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Hypertension, also known as high or raised blood pressure, is a condition in which the blood vessels have persistently raised pressure. Blood is carried from the heart to all parts of the body in the vessels. Each time the heart beats, it pumps blood into the vessels. Blood pressure is created by the force of blood pushing against the walls of blood vessels (arteries) as it is pumped by the heart. The higher the pressure, the harder the heart has to pump. 

Hypertension is a serious medical condition and can increase the risk of heart, brain, kidney and other diseases. It is a major cause of premature death worldwide, with upwards of 1 in 4 men and 1 in 5 women – over a billion people ­– having the condition. The burden of hypertension is felt disproportionately in low- and middle-income countries, where two thirds of cases are found, largely due to increased risk factors in those populations in recent decades. 

Many people with hypertension do not notice symptoms and may be unaware there is a problem. Symptoms can include early morning headaches, nosebleeds, irregular heart rhythms, vision changes, and buzzing in the ears. More severe forms may exhibit fatigue, nausea, vomiting, confusion, anxiety, chest pain, and muscle tremors. If left untreated, hypertension can cause persistent chest pain (also called angina), heart attacks, heart failure, and an irregular heartbeat, which can lead to a sudden death.  

Hypertension can also cause strokes by blocking or bursting arteries that supply blood and oxygen to the brain, as well as kidney damage, which can lead to kidney failure. High blood pressure causes damage to the heart by hardening arteries and decreasing the flood of blood and oxygen to the heart. 

Detecting hypertension is done with a quick and painless test of blood pressure. This can be done at home, but a health professional can help assess any risks or associated conditions. 

Reducing modifiable risk factors is the best way to prevent hypertension and associated diseases of the heart, brain, kidney and other organs. These factors include unhealthy diets (excessive salt consumption, a diet high in saturated fat and trans fats, low intake of fruits and vegetables), physical inactivity, consumption of tobacco and alcohol, and being overweight or obese.  

There are also non-modifiable risk factors, including a family history of hypertension, age over 65 years and co-existing diseases such as diabetes or kidney disease. Avoiding dietary and behavioural risk factors is doubly important for those with unmodifiable or hereditary risk factors.  

Hypertension can be managed by reducing and managing mental stress, regularly checking blood pressure and consulting with health professionals, treating high blood pressure and managing other medical conditions. Cessation of tobacco use and the harmful use of alcohol, as well as improvements in diet and exercise, can help reduce symptoms and risk factors from hypertension. 

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• Biology Article

Hypertension

Hypertension or high blood pressure is a serious health problem which currently affects nearly 1 billion people worldwide. According to the recent analysis by the World Health Organisation (WHO), this statistic might rise to around 1.57 billion by the year 2025.

Blood is the fluid connective tissue, carried to all parts of our body in blood vessels called arteries. The arteries play a key role in providing blood (thus oxygen and energy) to all organs of the body.

Blood pressure is the force of blood against the arteries. Around 75 million people are affected by high blood pressure in the US and more are at risk of dying from related cardiovascular disease. In the year 2017-2018, about one-third of all individuals above the age range of 20 have high blood pressure assessments and most are under antihypertensive medications.

What is Hypertension?

Abnormally high blood pressure and a combination of high psychological stress are known as Hypertension. These patients suffering from this disorder will have their blood pressure reading greater than 140 over 90 mm.

Hypertension is diagnosed by measuring blood pressure. The Systolic pressure would be the first readings viz. a pressure by which the heart pumps blood through the body, and second readings would be the Diastolic pressure, meaning a pressure at which the heart relaxes and refills the blood.

Types of Hypertension

When people talk about hypertension, they are usually referring to one of the two types, namely:

• Primary hypertension
• Secondary hypertension

Primary hypertension is also known as essential hypertension. This is the most prevalent form of hypertension and it has no identifiable cause.

Secondary hypertension is caused by an underlying disease or even medication. Thyroid dysfunction, sleep apnea and diabetes have been linked to secondary hypertension. Chemicals such as amphetamines, antidepressants and even caffeine can lead to hypertension.

Causes of Hypertension

Acute stress and unfavourable environmental factors are the main factors for increasing blood pressure in normal and healthy individuals. The increasing rate of the prevailing condition is mostly blamed on the lifestyle and dietary factors such as inactive habits, high diet sodium content from processed fatty foods, tobacco and alcohol use.

Symptoms of Hypertension

High blood pressure is itself asymptomatic, that means there is no indication or any clear symptoms. This is the reason why high blood pressure is also referred to as ‘the silent killer’ since it could cause damage to the Cardiovascular system.

High blood pressure could also create problems in certain organs. A prolonged illness may lead to complications such as arteriosclerosis, where the production of plaques narrows the blood vessels.

A systolic blood pressure readings of 180 mmHg or above and a diastolic blood pressure readings of 110 mmHg or above could indicate the signs of hypertensive crisis that requires immediate medical attention.

Diagnosis of Hypertension

The process of diagnosis is usually carried out by measuring the patient’s blood pressure using a sphygmomanometer. At least 3 different elevated readings are required to diagnose this condition. This examination along with additional tests help to identify the causes of high blood pressure and any other complications.

Additional diagnosis might include

• Kidney ultrasound imaging,
• Urine tests,
• Blood tests
• Electrocardiogram (or) ECG Test .

Treatment and Precautions

• Weight loss treatment programs like diet and exercise are recommended as high blood pressure and obesity are related to each other.
• Having a well-balanced diet including whole grains, fruits, vegetables and low-fat dairy products.
• Avoid foods that have high amounts of LDL cholesterol (low-density lipoprotein).
• Reduce intake of sodium in the diet.
• Increase the intake of calcium and vitamin D.

Hypertension can turn quite serious if left unchecked. However, it could be easily lowered or controlled by regular exercise. Following a strict, low sodium diet supplemented with foods rich in potassium and calcium is crucial. Eat more low-fat protein sources, whole grains, plenty of fruits and vegetables.

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Hypertension

• Pathophysiology |
• Symptoms and Signs |
• Diagnosis |
• Treatment |
• Prognosis |
• Key Points |
• More Information |

Hypertension is sustained elevation of resting systolic blood pressure ( 130 mm Hg), diastolic blood pressure ( 80 mm Hg), or both. Hypertension with no known cause (primary; formerly, essential, hypertension) is most common. Hypertension with an identified cause (secondary hypertension) is usually due to primary aldosteronism. Sleep apnea, chronic kidney disease, obesity, or renal artery stenosis are other causes of secondary hypertension. Usually, no symptoms develop unless hypertension is severe or long-standing. Diagnosis is by sphygmomanometry. Tests may be done to determine cause, assess organ damage, and identify other cardiovascular risk factors. Treatment involves lifestyle changes and medications, including diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, and calcium channel blockers.

Hypertension is defined as a systolic blood pressure (BP) ≥ 130 mm Hg or a diastolic blood pressure ≥ 80 mm Hg or taking medication for hypertension. Nearly half of adults in the United States have hypertension. Many of these people are not aware that they have hypertension. About 80% of adults with hypertension have been recommended treatment with medication and lifestyle modification, but only about 50% with hypertension receive treatment ( 1 ).

Even with medication and lifestyle modification only 26% of patients have their BP at goal (under control), and of treated adults whose BP is not at goal, almost 60% have a BP ≥ 140/90 mm Hg ( 1 ).

High blood pressure is more common in non-Hispanic Black adults (58%) than in non-Hispanic White adults (49%), non-Hispanic Asian adults (45%), or Hispanic adults (39%— 1 ). Among those recommended to take blood pressure medication and make lifestyle modifications, blood pressure control is higher among non-Hispanic White adults (31%) than in non-Hispanic Black adults (20%), non-Hispanic Asian adults (24%), or Hispanic adults (23%— 1 ).

Blood pressure increases with age. About two thirds of people > 65 years have hypertension, and people with a normal BP at age 55 have a 90% lifetime risk of developing hypertension ( 2 ). Because hypertension becomes so common with age, the age-related increase in BP may seem innocuous, but higher BP increases morbidity and mortality risk.

Hypertension during pregnancy has special considerations because complications are different; hypertension that develops during pregnancy may resolve after pregnancy (see Hypertension in Pregnancy and Preeclampsia and Eclampsia ).

Categories of BP in adults defined by the American College of Cardiology/American Heart Association (ACC/AHA) include normal, elevated BP, stage 1 (mild) or stage 2 hypertension ( 3 ) (see table Classification of Blood Pressure in Adults ). Normal blood pressure in infants and adolescents is much lower ( 4 ).

Hypertension is defined as resistant when BP remains above goal despite use of 3 different antihypertensive medications at maximally tolerated doses. Patients with resistant hypertension have higher cardiovascular morbidity and mortality ( 5 ).

General references

1. Million Hearts : Estimated Hypertension Prevalence, Treatment, and Control Among U.S. Adults. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html March 21, 2021. Accessed September 5, 2023. https://millionhearts.hhs.gov/data-reports/hypertension-prevalence.html

2. Vasan RS, Beiser A, Seshadri S, et al . Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study.  JAMA 287(8):1003-1010, 2002. doi:10.1001/jama.287.8.1003

3. Whelton PK, Carey RM, Aronow WS, et al . 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Hypertension. 2018 Jun;71(6):e136-e139] [published correction appears in Hypertension. 2018 Sep;72(3):e33].  Hypertension 71(6):1269-1324, 2018. doi:10.1161/HYP.000000000000006

4. Flynn J.T, Kaelber DC, Baker-Smith CM, et al; Subcommittee on Screening and Management of High Blood Pressure in Children : Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 140(3):e20171904, 2017.

