Hypertension Hypertension 1 Hypertension

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					Hypertension                                                                                                                        1

                                                 Classification and external resources

      Automated arm blood pressure meter showing arterial hypertension (shown a systolic blood pressure 158 mmHg, diastolic blood
                                      pressure 99 mmHg and heart rate of 80 beats per minute).

   ICD-10                                                                  [1]         [2]      [3]
                                                                    I 10. ,I 11. ,I 12.               ,
                                                                         [4]     [5]
                                                                    I 13. ,I 15.

   ICD-9                                                                  [6]

   OMIM                                                                          [7]

   DiseasesDB                                                              [8]

   MedlinePlus                                                                   [9]

   eMedicine                                                                       [10]               [11]               [12]
                                                                    med/1106              ped/1097           emerg/267

   MeSH                                                                            [13]

    Hypertension (HTN) or high blood pressure is a chronic medical condition in which the systemic arterial blood
    pressure is elevated. It is the opposite of hypotension. It is classified as either primary (essential) or secondary.
    About 90–95% of cases are termed "primary hypertension", which refers to high blood pressure for which no
    medical cause can be found.[14] The remaining 5–10% of cases (Secondary hypertension) are caused by other
    conditions that affect the kidneys, arteries, heart, or endocrine system.[15]
    Persistent hypertension is one of the risk factors for stroke, myocardial infarction, heart failure and arterial aneurysm,
    and is a leading cause of chronic kidney failure.[16] Moderate elevation of arterial blood pressure leads to shortened
    life expectancy. Dietary and lifestyle changes can improve blood pressure control and decrease the risk of associated
    health complications, although drug treatment may prove necessary in patients for whom lifestyle changes prove
    ineffective or insufficient.[17]
Hypertension                                                                                                                   2


         The variation in pressure in the left ventricle
         (blue line) and the aorta (red line) over two
          cardiac cycles ("heart beats"), showing the
         definitions of systolic and diastolic pressure

                                                Classification      Systolic pressure   Diastolic pressure

                                                                   mmHg        kPa      mmHg         kPa

                                                   Normal          90–119    12–15.9    60–79      8.0–10.5

                                               Prehypertension 120–139 16.0–18.5        80–89      10.7–11.9

                                                   Stage 1         140–159 18.7–21.2    90–99      12.0–13.2

                                                   Stage 2          ≥160      ≥21.3     ≥100        ≥13.3

                                               Isolated systolic    ≥140      ≥18.7      <90        <12.0

                                                      Source: American Heart Association (2003).

    Blood pressure is usually classified based on the systolic and diastolic blood pressures. Systolic blood pressure is the
    blood pressure in vessels during a heart beat. Diastolic blood pressure is the pressure between heartbeats. A systolic
    or the diastolic blood pressure measurement higher than the accepted normal values for the age of the individual is
    classified as prehypertension or hypertension.
    Hypertension[19] has several sub-classifications including, hypertension stage I, hypertension stage II, and isolated
    systolic hypertension. Isolated systolic hypertension refers to elevated systolic pressure with normal diastolic
    pressure and is common in the elderly. These classifications are made after averaging a patient's resting blood
    pressure readings taken on two or more office visits. Individuals older than 50 years are classified as having
    hypertension if their blood pressure is consistently at least 140 mmHg systolic or 90 mmHg diastolic. Patients with
    blood pressures higher than 130/80 mmHg with concomitant presence of diabetes mellitus or kidney disease require
    further treatment.[18]
    Hypertension is also classified as resistant if medications do not reduce blood pressure to normal levels.[18]
    Exercise hypertension is an excessively high elevation in blood pressure during exercise.[20] [21] [22] The range
    considered normal for systolic values during exercise is between 200 and 230 mm Hg.[23] Exercise hypertension may
    indicate that an individual is at risk for developing hypertension at rest.[22] [23]
Hypertension                                                                                                                     3

    Signs and symptoms
    Mild to moderate essential hypertension is usually asymptomatic.[24]

    Accelerated hypertension
    Accelerated hypertension is associated with headache, drowsiness, confusion, vision disorders, nausea, and vomiting
    symptoms which are collectively referred to as hypertensive encephalopathy.[25] . Hypertensive encephalopathy is
    caused by severe small blood vessel congestion and brain swelling, which is reversible if blood pressure is

