https://www.wikidoc.org/api.php?action=feedcontributions&feedformat=atom&user=Taylor+Palmieri wikidoc - User contributions [en] 2026-04-03T18:48:44Z User contributions MediaWiki 1.45.1 https://www.wikidoc.org/index.php?title=Bell%27s_palsy&diff=580562 Bell's palsy 2011-07-28T17:30:12Z <p>Taylor Palmieri: </p> <hr /> <div>{{Infobox_Disease<br /> | Name = Bell's palsy<br /> | Image = Gray781.png <br /> | Caption = <br /> | DiseasesDB = 1303<br /> | ICD10 = {{ICD10|G|51|0|g|50}}<br /> | ICD9 = {{ICD9|351.0}}<br /> | ICDO = <br /> | OMIM = <br /> | MedlinePlus = 000773<br /> | eMedicineSubj = <br /> | eMedicineTopic = <br /> | eMedicine_plus = <br /> | MeshID = D020330<br /> }}<br /> {{SI}}<br /> <br /> '''For patient information click [[{{PAGENAME}} (patient information)|here]]'''<br /> <br /> '''Editor-in-Chief:''' Gilbert Abou Dagher, M.D. <br /> <br /> ==Overview==<br /> '''Bell's palsy''' (or '''facial [[palsy]]''') is characterised by facial drooping on the affected half, due to malfunction of the [[facial nerve]] (VII [[cranial nerve]]), which controls the [[muscle]]s of the face. Named after Scottish anatomist Charles Bell, who first described it, Bell's palsy is the most common acute [[mononeuropathy]] (disease involving only one [[nerve]]), and is the most common cause of [[acute facial nerve paralysis]]. The paralysis is of the infranuclear/lower motor neuron type. Bell’s palsy affects about 40,000 people in the United States every year. It affects approximately 1 person in 65 during a lifetime. Until recently, its cause was unknown in most cases, but it has now been related to both [[Lyme disease]] and [[Herpes Zoster]].<br /> <br /> ==Epidemiology==<br /> <br /> The annual incidence rate of Bell's Palsy is between 13 and 34 cases per 100,000 population. <br /> There is no race, geographic, or gender predilection.<br /> The risk is three times greater during pregnancy, especially in the third trimester or in the first postpartum week. <br /> Its is to note that diabetes is present in about 5 to 10 percent of patients.<br /> <br /> ==Etiology== <br /> <br /> Many cases are likely due to [[Herpes Simplex Virus]] (HSV) reactivation<br /> <br /> '''Infectious causes '''<br /> <br /> :*Herpes simplex virus activation is the most likely cause of Bell's Palsy. <br /> :*Herpes Zoster may be the second most common viral infection. <br /> :*Cytomegalovirus<br /> :*Epstein Barr virus<br /> :*Adenovirus<br /> :*Rubella virus<br /> :*Mumps<br /> :*Influenza B<br /> :*Coxsackievirus <br /> :*Rickettsial infection <br /> :*Ehrlichiosis <br /> :*Borrelia burdopheri<br /> :*HIV<br /> <br /> <br /> '''Non-infectious causes'''<br /> <br /> :*Several cases of Bell' Palsy were linked to an inactivated intranasal influenza vaccine in Switzerland <br /> :*Genetic predisposition may be likely <br /> :*Ischemia of the facial nerve <br /> :*Tumors and compression of the facial nerve<br /> :*Temporal bone fracture<br /> :*Systemic Lupus Erythematosus (SLE)<br /> :*Sarcoidosis<br /> <br /> == Histopathology == <br /> <br /> :*The facial nerve has an edematous, thickened perineurium with infiltrates of inflammatory cells between nerve bundles and around blood vessels.<br /> :*It appears that the histology of the facial nerve in Bell's palsy is similar to Herpes Zoster infection, suggestive of an infectious cause.<br /> <br /> ==Peripheral versus central lesions ==<br /> <br /> :*Sparing of the forehead muscles is suggestive of a central (upper motor neuron) lesion because of bilateral innervation to this area. <br /> :*However, it does not exclude a peripheral site of pathology in all cases.<br /> <br /> == History and Symptoms == <br /> <br /> Sudden onset, usually over hours, of unilateral facial paralysis(maximal symptoms by 48 hours)<br /> <br /> :*Eyebrow sagging with inability to close the affected eye<br /> :*Nasolabial fold flattening with mouth drawn to the non affected side<br /> :*Inability to wrinkle forehead (peripheral lesion)<br /> :*May be associated with ear pain, impaired taste sensation on the anterior two-thirds of the tongue, decreased tearing, and hyperacusis<br /> <br /> ==Diagnostic Tests==<br /> <br /> :*Electrodiagnostic studies help determine the prognosis, and imaging studies can define potential surgical causes of facial palsy. <br /> :*These tests are not necessary in all patients. <br /> :*Patients with a typical lesion that is incomplete and recovers do not need further study. <br /> :*Electrodiagnostic studies (EMG, or motor nerve conduction study) and Imaging (CT, or MRI) are needed if the physical signs are atypical, there is slow progression beyond three weeks, or if there is no improvement at six months. <br /> :*Screening blood studies for an underlying systemic disease or infection may also be considered in these cases. <br /> :*There is no test that provides prognostic information early enough to be used for guiding treatment or prognosis.<br /> <br /> ==Differential Diagnosis==<br /> <br /> ===Lyme Disease===<br /> :*Facial nerve palsy is the most common cranial neuropathy associated with Lyme meningitis. <br /> :*Screening for antibodies to B.burgdorferi not recommended among patients with seventh nerve palsy with no additional manifestations of Lyme disease.<br /> :*Findings suggestive of possible Lyme disease include the development of facial palsy in a young patient, heart block, arthritis, vertigo, and hearing loss.<br /> <br /> ===HIV===<br /> :*HIV infection rarely causes facial palsy.<br /> :*Onset at the time of sero-conversion when a CSF lymphocytosis is usually present. <br /> :*In the later stages when cellular immunity wanes, the facial palsy is typically due to another infection such as Zoster, chronic demyelinating polyradiculopathy, or meningeal lymphomatosis.<br /> <br /> ===Melkersson-Rosenthal Syndrome===<br /> :*Facial paralysis, episodic facial swelling, and a fissured tongue, typically beginning in adolescence, with recurrent episodes of facial palsy. <br /> :*Incomplete forms of this syndrome outnumber those with the classic triad. <br /> :*The cause is unknown, and treatment unproven.<br /> <br /> ===Other Entities===<br /> :*Bacterial infection of the middle ear (otitis media) <br /> :*Cholesteatoma, or tumors should be suspected if the onset of facial palsy is gradual. <br /> :*Sarcoidosis, especially in patients with bilateral facial palsy. <br /> :*Sjogren's syndrome is an unusual cause.<br /> <br /> == Risk Stratification and Prognosis== <br /> <br /> :*The House-Brackmann grading system was devised both as a clinical indicator of severity and also an objective record of progress. <br /> :*Clinically incomplete lesions tend to recover. <br /> :*The natural history without treatment was described in a study of 1011 patients in 1982:<br /> ::*67% had incomplete paralysis, with 94% rate of return to normal function<br /> ::*33% had complete paralysis, with 60% rate of return to normal function<br /> ::*By 3 weeks, 71% had complete recovery, 13% had slight sequelae , and 16% had residual weakness<br /> :*Herpes zoster is associated with more severe paresis and worse prognosis compared with &quot;idiopathic&quot; Bell's palsy. <br /> :*There is a favorable prognosis if some recovery is seen within the first 21 days of onset. <br /> :*In severe lesions that recover, the outgrowth of new axons from the injury site may be disorganized and misdirected.<br /> :*On blinking there is twitching of the angle of the mouth, and on smiling the eye may close or wink. <br /> :*With misdirected autonomic fibers, a salivary stimulus may result in excess lacrimation, the syndrome of &quot;crocodile tears.&quot;<br /> :*Recurrent attacks of on either the ipsilateral or contralateral side have been observed in 7 to 15% of patients.<br /> <br /> ==Treatment==<br /> <br /> ===Eye care=== <br /> <br /> In severe cases, the cornea may be at risk because of poor eyelid closure and reduced tearing, which may result in drying and abrasion. <br /> <br /> :*The risk for blindness due to corneal trauma is significant, especially if there is 5th nerve concomitant damage.<br /> :*The use of artificial tears, every hour while awake, and ophthalmic ointments at night is recommeneded. <br /> :*Protective glasses or goggles during the day.<br /> :*Patches can be used at night, not to be placed directly on the eyelid since the patch can slip and scratch the cornea. <br /> :*Rarely tarsorrhaphy or temporary implantation of a gold weight into the upper lid can be used to close the eye and protect the cornea.<br /> <br /> ===Glucocorticoid and Antiviral Therapy===<br /> <br /> The mainstay of pharmacologic therapy is early short-term oral glucocorticoid treatment<br /> <br /> :*It is established as effective by randomized controlled trials: Prednisone 1mg/kg up to 60mg PO daily for 10 days<br /> :*The suspicion that Bell's palsy is caused by herpes simplex virus in most patients led to trials of antiviral therapy<br /> :*Compared with placebo, these trials found no benefit for antiviral therapy alone. <br /> :*The data is conflicting with regard to the possibility of additional benefit when antiviral agents are administered with glucocorticoids.<br /> :*In a meta-analysis involving 18 trials and 2786 patients, treatment with glucocorticoids alone was associated with a reduced risk of unfavorable recovery (relative risk [RR] 0.69, 95% CI 0.55-0.87), while treatment with antiviral agents alone was not (RR 1.14, 95% CI 0.80-1.62).<br /> :*In a pooled data from eight trials, the same meta-analysis found a trend towards a reduced risk of unfavorable recovery for combined antiviral and glucocorticoid treatment compared with glucocorticoid treatment alone; however, the outcome barely missed statistical significance (RR 0.75, 95% CI 0.56-1.0).<br /> :*In a second meta-analysis of six trials and 1145 patients, there was no significant benefit of combined antiviral and glucocorticoid treatment for achieving at least partial facial muscle recovery (odds ratio 1.5, 95% CI 0.83-2.69).<br /> :*Neither excludes the possibility of marginal benefit when antiviral therapy is combined with glucocorticoids. <br /> :*Some authorities recommend antiviral therapy in addition to steroids for severe complete lesions. Choices include:<br /> ::*Acyclovir 2000-4000 mg/24 h PO divided 5 times a day for 7-10 d or<br /> ::*Valcyclovir 1000-3000 mg/24 h PO for 5 d<br /> <br /> ==Bell’s Palsy-induced Blepharospasm==<br /> <br /> Blepharospasm associated with Bell's palsy has been rarely reported. Instead of the classic presentation with the affected eye wide open, the affected eye is closed shut, with the patient unable to open it(Blepharospasm).<br /> <br /> :*So far, seven patients previously reported: all women. <br /> :*In five of the seven patients, blepharospasm appeared within a month after the onset of Bell’s palsy.<br /> <br /> <br /> ===Possible mechanisms===<br /> <br /> :*The majority of patients with blepharospasm have a high incidence of local ocular symptoms prior to or at the onset of blepharospasm, such as blepharitis, conjunctivitis, dry eyes or photophobia.<br /> :*Chronically disturbed sensory inputs to the central nervous system due to lagophthalmos and corneal irritation may contribute to the generation of blepharospasm.<br /> :*In patients with Bell’s palsy, there is an enhanced blink reflex secondary to inputs from the paralyzed side compared which those of the non-paralyzed side.<br /> :*Abnormal afferent input from the paralyzed side contributes to the abnormal sensitization of the blink reflex, thus facilitating the induction of abnormal facial motor outputs such as blepharospasm.<br /> :*It is unclear why Bell’s palsy-induced blepharospasm is extremely rare.<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> ==Additional Resources==<br /> * Sullivan FM, Swan IRC, Donnan PT, et al. Early treatment with prednisolone or acyclovir in Bell's palsy. N Engl J Med 2007;357:1598-1607.<br /> * &quot;The Merck Manual&quot;<br /> * ''New England Journal of Medicine'', Sept. 2004<br /> * Lambert, Michael. (2007-03-05) [http://www.emedicine.com/emerg/topic56.htm &quot;Bell's Palsy.&quot;] (Website.) ''Emedicine''. Retrieved on 2007-09-27.<br /> <br /> ==External links==<br /> *[http://www.facialparalysisinstitute.com managment and treatment of facial paralysis]<br /> *[http://www.bellspalsy.ws/ Bell's Palsy Information Site], has a FAQ<br /> *[http://pregnancyandbaby.com/read/articles/5398.htm Bell's Palsy and Pregnancy]<br /> *[http://www.neurologychannel.com/bellspalsy/ Bell's Palsy Patient Info - Neurology Channel]<br /> *[http://www.facial-palsy.com/ Living with Facial Palsy], a site for parents of children with Facial Palsy<br /> *[http://www.lib.uiowa.edu/hardin/md/bellspalsy.html Links to pictures of Bells palsy (Hardin MD/Univ of Iowa)]<br /> *[http://www.bellspalsy.org.uk/ Bell's Palsy Association]<br /> <br /> {{SIB}}<br /> {{PNS diseases of the nervous system}}<br /> [[Category:Neurological disorders]]<br /> [[Category:Otolaryngology]]<br /> [[Category: Neurology]]<br /> [[Category: Mature chapter]]<br /> <br /> [[ar:شلل العصب الوجهي]]<br /> [[ca:Paràlisi de Bell]]<br /> [[de:Fazialislähmung]]<br /> [[es:Parálisis facial periférica]]<br /> [[fr:Paralysie faciale]]<br /> [[nl:Aangezichtsverlamming van Bell]]<br /> [[fi:Bellin halvaus]]<br /> [[vi:Méo miệng]]<br /> {{WH}}<br /> {{WikiDoc Sources}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Bell%27s_palsy_(patient_information)&diff=580561 Bell's palsy (patient information) 2011-07-28T17:29:36Z <p>Taylor Palmieri: </p> <hr /> <div>'''For the WikiDoc page for this topic, click [[Bell's palsy|here]]'''<br /> {{Infobox_Disease<br /> | Name = Bell's palsy<br /> | DiseasesDB = 1303<br /> | ICD10 = {{ICD10|G|51|0|g|50}}<br /> | ICD9 = {{ICD9|351.0}}<br /> | ICDO = <br /> | OMIM = <br /> | MedlinePlus = 000773<br /> | eMedicineSubj = <br /> | eMedicineTopic = <br /> | eMedicine_plus = <br /> | MeshID = D020330<br /> }}<br /> {{SI}}<br /> {{CMG}}; '''Assistant Editors-In-Chief:''' Alexandra M. Palmer, [[Taylor Palmieri|Taylor Palmieri, B.A.]] [mailto:tpalmieri@perfuse.org]<br /> <br /> ==Overview==<br /> [[Bell's palsy]] is a form of temporary facial paralysis resulting from damage or trauma to one of the two facial nerves. The facial nerve-also called the 7th cranial nerve-is a paired structure that travels through a narrow, bony canal (called the Fallopian canal) in the [[skull]], beneath the [[ear]], to the muscles on each side of the face. For most of its journey, the nerve is encased in this bony shell.<br /> <br /> Each facial nerve directs the muscles on one side of the face, including those that control eye blinking and closing, and facial expressions such as smiling and frowning. Additionally, the facial nerve carries nerve impulses to the lacrimal or tear glands, the saliva glands, and the muscles of a small bone in the middle of the ear called the [[stapes]]. The facial nerve also transmits taste sensations from the tongue.<br /> <br /> When [[Bell's palsy]] occurs, the function of the facial nerve is disrupted, causing an interruption in the messages the brain sends to the facial muscles. This interruption results in facial weakness or [[paralysis]].<br /> <br /> [[Bell's palsy]] is named for Sir Charles Bell, a 19th century Scottish surgeon who was the first to describe the condition. The disorder, which is not related to [[stroke]], is the most common cause of facial paralysis. Generally, [[Bell's palsy]] affects only one of the paired facial nerves and one side of the face, however, in rare cases, it can affect both sides.<br /> <br /> ==What are the symptoms of Bell's palsy?==<br /> Because the facial nerve has so many functions and is so complex, damage to the nerve or a disruption in its function can lead to many problems. [[Symptoms]] of [[Bell's palsy]], which vary from person to person and range in severity from mild weakness to total [[paralysis]], may include [[twitching]], [[weakness]], or [[paralysis]] on one or both sides of the face, drooping of the eyelid and corner of the mouth, drooling, dryness of the eye or mouth, impairment of taste, and excessive tearing in one eye. Most often these symptoms, which usually begin suddenly and reach their peak within 48 hours, lead to significant facial distortion.<br /> <br /> Other symptoms may include [[pain]] or discomfort around the jaw and behind the ear, ringing in one or both ears, [[headache]], loss of taste, hypersensitivity to sound on the affected side, impaired speech, [[dizziness]], and difficulty eating or drinking.<br /> <br /> ==What are the causes of Bell's palsy?==<br /> [[Bell's palsy]] occurs when the nerve that controls the facial muscles is swollen, inflamed, or compressed, resulting in facial weakness or [[paralysis]]. Exactly what causes this damage, however, is unknown.<br /> <br /> Most scientists believe that a [[viral]] [[infection]] such as [[viral meningitis]] or the [[common cold]] sore virus - [[herpes simplex]] - causes the disorder. They believe that the facial nerve swells and becomes inflamed in reaction to the [[infection]], causing pressure within the Fallopian canal and leading to an [[infarction]] (the death of nerve cells due to insufficient blood and oxygen supply). In some mild cases (where recovery is rapid), there is damage only to the [[myelin sheath]] of the nerve. The myelin sheath is the fatty covering-which acts as an insulator-on nerve fibers in the brain.<br /> <br /> The disorder has also been associated with [[influenza]] or a flu-like illness, [[headaches]], chronic middle ear infection, high [[blood pressure]], [[diabetes]], [[sarcoidosis]], [[tumors]], [[Lyme disease]], and [[trauma]] such as skull fracture or facial injury.<br /> <br /> ==Who is at highest risk?==<br /> [[Bell's palsy]] afflicts approximately 40,000 Americans each year. It affects men and women equally and can occur at any age, but it is less common before age 15 or after age 60. It disproportionately attacks pregnant women and people who have [[diabetes]] or upper respiratory ailments such as the [[flu]] or a [[cold]].<br /> <br /> ==How to know you have Bell's palsy?==<br /> A [[diagnosis]] of [[Bell's palsy]] is made based on clinical presentation-including a distorted facial appearance and the inability to move muscles on the affected side of the face-and by ruling out other possible causes of facial paralysis. There is no specific laboratory test to confirm [[diagnosis]] of the disorder.<br /> <br /> Generally, a physician will examine the individual for upper and lower facial weakness. In most cases this weakness is limited to one side of the face or occasionally to the [[forehead]], [[eyelid]], or [[mouth]]. A test called [[electromyography]] (EMG) can confirm the presence of nerve damage and determine the severity and the extent of nerve involvement. An [[x-ray]] of the [[skull]] can help rule out [[infection]] or [[tumor]]. A [[magnetic resonance imaging]] (MRI) or [[computed tomography]] (CT) scan can eliminate other causes of pressure on the facial nerve.<br /> <br /> ==When to seek urgent medical care==<br /> Urgent medical care is not usually necessary for [[Bell's palsy]]. However, since some of the [[symptoms]] of [[Bell's palsy]] resemble the [[symptoms]] of [[stroke]], it is important to seek medical care right away and rule out this more serious condition.<br /> <br /> ==Treatment options==<br /> There is no cure or standard course of treatment for [[Bell's palsy]]. The most important factor in treatment is to eliminate the source of the nerve damage.<br /> <br /> [[Bell's palsy]] affects each individual differently. Some cases are mild and do not require treatment as the [[symptoms]] usually subside on their own within 2 weeks. For others, treatment may include [[medications]] and other [[therapeutic]] options.<br /> <br /> Recent studies have shown that [[steroids]] are an effective treatment for [[Bell's palsy]] and that an antiviral drug such as [[acyclovir]]-used to fight [[viral infections]]-combined with an [[anti-inflammatory]] drug such as the [[steroid]] [[prednisone]]-used to reduce [[inflammation]] and swelling-may be effective in improving facial function by limiting or reducing damage to the nerve. [[Analgesics]] such as [[aspirin]], [[acetaminophen]], or [[ibuprofen]] may relieve [[pain]]. Because of possible drug interactions, patients taking [[prescription medicines]] should always talk to their doctors before taking any [[over-the-counter]] drugs.<br /> <br /> Another important factor in treatment is eye protection. [[Bell's palsy]] can interrupt the eyelid's natural [[blinking]] ability, leaving the eye exposed to [[irritation]] and drying. Therefore, keeping the eye moist and protecting the eye from debris and injury, especially at night, is important. Lubricating eye drops, such as artificial tears or eye ointments or gels, and eye patches are also effective.<br /> <br /> [[Physical therapy]] to stimulate the facial nerve and help maintain muscle tone may be beneficial to some. Facial massage and exercises may help prevent permanent [[contractures]] (shrinkage or shortening of muscles) of the paralyzed muscles before recovery takes place. Moist heat applied to the affected side of the face may help reduce [[pain]].<br /> <br /> Other therapies that may be useful for some individuals include relaxation techniques, [[acupuncture]], electrical stimulation, biofeedback training, and vitamin therapy (including [[vitamin B12]], [[B6]], and [[zinc]]), which may help nerve growth.<br /> <br /> In general, decompression surgery for [[Bell's palsy]] -to relieve pressure on the nerve-is controversial and is seldom recommended. On rare occasions, cosmetic or reconstructive surgery may be needed to reduce deformities and correct some damage such as an eyelid that will not fully close or a crooked smile.<br /> <br /> ==Diseases with similar symptoms==<br /> [[Bell's palsy]] is thought to be linked to swelling ([[inflammation]]) of the nerve in the area where it travels through the bones of the skull. Other conditions related to [[Bell's palsy]] include:<br /> *[[Stroke]]<br /> *[[Lyme disease]]<br /> *[[Sarcoidosis]]<br /> *[[Diabetes]]<br /> <br /> ==Where to find medical care for Bell's palsy==<br /> [http://maps.google.com/maps?f=q&amp;amp;hl=en&amp;amp;geocode=&amp;amp;q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|Bell's palsy}}}}&amp;amp;sll=37.0625,-95.677068&amp;amp;sspn=65.008093,112.148438&amp;amp;ie=UTF8&amp;amp;ll=37.0625,-95.677068&amp;amp;spn=91.690419,149.414063&amp;amp;z=2&amp;amp;source=embed Directions to Hospitals Treating Bell's palsy]<br /> <br /> ==Prevention of Bell's palsy==<br /> Safety measures may reduce the risk of head injury. Many of the other factors that lead to this disorder are not preventable.<br /> <br /> ==What to expect (Outlook/Prognosis)==<br /> The [[prognosis]] for individuals with [[Bell's palsy]] is generally very good. The extent of nerve damage determines the extent of recovery. Improvement is gradual and recovery times vary. With or without treatment, most individuals begin to get better within 2 weeks after the initial onset of [[symptoms]] and most recover completely, returning to normal function within 3 to 6 months. For some, however, the [[symptoms]] may last longer. In a few cases, the [[symptoms]] may never completely disappear. In rare cases, the disorder may recur, either on the same or the opposite side of the face.<br /> <br /> ==Sources==<br /> http://www.ninds.nih.gov/disorders/bells/detail_bells.htm#109613050<br /> http://www.nlm.nih.gov/medlineplus/ency/article/000773.htm<br /> <br /> [[Category:Patient information]]<br /> [[Category:Otolaryngology patient information]]<br /> [[Category:Otolaryngology]]<br /> [[Category:Disease state]]<br /> [[Category:Mature chapter]]<br /> [[Category: Neurology]]<br /> [[Category: Neurology patient information]]<br /> <br /> {{SIB}}<br /> {{WH}}<br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Aphthous_ulcer_(patient_information)&diff=580299 Aphthous ulcer (patient information) 2011-07-28T13:38:48Z <p>Taylor Palmieri: </p> <hr /> <div>'''For the WikiDoc page for this topic, click [[Aphthous ulcer|here]]'''<br /> {{Infobox_Disease |<br /> Name = Aphthous ulcer |<br /> DiseasesDB = |<br /> ICD10 = {{ICD10|K|12|0|k|00}} |<br /> ICD9 = {{ICD9|528.2}} |<br /> ICDO = |<br /> OMIM = |<br /> MedlinePlus = 000998 |<br /> eMedicineSubj = ent |<br /> eMedicineTopic = 700 |<br /> eMedicine_mult = {{eMedicine2|derm|486}} {{eMedicine2|ped|2672}} |<br /> }}<br /> {{SI}}<br /> {{CMG}}; '''Assistant Editors-in-Chief:''' Alexandra M. Palmer, [[Taylor Palmieri|Taylor Palmieri, B.A.]] [mailto:tpalmieri@perfuse.org]<br /> <br /> ==Overview==<br /> An [[aphthous ulcer]], more commonly known as a [[canker sore]], is a painful, open sore in the mouth. [[Canker sores]] are white or yellow and surrounded by a bright red area. They are [[benign]] (not [[cancer]]) and usually appear on the inner surface of the [[cheeks]] and [[lips]], [[tongue]], [[soft palate]], and the base of the gums.<br /> <br /> ==What are the symptoms of Aphthous ulcers?==<br /> The first [[symptom]] is usually a tingling or burning sensation that you feel before other [[symptoms]] develop.<br /> <br /> The following [[symptoms]] may then occur:<br /> <br /> *Painful, red spot or bump that develops into an open [[ulcer]]<br /> **Center is colored white or yellow<br /> **Usually small (under 1 cm) but occasionally larger<br /> **Single bump or group of bumps (crops)<br /> <br /> *Sore may turn gray just before starting to heal<br /> <br /> Less common [[symptoms]] include:<br /> *[[Fever]]<br /> *General [[discomfort]] or uneasiness (malaise)<br /> *Swollen [[lymph nodes]]<br /> <br /> [[Pain]] decreases in 7 to 10 days, with complete healing in 1 to 3 weeks. Particularly large [[ulcers]] (greater than 1 cm in diameter) often take longer to heal (2 to 4 weeks). Occasionally, a severe occurrence may be accompanied by nonspecific [[symptoms]] of [[illness]], such as [[fever]]. [[Canker sores]] often return.<br /> <br /> ==What are the causes of Aphthous ulcers?==<br /> [[Aphthous ulcers]] may be linked to problems with the body's immune (defense) system. The sores may occur after a mouth injury due to dental work, aggressive tooth cleaning, or biting the [[tongue]] or [[cheek]].<br /> <br /> They can also be triggered by emotional [[stress]], dietary deficiencies (especially [[iron]], [[folic acid]], or [[vitamin B-12]]), [[menstrual periods]], hormonal changes, [[food allergies]], and similar situations. They occur most commonly with [[viral infections]]. In some cases, the cause can not be identified.<br /> <br /> ==Who is at highest risk?==<br /> [[Aphthous ulcers]] are a common form of mouth [[ulcer]]. They occur in women more often than men. They may occur at any age, but usually first appear between the ages of 10 and 40.<br /> <br /> [[Aphthous ulcers]] can run in families.<br /> <br /> ==How to know you have an Aphthous ulcer?==<br /> Your health care provider can often make the [[diagnosis]] by looking at the sore. If [[Aphthous ulcers]] persist or continue to return, tests should be done to rule out other causes, such as [[erythema multiforme]], drug allergies, [[herpes]] infection, bullous lichen planus, and other disorders.<br /> <br /> [[Aphthous ulcers]] are not [[cancer]] and do not cause [[cancer]]. There are types of [[cancer]], however, that may first appear as a [[mouth ulcer]] that does not heal. [[Squamous cell carcinoma]] is an example of this type of [[cancer]].<br /> <br /> A [[biopsy]] may be used to distinguish an [[Aphthous ulcer]] from other causes of [[mouth ulcers]].<br /> <br /> ==When to seek urgent medical care==<br /> Apply home treatment and call your health care provider if [[symptoms]] of [[canker sores]] persist or worsen, or [[canker sores]] recur more often than 2 or 3 times per year. If you have a [[mouth ulcer]] that lasts more that 2 weeks, you should see your doctor to rule out possible [[cancer]].<br /> <br /> Call your health care provider if [[symptoms]] are associated with other problems such as [[fever]], [[diarrhea]], [[headache]], or [[skin rash]].<br /> <br /> ==Treatment options==<br /> Treatment is usually not necessary. In most cases, the sores go away by themselves.<br /> <br /> If you have an [[Aphthous ulcer]], you should not eat hot or spicy foods, which can cause [[pain]]. Mild, [[over-the-counter]] mouth washes or salt water may help. There are [[over-the-counter]] medicines that soothe the painful area. These medicines are applied directly to the sore area of the [[mouth]].<br /> <br /> The easiest home remedy is a mixture of half [[hydrogen peroxide]] and half water. Use a cotton swab to apply the mixture directly to the [[canker sore]]. Then, dab a small amount of [[Milk of Magnesia]] on the [[canker sore]], three to four times a day. This is soothing and may also help it heal.<br /> <br /> Another home remedy is to mix half [[Milk of Magnesia]] and half [[Benadryl]] liquid allergy medicine. Swish this mixture in your mouth for about 1 minutes, then spit it out.<br /> <br /> Other treatments for more severe cases include applying fluocinonide gel (Lidex) or [[chlorhexidine gluconate]] mouthwash. Powerful [[anti-inflammatory]] medicines called [[corticosteroids]] are sometimes used.<br /> <br /> To prevent [[bacterial infection]], brush and floss your [[teeth]] regularly and visit the [[dentist]] for routine care.<br /> <br /> ==Diseases with similar symptoms==<br /> [[Herpetic stomatitis]]<br /> <br /> ==Where to find medical care for Aphthous ulcers==<br /> [http://maps.google.com/maps?f=q&amp;amp;hl=en&amp;amp;geocode=&amp;amp;q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|Aphthous ulcer}}}}&amp;amp;sll=37.0625,-95.677068&amp;amp;sspn=65.008093,112.148438&amp;amp;ie=UTF8&amp;amp;ll=37.0625,-95.677068&amp;amp;spn=91.690419,149.414063&amp;amp;z=2&amp;amp;source=embed Directions to Hospitals Treating Aphthous ulcers]<br /> <br /> ==Prevention of Aphthous ulcers==<br /> The best way to prevent [[Aphthous ulcers]] is to keep your [[mouth]] free of [[infection]]. This includes brushing and flossing your [[teeth]], keeping your hands out of your mouth and visiting the [[dentist]] for regular cleanings.<br /> <br /> ==What to expect (Outlook/Prognosis)==<br /> [[Aphthous ulcers]] usually heal on their own. The [[pain]] usually decreases in a few days. Other [[symptoms]] disappear in 10 to 14 days.