Lexicon
Blood Pressure
Definition
Among the risk factors for cardiovascular disease, high blood pressure is associated with the strongest evidence for causation and has a high prevalence of exposure. [1] Hypertension is the most common condition seen in primary care and leads to myocardial infarction, stroke, renal failure, and death if not detected early and treated appropriately. [2] Large cohort studies show that high blood pressure is an important risk factor for heart failure, atrial fibrillation, chronic kidney disease, and dementia, in addition to coronary heart disease and stroke. [1]
How it works
Elastic arteries near the heart are most sensitive to the effects of blood pressure and age, and arterial stiffness promotes inward remodeling of small arteries that increases resistance and blood pressure in an insidious feedback loop. [3] Salt-sensitive hypertension is characterized by a blood pressure rise in response to high dietary salt intake, with the kidneys playing a central role through aberrant activation of the renin-angiotensin system and sympathetic nervous system and blunted renal blood flow leading to sodium retention. [4] A dose-response meta-analysis found a U-shaped relationship between potassium intake and blood pressure, with the blood-pressure-lowering effect of potassium supplementation stronger in participants with hypertension and at higher levels of sodium intake. [5]
Connected concepts
How it's measured
Accurate measurement is essential to classify individuals and guide management, and requires proper observer training, patient positioning, and selection of cuff size, with only independently validated devices used for oscillometric measurement. [6] Office measurements correlate poorly with blood pressure measured in other settings and can be supplemented by self-measured home readings and ambulatory monitoring, which gives a better prediction of risk than office measurements. [6] International bodies including AAMI, the European Society of Hypertension, and ISO have agreed to develop a single universal standard for the clinical validation of blood pressure measuring devices. [7]
What levels mean
The 2017 ACC/AHA guideline sets a blood pressure reading of 130/80 mm Hg or higher to be considered hypertensive, whereas the ESC/ESH guidelines use a threshold of 140/90 mm Hg. [8] The 2014 JNC 8 panel found strong evidence to treat hypertensive people aged 60 years or older to a goal of less than 150/90 mm Hg, and recommended less than 140/90 mm Hg for those younger than 60 years including adults with diabetes or chronic kidney disease. [2]
Community knowledge
## Vascular Age And Pulsatile Stress frames blood pressure as a direct readout of vascular age. A youthful artery is meant to absorb…
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- 1.Fuchs FD, Whelton PK. High Blood Pressure and Cardiovascular Disease. Hypertension · 2020
- 2.James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA · 2014
- 3.Boutouyrie P, Chowienczyk P, Humphrey JD, Mitchell GF. Arterial Stiffness and Cardiovascular Risk in Hypertension. Circ Res · 2021
- 4.Nishimoto M, Griffin KA, Wynne BM, Fujita T. Salt-Sensitive Hypertension and the Kidney. Hypertension · 2024
- 5.Filippini T, Naska A, Kasdagli MI, Torres D, Lopes C, Carvalho C, Moreira P, Malavolti M. Potassium Intake and Blood Pressure: A Dose-Response Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc · 2020
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