    Some signs and symptoms are especially important in newborns and infants such as failure to thrive, seizures,
    irritability, lack of energy, and difficulty breathing.[27] In children, hypertension can cause headache, fatigue, blurred
    vision, nosebleeds, and facial paralysis.[27]

    Secondary hypertension
    Some additional signs and symptoms suggest that the hypertension is caused by disorders in hormone regulation.
    Hypertension combined with obesity distributed on the trunk of the body, accumlated fat on the back of the neck
    ('buffalo hump'), wide purple marks on the abdomen (abdominal striae), or the recent on set of diabetes suggests that
    an individual has a hormone disorder known as Cushing's syndrome. Hypertension caused by other hormone
    disorders such as hyperthyroidism, hypothyroidism, or growth hormone excess will be accompanied by additional
    symptoms specific to these disorders. For example, hyperthyrodism can cause weight loss, tremors, heart rate
    abnormalities, reddening of the palms, and increased sweating.[28] Signs and symptoms associated with growth
    hormone excess include coarsening of facial features, protrusion of the lower jaw, enlargement of the tongue,[29]
    excessive hair growth, darkening of the skin color, and excessive sweating.[30] :499. Other hormone disorders like
    hyperaldosteronism may cause less specific symptoms such as numbness, excessive urination, excessive sweating,
    electrolyte imbalances and dehydration, and elevated blood alkalinity.[31] and also cause of mental pressure.

    Hypertension in pregnant women is known as pre-eclampsia. Pre-eclampsia can progress to a life-threatening
    condition called eclampsia, which is the development of protein in the urine, generalized swelling, and severe
    seizures. Other symptoms indicating that brain function is becoming impaired may precede these seizures such as
    nausea, vomiting, headaches, and vision loss.[32]


    Essential hypertension
    Essential hypertension is the most prevalent hypertension type, affecting 90–95% of hypertensive patients.[14]
    Although no direct cause has identified itself, there are many factors such as sedentary lifestyle,[33] stress, visceral
    obesity, potassium deficiency (hypokalemia),[33] obesity[34] (more than 85% of cases occur in those with a body
    mass index greater than 25),[35] salt (sodium) sensitivity,[36] alcohol intake,[37] and vitamin D deficiency that
    increase the risk of developing hypertension.[38] [39] Risk also increases with aging,[40] some inherited genetic
    mutations,[41] and having a family history of hypertension.[42] An elevation of renin, a hormone secreted by the
    kidney, is another risk factor,[43] as is sympathetic nervous system overactivity.[44] Insulin resistance which is a
    component of syndrome X, or the metabolic syndrome is also thought to contribute to hypertension.[43] [45] Recent
    studies have implicated low birth weight as a risk factor for adult essential hypertension.[46]
Hypertension                                                                                                                  4

    Secondary hypertension
    Secondary hypertension by definition results from an identifiable cause. This type is important to recognize since it's
    treated differently than essential hypertension, by treating the underlying cause of the elevated blood pressure.
    Hypertension results in the compromise or imbalance of the pathophysiological mechanisms, such as the
    hormone-regulating endocrine system, that regulate blood plasma volume and heart function. Many conditions cause
    hypertension, some are common and well recognized secondary causes such as Cushing's syndrome,[47] which is a
    condition where the adrenal glands overproduce the hormone cortisol.[47] In addition, hypertension is caused by
    other conditions that cause hormone changes such as hyperthyroidism, hypothyroidism (citation needed), and certain
    tumors of the adrenal medulla (e.g., pheochromocytoma). Other common causes of secondary hypertension include
    kidney disease, obesity/metabolic disorder, pre-eclampsia during pregnancy, the congenital defect known as
    coarctation of the aorta, and certain prescription and illegal drugs.

    Most of the mechanisms associated
    with secondary hypertension are
    generally fully understood. 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                      A diagram explaining factors affecting arterial pressure
    cardiac output drops to normal levels
    but TPR is increased. Three theories have been proposed to explain this:

    • 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.
    • An overactive Renin-angiotensin system leads to vasoconstriction and retention of sodium and water. The
      increase in blood volume leads to hypertension.[48]
    • An overactive sympathetic nervous system, leading to increased stress responses.[49]
    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.[50]
    Recently, work related to the association between essential hypertension and sustained endothelial damage has
    gained popularity among hypertension scientists. It remains unclear however whether endothelial changes precede
    the development of hypertension or whether such changes are mainly due to long standing elevated blood pressures.
Hypertension                                                                                                                   5