<br /> <br /> ==Sources==<br /> http://www.nlm.nih.gov/medlineplus/ency/article/000998.htm<br /> <br /> [[Category:Patient information]]<br /> [[Category:Otolaryngology patient information]]<br /> [[Category:Otolaryngology]]<br /> [[Category:Infectious diseases patient information]]<br /> [[Category:Infectious disease]]<br /> [[Category:Laryngology]]<br /> [[Category:Oral pathology]]<br /> [[Category:Disease state]]<br /> [[Category:Mature chapter]]<br /> <br /> {{SIB}}<br /> {{WH}}<br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Bell%27s_palsy_(patient_information)&diff=580286 Bell's palsy (patient information) 2011-07-28T13:20:24Z <p>Taylor Palmieri: </p> <hr /> <div>'''For the WikiDoc page for this topic, click [[Bell's palsy|here]]'''<br /> {{Infobox_Disease<br /> | Name = Bell's palsy<br /> | DiseasesDB = 1303<br /> | ICD10 = {{ICD10|G|51|0|g|50}}<br /> | ICD9 = {{ICD9|351.0}}<br /> | ICDO = <br /> | OMIM = <br /> | MedlinePlus = 000773<br /> | eMedicineSubj = emerg<br /> | eMedicineTopic = 56<br /> | eMedicine_plus = {{eMedicine2|neuro|413}} {{eMedicine2|ent|719}} {{eMedicine2|oph|508}}<br /> | MeshID = D020330<br /> }}<br /> {{SI}}<br /> {{CMG}}; '''Assistant Editors-In-Chief:''' Alexandra M. Palmer, [[Taylor Palmieri|Taylor Palmieri, B.A.]] [mailto:tpalmieri@perfuse.org]<br /> <br /> ==Overview==<br /> [[Bell's palsy]] is a form of temporary facial paralysis resulting from damage or trauma to one of the two facial nerves. The facial nerve-also called the 7th cranial nerve-is a paired structure that travels through a narrow, bony canal (called the Fallopian canal) in the [[skull]], beneath the [[ear]], to the muscles on each side of the face. For most of its journey, the nerve is encased in this bony shell.<br /> <br /> Each facial nerve directs the muscles on one side of the face, including those that control eye blinking and closing, and facial expressions such as smiling and frowning. Additionally, the facial nerve carries nerve impulses to the lacrimal or tear glands, the saliva glands, and the muscles of a small bone in the middle of the ear called the [[stapes]]. The facial nerve also transmits taste sensations from the tongue.<br /> <br /> When [[Bell's palsy]] occurs, the function of the facial nerve is disrupted, causing an interruption in the messages the brain sends to the facial muscles. This interruption results in facial weakness or [[paralysis]].<br /> <br /> [[Bell's palsy]] is named for Sir Charles Bell, a 19th century Scottish surgeon who was the first to describe the condition. The disorder, which is not related to [[stroke]], is the most common cause of facial paralysis. Generally, [[Bell's palsy]] affects only one of the paired facial nerves and one side of the face, however, in rare cases, it can affect both sides.<br /> <br /> ==What are the symptoms of Bell's palsy?==<br /> Because the facial nerve has so many functions and is so complex, damage to the nerve or a disruption in its function can lead to many problems. [[Symptoms]] of [[Bell's palsy]], which vary from person to person and range in severity from mild weakness to total [[paralysis]], may include [[twitching]], [[weakness]], or [[paralysis]] on one or both sides of the face, drooping of the eyelid and corner of the mouth, drooling, dryness of the eye or mouth, impairment of taste, and excessive tearing in one eye. Most often these symptoms, which usually begin suddenly and reach their peak within 48 hours, lead to significant facial distortion.<br /> <br /> Other symptoms may include [[pain]] or discomfort around the jaw and behind the ear, ringing in one or both ears, [[headache]], loss of taste, hypersensitivity to sound on the affected side, impaired speech, [[dizziness]], and difficulty eating or drinking.<br /> <br /> ==What are the causes of Bell's palsy?==<br /> [[Bell's palsy]] occurs when the nerve that controls the facial muscles is swollen, inflamed, or compressed, resulting in facial weakness or [[paralysis]]. Exactly what causes this damage, however, is unknown.<br /> <br /> Most scientists believe that a [[viral]] [[infection]] such as [[viral meningitis]] or the [[common cold]] sore virus - [[herpes simplex]] - causes the disorder. They believe that the facial nerve swells and becomes inflamed in reaction to the [[infection]], causing pressure within the Fallopian canal and leading to an [[infarction]] (the death of nerve cells due to insufficient blood and oxygen supply). In some mild cases (where recovery is rapid), there is damage only to the [[myelin sheath]] of the nerve. The myelin sheath is the fatty covering-which acts as an insulator-on nerve fibers in the brain.<br /> <br /> The disorder has also been associated with [[influenza]] or a flu-like illness, [[headaches]], chronic middle ear infection, high [[blood pressure]], [[diabetes]], [[sarcoidosis]], [[tumors]], [[Lyme disease]], and [[trauma]] such as skull fracture or facial injury.<br /> <br /> ==Who is at highest risk?==<br /> [[Bell's palsy]] afflicts approximately 40,000 Americans each year. It affects men and women equally and can occur at any age, but it is less common before age 15 or after age 60. It disproportionately attacks pregnant women and people who have [[diabetes]] or upper respiratory ailments such as the [[flu]] or a [[cold]].<br /> <br /> ==How to know you have Bell's palsy?==<br /> A [[diagnosis]] of [[Bell's palsy]] is made based on clinical presentation-including a distorted facial appearance and the inability to move muscles on the affected side of the face-and by ruling out other possible causes of facial paralysis. There is no specific laboratory test to confirm [[diagnosis]] of the disorder.<br /> <br /> Generally, a physician will examine the individual for upper and lower facial weakness. In most cases this weakness is limited to one side of the face or occasionally to the [[forehead]], [[eyelid]], or [[mouth]]. A test called [[electromyography]] (EMG) can confirm the presence of nerve damage and determine the severity and the extent of nerve involvement. An [[x-ray]] of the [[skull]] can help rule out [[infection]] or [[tumor]]. A [[magnetic resonance imaging]] (MRI) or [[computed tomography]] (CT) scan can eliminate other causes of pressure on the facial nerve.<br /> <br /> ==When to seek urgent medical care==<br /> Urgent medical care is not usually necessary for [[Bell's palsy]]. However, since some of the [[symptoms]] of [[Bell's palsy]] resemble the [[symptoms]] of [[stroke]], it is important to seek medical care right away and rule out this more serious condition.<br /> <br /> ==Treatment options==<br /> There is no cure or standard course of treatment for [[Bell's palsy]]. The most important factor in treatment is to eliminate the source of the nerve damage.<br /> <br /> [[Bell's palsy]] affects each individual differently. Some cases are mild and do not require treatment as the [[symptoms]] usually subside on their own within 2 weeks. For others, treatment may include [[medications]] and other [[therapeutic]] options.<br /> <br /> Recent studies have shown that [[steroids]] are an effective treatment for [[Bell's palsy]] and that an antiviral drug such as [[acyclovir]]-used to fight [[viral infections]]-combined with an [[anti-inflammatory]] drug such as the [[steroid]] [[prednisone]]-used to reduce [[inflammation]] and swelling-may be effective in improving facial function by limiting or reducing damage to the nerve. [[Analgesics]] such as [[aspirin]], [[acetaminophen]], or [[ibuprofen]] may relieve [[pain]]. Because of possible drug interactions, patients taking [[prescription medicines]] should always talk to their doctors before taking any [[over-the-counter]] drugs.<br /> <br /> Another important factor in treatment is eye protection. [[Bell's palsy]] can interrupt the eyelid's natural [[blinking]] ability, leaving the eye exposed to [[irritation]] and drying. Therefore, keeping the eye moist and protecting the eye from debris and injury, especially at night, is important. Lubricating eye drops, such as artificial tears or eye ointments or gels, and eye patches are also effective.<br /> <br /> [[Physical therapy]] to stimulate the facial nerve and help maintain muscle tone may be beneficial to some. Facial massage and exercises may help prevent permanent [[contractures]] (shrinkage or shortening of muscles) of the paralyzed muscles before recovery takes place. Moist heat applied to the affected side of the face may help reduce [[pain]].<br /> <br /> Other therapies that may be useful for some individuals include relaxation techniques, [[acupuncture]], electrical stimulation, biofeedback training, and vitamin therapy (including [[vitamin B12]], [[B6]], and [[zinc]]), which may help nerve growth.<br /> <br /> In general, decompression surgery for [[Bell's palsy]] -to relieve pressure on the nerve-is controversial and is seldom recommended. On rare occasions, cosmetic or reconstructive surgery may be needed to reduce deformities and correct some damage such as an eyelid that will not fully close or a crooked smile.<br /> <br /> ==Diseases with similar symptoms==<br /> [[Bell's palsy]] is thought to be linked to swelling ([[inflammation]]) of the nerve in the area where it travels through the bones of the skull. Other conditions related to [[Bell's palsy]] include:<br /> *[[Stroke]]<br /> *[[Lyme disease]]<br /> *[[Sarcoidosis]]<br /> *[[Diabetes]]<br /> <br /> ==Where to find medical care for Bell's palsy==<br /> [http://maps.google.com/maps?f=q&amp;amp;hl=en&amp;amp;geocode=&amp;amp;q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|Bell's palsy}}}}&amp;amp;sll=37.0625,-95.677068&amp;amp;sspn=65.008093,112.148438&amp;amp;ie=UTF8&amp;amp;ll=37.0625,-95.677068&amp;amp;spn=91.690419,149.414063&amp;amp;z=2&amp;amp;source=embed Directions to Hospitals Treating Bell's palsy]<br /> <br /> ==Prevention of Bell's palsy==<br /> Safety measures may reduce the risk of head injury. Many of the other factors that lead to this disorder are not preventable.<br /> <br /> ==What to expect (Outlook/Prognosis)==<br /> The [[prognosis]] for individuals with [[Bell's palsy]] is generally very good. The extent of nerve damage determines the extent of recovery. Improvement is gradual and recovery times vary. With or without treatment, most individuals begin to get better within 2 weeks after the initial onset of [[symptoms]] and most recover completely, returning to normal function within 3 to 6 months. For some, however, the [[symptoms]] may last longer. In a few cases, the [[symptoms]] may never completely disappear. In rare cases, the disorder may recur, either on the same or the opposite side of the face.<br /> <br /> ==Sources==<br /> http://www.ninds.nih.gov/disorders/bells/detail_bells.htm#109613050<br /> http://www.nlm.nih.gov/medlineplus/ency/article/000773.htm<br /> <br /> [[Category:Patient information]]<br /> [[Category:Otolaryngology patient information]]<br /> [[Category:Otolaryngology]]<br /> [[Category:Disease state]]<br /> [[Category:Mature chapter]]<br /> <br /> {{SIB}}<br /> {{WH}}<br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Bell%27s_palsy_(patient_information)&diff=580283 Bell's palsy (patient information) 2011-07-28T13:17:19Z <p>Taylor Palmieri: </p> <hr /> <div>'''For the WikiDoc page for this topic, click [[Bell's palsy|here]]'''<br /> {{Infobox_Disease<br /> | Name = Bell's palsy<br /> | DiseasesDB = 1303<br /> | ICD10 = {{ICD10|G|51|0|g|50}}<br /> | ICD9 = {{ICD9|351.0}}<br /> | ICDO = <br /> | OMIM = <br /> | MedlinePlus = 000773<br /> | eMedicineSubj = emerg<br /> | eMedicineTopic = 56<br /> | eMedicine_plus = {{eMedicine2|neuro|413}} {{eMedicine2|ent|719}} {{eMedicine2|oph|508}}<br /> | MeshID = D020330<br /> }}<br /> {{SI}}<br /> {{CMG}}; '''Assistant Editors-In-Chief:''' Alexandra M. Palmer, [[Taylor Palmieri|Taylor Palmieri, B.A.]] [mailto:tpalmieri@perfuse.org]<br /> <br /> ==Overview==<br /> [[Bell's palsy]] is a form of temporary facial paralysis resulting from damage or trauma to one of the two facial nerves. The facial nerve-also called the 7th cranial nerve-is a paired structure that travels through a narrow, bony canal (called the Fallopian canal) in the [[skull]], beneath the [[ear]], to the muscles on each side of the face. For most of its journey, the nerve is encased in this bony shell.<br /> <br /> Each facial nerve directs the muscles on one side of the face, including those that control eye blinking and closing, and facial expressions such as smiling and frowning. Additionally, the facial nerve carries nerve impulses to the lacrimal or tear glands, the saliva glands, and the muscles of a small bone in the middle of the ear called the [[stapes]]. The facial nerve also transmits taste sensations from the tongue.<br /> <br /> When [[Bell's palsy]] occurs, the function of the facial nerve is disrupted, causing an interruption in the messages the brain sends to the facial muscles. This interruption results in facial weakness or [[paralysis]].<br /> <br /> [[Bell's palsy]] is named for Sir Charles Bell, a 19th century Scottish surgeon who was the first to describe the condition. The disorder, which is not related to [[stroke]], is the most common cause of facial paralysis. Generally, [[Bell's palsy]] affects only one of the paired facial nerves and one side of the face, however, in rare cases, it can affect both sides.<br /> <br /> ==What are the symptoms of Bell's palsy?==<br /> Because the facial nerve has so many functions and is so complex, damage to the nerve or a disruption in its function can lead to many problems. [[Symptoms]] of [[Bell's palsy]], which vary from person to person and range in severity from mild weakness to total [[paralysis]], may include [[twitching]], [[weakness]], or [[paralysis]] on one or both sides of the face, drooping of the eyelid and corner of the mouth, drooling, dryness of the eye or mouth, impairment of taste, and excessive tearing in one eye. Most often these symptoms, which usually begin suddenly and reach their peak within 48 hours, lead to significant facial distortion.<br /> <br /> Other symptoms may include [[pain]] or discomfort around the jaw and behind the ear, ringing in one or both ears, [[headache]], loss of taste, hypersensitivity to sound on the affected side, impaired speech, [[dizziness]], and difficulty eating or drinking.<br /> <br /> ==How to know you have Bell's palsy?==<br /> [[Bell's palsy]] occurs when the nerve that controls the facial muscles is swollen, inflamed, or compressed, resulting in facial weakness or [[paralysis]]. Exactly what causes this damage, however, is unknown.<br /> <br /> Most scientists believe that a [[viral]] [[infection]] such as [[viral meningitis]] or the [[common cold]] sore virus - [[herpes simplex]] - causes the disorder. They believe that the facial nerve swells and becomes inflamed in reaction to the [[infection]], causing pressure within the Fallopian canal and leading to an [[infarction]] (the death of nerve cells due to insufficient blood and oxygen supply). In some mild cases (where recovery is rapid), there is damage only to the [[myelin sheath]] of the nerve. The myelin sheath is the fatty covering-which acts as an insulator-on nerve fibers in the brain.<br /> <br /> The disorder has also been associated with [[influenza]] or a flu-like illness, [[headaches]], chronic middle ear infection, high [[blood pressure]], [[diabetes]], [[sarcoidosis]], [[tumors]], [[Lyme disease]], and [[trauma]] such as skull fracture or facial injury.<br /> <br /> ==Who is at highest risk?==<br /> [[Bell's palsy]] afflicts approximately 40,000 Americans each year. It affects men and women equally and can occur at any age, but it is less common before age 15 or after age 60. It disproportionately attacks pregnant women and people who have [[diabetes]] or upper respiratory ailments such as the [[flu]] or a [[cold]].<br /> <br /> ==How do I know I have Bell's palsy?==<br /> A [[diagnosis]] of [[Bell's palsy]] is made based on clinical presentation-including a distorted facial appearance and the inability to move muscles on the affected side of the face-and by ruling out other possible causes of facial paralysis. There is no specific laboratory test to confirm [[diagnosis]] of the disorder.<br /> <br /> Generally, a physician will examine the individual for upper and lower facial weakness. In most cases this weakness is limited to one side of the face or occasionally to the [[forehead]], [[eyelid]], or [[mouth]]. A test called [[electromyography]] (EMG) can confirm the presence of nerve damage and determine the severity and the extent of nerve involvement. An [[x-ray]] of the [[skull]] can help rule out [[infection]] or [[tumor]]. A [[magnetic resonance imaging]] (MRI) or [[computed tomography]] (CT) scan can eliminate other causes of pressure on the facial nerve.<br /> <br /> ==When to seek urgent medical care==<br /> Urgent medical care is not usually necessary for [[Bell's palsy]]. However, since some of the [[symptoms]] of [[Bell's palsy]] resemble the [[symptoms]] of [[stroke]], it is important to seek medical care right away and rule out this more serious condition.<br /> <br /> ==Treatment options==<br /> There is no cure or standard course of treatment for [[Bell's palsy]]. The most important factor in treatment is to eliminate the source of the nerve damage.<br /> <br /> [[Bell's palsy]] affects each individual differently. Some cases are mild and do not require treatment as the [[symptoms]] usually subside on their own within 2 weeks. For others, treatment may include [[medications]] and other [[therapeutic]] options.<br /> <br /> Recent studies have shown that [[steroids]] are an effective treatment for [[Bell's palsy]] and that an antiviral drug such as [[acyclovir]]-used to fight [[viral infections]]-combined with an [[anti-inflammatory]] drug such as the [[steroid]] [[prednisone]]-used to reduce [[inflammation]] and swelling-may be effective in improving facial function by limiting or reducing damage to the nerve. [[Analgesics]] such as [[aspirin]], [[acetaminophen]], or [[ibuprofen]] may relieve [[pain]]. Because of possible drug interactions, patients taking [[prescription medicines]] should always talk to their doctors before taking any [[over-the-counter]] drugs.<br /> <br /> Another important factor in treatment is eye protection. [[Bell's palsy]] can interrupt the eyelid's natural [[blinking]] ability, leaving the eye exposed to [[irritation]] and drying. Therefore, keeping the eye moist and protecting the eye from debris and injury, especially at night, is important. Lubricating eye drops, such as artificial tears or eye ointments or gels, and eye patches are also effective.<br /> <br /> [[Physical therapy]] to stimulate the facial nerve and help maintain muscle tone may be beneficial to some. Facial massage and exercises may help prevent permanent [[contractures]] (shrinkage or shortening of muscles) of the paralyzed muscles before recovery takes place. Moist heat applied to the affected side of the face may help reduce [[pain]].<br /> <br /> Other therapies that may be useful for some individuals include relaxation techniques, [[acupuncture]], electrical stimulation, biofeedback training, and vitamin therapy (including [[vitamin B12]], [[B6]], and [[zinc]]), which may help nerve growth.<br /> <br /> In general, decompression surgery for [[Bell's palsy]] -to relieve pressure on the nerve-is controversial and is seldom recommended. On rare occasions, cosmetic or reconstructive surgery may be needed to reduce deformities and correct some damage such as an eyelid that will not fully close or a crooked smile.<br /> <br /> ==Diseases with similar symptoms==<br /> [[Bell's palsy]] is thought to be linked to swelling ([[inflammation]]) of the nerve in the area where it travels through the bones of the skull. Other conditions related to [[Bell's palsy]] include:<br /> *[[Stroke]]<br /> *[[Lyme disease]]<br /> *[[Sarcoidosis]]<br /> *[[Diabetes]]<br /> <br /> ==Where to find medical care for Bell's palsy==<br /> [http://maps.google.com/maps?f=q&amp;amp;hl=en&amp;amp;geocode=&amp;amp;q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|Bell's palsy}}}}&amp;amp;sll=37.0625,-95.677068&amp;amp;sspn=65.008093,112.148438&amp;amp;ie=UTF8&amp;amp;ll=37.0625,-95.677068&amp;amp;spn=91.690419,149.414063&amp;amp;z=2&amp;amp;source=embed Directions to Hospitals Treating Bell's palsy]<br /> <br /> ==Prevention of Bell's palsy==<br /> Safety measures may reduce the risk of head injury. Many of the other factors that lead to this disorder are not preventable.<br /> <br /> ==What to expect (Outlook/Prognosis)==<br /> The [[prognosis]] for individuals with [[Bell's palsy]] is generally very good. The extent of nerve damage determines the extent of recovery. Improvement is gradual and recovery times vary. With or without treatment, most individuals begin to get better within 2 weeks after the initial onset of [[symptoms]] and most recover completely, returning to normal function within 3 to 6 months. For some, however, the [[symptoms]] may last longer. In a few cases, the [[symptoms]] may never completely disappear. In rare cases, the disorder may recur, either on the same or the opposite side of the face.<br /> <br /> ==Sources==<br /> http://www.ninds.nih.gov/disorders/bells/detail_bells.htm#109613050<br /> http://www.nlm.nih.gov/medlineplus/ency/article/000773.htm<br /> <br /> [[Category:Patient information]]<br /> [[Category:Otolaryngology patient information]]<br /> [[Category:Otolaryngology]]<br /> [[Category:Disease state]]<br /> [[Category:Mature chapter]]<br /> <br /> {{SIB}}<br /> {{WH}}<br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_overview&diff=575976 Chronic hypertension overview 2011-07-01T19:05:35Z <p>Taylor Palmieri: </p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Overview==<br /> '''Hypertension''', commonly referred to as &quot;'''high blood pressure'''&quot; or '''HTN''', is a medical condition in which the [[blood pressure]] is chronically elevated.&lt;ref&gt;{{KMLEref|hypertension|07-04-17}}&lt;/ref&gt; While it is formally called '''arterial hypertension''', the word &quot;hypertension&quot; without a qualifier usually refers to [[artery|arterial]] hypertension. <br /> <br /> In 2003, the Joint National Committee provided a seventh report (JNC 7) which suggested the following definitions based upon the average of two or more properly measured readings at each of two or more visits after an initial screen&lt;ref name=&quot;pmid12748199&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. | journal=JAMA | year= 2003 | volume= 289 | issue= 19 | pages= 2560-72 | pmid=12748199 | doi=10.1001/jama.289.19.2560 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=12748199 }} &lt;/ref&gt;:<br /> :* Normal blood pressure: systolic &lt;120 mmHg and diastolic &lt;80 mmHg<br /> :* Prehypertension: systolic 120-139 mmHg or diastolic 80-89 mmHg<br /> :* Hypertension:<br /> ::: Stage 1: systolic 140-159 mmHg or diastolic 90-99 mmHg<br /> ::: Stage 2: systolic ≥160 or diastolic ≥100 mmHg<br /> <br /> Hypertension can be classified as either '''essential''' (primary) or '''secondary'''. Essential hypertension indicates that no specific medical cause can be found to explain a patient's condition. [[Secondary hypertension]] indicates that the high blood pressure is a result of (i.e. secondary to) another condition, such as [[kidney disease]] or certain [[tumor]]s (especially of the [[adrenal gland]]). Even moderate elevation of arterial blood pressure leads to shortened life expectancy. At severely high pressures, mean arterial pressures 50% or more above average, a person can expect to live no more than just a few years unless appropriately treated.&lt;ref&gt;Textbook of Medical Physiology, 7th Ed., Guyton &amp; Hall, Elsevier-Saunders, ISBN 0-7216-0240-1, page 220.&lt;/ref&gt;<br /> <br /> Hypertension is one of the most common diseases afflicting humans worldwide, estimated to have a prevalence of as many as 1 billion individuals, and causing 7.1 million deaths per year.&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; Hypertension is the most important modifiable risk factor for [[coronary heart disease]] (the leading cause of death in North America), [[stroke]] (the third leading cause), [[congestive heart failure]], peripheral vascular disease, and is a leading cause of [[chronic renal failure]]. Despite the prevalence and associated complications of hypertension, control of the disease is still exceedingly insufficient. <br /> <br /> The key to properly diagnosing hypertension is an accurate measurement of blood pressure. Accurate, reproducible blood pressure measurement is important to allow comparisons between blood pressure values and to correctly classify blood pressure. Incorrectly labeling a hypertensive patient as normotensive may increase risk for vascular events, since risk rises with increasing blood pressure. Labeling a patient with normal blood pressure as a hypertensive can affect insurability, employment, morbidity from medications, loss of time from work, and unnecessary lab and physician visits. <br /> <br /> Systolic blood pressure level should be the major factor for the detection, evaluation, and treatment of hypertension, especially in adults 50 years and older. The purpose of a hypertensive patient evaluation is to identify other cardiovascular risk factors that may affect prognosis and guide treatment, find any identifiable causes of high blood pressure, and determine the presence or extent of target organ damage and cardiovascular disease. Patients with hypertension are evaluated through medical history, physical examination, routine laboratory tests and other diagnostic procedures.&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; <br /> <br /> In order to properly diagnose a patient, the recommended laboratory tests include a 12-lead [[electrocardiogram]]; [[urinalysis]]; [[blood glucose]] and [[hematocrit]]; [[serum potassium]], [[creatinine]], [[electrolytes]], and [[uric acid]]; and a [[lipoprotein]] profile (after 9- to 12-hour fast).&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; Additional diagnostic tests may be performed to reveal causes of hypertension particularly in the event that a patient's medical history and examinations indicate a cause, blood pressure is unresponsive to drug treatment, blood pressure increases after being controlled, or onset was sudden. Currently, testing for [[microalbuminuria]] is limited primarily to patients with diabetes in order to screen for early nephropathy. The main indication for [[echocardiography]] is to detect suspected end-organ damage in a patient with borderline blood pressure values, who may not otherwise be treated based solely on clinical criteria. <br /> <br /> Hypertension is the most common primary diagnosis in America.&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; Initial treatment for hypertension generally involves lifestyle modifications (nonpharmacologic therapy), which is also critical for prevention of the disease. Modifications encouraged for hypertensive patients include moderate dietary salt restriction, maintain body weight or weight reduction in obese patients, increased intake of fruits and vegetables and low-fat dairy products, limited alcohol intake, and regular aerobic exercise. Although effective control of blood pressure can be achieved in most patients with hypertension, the majority will require 2 or more antihypertensive drugs.&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; <br /> <br /> There are three main classes of drugs that are used for initial monotherapy (when no specific indication requires other treatment methods): [[thiazide diuretics]], long-acting calcium channel blockers (usually a [[dihydropyridine]]), and [[ACE inhibitors]] or [[angiotensin II receptor blockers]]. In some cases, particularly with patients having moderate to severe hypertension, single agent therapy does not control the blood pressure. Over time, patients who were initially controlled with monotherapy need to increase treatment to a combined therapy in order for continued blood pressure control. The primary determinant of the outcome is the attained blood pressure, not the specific drug(s) used. The goal of antihypertensive therapy in patients with uncomplicated combined systolic and diastolic hypertension is a blood pressure of below 140/90 mmHg. <br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_overview&diff=575968 Chronic hypertension overview 2011-07-01T17:31:55Z <p>Taylor Palmieri: </p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Overview==<br /> '''Hypertension''', commonly referred to as &quot;'''high blood pressure'''&quot; or '''HTN''', is a medical condition in which the [[blood pressure]] is chronically elevated.&lt;ref&gt;{{KMLEref|hypertension|07-04-17}}&lt;/ref&gt; While it is formally called '''arterial hypertension''', the word &quot;hypertension&quot; without a qualifier usually refers to [[artery|arterial]] hypertension. <br /> <br /> In 2003, the Joint National Committee provided a seventh report (JNC 7) which suggested the following definitions based upon the average of two or more properly measured readings at each of two or more visits after an initial screen&lt;ref name=&quot;pmid12748199&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. | journal=JAMA | year= 2003 | volume= 289 | issue= 19 | pages= 2560-72 | pmid=12748199 | doi=10.1001/jama.289.19.2560 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=12748199 }} &lt;/ref&gt;:<br /> :* Normal blood pressure: systolic &lt;120 mmHg and diastolic &lt;80 mmHg<br /> :* Prehypertension: systolic 120-139 mmHg or diastolic 80-89 mmHg<br /> :* Hypertension:<br /> ::: Stage 1: systolic 140-159 mmHg or diastolic 90-99 mmHg<br /> ::: Stage 2: systolic ≥160 or diastolic ≥100 mmHg<br /> <br /> Hypertension can be classified as either '''essential''' (primary) or '''secondary'''. Essential hypertension indicates that no specific medical cause can be found to explain a patient's condition. [[Secondary hypertension]] indicates that the high blood pressure is a result of (i.e. secondary to) another condition, such as [[kidney disease]] or certain [[tumor]]s (especially of the [[adrenal gland]]). Even moderate elevation of arterial blood pressure leads to shortened life expectancy. At severely high pressures, mean arterial pressures 50% or more above average, a person can expect to live no more than just a few years unless appropriately treated.&lt;ref&gt;Textbook of Medical Physiology, 7th Ed., Guyton &amp; Hall, Elsevier-Saunders, ISBN 0-7216-0240-1, page 220.&lt;/ref&gt;<br /> <br /> Hypertension is one of the most common diseases afflicting humans worldwide, estimated to have a prevalence of as many as 1 billion individuals, and causing 7.1 million deaths per year.