especially benefit from lowering their blood pressure.6
- If manufacturers gradually reduced the amount of sodium in processed and prepared foods, public consumption of sodium could be reduced to safer levels with little or no change in behavior on the part of the individual consumer.14
- Sodium intake from processed and restaurant foods contributes to high rates of high blood pressure, heart attack, and stroke. Because nearly 500,000 deaths each year are related to high blood pressure, reducing sodium intake could prevent thousands of deaths annually.15
- Reducing average population sodium intake to 2,300 mg per day may save $18 billion in health care dollars and reduce cases of high blood pressure by 11 million annually.16
- Sodium reduction continues to be an effective and safe strategy to lower blood pressure.3,11,17,18
- Lowering blood pressure reduces and prevents heart attacks and stroke.19
Lower Your Blood Pressure And Decrease Your Risks
Unfortunately, it can be difficult to spot the early signs of hypertension since there are almost no visible symptoms. While certain habits or lifestyle patterns may indicate that someone is at risk for the development of heart complications, there is no single symptom that patients can be on the lookout for.
However, there are specific ways to lower blood pressure and invest in a healthier lifestyle to reduce the risk of a stroke or heart failure. Dr. Gura recommends that you get regular checkups to ensure that your blood pressure levels are stable. Knowing how hypertension, heart disease, and stroke are related is the key first step in lowering your risks.
For more information, contact us online or give us a call at 550-6240 to set an appointment.
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Heart Attack And Heart Disease
High blood pressure can damage your arteries by making them less elastic, which decreases the flow of blood and oxygen to your heart and leads to heart disease. In addition, decreased blood flow to the heart can cause:
- Chest pain, also called angina.
- Heart attack, which happens when the blood supply to your heart is blocked and heart muscle begins to die without enough oxygen. The longer the blood flow is blocked, the greater the damage to the heart.
- Heart failure, a condition that means your heart cant pump enough blood and oxygen to your other organs.
The Benefits Of Using Proven Strategies
Many effective strategies to manage high blood pressure are a good value in terms of cost per quality-adjusted life year gained.* For example:
- Team-based care to improve blood pressure control has a median cost of $9,716 to $13,992 per QALY gained.3
- The use of community health workers, especially as part of a team, has a median estimated cost of $17,670 per QALY gained.5
- When used with other approaches, self-measured blood pressure monitoring has a median cost of $2,800 to $10,800 per QALY gained.6
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What Causes High Blood Pressure
High blood pressure usually develops over time. It can happen because of unhealthy lifestyle choices, such as not getting enough regular physical activity. Certain health conditions, such as diabetes and having obesity, can also increase the risk for developing high blood pressure. High blood pressure can also happen during pregnancy.
You can manage your blood pressure to lower your risk for serious health problems that may affect your heart, brain, kidneys, and eyes.
Environmental And Genetic Factors
Essential hypertension is a complex trait resulting from the interactions of multiple environmental and genetic factors. People living in non-industrialized societies rarely develop hypertension or age-related increases in systolic and mean pressures, confirming the importance of environmental exposure in defining the risk of hypertension. Similarly, familial aggregation of hypertension is well recognized, and a family history of hypertension has been associated with an increased risk and earlier onset of hypertension in the offspring, highlighting the importance of genetic factors in hypertension.
Environmental factors: traditional environmental and lifestyle factors associated with an increased risk of hypertension are obesity, physical inactivity, and excess sodium intake. Over the last few years, low birth weight, exposure to air and noise pollution, as well as chronic stress have emerged as other potentially important factors influencing the risk of hypertension.
Table 44.1.1 Validated genetic loci/nearest mapped genes for blood pressure traits identified through genome-wide association studies
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Lowering Blood Pressure Decreases The Risk Of Heart Disease And Stroke
Despite the dangers of hypertension, the CDC estimates that 11 million US adults don’t know they have it. You can’t feel high blood pressure, which is why the American Heart Association calls it a “silent killer.”