    Hypertension is generally diagnosed on the basis of a persistently high blood pressure. Usually this requires three
    separate sphygmomanometer (see figure) measurements at least one week apart. Initial assessment of the
    hypertensive patient should include a complete history and physical examination. Exceptionally, if the elevation is
    extreme, or if symptoms of organ damage are present then the diagnosis may be given and treatment started
    Once the diagnosis of hypertension has been made, physicians will attempt to identify the underlying cause based on
    risk factors and other symptoms, if present. Secondary hypertension is more common in preadolescent children, with
    most cases caused by renal disease. Primary or essential hypertension is more common in adolescents and has
    multiple risk factors, including obesity and a family history of hypertension.[42] Laboratory tests can also be
    performed to identify possible causes of secondary hypertension, and determine if hypertension has caused damage
    to the heart, eyes, and kidneys. Additional tests for Diabetes and high cholesterol levels are also usually performed
    because they are additional risk factors for the development of heart disease require treatment.[14] Tests typically
    performed are classified as follows:

                        System                                              Tests

                       Renal       Microscopic urinalysis, proteinuria, serum BUN (blood urea nitrogen) and/or creatinine

                       Endocrine Serum sodium, potassium, calcium, TSH (thyroid-stimulating hormone).

                       Metabolic Fasting blood glucose, total cholesterol, HDL and LDL cholesterol, triglycerides

                       Other       Hematocrit, electrocardiogram, and chest radiograph

                                                                          [51]       [52] [53] [54] [55] [56] [57]
                       Sources: Harrison's principles of internal medicine     others

    Creatinine (renal function) testing is done to determine if kidney disease is present, which can be either the cause or
    result of hypertension. In addition, it provides a baseline measurement of kidney function that can be used to monitor
    for side-effects of certain antihypertensive drugs on kidney function. Additionally, testing of urine samples for
    protein is used as a secondary indicator of kidney disease. Glucose testing is done to determine if diabetes mellitus is
    present. Electrocardiogram (EKG/ECG) testing is done to check for evidence of the heart being under strain from
    high blood pressure. It may also show if there is thickening of the heart muscle (left ventricular hypertrophy) or has
    experienced a prior minor heart distubance such as a silent heart attack. A chest X-ray may be performed to look for
    signs of heart enlargement or damage to heart tissue.

    The degree to which hypertension can be prevented depends on a number of features including current blood
    pressure level, sodium/potassium balance, detection and omission of environmental toxins, changes in end/target
    organs (retina, kidney, heart, among others), risk factors for cardiovascular diseases and the age at diagnosis of
    prehypertension or at risk for hypertension. A prolonged assessment in which repeated measurements of blood
    pressure are taken provides the most accurate assessment of blood pressure levels. Following this, lifestyle changes
    are recommended to lower blood pressure, before the initiation of prescription drug therapy. The process of
    managing prehypertension according the guidelines of the British Hypertension Society suggest the following
    lifestyle changes:
    • Weight reduction and regular aerobic exercise (e.g., walking): Regular exercise improves blood flow and helps to
      reduce the resting heart rate and blood pressure.[58]
    • Reducing dietary sugar.
    • Reducing sodium (salt) in the diet: This step decreases blood pressure in about 33% of people (see above). Many
      people use a salt substitute to reduce their salt intake.[59]
Hypertension                                                                                                                   6

    • Additional dietary changes beneficial to reducing blood pressure include the DASH diet (dietary approaches to
      stop hypertension) which is rich in fruits and vegetables and low-fat or fat-free dairy products. This diet has been
      shown to be effective based on research sponsored by the National Heart, Lung, and Blood Institute.[60] In
      addition, an increase in dietary potassium, which offsets the effect of sodium has been shown to be highly
      effective in reducing blood pressure.[61]
    • Discontinuing tobacco use and alcohol consumption has been shown to lower blood pressure. The exact
      mechanisms are not fully understood, but blood pressure (especially systolic) always transiently increases
      following alcohol or nicotine consumption. Abstaining from cigarette smoking reduces the risk of stroke and heart
      attack which are associated with hypertension.
    • Reducing stress, for example with relaxation therapy, such as meditation and other mindbody relaxation
      techniques,[62] by reducing environmental stress such as high sound levels and over-illumination can also lower
      blood pressure. Jacobson's Progressive Muscle Relaxation and biofeedback are also beneficial,[63] such as
      device-guided paced breathing,[64] [65] although meta-analysis suggests it is not effective unless combined with
      other relaxation techniques.[66]