5. Carey RM, Calhoun DA, Bakris GL, et al : Resistant hypertension: Detection, evaluation, and management: A Scientific Statement From the American Heart Association. Hypertension 72:e53–e90, 2018. doi: 10.1161/HYP.0000000000000084

Etiology of Hypertension

Hypertension may be

Primary (no specific cause—85% of cases)

Secondary (an identified cause)

Primary hypertension

Hemodynamics and physiologic components (eg, plasma volume, activity of the renin-angiotensin system) vary, indicating that primary hypertension is unlikely to have a single cause. Even if one factor is initially responsible, multiple factors are probably involved in sustaining elevated blood pressure (the mosaic theory). In afferent systemic arterioles, malfunction of ion pumps on sarcolemmal membranes of smooth muscle cells may lead to chronically increased vascular tone. Heredity is a predisposing factor, but the exact mechanism is unclear. Environmental factors (eg, dietary sodium, stress) seem to affect only people who are genetically susceptible at younger ages; however, in patients > 65 years, high sodium intake is more likely to precipitate hypertension.

Secondary hypertension

Common causes include

Primary aldosteronism (1)

Obstructive sleep apnea

Renal parenchymal disease (eg, chronic glomerulonephritis or pyelonephritis , polycystic renal disease, lupus nephritis, obstructive uropathy )

Renovascular disease

Other, much rarer, causes include pheochromocytoma , Cushing syndrome , congenital adrenal hyperplasia , hyperthyroidism , hypothyroidism (myxedema), primary hyperparathyroidism , acromegaly , coarctation of the aorta , and mineralocorticoid excess syndromes other than primary aldosteronism.

Excessive alcohol intake and use of oral contraceptives are common reversible causes of hypertension.

Also, use of sympathomimetics, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, cocaine , or licorice may contribute to worsening of blood pressure control.

Although hypertension is common in patients with diabetes , diabetes is not considered a cause.

Etiology reference

1. Brown JM, Siddiqui M, Calhoun DA, et al : The unrecognized prevalence of primary aldosteronism: A cross-sectional study.  Ann Intern Med 173(1):10–20, 2020. doi:10.7326/M20-0065

Pathophysiology of Hypertension

Because blood pressure equals cardiac output (CO) × total peripheral vascular resistance (TPR), pathogenic mechanisms involve

Increased CO

Increased TPR

In most patients, CO is normal or slightly increased, and TPR is increased. This pattern is typical of primary hypertension and hypertension due to primary aldosteronism , pheochromocytoma , renovascular disease, and renal parenchymal disease.

In other patients, CO is increased (possibly because of venoconstriction in large veins), and TPR is inappropriately normal for the level of CO. Later in the disorder, TPR increases and CO returns to normal, probably because of autoregulation. Some disorders that increase CO (eg, thyrotoxicosis , arteriovenous fistula , aortic regurgitation ), particularly when stroke volume is increased, cause isolated systolic hypertension. Some older patients have isolated systolic hypertension with normal or low CO, probably due to inelasticity of the aorta and its major branches. Patients with high, fixed diastolic pressures often have decreased CO.

Plasma volume tends to decrease as BP increases; rarely, plasma volume remains normal or increases. Plasma volume tends to be high in hypertension due to primary aldosteronism or renal parenchymal disease and may be quite low in hypertension due to pheochromocytoma.

Renal blood flow gradually decreases as diastolic BP increases and arteriolar sclerosis begins. Glomerular filtration rate (GFR) remains normal until late in the disorder; as a result, the filtration fraction is increased.

Coronary, cerebral, and muscle blood flow is maintained unless severe atherosclerosis coexists in these vascular beds.

Abnormal sodium transport

In many cases of hypertension, sodium transport across the cell wall is abnormal, because the sodium-potassium pump (Na+, K+-ATPase) is defective or inhibited or because permeability to sodium ions is increased. The result is increased intracellular sodium, which makes the cell more sensitive to sympathetic stimulation. Calcium follows sodium, so accumulation of intracellular calcium may be responsible for the increased sensitivity. Because Na+, K+-ATPase may pump norepinephrine back into sympathetic neurons (thus inactivating this neurotransmitter), inhibition of this mechanism could also enhance the effect of norepinephrine , increasing BP. Defects in sodium transport may occur in children who are normotensive but have a parent with hypertension.

Sympathetic nervous system

Sympathetic stimulation increases blood pressure, usually more in patients with elevated BP and hypertension than in patients who are normotensive. Whether this hyperresponsiveness resides in the sympathetic nervous system or in the myocardium and vascular smooth muscle is unknown.

A high resting pulse rate, which may result from increased sympathetic nervous activity, is a well-known predictor of hypertension.

In some patients with hypertension, circulating plasma catecholamine levels during rest are higher than normal.

Renin-angiotensin-aldosterone system

The renin-angiotensin-aldosterone system helps regulate blood volume and therefore blood pressure. Renin, an enzyme formed in the juxtaglomerular apparatus, catalyzes conversion of angiotensinogen to angiotensin I. This inactive product is cleaved by angiotensin-converting enzyme (ACE), mainly in the lungs but also in the kidneys and brain, to angiotensin II , a potent vasoconstrictor that also stimulates autonomic centers in the brain to increase sympathetic discharge and stimulates release of aldosterone and vasopressin . Aldosterone and vasopressin cause sodium and water retention, elevating BP. Aldosterone also enhances potassium excretion; low plasma potassium ( < 3.5 mEq/L [ angiotensin II but has much less pressor activity. Because chymase enzymes also convert angiotensin I to angiotensin II , medications that inhibit ACE do not fully suppress angiotensin II production.

Renin secretion is controlled by at least 4 mechanisms, which are not mutually exclusive:

A renal vascular receptor responds to changes in tension in the afferent arteriolar wall

A macula densa receptor detects changes in the delivery rate or concentration of sodium chloride in the distal tubule

Circulating angiotensin has a negative feedback effect on renin secretion

Sympathetic nervous system stimulates renin secretion mediated by beta-receptors (via the renal nerve)

Angiotensin is generally acknowledged to be responsible for renovascular hypertension , at least in the early phase, but the role of the renin-angiotensin-aldosterone system in primary hypertension is not established. However, in patients with African ancestry and older patients with hypertension, renin levels tend to be low ( 1 ). Older patients also tend to have low angiotensin II levels.

Hypertension due to chronic renal parenchymal disease (renoprival hypertension) results from the combination of a renin-dependent mechanism and a volume-dependent mechanism. In most cases, increased renin activity is not evident in peripheral blood. Hypertension is typically moderate and sensitive to sodium and water balance.

Vasodilator deficiency

Deficiency of a vasodilator (eg, bradykinin, nitric oxide) rather than excess of a vasoconstrictor (eg, angiotensin, norepinephrine ) may cause hypertension. Reductions in nitric oxide occur with aging, and this reduction contributes to salt sensitivity (ie, lesser amounts of salt ingestion will raise BP higher compared to younger people— 2 ).

Reduction in nitric oxide due to stiff arteries is linked to salt-sensitive hypertension, an inordinate increase of > 10 to 20 mm Hg systolic BP after a large sodium load (eg, a salty meal).

If the kidneys do not produce adequate amounts of vasodilators (because of renal parenchymal disease or bilateral nephrectomy), blood pressure can increase.

Vasodilators and vasoconstrictors (mainly endothelin) are also produced in endothelial cells. Therefore, endothelial dysfunction greatly affects blood pressure.

Pathology and complications

No pathologic changes occur early in hypertension. Severe or prolonged hypertension damages target organs (primarily the cardiovascular system, brain, and kidneys), increasing risk of

Coronary artery disease (CAD) and myocardial infarction (MI)

Heart failure

Stroke (particularly hemorrhagic)

Renal failure

The mechanism involves development of generalized arteriolosclerosis and acceleration of atherogenesis. Arteriolosclerosis is characterized by medial hypertrophy, hyperplasia, and hyalinization; it is particularly apparent in small arterioles, notably in the eyes and the kidneys. In the kidneys, the changes narrow the arteriolar lumen, increasing TPR; thus, hypertension leads to more hypertension. Furthermore, once arteries are narrowed, any slight additional shortening of already hypertrophied smooth muscle reduces the lumen to a greater extent than in normal-diameter arteries. These effects may explain why the longer hypertension has existed, the less likely specific treatment (eg, renovascular surgery) for secondary causes is to restore blood pressure to normal.

Because of increased afterload, the left ventricle gradually hypertrophies, causing diastolic dysfunction. The ventricle eventually dilates, causing dilated cardiomyopathy and heart failure due to systolic dysfunction often worsened by arteriosclerotic coronary artery disease. Thoracic aortic dissection is typically a consequence of hypertension; almost all patients with abdominal aortic aneurysms have hypertension.

Pathophysiology references

1. Williams SF, Nicholas SB, Vaziri ND, Norris KC . African Americans, hypertension and the renin angiotensin system.  World J Cardiol 6(9):878-889, 2014. doi:10.4330/wjc.v6.i9.878

2. Fujiwara N, Osanai T, Kamada T, et al : Study on the relationship between plasma nitrite and nitrate level and salt sensitivity in human hypertension: modulation of nitric oxide synthesis by salt intake. Circulation 101:856–861, 2000.

