Blood pressure prevalence

Essential hypertension, whose prevalence is increased nearly two-fold in the diabetic population, may be another source of free-radical activity. The vascular lesions of hypertension can be produced by free-radical reactions (Selwign, 1983). In the recent Kuopio Ischaemic Heart Risk Factor Study in Finnish men, a marked elevation of blood pressure was associated with low levels of both plasma ascorbate and serum selenium (Salonen etal., 1988). A few studies report a hypotensive effect of supplementary ascorbate in patients with hypertension, but the actual changes in both systolic and diastolic pressure after ascorbate were not statistically significant in comparison with placebo (Trout, 1991). 

The prevalence of hypertension differs based on age, sex, and ethnicity. As individuals become older, their risk of high blood pressure increases. Individuals 55 years of age who do not have hypertension are estimated to have a lifetime risk of 90% of eventually developing hypertension. The National Health and Nutrition Examination Survey from 1999 to 2000 indicated that hypertension is slightly more prevalent in men (30.1%) than women (27.1%). However, the prevalence increased by 5.6% in women and has remained unchanged in men from 1988 to 2000.5 Hypertension prevalence is highest in African-Americans when compared to non-Hispanic whites and Mexican-Americans.1... 

The selection of blood pressure cuff size based on a patient s arm circumference is crucial for the accurate measurement of blood pressure. Systolic and diastolic blood pressure tend to increase when the cuff size is too small relative to the patient s arm circumference. This circumstance is important due to the increasing prevalence of obesity in developed nations. Currently, the guidelines of the American College of Cardiology/American Heart Association (ACC/AHA) Blood Pressure Measurement in Humans recommends cuff sizes for small, standard, and large adults with an optimal 2 1 ratio of cuff length/width based on arm circumference.18... 

Elevated blood pressure Elevated blood pressure and hypertension may occur within a few months of beginning use. The prevalence increases with the duration of use and age. Incidence of hypertension may directly correlate with increasing dosages of progestin. Discontinue use if elevated blood pressure occurs. Encourage women with a history of hypertension or hypertension-related diseases during pregnancy, or renal disease to use another method of contraception. 

In 534 individuals aged 30 years, whose mothers had participated in a double-blind, randomized, placebo-controlled trial of antenatal betamethasone (two intramuscular doses 24 hours apart) for the prevention of neonatal respiratory distress syndrome, there were no differences between those exposed to betamethasone and placebo in body size, blood lipids, blood pressure, plasma cortisol, prevalence of diabetes, or history of cardiovascular disease (397). After the oral glucose tolerance test, those who had been exposed to betamethasone had higher plasma insulin concentrations at 30 minutes (61 versus 52 mIU/1) and lower glucose concentrations at 120 minutes (4.8 versus 5.1 mmol/1) than did those exposed to placebo. Antenatal exposure to betamethasone might result in insulin resistance in adult offspring, but has no effect on cardiovascular risk factors at 30 years of age. 

Tyrosinase and amine oxidase appear to be true antihypertensive substances they are useless at the present time for clinical application. Many cardiotoxic and depressor agents are known which will lower blood pressure at the expense of kidneys, heart, or blood volume. A few newer compounds, however, are now being studied which on preliminary trial appear to fit the definition of antihypertensive substances. It is believed that, in the not too distant future, a practical method for the control of this prevalent condition will be found. 

Hypertension is a sustained, reproducible increase in blood pressure. Hypertension is one of the most common diseases affecting adults living in industrialized nations. In the United States, for example, hypertension occurs in approximately 30% of the general population aged 20 and over.44 The prevalence of this disease can be even higher in certain subpopulations (e.g., 41% in African Americans), and the incidence of hypertension increases with age.44,45 If left untreated, the sustained increase in blood pressure associated with hypertension can lead to cardiovascular problems (stroke, heart failure), renal disease, and blindness.15,22 108 111 These and other medical problems ultimately lead to an increased mortality rate in hypertensive individuals. 