    Lifestyle modifications
    The first line of treatment for hypertension is the same as the recommended preventative lifestyle changes such as
    the dietary changes, physical exercise, and weight loss, which have all been shown to significantly reduce blood
    pressure in people with hypertension.[67] If hypertension is high enough to justify immediate use of medications,
    lifestyle changes are still recommended in conjunction with medication. Drug prescription should take into account
    the patient's absolute cardiovascular risk (including risk of myocardial infarction and stroke) as well as blood
    pressure readings, in order to gain a more accurate picture of the patient's cardiovascular profile.[17] Different
    programs aimed to reduce psychological stress such as biofeedback, relaxation or meditation are advertised to reduce
    hypertension. However, in general claims of efficacy are not supported by scientific studies, which have been in
    general of low quality.[68] [69] [70]
    Regarding dietary changes, a low sodium diet is beneficial; A Cochrane review published in 2008 concluded that a
    long term (more than 4 weeks) low sodium diet in Caucasians has a useful effect to reduce blood pressure, both in
    people with hypertension and in people with normal blood pressure.[71] Also, the DASH diet (Dietary Approaches to
    Stop Hypertension) is a diet promoted by the National Heart, Lung, and Blood Institute (part of the NIH, a United
    States government organization) to control hypertension. A major feature of the plan is limiting intake of sodium,[72]
    and it also generally encourages the consumption of nuts, whole grains, fish, poultry, fruits and vegetables while
    lowering the consumption of red meats, sweets, and sugar. It is also "rich in potassium, magnesium, and calcium, as
    well as protein".

    Several classes of medications, collectively referred to as antihypertensive drugs, are currently available for treating
    hypertension. Agents within a particular class generally share a similar pharmacologic mechanism of action, and in
    many cases have an affinity for similar cellular receptors. An exception to this rule is the diuretics, which are
    grouped together for the sake of simplicity but actually exert their effects by a number of different mechanisms.
    Reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34%, of ischaemic heart disease by
    21%, and reduce the likelihood of dementia, heart failure, and mortality from cardiovascular disease.[73] The aim of
    treatment should be reduce blood pressure to <140/90 mmHg for most individuals, and lower for individuals with
    diabetes or kidney disease (some medical professionals recommend keeping levels below 120/80 mmHg).[74]
    Comorbidity also plays a role in determining target blood pressure, with lower BP targets applying to patients with
Hypertension                                                                                                                       7

    end-organ damage or proteinuria.[17]
    Often multiple drugs are combined to achieve the goal blood pressure. Commonly used prescription drugs
    •   ACE inhibitors (e.g., captopril)
    •   Alpha blockers (e.g., prazosin)
    •   Angiotensin II receptor antagonists (e.g., losartan)
    •   Beta blockers (e.g., propranolol)
    •   Calcium channel blockers (e.g., verapamil)
    •   Diuretics (e.g. hydrochlorothiazide)
    •   Direct renin inhibitors (e.g., aliskiren)
    Some examples of common combined prescription drug treatments include:
    • A fixed combination of an ACE inhibitor and a calcium channel blocker. One example of this is the combination
      of perindopril and amlodipine, the efficacy of which has been demonstrated in individuals with glucose
      intolerance or metabolic syndrome.[76]
    • A fixed combination of an ACE inhibitor and a calcium channel blocker.
    • A fixed combination of a diuretic and an ARB.

    Guidelines for treating resistant hypertension have been published in the UK[75] and US.[77]

    Hypertension is the most important risk factor for death in
    industrialized countries.[78] It increases hardening of the arteries[79]
    thus predisposes individuals to heart disease,[80] peripheral vascular
    disease,[81] and strokes.[82] Types of heart disease that may occur
    include: myocardial infarction,[82] heart failure,[83] and left ventricular
    hypertrophy[84] Other complications include:

    • Hypertensive retinopathy[85]
    • Hypertensive nephropathy[86]
    • If blood pressure is very high hypertensive encephalopathy may
                                                                                  Diagram illustrating the main complications of
                                                                                         persistent high blood pressure.
    In the year 2000 it is estimated that nearly one billion people or ~26% of the adult population have hypertension
    worldwide.[87] It was common in both developed (333 million ) and undeveloped (639 million) countries.[87]
    However rates vary markedly in different regions with rates as low as 3.4% (men) and 6.8% (women) in rural India
    and as high as 68.9% (men) and 72.5% (women) in Poland.[88]
    In 1995 it is estimated that 43 million people in the United States had hypertension or were taking antihypertensive
    medication, almost 24% of the adult population.[89] The prevalence of hypertension in the United States is increasing
    and reached 29% in 2004.[90] [91] It is more common in blacks and less in whites and Mexican Americans, rates
    increase with age, and is greater in the southeastern United States. Hypertension is more prevalent in men (though
    menopause tends to decrease this difference) and those of low socioeconomic status.[14]
    Over 90–95% of adult hypertension is essential hypertension.[14] The most common cause of secondary hypertension
    is primary aldosteronism.[53] The incidence of exercise hypertension is reported to range from 1–10%.[23]
Hypertension                                                                                                                  8

    The prevalence of high blood pressure in the young is increasing.[92] Most childhood hypertension, particularly in
    preadolescents, is secondary to an underlying disorder. Kidney disease is the most common (60–70%) cause of
    hypertension in children. Adolescents usually have primary or essential hypertension, which accounts for 85–95% of

    Some cite the writings of Sushruta in the 6th century BC as being the
    first mention of symptoms like those of hypertension.[94] Others
    propose even earlier descriptions dating as far as 2600 years before
    Christ. Main treatment for what was called the "hard pulse disease"
    consisted in reducing the quantity of blood in a subject by the
    sectioning of veins or the application of leeches.[95] Well known
    individuals such as The Yellow Emperor of China, Cornelius Celsus,
    Galen, and Hipocrates advocated such treatments.[95]
                                                                                   Image of veins from Harvey's Exercitatio
    Our modern understanding of hypertension began with the work of
                                                                                  Anatomica de Motu Cordis et Sanguinis in
    physician William Harvey (1578–1657), who was the first to describe                         Animalibus
    correctly the systemic circulation of blood being pumped around the
    body by the heart in his book "De motu cordis". The basis for measuring blood pressure were established by Stephen
    Hales in 1733.[95] Initial descriptions of hypertension as a disease came among others from Thomas Young in 1808
    and specially Richard Bright in 1836.[95] The first ever elevated blood pressure in a patient without kidney disease
    was reported by Frederick Mahomed (1849–1884).[96] It was not until 1904 that sodium restriction was advocated
    while a rice diet was popularized around 1940.[95]

    Studies in the 1920s demonstrated the public health impact of untreated high blood pressure; treatment options were
    limited at the time, and deaths from malignant hypertension and its complications were common. A prominent
    victim of severe hypertension leading to cerebral hemorrhage was Franklin D. Roosevelt (1882–1945). The
    Framingham Heart Study added to the epidemiological understanding of hypertension and its relationship with
    coronary artery disease. The National Institutes of Health also sponsored other population studies, which additionally
    showed that African Americans had a higher burden of hypertension and its complications.[97] Before
    pharmacological treatment for hypertension became possible, three treatment modalities were used, all with
    numerous side-effects: strict sodium restriction, sympathectomy (surgical ablation of parts of the sympathetic
    nervous system), and pyrogen therapy (injection of substances that caused a fever, indirectly reducing blood
    pressure).[95] [97]
    The first chemical for hypertension, sodium thiocyanate, was used in 1900 but had many side effects and was
    unpopular.[95] Several other agents were developed after the Second World War, the most popular and reasonably
    effective of which were tetramethylammonium chloride and its derivative hexamethonium, hydralazine and reserpine
    (derived from the medicinal plant Rauwolfia serpentina). A randomized controlled trial sponsored by the Veterans
    Administration using these drugs had to be stopped early because those not receiving treatment were developing
    more complications and it was deemed unethical to withhold treatment from them. These studies prompted public
    health campaigns to increase public awareness of hypertension and the advice to get blood pressure measured and
    treated. These measures appear to have contributed at least in part of the observed 50% fall in stroke and ischemic
    heart disease beween 1972 and 1994.[97]
    A major breakthrough was achieved with the discovery of the first well-tolerated orally available agents. The first
    was chlorothiazide, the first thiazide and developed from the antibiotic sulfanilamide, which became available in
    1958;[95] [98] it increased salt excretion while preventing fluid accumulation. In 1975, the Lasker Special Public
Hypertension                                                                                                                       9

