Hypertension HTN or HTalso known as high blood pressure HBPis a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure is classified as either primary essential high blood pressure or secondary high blood pressure. Blood pressure is expressed by two measurements, elevated blood pressure and heart rate, the systolic and diastolic pressures, which are the maximum and minimum pressures, respectively. Lifestyle changes and medications can lower blood pressure and decrease the risk of health complications.
Hypertension is rarely accompanied by symptoms, and its identification is usually through screeningor when seeking healthcare for an unrelated problem. Some with high blood pressure report headaches particularly at the back of the head and in the morningas well as lightheadednessvertigotinnitus buzzing or hissing in the earsaltered vision or fainting episodes.
On physical examinationhypertension may be associated with the presence of changes elevated blood pressure and heart rate the optic fundus seen by ophthalmoscopy.
Hypertension with certain specific additional signs and symptoms may suggest secondary hypertension, i. Coarctation of the aorta frequently causes a decreased blood pressure in the lower extremities relative to the arms, or delayed or absent femoral arterial pulses.
Pheochromocytoma may cause abrupt "paroxysmal" episodes of hypertension accompanied by headache, elevated blood pressure and heart rate, palpitationspale appearanceand excessive sweating. Severely elevated blood pressure equal to or greater than a systolic or diastolic of is referred to as a hypertensive crisis. Hypertensive crisis is categorized as either hypertensive urgency or hypertensive emergencyaccording to the absence or presence of end organ damage, respectively. In hypertensive urgency, there is no evidence of end organ damage resulting from the elevated blood pressure, elevated blood pressure and heart rate.
In these cases, oral medications are used to lower the BP gradually over 24 to 48 hours. In hypertensive emergency, there is evidence of direct damage to one or more organs.
Pre-eclampsia is a serious condition of the second half of pregnancy and following delivery characterised by increased blood pressure and the presence of protein in the urine. When symptoms of pre-eclampsia occur the most common are headache, visual disturbance often "flashing lights"vomiting, pain over the stomach, and swelling. Pre-eclampsia can occasionally progress to a life-threatening condition called eclampsiawhich is a hypertensive emergency and has several serious complications including vision lossbrain swellingseizureskidney failurepulmonary edemaand disseminated intravascular coagulation a blood clotting disorder.
In contrast, gestational hypertension is defined as new-onset hypertension during pregnancy without protein in the urine. Failure to thriveseizuresirritabilitylack of energyand difficulty in breathing  can be associated with hypertension in newborns and young infants. In older infants and children, hypertension can cause headache, unexplained irritability, fatiguefailure to thrive, blurred visionnosebleedsand facial paralysis.
Hypertension results from a complex interaction of genes and environmental factors. Numerous common genetic variants with small effects on blood pressure have been identified  as well as some rare genetic variants with large effects elevated blood pressure and heart rate blood pressure.
These sentinel SNP are located within genes related to vascular smooth muscle and renal function. DNA methylation might affect in some way linking common genetic variation to multiple phenotypes even though mechanisms underlying these associations are not elevated blood pressure and heart rate. Single variant test performed in this study for the 35 sentinel SNP known and new showed that genetic variants singly or in aggregate contribute to risk of clinical phenotypes related to high blood pressure.
Blood pressure rises with aging and the risk of becoming hypertensive in later life is considerable. High salt intake raises the blood pressure in salt sensitive individuals; lack of exercise, obesity, and depression  can play a role in individual cases.
The possible role of other factors such as caffeine consumption,  and vitamin D deficiency  are less clear. Insulin resistancewhich is common in obesity and is a component of syndrome Elevated blood pressure and heart rate or the metabolic syndromeis also thought to contribute to hypertension.
Events in early life, such as low birth weightmaternal smokingand lack of breastfeeding may be risk factors for adult essential hypertension, although the mechanisms linking these exposures to adult hypertension remain unclear. Secondary hypertension results from an identifiable cause. Kidney disease is the most common secondary cause of hypertension.
A review found that any alcohol increased blood pressure in males while over one or two drinks increased the risk in females.
In most people with established essential hypertensionincreased resistance to blood flow total peripheral resistance accounts for the high pressure while cardiac output remains normal, elevated blood pressure and heart rate. It is not clear whether or not vasoconstriction of arteriolar blood vessels plays a role in hypertension. Pulse pressure the difference between systolic and diastolic blood pressure is frequently increased in older people with hypertension.
This can mean that systolic pressure is abnormally high, but diastolic pressure may be normal or low a condition termed isolated systolic hypertension. Many mechanisms have been proposed to account for the rise in peripheral resistance in hypertension. It has also been suggested that endothelial dysfunction and vascular inflammation may also contribute to increased elevated blood pressure and heart rate resistance and vascular damage in hypertension.
Hypertension is diagnosed on the basis of a persistently high resting blood pressure. Traditionally, the National Institute of Clinical Excellence recommends three separate resting sphygmomanometer measurements at monthly intervals. For an accurate diagnosis of hypertension to be made, it is essential for proper blood pressure measurement technique to be used. Proper blood pressure measurement requires the person whose blood pressure is being measured to sit quietly for at least five minutes which is then followed by application of a properly fitted blood pressure cuff to a bare upper arm.
An exception to this is those with very high blood pressure readings especially when there is poor organ function, elevated blood pressure and heart rate. With the availability of hour ambulatory blood pressure monitors and home blood pressure machines, the importance of not wrongly diagnosing those who have white coat hypertension has led to a change in protocols.