&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; Hypertension is the most important modifiable risk factor for [[coronary heart disease]] (the leading cause of death in North America), [[stroke]] (the third leading cause), [[congestive heart failure]], peripheral vascular disease, and is a leading cause of [[chronic renal failure]]. Despite the prevalence and associated complications of hypertension, control of the disease is still exceedingly insufficient. <br /> <br /> The purpose of a hypertensive patient evaluation is to identify other cardiovascular risk factors that may affect prognosis and guide treatment, find any identifiable causes of high blood pressure, and determine the presence or extent of target organ damage and cardiovascular disease. Patients with hypertension are evaluated through medical history, physical examination, routine laboratory tests and other diagnostic procedures. In order to properly diagnose a patient, the recommended laboratory tests include a 12-lead [[electrocardiogram]]; [[urinalysis]]; [[blood glucose]] and [[hematocrit]]; [[serum potassium]], [[creatinine]], [[electrolytes]], and [[uric acid]]; and a [[lipoprotein]] profile (after 9- to 12-hour fast).&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; Additional diagnostic tests may be performed to reveal causes of hypertension particularly in the event that a patient's medical history and examinations indicate a cause, blood pressure is unresponsive to drug treatment, blood pressure increases after being controlled, or onset was sudden. Currently, testing for [[microalbuminuria]] is limited primarily to patients with diabetes in order to screen for early nephropathy. The main indication for [[echocardiography]] is to detect suspected end-organ damage in a patient with borderline blood pressure values, who may not otherwise be treated based solely on clinical criteria. <br /> <br /> Hypertension is the most common primary diagnosis in America.&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; Initial treatment for hypertension generally involves lifestyle modifications (nonpharmacologic therapy), which is also critical for prevention of the disease. Modifications encouraged for hypertensive patients include moderate dietary salt restriction, maintain body weight or weight reduction in obese patients, increased intake of fruits and vegetables and low-fat dairy products, limited alcohol intake, and regular aerobic exercise. Although effective control of blood pressure can be achieved in most patients with hypertension, the majority will require 2 or more antihypertensive drugs.&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; <br /> <br /> There are three main classes of drugs that are used for initial monotherapy (when no specific indication requires other treatment methods): [[thiazide diuretics]], long-acting calcium channel blockers (usually a [[dihydropyridine]]), and [[ACE inhibitors]] or [[angiotensin II receptor blockers]]. In some cases, particularly with patients having moderate to severe hypertension, single agent therapy does not control the blood pressure. Over time, patients who were initially controlled with monotherapy need to increase treatment to a combined therapy in order for continued blood pressure control. The primary determinant of the outcome is the attained blood pressure, not the specific drug(s) used. The goal of antihypertensive therapy in patients with uncomplicated combined systolic and diastolic hypertension is a blood pressure of below 140/90 mmHg. <br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_overview&diff=575908 Chronic hypertension overview 2011-06-30T19:27:19Z <p>Taylor Palmieri: </p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Overview==<br /> '''Hypertension''', commonly referred to as &quot;'''high blood pressure'''&quot; or '''HTN''', is a medical condition in which the [[blood pressure]] is chronically elevated.&lt;ref&gt;{{KMLEref|hypertension|07-04-17}}&lt;/ref&gt; While it is formally called '''arterial hypertension''', the word &quot;hypertension&quot; without a qualifier usually refers to [[artery|arterial]] hypertension. <br /> <br /> In 2003, the Joint National Committee provided a seventh report (JNC 7) which suggested the following definitions based upon the average of two or more properly measured readings at each of two or more visits after an initial screen&lt;ref name=&quot;pmid12748199&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. | journal=JAMA | year= 2003 | volume= 289 | issue= 19 | pages= 2560-72 | pmid=12748199 | doi=10.1001/jama.289.19.2560 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=12748199 }} &lt;/ref&gt;:<br /> :* Normal blood pressure: systolic &lt;120 mmHg and diastolic &lt;80 mmHg<br /> :* Prehypertension: systolic 120-139 mmHg or diastolic 80-89 mmHg<br /> :* Hypertension:<br /> ::: Stage 1: systolic 140-159 mmHg or diastolic 90-99 mmHg<br /> ::: Stage 2: systolic ≥160 or diastolic ≥100 mmHg<br /> <br /> Hypertension can be classified as either '''essential''' (primary) or '''secondary'''. Essential hypertension indicates that no specific medical cause can be found to explain a patient's condition. [[Secondary hypertension]] indicates that the high blood pressure is a result of (i.e. secondary to) another condition, such as [[kidney disease]] or certain [[tumor]]s (especially of the [[adrenal gland]]). Even moderate elevation of arterial blood pressure leads to shortened life expectancy. At severely high pressures, mean arterial pressures 50% or more above average, a person can expect to live no more than just a few years unless appropriately treated.&lt;ref&gt;Textbook of Medical Physiology, 7th Ed., Guyton &amp; Hall, Elsevier-Saunders, ISBN 0-7216-0240-1, page 220.&lt;/ref&gt;<br /> <br /> Hypertension is one of the most common diseases afflicting humans worldwide, estimated to have a prevalence of as many as 1 billion individuals, and causing 7.1 million deaths per year.&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; Hypertension is the most important modifiable risk factor for [[coronary heart disease]] (the leading cause of death in North America), [[stroke]] (the third leading cause), [[congestive heart failure]], peripheral vascular disease, and is a leading cause of [[chronic renal failure]]. Despite the prevalence and associated complications of hypertension, control of the disease is still exceedingly insufficient. <br /> <br /> The purpose of a hypertensive patient evaluation is to identify other cardiovascular risk factors that may affect prognosis and guide treatment, find any identifiable causes of high blood pressure, and determine the presence or extent of target organ damage and cardiovascular disease. Patients with hypertension are evaluated through medical history, physical examination, routine laboratory tests and other diagnostic procedures. In order to properly diagnose a patient, the recommended laboratory tests include a 12-lead [[electrocardiogram]]; [[urinalysis]]; [[blood glucose]] and [[hematocrit]]; [[serum potassium]], [[creatinine]], [[electrolytes]], and [[uric acid]]; and a [[lipoprotein]] profile (after 9- to 12-hour fast).&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; Additional diagnostic tests may be performed to reveal causes of hypertension particularly in the event that a patient's medical history and examinations indicate a cause, blood pressure is unresponsive to drug treatment, blood pressure increases after being controlled, or onset was sudden. Currently, testing for [[microalbuminuria]] is limited primarily to patients with diabetes in order to screen for early nephropathy. The main indication for [[echocardiography]] is to detect suspected end-organ damage in a patient with borderline blood pressure values, who may not otherwise be treated based solely on clinical criteria. <br /> <br /> Hypertension is the most common primary diagnosis in America.&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; Initial treatment for hypertension generally involves lifestyle modifications (nonpharmacologic therapy), which is also critical for prevention of the disease. Modifications encouraged for hypertensive patients include moderate dietary salt restriction, maintain body weight or weight reduction in obese patients, increased intake of fruits and vegetables and low-fat dairy products, limited alcohol intake, and regular aerobic exercise. Although effective blood pressure control can be achieved in most patients with hypertension, the majority will require 2 or more antihypertensive drugs.&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; <br /> <br /> There are three main classes of drugs that are used for initial monotherapy (when no specific indication requires other treatment methods): [[thiazide diuretics]], long-acting calcium channel blockers (most often a [[dihydropyridine]]), and [[ACE inhibitors]] or [[angiotensin II receptor blockers]]. In some cases, particularly with patients having moderate to severe hypertension, single agent therapy does not control the blood pressure. Over time, patients who were initially controlled with monotherapy need to increase medication to a combined therapy in order for continued blood pressure control. The primary determinant of the outcome is the attained blood pressure, not the specific drug(s) used. The goal of antihypertensive therapy in patients with uncomplicated combined systolic and diastolic hypertension is a blood pressure of below 140/90 mmHg. <br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_overview&diff=575905 Chronic hypertension overview 2011-06-30T19:15:27Z <p>Taylor Palmieri: </p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Overview==<br /> '''Hypertension''', commonly referred to as &quot;'''high blood pressure'''&quot; or '''HTN''', is a medical condition in which the [[blood pressure]] is chronically elevated.&lt;ref&gt;{{KMLEref|hypertension|07-04-17}}&lt;/ref&gt; While it is formally called '''arterial hypertension''', the word &quot;hypertension&quot; without a qualifier usually refers to [[artery|arterial]] hypertension. <br /> <br /> In 2003, the Joint National Committee provided a seventh report (JNC 7) which suggested the following definitions based upon the average of two or more properly measured readings at each of two or more visits after an initial screen&lt;ref name=&quot;pmid12748199&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. | journal=JAMA | year= 2003 | volume= 289 | issue= 19 | pages= 2560-72 | pmid=12748199 | doi=10.1001/jama.289.19.2560 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=12748199 }} &lt;/ref&gt;:<br /> :* Normal blood pressure: systolic &lt;120 mmHg and diastolic &lt;80 mmHg<br /> :* Prehypertension: systolic 120-139 mmHg or diastolic 80-89 mmHg<br /> :* Hypertension:<br /> ::: Stage 1: systolic 140-159 mmHg or diastolic 90-99 mmHg<br /> ::: Stage 2: systolic ≥160 or diastolic ≥100 mmHg<br /> <br /> Hypertension is one of the most common diseases afflicting humans worldwide, estimated to have a prevalence of as many as 1 billion individuals, and causing 7.1 million deaths per year.&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; Hypertension is the most important modifiable risk factor for [[coronary heart disease]] (the leading cause of death in North America), [[stroke]] (the third leading cause), [[congestive heart failure]], peripheral vascular disease, and is a leading cause of [[chronic renal failure]]. Despite the prevalence and associated complications of hypertension, control of the disease is still exceedingly insufficient. <br /> <br /> Hypertension can be classified as either '''essential''' (primary) or '''secondary'''. Essential hypertension indicates that no specific medical cause can be found to explain a patient's condition. [[Secondary hypertension]] indicates that the high blood pressure is a result of (i.e. secondary to) another condition, such as [[kidney disease]] or certain [[tumor]]s (especially of the [[adrenal gland]]). Even moderate elevation of arterial blood pressure leads to shortened life expectancy. At severely high pressures, mean arterial pressures 50% or more above average, a person can expect to live no more than just a few years unless appropriately treated.&lt;ref&gt;Textbook of Medical Physiology, 7th Ed., Guyton &amp; Hall, Elsevier-Saunders, ISBN 0-7216-0240-1, page 220.&lt;/ref&gt;<br /> <br /> The purpose of a hypertensive patient evaluation is to identify other cardiovascular risk factors that may affect prognosis and guide treatment, find any identifiable causes of high blood pressure, and determine the presence or extent of target organ damage and cardiovascular disease. Patients with hypertension are evaluated through medical history, physical examination, routine laboratory tests and other diagnostic procedures. In order to properly diagnose a patient, the recommended laboratory tests include a 12-lead [[electrocardiogram]]; [[urinalysis]]; [[blood glucose]] and [[hematocrit]]; [[serum potassium]], [[creatinine]], [[electrolytes]], and [[uric acid]]; and a [[lipoprotein]] profile (after 9- to 12-hour fast).&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; Additional diagnostic tests may be performed to reveal causes of hypertension particularly in the event that a patient's medical history and examinations indicate a cause, blood pressure is unresponsive to drug treatment, blood pressure increases after being controlled, or onset was sudden. Currently, testing for [[microalbuminuria]] is limited primarily to patients with diabetes in order to screen for early nephropathy. The main indication for [[echocardiography]] is to detect suspected end-organ damage in a patient with borderline blood pressure values, who may not otherwise be treated based solely on clinical criteria. <br /> <br /> Hypertension is the most common primary diagnosis in America.&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; Initial treatment for hypertension generally involves lifestyle modifications (nonpharmacologic therapy), which is also critical for prevention of the disease. Modifications encouraged for hypertensive patients include moderate dietary salt restriction, maintain body weight or weight reduction in obese patients, increased intake of fruits and vegetables and low-fat dairy products, limited alcohol intake, and regular aerobic exercise. Although effective blood pressure control can be achieved in most patients with hypertension, the majority will require 2 or more antihypertensive drugs.&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; <br /> <br /> There are three main classes of drugs that are used for initial monotherapy (when no specific indication requires other treatment methods): [[thiazide diuretics]], long-acting calcium channel blockers (most often a [[dihydropyridine]]), and [[ACE inhibitors]] or [[angiotensin II receptor blockers]]. In some cases, particularly with patients having moderate to severe hypertension, single agent therapy does not control the blood pressure. Over time, patients who were initially controlled with monotherapy need to increase medication to a combined therapy in order for continued blood pressure control. The primary determinant of the outcome is the attained blood pressure, not the specific drug(s) used. The goal of antihypertensive therapy in patients with uncomplicated combined systolic and diastolic hypertension is a blood pressure of below 140/90 mmHg. <br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_overview&diff=575904 Chronic hypertension overview 2011-06-30T19:11:08Z <p>Taylor Palmieri: </p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Overview==<br /> '''Hypertension''', commonly referred to as &quot;'''high blood pressure'''&quot; or '''HTN''', is a medical condition in which the [[blood pressure]] is chronically elevated.&lt;ref&gt;{{KMLEref|hypertension|07-04-17}}&lt;/ref&gt; While it is formally called '''arterial hypertension''', the word &quot;hypertension&quot; without a qualifier usually refers to [[artery|arterial]] hypertension. <br /> <br /> In 2003, the Joint National Committee provided a seventh report (JNC 7) which suggested the following definitions based upon the average of two or more properly measured readings at each of two or more visits after an initial screen&lt;ref name=&quot;pmid12748199&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. | journal=JAMA | year= 2003 | volume= 289 | issue= 19 | pages= 2560-72 | pmid=12748199 | doi=10.1001/jama.289.19.2560 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=12748199 }} &lt;/ref&gt;:<br /> :* Normal blood pressure: systolic &lt;120 mmHg and diastolic &lt;80 mmHg<br /> :* Prehypertension: systolic 120-139 mmHg or diastolic 80-89 mmHg<br /> :* Hypertension:<br /> ::: Stage 1: systolic 140-159 mmHg or diastolic 90-99 mmHg<br /> ::: Stage 2: systolic ≥160 or diastolic ≥100 mmHg<br /> <br /> Hypertension is one of the most common diseases afflicting humans worldwide, estimated to have a prevalence of as many as 1 billion individuals, and causing 7.1 million deaths per year.&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; Hypertension is the most important modifiable risk factor for [[coronary heart disease]] (the leading cause of death in North America), [[stroke]] (the third leading cause), [[congestive heart failure]], peripheral vascular disease, and is a leading cause of [[chronic renal failure]]. Despite the prevalence and associated complications of hypertension, control of the disease is still exceedingly insufficient. <br /> <br /> Hypertension can be classified as either '''essential''' (primary) or '''secondary'''. Essential hypertension indicates that no specific medical cause can be found to explain a patient's condition. [[Secondary hypertension]] indicates that the high blood pressure is a result of (i.e. secondary to) another condition, such as [[kidney disease]] or certain [[tumor]]s (especially of the [[adrenal gland]]). Even moderate elevation of arterial blood pressure leads to shortened life expectancy. At severely high pressures, mean arterial pressures 50% or more above average, a person can expect to live no more than just a few years unless appropriately treated.&lt;ref&gt;Textbook of Medical Physiology, 7th Ed., Guyton &amp; Hall, Elsevier-Saunders, ISBN 0-7216-0240-1, page 220.&lt;/ref&gt;<br /> <br /> The purpose of a hypertensive patient evaluation is to identify other cardiovascular risk factors that may affect prognosis and guide treatment, find any identifiable causes of high blood pressure, and determine the presence or extent of target organ damage and cardiovascular disease. Patients with hypertension are evaluated through medical history, physical examination, routine laboratory tests and other diagnostic procedures. In order to properly diagnose a patient, the recommended laboratory tests include a 12-lead [[electrocardiogram]]; [[urinalysis]]; [[blood glucose]] and [[hematocrit]]; [[serum potassium]], [[creatinine]], [[electrolytes]], and [[uric acid]]; and a [[lipoprotein]] profile (after 9- to 12-hour fast).&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; Additional diagnostic tests may be performed to reveal causes of hypertension particularly in the event that a patient's medical history and examinations indicate a cause, blood pressure is unresponsive to drug treatment, blood pressure increases after being controlled, or onset was sudden. Currently, testing for [[microalbuminuria]] is limited primarily to patients with diabetes in order to screen for early nephropathy. The main indication for [[echocardiography]] is to detect suspected end-organ damage in a patient with borderline blood pressure values, who may not otherwise be treated based solely on clinical criteria. <br /> <br /> Hypertension is the most common primary diagnosis in America.&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; Initial treatment for hypertension generally involves lifestyle modifications (nonpharmacologic therapy), which is also critical for prevention of the disease. Modifications encouraged for hypertensive patients include moderate dietary salt restriction, weight reduction in obese patients, increased intake of fruits and vegetables and low-fat dairy products, limited alcohol intake, and regular aerobic exercise. Although effective blood pressure control can be achieved in most patients with hypertension, the majority will require 2 or more antihypertensive drugs.&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; <br /> <br /> There are three main classes of drugs that are used for initial monotherapy (when no specific indication requires other treatment methods): [[thiazide diuretics]], long-acting calcium channel blockers (most often a [[dihydropyridine]]), and [[ACE inhibitors]] or [[angiotensin II receptor blockers]]. In some cases, particularly with patients having moderate to severe hypertension, single agent therapy does not control the blood pressure. Over time, patients who were initially controlled with monotherapy need to increase medication to a combined therapy in order for continued blood pressure control. The primary determinant of the outcome is the attained blood pressure, not the specific drug(s) used. The goal of antihypertensive therapy in patients with uncomplicated combined systolic and diastolic hypertension is a blood pressure of below 140/90 mmHg. <br /> <br /> <br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_overview&diff=575850 Chronic hypertension overview 2011-06-30T13:39:03Z <p>Taylor Palmieri: </p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Overview==<br /> '''Hypertension''', commonly referred to as &quot;'''high blood pressure'''&quot; or '''HTN''', is a medical condition in which the [[blood pressure]] is chronically elevated.&lt;ref&gt;{{KMLEref|hypertension|07-04-17}}&lt;/ref&gt; While it is formally called '''arterial hypertension''', the word &quot;hypertension&quot; without a qualifier usually refers to [[artery|arterial]] hypertension. <br /> <br /> Hypertension is one of the most common diseases afflicting humans worldwide, estimated to have a prevalence of as many as 1 billion individuals, and causing 7.1 million deaths per year.&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; Hypertension is the most important modifiable risk factor for [[coronary heart disease]] (the leading cause of death in North America), [[stroke]] (the third leading cause), [[congestive heart failure]], peripheral vascular disease, and is a leading cause of [[chronic renal failure]]. Despite the prevalence and associated complications of hypertension, control of the disease is still exceedingly insufficient. <br /> <br /> Hypertension can be classified as either '''essential''' (primary) or '''secondary'''. Essential hypertension indicates that no specific medical cause can be found to explain a patient's condition. [[Secondary hypertension]] indicates that the high blood pressure is a result of (i.e. secondary to) another condition, such as [[kidney disease]] or certain [[tumor]]s (especially of the [[adrenal gland]]). Even moderate elevation of arterial blood pressure leads to shortened life expectancy. At severely high pressures, mean arterial pressures 50% or more above average, a person can expect to live no more than just a few years unless appropriately treated.&lt;ref&gt;Textbook of Medical Physiology, 7th Ed., Guyton &amp; Hall, Elsevier-Saunders, ISBN 0-7216-0240-1, page 220.&lt;/ref&gt;<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_overview&diff=575820 Chronic hypertension overview 2011-06-29T20:45:28Z <p>Taylor Palmieri: </p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Overview==<br /> '''Hypertension''', commonly referred to as &quot;'''high blood pressure'''&quot; or '''HTN''', is a medical condition in which the [[blood pressure]] is chronically elevated.&lt;ref&gt;{{KMLEref|hypertension|07-04-17}}&lt;/ref&gt; While it is formally called '''arterial hypertension''', the word &quot;hypertension&quot; without a qualifier usually refers to [[artery|arterial]] hypertension. <br /> <br /> Hypertension is one of the most common diseases afflicting humans worldwide, estimated to have a prevalence of as many as 1 billion individuals, and 7.1 million deaths per year.&lt;ref name=&quot;pmid14656957&quot;&gt;{{cite journal| author=Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL et al.| title=Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. | journal=Hypertension | year= 2003 | volume= 42 | issue= 6 | pages= 1206-52 | pmid=14656957 | doi=10.1161/01.HYP.0000107251.49515.c2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&amp;tool=sumsearch.org/cite&amp;retmode=ref&amp;cmd=prlinks&amp;id=14656957 }} &lt;/ref&gt; Hypertension is the most important modifiable risk factor for [[coronary heart disease]] (the leading cause of death in North America), [[stroke]] (the third leading cause), [[congestive heart failure]], peripheral vascular disease, and is a leading cause of [[chronic renal failure]]. Despite the prevalence and associated complications of hypertension, control of the disease is still exceedingly insufficient. <br /> <br /> Hypertension can be classified as either '''essential''' (primary) or '''secondary'''. Essential hypertension indicates that no specific medical cause can be found to explain a patient's condition. [[Secondary hypertension]] indicates that the high blood pressure is a result of (i.e. secondary to) another condition, such as [[kidney disease]] or certain [[tumor]]s (especially of the [[adrenal gland]]). Even moderate elevation of arterial blood pressure leads to shortened life expectancy. At severely high pressures, mean arterial pressures 50% or more above average, a person can expect to live no more than just a few years unless appropriately treated.&lt;ref&gt;Textbook of Medical Physiology, 7th Ed., Guyton &amp; Hall, Elsevier-Saunders, ISBN 0-7216-0240-1, page 220.&lt;/ref&gt;<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_overview&diff=575767 Chronic hypertension overview 2011-06-29T16:56:20Z <p>Taylor Palmieri: </p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Overview==<br /> '''Hypertension''', commonly referred to as &quot;'''high blood pressure'''&quot; or '''HTN''', is a medical condition in which the [[blood pressure]] is chronically elevated.&lt;ref&gt;{{KMLEref|hypertension|07-04-17}}&lt;/ref&gt; While it is formally called '''arterial hypertension''', the word &quot;hypertension&quot; without a qualifier usually refers to [[artery|arterial]] hypertension. <br /> <br /> Hypertension can be classified as either '''essential''' (primary) or '''secondary'''. Essential hypertension indicates that no specific medical cause can be found to explain a patient's condition. [[Secondary hypertension]] indicates that the high blood pressure is a result of (i.e. secondary to) another condition, such as [[kidney disease]] or certain [[tumor]]s (especially of the [[adrenal gland]]). Persistent hypertension is one of the risk factors for [[stroke]]s, [[myocardial infarction|heart attacks]], [[heart failure]] and arterial [[aneurysm]], and is a leading cause of [[chronic renal failure]]. Even moderate elevation of arterial blood pressure leads to shortened life expectancy. At severely high pressures, mean arterial pressures 50% or more above average, a person can expect to live no more than just a few years unless appropriately treated.&lt;ref&gt;Textbook of Medical Physiology, 7th Ed., Guyton &amp; Hall, Elsevier-Saunders, ISBN 0-7216-0240-1, page 220.&lt;/ref&gt;<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension&diff=575729 Chronic hypertension 2011-06-29T14:46:52Z <p>Taylor Palmieri: </p> <hr /> <div>{{Infobox_Disease |<br /> Name = Hypertension |<br /> Image = |<br /> Caption = |<br /> DiseasesDB = 6330 |<br /> ICD10 = {{ICD10|I|10||i|10}},{{ICD10|I|11||i|10}},{{ICD10|I|12||i|10}},&lt;br&gt;{{ICD10|I|13||i|10}},{{ICD10|I|15||i|10}} |<br /> ICD9 = {{ICD9|401.x}} |<br /> ICDO = |<br /> OMIM = 145500 |<br /> MedlinePlus = 000468 |<br /> eMedicineSubj = med |<br /> eMedicineTopic = 1106 |<br /> eMedicine_mult = {{eMedicine2|ped|1097}} {{eMedicine2|emerg|267}} |<br /> MeshID = |<br /> }}<br /> <br /> {{Template:Hypertension}}<br /> <br /> '''For patient information click [[{{PAGENAME}} (patient information)|here]]'''<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> ==[[Hypertension overview|Overview]]==<br /> <br /> ==[[Hyptertension classification|Classification]]==<br /> <br /> ==[[Hypertension pathophysiology|Pathophysiology]]==<br /> <br /> ==[[Hypertension epidemiology and demographics|Epidemiology &amp; Demographics]]==<br /> <br /> ==[[Hypertension natural history|Complications]]==<br /> <br /> ==[[Hypertension causes|Causes of Hypertension]]==<br /> <br /> ==[[Hypertension differential diagnosis|Complete List of Differential Diagnoses]]==<br /> <br /> == Diagnosis ==<br /> : [[Hypertension history &amp; symptoms|Signs and symptoms]] | [[Hypertension blood pressure|Measuring blood pressure]] | [[Hypertension physical examination|Physical Examination]] | [[Hypertension laboratory tests|Laboratory Tests]] | [[Hypertension additional tests#Electrocardiogram|Electrocardiogram]] | [[Hypertension additional tests#Chest X-ray|Chest X-ray]] | [[Hypertension additional tests#MRI or CT|MRI or CT]] | [[Hypertension additional tests#Echocardiography or Ultrasound|Echocardiography or Ultrasound]] <br /> <br /> == Treatment ==<br /> &lt;!---need to be updated in accordance with the latest NICE guidelines (28th June 2006) ---&gt;<br /> : [[Hypertension lifestyle modification|Lifestyle modification]] (nonpharmacologic treatment) | [[Hypertension medical treatment|Medical Treatment]]<br /> <br /> ===Systolic hypertension===<br /> {{details|Systolic hypertension}}<br /> <br /> == See also ==<br /> * [[Edible salt]]<br /> * [[Hypertensive emergency]]<br /> * [[Malignant hypertension]]<br /> * [[Exercise hypertension]]<br /> * [[White coat hypertension]]<br /> * [[Home blood pressure monitoring]]<br /> <br /> ==References==<br /> &lt;!