    Health Award was awarded to the team that developed chlorothiazide.[97] The British physician James W. Black
    developed beta blockers in the early 1960s;[99] these were initially used for angina, but turned out to lower blood
    pressure. Black received the 1976 Lasker Award and in 1988 the Nobel Prize in Physiology or Medicine for his
    discovery.[97] The next class of antihypertensives to be discovered was that of the calcium channel blockers. The
    first member was verapamil, a derivative of papaverine that was initially thought to be a beta blocker and used for
    angina, but then turned out to have a different mode of action and was shown to lower blood pressure.[97] ACE
    inhibitors were developed through rational drug design; the renin-angiotensin system was known to play an
    important role in blood pressure regulation, and snake venom from Bothrops jararaca could lower blood pressure
    through inhibition of ACE. In 1977 captopril, an orally active agent, was described;[100] this led to the development
    of a number of other ACE inhibitors.[97]

    Society and culture

    The National Heart, Lung, and Blood Institute (NHLBI) estimated in 2002 that hypertension cost the United States
    $47.2 billion.[101]
    High blood pressure is the most common chronic medical problem prompting visits to primary health care providers,
    yet it is estimated that only 34% of the 50 million American adults with hypertension have their blood pressure
    controlled to a level of <140/90 mm Hg . Thus, about two thirds of Americans with hypertension are at increased
    risk for heart disease. The medical, economic, and human costs of untreated and inadequately controlled high blood
    pressure are enormous. Adequate management of hypertension can be hampered by inadequacies in the diagnosis,
    treatment, and/or control of high blood pressure.[102] Health care providers face many obstacles to achieving blood
    pressure control from their patients, including resistance to taking multiple medications to reach blood pressure
    goals. Patients also face the challenges of adhering to medicine schedules and making lifestyle changes. Nonetheless,
    the achievement of blood pressure goals is possible, and most importantly, lowering blood pressure significantly
    reduces the risk of death due to heart disease, the development of other debilitating conditions, and the cost
    associated with advanced medical care.,[103] [104]

    The World Health Organization attributes hypertension, or high blood
    pressure, as the leading cause of cardiovascular mortality. The World
    Hypertension League (WHL), an umbrella organization of 85 national
    hypertension societies and leagues, recognized that more than 50% of
    the hypertensive population worldwide are unaware of their
    condition.[105] To address this problem, the WHL initiated a global
    awareness campaign on hypertension in 2005 and dedicated May 17 of
    each year as World Hypertension Day (WHD). Over the past three
                                                                                      Graph showing, prevalence of awareness,
    years, more national societies have been engaging in WHD and have             treatment and control of hypertension compared
    been innovative in their activities to get the message to the public. In         between the four studies of NHANES
    2007, there was record participation from 47 member countries of the
    WHL. During the week of WHD, all these countries – in partnership with their local governments, professional
    societies, nongovernmental organizations and private industries – promoted hypertension awareness among the
    public through several media and public rallies. Using mass media such as Internet and television, the message
    reached more than 250 million people. As the momentum picks up year after year, the WHL is confident that almost
    all the estimated 1.5 billion people affected by elevated blood pressure can be reached.[106]
Hypertension                                                                                                                                          10

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    Further reading
    • Oke DA, Bandele EO (September 2004). "Misconceptions of hypertension" (http://www.pubmedcentral.nih.
      gov/articlerender.fcgi?tool=pmcentrez&artid=2568468). Journal of the National Medical Association 96 (9):
      1221–4. PMID 15481752. PMC 2568468.
    • The American Journal of Hypertension (http://www.nature.com/ajh)

    External links
    • The Framingham Heart Study (http://www.nhlbi.nih.gov/about/framingham/)
    • Video showing how to measure blood pressure (http://www.medicalvideos.us/
    • Hypertension (http://www.dmoz.org//Health/Conditions_and_Diseases/Cardiovascular_Disorders/
      Vascular_Disorders/Hypertension//) at the Open Directory Project
Hypertension                                                                                                       14