Symptoms and Signs of Hypertension

Hypertension is usually asymptomatic until complications develop in target organs. Dizziness, facial flushing, headache, fatigue, epistaxis, and nervousness are not caused by uncomplicated hypertension. Severe hypertension (typically defined as systolic blood pressure ≥ 180 mm Hg and/or diastolic blood pressure ≥ 120 mm Hg) can be asymptomatic (hypertensive urgency). When severe hypertension causes severe cardiovascular, neurologic, renal, and retinal symptoms (eg, symptomatic coronary atherosclerosis, heart failure, hypertensive encephalopathy, renal failure), it is referred to as a hypertensive emergency .

A 4th heart sound is one of the earliest signs of hypertensive heart disease.

Retinal changes may include arteriolar narrowing, hemorrhages, exudates, and, in patients with encephalopathy, papilledema ( hypertensive retinopathy ). Changes are classified (according to the Keith, Wagener, and Barker classification) into 4 groups with increasingly worse prognosis:

Grade 1: Constriction of arterioles only

Grade 2: Constriction and sclerosis of arterioles

Grade 3: Hemorrhages and exudates in addition to vascular changes

Grade 4: Papilledema

Diagnosis of Hypertension

Multiple measurements of BP to confirm

Testing to diagnose causes and complications

Hypertension is diagnosed by sphygmomanometry. History, physical examination, and other tests help identify etiology and determine whether target organs are damaged.

Blood pressure measurement

The blood pressure used for formal diagnosis should be an average of 2 or 3 measurements taken at different times with the patient:

Seated in a chair (not examination table) for > 5 minutes, feet on floor, back supported

With their limb supported at heart level with no clothing covering the area of cuff placement

Having had no exercise, caffeine , or smoking for at least 30 minutes

At the first visit, measure BP in both arms; subsequent measurements should use the arm that gave the higher reading.

A properly sized BP cuff is applied to the upper arm. An appropriately sized cuff covers two thirds of the biceps; the bladder is long enough to encircle > 80% of the arm, and bladder width equals at least 40% of the arm’s circumference. Thus, patients with obesity usually require large cuffs. The clinician inflates the cuff above the expected systolic pressure and gradually releases the air while listening over the brachial artery. The pressure at which the first heartbeat is heard as the pressure falls is systolic BP. Total disappearance of the sound marks diastolic BP. The same principles are followed to measure BP in a forearm (radial artery) and thigh (popliteal artery). Mechanical devices should be calibrated periodically; automated readers are often inaccurate ( 1 ).

BP is measured in both arms because BP that is > 15 mm Hg higher in one arm than the other requires evaluation of the upper vasculature.

BP is measured in a thigh (with a much larger cuff) to rule out coarctation of the aorta , particularly in patients with diminished or delayed femoral pulses; with coarctation, BP is significantly lower in the legs.

If BP is in the stage 1 hypertensive range or is markedly labile, more BP measurements are desirable. BP measurements may be sporadically high before hypertension becomes sustained; this phenomenon probably accounts for “white coat hypertension,” in which BP is elevated when measured in the physician’s office but normal when measured at home or by ambulatory BP monitoring.

Home or ambulatory BP monitoring is indicated when "white coat hypertension" is suspected. In addition, ambulatory BP monitoring also may be indicated when "masked hypertension" (a condition in which BP measured at home is higher than values obtained in the clinician's office) is suspected, typically in patients who demonstrate sequelae of hypertension without evidence of hypertension according to in-office measurements.

The history includes the

Duration of hypertension and previously recorded BP levels

History or symptoms of coronary artery disease , heart failure , or obstructive sleep apnea

Symptoms of or personal or family history of other relevant coexisting disorders (eg, stroke , renal dysfunction, peripheral arterial disease , dyslipidemia , diabetes , gout )

Use of medications that predispose to hypertension (eg, NSAIDs, estrogen -containing oral contraceptives)

Sleep duration

Social history includes exercise levels and use of tobacco, alcohol, and stimulants (including medications and illicit drugs).

A dietary history focuses on intake of salt and stimulants (eg, tea, coffee, caffeine -containing sodas, energy drinks).

Physical examination

The physical examination includes measurement of height, weight, and waist circumference; funduscopic examination for retinopathy ; auscultation for bruits in the neck and abdomen; and a full cardiac, respiratory, and neurologic examination. The abdomen is palpated for kidney enlargement and abdominal masses. Peripheral arterial pulses are evaluated; diminished or delayed femoral pulses suggest aortic coarctation, particularly in patients < 30 years. A unilateral renal artery bruit may be heard in thin patients with renovascular hypertension .

After hypertension is diagnosed based on blood pressure measurements, testing is needed to

Detect target-organ damage

Identify cardiovascular risk factors

The more severe the hypertension and the younger the patient, the more extensive is the evaluation. Tests may include

Urinalysis and urinary albumin :creatinine ratio; if abnormal, consider renal ultrasonography

Lipid panel, complete metabolic panel (including creatinine, potassium, and calcium), fasting plasma glucose

Sometimes measurement of thyroid-stimulating hormone levels

Sometimes measurement of plasma free metanephrines (to detect pheochromocytoma)

Sometimes a sleep study

Depending on results of the examination and initial tests, other tests may be needed.

Renal ultrasonography to evaluate kidney size may provide useful information if urinalysis detects albuminuria (proteinuria), casts, or microhematuria, or if serum creatinine or cystatin C is elevated.

Patients with hypokalemia unrelated to diuretic use are evaluated for high salt intake and for primary aldosteronism by measuring plasma aldosterone levels and plasma renin activity. Primary aldosteronism is present in about 10 to 20% of patients with resistant hypertension, which is much higher than previous estimates ( 2, 3 ).

On ECG, a broad, notched P-wave indicates atrial hypertrophy and, although nonspecific, may be one of the earliest signs of hypertensive heart disease. Elevated QRS voltage with or without evidence of ischemia, may occur later and indicates left ventricular hypertrophy (LVH). When LVH is seen on ECG, echocardiography is often done.

If coarctation of the aorta is suspected, echocardiography, CT, or MRI helps confirm the diagnosis.

Patients with labile, significantly elevated BP and symptoms such as headache, palpitations, tachycardia, excessive perspiration, tremor, and pallor are screened for pheochromocytoma by measuring plasma free metanephrines and for hyperthyroidism , first by measuring thyroid-stimulating hormone (TSH). A sleep study should also be strongly considered in those whose history suggests sleep apnea.

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Patients with symptoms suggesting Cushing syndrome , systemic rheumatic diseases, eclampsia , acute porphyria , hyperthyroidism , myxedema , acromegaly , or central nervous system (CNS) disorders also require further evaluation.

Diagnosis references

1. Muntner P, Shimbo D, Carey RM, et al : Measurement of blood pressure in humans: A scientific statement from the American Heart Association. Hypertension 73:e35–e66, 2019.

2. Burrello J, Monticone S, Losano I, et al : Prevalence of Hypokalemia and Primary Aldosteronism in 5100 Patients Referred to a Tertiary Hypertension Unit.  Hypertension 2020;75(4):1025-1033. doi:10.1161/HYPERTENSIONAHA.119.14063

3. Mulatero P, Stowasser M, Loh KC, et al : Increased diagnosis of primary aldosteronism, including surgically correctable forms, in centers from five continents.  J Clin Endocrinol Metab 2004;89(3):1045-1050. doi:10.1210/jc.2003-031337

Treatment of Hypertension

Weight loss and exercise

Smoking cessation

Adequate sleep duration (> 6 hours/night)

Diet: Increased fruits and vegetables, decreased salt, limited alcohol

Medications: Depending on BP and presence of cardiovascular disease or risk factors

Primary hypertension has no cure, but some causes of secondary hypertension can be corrected. In all cases, control of blood pressure can significantly limit adverse consequences.

Goal blood pressure for the most patients, including patients with a kidney disorder or diabetes, is

BP < 130/80 mm Hg regardless of age up to age 80 years

Lowering BP below 130/80 mm Hg appears to continue to reduce the risk of vascular complications. However, decreasing systolic pressure further also increases the risk of adverse medication effects. Thus, the benefits of lowering BP to levels approaching 120 mm Hg systolic should be weighed against the higher risk of dizziness and light-headedness and possible worsening of kidney function. This is a particular concern among patients with diabetes, in whom BP < 120 mm Hg systolic or a diastolic BP approaching 60 mm Hg increases risk of these adverse events ( 1 ).

Even older patients, including frail older patients, can tolerate a diastolic BP as low as 60 to 65 mm Hg well and without an increase in cardiovascular events ( 2, 3 ). Ideally, patients or family members measure BP at home, provided they have been trained to do so, they are closely monitored, and the sphygmomanometer is regularly calibrated.

Treatment of   hypertension during pregnancy requires careful medication selection because some antihypertensive medications can harm the fetus.

Lifestyle modifications

Lifestyle modifications are recommended for all patients with elevated BP or any stage hypertension (see also Table 15. Nonpharmacological Interventions in 2017 Hypertension Guidelines ). The best proven nonpharmacologic interventions for prevention and treatment of hypertension include the following:

Increased physical activity, ideally with a structured exercise program

Weight loss if the patient has overweight or obesity

Healthy diet rich in fruits, vegetables, whole grains, and low-fat dairy products, with reduced saturated and total fat content

Reduced dietary sodium to < 1500 mg/day ( < 3.75 g sodium chloride ) optimally, but at least a 1000 mg/day reduction

Enhanced dietary potassium intake, unless contraindicated due to chronic kidney disease or use of medications that reduce potassium excretion

Moderation in alcohol intake in those who drink alcohol to ≤ 2 drinks daily for men and ≤ 1 drink daily for women (one drink is about 12 oz of beer, 5 oz of wine, or 1.5 oz distilled spirits)

Adequate sleep duration (> 6 hours/night) is also recommended. Short sleep duration (typically defined as < 5 or 6 hours per night in adults, has been associated with hypertension ( 4 ). For example, data suggest that optimizing sleep quality and duration (> 6 hours/night) improves blood pressure control in patients with chronic kidney disease ( 5 ).