-- ---------------------------------------------------------------<br /> See http://en.wikipedia.org/wiki/Wikipedia:Footnotes for a<br /> discussion of different citation methods and how to generate<br /> footnotes using the &lt;ref&gt; &amp; &lt;/ref&gt; tags and the {{Reflist}} template<br /> -------------------------------------------------------------------- --&gt;<br /> {{Reflist|2}}<br /> <br /> == External links ==<br /> <br /> * [http://www.dmoz.org//Health/Conditions_and_Diseases/Cardiovascular_Disorders/Vascular_Disorders/Hypertension/]<br /> * [http://ww2.heartandstroke.ca/Page.asp?PageID=1975&amp;ArticleID=5211 High Blood Pressure] from the Heart and Stroke Foundation of Canada<br /> * [http://medlineplus.nlm.nih.gov/medlineplus/highbloodpressure.html High Blood Pressure] from [[MedlinePlus]]<br /> * [http://www.nhlbi.nih.gov/hbp/ A guide to lowering high blood pressure] from the National Heart, Lung, and Blood Institute<br /> * [http://www.nhlbi.nih.gov/hbp/prevent/h_eating/h_eating.htm The DASH diet] from the National Heart, Lung, and Blood Institute<br /> * [http://www.americanheart.org/presenter.jhtml?identifier=2114 High Blood Pressure] (from the American Heart Association)<br /> * [http://kidney.niddk.nih.gov/kudiseases/pubs/hypertension/index.htm High Blood Pressure and Kidney Disease] from The National Kidney and Urologic Diseases Information Clearinghouse<br /> * [http://www.earthclinic.com/CURES/blood_pressure.html Natural Remedies for High Blood Pressure] from Earth Clinic's Folk Medicine Archive<br /> <br /> === Major studies ===<br /> * [http://www.nhlbi.nih.gov/about/framingham/ The Framingham Heart Study]<br /> * [http://allhat.sph.uth.tmc.edu/default.htm#study Information on ALLHAT]<br /> * [http://www.adalat.com/professionals-home/research/action-trial/ Information on ACTION - A Coronary Disease Trial Investigating Outcome with Nifedipine GITS]<br /> * [http://www.adalat.com/professionals-home/research/insight-trial Information on INSIGHT]<br /> * [http://www.adalat.com/professionals-home/research/encore-trial/ Information on ENCORE]<br /> <br /> {{Circulatory system pathology}}<br /> [[zh-min-nan:Ko-hoeh-ap]]<br /> [[bg:Хипертония]]<br /> [[ceb:Alta Presyon]]<br /> [[de:Arterielle Hypertonie]]<br /> [[et:Hüpertensioon]]<br /> [[es:Hipertensión arterial]]<br /> [[eu:Hipertentsio]]<br /> [[fr:Hypertension artérielle]]<br /> [[id:Tekanan darah tinggi]]<br /> [[it:Ipertensione arteriosa sistemica]]<br /> [[ku:Hîpertansiyon]]<br /> [[hu:Magas vérnyomás]]<br /> [[ms:Penyakit Darah Tinggi]]<br /> [[nl:Hypertensie]]<br /> [[ja:高血圧]]<br /> [[no:Hypertensjon]]<br /> [[pl:Nadciśnienie tętnicze]]<br /> [[pt:Hipertensão arterial]]<br /> [[ru:Артериальная гипертензия]]<br /> [[sr:Висок притисак]]<br /> [[sv:Högt blodtryck]]<br /> [[th:โรคความดันโลหิตสูง]]<br /> [[tr:Hipertansiyon]]<br /> [[zh:高血壓]]<br /> <br /> <br /> [[Category:Aging-associated diseases]]<br /> [[Category:Cardiology]]<br /> [[Category:Emergency medicine]]<br /> [[Category:Cardiovascular diseases]]<br /> [[Category:Medical conditions related to obesity]]<br /> [[Category:Nephrology]]<br /> <br /> <br /> {{WikiDoc Help Menu}}<br /> {{WikiDoc Sources}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Template:Hypertension&diff=575727 Template:Hypertension 2011-06-29T14:45:31Z <p>Taylor Palmieri: </p> <hr /> <div>{| class=&quot;infobox bordered&quot; style=&quot;width: 15em; text-align: left; font-size: 90%; background:AliceBlue&quot;<br /> |-<br /> | colspan=&quot;1&quot; style=&quot;text-align:center; background:DarkGray&quot; |<br /> <br /> '''Hypertension Microchapters<br /> '''<br /> |- bgcolor=&quot;LightGrey&quot;<br /> !<br /> <br /> |- bgcolor=&quot;LightCoral&quot;<br /> !<br /> [[Hypertension|Home]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension (patient information)|Patient Info]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension overview|Overview]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension classification|Classification]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension pathophysiology|Pathophysiology]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension epidemiology and demographics|Epidemiology &amp; Demographics]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension natural history|Natural History, Complications &amp; Prognosis]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension causes|Causes of Hypertension]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension differential diagnosis|Differentiating Hypertension from other Diseases]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;CornFlowerBlue&quot;<br /> !<br /> Diagnosis<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension history and symptoms|History &amp; Symptoms]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension blood pressure|Blood Pressure]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension physical examination|Physical Examination]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension laboratory tests|Lab Tests]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension additional tests|Additional Tests]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;CadetBlue&quot;<br /> !<br /> Treatment<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> [[Hypertension lifestyle modification|Lifestyle Modification]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> 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'''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Medical Therapy==<br /> <br /> ===Medications===<br /> {{main|Antihypertensive}}<br /> There are many classes of medications for treating hypertension, together called [[antihypertensive]]s, which &amp;mdash; by varying means &amp;mdash; act by lowering blood pressure. Evidence suggests that reduction of the blood pressure by 5-6 mmHg can decrease the risk of stroke by 40%, of coronary heart disease by 15-20%, and reduces the likelihood of dementia, heart failure, and mortality from vascular disease.<br /> <br /> The aim of treatment should be blood pressure control to &lt;140/90 mmHg for most patients, and lower in certain contexts such as diabetes or kidney disease (some medical professionals recommend keeping levels below 120/80 mmHg).[http://www.webmd.com/content/article/73/88927.htm] Each added drug may reduce the systolic blood pressure by 5-10 mmHg, so often multiple drugs are necessary to achieve blood pressure control.<br /> <br /> Commonly used drugs include:<br /> *[[ACE inhibitor]]s such as [[captopril]], [[enalapril]], [[fosinopril]] (Monopril), [[lisinopril]] (Zestril), [[quinapril]], [[ramipril]] (Altace)<br /> *[[Angiotensin II receptor antagonist]]s: eg, [[telmisartan]] (Micardis, Pritor), [[irbesartan]] (Avapro), [[losartan]] (Cozaar), [[valsartan]] (Diovan), [[candesartan]] (Atacand)<br /> *[[Alpha blocker]]s such as [[doxazosin]], [[prazosin]], or [[terazosin]]<br /> *[[Beta blocker]]s such as [[atenolol]], [[labetalol]], [[metoprolol]] (Lopressor, Toprol-XL), [[propranolol]].<br /> *[[Calcium channel blocker]]s such as nifedipine (Adalat®)&lt;ref&gt;[http://www.adalat.com/professionals-home/research/publications/ Kragten JA, Dunselman PHJM. Nifedipine gastrointestinal therapeutic system (GITS) in the treatment of coronary heart disease and hypertension. Expert Rev Cardiovasc Ther 5 (2007):643-653. FULL TEXT!] &lt;/ref&gt; [[amlodipine]] (Norvasc), [[diltiazem]], [[verapamil]]<br /> *Direct renin inhibitors such as [[aliskiren]] (Tekturna)<br /> *[[Diuretic]]s: eg, [[bendroflumethiazide]], [[chlortalidone]], [[hydrochlorothiazide]] (also called HCTZ)<br /> *Combination products (which usually contain HCTZ and one other drug)<br /> <br /> ====Influence of age and race on medication efficacy====<br /> A [[randomized controlled trial]] by the Veterans Affairs Cooperative Study Group on Antihypertensive Agents reported the influence of patient age and race on the proportion of patients whose blood pressure was controlled by different agents.&lt;ref name=&quot;pmid8446138&quot;&gt;{{cite journal |author=Materson BJ, Reda DJ, Cushman WC, ''et al'' |title=Single-drug therapy for hypertension in men. A comparison of six antihypertensive agents with placebo. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents |journal=N. Engl. J. Med. |volume=328 |issue=13 |pages=914-21 |year=1993 |pmid=8446138 |doi=|url=http://content.nejm.org/cgi/content/full/328/13/914}}&lt;/ref&gt;&lt;ref name=&quot;pmid8177286&quot;&gt;{{cite journal |author=Materson BJ, Reda DJ |title=Correction: single-drug therapy for hypertension in men |journal=N. Engl. J. Med. |volume=330 |issue=23 |pages=1689 |year=1994 |pmid=8177286 |doi=|url=http://content.nejm.org/cgi/content/full/330/23/1689}} [http://content.nejm.org/cgi/content/full/330/23/1689/T1 Summary]&lt;/ref&gt; For example:<br /> * Less than 7% of young white patients responded to a [[diuretic]] ([[hydrochlorothiazide]])<br /> * Only 6% of older black patients responded to an [[ACE inhibitor]] ([[captopril]])<br /> The effect of age and race are in part due to differences in plasma [[renin]] activity.&lt;ref name=&quot;pmid1538559&quot;&gt;{{cite journal |author=Blaufox MD, Lee HB, Davis B, Oberman A, Wassertheil-Smoller S, Langford H |title=Renin predicts diastolic blood pressure response to nonpharmacologic and pharmacologic therapy |journal=JAMA |volume=267 |issue=9 |pages=1221-5 |year=1992 |pmid=1538559 |doi=}}&lt;/ref&gt;&lt;ref name=&quot;pmid9777817&quot;&gt;{{cite journal |author=Preston RA, Materson BJ, Reda DJ, ''et al'' |title=Age-race subgroup compared with renin profile as predictors of blood pressure response to antihypertensive therapy. Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents |journal=JAMA |volume=280 |issue=13 |pages=1168-72 |year=1998 |pmid=9777817 |doi=}}&lt;/ref&gt;<br /> <br /> ====Choice of initial medication====<br /> Which type of many medications should be used initially for hypertension has been the subject of several large studies and various national guidelines.<br /> <br /> Regarding cardiovascular outcomes, the ALLHAT study showed a slightly better outcome and cost-effectiveness for the [[thiazide]] diuretic [[chlortalidone]] compared to other anti-hypertensives in an ethnically mixed population.&lt;ref name=&quot;allhat&quot;&gt;{{cite journal<br /> |url=http://jama.ama-assn.org/cgi/content/full/288/23/2981<br /> |author=ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group<br /> |journal=[[Journal of the American Medical Association|JAMA]]<br /> |title=Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)<br /> |year = 2002<br /> |month = Dec 18<br /> |volume = 288<br /> |issue = 23<br /> |pages = 2981-97<br /> |id = PMID 12479763<br /> }}&lt;/ref&gt;<br /> Whilst a subsequent smaller study (ANBP2) did not show this small difference in outcome and actually showed a slightly better outcome for ACE-inhibitors in older white male patients.&lt;ref name=&quot;anbp2&quot;&gt;{{<br /> cite journal<br /> |url=http://content.nejm.org/cgi/content/abstract/348/7/583<br /> |author=Wing LM, Reid CM, Ryan P et al<br /> |journal=[[N Engl J Med|NEJM]]<br /> |title=A comparison of outcomes with angiotensin-converting--enzyme inhibitors and diuretics for hypertension in the elderly<br /> |year = 2003<br /> |month = Feb 13<br /> |volume = 348<br /> |issue = 7<br /> |pages = 583-92<br /> |id = PMID 12584366<br /> }}&lt;/ref&gt;<br /> <br /> Whilst thiazides are cheap, effective, and recommended as the best first-line drug for hypertension by many experts, they are not prescribed as often as some newer drugs. Arguably, this is because they are off-patent and thus rarely promoted by the drug industry.&lt;ref name=&quot;promotion&quot;&gt;{{cite journal<br /> |url=http://circ.ahajournals.org/cgi/content/full/99/15/2055<br /> |author=Wang TJ, Ausiello JC, Stafford RS<br /> |journal=Circulation<br /> |title=Trends in Antihypertensive Drug Advertising, 1985–1996<br /> |year = 1999<br /> |volume = 99<br /> |pages = 2055-2057<br /> |id = PMID 10209012<br /> }}&lt;/ref&gt; <br /> &lt;br /&gt;&lt;br /&gt;<br /> Due to their metabolic impact (hypercholesterinemia, impairment of glucose tolerance, increased risk of developing [[Diabetes mellitus type 2]]), the use of thiazides as first line treatment for essential hypertension has been repeatedly questioned and strongly disencouraged.&lt;ref&gt;{{cite journal | author = Lewis PJ, Kohner EM, Petrie A, Dollery CT | title = Deterioration of glucose tolerance in hypertensive patients on prolonged diuretic treatment | journal = Lancet | volume = 307 | issue = 7959 | pages = 564 - 566 | year = 1976 | id = PMID 55840 }} &lt;/ref&gt; &lt;ref&gt;{{cite journal | author = Murphy MB, Lewis PJ, Kohner E, Schumer B, Dollery CT | title = Glucose intolerance in hypertensive patients treated with diuretics; a fourteen-year follow-up | journal = Lancet | volume = 320 | issue = 8311 | pages = 1293 - 1295 | year = 1982 | id = PMID 6128594 }}&lt;/ref&gt; &lt;ref&gt;{{cite journal | author =Messerli FH, Williams B,Ritz E | title = Essential hypertension | journal = Lancet | volume = 370 | issue = 9587 | pages = 591-603| year = 2007 | id = PMID }}&lt;/ref&gt; <br /> &lt;br /&gt;&lt;br /&gt;<br /> Physicians may start with non-thiazide antihypertensive medications if there is a compelling reason to do so. An example is the use of ACE-inhibitors in diabetic patients who have evidence of kidney disease, as they have been shown to both reduce blood pressure and slow the progression of [[diabetic nephropathy]].&lt;ref name=ruggenenti&gt;{{cite journal<br /> |url=http://linkinghub.elsevier.com/retrieve/pii/S014067369804433X<br /> |author=Ruggenenti P, Perna A, Gherardi G, Gaspari F, Benini R, Remuzzi G.<br /> |journal=Lancet<br /> |title=Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril: REIN follow-up trial. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN). Ramipril Efficacy in Nephropathy.<br /> |year = 1998<br /> |volume = 352<br /> |pages = 1252-6<br /> |id = PMID 9788454<br /> }}&lt;/ref&gt; In patients with coronary artery disease or a history of a heart attack, beta blockers and ACE-inhibitors both lower blood pressure and protect heart muscle over a lifetime, leading to reduced mortality.<br /> <br /> ===Advice in the United Kingdom===<br /> The risk of [[beta-blocker]]s provoking [[type 2 diabetes]] led to their downgrading to fourth-line therapy in the United Kingdom in June 2006&lt;ref&gt;{{cite web | author= Sheetal Ladva | title=NICE and BHS launch updated hypertension guideline | url=http://www.nelm.nhs.uk/Record%20Viewing/viewRecord.aspx?id=567178 | date=28/06/2006 | publisher=[[National Institute for Health and Clinical Excellence]]}}&lt;/ref&gt;, in the revised national guidelines.&lt;ref&gt;{{cite web | title=Hypertension: management of hypertension in adults in primary care | url=http://www.nice.org.uk/download.aspx?o=CG034quickrefguide | format=PDF | publisher=[[National Institute for Health and Clinical Excellence]]}}&lt;/ref&gt;<br /> <br /> ===Advice in the United States===<br /> The ''Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure'' (JNC 7) in the United States recommends starting with a [[thiazide diuretic]] if single therapy is being initiated and another medication is not indicated.&lt;ref name=&quot;jnc7&quot; /&gt;<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Hypertension_medical_treatment&diff=575719 Hypertension medical treatment 2011-06-29T14:32:22Z <p>Taylor Palmieri: Hypertension medical treatment moved to Hypertension medical therapy</p> <hr /> <div>#REDIRECT [[Hypertension medical therapy]]</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_medical_therapy&diff=575718 Chronic hypertension medical therapy 2011-06-29T14:32:22Z <p>Taylor Palmieri: Hypertension medical treatment moved to Hypertension medical therapy</p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Medical Treatment==<br /> <br /> ===Medications===<br /> {{main|Antihypertensive}}<br /> There are many classes of medications for treating hypertension, together called [[antihypertensive]]s, which &amp;mdash; by varying means &amp;mdash; act by lowering blood pressure. Evidence suggests that reduction of the blood pressure by 5-6 mmHg can decrease the risk of stroke by 40%, of coronary heart disease by 15-20%, and reduces the likelihood of dementia, heart failure, and mortality from vascular disease.<br /> <br /> The aim of treatment should be blood pressure control to &lt;140/90 mmHg for most patients, and lower in certain contexts such as diabetes or kidney disease (some medical professionals recommend keeping levels below 120/80 mmHg).[http://www.webmd.com/content/article/73/88927.htm] Each added drug may reduce the systolic blood pressure by 5-10 mmHg, so often multiple drugs are necessary to achieve blood pressure control.<br /> <br /> Commonly used drugs include:<br /> *[[ACE inhibitor]]s such as [[captopril]], [[enalapril]], [[fosinopril]] (Monopril), [[lisinopril]] (Zestril), [[quinapril]], [[ramipril]] (Altace)<br /> *[[Angiotensin II receptor antagonist]]s: eg, [[telmisartan]] (Micardis, Pritor), [[irbesartan]] (Avapro), [[losartan]] (Cozaar), [[valsartan]] (Diovan), [[candesartan]] (Atacand)<br /> *[[Alpha blocker]]s such as [[doxazosin]], [[prazosin]], or [[terazosin]]<br /> *[[Beta blocker]]s such as [[atenolol]], [[labetalol]], [[metoprolol]] (Lopressor, Toprol-XL), [[propranolol]].<br /> *[[Calcium channel blocker]]s such as nifedipine (Adalat®)&lt;ref&gt;[http://www.adalat.com/professionals-home/research/publications/ Kragten JA, Dunselman PHJM. Nifedipine gastrointestinal therapeutic system (GITS) in the treatment of coronary heart disease and hypertension. Expert Rev Cardiovasc Ther 5 (2007):643-653. FULL TEXT!] &lt;/ref&gt; [[amlodipine]] (Norvasc), [[diltiazem]], [[verapamil]]<br /> *Direct renin inhibitors such as [[aliskiren]] (Tekturna)<br /> *[[Diuretic]]s: eg, [[bendroflumethiazide]], [[chlortalidone]], [[hydrochlorothiazide]] (also called HCTZ)<br /> *Combination products (which usually contain HCTZ and one other drug)<br /> <br /> ====Influence of age and race on medication efficacy====<br /> A [[randomized controlled trial]] by the Veterans Affairs Cooperative Study Group on Antihypertensive Agents reported the influence of patient age and race on the proportion of patients whose blood pressure was controlled by different agents.&lt;ref name=&quot;pmid8446138&quot;&gt;{{cite journal |author=Materson BJ, Reda DJ, Cushman WC, ''et al'' |title=Single-drug therapy for hypertension in men. A comparison of six antihypertensive agents with placebo. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents |journal=N. Engl. J. Med. |volume=328 |issue=13 |pages=914-21 |year=1993 |pmid=8446138 |doi=|url=http://content.nejm.org/cgi/content/full/328/13/914}}&lt;/ref&gt;&lt;ref name=&quot;pmid8177286&quot;&gt;{{cite journal |author=Materson BJ, Reda DJ |title=Correction: single-drug therapy for hypertension in men |journal=N. Engl. J. Med. |volume=330 |issue=23 |pages=1689 |year=1994 |pmid=8177286 |doi=|url=http://content.nejm.org/cgi/content/full/330/23/1689}} [http://content.nejm.org/cgi/content/full/330/23/1689/T1 Summary]&lt;/ref&gt; For example:<br /> * Less than 7% of young white patients responded to a [[diuretic]] ([[hydrochlorothiazide]])<br /> * Only 6% of older black patients responded to an [[ACE inhibitor]] ([[captopril]])<br /> The effect of age and race are in part due to differences in plasma [[renin]] activity.&lt;ref name=&quot;pmid1538559&quot;&gt;{{cite journal |author=Blaufox MD, Lee HB, Davis B, Oberman A, Wassertheil-Smoller S, Langford H |title=Renin predicts diastolic blood pressure response to nonpharmacologic and pharmacologic therapy |journal=JAMA |volume=267 |issue=9 |pages=1221-5 |year=1992 |pmid=1538559 |doi=}}&lt;/ref&gt;&lt;ref name=&quot;pmid9777817&quot;&gt;{{cite journal |author=Preston RA, Materson BJ, Reda DJ, ''et al'' |title=Age-race subgroup compared with renin profile as predictors of blood pressure response to antihypertensive therapy. Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents |journal=JAMA |volume=280 |issue=13 |pages=1168-72 |year=1998 |pmid=9777817 |doi=}}&lt;/ref&gt;<br /> <br /> ====Choice of initial medication====<br /> Which type of many medications should be used initially for hypertension has been the subject of several large studies and various national guidelines.<br /> <br /> Regarding cardiovascular outcomes, the ALLHAT study showed a slightly better outcome and cost-effectiveness for the [[thiazide]] diuretic [[chlortalidone]] compared to other anti-hypertensives in an ethnically mixed population.&lt;ref name=&quot;allhat&quot;&gt;{{cite journal<br /> |url=http://jama.ama-assn.org/cgi/content/full/288/23/2981<br /> |author=ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group<br /> |journal=[[Journal of the American Medical Association|JAMA]]<br /> |title=Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)<br /> |year = 2002<br /> |month = Dec 18<br /> |volume = 288<br /> |issue = 23<br /> |pages = 2981-97<br /> |id = PMID 12479763<br /> }}&lt;/ref&gt;<br /> Whilst a subsequent smaller study (ANBP2) did not show this small difference in outcome and actually showed a slightly better outcome for ACE-inhibitors in older white male patients.&lt;ref name=&quot;anbp2&quot;&gt;{{<br /> cite journal<br /> |url=http://content.nejm.org/cgi/content/abstract/348/7/583<br /> |author=Wing LM, Reid CM, Ryan P et al<br /> |journal=[[N Engl J Med|NEJM]]<br /> |title=A comparison of outcomes with angiotensin-converting--enzyme inhibitors and diuretics for hypertension in the elderly<br /> |year = 2003<br /> |month = Feb 13<br /> |volume = 348<br /> |issue = 7<br /> |pages = 583-92<br /> |id = PMID 12584366<br /> }}&lt;/ref&gt;<br /> <br /> Whilst thiazides are cheap, effective, and recommended as the best first-line drug for hypertension by many experts, they are not prescribed as often as some newer drugs. Arguably, this is because they are off-patent and thus rarely promoted by the drug industry.&lt;ref name=&quot;promotion&quot;&gt;{{cite journal<br /> |url=http://circ.ahajournals.org/cgi/content/full/99/15/2055<br /> |author=Wang TJ, Ausiello JC, Stafford RS<br /> |journal=Circulation<br /> |title=Trends in Antihypertensive Drug Advertising, 1985–1996<br /> |year = 1999<br /> |volume = 99<br /> |pages = 2055-2057<br /> |id = PMID 10209012<br /> }}&lt;/ref&gt; <br /> &lt;br /&gt;&lt;br /&gt;<br /> Due to their metabolic impact (hypercholesterinemia, impairment of glucose tolerance, increased risk of developing [[Diabetes mellitus type 2]]), the use of thiazides as first line treatment for essential hypertension has been repeatedly questioned and strongly disencouraged.&lt;ref&gt;{{cite journal | author = Lewis PJ, Kohner EM, Petrie A, Dollery CT | title = Deterioration of glucose tolerance in hypertensive patients on prolonged diuretic treatment | journal = Lancet | volume = 307 | issue = 7959 | pages = 564 - 566 | year = 1976 | id = PMID 55840 }} &lt;/ref&gt; &lt;ref&gt;{{cite journal | author = Murphy MB, Lewis PJ, Kohner E, Schumer B, Dollery CT | title = Glucose intolerance in hypertensive patients treated with diuretics; a fourteen-year follow-up | journal = Lancet | volume = 320 | issue = 8311 | pages = 1293 - 1295 | year = 1982 | id = PMID 6128594 }}&lt;/ref&gt; &lt;ref&gt;{{cite journal | author =Messerli FH, Williams B,Ritz E | title = Essential hypertension | journal = Lancet | volume = 370 | issue = 9587 | pages = 591-603| year = 2007 | id = PMID }}&lt;/ref&gt; <br /> &lt;br /&gt;&lt;br /&gt;<br /> Physicians may start with non-thiazide antihypertensive medications if there is a compelling reason to do so. An example is the use of ACE-inhibitors in diabetic patients who have evidence of kidney disease, as they have been shown to both reduce blood pressure and slow the progression of [[diabetic nephropathy]].&lt;ref name=ruggenenti&gt;{{cite journal<br /> |url=http://linkinghub.elsevier.com/retrieve/pii/S014067369804433X<br /> |author=Ruggenenti P, Perna A, Gherardi G, Gaspari F, Benini R, Remuzzi G.<br /> |journal=Lancet<br /> |title=Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril: REIN follow-up trial. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN). Ramipril Efficacy in Nephropathy.<br /> |year = 1998<br /> |volume = 352<br /> |pages = 1252-6<br /> |id = PMID 9788454<br /> }}&lt;/ref&gt; In patients with coronary artery disease or a history of a heart attack, beta blockers and ACE-inhibitors both lower blood pressure and protect heart muscle over a lifetime, leading to reduced mortality.<br /> <br /> ===Advice in the United Kingdom===<br /> The risk of [[beta-blocker]]s provoking [[type 2 diabetes]] led to their downgrading to fourth-line therapy in the United Kingdom in June 2006&lt;ref&gt;{{cite web | author= Sheetal Ladva | title=NICE and BHS launch updated hypertension guideline | url=http://www.nelm.nhs.uk/Record%20Viewing/viewRecord.aspx?id=567178 | date=28/06/2006 | publisher=[[National Institute for Health and Clinical Excellence]]}}&lt;/ref&gt;, in the revised national guidelines.&lt;ref&gt;{{cite web | title=Hypertension: management of hypertension in adults in primary care | url=http://www.nice.org.uk/download.aspx?o=CG034quickrefguide | format=PDF | publisher=[[National Institute for Health and Clinical Excellence]]}}&lt;/ref&gt;<br /> <br /> ===Advice in the United States===<br /> The ''Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure'' (JNC 7) in the United States recommends starting with a [[thiazide diuretic]] if single therapy is being initiated and another medication is not indicated.&lt;ref name=&quot;jnc7&quot; /&gt;<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Hypertension_additional_tests&diff=575714 Hypertension additional tests 2011-06-29T14:23:35Z <p>Taylor Palmieri: </p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Additional tests often include:==<br /> <br /> ===Electrocardiogram=== <br /> * [[Electrocardiogram]] (EKG/ECG) - for evidence of the heart being under strain from working against a high blood pressure. Also may show resulting thickening of the heart muscle ([[left ventricular hypertrophy]]) or of the occurrence of previous silent cardiac disease (either subtle electrical conduction disruption or even a myocardial infarction).<br /> <br /> ===Chest X-ray===<br /> * [[Chest X-ray]] - again for signs of cardiac enlargement or evidence of [[Congestive heart failure|cardiac failure]].<br /> <br /> ===MRI or CT===<br /> * see [[Cardiac MRI]] in [[Hypertension]]<br /> <br /> === Echocardiography or Ultrasound === <br /> * [[Echocardiogram]] for diagnosis<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Template:Hypertension&diff=575713 Template:Hypertension 2011-06-29T14:20:31Z <p>Taylor Palmieri: </p> <hr /> <div>{| class=&quot;infobox bordered&quot; style=&quot;width: 15em; text-align: left; font-size: 90%; background:AliceBlue&quot;<br /> |-<br /> | colspan=&quot;1&quot; style=&quot;text-align:center; background:DarkGray&quot; |<br /> <br /> '''Hypertension Microchapters<br /> '''<br /> |- bgcolor=&quot;LightGrey&quot;<br /> !<br /> <br /> |- bgcolor=&quot;LightCoral&quot;<br /> !<br /> [[Hypertension|Home]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension (patient information)|Patient Info]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension overview|Overview]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension classification|Classification]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension pathophysiology|Pathophysiology]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension epidemiology and demographics|Epidemiology &amp; Demographics]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension risk factors|Risk Factors]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension screening|Screening]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension natural history|Natural History, Complications &amp; Prognosis]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension causes|Causes of Hypertension]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension differential diagnosis|Differentiating Hypertension from other Diseases]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;CornFlowerBlue&quot;<br /> !<br /> Diagnosis<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension history and symptoms|History &amp; Symptoms]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension blood pressure|Blood Pressure]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension physical examination|Physical Examination]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension laboratory tests|Lab Tests]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension electrocardiogram|Electrocardiogram]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension chest x ray|Chest X Ray]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension MRI|MRI]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension CT|CT]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension echocardiography or ultrasound|Echocardiography or Ultrasound]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension other imaging findings|Other Imaging Findings]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension other diagnostic studies|Other Diagnostic Studies]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;CadetBlue&quot;<br /> !<br /> Treatment<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> [[Hypertension lifestyle modification|Lifestyle Modification]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> [[Hypertension medical therapy|Medical Therapy]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> [[Hypertension surgery|Surgery]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> [[Hypertension primary prevention|Primary Prevention]]<br /> |- <br /> ! <br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> [[Hypertension secondary prevention|Secondary Prevention]]<br /> |- <br /> ! <br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> [[Hypertension cost-effectiveness of therapy|Cost-Effectiveness of Therapy]]<br /> |- <br /> ! <br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> [[Hypertension future or investigational therapies|Future or Investigational Therapies]]<br /> |- <br /> ! <br /> <br /> |- bgcolor=&quot;PaleGoldenrod &quot;<br /> !<br /> {{PAGENAME}} On the Web<br /> |- <br /> ! <br /> <br /> |- bgcolor=&quot;LightYellow&quot;<br /> !<br /> [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&amp;db=pubmed&amp;term={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}} Most recent articles]<br /> |- <br /> ! <br /> <br /> |- bgcolor=&quot;LightYellow&quot;<br /> !<br /> [http://scholar.google.com/scholar?ie=UTF-8&amp;oe=utf-8&amp;q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}&amp;qt_s=Search&amp;sa=N&amp;tab=ps Most cited articles]<br /> |- <br /> ! 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Also may show resulting thickening of the heart muscle ([[left ventricular hypertrophy]]) or of the occurrence of previous silent cardiac disease (either subtle electrical conduction disruption or even a myocardial infarction).<br /> <br /> ===Chest X-ray===<br /> * [[Chest X-ray]] - again for signs of cardiac enlargement or evidence of [[Congestive heart failure|cardiac failure]].<br /> <br /> === Echocardiography or Ultrasound === <br /> * [[Echocardiogram]] for diagnosis<br /> <br /> ===MRI or CT===<br /> * see [[Cardiac MRI]] in [[Hypertension]]<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_laboratory_findings&diff=575707 Chronic hypertension laboratory findings 2011-06-29T14:06:34Z <p>Taylor Palmieri: </p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Laboratory Tests==<br /> ===Investigations commonly performed in newly diagnosed hypertension===<br /> Tests are undertaken to identify possible causes of secondary hypertension, and seek evidence for end-organ damage to the heart itself or the eyes (retina) and kidneys. Diabetes and raised cholesterol levels being additional risk factors for the development of cardiovascular disease are also tested for as they will also require management.