“Unless one has regular medical care and is getting checkups, you may not even be aware of having high blood pressure until unfortunately, you have had one of the unfortunate consequences,” says Usman Baber, MD, a cardiologist at Icahn School of Medicine at Mount Sinai.
But there are common risk factors. According to Lattore, about 60% of people aged 60 or older have hypertension, and as you get older, it’s a good idea to stay on top of your blood pressure.
Certain demographics are also prone to hypertension, Fergus says, such as African-Americans and second-generation immigrants, and you should be aware if it runs in your family.
If you do have hypertension, treating it can have a strong effect on your health. For example, research has found that reducing systolic blood pressure by 10 points is associated with a 50% to 60% lower risk of stroke death and a 40% to 50% lower risk of death resulting from coronary artery disease.
To treat hypertension and lower the chances of a stroke or heart disease, Fergus says you should exercise regularly, eat a low-salt and high-potassium diet, and stay away from cigarettes. For more detailed information, read our article, “How to lower blood pressure with a heart-healthy diet and exercise.”
What Is Heart Failure
Heart failure does not mean the heart has stopped working. Rather, it means that the heart’s pumping power is weaker than normal or the heart has become less elastic. With heart failure, blood moves through the heart’s pumping chambers less effectively, and pressure in the heart increases, making it harder for your heart to deliver oxygen and nutrients to your body.
To compensate for reduced pumping power, the heart’s chambers respond by stretching to hold more blood. This keeps the blood moving, but over time, the heart muscle walls may weaken and become unable to pump as strongly. As a result, the kidneys often respond by causing the body to retain fluid and sodium. The resulting fluid buildup in the arms, legs, ankles, feet, lungs, or other organs, and is called congestive heart failure.
High blood pressure may also bring on heart failure by causing left ventricular hypertrophy, a thickening of the heart muscle that results in less effective muscle relaxation between heart beats. This makes it difficult for the heart to fill with enough blood to supply the bodyâs organs, especially during exercise, leading your body to hold onto fluids and your heart rate to increase.
- Greater need to urinate at night
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Hypertensive Urgencies And Emergencies
Hypertensive urgencies are situations associated with severe BP elevation in otherwise stable patients without acute or impending change in target organ damage or dysfunction. Many of these patients have withdrawn from or are noncompliant with antihypertensive therapy and do not have clinical or laboratory evidence of acute target organ damage. These patients should not be considered as having a hypertensive emergency and instead should be treated by reinstituting or intensifying their antihypertensive drug therapy and treatment of anxiety, as applicable. There is no indication for referral to emergency departments, immediate reduction of BP or hospitalisation for these patients.
Hypertensive emergencies are defined as severe elevations in BP associated with evidence of new or worsening target organ damage. People with chronic hypertension can often tolerate higher BP levels than those who were previously normotensive. However, if the emergency is left untreated, the one-year death rate associated with hypertensive emergencies is higher than 79% and the median survival is 10.4 months.
If conditions requiring rapid lowering of systolic BP, such as aortic dissection or pheochromocytoma, are not present, the recommendation is to reduce blood pressure by a maximum of 25% over the first hour, then to 160/100160/110 mmHg over the next 26 hours, then to normal over the next 2448 hours.
Why Is This A Big Deal
For people with OSA, it becomes difficult to keep the upper airway open during sleep because weight overpowers the muscles that hold it open. Each time the airway closes during sleep, there is a pause in breathing it can happen five to 30 times an hour or more, causing the sleeper to wake up suddenly, gasping for air.When the air flow stops, the body releases stress hormones, which over time can lead to heart disease the leading cause of death in the United States stroke and high blood pressure. It also can increase the risk of type 2 diabetes, liver problems and metabolic syndrome.Its also associated with obesity, and experts say it can be part of a vicious cycle in which the sleep deprivation it causes can lead to even more obesity, which in turn makes the condition worse.
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