Dietary modifications can also help control diabetes, obesity, and dyslipidemia. Patients with uncomplicated hypertension do not need to restrict their activities as long as blood pressure is controlled.

Medications

(See also Medications for Hypertension .)

The decision to treat with medication is based on the BP level and the presence of atherosclerotic cardiovascular disease (ASCVD) or its risk factors (see table Initial Approach to Management of High Blood Pressure ). The presence of diabetes or kidney disease is not factored in separately because these diseases are part of ASCVD risk assessment.

An important part of management is continued reassessment. If patients are not at goal BP, clinicians should strive to optimize adherence before switching or adding medications.

Medication selection is based on several factors, including comorbidities and contraindications. For most patients, when selecting an agent for monotherapy , initial treatment may be with any of the following medication classes:

Angiotensin-converting enzyme (ACE) inhibitor

Angiotensin II receptor blocker (ARB)

Dihydropyridine calcium channel blocker

In addition, some experts recommend that for patients of African ancestry who are candidates for monotherapy, a calcium channel blocker or a thiazide diuretic should be used initially (unless patients also have stage 3 or higher chronic kidney disease). The preference for a calcium channel blocker or a thiazide diuretic in patients of African ancestry is based on evidence from randomized trials showing that these classes of medications have superior efficacy in lowering blood pressure and rates of cardiovascular events than ACE inhibitors or ARBs ( 6, 7, 8, 9 ). However, subsequent data suggest that despite the use of this race-based approach, control of hypertension and racial disparities in blood pressure control have not improved ( 10 ). Thus, some experts favor an individualized approach to therapeutic selection rather than a race-based approach. In addition, there is substantial variability in blood pressure response within racial groups ( 11 ).

When combination therapy with 2 antihypertensive agents is selected, options include either an ACE inhibitor or ARB combined with either a diuretic or a calcium channel blocker. Many combinations are available as single pills, which are preferable to improve patient adherence ( 12, 13 ).

Signs of hypertensive emergencies require immediate blood pressure reduction with parenteral antihypertensives.

Some antihypertensives are avoided in certain disorders (eg, ACE inhibitors in severe aortic stenosis ) whereas others are preferred for certain disorders (eg, calcium channel blockers for angina pectoris , ACE inhibitors or ARBs for diabetes with proteinuria —see tables Initial Choice of Antihypertensive Medication Class and Antihypertensives for Patients With Comorbidities ).

If the goal BP is not achieved within 1 month, assess adherence and reinforce the importance of following treatment. If patients are adherent, the dose of the initial medication can be increased or a second medication added (selected from among the medications recommended for initial treatment). Note that an ACE inhibitor and an ARB should not be used together. Therapy is titrated frequently. If target BP cannot be achieved with 2 medications, a third medication from the initial group is added. If such a third medication is not tolerated or is contraindicated, a medication from another class (eg, aldosterone antagonist) can be used. Patients with such difficult to control BP may benefit from consultation with a hypertension specialist.

If initial systolic BP is > 160 mm Hg, 2 medications should be initiated regardless of cardiovascular disease risk. An appropriate combination and dose are determined. For resistant hypertension (BP remains above goal despite use of 3 different antihypertensive medications), 4 or more medications are commonly needed.

Achieving adequate blood pressure control often requires several evaluations and changes in pharmacotherapy. Reluctance to titrate or add medications to control BP must be overcome. Nonadherence to therapy, particularly because lifelong treatment is required, can interfere with adequate BP control. Education, with empathy and support, is essential for success.

Devices and physical interventions

Percutaneous catheter-based radiofrequency ablation of the sympathetic nerves in the renal artery is used in Europe and Australia for resistant hypertension. Several industry-funded sham-controlled studies with different patient populations (eg, those with untreated hypertension [ 14 ], treated hypertension [ 15 ], or resistant hypertension [ 16 ]) have demonstrated statistically and/or clinically significant reductions in systolic blood pressure. However, whether these devices reduce major cardiovascular events remains uncertain. Thus, sympathetic ablation should be considered experimental and used only in centers with extensive experience.

A physical intervention to lower blood pressure involves stimulating the carotid baroreceptor with a device surgically implanted around the carotid body. A battery attached to the device, much like a pacemaker, is designed to stimulate the baroreceptor and, in a dose-dependent manner, lower blood pressure. Long-term follow-up of patients with resistant hypertension who were included in earlier pivotal trials suggests that baroreflex activation therapy maintained its efficacy for persistent reduction of office BP without major safety issues ( 17 ). However, the 2017 American College of Cardiology/American Heart Association guidelines concluded that studies have not provided sufficient evidence to recommend the use of these devices in managing resistant hypertension ( 18 ).

Treatment references

1. Gomadam P, Shah A, Qureshi W, et al . Blood pressure indices and cardiovascular disease mortality in persons with or without diabetes mellitus.  J Hypertens 36(1):85-92, 2018. doi:10.1097/HJH.0000000000001509

2. Williamson JD, Supiano MA, Applegate WB, et al . Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥ 75 Years: A Randomized Clinical Trial.  JAMA 315(24):2673-2682, 2016. doi:10.1001/jama.2016.7050

3. White WB, Wakefield DB, Moscufo N, et al . Effects of Intensive Versus Standard Ambulatory Blood Pressure Control on Cerebrovascular Outcomes in Older People (INFINITY).  Circulation 140(20):1626-1635, 2019. doi:10.1161/CIRCULATIONAHA.119.041603

4. Thomas SJ, Calhoun D . Sleep, insomnia, and hypertension: current findings and future directions.  J Am Soc Hypertens 11(2):122-129, 2017. doi:10.1016/j.jash.2016.11.008

5. Ali W, Gao G, Bakris GL . Improved Sleep Quality Improves Blood Pressure Control among Patients with Chronic Kidney Disease: A Pilot Study.  Am J Nephrol 51(3):249-254, 2020. doi:10.1159/000505895

6. Materson BJ, Reda DJ, Cushman WC, et al . 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 [published correction appears in N Engl J Med 1994 Jun 9;330(23):1689].  N Engl J Med 1993;328(13):914-921. doi:10.1056/NEJM199304013281303

7. Yamal JM, Oparil S, Davis BR, et al J Am Soc Hypertens 2014;8(11):808-819. doi:10.1016/j.jash.2014.08.003

8. Wright JT Jr, Harris-Haywood S, Pressel S, et al . Clinical outcomes by race in hypertensive patients with and without the metabolic syndrome: Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).  Arch Intern Med 2008;168(2):207-217. doi:10.1001/archinternmed.2007.66

9. Hall WD, Reed JW, Flack JM, Yunis C, Preisser J . Comparison of the efficacy of dihydropyridine calcium channel blockers in African American patients with hypertension. ISHIB Investigators Group. International Society on Hypertension in Blacks. Arch Intern Med 158(18):2029-2034, 1998. doi: 10.1001/archinte.158.18.2029

10. Egan BM, Li J, Sutherland SE, Rakotz MK, Wozniak GD . Hypertension Control in the United States 2009 to 2018: Factors Underlying Falling Control Rates During 2015 to 2018 Across Age- and Race-Ethnicity Groups.  Hypertension 78(3):578-587, 2021. doi:10.1161/HYPERTENSIONAHA.120.16418

11. Mokwe E, Ohmit SE, Nasser SA, et al . Determinants of blood pressure response to quinapril in black and white hypertensive patients: the Quinapril Titration Interval Management Evaluation trial.  Hypertension 2004;43(6):1202-1207. doi:10.1161/01.HYP.0000127924.67353.86

12. Parati G, Kjeldsen S, Coca A, Cushman WC, Wang J . Adherence to Single-Pill Versus Free-Equivalent Combination Therapy in Hypertension: A Systematic Review and Meta-Analysis.  Hypertension 77(2):692-705, 2021. doi:10.1161/HYPERTENSIONAHA.120.15781

13. Williams B, Mancia G, Spiering W, et al . 2018 Practice Guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology: ESH/ESC Task Force for the Management of Arterial Hypertension [published correction appears in J Hypertens 2019 Feb;37(2):456].  J Hypertens 8;36(12):2284-2309, 2018. doi:10.1097/HJH.0000000000001961

14. Böhm M, Kario K, Kandzari DE, et al . Efficacy of catheter-based renal denervation in the absence of antihypertensive medications (SPYRAL HTN-OFF MED Pivotal): a multicentre, randomised, sham-controlled trial.  Lancet 395(10234):1444-1451, 2020. doi:10.1016/S0140-6736(20)30554-7

15. Mahfoud F, Kandzari DE, Kario K, et al . Long-term efficacy and safety of renal denervation in the presence of antihypertensive drugs (SPYRAL HTN-ON MED): a randomised, sham-controlled trial.  Lancet 399(10333):1401-1410, 2022. doi:10.1016/S0140-6736(22)00455-X

16. Bhatt DL, Vaduganathan M, Kandzari DE, et al . Long-term outcomes after catheter-based renal artery denervation for resistant hypertension: final follow-up of the randomised SYMPLICITY HTN-3 Trial.  Lancet 400(10361):1405-1416, 2022. doi:10.1016/S0140-6736(22)01787-1

17. de Leeuw PW, Bisognano JD, Bakris GL, Nadim MK, Haller H, Kroon AA, DEBuT-T and Rheos Trial Investigators : Sustained reduction of blood pressure with baroreceptor activation therapy: Results of the 6-year open follow-up. Hypertension 69:836–843, 2017.