<br /> <br /> [[Blood test]]s commonly performed include:<br /> * [[Creatinine]] ([[renal function]]) - to identify both underlying renal disease as a cause of hypertension and conversely hypertension causing onset of kidney damage. Also a baseline for later monitoring the possible side-effects of certain antihypertensive drugs.<br /> * [[Electrolyte]]s ([[sodium]], [[potassium]])<br /> * [[Glucose]] - to identify [[diabetes mellitus]]<br /> * [[Cholesterol]]<br /> <br /> Additional tests often include:<br /> * Testing of urine samples for [[proteinuria]] - again to pick up underlying kidney disease or evidence of hypertensive renal damage.<br /> <br /> == Laboratory Findings == <br /> * [[Urinalysis]]<br /> * [[Glucose]]<br /> * [[Blood urea nitrogen]] ([[BUN]]) / [[creatinine]]<br /> * Basic metabolic panel<br /> * [[Calcium]]<br /> * [[Lipid]]s<br /> * Urinary [[albumin]]<br /> * [[Glomerular filtration rate]]<br /> === Electrolyte and Biomarker Studies === <br /> * [[Electrolyte]]s<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_laboratory_findings&diff=575706 Chronic hypertension laboratory findings 2011-06-29T14:04:52Z <p>Taylor Palmieri: New page: {{Template:Hypertension}} {{CMG}} &#039;&#039;&#039;Associate Editor in Chief&#039;&#039;&#039;: Firas Ghanem, M.D. and Atif Mohammad, M.D. {{EH}} ==Laboratory Tests== ===Investigations commonly performed in newly ...</p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Laboratory Tests==<br /> ===Investigations commonly performed in newly diagnosed hypertension===<br /> Tests are undertaken to identify possible causes of secondary hypertension, and seek evidence for end-organ damage to the heart itself or the eyes (retina) and kidneys. Diabetes and raised cholesterol levels being additional risk factors for the development of cardiovascular disease are also tested for as they will also require management.<br /> <br /> [[Blood test]]s commonly performed include:<br /> * [[Creatinine]] ([[renal function]]) - to identify both underlying renal disease as a cause of hypertension and conversely hypertension causing onset of kidney damage. Also a baseline for later monitoring the possible side-effects of certain antihypertensive drugs.<br /> * [[Electrolyte]]s ([[sodium]], [[potassium]])<br /> * [[Glucose]] - to identify [[diabetes mellitus]]<br /> * [[Cholesterol]]<br /> <br /> Additional tests often include:<br /> * Testing of urine samples for [[proteinuria]] - again to pick up underlying kidney disease or evidence of hypertensive renal damage.<br /> <br /> == Laboratory Findings == <br /> * [[Urinalysis]]<br /> * [[Glucose]]<br /> * [[Blood urea nitrogen]] ([[BUN]]) / [[creatinine]]<br /> * Basic metabolic panel<br /> * [[Calcium]]<br /> * [[Lipid]]s<br /> * Urinary [[albumin]]<br /> * [[Glomerular filtration rate]]<br /> === Electrolyte and Biomarker Studies === <br /> * [[Electrolyte]]s<br /> === [[Electrocardiogram]] === <br /> * ECG to make accurate diagnosis<br /> === Echocardiography or Ultrasound === <br /> * [[Echocardiogram]] for diagnosis<br /> ===MRI or CT===<br /> * see [[Cardiac MRI]] in [[Hypertension]]<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Template:Hypertension&diff=575701 Template:Hypertension 2011-06-29T13:56:48Z <p>Taylor Palmieri: </p> <hr /> <div>{| class=&quot;infobox bordered&quot; style=&quot;width: 15em; text-align: left; font-size: 90%; background:AliceBlue&quot;<br /> |-<br /> | colspan=&quot;1&quot; style=&quot;text-align:center; background:DarkGray&quot; |<br /> <br /> '''Hypertension Microchapters<br /> '''<br /> |- bgcolor=&quot;LightGrey&quot;<br /> !<br /> <br /> |- bgcolor=&quot;LightCoral&quot;<br /> !<br /> [[Hypertension|Home]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension (patient information)|Patient Info]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension overview|Overview]]<br /> |- <br /> !<br /> <br /> |- 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in Chief&#039;&#039;&#039;: Firas Ghanem, M.D. and Atif Mohammad, M.D. {{EH}} ==Medical Treatment== ===Medications=== {{main|Antihypertensive}} ...</p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Medical Treatment==<br /> <br /> ===Medications===<br /> {{main|Antihypertensive}}<br /> There are many classes of medications for treating hypertension, together called [[antihypertensive]]s, which &amp;mdash; by varying means &amp;mdash; act by lowering blood pressure. Evidence suggests that reduction of the blood pressure by 5-6 mmHg can decrease the risk of stroke by 40%, of coronary heart disease by 15-20%, and reduces the likelihood of dementia, heart failure, and mortality from vascular disease.<br /> <br /> The aim of treatment should be blood pressure control to &lt;140/90 mmHg for most patients, and lower in certain contexts such as diabetes or kidney disease (some medical professionals recommend keeping levels below 120/80 mmHg).[http://www.webmd.com/content/article/73/88927.htm] Each added drug may reduce the systolic blood pressure by 5-10 mmHg, so often multiple drugs are necessary to achieve blood pressure control.<br /> <br /> Commonly used drugs include:<br /> *[[ACE inhibitor]]s such as [[captopril]], [[enalapril]], [[fosinopril]] (Monopril), [[lisinopril]] (Zestril), [[quinapril]], [[ramipril]] (Altace)<br /> *[[Angiotensin II receptor antagonist]]s: eg, [[telmisartan]] (Micardis, Pritor), [[irbesartan]] (Avapro), [[losartan]] (Cozaar), [[valsartan]] (Diovan), [[candesartan]] (Atacand)<br /> *[[Alpha blocker]]s such as [[doxazosin]], [[prazosin]], or [[terazosin]]<br /> *[[Beta blocker]]s such as [[atenolol]], [[labetalol]], [[metoprolol]] (Lopressor, Toprol-XL), [[propranolol]].<br /> *[[Calcium channel blocker]]s such as nifedipine (Adalat®)&lt;ref&gt;[http://www.adalat.com/professionals-home/research/publications/ Kragten JA, Dunselman PHJM. Nifedipine gastrointestinal therapeutic system (GITS) in the treatment of coronary heart disease and hypertension. Expert Rev Cardiovasc Ther 5 (2007):643-653. FULL TEXT!] &lt;/ref&gt; [[amlodipine]] (Norvasc), [[diltiazem]], [[verapamil]]<br /> *Direct renin inhibitors such as [[aliskiren]] (Tekturna)<br /> *[[Diuretic]]s: eg, [[bendroflumethiazide]], [[chlortalidone]], [[hydrochlorothiazide]] (also called HCTZ)<br /> *Combination products (which usually contain HCTZ and one other drug)<br /> <br /> ====Influence of age and race on medication efficacy====<br /> A [[randomized controlled trial]] by the Veterans Affairs Cooperative Study Group on Antihypertensive Agents reported the influence of patient age and race on the proportion of patients whose blood pressure was controlled by different agents.&lt;ref name=&quot;pmid8446138&quot;&gt;{{cite journal |author=Materson BJ, Reda DJ, Cushman WC, ''et al'' |title=Single-drug therapy for hypertension in men. A comparison of six antihypertensive agents with placebo. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents |journal=N. Engl. J. Med. |volume=328 |issue=13 |pages=914-21 |year=1993 |pmid=8446138 |doi=|url=http://content.nejm.org/cgi/content/full/328/13/914}}&lt;/ref&gt;&lt;ref name=&quot;pmid8177286&quot;&gt;{{cite journal |author=Materson BJ, Reda DJ |title=Correction: single-drug therapy for hypertension in men |journal=N. Engl. J. Med. |volume=330 |issue=23 |pages=1689 |year=1994 |pmid=8177286 |doi=|url=http://content.nejm.org/cgi/content/full/330/23/1689}} [http://content.nejm.org/cgi/content/full/330/23/1689/T1 Summary]&lt;/ref&gt; For example:<br /> * Less than 7% of young white patients responded to a [[diuretic]] ([[hydrochlorothiazide]])<br /> * Only 6% of older black patients responded to an [[ACE inhibitor]] ([[captopril]])<br /> The effect of age and race are in part due to differences in plasma [[renin]] activity.&lt;ref name=&quot;pmid1538559&quot;&gt;{{cite journal |author=Blaufox MD, Lee HB, Davis B, Oberman A, Wassertheil-Smoller S, Langford H |title=Renin predicts diastolic blood pressure response to nonpharmacologic and pharmacologic therapy |journal=JAMA |volume=267 |issue=9 |pages=1221-5 |year=1992 |pmid=1538559 |doi=}}&lt;/ref&gt;&lt;ref name=&quot;pmid9777817&quot;&gt;{{cite journal |author=Preston RA, Materson BJ, Reda DJ, ''et al'' |title=Age-race subgroup compared with renin profile as predictors of blood pressure response to antihypertensive therapy. Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents |journal=JAMA |volume=280 |issue=13 |pages=1168-72 |year=1998 |pmid=9777817 |doi=}}&lt;/ref&gt;<br /> <br /> ====Choice of initial medication====<br /> Which type of many medications should be used initially for hypertension has been the subject of several large studies and various national guidelines.<br /> <br /> Regarding cardiovascular outcomes, the ALLHAT study showed a slightly better outcome and cost-effectiveness for the [[thiazide]] diuretic [[chlortalidone]] compared to other anti-hypertensives in an ethnically mixed population.&lt;ref name=&quot;allhat&quot;&gt;{{cite journal<br /> |url=http://jama.ama-assn.org/cgi/content/full/288/23/2981<br /> |author=ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group<br /> |journal=[[Journal of the American Medical Association|JAMA]]<br /> |title=Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)<br /> |year = 2002<br /> |month = Dec 18<br /> |volume = 288<br /> |issue = 23<br /> |pages = 2981-97<br /> |id = PMID 12479763<br /> }}&lt;/ref&gt;<br /> Whilst a subsequent smaller study (ANBP2) did not show this small difference in outcome and actually showed a slightly better outcome for ACE-inhibitors in older white male patients.&lt;ref name=&quot;anbp2&quot;&gt;{{<br /> cite journal<br /> |url=http://content.nejm.org/cgi/content/abstract/348/7/583<br /> |author=Wing LM, Reid CM, Ryan P et al<br /> |journal=[[N Engl J Med|NEJM]]<br /> |title=A comparison of outcomes with angiotensin-converting--enzyme inhibitors and diuretics for hypertension in the elderly<br /> |year = 2003<br /> |month = Feb 13<br /> |volume = 348<br /> |issue = 7<br /> |pages = 583-92<br /> |id = PMID 12584366<br /> }}&lt;/ref&gt;<br /> <br /> Whilst thiazides are cheap, effective, and recommended as the best first-line drug for hypertension by many experts, they are not prescribed as often as some newer drugs. Arguably, this is because they are off-patent and thus rarely promoted by the drug industry.&lt;ref name=&quot;promotion&quot;&gt;{{cite journal<br /> |url=http://circ.ahajournals.org/cgi/content/full/99/15/2055<br /> |author=Wang TJ, Ausiello JC, Stafford RS<br /> |journal=Circulation<br /> |title=Trends in Antihypertensive Drug Advertising, 1985–1996<br /> |year = 1999<br /> |volume = 99<br /> |pages = 2055-2057<br /> |id = PMID 10209012<br /> }}&lt;/ref&gt; <br /> &lt;br /&gt;&lt;br /&gt;<br /> Due to their metabolic impact (hypercholesterinemia, impairment of glucose tolerance, increased risk of developing [[Diabetes mellitus type 2]]), the use of thiazides as first line treatment for essential hypertension has been repeatedly questioned and strongly disencouraged.&lt;ref&gt;{{cite journal | author = Lewis PJ, Kohner EM, Petrie A, Dollery CT | title = Deterioration of glucose tolerance in hypertensive patients on prolonged diuretic treatment | journal = Lancet | volume = 307 | issue = 7959 | pages = 564 - 566 | year = 1976 | id = PMID 55840 }} &lt;/ref&gt; &lt;ref&gt;{{cite journal | author = Murphy MB, Lewis PJ, Kohner E, Schumer B, Dollery CT | title = Glucose intolerance in hypertensive patients treated with diuretics; a fourteen-year follow-up | journal = Lancet | volume = 320 | issue = 8311 | pages = 1293 - 1295 | year = 1982 | id = PMID 6128594 }}&lt;/ref&gt; &lt;ref&gt;{{cite journal | author =Messerli FH, Williams B,Ritz E | title = Essential hypertension | journal = Lancet | volume = 370 | issue = 9587 | pages = 591-603| year = 2007 | id = PMID }}&lt;/ref&gt; <br /> &lt;br /&gt;&lt;br /&gt;<br /> Physicians may start with non-thiazide antihypertensive medications if there is a compelling reason to do so. An example is the use of ACE-inhibitors in diabetic patients who have evidence of kidney disease, as they have been shown to both reduce blood pressure and slow the progression of [[diabetic nephropathy]].&lt;ref name=ruggenenti&gt;{{cite journal<br /> |url=http://linkinghub.elsevier.com/retrieve/pii/S014067369804433X<br /> |author=Ruggenenti P, Perna A, Gherardi G, Gaspari F, Benini R, Remuzzi G.<br /> |journal=Lancet<br /> |title=Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril: REIN follow-up trial. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN). Ramipril Efficacy in Nephropathy.<br /> |year = 1998<br /> |volume = 352<br /> |pages = 1252-6<br /> |id = PMID 9788454<br /> }}&lt;/ref&gt; In patients with coronary artery disease or a history of a heart attack, beta blockers and ACE-inhibitors both lower blood pressure and protect heart muscle over a lifetime, leading to reduced mortality.<br /> <br /> ===Advice in the United Kingdom===<br /> The risk of [[beta-blocker]]s provoking [[type 2 diabetes]] led to their downgrading to fourth-line therapy in the United Kingdom in June 2006&lt;ref&gt;{{cite web | author= Sheetal Ladva | title=NICE and BHS launch updated hypertension guideline | url=http://www.nelm.nhs.uk/Record%20Viewing/viewRecord.aspx?id=567178 | date=28/06/2006 | publisher=[[National Institute for Health and Clinical Excellence]]}}&lt;/ref&gt;, in the revised national guidelines.&lt;ref&gt;{{cite web | title=Hypertension: management of hypertension in adults in primary care | url=http://www.nice.org.uk/download.aspx?o=CG034quickrefguide | format=PDF | publisher=[[National Institute for Health and Clinical Excellence]]}}&lt;/ref&gt;<br /> <br /> ===Advice in the United States===<br /> The ''Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure'' (JNC 7) in the United States recommends starting with a [[thiazide diuretic]] if single therapy is being initiated and another medication is not indicated.&lt;ref name=&quot;jnc7&quot; /&gt;<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_lifestyle_modification&diff=575698 Chronic hypertension lifestyle modification 2011-06-29T13:51:33Z <p>Taylor Palmieri: New page: {{Template:Hypertension}} {{CMG}} &#039;&#039;&#039;Associate Editor in Chief&#039;&#039;&#039;: Firas Ghanem, M.D. and Atif Mohammad, M.D. {{EH}} ==Lifestyle Modification (nonpharmacologic treatment)== * [[weight ...</p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Lifestyle Modification (nonpharmacologic treatment)==<br /> * [[weight loss|Weight reduction]] and regular aerobic exercise (e.g. jogging) are recommended as the first steps in treating mild to moderate hypertension. Regular mild exercise improves blood flow and helps to reduce resting heart rate and blood pressure. These steps are highly effective in reducing blood pressure, although drug therapy is still necessary for many patients with moderate or severe hypertension to bring their blood pressure down to a safe level. <br /> <br /> * Reducing [[sodium chloride|sodium (salt)]] [[Dieting|diet]] is proven very effective: it decreases blood pressure in about 60% of people (see above). Many people choose to use a [[salt substitute]] to reduce their salt intake.<br /> <br /> * Additional dietary changes beneficial to reducing blood pressure includes the [[DASH diet]] (Dietary Approaches to Stop Hypertension), which is rich in fruits and vegetables and low fat or fat-free dairy foods. This diet is shown effective based on National Institutes of Health sponsored research. In addition, an increase in daily calcium intake has also been shown to be highly effective in reducing blood pressure. Fruits, vegetables, and nuts have the added benefit of increasing dietary [[potassium]], which theoretically can offset the effect of sodium and act on the kidney to decrease blood pressure. <br /> <br /> * Discontinuing [[tobacco smoking]] and alcohol drinking has been shown to lower blood pressure. The exact mechanisms are not fully understood, but blood pressure (especially systolic) always transiently increases following alcohol and/or nicotine consumption. Besides, abstention from cigarette smoking is important for people with hypertension because it reduces the risk of many dangerous outcomes of hypertension, such as stroke and heart attack. Note that coffee drinking (caffeine ingestion) also increases blood pressure transiently, but does ''not'' produce chronic hypertension.<br /> <br /> * Relaxation therapy, such as meditation, that reduces environmental stress, [[Noise health effects|high sound levels]] and [[over-illumination]] can be an additional method of ameliorating hypertension. [[Biofeedback]] is also used [http://www.mayoclinic.org/news2006-rst/3334.html] particularly device guided paced breathing [http://www.emaxhealth.com/106/5912.html] [http://www.medscape.com/viewarticle/539099]. Obviously, the effectiveness of relaxation therapy relies on the patient's attitude and compliance.<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_epidemiology_and_demographics&diff=575695 Chronic hypertension epidemiology and demographics 2011-06-29T13:49:17Z <p>Taylor Palmieri: </p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Epidemiology &amp; Demographics==<br /> The level of blood pressure regarded as deleterious has been revised down during years of epidemiological studies. A widely quoted and important series of such studies is the [[Framingham Heart Study]] carried out in an American town: Framingham, Massachusetts. The results from Framingham and of similar work in Busselton, Western Australia have been widely applied. To the extent that people are similar this seems reasonable, but there are known to be genetic variations in the most effective drugs for particular sub-populations. Recently (2004), the Framingham figures have been found to overestimate risks for the UK population considerably. The reasons are unclear. Nevertheless the Framingham work has been an important element of UK health policy.<br /> <br /> ===Impact of race===<br /> {{seealso|Race and health}}<br /> In a summary of recent research Jules P. Harrell, Sadiki Hall, and James Taliaferro describe how a growing body of research has explored the impact of encounters with racism or discrimination on physiological activity. &quot;Several of the studies suggest that higher blood pressure levels are associated with the tendency not to recall or report occurrences identified as racist and discriminatory.&quot;&lt;ref&gt;[http://www.ajph.org/cgi/content/abstract/93/2/243 Physiological Responses to Racism and Discrimination: An Assessment of the Evidence]&lt;/ref&gt; In other words, failing to recognize instances of racism has a direct impact on the blood pressure of the person experiencing the racist event. Investigators have reported that physiological arousal is associated with laboratory analogues of ethnic discrimination and mistreatment.<br /> <br /> The interaction between high blood pressure and racism has also been documented in studies by [[Claude Steele]], Joshua Aronson, and Steven Spencer on what they term &quot;stereotype threat&quot;.&lt;ref&gt;African Americans and high blood pressure: the role of stereotype threat. Blascovich J, Spencer SJ, Quinn D and Steele C. Department of Psychology, University of California, Santa Barbara 93106, USA.&lt;/ref&gt;<br /> <br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_epidemiology_and_demographics&diff=575692 Chronic hypertension epidemiology and demographics 2011-06-29T13:43:42Z <p>Taylor Palmieri: New page: {{Template:Hypertension}} {{CMG}} &#039;&#039;&#039;Associate Editor in Chief&#039;&#039;&#039;: Firas Ghanem, M.D. and Atif Mohammad, M.D. {{EH}} ==Epidemiology== The level of blood pressure regarded as deleteriou...</p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Epidemiology==<br /> The level of blood pressure regarded as deleterious has been revised down during years of epidemiological studies. A widely quoted and important series of such studies is the [[Framingham Heart Study]] carried out in an American town: Framingham, Massachusetts. The results from Framingham and of similar work in Busselton, Western Australia have been widely applied. To the extent that people are similar this seems reasonable, but there are known to be genetic variations in the most effective drugs for particular sub-populations. Recently (2004), the Framingham figures have been found to overestimate risks for the UK population considerably. The reasons are unclear. Nevertheless the Framingham work has been an important element of UK health policy.<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_physical_examination&diff=575686 Chronic hypertension physical examination 2011-06-29T13:28:31Z <p>Taylor Palmieri: New page: {{Template:Hypertension}} {{CMG}} &#039;&#039;&#039;Associate Editor in Chief&#039;&#039;&#039;: Firas Ghanem, M.D. and Atif Mohammad, M.D. {{EH}} ==Physical Examination== * Look for end organ disease: *:* [[Corona...</p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Physical Examination==<br /> * Look for end organ disease:<br /> *:* [[Coronary Artery Disease]] (CAD) symptoms<br /> *:* Retinal hemorrhage<br /> *:* Retinalvenous crossing changes<br /> *:* Vascular disease<br /> * Heart exam<br /> * Lung exam<br /> * Neurological Examination<br /> * Possible symptoms:<br /> *:* [[Osteoporosis]]<br /> *:* [[Obesity]]<br /> *:* Muscle weakness<br /> *:* Moon facies<br /> *:* [[Hirsutism]]<br /> *:* Elevated lipids<br /> *:* Elevated sugar<br /> *:* Low [[potassium]]<br /> *:* Elevated [[creatinine]]<br /> *:* [[Ddx:Headache|Headaches]]<br /> *:* [[Palpitation]]s<br /> *:* Diaphoresis<br /> *:* Labile blood pressure<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_blood_pressure_measurement&diff=575679 Chronic hypertension blood pressure measurement 2011-06-29T13:11:13Z <p>Taylor Palmieri: New page: {{Template:Hypertension}} {{CMG}} &#039;&#039;&#039;Associate Editor in Chief&#039;&#039;&#039;: Firas Ghanem, M.D. and Atif Mohammad, M.D. {{EH}} ==Measuring Blood Pressure== Diagnosis of hypertension is generally...</p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Measuring Blood Pressure==<br /> Diagnosis of hypertension is generally on the basis of a persistently high blood pressure. Usually this requires three separate measurements at least one week apart. Exceptionally, if the elevation is extreme, or end-organ damage is present then the diagnosis may be applied and treatment commenced immediately.<br /> <br /> Obtaining reliable blood pressure measurements relies on following several rules and understanding the many factors that influence blood pressure reading&lt;ref name=&quot;pmid7707630&quot;&gt;{{cite journal| author=Reeves RA| title=The rational clinical examination. Does this patient have hypertension? How to measure blood pressure. | journal=JAMA | year= 1995 | volume= 273 | issue= 15 | pages= 1211-8 | pmid=7707630 | doi=10.1001/jama.1995.03520390071036|}} &lt;/ref&gt;.<br /> <br /> For instance, measurements in control of hypertension should be at least 1 hour after caffeine, 30 minutes after smoking and without any stress. Cuff size is also important. The bladder should encircle and cover two-thirds of the length of the arm. The patient should be sitting for a minimum of five minutes. The patient should not be on any adrenergic stimulants, such as those found in many cold medications. <br /> <br /> When taking manual measurements, the person taking the measurement should be careful to inflate the cuff suitably above anticipated systolic pressure. The person should inflate the cuff to 200 mmHg and then slowly release the air while palpating the radial pulse. After one minute, the cuff should be reinflated to 30 mmHg higher than the pressure at which the radial pulse was no longer palpable. A stethoscope should be placed lightly over the brachial artery. The cuff should be at the level of the heart and the cuff should be deflated at a rate of 2 to 3 mmHg/s. Systolic pressure is the pressure reading at the onset of the [[Korotkoff sound|sounds]] described by [[Nikolai Korotkoff|Korotkoff]] (Phase one). Diastolic pressure is then recorded as the pressure at which the sounds disappear (K5) or sometimes the K4 point, where the sound is abruptly muffled. Two measurements should be made at least 5 minutes apart, and, if there is a discrepancy of more than 5 mmHg, a third reading should be done. The readings should then be averaged. An initial measurement should include both arms. In elderly patients who particularly when treated may show orthostatic hypotension, measuring lying sitting and standing BP may be useful. The BP should at some time have been measured in each arm, and the higher pressure arm preferred for subsequent measurements.<br /> <br /> BP varies with time of day, as may the effectiveness of treatment, and [[Medical informatics|archetypes]] used to record the data should include the time taken. Analysis of this is rare at present.<br /> <br /> Automated machines are commonly used and reduce the variability in manually collected readings &lt;ref name=&quot;pmid2294682&quot;&gt;{{cite journal | author = White W, Lund-Johansen P, Omvik P | title = Assessment of four ambulatory blood pressure monitors and measurements by clinicians versus intraarterial blood pressure at rest and during exercise. | journal = Am J Cardiol | volume = 65 | issue = 1 | pages = 60-6 | year = 1990 | id = PMID 2294682}}&lt;/ref&gt;. Routine measurements done in medical offices of patients with known hypertension may incorrectly diagnose 20% of patients with uncontrolled hypertension &lt;ref name=&quot;pmid16050862&quot;&gt;{{cite journal | author = Kim J, Bosworth H, Voils C, Olsen M, Dudley T, Gribbin M, Adams M, Oddone E | title = How well do clinic-based blood pressure measurements agree with the mercury standard? | journal = J Gen Intern Med | volume = 20 | issue = 7 | pages = 647-9 | year = 2005 | id = PMID 16050862}}&lt;/ref&gt;<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Template:Hypertension&diff=575676 Template:Hypertension 2011-06-29T13:03:42Z <p>Taylor Palmieri: </p> <hr /> <div>{| class=&quot;infobox bordered&quot; style=&quot;width: 15em; text-align: left; font-size: 90%; background:AliceBlue&quot;<br /> |-<br /> | colspan=&quot;1&quot; style=&quot;text-align:center; background:DarkGray&quot; |<br /> <br /> '''Hypertension Microchapters<br /> '''<br /> |- bgcolor=&quot;LightGrey&quot;<br /> !<br /> <br /> |- bgcolor=&quot;LightCoral&quot;<br /> !<br /> [[Hypertension|Home]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension (patient information)|Patient Info]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension overview|Overview]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension classification|Classification]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension pathophysiology|Pathophysiology]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension epidemiology and demographics|Epidemiology &amp; Demographics]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension risk factors|Risk Factors]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension screening|Screening]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension natural history|Natural History, Complications &amp; Prognosis]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension causes|Causes of Hypertension]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension differential diagnosis|Differentiating Hypertension from other Diseases]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;CornFlowerBlue&quot;<br /> !<br /> Diagnosis<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension history and symptoms|History &amp; Symptoms]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension blood pressure|Blood Pressure]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension physical examination|Physical Examination]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension laboratory tests|Lab Tests]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension electrocardiogram|Electrocardiogram]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension chest x ray|Chest X Ray]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension MRI|MRI]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension CT|CT]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension echocardiography or ultrasound|Echocardiography or Ultrasound]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension other imaging findings|Other Imaging Findings]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension other diagnostic studies|Other Diagnostic Studies]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;CadetBlue&quot;<br /> !<br /> Treatment<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> [[Hypertension medical therapy|Medical Therapy]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> [[Hypertension surgery|Surgery]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> [[Hypertension primary prevention|Primary Prevention]]<br /> |- <br /> ! <br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> [[Hypertension secondary prevention|Secondary Prevention]]<br /> |- <br /> ! <br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> [[Hypertension cost-effectiveness of therapy|Cost-Effectiveness of Therapy]]<br /> |- <br /> ! <br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> [[Hypertension future or investigational therapies|Future or Investigational Therapies]]<br /> |- <br /> ! <br /> <br /> |- bgcolor=&quot;PaleGoldenrod &quot;<br /> !<br /> {{PAGENAME}} On the Web<br /> |- <br /> ! <br /> <br /> |- bgcolor=&quot;LightYellow&quot;<br /> !<br /> [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&amp;db=pubmed&amp;term={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}} Most recent articles]<br /> |- <br /> ! <br /> <br /> |- bgcolor=&quot;LightYellow&quot;<br /> !<br /> [http://scholar.google.com/scholar?ie=UTF-8&amp;oe=utf-8&amp;q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}&amp;qt_s=Search&amp;sa=N&amp;tab=ps Most cited articles]<br /> |- <br /> ! 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The [http://www.mayoclinic.com/health/high-blood-pressure/DS00100/DSECTION=6 Mayo Clinic website] specifies blood pressure is &quot;normal if it's below 120/80&quot; but that &quot;some data indicate that 115/75 mm Hg should be the gold standard.&quot; In patients with [[diabetes mellitus]] or [[Nephropathy|kidney disease]] studies have shown that blood pressure over 130/80 mmHg should be considered high and warrants further treatment. Even lower numbers are considered diagnostic using home blood pressure monitoring devices.