Hypertension is the most common cardiovascular disease. Thus, the third National Health and Nutrition Examination Survey (NHANES III), conducted from 1992 to 1994, found that 27% of the USA adult population had hypertension. The prevalence varies with age, race, education, and many other variables. Sustained arterial hypertension damages blood vessels in kidney, heart, and brain and leads to an increased incidence of renal failure, coronary disease, cardiac failure, and stroke. Effective pharmacologic lowering of blood pressure has been shown to prevent damage to blood vessels and to substantially reduce morbidity and mortality rates. Many effective drugs are available. Knowledge of their antihypertensive mechanisms and sites of action allows accurate prediction of efficacy and toxicity. As a result, rational use of these agents, alone or in combination, can lower blood pressure with minimal risk of serious toxicity in most patients. 

Overweight and resistance to insulin appear to play pivotal roles in the pathophysiological process. The resulting hyperinsulinemia induces a rise in systemic arterial blood pressure and probably also a hyperglyceridemia associated with an unfavorable LDL/HDL quotient. This combination of risk factors lowers life expectancy and calls for therapeutic intervention. The metabolic syndrome has a high prevalence in industrialized countries, up to 20% of adults are believed to suffer from it. 

Race definitely comes into play. High blood pressure is far more common in blacks than in any other racial group, and it hits at an earlier age. But we know that African Americans are far more sodium sensitive than whites are and at the same time they have diets that are high in sodium, doubling the problem. The solution seems pretty obvious. Similarly, obesity and diabetes are more prevalent among blacks. Rather than wringing his or her hands in despair, the wise black individual will take appropriate action. 

Ssalt-sensitive people tend to develop hypertension with an intake of 125 to 250 mmol of Na per day, whereas salt-resistant people may not have a rise in blood pressure with up to 500 irunol of Na per day. Very large amounts of Na (800 mmol/day) lead to hypertension in both salt-sensitive and -insensitive people. It has been estimated that close to 20% of adult Americans lire salt sensitive. African-Americans have a greater incidence of Na sensitivity and hypertension than Americans of European descent. Generally, blood pressure tends to increase with age in salt-sensitive individuals consuming mrrderate or high levels of sodium. The prevalence of hypertension is very low in children and adolescents. The interracial differences in blood pressure that are found in adults arc not found among children (Sinaiko, 1996). 

The incidence, clinical features, consequences, and management of ciclosporin-induced hjq)ertension have been reviewed (9). The prevalence was 29-54% in nontransplant patients and 65-100% in heart and hver transplant patients also taking glucocorticoids. Disturbed circadian rhythm with a loss of nocturnal blood pressure fall was the main characteristic, and patients therefore had higher risks of left ventricular hjq)ertrophy. 

Alcohol is one of many drugs that cause or aggravate systemic hypertension. Acute alcohol exposure has an inconsistent effect on blood pressure, but cross-sectional population studies have shown a relation between chronic alcohol consumption and blood pressure, and the prevalence of hypertension up to three times higher in heavy drinkers (5). Although the mechanism of hypertension caused by chronic alcohol consumption is not known, it is suspected that it is partly related to repeated episodes of acute withdrawal, causing increased sympathoadrenomedullary activity, an increase in plasma renin activity, and increased ACTH secretion, which may be sufficient to have a mineralo-corticoid effect (6). 

The determinants of valvulopathy in patients treated with dexfenfluramine have been investigated age and blood pressure can also affect the prevalence of regurgitation (36,37), as can duration of exposure (36). Others have found no correlation between valvular disease associated with appetite suppressants and either dose or duration of drug exposure (29). 

Patients with Balkan nephropathy do not suffer from edema, and their blood pressure is usually described as normal [18,88-90]. Recently, several studies reported a higher prevalence of hypertension even in offspring of Balkan nephropathy famihes [91, 92, 93]. 

An association between obesity and a raised blood pressure (hypertension) was clearly demonstrated in the Build and Blood Pressure Study undertaken by the Metropolitan Life Insurance Company some 40 years ago (Company 1960). Since then several other large-scale investigations have confirmed this relationship. In a representative epidemiological sample of some 10,000 US residents the prevalence of hypertension (blood... 

---