    • High Blood Pressure (http://ww2.heartandstroke.ca/Page.asp?PageID=1975&ArticleID=5211) from the Heart
      and Stroke Foundation of Canada
    • High Blood Pressure (http://medlineplus.nlm.nih.gov/medlineplus/highbloodpressure.html) from
    • A guide to lowering high blood pressure (http://www.nhlbi.nih.gov/hbp/) from the National Heart, Lung, and
      Blood Institute
    • High Blood Pressure (http://www.americanheart.org/presenter.jhtml?identifier=2114) (from the American
      Heart Association)
    • Pulmonary Hypertension (http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/
      nephrology/arterial-hypertension/) from Cleveland Clinic Online Medical Reference
Article Sources and Contributors                                                                                                                                                                          15

    Article Sources and Contributors
    Hypertension  Source: http://en.wikipedia.org/w/index.php?oldid=389163158  Contributors: 1ForTheMoney, 207-203-156-105, 2D, 4wajzkd02, A. B., A930913, ABF, ARHAPSTF, AS,
    Abdulnour, Acerperi, Adamflorin, Adamtunis, Ageekgal, Ahoerstemeier, Aifaa, Aitias, AkiAkira, Alansohn, Aldis90, Ale jrb, Alensha, AlexandriNo, Alias Flood, Allstarecho, Altzinn, Amaher,
    Ami9167, AmiDaniel, Amplitude101, Ampoicojsteinway, AnakngAraw, Andre Engels, Andrew73, AndrewHowse, Andrewkrals, Andycjp, AngelOfSadness, Angela, Angelus Aran, Angus
    Lepper, Anim8cme, Anlace, Antelan, Anthony Bradbury, Anupamgahalout, Aphid360, Apollo the Archer, Appraiser, Aquaepulse, Arcadian, ArielGold, Arif Zaman, Astronaut, AtheWeatherman,
    Aura99, Auslander99, AxelBoldt, Axl, Axxaer, BD2412, BSW-RMH, BService, Badgettrg, Baobabtree, BeautifulMachine, Beetstra, Belovedfreak, Bemoeial, Benbest, BiT, Blabberhand, Black
    Falcon, Blenda, Blood Pressure Association Publications Officer, Blurpeace, BobKawanaka, Bobblewik, Bobo192, BradBeattie, Bradeos Graphon, BrettMontgomery, Brian Crawford, Brianga,
    Briansymon, Brighterorange, Bunnyhop11, Buster7, CAMiasm, CERminator, Cacophony, Caltas, Can't sleep, clown will eat me, Caroline Sanford, Carto308, Casliber, Centrx, Certes, Chipuni,
    Chowbok, Chris Capoccia, Chris the speller, Chrysaor, Chuckmoran7, Chun-hian, Citylover, Cjrother, Clicketyclack, Closedmouth, Cody574, Countincr, Crockwell1, Cryos, Crystallina,
    Cuaxdon, Cwenger, Cyfal, Cynthiamonster, DGAllan, DGG, DRosenbach, DSRH, DVD R W, DabMachine, Dararivera, DarkFuture, Daughter of Mímir, Davidoff, Davidruben, Davidrubenstern,
    Ddrane, DeadEyeArrow, Deathstyler2, Deli nk, Delldot, Denis tarasov, DerHexer, Derek.cashman, Derumi, Discospinster, Dispenser, DiverDave, Dj stone, Doctorevil64, Domminico, Donama,
    Doomsayer, Doops, Dougofborg, Dr.Gangino, Draeco, Dreamyshade, Drevrengul, Drew R. Smith, Drfarhan99, Drflgd, Drjayakumar1999, Drmies, Dthomsen8, Duster.Cleaner, Dysepsion,
    ESkog, EagleFan, Easterangel, Edcolins, Edgar181, Edward, Edward130603, Egil, EhJJ, El aprendelenguas, Elagatis, Eleassar777, Eliz81, Emily29G, Emrexpert, Enigmaman, Epbr123, Erich
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Description: Hypertension (HTN) or high blood pressure is a chronic medical condition in which the systemic arterial blood pressure is elevated. It is the opposite of hypotension. It is classified as either primary (essential) or secondary
Dean Demetrius Chu Dean Demetrius Chu OS / OE none
About I was born in Malaysia in 1986. I am a writer and a blogger. I love music so much. Music is my life. As a blogger, I always try to come out with brilliant idea to keep my post interesting. I love to help out blogger if they need my help. During my free time, I always hang out with my friends and having a great time with them. Positive thinking is crucial to keep me or even you happy.