<br /> {| <br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''''Blood Pressure''''' || '''''Systolic''''' (mm Hg) || '''''Diastolic''''' (mm Hg) <br /> |-style=&quot;background:silver; color:black&quot; <br /> | '''Optimal''' || '''&lt; 120''' || '''&lt; 80'''<br /> |- style=&quot;background:silver; color:black&quot;<br /> | '''Normal''' || '''&lt; 130''' || '''&lt; 85'''<br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''High Normal''' || '''130-139''' || '''85-89'''<br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''Mild Hypertension''' || '''140-159''' || '''90-99'''<br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''Moderate Hypertension''' || '''160-179''' || '''100-109'''<br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''Severe Hypertension''' || '''180-209''' || '''110-119'''<br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''Very Severe Hypertension''' || '''&gt; 210''' || '''&gt; 120''' <br /> |}<br /> <br /> <br /> ==Distinguishing primary vs. secondary hypertension==<br /> Once the diagnosis of hypertension has been made it is important to attempt to exclude or identify reversible (secondary) causes. <br /> * Over 90% of adult hypertension has no clear cause and is therefore called '''essential/primary hypertension'''. Often, it is part of the [[metabolic syndrome|metabolic &quot;syndrome X&quot;]] in patients with [[insulin resistance]]: it occurs in combination with [[diabetes mellitus]] (type 2), [[combined hyperlipidemia]] and [[central obesity]]. <br /> * [[Secondary hypertension]] is more common in preadolescent children, with most cases caused by [[renal disease]]. Primary or [[essential hypertension]] is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension. &lt;ref name=&quot;pmid16719248&quot;&gt;{{cite journal | author = Luma GB, Spiotta RT | title = Hypertension in children and adolescents. | journal = Am Fam Physician | volume = 73 | issue = 9 | pages = 1558-68 | month = may | year = 2006 | id = PMID 16719248}}&lt;/ref&gt;<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Hyptertension_classification&diff=575672 Hyptertension classification 2011-06-29T12:45:39Z <p>Taylor Palmieri: Hyptertension classification moved to Hypertension classification</p> <hr /> <div>#REDIRECT [[Hypertension classification]]</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_classification&diff=575671 Chronic hypertension classification 2011-06-29T12:45:39Z <p>Taylor Palmieri: Hyptertension classification moved to Hypertension classification</p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Classification of Hypertension==<br /> Hypertension is considered to be present when a person's [[systole (medicine)|systolic]] blood pressure is consistently 140 mmHg or greater, and/or their [[diastole|diastolic]] blood pressure is consistently 90&amp;nbsp;mmHg or greater.&lt;ref&gt;http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&amp;index=6693&lt;/ref&gt; Recently, as of 2003, the ''Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure''&lt;ref name=&quot;jnc7&quot;&gt;{{<br /> cite journal<br /> |url=http://jama.ama-assn.org/cgi/content/full/289.19.2560v1<br /> |author=Chobanian AV et al<br /> |journal=[[Journal of the American Medical Association|JAMA]]<br /> |title=The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.<br /> |year = 2003<br /> |volume = 289<br /> |pages = 2560-72<br /> |pmid = 12748199<br /> }}&lt;/ref&gt; has defined blood pressure 120/80 mmHg to 139/89 mmHg as &quot;prehypertension.&quot; Prehypertension is not a disease category; rather, it is a designation chosen to identify individuals at high risk of developing hypertension. The [http://www.mayoclinic.com/health/high-blood-pressure/DS00100/DSECTION=6 Mayo Clinic website] specifies blood pressure is &quot;normal if it's below 120/80&quot; but that &quot;some data indicate that 115/75 mm Hg should be the gold standard.&quot; In patients with [[diabetes mellitus]] or [[Nephropathy|kidney disease]] studies have shown that blood pressure over 130/80 mmHg should be considered high and warrants further treatment. Even lower numbers are considered diagnostic using home blood pressure monitoring devices.<br /> {| <br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''''Blood Pressure''''' || '''''Systolic''''' (mm Hg) || '''''Diastolic''''' (mm Hg) <br /> |-style=&quot;background:silver; color:black&quot; <br /> | '''Optimal''' || '''&lt; 120''' || '''&lt; 80'''<br /> |- style=&quot;background:silver; color:black&quot;<br /> | '''Normal''' || '''&lt; 130''' || '''&lt; 85'''<br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''High Normal''' || '''130-139''' || '''85-89'''<br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''Mild Hypertension''' || '''140-159''' || '''90-99'''<br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''Moderate Hypertension''' || '''160-179''' || '''100-109'''<br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''Severe Hypertension''' || '''180-209''' || '''110-119'''<br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''Very Severe Hypertension''' || '''&gt; 210''' || '''&gt; 120''' <br /> |}<br /> <br /> ==Distinguishing primary vs. secondary hypertension==<br /> Once the diagnosis of hypertension has been made it is important to attempt to exclude or identify reversible (secondary) causes. <br /> * Over 90% of adult hypertension has no clear cause and is therefore called '''essential/primary hypertension'''. Often, it is part of the [[metabolic syndrome|metabolic &quot;syndrome X&quot;]] in patients with [[insulin resistance]]: it occurs in combination with [[diabetes mellitus]] (type 2), [[combined hyperlipidemia]] and [[central obesity]]. <br /> * [[Secondary hypertension]] is more common in preadolescent children, with most cases caused by [[renal disease]]. Primary or [[essential hypertension]] is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension. &lt;ref name=&quot;pmid16719248&quot;&gt;{{cite journal | author = Luma GB, Spiotta RT | title = Hypertension in children and adolescents. | journal = Am Fam Physician | volume = 73 | issue = 9 | pages = 1558-68 | month = may | year = 2006 | id = PMID 16719248}}&lt;/ref&gt;<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Template:Hypertension&diff=575670 Template:Hypertension 2011-06-29T12:43:58Z <p>Taylor Palmieri: </p> <hr /> <div>{| class=&quot;infobox bordered&quot; style=&quot;width: 15em; text-align: left; font-size: 90%; background:AliceBlue&quot;<br /> |-<br /> | colspan=&quot;1&quot; style=&quot;text-align:center; background:DarkGray&quot; |<br /> <br /> '''Hypertension Microchapters<br /> '''<br /> |- bgcolor=&quot;LightGrey&quot;<br /> !<br /> <br /> |- bgcolor=&quot;LightCoral&quot;<br /> !<br /> [[Hypertension|Home]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension (patient information)|Patient Info]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension overview|Overview]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension classification|Classification]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension pathophysiology|Pathophysiology]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension epidemiology and demographics|Epidemiology &amp; Demographics]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension risk factors|Risk Factors]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension screening|Screening]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension natural history|Natural History, Complications &amp; Prognosis]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension causes|Causes of Hypertension]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;Pink&quot;<br /> !<br /> [[Hypertension differential diagnosis|Differentiating Hypertension from other Diseases]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;CornFlowerBlue&quot;<br /> !<br /> Diagnosis<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension history and symptoms|History &amp; Symptoms]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension physical examination|Physical Examination]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension laboratory tests|Lab Tests]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension electrocardiogram|Electrocardiogram]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension chest x ray|Chest X Ray]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension MRI|MRI]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension CT|CT]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension echocardiography or ultrasound|Echocardiography or Ultrasound]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension other imaging findings|Other Imaging Findings]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;LightSkyBlue&quot;<br /> !<br /> [[Hypertension other diagnostic studies|Other Diagnostic Studies]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;CadetBlue&quot;<br /> !<br /> Treatment<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> [[Hypertension medical therapy|Medical Therapy]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> [[Hypertension surgery|Surgery]]<br /> |- <br /> !<br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> [[Hypertension primary prevention|Primary Prevention]]<br /> |- <br /> ! <br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> [[Hypertension secondary prevention|Secondary Prevention]]<br /> |- <br /> ! <br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> [[Hypertension cost-effectiveness of therapy|Cost-Effectiveness of Therapy]]<br /> |- <br /> ! <br /> <br /> |- bgcolor=&quot;PaleTurquoise&quot;<br /> !<br /> [[Hypertension future or investigational therapies|Future or Investigational Therapies]]<br /> |- <br /> ! <br /> <br /> |- bgcolor=&quot;PaleGoldenrod &quot;<br /> !<br /> {{PAGENAME}} On the Web<br /> |- <br /> ! <br /> <br /> |- bgcolor=&quot;LightYellow&quot;<br /> !<br /> [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&amp;db=pubmed&amp;term={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}} Most recent articles]<br /> |- <br /> ! <br /> <br /> |- bgcolor=&quot;LightYellow&quot;<br /> !<br /> [http://scholar.google.com/scholar?ie=UTF-8&amp;oe=utf-8&amp;q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|{{PAGENAME}}}}}}&amp;qt_s=Search&amp;sa=N&amp;tab=ps Most cited articles]<br /> |- <br /> ! 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Hypertension can be classified as either '''essential''' (primary) or '''secondary'''. Essential hypertension indicates that no specific medical cause can be found to explain a patient's condition. [[Secondary hypertension]] indicates that the high blood pressure is a result of (i.e. secondary to) another condition, such as [[kidney disease]] or certain [[tumor]]s (especially of the [[adrenal gland]]). Persistent hypertension is one of the risk factors for [[stroke]]s, [[myocardial infarction|heart attacks]], [[heart failure]] and arterial [[aneurysm]], and is a leading cause of [[chronic renal failure]]. Even moderate elevation of arterial blood pressure leads to shortened life expectancy. At severely high pressures, mean arterial pressures 50% or more above average, a person can expect to live no more than just a few years unless appropriately treated.&lt;ref&gt;Textbook of Medical Physiology, 7th Ed., Guyton &amp; Hall, Elsevier-Saunders, ISBN 0-7216-0240-1, page 220.&lt;/ref&gt;<br /> <br /> Hypertension is considered to be present when a person's [[systole (medicine)|systolic]] blood pressure is consistently 140 mmHg or greater, and/or their [[diastole|diastolic]] blood pressure is consistently 90&amp;nbsp;mmHg or greater.&lt;ref&gt;http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&amp;index=6693&lt;/ref&gt; Recently, as of 2003, the ''Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure''&lt;ref name=&quot;jnc7&quot;&gt;{{<br /> cite journal<br /> |url=http://jama.ama-assn.org/cgi/content/full/289.19.2560v1<br /> |author=Chobanian AV et al<br /> |journal=[[Journal of the American Medical Association|JAMA]]<br /> |title=The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.<br /> |year = 2003<br /> |volume = 289<br /> |pages = 2560-72<br /> |pmid = 12748199<br /> }}&lt;/ref&gt; has defined blood pressure 120/80 mmHg to 139/89 mmHg as &quot;prehypertension.&quot; Prehypertension is not a disease category; rather, it is a designation chosen to identify individuals at high risk of developing hypertension. The [http://www.mayoclinic.com/health/high-blood-pressure/DS00100/DSECTION=6 Mayo Clinic website] specifies blood pressure is &quot;normal if it's below 120/80&quot; but that &quot;some data indicate that 115/75 mm Hg should be the gold standard.&quot; In patients with [[diabetes mellitus]] or [[Nephropathy|kidney disease]] studies have shown that blood pressure over 130/80 mmHg should be considered high and warrants further treatment. Even lower numbers are considered diagnostic using home blood pressure monitoring devices.<br /> {| <br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''''Blood Pressure''''' || '''''Systolic''''' (mm Hg) || '''''Diastolic''''' (mm Hg) <br /> |-style=&quot;background:silver; color:black&quot; <br /> | '''Optimal''' || '''&lt; 120''' || '''&lt; 80'''<br /> |- style=&quot;background:silver; color:black&quot;<br /> | '''Normal''' || '''&lt; 130''' || '''&lt; 85'''<br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''High Normal''' || '''130-139''' || '''85-89'''<br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''Mild Hypertension''' || '''140-159''' || '''90-99'''<br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''Moderate Hypertension''' || '''160-179''' || '''100-109'''<br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''Severe Hypertension''' || '''180-209''' || '''110-119'''<br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''Very Severe Hypertension''' || '''&gt; 210''' || '''&gt; 120''' <br /> |}<br /> <br /> === Salt sensitivity ===<br /> [[Salt#Health effects|Sodium]] is the environmental factor that has received the greatest attention. Approximately 60% of the essential hypertension population is responsive to sodium intake. This is due to the fact that increasing amounts of salt in a person's bloodstream causes the body to draw more water, increasing the pressure on the blood vessel walls.In addition to sodium,choride plays an important role as it causes volume expansion increasing blood pressure as sodium with combined iwth other anions does not increase blood pressure.&lt;ref&gt;{{cite journal |author=Kurtz TW, Al-Bander HA, Morris RC |title=&quot;Salt-sensitive&quot; essential hypertension in men. Is the sodium ion alone important? |journal=[[N. Engl. J. Med.]] |volume=317 |issue=17 |pages=1043–8 |year=1987 |month=October |pmid=3309653 |doi= |url=}}&lt;/ref&gt;<br /> Also salt sensitivity is known to be increased in increasing age,obesity,African americans and metabolic syndrome.&lt;ref&gt;{{cite journal |author=Obarzanek E, Proschan MA, Vollmer WM, ''et al.'' |title=Individual blood pressure responses to changes in salt intake: results from the DASH-Sodium trial |journal=[[Hypertension]] |volume=42 |issue=4 |pages=459–67 |year=2003 |month=October |pmid=12953018 |doi=10.1161/01.HYP.0000091267.39066.72 |url=http://hyper.ahajournals.org/cgi/pmidlookup?view=long&amp;pmid=12953018}}&lt;/ref&gt;<br /> ====Mechanisms====<br /> The known mechanisms for salt-sensitvity is incraesed salt intake over a long period of time leads to impaired excretion of salt which causes hypertension.But there are several other pathways involved in the pathophysiology of salt-sensitivity leading to hypertension.A recent study showed that salt-sensitive patients are known to have a dysregulated Renin-Angiotensin pathway and patients show an abnormal vascular response to Angiotensin II.&lt;ref&gt;{{cite journal |author=Chamarthi B, Williams JS, Williams GH |title=A mechanism for salt-sensitive hypertension: abnormal dietary sodium-mediated vascular response to angiotensin-II |journal=[[J. Hypertens.]] |volume=28 |issue=5 |pages=1020–6 |year=2010 |month=May |pmid=20216091 |doi=10.1097/HJH.0b013e3283375974 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0263-6352&amp;volume=28&amp;issue=5&amp;spage=1020}}&lt;/ref&gt;<br /> Increased sodium re absorption, though not well understood is mostly related abnormalities across Na-H proximal tubule channels,Na-K-Cl co-transporter across the thick ascending limb,Na-Cl distal tubule co-transporter and epithelial Na channels.Dietary deficiency in potassium is also known to trigger increased sodium sensitivity in patients in particular African-Americans, but the mechanism is still not clearly determined.<br /> <br /> <br /> === Role of renin ===<br /> [[Renin]] is a [[hormone]] secreted by the [[juxtaglomerular cell]]s of the kidney and linked with [[aldosterone]] in a negative feedback loop. The range of renin activity observed in hypertensive subjects tends to be broader than in normotensive individuals. In consequence, some hypertensive patients have been defined as having low-renin and others as having essential hypertension. Low-renin hypertension is more common in African Americans than Caucasians and may explain why they tend to respond better to diuretic therapy than drugs that interfere with the renin-angiotensin system.<br /> <br /> High Renin levels predispose to Hypertension:<br /> Increased Renin --&gt; Increased Angiotensin II --&gt; Increased Vasoconstriction, Thirst/ADH and Aldosterone --&gt; Increased Sodium Reabsorption in the Kidneys (DCT and CD) --&gt; Increased Blood Pressure.<br /> <br /> === Insulin resistance ===<br /> [[Insulin]] is a polypeptide [[hormone]] secreted by the [[pancreas]]. Its main purpose is to regulate the levels of [[glucose]] in the body antagonistically with [[glucagon]] through negative feedback loops. Insulin also exhibits vasodilatory properties. In normotensive individuals, insulin may stimulate sympathetic activity without elevating mean arterial pressure. However, in more extreme conditions such as that of the metabolic syndrome, the increased sympathetic neural activity may over-ride the vasodilatory effects of insulin. Insulin resistance and/or [[hyperinsulinemia]] have been suggested as being responsible for the increased arterial pressure in some patients with hypertension. This feature is now widely recognized as part of [[metabolic syndrome|syndrome X]], or the [[metabolic syndrome]].<br /> <br /> === Sleep apnea ===<br /> [[Sleep apnea]] is a common, under-recognized cause of hypertension.&lt;ref name=&quot;Sleep Apnea&quot;&gt;{{<br /> cite journal<br /> |url=http://www.aafp.org/afp/20020115/229.html<br /> |author=Silverberg DS, Iaina A and Oksenberg A<br /> |journal=American Family Physicians<br /> |title=Treating Obstructive Sleep Apnea Improves Essential Hypertension and Quality of Life<br /> |year = 2002<br /> |month = January<br /> |volume = 65<br /> |issue = 2<br /> |pages = 229-36<br /> |pmid = 11820487<br /> }}&lt;/ref&gt; It is best treated with [[UPPP]], [[tonsilectomy]], [[adenoidectomy]], [[sinus surgery]], or weight loss, nocturnal nasal [[CPAP|positive airway pressure]], or the [[Mandibular advancement splint]] (MAS).<br /> <br /> === Genetics ===<br /> Hypertension is one of the most common complex disorders, with genetic [[heritability]] averaging 30%. Data supporting this view emerge from animal studies as well as in population studies in humans. Most of these studies support the concept that the inheritance is probably multifactorial or that a number of different genetic defects each have an elevated blood pressure as one of their [[phenotypic]] expressions.<br /> <br /> More than 50 genes have been examined in association studies with hypertension, and the number is constantly growing.<br /> <br /> === Other etiologies ===<br /> There are some anecdotal or transient causes of high blood pressure. These are not to be confused with the disease called hypertension in which there is an intrinsic physiopathological mechanism as described below.<br /> <br /> == Etiology of secondary hypertension ==<br /> Only in a small minority of patients with elevated arterial pressure, can a specific cause be identified. These individuals will probably have an [[endocrine]] or renal defect that, if corrected, could bring blood pressure back to normal values.<br /> <br /> ;Renal hypertension<br /> :Hypertension produced by diseases of the [[kidney]]. This includes diseases such as [[polycystic kidney disease]] or chronic [[glomerulonephritis]]. Hypertension can also be produced by diseases of the [[renal artery|renal arteries]] supplying the kidney. This is known as [[renovascular hypertension]]; it is thought that decreased perfusion of renal tissue due to [[stenosis]] of a main or branch renal artery activates the renin-angiotensin system.<br /> <br /> ;Adrenal hypertension<br /> :Hypertension is a feature of a variety of adrenal cortical abnormalities. In primary [[aldosteronism]] there is a clear relationship between the aldosterone-induced sodium retention and the hypertension.<br /> <br /> :In patients with [[pheochromocytoma]] increased secretion of [[catecholamines]] such as [[epinephrine]] and [[norepinephrine]] by a tumor (most often located in the adrenal medulla) causes excessive stimulation of [adrenergic receptors], which results in peripheral vasoconstriction and cardiac stimulation. This diagnosis is confirmed by demonstrating increased urinary excretion of epinephrine and norepinephrine and/or their metabolites ([[vanillylmandelic acid]]).<br /> <br /> ;[[Coarctation of the aorta]]<br /> <br /> ;Diet<br /> :The North American diet that is high in fat and salt has been proven to exacerbate hypertension. A study in the U.S. found that patients placed on a strict [[vegetarian]] diet showed a significant benefit to their condition over the one year. Certain medications, especially NSAIDS (Motrin/ibuprofen) and steroids can cause hypertension. Imported licorice (''Glycyrrhiza glabra'') inhibits the 11-hydroxysteroid hydrogenase enzyme (catalyzes the reaction of cortisol to cortison) which allows cortisol to stimulate the Mineralocorticoid Receptor (MR) which will lead to effects similar to hyperaldosteronism, which itself is a cause of hypertension. [Reference: Harrisons Internal Medicine, online edition (2007-04-14)]<br /> <br /> ;Age<br /> :Over time, the number of [[collagen]] fibers in artery and arteriole walls increases, making blood vessels stiffer. With the reduced elasticity comes a smaller cross-sectional area in systole, and so a raised mean arterial blood pressure.<br /> <br /> ;[[Acromegaly]]<br /> <br /> == Pathophysiology ==<br /> Most of the secondary mechanisms associated with hypertension are generally fully understood, and are outlined at [[secondary hypertension]]. However, those associated with essential (primary) hypertension are far less understood. What is known is that [[cardiac output]] is raised early in the disease course, with [[total peripheral resistance]] (TPR) normal; over time cardiac output drops to normal levels but TPR is increased. Three theories have been proposed to explain this:<br /> * Inability of the kidneys to excrete sodium, resulting in [[natriuretic]] factors such as [[Atrial Natriuretic Factor]] being secreted to promote salt excretion with the side-effect of raising total peripheral resistance.<br /> * An overactive [[renin / angiotension system]] leads to [[vasoconstriction]] and retention of sodium and water. The increase in blood volume leads to hypertension.<br /> * An overactive [[sympathetic nervous system]], leading to increased stress responses.<br /> It is also known that hypertension is highly heritable and [[polygenic]] (caused by more than one gene) and a few candidate [[genes]] have been postulated in the etiology of this condition.&lt;ref name=&quot;polymorphism&quot;&gt;{{cite journal |author= Sagnella GA, Swift PA |journal=Current Pharmaceutical Design |title=The Renal Epithelial Sodium Channel: Genetic Heterogeneity and Implications for the Treatment of High Blood Pressure |year = 2006 |month = June |volume = 12 |issue = 14 |pages = 2221-2234 |id = PMID 16787251}}&lt;/ref&gt;&lt;ref name=&quot;polymorphism2&quot;&gt;{{cite journal |author= Johnson JA, Turner ST |journal=Current Opinion in Molecular Therapy |title=Hypertension pharmacogenomics: current status and future directions. |year = 2005 |month = June |volume = 7 |issue = 3 |pages = 218-225 |id = PMID 15977418}}&lt;/ref&gt;&lt;ref name=&quot;polymorphism3&quot;&gt;{{cite journal|author= Hideo Izawa; Yoshiji Yamada et al |journal=Hypertension |title=Prediction of Genetic Risk for Hypertension |year = 2003 |month = May |volume = 41 |issue = 5 |pages = 1035-1040 |id = PMID 12654703 | url=http://hyper.ahajournals.org/cgi/content/short/01.HYP.0000065618.56368.24v1}}&lt;/ref&gt;<br /> <br /> == Signs and symptoms ==<br /> Hypertension is usually found incidentally - &quot;case finding&quot; - by healthcare professionals during a routine checkup. The only test for hypertension is a blood pressure measurement. Hypertension in isolation usually produces no symptoms although some people report headaches, fatigue, dizziness, blurred vision, facial flushing or [[tinnitus]]. &lt;ref&gt;{{cite web|url=http://www.treatment-for.com/high-blood-pressure-symptoms.htm|title=Symptoms of High Blood Pressure}}&lt;/ref&gt;<br /> <br /> [[Malignant hypertension]] (or accelerated hypertension) is distinct as a late phase in the condition, and may present with headaches, blurred vision and end-organ damage.<br /> <br /> Hypertension is often confused with mental tension, stress and anxiety. While chronic anxiety is associated with poor outcomes in people with hypertension, it alone does not cause it. Accelerated hypertension is associated with somnolence, confusion, visual disturbances, and nausea and vomiting (hypertensive encephalopathy). &lt;ref name=health.am&gt;{{cite web | H. Michael MacMay, MD, MPH; Michael Sutters, MD | title =Hypertension symptoms and signs | publisher=Armenian Medical Network | work =Systemic Hypertension - Hypertension Health Center | url=http://www.health.am/hypertension/hypertension-symptoms-and-signs/ | year = 2006}}&lt;/ref&gt;<br /> <br /> === Hypertensive urgencies and emergencies ===<br /> Hypertension is rarely severe enough to cause symptoms. These typically only surface with a [[systolic blood pressure]] over 240 mmHg and/or a [[diastolic blood pressure]] over 120 mmHg. These pressures without signs of end-organ damage (such as renal failure) are termed &quot;accelerated&quot; hypertension. When end-organ damage is possible or already ongoing, but in absence of raised [[intracranial pressure]], it is called [[hypertensive emergency]]. Hypertension under this circumstance needs to be controlled, but prolonged hospitalization is not necessarily required. When hypertension causes increased intracranial pressure, it is called [[malignant hypertension]]. Increased intracranial pressure causes [[papilledema]], which is visible on [[ophthalmoscopy|ophthalmoscopic]] examination of the [[retina]].<br /> <br /> === Complications ===<br /> While elevated blood pressure alone is not an illness, it often requires treatment due to its short- and long-term effects on many organs. The risk is increased for:<br /> * [[Cerebrovascular accident]] (CVAs or strokes)<br /> * [[Myocardial infarction]] (heart attack)<br /> * [[Hypertensive cardiomyopathy]] ([[heart failure]] due to chronically high blood pressure)<br /> * [[Hypertensive retinopathy]] - damage to the [[retina]]<br /> * [[Hypertensive nephropathy]] - [[chronic renal failure]] due to chronically high blood pressure<br /> <br /> === Pregnancy ===<br /> {{main|Hypertension of pregnancy}}<br /> Although few women of childbearing age have high blood pressure, up to 10% develop [[hypertension of pregnancy]]. While generally benign, it may herald three complications of pregnancy: [[pre-eclampsia]], [[HELLP syndrome]] and [[eclampsia]]. Follow-up and control with medication is therefore often necessary.<br /> <br /> ===Children and adolescents ===<br /> As with adults, blood pressure is a variable parameter in children. It varies between individuals and within individuals from day to day and at various times of the day. The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early development of atherosclerosis in children would make the detection of and intervention in childhood hypertension important to reduce long-term health risks; however, supporting data are lacking. <br /> <br /> Most childhood hypertension, particularly in preadolescents, is secondary to an underlying disorder. Renal parenchymal disease is the most common (60 to 70 percent) cause of hypertension. Adolescents usually have primary or essential hypertension, making up 85 to 95 percent of cases. &lt;ref name=aafp&gt;{{cite web | GREGORY B. LUMA, M.D., and ROSEANN T. SPIOTTA, M.D., Jamaica Hospital Medical Center | title =Hypertension in Children and Adolescents | publisher=American Academy of Family Physicians | work =Hypertension in Children and Adolescents | url=http://www.aafp.org/afp/20060501/1558.html | year = 2006}}&lt;/ref&gt;<br /> ==Complete List of Differential Diagnoses&lt;ref&gt;isbn=140510368X Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:85&lt;/ref&gt;&lt;ref&gt;isbn=1591032016 Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:194-195&lt;/ref&gt;==<br /> * [[Acromegaly]]<br /> * [[Acute Renal Failure]]<br /> * After [[kidney transplantation]]<br /> * [[Alcohol]] withdrawal<br /> * Analgesic [[nephritis]]<br /> * [[Aneurysm]]<br /> * [[Anxiety]]<br /> * [[Aortic isthmus stenosis]]<br /> * [[Aortic Regurgitation]]<br /> * [[Arteriosclerosis]]<br /> * [[Arteriovenous fistula]]<br /> * [[Arteritis]]<br /> * [[Burns]]<br /> * [[Bartter's Syndrome]]<br /> * [[Carcinoid Syndrome]]<br /> * [[Chronic Renal Disease]]<br /> * [[Coarctation of aorta]]<br /> * [[Cocaine]] use<br /> * Compression [[tumor]]<br /> * [[Congenital adrenal hyperplasia]]<br /> * [[Conn's Syndrome]]<br /> * [[Cushing's Syndrome]]<br /> * [[Diabetic nephropathy]]<br /> * Dialysis<br /> * [[Dissection of the aorta]]<br /> * Dissection of the [[renal arteries]]<br /> * [[Drugs]]<br /> * [[Eclampsia]]<br /> * [[Elevated intracranial pressure]]<br /> * Embolism or thrombosis of the [[renal artery]]<br /> * [[Endothelin]] producing tumor<br /> * Fibromuscular hyperplasia<br /> * Gestational hypertension<br /> * [[Guillain-Barre Syndrome]]<br /> * [[Gitelman's Syndrome]]<br /> * [[Hydronephrosis]]<br /> * [[Hyperthyroidism]]<br /> * [[Hyperventilation]]<br /> * [[Hypoglycemia]]<br /> * Interstitial [[nephritis]]<br /> * Kidney involvement in systemic diseases<br /> * [[Liddle's Syndrome]]<br /> * [[Meningitis]]<br /> * [[Obesity]]<br /> * [[Pain]]<br /> * [[Pancreatitis]]<br /> * [[Patent ductus arteriosus]]<br /> * Perioperative<br /> * Perirenal hematoma<br /> * [[Pheochromocytoma]]<br /> * [[Polycystic kidney disease]]<br /> * [[Polycythemia]]<br /> * [[Polyradiculitis]]<br /> * [[Porphyria]]<br /> * Post-exercise<br /> * [[Preeclampsia]]<br /> * [[Pregnancy]]-induced hypertension<br /> * [[Primary hyperaldosteronism]]<br /> * [[Primary hyperparathyroidism]]<br /> * [[Quadriplegia]]<br /> * Reflux nephropathy<br /> * [[Renal Artery Stenosis]]<br /> * [[Renin]] producing tumors<br /> * [[Retroperitoneal Fibrosis]]<br /> * [[Sleep Apnea]]<br /> * [[Stress]]<br /> * [[Third degree AV block]]<br /> * [[Thrombosis]]<br /> * [[Transfusion]] of large blood volumes<br /> * Trauma to the [[renal artery]]<br /> * [[Traumatic brain injury]]<br /> * &quot;White coat&quot; hypertension<br /> <br /> == Diagnosis ==<br /> ===Measuring blood pressure===<br /> Diagnosis of hypertension is generally on the basis of a persistently high blood pressure. Usually this requires three separate measurements at least one week apart. Exceptionally, if the elevation is extreme, or end-organ damage is present then the diagnosis may be applied and treatment commenced immediately.