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                                                     HYPERTENSIVE  HEART  DISEASE

                                                             Andrew Ying-Siu Lee, MD,PhD.

 

         Hypertension is common heart disease.  It can be divided into (1) primary hypertension and (2) secondary

hypertension.  Primary hypertension comprises 95% of hypertension, cause unknown,  may be related to genetic

and environmental factors such as diet, obesity, hyperlipidemia, smoking, alcoholic, lack of exercise, anxiety etc.

Secondary hypertension comprises only 5% of hypertension, the common causes are renal or endocrine diseases,

drugs such as steroids and contraceptives.

 

        According to WHO classification, the severity of hypertension can be divided into :-

                                          Systolic hypertension(mmHg)     Diastolic hypertension(mmHg)

optimal blood pressure                                     <120                                                 <80 

normal blood pressure                                    <130                                                  <85

 borderline hypertension                               130-139                                              85-89

mild hypertension                                         140-159                                              90-99

moderate hypertension                                 160-179                                             100-109

severe hypertension                                         >180                                                   >110

 

According to JNC7 classification, the severity of hypertension can be divided into: -

       Blood pressure                                   Systolic BP                                       Diastolic BP

          Classification                                         (mmHg)                                          (mmHg)

            normal                                                       < 120                                                  < 80

   e     Prehypertension                                     120-139                                              80-89

          stage 1 hypertension                        140-159                                              90-99

          stage 2 hypertension                               > 160                                                 > 100

               - Prehypertension is not disease category and not for drug therapy (lifestyle

                 modification needed to reduce risk of developing hypertension)

              -  All people with stage 1 or 2 hypertension need drug therapy. Treatment goal is <140/90mmHg.

                 If there are diabetes or kidney disease, treatment goal is < 130/80mmHg     

        To confirm or diagnose hypertension, one should have blood pressure higher than 140/90mmHg for more than

two times at different period.  For mild hypertension, non-drug therapy is attempted first.  One should stop smoking

and alcohol abuse, and have diet control, body fittness, regular exercise, control anxiety and emotion et.  After 6 months,

if blood pressure remains high, then medical therapy with antihypertensive drugs is recommended.

 

        Most hypertensive patients have no symptom.  Sometimes they may have headache, dizziness, face flush , cold

sweating, chest discomfort, shortness of breath etc.  Therefore, most people do not check their blood pressure regularly.

And most hypertensive patients do not take antihypertensive drugs regularly.  Therefore, patients usually have organ

failure or serious complication when they have obvious symptoms, as :-

(1)       HEART:  Hypertension is risk and precipitating factors for coronary artery disease and

                        heart failure.  Hypertension can lead to myocardial infarction, cardiomegaly,

                        valvular heart disease,  heart failure, cariomyopathies, cardiac arrhythmias and  

                        sudden cardiac death.

(2)       BRAIN :  Hypertension is risk and precipitating factors for stroke, coma and death.

(3)       KIDNEY:  Hypertension is the commonest cause of end-stage renal disease requiring dialysis.

(4)       VESSELS: Hypertension can lead to peripheral arterial disease.  If aorta is involved,

                          aortic aneurysm  or aortic  dissection (leading to death) may happen.

          (5) EYES      : Hypertension can lead to retinal hemorrhage and blindness.

 

         It is therefore particularly important to early diagnose and treat the hypertensive patients.  This can avoid the

above mentioned organ failure and complications, prevent the life threatening "hypertensive crisis".  Hypertensive crisis

is sudden onset of very high blood pressure (diastolic blood pressure greater than 140 mmHg) associated with

hypertensive encephalopathy, stroke, acute aortic dissection, acute renal failure, acute heart failure, pulmonary

edema and death.

 

        "Therefore, hypertension looks like simple disease, but it is life threatening if organ failure or complications

occur!"  If hypertension is not well controlled, 50% patients will die of heart diseases, 30% of strokes and 15% of

renal failure.  Therefore, hypertensive patients should have regular medication and follow up.  They should stop

smoking and drinking, and should have diet control, regular exercise, emotion control etc.  Antihypertensive therapy

should include antihypertensive drugs, as well as drugs for preventing and treating complications.