18. Whelton PK, Carey RM, Aronow WS, et al : 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 71(6):e13–e115, 2018. doi: 10.1161/HYP.0000000000000065

Prognosis for Hypertension

The higher the blood pressure and the more severe the retinal changes and other evidence of target-organ involvement, the worse the prognosis. Systolic BP predicts fatal and nonfatal cardiovascular events better than diastolic BP ( 1, 2 ).

Without treatment, 1-year survival is < 10% in patients with retinal sclerosis, cotton-wool exudates, arteriolar narrowing, and hemorrhage (grade 3 retinopathy), and < 5% in patients with the same changes plus papilledema (grade 4 retinopathy [ 3 ]).

Coronary artery disease is the most common cause of death among treated patients. Ischemic or hemorrhagic stroke is a common consequence of inadequately treated hypertension. However, effective control of hypertension prevents most complications and prolongs life.

Prognosis references

1. Bourdillon MT, Song RJ, Musa Yola I, Xanthakis V, Vasan RS . Prevalence, Predictors, Progression, and Prognosis of Hypertension Subtypes in the Framingham Heart Study.  J Am Heart Assoc 11(6):e024202, 2022. doi:10.1161/JAHA.121.024202

2. Kannel WB, Gordon T, Schwartz MJ . Systolic versus diastolic blood pressure and risk of coronary heart disease. The Framingham study.  Am J Cardiol 27(4):335-346, 1971. doi:10.1016/0002-9149(71)90428-0

3. Dziedziak J, Zaleska-Żmijewska A, Szaflik JP, Cudnoch-Jędrzejewska A . Impact of Arterial Hypertension on the Eye: A Review of the Pathogenesis, Diagnostic Methods, and Treatment of Hypertensive Retinopathy.  Med Sci Monit 28:e935135, 2022. doi:10.12659/MSM.935135

Only about 50% of patients in the United States with hypertension receive treatment, and about one quarter of those patients have adequate blood pressure (BP) control.

Most hypertension is primary; only 5 to 15% is secondary to another disorder (eg, primary aldosteronism , renal parenchymal disease).

Severe or prolonged hypertension damages the cardiovascular system, brain, and kidneys, increasing risk of myocardial infarction, stroke, and chronic kidney disease.

Hypertension is usually asymptomatic until complications develop in target organs.

When hypertension is newly diagnosed, do a urinalysis, spot urine albumin :creatinine ratio, blood tests (creatinine, potassium, sodium, calcium, fasting plasma glucose, lipid panel, and often thyroid-stimulating hormone), and ECG.

Reduce BP to < 130/80 mm Hg for everyone up to age 80 years, including those with a kidney disorder or diabetes.

Treatment involves lifestyle changes, especially a low-sodium and higher potassium diet, management of secondary causes of hypertension, and medications (including thiazide diuretics, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and dihydropyridine calcium channel blockers).

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

2017 ACC/AHA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.

Carey RM, Calhoun DA, Bakris GL, et al : Resistant hypertension: Detection, evaluation, and management: A Scientific Statement From the American Heart Association. Hypertension 72:e53–e90, 2018. doi: 10.1161/HYP.0000000000000084

Williams B, Mancia G, Spiering W, et al : 2018 Practice Guidelines for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology: ESH/ESC Task Force for the Management of Arterial Hypertension [published correction appears in J Hypertens 2019 Feb;37(2):456].  J Hypertens 2018;36(12):2284-2309. doi:10.1097/HJH.0000000000001961

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High Blood Pressure What Is High Blood Pressure?

Language switcher.

Half of all American adults have high blood pressure, also known as hypertension. Many don’t even know it. High blood pressure develops when blood flows through your arteries at higher-than-normal pressures. 

Blood pressures are written as two numbers separated by a slash like this: 120/80 mm Hg. You can say this as “120 over 80 millimeters of mercury” or just as “120 over 80.” The first number is your  systolic pressure — that’s the force of the blood flow when blood is pumped out of the heart. The second number is your  diastolic pressure, which is measured between heartbeats when the heart is filling with blood. 

Your blood pressure changes throughout the day based on your activities. A healthy systolic blood pressure is less than 120 mm Hg. A healthy diastolic pressure is less than 80 mm Hg . Your blood pressure is high when you have consistent systolic readings of 130 mm Hg or higher, or diastolic readings of 80 mm Hg or higher.

Blood pressure levels

Symptoms from high blood pressure don’t usually occur until it causes serious health problems. About 1 in 3 U.S. adults with high blood pressure aren’t even aware they have it and are not being treated to control their blood pressure. That’s why it is important to have your blood pressure checked at least once a year. Regular monitoring using home blood pressure is also recommended.

To control or lower high blood pressure, your healthcare provider may recommend that you adopt a heart-healthy lifestyle that includes: 

• Choosing a heart-healthy dietary pattern and foods such as those in the DASH eating plan ,  the Dietary Guidelines for Americans , or the Mediterranean eating pattern
• Being physically active and reducing sedentary behavior
• Losing weight for people with overweight or obesity
• Quitting smoking 
• Reducing stress 
• Getting enough good-quality sleep  

Your healthcare provider may also recommend medicines to help control your blood pressure.   

Controlling your blood pressure can help prevent or delay serious health problems such as chronic kidney disease , heart attack , heart failure , stroke , and possibly vascular dementia .

Find research studies and get resources on high blood pressure .

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• Bill Kraus, M.D., FACSM, Introduces ACSM's New Scientific Pronouncements 2019
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ACSM is pleased to present the scientific reviews underlying the second edition of the Physical Activity Guidelines . Health professionals, scientists, community organizations and policymakers can use the papers included in the  ACSM Scientific Pronouncements: Physical Activity Guidelines for Americans, 2nd Edition  to promote more active, healthier lifestyles for individuals and communities. All papers were published in Medicine & Science in Sports & Exercise . 

• The U.S. Physical Activity Guidelines Advisory Committee Report—Introduction
• Physical Activity Promotion: Highlights from the 2018 PAGAC Systematic Review
• Daily Step Counts for Measuring Physical Activity Exposure and Its Relation to Health
• Association between Bout Duration of Physical Activity and Health: Systematic Review
• High-Intensity Interval Training (HIIT) for Cardiometabolic Disease Prevention
• Sedentary Behavior and Health: Update from the 2018 Physical Activity Guidelines Advisory Committee
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• Physical Activity to Prevent and Treat Hypertension: A Systematic Review
• Effects of Physical Activity in Knee and Hip Osteoarthritis: A Systematic Umbrella Review

Earlier Papers

• Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise

Guidelines for Physical Activity and Health: Evolution Over 50 Years

Presented as the D.B. Dill Historical Lecture at the 2019 ACSM Annual Meeting, William Haskell, PhD, FACSM, and ACSM past president, presented a timeline of the developing science behind the Physical Activity Guidelines for Americans.

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High Blood Pressure & Kidney Disease

On this page:

What is high blood pressure?

What are the kidneys and what do they do.

• How does high blood pressure affect the kidneys?

How common are high blood pressure and kidney disease?

Who is more likely to have high blood pressure or kidney disease, what are the symptoms of high blood pressure and kidney disease, how do health care professionals diagnose high blood pressure and kidney disease, how can i prevent or slow the progression of kidney disease from high blood pressure, how does eating, diet, and nutrition affect high blood pressure and kidney disease, clinical trials for kidney disease.

Blood pressure is the force of blood pushing against blood vessel walls as your heart pumps out blood. High blood pressure , also called hypertension , is an increase in the amount of force that blood places on blood vessels as it moves through the body.

Healthy kidneys filter about a half cup of blood every minute, removing wastes and extra water to make urine . The urine flows from each kidney to the bladder through a pair of thin tubes called ureters, one on each side of your bladder. Your bladder stores urine. Your kidneys, ureters, and bladder are part of your urinary tract system.

How does high blood pressure affect the kidneys

High blood pressure can constrict and narrow the blood vessels, which eventually damages and weakens them throughout the body, including in the kidneys. The narrowing reduces blood flow.

If your kidneys’ blood vessels are damaged, they may no longer work properly. When this happens, the kidneys are not able to remove all wastes and extra fluid from your body. Extra fluid in the blood vessels can raise your blood pressure even more, creating a dangerous cycle, and cause more damage leading to kidney failure.

Almost 1 in 2 U.S. adults—or about 108 million people—have high blood pressure. 1

More than 1 in 7 U.S. adults—or about 37 million people—may have chronic kidney disease (CKD) . 2

High blood pressure is the second leading cause of kidney failure in the United States after diabetes , as illustrated in Figure 1. 2

Almost 1 in 2 U.S. adults—or about 108 million people—have high blood pressure.

High blood pressure

You are more likely to have high blood pressure if you

• are older. Blood pressures tends to increase with age. Our blood vessels naturally thicken and stiffen over time.
• have family members with high blood pressure. High blood pressure tends to run in families.
• have unhealthy lifestyle habits. Unhealthy habits such as eating too much sodium (salt), drinking too many alcoholic beverages, or not being physically active can increase your risk of high blood pressure.
• are African American. High blood pressure is more common in African American adults than in Caucasian, Hispanic, or Asian adults.
• are male.  Men are more likely to develop high blood pressure before age 55; women are more likely to develop it after age 55.