<br /> <br /> Obtaining reliable blood pressure measurements relies on following several rules and understanding the many factors that influence blood pressure reading&lt;ref name=&quot;pmid7707630&quot;&gt;{{cite journal| author=Reeves RA| title=The rational clinical examination. Does this patient have hypertension? How to measure blood pressure. | journal=JAMA | year= 1995 | volume= 273 | issue= 15 | pages= 1211-8 | pmid=7707630 | doi=10.1001/jama.1995.03520390071036|}} &lt;/ref&gt;.<br /> <br /> For instance, measurements in control of hypertension should be at least 1 hour after caffeine, 30 minutes after smoking and without any stress. Cuff size is also important. The bladder should encircle and cover two-thirds of the length of the arm. The patient should be sitting for a minimum of five minutes. The patient should not be on any adrenergic stimulants, such as those found in many cold medications. <br /> <br /> When taking manual measurements, the person taking the measurement should be careful to inflate the cuff suitably above anticipated systolic pressure. The person should inflate the cuff to 200 mmHg and then slowly release the air while palpating the radial pulse. After one minute, the cuff should be reinflated to 30 mmHg higher than the pressure at which the radial pulse was no longer palpable. A stethoscope should be placed lightly over the brachial artery. The cuff should be at the level of the heart and the cuff should be deflated at a rate of 2 to 3 mmHg/s. Systolic pressure is the pressure reading at the onset of the [[Korotkoff sound|sounds]] described by [[Nikolai Korotkoff|Korotkoff]] (Phase one). Diastolic pressure is then recorded as the pressure at which the sounds disappear (K5) or sometimes the K4 point, where the sound is abruptly muffled. Two measurements should be made at least 5 minutes apart, and, if there is a discrepancy of more than 5 mmHg, a third reading should be done. The readings should then be averaged. An initial measurement should include both arms. In elderly patients who particularly when treated may show orthostatic hypotension, measuring lying sitting and standing BP may be useful. The BP should at some time have been measured in each arm, and the higher pressure arm preferred for subsequent measurements.<br /> <br /> BP varies with time of day, as may the effectiveness of treatment, and [[Medical informatics|archetypes]] used to record the data should include the time taken. Analysis of this is rare at present.<br /> <br /> Automated machines are commonly used and reduce the variability in manually collected readings &lt;ref name=&quot;pmid2294682&quot;&gt;{{cite journal | author = White W, Lund-Johansen P, Omvik P | title = Assessment of four ambulatory blood pressure monitors and measurements by clinicians versus intraarterial blood pressure at rest and during exercise. | journal = Am J Cardiol | volume = 65 | issue = 1 | pages = 60-6 | year = 1990 | id = PMID 2294682}}&lt;/ref&gt;. Routine measurements done in medical offices of patients with known hypertension may incorrectly diagnose 20% of patients with uncontrolled hypertension &lt;ref name=&quot;pmid16050862&quot;&gt;{{cite journal | author = Kim J, Bosworth H, Voils C, Olsen M, Dudley T, Gribbin M, Adams M, Oddone E | title = How well do clinic-based blood pressure measurements agree with the mercury standard? | journal = J Gen Intern Med | volume = 20 | issue = 7 | pages = 647-9 | year = 2005 | id = PMID 16050862}}&lt;/ref&gt;<br /> <br /> ===Distinguishing primary vs. secondary hypertension===<br /> Once the diagnosis of hypertension has been made it is important to attempt to exclude or identify reversible (secondary) causes. <br /> * Over 90% of adult hypertension has no clear cause and is therefore called '''essential/primary hypertension'''. Often, it is part of the [[metabolic syndrome|metabolic &quot;syndrome X&quot;]] in patients with [[insulin resistance]]: it occurs in combination with [[diabetes mellitus]] (type 2), [[combined hyperlipidemia]] and [[central obesity]]. <br /> * [[Secondary hypertension]] is more common in preadolescent children, with most cases caused by [[renal disease]]. Primary or [[essential hypertension]] is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension. &lt;ref name=&quot;pmid16719248&quot;&gt;{{cite journal | author = Luma GB, Spiotta RT | title = Hypertension in children and adolescents. | journal = Am Fam Physician | volume = 73 | issue = 9 | pages = 1558-68 | month = may | year = 2006 | id = PMID 16719248}}&lt;/ref&gt;<br /> <br /> ===Investigations commonly performed in newly diagnosed hypertension===<br /> Tests are undertaken to identify possible causes of secondary hypertension, and seek evidence for end-organ damage to the heart itself or the eyes (retina) and kidneys. Diabetes and raised cholesterol levels being additional risk factors for the development of cardiovascular disease are also tested for as they will also require management.<br /> <br /> [[Blood test]]s commonly performed include:<br /> * [[Creatinine]] ([[renal function]]) - to identify both underlying renal disease as a cause of hypertension and conversely hypertension causing onset of kidney damage. Also a baseline for later monitoring the possible side-effects of certain antihypertensive drugs.<br /> * [[Electrolyte]]s ([[sodium]], [[potassium]])<br /> * [[Glucose]] - to identify [[diabetes mellitus]]<br /> * [[Cholesterol]]<br /> <br /> Additional tests often include:<br /> * Testing of urine samples for [[proteinuria]] - again to pick up underlying kidney disease or evidence of hypertensive renal damage.<br /> * [[Electrocardiogram]] (EKG/ECG) - for evidence of the heart being under strain from working against a high blood pressure. Also may show resulting thickening of the heart muscle ([[left ventricular hypertrophy]]) or of the occurrence of previous silent cardiac disease (either subtle electrical conduction disruption or even a myocardial infarction).<br /> * [[Chest X-ray]] - again for signs of cardiac enlargement or evidence of [[Congestive heart failure|cardiac failure]].<br /> <br /> == Physical Examination == <br /> * Look for end organ disease:<br /> *:* [[Coronary Artery Disease]] (CAD) symptoms<br /> *:* Retinal hemorrhage<br /> *:* Retinalvenous crossing changes<br /> *:* Vascular disease<br /> * Heart exam<br /> * Lung exam<br /> * Neurological Examination<br /> * Possible symptoms:<br /> *:* [[Osteoporosis]]<br /> *:* [[Obesity]]<br /> *:* Muscle weakness<br /> *:* Moon facies<br /> *:* [[Hirsutism]]<br /> *:* Elevated lipids<br /> *:* Elevated sugar<br /> *:* Low [[potassium]]<br /> *:* Elevated [[creatinine]]<br /> *:* [[Ddx:Headache|Headaches]]<br /> *:* [[Palpitation]]s<br /> *:* Diaphoresis<br /> *:* Labile blood pressure<br /> <br /> == Laboratory Findings == <br /> * [[Urinalysis]]<br /> * [[Glucose]]<br /> * [[Blood urea nitrogen]] ([[BUN]]) / [[creatinine]]<br /> * Basic metabolic panel<br /> * [[Calcium]]<br /> * [[Lipid]]s<br /> * Urinary [[albumin]]<br /> * [[Glomerular filtration rate]]<br /> === Electrolyte and Biomarker Studies === <br /> * [[Electrolyte]]s<br /> === [[Electrocardiogram]] === <br /> * ECG to make accurate diagnosis<br /> === Echocardiography or Ultrasound === <br /> * [[Echocardiogram]] for diagnosis<br /> ===MRI or CT===<br /> * see [[Cardiac MRI]] in [[Hypertension]]<br /> <br /> == Epidemiology ==<br /> The level of blood pressure regarded as deleterious has been revised down during years of epidemiological studies. A widely quoted and important series of such studies is the [[Framingham Heart Study]] carried out in an American town: Framingham, Massachusetts. The results from Framingham and of similar work in Busselton, Western Australia have been widely applied. To the extent that people are similar this seems reasonable, but there are known to be genetic variations in the most effective drugs for particular sub-populations. Recently (2004), the Framingham figures have been found to overestimate risks for the UK population considerably. The reasons are unclear. Nevertheless the Framingham work has been an important element of UK health policy.<br /> <br /> == Treatment ==<br /> &lt;!---need to be updated in accordance with the latest NICE guidelines (28th June 2006) ---&gt;<br /> ===Lifestyle modification (nonpharmacologic treatment)===<br /> * [[weight loss|Weight reduction]] and regular aerobic exercise (e.g. jogging) are recommended as the first steps in treating mild to moderate hypertension. Regular mild exercise improves blood flow and helps to reduce resting heart rate and blood pressure. These steps are highly effective in reducing blood pressure, although drug therapy is still necessary for many patients with moderate or severe hypertension to bring their blood pressure down to a safe level. <br /> <br /> * Reducing [[sodium chloride|sodium (salt)]] [[Dieting|diet]] is proven very effective: it decreases blood pressure in about 60% of people (see above). Many people choose to use a [[salt substitute]] to reduce their salt intake.<br /> <br /> * Additional dietary changes beneficial to reducing blood pressure includes the [[DASH diet]] (Dietary Approaches to Stop Hypertension), which is rich in fruits and vegetables and low fat or fat-free dairy foods. This diet is shown effective based on National Institutes of Health sponsored research. In addition, an increase in daily calcium intake has also been shown to be highly effective in reducing blood pressure. Fruits, vegetables, and nuts have the added benefit of increasing dietary [[potassium]], which theoretically can offset the effect of sodium and act on the kidney to decrease blood pressure. <br /> <br /> * Discontinuing [[tobacco smoking]] and alcohol drinking has been shown to lower blood pressure. The exact mechanisms are not fully understood, but blood pressure (especially systolic) always transiently increases following alcohol and/or nicotine consumption. Besides, abstention from cigarette smoking is important for people with hypertension because it reduces the risk of many dangerous outcomes of hypertension, such as stroke and heart attack. Note that coffee drinking (caffeine ingestion) also increases blood pressure transiently, but does ''not'' produce chronic hypertension.<br /> <br /> * Relaxation therapy, such as meditation, that reduces environmental stress, [[Noise health effects|high sound levels]] and [[over-illumination]] can be an additional method of ameliorating hypertension. [[Biofeedback]] is also used [http://www.mayoclinic.org/news2006-rst/3334.html] particularly device guided paced breathing [http://www.emaxhealth.com/106/5912.html] [http://www.medscape.com/viewarticle/539099]. Obviously, the effectiveness of relaxation therapy relies on the patient's attitude and compliance.<br /> <br /> ===Impact of race===<br /> {{seealso|Race and health}}<br /> In a summary of recent research Jules P. Harrell, Sadiki Hall, and James Taliaferro describe how a growing body of research has explored the impact of encounters with racism or discrimination on physiological activity. &quot;Several of the studies suggest that higher blood pressure levels are associated with the tendency not to recall or report occurrences identified as racist and discriminatory.&quot;&lt;ref&gt;[http://www.ajph.org/cgi/content/abstract/93/2/243 Physiological Responses to Racism and Discrimination: An Assessment of the Evidence]&lt;/ref&gt; In other words, failing to recognize instances of racism has a direct impact on the blood pressure of the person experiencing the racist event. Investigators have reported that physiological arousal is associated with laboratory analogues of ethnic discrimination and mistreatment.<br /> <br /> The interaction between high blood pressure and racism has also been documented in studies by [[Claude Steele]], Joshua Aronson, and Steven Spencer on what they term &quot;stereotype threat&quot;.&lt;ref&gt;African Americans and high blood pressure: the role of stereotype threat. Blascovich J, Spencer SJ, Quinn D and Steele C. Department of Psychology, University of California, Santa Barbara 93106, USA.&lt;/ref&gt;<br /> <br /> ===Medications===<br /> {{main|Antihypertensive}}<br /> There are many classes of medications for treating hypertension, together called [[antihypertensive]]s, which &amp;mdash; by varying means &amp;mdash; act by lowering blood pressure. Evidence suggests that reduction of the blood pressure by 5-6 mmHg can decrease the risk of stroke by 40%, of coronary heart disease by 15-20%, and reduces the likelihood of dementia, heart failure, and mortality from vascular disease.<br /> <br /> The aim of treatment should be blood pressure control to &lt;140/90 mmHg for most patients, and lower in certain contexts such as diabetes or kidney disease (some medical professionals recommend keeping levels below 120/80 mmHg).[http://www.webmd.com/content/article/73/88927.htm] Each added drug may reduce the systolic blood pressure by 5-10 mmHg, so often multiple drugs are necessary to achieve blood pressure control.<br /> <br /> Commonly used drugs include:<br /> *[[ACE inhibitor]]s such as [[captopril]], [[enalapril]], [[fosinopril]] (Monopril), [[lisinopril]] (Zestril), [[quinapril]], [[ramipril]] (Altace)<br /> *[[Angiotensin II receptor antagonist]]s: eg, [[telmisartan]] (Micardis, Pritor), [[irbesartan]] (Avapro), [[losartan]] (Cozaar), [[valsartan]] (Diovan), [[candesartan]] (Atacand)<br /> *[[Alpha blocker]]s such as [[doxazosin]], [[prazosin]], or [[terazosin]]<br /> *[[Beta blocker]]s such as [[atenolol]], [[labetalol]], [[metoprolol]] (Lopressor, Toprol-XL), [[propranolol]].<br /> *[[Calcium channel blocker]]s such as nifedipine (Adalat®)&lt;ref&gt;[http://www.adalat.com/professionals-home/research/publications/ Kragten JA, Dunselman PHJM. Nifedipine gastrointestinal therapeutic system (GITS) in the treatment of coronary heart disease and hypertension. Expert Rev Cardiovasc Ther 5 (2007):643-653. FULL TEXT!] &lt;/ref&gt; [[amlodipine]] (Norvasc), [[diltiazem]], [[verapamil]]<br /> *Direct renin inhibitors such as [[aliskiren]] (Tekturna)<br /> *[[Diuretic]]s: eg, [[bendroflumethiazide]], [[chlortalidone]], [[hydrochlorothiazide]] (also called HCTZ)<br /> *Combination products (which usually contain HCTZ and one other drug)<br /> <br /> ====Influence of age and race on medication efficacy====<br /> A [[randomized controlled trial]] by the Veterans Affairs Cooperative Study Group on Antihypertensive Agents reported the influence of patient age and race on the proportion of patients whose blood pressure was controlled by different agents.&lt;ref name=&quot;pmid8446138&quot;&gt;{{cite journal |author=Materson BJ, Reda DJ, Cushman WC, ''et al'' |title=Single-drug therapy for hypertension in men. A comparison of six antihypertensive agents with placebo. The Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents |journal=N. Engl. J. Med. |volume=328 |issue=13 |pages=914-21 |year=1993 |pmid=8446138 |doi=|url=http://content.nejm.org/cgi/content/full/328/13/914}}&lt;/ref&gt;&lt;ref name=&quot;pmid8177286&quot;&gt;{{cite journal |author=Materson BJ, Reda DJ |title=Correction: single-drug therapy for hypertension in men |journal=N. Engl. J. Med. |volume=330 |issue=23 |pages=1689 |year=1994 |pmid=8177286 |doi=|url=http://content.nejm.org/cgi/content/full/330/23/1689}} [http://content.nejm.org/cgi/content/full/330/23/1689/T1 Summary]&lt;/ref&gt; For example:<br /> * Less than 7% of young white patients responded to a [[diuretic]] ([[hydrochlorothiazide]])<br /> * Only 6% of older black patients responded to an [[ACE inhibitor]] ([[captopril]])<br /> The effect of age and race are in part due to differences in plasma [[renin]] activity.&lt;ref name=&quot;pmid1538559&quot;&gt;{{cite journal |author=Blaufox MD, Lee HB, Davis B, Oberman A, Wassertheil-Smoller S, Langford H |title=Renin predicts diastolic blood pressure response to nonpharmacologic and pharmacologic therapy |journal=JAMA |volume=267 |issue=9 |pages=1221-5 |year=1992 |pmid=1538559 |doi=}}&lt;/ref&gt;&lt;ref name=&quot;pmid9777817&quot;&gt;{{cite journal |author=Preston RA, Materson BJ, Reda DJ, ''et al'' |title=Age-race subgroup compared with renin profile as predictors of blood pressure response to antihypertensive therapy. Department of Veterans Affairs Cooperative Study Group on Antihypertensive Agents |journal=JAMA |volume=280 |issue=13 |pages=1168-72 |year=1998 |pmid=9777817 |doi=}}&lt;/ref&gt;<br /> <br /> ====Choice of initial medication====<br /> Which type of many medications should be used initially for hypertension has been the subject of several large studies and various national guidelines.<br /> <br /> Regarding cardiovascular outcomes, the ALLHAT study showed a slightly better outcome and cost-effectiveness for the [[thiazide]] diuretic [[chlortalidone]] compared to other anti-hypertensives in an ethnically mixed population.&lt;ref name=&quot;allhat&quot;&gt;{{cite journal<br /> |url=http://jama.ama-assn.org/cgi/content/full/288/23/2981<br /> |author=ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group<br /> |journal=[[Journal of the American Medical Association|JAMA]]<br /> |title=Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)<br /> |year = 2002<br /> |month = Dec 18<br /> |volume = 288<br /> |issue = 23<br /> |pages = 2981-97<br /> |id = PMID 12479763<br /> }}&lt;/ref&gt;<br /> Whilst a subsequent smaller study (ANBP2) did not show this small difference in outcome and actually showed a slightly better outcome for ACE-inhibitors in older white male patients.&lt;ref name=&quot;anbp2&quot;&gt;{{<br /> cite journal<br /> |url=http://content.nejm.org/cgi/content/abstract/348/7/583<br /> |author=Wing LM, Reid CM, Ryan P et al<br /> |journal=[[N Engl J Med|NEJM]]<br /> |title=A comparison of outcomes with angiotensin-converting--enzyme inhibitors and diuretics for hypertension in the elderly<br /> |year = 2003<br /> |month = Feb 13<br /> |volume = 348<br /> |issue = 7<br /> |pages = 583-92<br /> |id = PMID 12584366<br /> }}&lt;/ref&gt;<br /> <br /> Whilst thiazides are cheap, effective, and recommended as the best first-line drug for hypertension by many experts, they are not prescribed as often as some newer drugs. Arguably, this is because they are off-patent and thus rarely promoted by the drug industry.&lt;ref name=&quot;promotion&quot;&gt;{{cite journal<br /> |url=http://circ.ahajournals.org/cgi/content/full/99/15/2055<br /> |author=Wang TJ, Ausiello JC, Stafford RS<br /> |journal=Circulation<br /> |title=Trends in Antihypertensive Drug Advertising, 1985–1996<br /> |year = 1999<br /> |volume = 99<br /> |pages = 2055-2057<br /> |id = PMID 10209012<br /> }}&lt;/ref&gt; <br /> &lt;br /&gt;&lt;br /&gt;<br /> Due to their metabolic impact (hypercholesterinemia, impairment of glucose tolerance, increased risk of developing [[Diabetes mellitus type 2]]), the use of thiazides as first line treatment for essential hypertension has been repeatedly questioned and strongly disencouraged.&lt;ref&gt;{{cite journal | author = Lewis PJ, Kohner EM, Petrie A, Dollery CT | title = Deterioration of glucose tolerance in hypertensive patients on prolonged diuretic treatment | journal = Lancet | volume = 307 | issue = 7959 | pages = 564 - 566 | year = 1976 | id = PMID 55840 }} &lt;/ref&gt; &lt;ref&gt;{{cite journal | author = Murphy MB, Lewis PJ, Kohner E, Schumer B, Dollery CT | title = Glucose intolerance in hypertensive patients treated with diuretics; a fourteen-year follow-up | journal = Lancet | volume = 320 | issue = 8311 | pages = 1293 - 1295 | year = 1982 | id = PMID 6128594 }}&lt;/ref&gt; &lt;ref&gt;{{cite journal | author =Messerli FH, Williams B,Ritz E | title = Essential hypertension | journal = Lancet | volume = 370 | issue = 9587 | pages = 591-603| year = 2007 | id = PMID }}&lt;/ref&gt; <br /> &lt;br /&gt;&lt;br /&gt;<br /> Physicians may start with non-thiazide antihypertensive medications if there is a compelling reason to do so. An example is the use of ACE-inhibitors in diabetic patients who have evidence of kidney disease, as they have been shown to both reduce blood pressure and slow the progression of [[diabetic nephropathy]].&lt;ref name=ruggenenti&gt;{{cite journal<br /> |url=http://linkinghub.elsevier.com/retrieve/pii/S014067369804433X<br /> |author=Ruggenenti P, Perna A, Gherardi G, Gaspari F, Benini R, Remuzzi G.<br /> |journal=Lancet<br /> |title=Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril: REIN follow-up trial. Gruppo Italiano di Studi Epidemiologici in Nefrologia (GISEN). Ramipril Efficacy in Nephropathy.<br /> |year = 1998<br /> |volume = 352<br /> |pages = 1252-6<br /> |id = PMID 9788454<br /> }}&lt;/ref&gt; In patients with coronary artery disease or a history of a heart attack, beta blockers and ACE-inhibitors both lower blood pressure and protect heart muscle over a lifetime, leading to reduced mortality.<br /> <br /> ===Advice in the United Kingdom===<br /> The risk of [[beta-blocker]]s provoking [[type 2 diabetes]] led to their downgrading to fourth-line therapy in the United Kingdom in June 2006&lt;ref&gt;{{cite web | author= Sheetal Ladva | title=NICE and BHS launch updated hypertension guideline | url=http://www.nelm.nhs.uk/Record%20Viewing/viewRecord.aspx?id=567178 | date=28/06/2006 | publisher=[[National Institute for Health and Clinical Excellence]]}}&lt;/ref&gt;, in the revised national guidelines.&lt;ref&gt;{{cite web | title=Hypertension: management of hypertension in adults in primary care | url=http://www.nice.org.uk/download.aspx?o=CG034quickrefguide | format=PDF | publisher=[[National Institute for Health and Clinical Excellence]]}}&lt;/ref&gt;<br /> <br /> ===Advice in the United States===<br /> The ''Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure'' (JNC 7) in the United States recommends starting with a [[thiazide diuretic]] if single therapy is being initiated and another medication is not indicated.&lt;ref name=&quot;jnc7&quot; /&gt;<br /> <br /> ===Systolic hypertension===<br /> {{details|Systolic hypertension}}<br /> <br /> == See also ==<br /> * [[Edible salt]]<br /> * [[Hypertensive emergency]]<br /> * [[Malignant hypertension]]<br /> * [[Exercise hypertension]]<br /> * [[White coat hypertension]]<br /> * [[Home blood pressure monitoring]]<br /> <br /> ==References==<br /> &lt;!-- ---------------------------------------------------------------<br /> See http://en.wikipedia.org/wiki/Wikipedia:Footnotes for a<br /> discussion of different citation methods and how to generate<br /> footnotes using the &lt;ref&gt; &amp; &lt;/ref&gt; tags and the {{Reflist}} template<br /> -------------------------------------------------------------------- --&gt;<br /> {{Reflist|2}}<br /> <br /> == External links ==<br /> <br /> * [http://www.dmoz.org//Health/Conditions_and_Diseases/Cardiovascular_Disorders/Vascular_Disorders/Hypertension/]<br /> * [http://ww2.heartandstroke.ca/Page.asp?PageID=1975&amp;ArticleID=5211 High Blood Pressure] from the Heart and Stroke Foundation of Canada<br /> * [http://medlineplus.nlm.nih.gov/medlineplus/highbloodpressure.html High Blood Pressure] from [[MedlinePlus]]<br /> * [http://www.nhlbi.nih.gov/hbp/ A guide to lowering high blood pressure] from the National Heart, Lung, and Blood Institute<br /> * [http://www.nhlbi.nih.gov/hbp/prevent/h_eating/h_eating.htm The DASH diet] from the National Heart, Lung, and Blood Institute<br /> * [http://www.americanheart.org/presenter.jhtml?identifier=2114 High Blood Pressure] (from the American Heart Association)<br /> * [http://kidney.niddk.nih.gov/kudiseases/pubs/hypertension/index.htm High Blood Pressure and Kidney Disease] from The National Kidney and Urologic Diseases Information Clearinghouse<br /> * [http://www.earthclinic.com/CURES/blood_pressure.html Natural Remedies for High Blood Pressure] from Earth Clinic's Folk Medicine Archive<br /> <br /> === Major studies ===<br /> * [http://www.nhlbi.nih.gov/about/framingham/ The Framingham Heart Study]<br /> * [http://allhat.sph.uth.tmc.edu/default.htm#study Information on ALLHAT]<br /> * [http://www.adalat.com/professionals-home/research/action-trial/ Information on ACTION - A Coronary Disease Trial Investigating Outcome with Nifedipine GITS]<br /> * [http://www.adalat.com/professionals-home/research/insight-trial Information on INSIGHT]<br /> * [http://www.adalat.com/professionals-home/research/encore-trial/ Information on ENCORE]<br /> <br /> {{Circulatory system pathology}}<br /> {{SIB}}<br /> [[zh-min-nan:Ko-hoeh-ap]]<br /> [[bg:Хипертония]]<br /> [[ceb:Alta Presyon]]<br /> [[de:Arterielle Hypertonie]]<br /> [[et:Hüpertensioon]]<br /> [[es:Hipertensión arterial]]<br /> [[eu:Hipertentsio]]<br /> [[fr:Hypertension artérielle]]<br /> [[id:Tekanan darah tinggi]]<br /> [[it:Ipertensione arteriosa sistemica]]<br /> [[ku:Hîpertansiyon]]<br /> [[hu:Magas vérnyomás]]<br /> [[ms:Penyakit Darah Tinggi]]<br /> [[nl:Hypertensie]]<br /> [[ja:高血圧]]<br /> [[no:Hypertensjon]]<br /> [[pl:Nadciśnienie tętnicze]]<br /> [[pt:Hipertensão arterial]]<br /> [[ru:Артериальная гипертензия]]<br /> [[sr:Висок притисак]]<br /> [[sv:Högt blodtryck]]<br /> [[th:โรคความดันโลหิตสูง]]<br /> [[tr:Hipertansiyon]]<br /> [[zh:高血壓]]<br /> <br /> <br /> [[Category:Aging-associated diseases]]<br /> [[Category:Cardiology]]<br /> [[Category:Emergency medicine]]<br /> [[Category:Cardiovascular diseases]]<br /> [[Category:Medical conditions related to obesity]]<br /> [[Category:Nephrology]]<br /> <br /> <br /> {{WikiDoc Help Menu}}<br /> {{WikiDoc Sources}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_classification&diff=575597 Chronic hypertension classification 2011-06-28T20:41:43Z <p>Taylor Palmieri: </p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Classification of Hypertension==<br /> Hypertension is considered to be present when a person's [[systole (medicine)|systolic]] blood pressure is consistently 140 mmHg or greater, and/or their [[diastole|diastolic]] blood pressure is consistently 90&amp;nbsp;mmHg or greater.&lt;ref&gt;http://www.nlm.nih.gov/cgi/mesh/2007/MB_cgi?mode=&amp;index=6693&lt;/ref&gt; Recently, as of 2003, the ''Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure''&lt;ref name=&quot;jnc7&quot;&gt;{{<br /> cite journal<br /> |url=http://jama.ama-assn.org/cgi/content/full/289.19.2560v1<br /> |author=Chobanian AV et al<br /> |journal=[[Journal of the American Medical Association|JAMA]]<br /> |title=The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.<br /> |year = 2003<br /> |volume = 289<br /> |pages = 2560-72<br /> |pmid = 12748199<br /> }}&lt;/ref&gt; has defined blood pressure 120/80 mmHg to 139/89 mmHg as &quot;prehypertension.&quot; Prehypertension is not a disease category; rather, it is a designation chosen to identify individuals at high risk of developing hypertension. The [http://www.mayoclinic.com/health/high-blood-pressure/DS00100/DSECTION=6 Mayo Clinic website] specifies blood pressure is &quot;normal if it's below 120/80&quot; but that &quot;some data indicate that 115/75 mm Hg should be the gold standard.&quot; In patients with [[diabetes mellitus]] or [[Nephropathy|kidney disease]] studies have shown that blood pressure over 130/80 mmHg should be considered high and warrants further treatment. Even lower numbers are considered diagnostic using home blood pressure monitoring devices.<br /> {| <br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''''Blood Pressure''''' || '''''Systolic''''' (mm Hg) || '''''Diastolic''''' (mm Hg) <br /> |-style=&quot;background:silver; color:black&quot; <br /> | '''Optimal''' || '''&lt; 120''' || '''&lt; 80'''<br /> |- style=&quot;background:silver; color:black&quot;<br /> | '''Normal''' || '''&lt; 130''' || '''&lt; 85'''<br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''High Normal''' || '''130-139''' || '''85-89'''<br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''Mild Hypertension''' || '''140-159''' || '''90-99'''<br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''Moderate Hypertension''' || '''160-179''' || '''100-109'''<br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''Severe Hypertension''' || '''180-209''' || '''110-119'''<br /> |-style=&quot;background:silver; color:black&quot;<br /> | '''Very Severe Hypertension''' || '''&gt; 210''' || '''&gt; 120''' <br /> |}<br /> <br /> ==Distinguishing primary vs. secondary hypertension==<br /> Once the diagnosis of hypertension has been made it is important to attempt to exclude or identify reversible (secondary) causes. <br /> * Over 90% of adult hypertension has no clear cause and is therefore called '''essential/primary hypertension'''. Often, it is part of the [[metabolic syndrome|metabolic &quot;syndrome X&quot;]] in patients with [[insulin resistance]]: it occurs in combination with [[diabetes mellitus]] (type 2), [[combined hyperlipidemia]] and [[central obesity]]. <br /> * [[Secondary hypertension]] is more common in preadolescent children, with most cases caused by [[renal disease]]. Primary or [[essential hypertension]] is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension. &lt;ref name=&quot;pmid16719248&quot;&gt;{{cite journal | author = Luma GB, Spiotta RT | title = Hypertension in children and adolescents. | journal = Am Fam Physician | volume = 73 | issue = 9 | pages = 1558-68 | month = may | year = 2006 | id = PMID 16719248}}&lt;/ref&gt;<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Hypertension_natural_history,_complications_%26_prognosis&diff=575595 Hypertension natural history, complications & prognosis 2011-06-28T20:34:53Z <p>Taylor Palmieri: Hypertension natural history, complications &amp; prognosis moved to Hypertension natural history</p> <hr /> <div>#REDIRECT [[Hypertension natural history]]</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_natural_history&diff=575594 Chronic hypertension natural history 2011-06-28T20:34:53Z <p>Taylor Palmieri: Hypertension natural history, complications &amp; prognosis moved to Hypertension natural history</p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Complications==<br /> While elevated blood pressure alone is not an illness, it often requires treatment due to its short- and long-term effects on many organs. The risk is increased for:<br /> * [[Cerebrovascular accident]] (CVAs or strokes)<br /> * [[Myocardial infarction]] (heart attack)<br /> * [[Hypertensive cardiomyopathy]] ([[heart failure]] due to chronically high blood pressure)<br /> * [[Hypertensive retinopathy]] - damage to the [[retina]]<br /> * [[Hypertensive nephropathy]] - [[chronic renal failure]] due to chronically high blood pressure<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WS}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_differential_diagnosis&diff=575593 Chronic hypertension differential diagnosis 2011-06-28T20:32:57Z <p>Taylor Palmieri: New page: {{Template:Hypertension}} {{CMG}} &#039;&#039;&#039;Associate Editor in Chief&#039;&#039;&#039;: Firas Ghanem, M.D. and Atif Mohammad, M.D. {{EH}} ==Complete List of Differential Diagnoses &lt;ref&gt;isbn=140510368X Kaha...