In the United Kingdom, current best practice is to follow up a single raised clinic reading with ambulatory measurement, or less ideally with home blood pressure monitoring over the course of 7 days. This condition is believed to be due to calcification of the arteries resulting in abnormally high blood pressure readings with a blood pressure cuff while intra arterial measurements of blood pressure are normal.
Once the diagnosis of hypertension has been made, healthcare providers should attempt to identify the underlying cause based on risk factors and other symptoms, if present. Secondary hypertension is more common in preadolescent children, with most cases caused by kidney disease. Primary or essential hypertension is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension.
Additional tests for diabetes and high cholesterol levels are usually performed because these conditions are additional risk factors for the development of heart disease and may require treatment. Serum creatinine is measured to assess for the presence of kidney disease, which can be either the cause or the result of hypertension.
Serum creatinine alone may overestimate glomerular filtration rate and recent guidelines elevated blood pressure and heart rate the use of predictive equations such as the Modification of Diet in Renal Disease MDRD formula to estimate glomerular filtration rate eGFR. Additionally, testing of urine samples for protein is used as a secondary indicator of kidney disease.
It may also show whether there is thickening of the heart muscle left ventricular hypertrophy or whether the heart has experienced a prior minor disturbance such as a silent heart attack. A chest X-ray or an echocardiogram may also be performed to look for signs of heart enlargement or damage to the heart. Hypertension is also sub-classified: Isolated systolic hypertension refers to elevated systolic pressure with normal diastolic pressure and is common in the elderly.
Hypertension is classified as "resistant" if medications do not reduce blood pressure to normal levels. Hypertension occurs in around 0.
A variety of factors, such as gestational agepostconceptional age and birth weight evista and breas cancer to be taken into account when deciding if a blood pressure is normal in a newborn. High blood pressure must be confirmed on repeated visits however before characterizing a child as having hypertension. The value of routine screening for hypertension in children over the age of 3 years is debated. Preventive Services Task Force that the available evidence is insufficient to determine the balance of benefits and harms of screening for hypertension in children and adolescents who do not have symptoms.
Much of the disease elevated blood pressure and heart rate of high blood pressure is experienced by people who are not labeled as hypertensive. Lifestyle changes are recommended to lower blood pressure, before starting medications. The British Hypertension Society guidelines  proposed lifestyle changes consistent with those outlined by the US National High BP Education Program in  for the primary prevention of hypertension:. Effective lifestyle modification may lower blood pressure as much as an individual antihypertensive medication.
Combinations of two or more lifestyle modifications can achieve even better results. Various expert groups have produced guidelines regarding how low the blood pressure target should be when a person is treated for hypertension. The first line of treatment for hypertension is lifestyle changes, including dietary changes, physical exercise, and weight loss. Though these have all been recommended in scientific advisories,  a Cochrane systematic review found no evidence for effects of weight loss diets on death, long-term complications or adverse events in persons with hypertension.
Dietary changes shown to reduce blood pressure include diets with low sodium,    the DASH diet vegetarian diets and green tea consumption.
Increasing dietary potassium has a potential benefit for lowering the risk of hypertension. Physical exercise regimens which are shown to reduce blood pressure include isometric resistance exerciseaerobic exerciseresistance exerciseand device-guided breathing.
Stress reduction techniques such as biofeedback or transcendental meditation may be considered as an add-on to other treatments to reduce hypertension, but do not have evidence for preventing cardiovascular disease on their own.
Several classes of medications, collectively referred to as antihypertensive medicationsare available for treating hypertension. First-line medications for hypertension include thiazide-diureticscalcium channel blockersangiotensin elevated blood pressure and heart rate enzyme inhibitorsand angiotensin receptor blockers. However, a Cochrane review that included 13 trials found that the effects of beta-blockers are inferior to that of other antihypertensive medications.
Resistant hypertension is defined as high blood pressure that remains above a target level, in spite of being prescribed three or more antihypertensive drugs simultaneously with different mechanisms of action. Rates also vary markedly within regions with rates as low as 3. Rates of high blood pressure in children and adolescents have increased in the last 20 years in the United States. Kidney disease is the most common secondary cause of hypertension in children and adolescents.
Nevertheless, primary or essential hypertension accounts for most cases. Hypertension is the most important preventable risk factor for premature death worldwide. Modern understanding of the cardiovascular system began with the work of physician William Harvey —who described the circulation of blood in his book " De motu cordis elevated blood pressure and heart rate. The English clergyman Stephen Hales made the first published measurement of blood pressure in InNikolai Korotkoff improved the technique by describing the Korotkoff sounds that are heard when the artery is ausculated with a stethoscope while the sphygmomanometer cuff is deflated.
The symptoms similar to symptoms of patients elevated blood pressure and heart rate hypertensive crisis are discussed in medieval Persian medical texts in the chapter of "fullness disease". Descriptions of hypertension as a disease came among others from Thomas Young in and especially Richard Bright in Historically the treatment for what was called the "hard pulse disease" consisted in reducing the quantity of blood by bloodletting or the application of leeches.
In the 19th and 20th centuries, before effective pharmacological treatment for hypertension became possible, three treatment modalities were used, all with numerous side-effects: The first chemical for hypertension, sodium thiocyanatewas used in but had many side effects and was unpopular. None of these were well tolerated. The first was chlorothiazidethe first thiazide diuretic and developed from the antibiotic sulfanilamidewhich became available in The World Health Organization has identified hypertension, or high blood pressure, as the leading cause of cardiovascular mortality.
Over the past three years, elevated blood pressure and heart rate, more national societies have been engaging in WHD and have been innovative in their activities to get the message to the public. Inelevated blood pressure and heart rate was record participation from 47 member countries of the WHL, elevated blood pressure and heart rate.