Kidney disease

In addition to high blood pressure, other factors that increase your risk of kidney disease are

• a family history of kidney failure
• race or ethnicity—African Americans, Hispanics, and American Indians tend to have a greater risk for CKD

High blood pressure can be both a cause and a result of kidney disease.

Most people with high blood pressure do not have symptoms. In rare cases, high blood pressure can cause headaches.

Early CKD also may not have symptoms. As kidney disease gets worse, some people may have swelling, called edema . Edema happens when the kidneys cannot get rid of extra fluid and salt. Edema can occur in the legs, feet, ankles, or—less often—in the hands or face.

Symptoms of advanced kidney disease can include

• loss of appetite, nausea, or vomiting
• drowsiness, feeling tired, or sleep problems
• headaches or trouble concentrating
• increased or decreased urination
• generalized itching or numbness, dry skin, or darkened skin
• weight loss
• muscle cramps
• chest pain or shortness of breath

Blood pressure test results are written with the two numbers separated by a slash. The top number is called the systolic pressure and represents the pressure as the heart beats and pushes blood through the blood vessels. The bottom number is called the diastolic pressure and represents the pressure as blood vessels relax between heartbeats.

Your health care professional will diagnose you with high blood pressure if your blood pressure readings are consistently higher than 130/80 when tested repeatedly in a health care office.

Health care professionals measure blood pressure with a blood pressure cuff. You can also buy a blood pressure cuff to monitor your blood pressure at home.

To check for kidney disease , health care professionals use

• a blood test that checks how well your kidneys are filtering your blood, called GFR, which stands for glomerular filtration rate .
• a urine test to check for albumin . Albumin is a protein that can pass into the urine when the kidneys are damaged.

If you have kidney disease, your health care professional will use the same two tests to monitor your kidney disease.

The best way to slow or prevent kidney disease  from high blood pressure is to take steps to lower your blood pressure. These steps include a combination of medicines and lifestyle changes, such as

• being physically active
• maintaining a healthy weight
• quitting smoking
• managing stress
• following a healthy diet, including less sodium (salt) intake

No matter what the cause of your kidney disease, high blood pressure can make your kidneys worse. If you have kidney disease, you should talk with your health care professional about your individual blood pressure goals and how often you should have your blood pressure checked.

Medicines that lower blood pressure can also significantly slow the progression of kidney disease. Two types of blood pressure-lowering medications, angiotensin-converting enzyme (ACE) inhibitors  and angiotensin receptor blockers (ARBs) , may be effective in slowing the progression of kidney disease.

Many people require two or more medications to control their blood pressure. In addition to an ACE inhibitor or an ARB, a health care professional may prescribe a diuretic —a medication that helps the kidneys remove fluid from the blood—or other blood pressure medications .

Physical activity

Regular physical activity  can lower your blood pressure and reduce your chances of other health problems.

Aim for at least 150 minutes per week of moderate-intensity aerobic activity. These activities make your heart beat faster and may cause you to breathe harder. Start by trying to be active for at least 10 minutes at a time without breaks. You can count each 10-minute segment of activity toward your physical activity goal. Aerobic activities include

• biking (Don’t forget the helmet.)
• brisk walking
• wheeling yourself in a wheelchair or engaging in activities that will support you such as chair aerobics

If you have concerns, a health care professional can provide information about how much and what kinds of activity are safe for you.

Body weight

If you are overweight or have obesity , aim to reduce your weight by 7 to 10 percent during the first year of treatment for high blood pressure. This amount of weight loss can lower your chance of developing health problems related to high blood pressure.

Body Mass Index (BMI) is the tool most commonly used to estimate and screen for overweight and obesity in adults. BMI is a measure based on your weight in relation to your height. Your BMI can tell if you are at a normal or healthy weight, are overweight, or have obesity.

• Normal or healthy weight. A person with a BMI of 18.5 to 24.9 is in the normal or healthy range.
• Overweight. A person with a BMI of 25 to 29.9 is considered overweight.
• Obesity. A person with a BMI of 30 to 39.9 is considered to have obesity.
• Severe obesity. A person with a BMI of 40 or greater is considered to have severe obesity.

Your goal should be a BMI lower than 25 to help keep your blood pressure under control. 3

If you smoke, you should quit. Smoking can damage blood vessels, raise the chance of developing high blood pressure, and worsen health problems related to high blood pressure.

If you have high blood pressure, talk with your health care professional about programs and products to help you quit smoking.

Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health. Some activities that may help you reduce stress include

• practicing yoga or tai chi
• listening to music
• focusing on something calm or peaceful

Following a healthy eating plan  can help lower your blood pressure. Reducing the amount of sodium in your diet is an important part of any healthy eating plan. Your health care professional may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan . DASH focuses on fruits, vegetables, whole grains, and other foods that are healthy for your heart and lower in sodium, which often comes from salt. The DASH eating plan

• is low in fat and cholesterol
• features fat-free or low-fat milk and dairy products, fish, poultry, and nuts
• suggests less red meat, sweets, added sugars, and sugar-containing beverages
• is rich in nutrients, protein, and fiber

A registered dietitian can help tailor your diet to your kidney disease. If you have congestive heart failure or edema, a diet low in sodium intake can help reduce edema and lower blood pressure. Reducing saturated fat and cholesterol can help control high levels of lipids, or fats, in the blood.

People with advanced kidney disease should speak with their health care professional about their diet.

What should I avoid eating if I have high blood pressure or kidney disease?

If you have kidney disease, avoid foods and beverages that are high in sodium .

Additional steps you can take to meet your blood pressure goals may include eating heart-healthy and low-sodium meals, quitting smoking, being active, getting enough sleep, and taking your medicines as prescribed. You should also limit alcoholic drinks—no more than two per day for men and one per day for women—because consuming too many alcoholic beverages raises blood pressure.

In addition, a health care professional may recommend that you eat moderate or reduced amounts of protein.

Proteins break down into waste products that the kidneys filter from the blood. Eating more protein than your body needs may burden your kidneys and cause kidney function to decline faster. However, eating too little protein may lead to malnutrition, a condition that occurs when the body does not get enough nutrients.

If you have kidney disease and are on a restricted protein diet, a health care professional will use blood tests to monitor your nutrient levels.

The NIDDK conducts and supports clinical trials in many diseases and conditions, including kidney diseases. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for high blood pressure and kidney disease?

Clinical trials—and other types of clinical studies —are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help doctors and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of high blood pressure and kidney disease, such as

• managing high blood pressure through diet, education, and counseling in patients with kidney disease
• testing new medications to treat high blood pressure and kidney disease

Find out if clinical studies are right for you .

What clinical studies for high blood pressure and kidney disease are looking for participants?

You can view a filtered list of clinical studies on high blood pressure and kidney disease that are federally funded, open, and recruiting at www.ClinicalTrials.gov . You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe. Always talk with your health care professional before you participate in a clinical study.

What have we learned about high blood pressure and kidney disease from NIDDK-funded research?

The NIDDK has supported many research projects to learn more about the effects of high blood pressure on kidney disease including identifying genes related to a cholesterol protein that causes African Americans to be at higher risk for kidney disease .

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

The NIDDK would like to thank: Raymond R. Townsend, M.D., Perelman School of Medicine, University of Pennsylvania, and Matthew Weir, M.D., University of Maryland School of Medicine

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• Int Cardiovasc Res J
• v.8(3); 2014 Sep

The Effect of Educational Programs on Hypertension Management

Mohammad ali babaee beigi.

1 Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran

Mohammad Javad Zibaeenezhad

Kamran aghasadeghi, abutaleb jokar, shahnaz shekarforoush.

2 Department of Physiology, Islamic Azad University, Arsanjan Branch, Arsanjan, Fars, IR Iran

Hajar Khazraei

Background:.

Hypertension is the main risk factor for cardiovascular diseases and stroke. Blood pressure control is a challenge for healthcare providers and the rate of blood pressure control is not more than 50% worldwide.

Objectives:

The present study aimed to determine the effectiveness of a short-term educational program on the level of knowledge, lifestyle changes, and blood pressure control among hypertensive patients.

Patients and Methods:

This quasi-experimental study was conducted on the hypertensive patients attending Shiraz Healthy Heart House. In this study, 112 patients were selected via systematic random sampling. The study data were collected using a data gathering form which consisted of baseline characteristics and measurements of blood pressure. Multivariate analyses were used to assess the relationship between education and hypertension.

At baseline, the scores of aware, treated, and controlled hypertensive patients were 21%, 20%, and 12%, respectively. However, these measures were increased to 92%, 95%, and 51%, respectively at the end of the study. The mean knowledge scores improved from 2.77 ± 2.7 to 7.99 ± 1.78 after 3 months (P < 0.001). Also, the mean lifestyle scores changed from 3.15 ± 1.52 to 4.53 ± 1.23 (P < 0.001).

Conclusions:

The results of the current study indicated that the educational programs were effective in increasing knowledge, improving self-management, and controlling detrimental lifestyle habits of the patients with hypertension.

1. Background

Hypertension (HTN) is the main risk factor for cardiovascular diseases and stroke. However, it is not taken seriously and is often deficiently controlled ( 1 ). Lowering the Blood Pressure (BP) reduces the associated risks. Therefore, an effective strategy for reducing HTN complications is increasing the number of patients who control BP ( 2 , 3 ).

A survey of the risk factors of non-communicable diseases in Iran revealed that 25.2% and 45.5% of the adults between 25 and 64 years old had HTN and prehypertension, respectively. However, 66% of the hypertensive patients were unaware of their disorder, 75% were untreated, and 94% were not controlled. These proportions are relatively high compared to those reported in other countries ( 4 ).