</p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Complete List of Differential Diagnoses &lt;ref&gt;isbn=140510368X Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:85&lt;/ref&gt;&lt;ref&gt;isbn=1591032016 Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:194-195&lt;/ref&gt;==<br /> * [[Acromegaly]]<br /> * [[Acute Renal Failure]]<br /> * After [[kidney transplantation]]<br /> * [[Alcohol]] withdrawal<br /> * Analgesic [[nephritis]]<br /> * [[Aneurysm]]<br /> * [[Anxiety]]<br /> * [[Aortic isthmus stenosis]]<br /> * [[Aortic Regurgitation]]<br /> * [[Arteriosclerosis]]<br /> * [[Arteriovenous fistula]]<br /> * [[Arteritis]]<br /> * [[Burns]]<br /> * [[Bartter's Syndrome]]<br /> * [[Carcinoid Syndrome]]<br /> * [[Chronic Renal Disease]]<br /> * [[Coarctation of aorta]]<br /> * [[Cocaine]] use<br /> * Compression [[tumor]]<br /> * [[Congenital adrenal hyperplasia]]<br /> * [[Conn's Syndrome]]<br /> * [[Cushing's Syndrome]]<br /> * [[Diabetic nephropathy]]<br /> * Dialysis<br /> * [[Dissection of the aorta]]<br /> * Dissection of the [[renal arteries]]<br /> * [[Drugs]]<br /> * [[Eclampsia]]<br /> * [[Elevated intracranial pressure]]<br /> * Embolism or thrombosis of the [[renal artery]]<br /> * [[Endothelin]] producing tumor<br /> * Fibromuscular hyperplasia<br /> * Gestational hypertension<br /> * [[Guillain-Barre Syndrome]]<br /> * [[Gitelman's Syndrome]]<br /> * [[Hydronephrosis]]<br /> * [[Hyperthyroidism]]<br /> * [[Hyperventilation]]<br /> * [[Hypoglycemia]]<br /> * Interstitial [[nephritis]]<br /> * Kidney involvement in systemic diseases<br /> * [[Liddle's Syndrome]]<br /> * [[Meningitis]]<br /> * [[Obesity]]<br /> * [[Pain]]<br /> * [[Pancreatitis]]<br /> * [[Patent ductus arteriosus]]<br /> * Perioperative<br /> * Perirenal hematoma<br /> * [[Pheochromocytoma]]<br /> * [[Polycystic kidney disease]]<br /> * [[Polycythemia]]<br /> * [[Polyradiculitis]]<br /> * [[Porphyria]]<br /> * Post-exercise<br /> * [[Preeclampsia]]<br /> * [[Pregnancy]]-induced hypertension<br /> * [[Primary hyperaldosteronism]]<br /> * [[Primary hyperparathyroidism]]<br /> * [[Quadriplegia]]<br /> * Reflux nephropathy<br /> * [[Renal Artery Stenosis]]<br /> * [[Renin]] producing tumors<br /> * [[Retroperitoneal Fibrosis]]<br /> * [[Sleep Apnea]]<br /> * [[Stress]]<br /> * [[Third degree AV block]]<br /> * [[Thrombosis]]<br /> * [[Transfusion]] of large blood volumes<br /> * Trauma to the [[renal artery]]<br /> * [[Traumatic brain injury]]<br /> * &quot;White coat&quot; hypertension<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_natural_history&diff=575585 Chronic hypertension natural history 2011-06-28T20:21:28Z <p>Taylor Palmieri: </p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Complications==<br /> While elevated blood pressure alone is not an illness, it often requires treatment due to its short- and long-term effects on many organs. The risk is increased for:<br /> * [[Cerebrovascular accident]] (CVAs or strokes)<br /> * [[Myocardial infarction]] (heart attack)<br /> * [[Hypertensive cardiomyopathy]] ([[heart failure]] due to chronically high blood pressure)<br /> * [[Hypertensive retinopathy]] - damage to the [[retina]]<br /> * [[Hypertensive nephropathy]] - [[chronic renal failure]] due to chronically high blood pressure<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WS}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_natural_history&diff=575584 Chronic hypertension natural history 2011-06-28T20:19:14Z <p>Taylor Palmieri: New page: {{Template:Hypertension}} {{CMG}} &#039;&#039;&#039;Associate Editor in Chief&#039;&#039;&#039;: Firas Ghanem, M.D. and Atif Mohammad, M.D. {{EH}} ==Complications== While elevated blood pressure alone is not an ill...</p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Complications==<br /> While elevated blood pressure alone is not an illness, it often requires treatment due to its short- and long-term effects on many organs. The risk is increased for:<br /> * [[Cerebrovascular accident]] (CVAs or strokes)<br /> * [[Myocardial infarction]] (heart attack)<br /> * [[Hypertensive cardiomyopathy]] ([[heart failure]] due to chronically high blood pressure)<br /> * [[Hypertensive retinopathy]] - damage to the [[retina]]<br /> * [[Hypertensive nephropathy]] - [[chronic renal failure]] due to chronically high blood pressure<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> {{WS}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Hypertension_signs_and_symptoms&diff=575582 Hypertension signs and symptoms 2011-06-28T20:08:51Z <p>Taylor Palmieri: Hypertension signs and symptoms moved to Hypertension history &amp; symptoms</p> <hr /> <div>#REDIRECT [[Hypertension history &amp; symptoms]]</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Hypertension_history_%26_symptoms&diff=575581 Hypertension history & symptoms 2011-06-28T20:08:51Z <p>Taylor Palmieri: Hypertension signs and symptoms moved to Hypertension history &amp; symptoms</p> <hr /> <div>#REDIRECT [[Hypertension history and symptoms]]</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Hypertension_history_%26_symptoms&diff=575580 Hypertension history & symptoms 2011-06-28T20:07:57Z <p>Taylor Palmieri: Hypertension signs and symptoms moved to Hypertension history and symptoms</p> <hr /> <div>#REDIRECT [[Hypertension history and symptoms]]</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_history_and_symptoms&diff=575579 Chronic hypertension history and symptoms 2011-06-28T20:07:56Z <p>Taylor Palmieri: Hypertension signs and symptoms moved to Hypertension history and symptoms</p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Signs and Symptoms==<br /> Hypertension is usually found incidentally - &quot;case finding&quot; - by healthcare professionals during a routine checkup. The only test for hypertension is a blood pressure measurement. Hypertension in isolation usually produces no symptoms although some people report headaches, fatigue, dizziness, blurred vision, facial flushing or [[tinnitus]]. &lt;ref&gt;{{cite web|url=http://www.treatment-for.com/high-blood-pressure-symptoms.htm|title=Symptoms of High Blood Pressure}}&lt;/ref&gt;<br /> <br /> [[Malignant hypertension]] (or accelerated hypertension) is distinct as a late phase in the condition, and may present with headaches, blurred vision and end-organ damage.<br /> <br /> Hypertension is often confused with mental tension, stress and anxiety. While chronic anxiety is associated with poor outcomes in people with hypertension, it alone does not cause it. Accelerated hypertension is associated with somnolence, confusion, visual disturbances, and nausea and vomiting (hypertensive encephalopathy). &lt;ref name=health.am&gt;{{cite web | H. Michael MacMay, MD, MPH; Michael Sutters, MD | title =Hypertension symptoms and signs | publisher=Armenian Medical Network | work =Systemic Hypertension - Hypertension Health Center | url=http://www.health.am/hypertension/hypertension-symptoms-and-signs/ | year = 2006}}&lt;/ref&gt;<br /> <br /> === Hypertensive urgencies and emergencies ===<br /> Hypertension is rarely severe enough to cause symptoms. These typically only surface with a [[systolic blood pressure]] over 240 mmHg and/or a [[diastolic blood pressure]] over 120 mmHg. These pressures without signs of end-organ damage (such as renal failure) are termed &quot;accelerated&quot; hypertension. When end-organ damage is possible or already ongoing, but in absence of raised [[intracranial pressure]], it is called [[hypertensive emergency]]. Hypertension under this circumstance needs to be controlled, but prolonged hospitalization is not necessarily required. When hypertension causes increased intracranial pressure, it is called [[malignant hypertension]]. Increased intracranial pressure causes [[papilledema]], which is visible on [[ophthalmoscopy|ophthalmoscopic]] examination of the [[retina]].<br /> <br /> === Pregnancy ===<br /> {{main|Hypertension of pregnancy}}<br /> Although few women of childbearing age have high blood pressure, up to 10% develop [[hypertension of pregnancy]]. While generally benign, it may herald three complications of pregnancy: [[pre-eclampsia]], [[HELLP syndrome]] and [[eclampsia]]. Follow-up and control with medication is therefore often necessary.<br /> <br /> ===Children and adolescents ===<br /> As with adults, blood pressure is a variable parameter in children. It varies between individuals and within individuals from day to day and at various times of the day. The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early development of atherosclerosis in children would make the detection of and intervention in childhood hypertension important to reduce long-term health risks; however, supporting data are lacking. <br /> <br /> Most childhood hypertension, particularly in preadolescents, is secondary to an underlying disorder. Renal parenchymal disease is the most common (60 to 70 percent) cause of hypertension. Adolescents usually have primary or essential hypertension, making up 85 to 95 percent of cases. &lt;ref name=aafp&gt;{{cite web | GREGORY B. LUMA, M.D., and ROSEANN T. SPIOTTA, M.D., Jamaica Hospital Medical Center | title =Hypertension in Children and Adolescents | publisher=American Academy of Family Physicians | work =Hypertension in Children and Adolescents | url=http://www.aafp.org/afp/20060501/1558.html | year = 2006}}&lt;/ref&gt;<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_history_and_symptoms&diff=575576 Chronic hypertension history and symptoms 2011-06-28T20:03:41Z <p>Taylor Palmieri: </p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Signs and Symptoms==<br /> Hypertension is usually found incidentally - &quot;case finding&quot; - by healthcare professionals during a routine checkup. The only test for hypertension is a blood pressure measurement. Hypertension in isolation usually produces no symptoms although some people report headaches, fatigue, dizziness, blurred vision, facial flushing or [[tinnitus]]. &lt;ref&gt;{{cite web|url=http://www.treatment-for.com/high-blood-pressure-symptoms.htm|title=Symptoms of High Blood Pressure}}&lt;/ref&gt;<br /> <br /> [[Malignant hypertension]] (or accelerated hypertension) is distinct as a late phase in the condition, and may present with headaches, blurred vision and end-organ damage.<br /> <br /> Hypertension is often confused with mental tension, stress and anxiety. While chronic anxiety is associated with poor outcomes in people with hypertension, it alone does not cause it. Accelerated hypertension is associated with somnolence, confusion, visual disturbances, and nausea and vomiting (hypertensive encephalopathy). &lt;ref name=health.am&gt;{{cite web | H. Michael MacMay, MD, MPH; Michael Sutters, MD | title =Hypertension symptoms and signs | publisher=Armenian Medical Network | work =Systemic Hypertension - Hypertension Health Center | url=http://www.health.am/hypertension/hypertension-symptoms-and-signs/ | year = 2006}}&lt;/ref&gt;<br /> <br /> === Hypertensive urgencies and emergencies ===<br /> Hypertension is rarely severe enough to cause symptoms. These typically only surface with a [[systolic blood pressure]] over 240 mmHg and/or a [[diastolic blood pressure]] over 120 mmHg. These pressures without signs of end-organ damage (such as renal failure) are termed &quot;accelerated&quot; hypertension. When end-organ damage is possible or already ongoing, but in absence of raised [[intracranial pressure]], it is called [[hypertensive emergency]]. Hypertension under this circumstance needs to be controlled, but prolonged hospitalization is not necessarily required. When hypertension causes increased intracranial pressure, it is called [[malignant hypertension]]. Increased intracranial pressure causes [[papilledema]], which is visible on [[ophthalmoscopy|ophthalmoscopic]] examination of the [[retina]].<br /> <br /> === Pregnancy ===<br /> {{main|Hypertension of pregnancy}}<br /> Although few women of childbearing age have high blood pressure, up to 10% develop [[hypertension of pregnancy]]. While generally benign, it may herald three complications of pregnancy: [[pre-eclampsia]], [[HELLP syndrome]] and [[eclampsia]]. Follow-up and control with medication is therefore often necessary.<br /> <br /> ===Children and adolescents ===<br /> As with adults, blood pressure is a variable parameter in children. It varies between individuals and within individuals from day to day and at various times of the day. The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early development of atherosclerosis in children would make the detection of and intervention in childhood hypertension important to reduce long-term health risks; however, supporting data are lacking. <br /> <br /> Most childhood hypertension, particularly in preadolescents, is secondary to an underlying disorder. Renal parenchymal disease is the most common (60 to 70 percent) cause of hypertension. Adolescents usually have primary or essential hypertension, making up 85 to 95 percent of cases. &lt;ref name=aafp&gt;{{cite web | GREGORY B. LUMA, M.D., and ROSEANN T. SPIOTTA, M.D., Jamaica Hospital Medical Center | title =Hypertension in Children and Adolescents | publisher=American Academy of Family Physicians | work =Hypertension in Children and Adolescents | url=http://www.aafp.org/afp/20060501/1558.html | year = 2006}}&lt;/ref&gt;<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_history_and_symptoms&diff=575574 Chronic hypertension history and symptoms 2011-06-28T20:00:09Z <p>Taylor Palmieri: New page: {{Template:Hypertension}} {{CMG}} &#039;&#039;&#039;Associate Editor in Chief&#039;&#039;&#039;: Firas Ghanem, M.D. and Atif Mohammad, M.D. {{EH}} ==Pathophysiology== Hypertension is usually found incidentally - &quot;c...</p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Pathophysiology==<br /> Hypertension is usually found incidentally - &quot;case finding&quot; - by healthcare professionals during a routine checkup. The only test for hypertension is a blood pressure measurement. Hypertension in isolation usually produces no symptoms although some people report headaches, fatigue, dizziness, blurred vision, facial flushing or [[tinnitus]]. &lt;ref&gt;{{cite web|url=http://www.treatment-for.com/high-blood-pressure-symptoms.htm|title=Symptoms of High Blood Pressure}}&lt;/ref&gt;<br /> <br /> [[Malignant hypertension]] (or accelerated hypertension) is distinct as a late phase in the condition, and may present with headaches, blurred vision and end-organ damage.<br /> <br /> Hypertension is often confused with mental tension, stress and anxiety. While chronic anxiety is associated with poor outcomes in people with hypertension, it alone does not cause it. Accelerated hypertension is associated with somnolence, confusion, visual disturbances, and nausea and vomiting (hypertensive encephalopathy). &lt;ref name=health.am&gt;{{cite web | H. Michael MacMay, MD, MPH; Michael Sutters, MD | title =Hypertension symptoms and signs | publisher=Armenian Medical Network | work =Systemic Hypertension - Hypertension Health Center | url=http://www.health.am/hypertension/hypertension-symptoms-and-signs/ | year = 2006}}&lt;/ref&gt;<br /> <br /> === Hypertensive urgencies and emergencies ===<br /> Hypertension is rarely severe enough to cause symptoms. These typically only surface with a [[systolic blood pressure]] over 240 mmHg and/or a [[diastolic blood pressure]] over 120 mmHg. These pressures without signs of end-organ damage (such as renal failure) are termed &quot;accelerated&quot; hypertension. When end-organ damage is possible or already ongoing, but in absence of raised [[intracranial pressure]], it is called [[hypertensive emergency]]. Hypertension under this circumstance needs to be controlled, but prolonged hospitalization is not necessarily required. When hypertension causes increased intracranial pressure, it is called [[malignant hypertension]]. Increased intracranial pressure causes [[papilledema]], which is visible on [[ophthalmoscopy|ophthalmoscopic]] examination of the [[retina]].<br /> <br /> === Pregnancy ===<br /> {{main|Hypertension of pregnancy}}<br /> Although few women of childbearing age have high blood pressure, up to 10% develop [[hypertension of pregnancy]]. While generally benign, it may herald three complications of pregnancy: [[pre-eclampsia]], [[HELLP syndrome]] and [[eclampsia]]. Follow-up and control with medication is therefore often necessary.<br /> <br /> ===Children and adolescents ===<br /> As with adults, blood pressure is a variable parameter in children. It varies between individuals and within individuals from day to day and at various times of the day. The epidemic of childhood obesity, the risk of developing left ventricular hypertrophy, and evidence of the early development of atherosclerosis in children would make the detection of and intervention in childhood hypertension important to reduce long-term health risks; however, supporting data are lacking. <br /> <br /> Most childhood hypertension, particularly in preadolescents, is secondary to an underlying disorder. Renal parenchymal disease is the most common (60 to 70 percent) cause of hypertension. Adolescents usually have primary or essential hypertension, making up 85 to 95 percent of cases. &lt;ref name=aafp&gt;{{cite web | GREGORY B. LUMA, M.D., and ROSEANN T. SPIOTTA, M.D., Jamaica Hospital Medical Center | title =Hypertension in Children and Adolescents | publisher=American Academy of Family Physicians | work =Hypertension in Children and Adolescents | url=http://www.aafp.org/afp/20060501/1558.html | year = 2006}}&lt;/ref&gt;<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_pathophysiology&diff=575569 Chronic hypertension pathophysiology 2011-06-28T19:37:41Z <p>Taylor Palmieri: New page: {{Template:Hypertension}} {{CMG}} &#039;&#039;&#039;Associate Editor in Chief&#039;&#039;&#039;: Firas Ghanem, M.D. and Atif Mohammad, M.D. {{EH}} ==Pathophysiology== Most of the secondary mechanisms associated wit...</p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Pathophysiology==<br /> Most of the secondary mechanisms associated with hypertension are generally fully understood, and are outlined at [[secondary hypertension]]. However, those associated with essential (primary) hypertension are far less understood. What is known is that [[cardiac output]] is raised early in the disease course, with [[total peripheral resistance]] (TPR) normal; over time cardiac output drops to normal levels but TPR is increased. Three theories have been proposed to explain this:<br /> * Inability of the kidneys to excrete sodium, resulting in [[natriuretic]] factors such as [[Atrial Natriuretic Factor]] being secreted to promote salt excretion with the side-effect of raising total peripheral resistance.<br /> * An overactive [[renin / angiotension system]] leads to [[vasoconstriction]] and retention of sodium and water. The increase in blood volume leads to hypertension.<br /> * An overactive [[sympathetic nervous system]], leading to increased stress responses.<br /> It is also known that hypertension is highly heritable and [[polygenic]] (caused by more than one gene) and a few candidate [[genes]] have been postulated in the etiology of this condition.&lt;ref name=&quot;polymorphism&quot;&gt;{{cite journal |author= Sagnella GA, Swift PA |journal=Current Pharmaceutical Design |title=The Renal Epithelial Sodium Channel: Genetic Heterogeneity and Implications for the Treatment of High Blood Pressure |year = 2006 |month = June |volume = 12 |issue = 14 |pages = 2221-2234 |id = PMID 16787251}}&lt;/ref&gt;&lt;ref name=&quot;polymorphism2&quot;&gt;{{cite journal |author= Johnson JA, Turner ST |journal=Current Opinion in Molecular Therapy |title=Hypertension pharmacogenomics: current status and future directions. |year = 2005 |month = June |volume = 7 |issue = 3 |pages = 218-225 |id = PMID 15977418}}&lt;/ref&gt;&lt;ref name=&quot;polymorphism3&quot;&gt;{{cite journal|author= Hideo Izawa; Yoshiji Yamada et al |journal=Hypertension |title=Prediction of Genetic Risk for Hypertension |year = 2003 |month = May |volume = 41 |issue = 5 |pages = 1035-1040 |id = PMID 12654703 | url=http://hyper.ahajournals.org/cgi/content/short/01.HYP.0000065618.56368.24v1}}&lt;/ref&gt;<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri https://www.wikidoc.org/index.php?title=Chronic_hypertension_causes&diff=575564 Chronic hypertension causes 2011-06-28T19:16:00Z <p>Taylor Palmieri: New page: {{Template:Hypertension}} {{CMG}} &#039;&#039;&#039;Associate Editor in Chief&#039;&#039;&#039;: Firas Ghanem, M.D. and Atif Mohammad, M.D. {{EH}} ==Etiology== === Salt sensitivity === [[Salt#Health effects|Sodium]...</p> <hr /> <div>{{Template:Hypertension}}<br /> <br /> {{CMG}}<br /> <br /> '''Associate Editor in Chief''': Firas Ghanem, M.D. and Atif Mohammad, M.D.<br /> <br /> {{EH}}<br /> <br /> ==Etiology==<br /> === Salt sensitivity ===<br /> [[Salt#Health effects|Sodium]] is the environmental factor that has received the greatest attention. Approximately 60% of the essential hypertension population is responsive to sodium intake. This is due to the fact that increasing amounts of salt in a person's bloodstream causes the body to draw more water, increasing the pressure on the blood vessel walls.In addition to sodium,choride plays an important role as it causes volume expansion increasing blood pressure as sodium with combined iwth other anions does not increase blood pressure.&lt;ref&gt;{{cite journal |author=Kurtz TW, Al-Bander HA, Morris RC |title=&quot;Salt-sensitive&quot; essential hypertension in men. Is the sodium ion alone important? |journal=[[N. Engl. J. Med.]] |volume=317 |issue=17 |pages=1043–8 |year=1987 |month=October |pmid=3309653 |doi= |url=}}&lt;/ref&gt;<br /> Also salt sensitivity is known to be increased in increasing age,obesity,African americans and metabolic syndrome.&lt;ref&gt;{{cite journal |author=Obarzanek E, Proschan MA, Vollmer WM, ''et al.'' |title=Individual blood pressure responses to changes in salt intake: results from the DASH-Sodium trial |journal=[[Hypertension]] |volume=42 |issue=4 |pages=459–67 |year=2003 |month=October |pmid=12953018 |doi=10.1161/01.HYP.0000091267.39066.72 |url=http://hyper.ahajournals.org/cgi/pmidlookup?view=long&amp;pmid=12953018}}&lt;/ref&gt;<br /> ====Mechanisms====<br /> The known mechanisms for salt-sensitvity is incraesed salt intake over a long period of time leads to impaired excretion of salt which causes hypertension.But there are several other pathways involved in the pathophysiology of salt-sensitivity leading to hypertension.A recent study showed that salt-sensitive patients are known to have a dysregulated Renin-Angiotensin pathway and patients show an abnormal vascular response to Angiotensin II.&lt;ref&gt;{{cite journal |author=Chamarthi B, Williams JS, Williams GH |title=A mechanism for salt-sensitive hypertension: abnormal dietary sodium-mediated vascular response to angiotensin-II |journal=[[J. Hypertens.]] |volume=28 |issue=5 |pages=1020–6 |year=2010 |month=May |pmid=20216091 |doi=10.1097/HJH.0b013e3283375974 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0263-6352&amp;volume=28&amp;issue=5&amp;spage=1020}}&lt;/ref&gt;<br /> Increased sodium re absorption, though not well understood is mostly related abnormalities across Na-H proximal tubule channels,Na-K-Cl co-transporter across the thick ascending limb,Na-Cl distal tubule co-transporter and epithelial Na channels.Dietary deficiency in potassium is also known to trigger increased sodium sensitivity in patients in particular African-Americans, but the mechanism is still not clearly determined.<br /> === Role of renin ===<br /> [[Renin]] is a [[hormone]] secreted by the [[juxtaglomerular cell]]s of the kidney and linked with [[aldosterone]] in a negative feedback loop. The range of renin activity observed in hypertensive subjects tends to be broader than in normotensive individuals. In consequence, some hypertensive patients have been defined as having low-renin and others as having essential hypertension. Low-renin hypertension is more common in African Americans than Caucasians and may explain why they tend to respond better to diuretic therapy than drugs that interfere with the renin-angiotensin system.<br /> <br /> High Renin levels predispose to Hypertension:<br /> Increased Renin --&gt; Increased Angiotensin II --&gt; Increased Vasoconstriction, Thirst/ADH and Aldosterone --&gt; Increased Sodium Reabsorption in the Kidneys (DCT and CD) --&gt; Increased Blood Pressure.<br /> === Insulin resistance ===<br /> [[Insulin]] is a polypeptide [[hormone]] secreted by the [[pancreas]]. Its main purpose is to regulate the levels of [[glucose]] in the body antagonistically with [[glucagon]] through negative feedback loops. Insulin also exhibits vasodilatory properties. In normotensive individuals, insulin may stimulate sympathetic activity without elevating mean arterial pressure. However, in more extreme conditions such as that of the metabolic syndrome, the increased sympathetic neural activity may over-ride the vasodilatory effects of insulin. Insulin resistance and/or [[hyperinsulinemia]] have been suggested as being responsible for the increased arterial pressure in some patients with hypertension. This feature is now widely recognized as part of [[metabolic syndrome|syndrome X]], or the [[metabolic syndrome]].<br /> === Sleep apnea ===<br /> [[Sleep apnea]] is a common, under-recognized cause of hypertension.&lt;ref name=&quot;Sleep Apnea&quot;&gt;{{<br /> cite journal<br /> |url=http://www.aafp.org/afp/20020115/229.html<br /> |author=Silverberg DS, Iaina A and Oksenberg A<br /> |journal=American Family Physicians<br /> |title=Treating Obstructive Sleep Apnea Improves Essential Hypertension and Quality of Life<br /> |year = 2002<br /> |month = January<br /> |volume = 65<br /> |issue = 2<br /> |pages = 229-36<br /> |pmid = 11820487<br /> }}&lt;/ref&gt; It is best treated with [[UPPP]], [[tonsilectomy]], [[adenoidectomy]], [[sinus surgery]], or weight loss, nocturnal nasal [[CPAP|positive airway pressure]], or the [[Mandibular advancement splint]] (MAS).<br /> === Genetics ===<br /> Hypertension is one of the most common complex disorders, with genetic [[heritability]] averaging 30%. Data supporting this view emerge from animal studies as well as in population studies in humans. Most of these studies support the concept that the inheritance is probably multifactorial or that a number of different genetic defects each have an elevated blood pressure as one of their [[phenotypic]] expressions.<br /> <br /> More than 50 genes have been examined in association studies with hypertension, and the number is constantly growing.<br /> <br /> === Other etiologies ===<br /> There are some anecdotal or transient causes of high blood pressure. These are not to be confused with the disease called hypertension in which there is an intrinsic physiopathological mechanism as described below.<br /> <br /> == Etiology of secondary hypertension ==<br /> Only in a small minority of patients with elevated arterial pressure, can a specific cause be identified. These individuals will probably have an [[endocrine]] or renal defect that, if corrected, could bring blood pressure back to normal values.<br /> <br /> ;Renal hypertension<br /> :Hypertension produced by diseases of the [[kidney]]. This includes diseases such as [[polycystic kidney disease]] or chronic [[glomerulonephritis]]. Hypertension can also be produced by diseases of the [[renal artery|renal arteries]] supplying the kidney. This is known as [[renovascular hypertension]]; it is thought that decreased perfusion of renal tissue due to [[stenosis]] of a main or branch renal artery activates the renin-angiotensin system.<br /> <br /> ;Adrenal hypertension<br /> :Hypertension is a feature of a variety of adrenal cortical abnormalities. In primary [[aldosteronism]] there is a clear relationship between the aldosterone-induced sodium retention and the hypertension.<br /> <br /> :In patients with [[pheochromocytoma]] increased secretion of [[catecholamines]] such as [[epinephrine]] and [[norepinephrine]] by a tumor (most often located in the adrenal medulla) causes excessive stimulation of [adrenergic receptors], which results in peripheral vasoconstriction and cardiac stimulation. This diagnosis is confirmed by demonstrating increased urinary excretion of epinephrine and norepinephrine and/or their metabolites ([[vanillylmandelic acid]]).<br /> <br /> ;[[Coarctation of the aorta]]<br /> <br /> ;Diet<br /> :The North American diet that is high in fat and salt has been proven to exacerbate hypertension. A study in the U.S. found that patients placed on a strict [[vegetarian]] diet showed a significant benefit to their condition over the one year. Certain medications, especially NSAIDS (Motrin/ibuprofen) and steroids can cause hypertension. Imported licorice (''Glycyrrhiza glabra'') inhibits the 11-hydroxysteroid hydrogenase enzyme (catalyzes the reaction of cortisol to cortison) which allows cortisol to stimulate the Mineralocorticoid Receptor (MR) which will lead to effects similar to hyperaldosteronism, which itself is a cause of hypertension. [Reference: Harrisons Internal Medicine, online edition (2007-04-14)]<br /> <br /> ;Age<br /> :Over time, the number of [[collagen]] fibers in artery and arteriole walls increases, making blood vessels stiffer. With the reduced elasticity comes a smaller cross-sectional area in systole, and so a raised mean arterial blood pressure.<br /> <br /> ;[[Acromegaly]]<br /> <br /> ==References==<br /> {{reflist|2}}<br /> <br /> [[Category:Cardiology]]<br /> <br /> {{WH}}<br /> <br /> {{WS}}</div> Taylor Palmieri