High blood pressure, termed "hypertension," is a condition that afflicts almost 1 billion people worldwide

and is a leading cause of morbidity and mortality. More than 20% of Americans are hypertensive, and one-
third of these Americans are not even aware they are hypertensive. Therefore, this disease is sometimes
called the "silent killer." This disease is usually asymptomatic until the damaging effects of hypertension
(such as stroke, myocardial infarction, renal dysfunction, visual problems, etc.) are observed.

Definition of Hypertension

Hypertensive is defined as an abnormal elevation in diastolic pressure and/or systolic pressure; mean
arterial pressure is also elevated in hypertension, but it is not usually measured in people. In past years,
the diastolic value was emphasized in assessing hypertension. However, elevations in systolic pressure
("systolic hypertension") are also associated with increased incidence of coronary and cerebrovascular
disease (e.g., stroke). Therefore, we now recognize that both systolic and diastolic pressure values are
important to note. According to the latest U.S. national guidelines (JNC 7 Report)), the following represents
different stages of hypertension:

Systolic Diastolic
Classification
(mmHg) (mmHg)
Normal <120 <80
Prehypertension 120-139 80-89
Stage 1 140-159 90-99
Stage 2 >160 >100

Two Classes of Hypertension

In 90-95% of patients presenting with hypertension, the cause is unknown. This condition is called primary
(or essential) hypertension. The remaining 5-10% of hypertensive patients have hypertension that results
secondarily from renal disease, endocrine disorders, or other identifiable causes. This form of hypertension
is called secondary hypertension.

Hemodynamic Basis of Hypertension

Regardless of the origin of hypertension, the actual increase in arterial blood pressure is caused by either
an increase in systemic vascular resistance (SVR) or an increase in cardiac output (CO). The former is
determined by the vascular tone (i.e., state of constriction) of systemic resistance vessels, whereas the
latter is determined by heart rate and stroke volume. Therefore, in order to understand how arterial blood
pressure can become elevated, it is necessary to understand the mechanisms that regulate both SVR and
CO.

Treatment of Hypertension

Most people with hypertension are treated with antihypertensive medications. In most forms of
hypertension, the hypertensive state is maintained by an elevation in blood volume, which in turn increases
cardiac output by the Frank-Starling relationship. Diuretic drugs, which enhance the removal of sodium
and water by the kidneys and thereby decrease blood volume, are very effective in the treatment of
hypertension. Hypertension is also commonly treated with drugs that decrease cardiac output. These
cardioinhibitory drugs either block beta-adrenoceptors on the heart (i.e., beta-blockers) or L-type calcium
channels (i.e., calcium-channel blockers), which decreases cardiac output by decreasing heart rate and
contractility (inotropy). Vasodilator drugs, which decrease systemic vascular resistance, are also used to
treat hypertension. Included in these drugs are alpha-adrenoceptor antagonists (alpha-blockers), direct-
acting vasodilators, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. A
complete list of drugs used to treat hypertension can be found by clicking here.

Go to: primary hypertension

RK Revised 03/29/2007

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