Patients’ knowledge about HTN and benefits of lifestyle modifications seems to be the key to successful control of HTN ( 5 ). However, lifestyle changes are not easily achieved. Adherence to treatment increases when the patients are active ( 6 ). Therefore, well-designed educational interventions with active participation of the patients are necessary for increasing HTN knowledge, self-monitoring, and control.

2. Objectives

The present study aims to determine the effectiveness of a short-term educational program in BP control and adherence to healthy lifestyle.

3. Patients and Methods

The data were collected using a validated researcher-made questionnaire through face-to-face interviews. The participants’ demographic characteristics, including age, sex, education level, and occupation, were recorded, as well. The interview included questions about HTN knowledge (9 questions) and detrimental lifestyle behaviors (6 questions). Accordingly, one point was allocated to correct answers or behaviors and no points were considered for incorrect answers or behaviors. The total score was computed by summing up the correct answers or behaviors for each patient, ranging from 0 to 15.

Resting BP, height, weight, and BMI (kg/m 2 ) were measured and cardiovascular examinations were performed for all the patients. Besides, eye examination, including visual acuity, was carried out using Snellen chart and ophtalmoscopy. In addition, ECGs were taken and interpreted by a trained resident to diagnose left ventricular hypertrophy according to Romhilt-Estes criteria. Blood samples were collected after a 12-h fasting for assessment of FBS, TG, total cholesterol, HDL, BUN, Cr, Na, and K. It should be noted that written informed consents were signed by all the participants before beginning the study.

HTN was defined according to the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). The patients were labeled as hypertensive if on the average of three measurements, Systolic Blood Pressure (SBP) was ≥ 140 mm Hg, Diastolic Blood Pressure (DBP) was ≥ 90 mm Hg, or if s/he reported current use of antihypertensive medication. The patients were considered “aware” if they gave a positive response to the question, “Have you ever been told by a doctor or another health professional that you have hypertension, also called high blood pressure?” Moreover, a patient with HTN was classified as “treated” if s/he reported taking antihypertensive medication at the time of the survey. Furthermore, a treated patient was considered “controlled” if his/her SBP was < 140 mm Hg and his/her DBP was < 90 mm Hg” ( 7 ). Overall, BP was classified as stage 1, stage 2, and severe according to the JNC 7.

3.1. Educational Program

At first, each patient was trained individually and face to face by a trained cardiology resident about the definitions of high BP and controlled HTN, symptoms and complications of HTN, follow up intervals, and medication adherence. Additionally, nutritional and exercise counseling was conducted by the experts at the center. A diet habit questionnaire was designed to assess the patients’ dietary patterns. The dietary recommendations included a low fat, low sodium diet with adequate consumption of fruits, vegetables, and fish. Exercise was also recommended to be done for at least 30 min/day. Then, the patients were divided into 10 groups and followed up for 3 months. Each group took part in two one-hour training sessions once a month. Class topics included definition of HTN, course of illness, symptoms, BP monitoring at home, healthy lifestyle, healthy self-management behaviors, and emphasis on the previous trainings. The patients were interviewed again after 3 months to complete the post-test questionnaire, which was exactly the same as the pre-test. Resting BP was measured again, as well.

3.2. Data Analysis

The SPSS statistical software, version 16 (SPSS, Inc. Chicago, IL) was used to compute the frequencies and means of the patients’ demographic characteristics and their responses to the knowledge and lifestyle behaviors test. McNemar’s test was used to analyze the categorical data. In addition, paired sample t-test was employed to analyze any changes in the mean scores of knowledge and behaviors at the end of the study. P value < 0.05 was considered as statistically significant.

The present study was conducted on 100 hypertensive patients. A total of 12 patients, who failed to return for follow up, were excluded from the study. Among the study participants, 65% were male. In addition, approximately two third of the patients had below high school degrees. At baseline, 21% of the hypertensive patients were aware of their high BP, 20% of the aware patients were treated, and only 12% of the treated ones were controlled. All these variables significantly improved at the end of the study ( Table 1 ). Moreover, the percentage of the patients taking medication during the 3-month period increased from 20 to 95.

a Measured SBP lower than 140 mm Hg and measured DBP lower than 90 mm Hg

According to Table 2 , almost 99% of the hypertensive patients had other concomitant risk factors, the most common of which being overweight or obesity.

At baseline, 11 - 90% of the responses to the questionnaires were correct ( Table 3 ). Accordingly, the majority of the participants (90%) knew about the range of a blood pressure reading. However, a low percentage of the hypertensive patients were knowledgeable about the meaning of high BP and controlled HTN. Besides, 32% of the patients knew that HTN increases the risk of stroke, heart attack, heart failure, and kidney disease and only 24% believed that people can help lower their high BP. However, the patients had less information about more specific questions on BP. The patients’ mean scores of knowledge improved from 2.77 ± 2.7 before the intervention to 7.99 ± 1.78 after 3 months (P < 0.001).

a Excessive salt use was considered to be ≥ 5 g/day ( 7 )

Table 4 displays self-reported detrimental lifestyle behaviors at baseline and 3 months after the educational program. As the table depicts, the number of participants with physical inactivity, excessive salt use, and inadequate use of vegetables, fruits, and fish was significantly decreased after the intervention. The patients’ mean scores of lifestyle changed from 3.15 ± 1.52 at baseline to 4.53 ± 1.23 after three months.

5. Discussion

It has been reported that a fall of 10 - 20 mmHg in systolic pressure maintained for 5 years could reduce the risks of myocardial infarction by 25% and that of stroke by40% ( 8 ). However, BP control is a challenge for healthcare providers and the rate of BP control worldwide is on average not more than 50% and may even be as low as 8.1%. Wu Y et al. conducted a study on a group of hypertensive patients in Singapore and showed that although HTN treatment was high, its awareness and control were low ( 9 ). Similarly, in spite of the high prevalence of HTN in China, the percentage of hypertensive patients who were aware, treated, and controlled was very low ( 11 ).

The present study was a well-organized educational model which involved the patients in their own health care. This study was conducted in order to determine the status of HTN awareness, treatment, and control in the Iranian population and to evaluate the effect of a short-term educational program on the above-mentioned parameters. According to the study findings, the rate of HTN awareness (21% of those having HTN), treatment (20% of those aware of HTN), and control (12% of the hypertensive patients on treatment) was low in our population. HTN control was even less than that reported in other studies ( 12 ). However, this measure was significantly increased from 12% to 51% after the educational intervention, demonstrating the beneficial effects of education on the triad of patient’s awareness, lifestyle changes, and adherence to medications. Patient’s education, self monitoring of BP, and regular follow up were also revealed to be effective healthcare measures for controlling HTN.

Patient’s involvement in self-monitoring and management, together with continuous follow up has also been recommended by others ( 13 , 14 ). Similarly, Wang YR et al. emphasized that the most important points for BP control were lifestyle modifications, home BP monitoring, reinforcement of healthy behaviors, and continuous follow up ( 15 ).

In spite of the increasing emphasis on drug therapy, lifestyle modification is an important part of BP control ( 16 , 17 ). It has been found that the patients who adhered to medication and lifestyle regimens had better health outcomes ( 18 ).

Because few hypertensive patients receive guidance on changing their lifestyles, healthcare professionals should further encourage the hypertensive patients regarding lifestyle habits ( 1 ).

Moreover, Wai Chiu et al. demonstrated that follow-up calls after nursing clinic consultation were effective in improvement of the patients’ adherence to a healthy lifestyle and their BP control ( 9 ). In the present study, the proportion of physically inactive individuals, excessive salt users, and those with inadequate intake of vegetables, fruits, and fish was significantly decreased after 3 months as indicated by improvement in the patients’ life style scores. This strongly suggests the effectiveness of our approach in transferring information regarding life style changes for BP control.

One of the strong points of this study was a matched-pair analysis before and after the measurements on the same patient, because it helps match the unmeasured variables.

The present study had some limitations, with small sample size and short follow-up period being the most important ones. Further studies with larger sample sizes and longer follow-ups are therefore recommended to be conducted on the issue. Another limitation was lack of a special emphasis on smoking cessation in the educational program offered to our patients. The importance of smoking avoidance, as one of the strongest predictors of cardiovascular health and survival, has been shown in several studies ( 19 , 20 ). Recently, it has been expressed that “smokers who adopted other healthy behaviors still had lower survival rates than sedentary and obese nonsmokers” ( 22 ). Unfortunately, this habit does not change easily ( 21 ) and only 2% of smokers quit smoking at the end of counseling. Thus, healthcare providers should insist more on smoking avoidance.

In conclusion, educational interventions have significantly desirable effects on lifestyle modification and BP control. Therefore, they should become an integral part of management of the patients with HTN. On the other hand, HTN control in our hypertensive population was found to be less than that reported in many other countries. Thus, a public educational program for promoting HTN awareness and lifestyle modification is an urgent need.

Acknowledgments

The present article was extracted from the thesis written by Dr. Jokar and was financially supported by Shiraz University of Medical Sciences (Grant No. 3273).

The authors would like to thank the Research vice-chancellery of Shiraz University of Medical Science for financially supporting this research.

Implication for health policy/practice/research/medical education: This article can improve the individuals’ health and control their blood pressure. We investigated whether meals affected the subjects’ blood pressure. We also showed a relationship between education and blood pressure. These can decrease the prevalence of blood pressure in both developed and developing countries.

Authors’ Contribution: Study concept and design: Mohamad Javad Zibaeenezhad; Analysis and interpretation of the data: Abutaleb Jokar, Shahnaz Shekarforoush, Hajar Khazraee; Study supervision: Mohamad Ali Babaee Beigi, Kamran Aghasadeghi

Financial disclosure: The authors have no financial interests related to the material in the manuscript.

Funding/Support: The funding organizations are public institutions and had no role in design and conduct of the study, collection, management, and analysis of the data, or preparation, review, and approval of the manuscript.

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Staying up to date with COVID-19 vaccines and taking COVID-19 prevention actions  are important. This is especially important if you are older or have severe health conditions or more than one health condition, including those on this list. Learn more about how CDC develops COVID-19 vaccination recommendations. If you have a medical condition, learn more about Actions You Can Take .

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Having cancer   can make you more likely to get very sick from COVID-19. Treatments for many types of cancer can weaken your body’s ability to fight off disease. At this time, based on available studies, having a history of cancer may increase your risk.

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• COVID-19: What People with Cancer Should Know – National Cancer Institute

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• Chronic Kidney Disease
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• Overweight and Obesity
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• COVID19 Stroke Podcast Series for Patients and Caregivers 

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• Basic TB Facts
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• Type 1 diabetes

What is type 1 diabetes? A Mayo Clinic expert explains

Learn more about type 1 diabetes from endocrinologist Yogish Kudva, M.B.B.S.

I'm Dr. Yogish C. Kudva an endocrinologist at Mayo Clinic. In this video, we'll cover the basics of type 1 diabetes. What is it? Who gets it? The symptoms, diagnosis, and treatment. Whether you're looking for answers for yourself or someone you love. We are here to give you the best information available. Type 1 diabetes is a chronic condition that affects the insulin making cells of the pancreas. It's estimated that about 1.25 million Americans live with it. People with type 1 diabetes don't make enough insulin. An important hormone produced by the pancreas. Insulin allows your cells to store sugar or glucose and fat and produce energy. Unfortunately, there is no known cure. But treatment can prevent complications and also improve everyday life for patients with type 1 diabetes. Lots of people with type 1 diabetes live a full life. And the more we learn and develop treatment for the disorder, the better the outcome.

We don't know what exactly causes type 1 diabetes. We believe that it is an auto-immune disorder where the body mistakenly destroys insulin producing cells in the pancreas. Typically, the pancreas secretes insulin into the bloodstream. The insulin circulates, letting sugar enter your cells. This sugar or glucose, is the main source of energy for cells in the brain, muscle cells, and other tissues. However, once most insulin producing cells are destroyed, the pancreas can't produce enough insulin, meaning the glucose can't enter the cells, resulting in an excess of blood sugar floating in the bloodstream. This can cause life-threatening complications. And this condition is called diabetic ketoacidosis. Although we don't know what causes it, we do know certain factors can contribute to the onset of type 1 diabetes. Family history. Anyone with a parent or sibling with type 1 diabetes has a slightly increased risk of developing it. Genetics. The presence of certain genes can also indicate an increased risk. Geography. Type 1 diabetes becomes more common as you travel away from the equator. Age, although it can occur at any age there are two noticeable peaks. The first occurs in children between four and seven years of age and the second is between 10 and 14 years old.

Signs and symptoms of type 1 diabetes can appear rather suddenly, especially in children. They may include increased thirst, frequent urination, bed wetting in children who previously didn't wet the bed. Extreme hunger, unintended weight loss, fatigue and weakness, blurred vision, irritability, and other mood changes. If you or your child are experiencing any of these symptoms, you should talk to your doctor.

The best way to determine if you have type 1 diabetes is a blood test. There are different methods such as an A1C test, a random blood sugar test, or a fasting blood sugar test. They are all effective and your doctor can help determine what's appropriate for you. If you are diagnosed with diabetes, your doctor may order additional tests to check for antibodies that are common in type 1 diabetes in the test called C-peptide, which measures the amount of insulin produced when checked simultaneously with a fasting glucose. These tests can help distinguish between type 1 and type 2 diabetes when a diagnosis is uncertain.

If you have been diagnosed with type 1 diabetes, you may be wondering what treatment looks like. It could mean taking insulin, counting carbohydrates, fat protein, and monitoring your glucose frequently, eating healthy foods, and exercising regularly to maintain a healthy weight. Generally, those with type 1 diabetes will need lifelong insulin therapy. There are many different types of insulin and more are being developed that are more efficient. And what you may take may change. Again, your doctor will help you navigate what's right for you. A significant advance in treatment from the last several years has been the development and availability of continuous glucose monitoring and insulin pumps that automatically adjust insulin working with the continuous glucose monitor. This type of treatment is the best treatment at this time for type 1 diabetes. This is an exciting time for patients and for physicians that are keen to develop, prescribe such therapies. Surgery is another option. A successful pancreas transplant can erase the need for additional insulin. However, transplants aren't always available, not successful and the procedure can pose serious risks. Sometimes it may outweigh the dangers of diabetes itself. So transplants are often reserved for those with very difficult to manage conditions. A successful transplant can bring life transforming results. However, surgery is always a serious endeavor and requires ample research and concentration from you, your family, and your medical team.

The fact that we don't know what causes type 1 diabetes can be alarming. The fact that we don't have a cure for it even more so. But with the right doctor, medical team and treatment, type 1 diabetes can be managed. So those who live with it can get on living. If you would like to learn even more about type 1 diabetes, watch our other related videos or visit mayoclinic.org. We wish you well.

Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition. In this condition, the pancreas makes little or no insulin. Insulin is a hormone the body uses to allow sugar (glucose) to enter cells to produce energy.

Different factors, such as genetics and some viruses, may cause type 1 diabetes. Although type 1 diabetes usually appears during childhood or adolescence, it can develop in adults.

Even after a lot of research, type 1 diabetes has no cure. Treatment is directed toward managing the amount of sugar in the blood using insulin, diet and lifestyle to prevent complications.

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Type 1 diabetes symptoms can appear suddenly and may include:

• Feeling more thirsty than usual
• Urinating a lot
• Bed-wetting in children who have never wet the bed during the night
• Feeling very hungry
• Losing weight without trying
• Feeling irritable or having other mood changes
• Feeling tired and weak
• Having blurry vision

When to see a doctor

Talk to your health care provider if you notice any of the above symptoms in you or your child.

The exact cause of type 1 diabetes is unknown. Usually, the body's own immune system — which normally fights harmful bacteria and viruses — destroys the insulin-producing (islet) cells in the pancreas. Other possible causes include:

• Exposure to viruses and other environmental factors

The role of insulin

Once a large number of islet cells are destroyed, the body will produce little or no insulin. Insulin is a hormone that comes from a gland behind and below the stomach (pancreas).

• The pancreas puts insulin into the bloodstream.
• Insulin travels through the body, allowing sugar to enter the cells.
• Insulin lowers the amount of sugar in the bloodstream.
• As the blood sugar level drops, the pancreas puts less insulin into the bloodstream.

The role of glucose

Glucose — a sugar — is a main source of energy for the cells that make up muscles and other tissues.

• Glucose comes from two major sources: food and the liver.
• Sugar is absorbed into the bloodstream, where it enters cells with the help of insulin.
• The liver stores glucose in the form of glycogen.
• When glucose levels are low, such as when you haven't eaten in a while, the liver breaks down the stored glycogen into glucose. This keeps glucose levels within a typical range.

In type 1 diabetes, there's no insulin to let glucose into the cells. Because of this, sugar builds up in the bloodstream. This can cause life-threatening complications.

Risk factors

Some factors that can raise your risk for type 1 diabetes include:

• Family history. Anyone with a parent or sibling with type 1 diabetes has a slightly higher risk of developing the condition.
• Genetics. Having certain genes increases the risk of developing type 1 diabetes.
• Geography. The number of people who have type 1 diabetes tends to be higher as you travel away from the equator.
• Age. Type 1 diabetes can appear at any age, but it appears at two noticeable peaks. The first peak occurs in children between 4 and 7 years old. The second is in children between 10 and 14 years old.

Complications

Over time, type 1 diabetes complications can affect major organs in the body. These organs include the heart, blood vessels, nerves, eyes and kidneys. Having a normal blood sugar level can lower the risk of many complications.

Diabetes complications can lead to disabilities or even threaten your life.

• Heart and blood vessel disease. Diabetes increases the risk of some problems with the heart and blood vessels. These include coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of the arteries (atherosclerosis) and high blood pressure.

Nerve damage (neuropathy). Too much sugar in the blood can injure the walls of the tiny blood vessels (capillaries) that feed the nerves. This is especially true in the legs. This can cause tingling, numbness, burning or pain. This usually begins at the tips of the toes or fingers and spreads upward. Poorly controlled blood sugar could cause you to lose all sense of feeling in the affected limbs over time.

Damage to the nerves that affect the digestive system can cause problems with nausea, vomiting, diarrhea or constipation. For men, erectile dysfunction may be an issue.

• Kidney damage (nephropathy). The kidneys have millions of tiny blood vessels that keep waste from entering the blood. Diabetes can damage this system. Severe damage can lead to kidney failure or end-stage kidney disease that can't be reversed. End-stage kidney disease needs to be treated with mechanical filtering of the kidneys (dialysis) or a kidney transplant.
• Eye damage. Diabetes can damage the blood vessels in the retina (part of the eye that senses light) (diabetic retinopathy). This could cause blindness. Diabetes also increases the risk of other serious vision conditions, such as cataracts and glaucoma.
• Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of some foot complications. Left untreated, cuts and blisters can become serious infections. These infections may need to be treated with toe, foot or leg removal (amputation).
• Skin and mouth conditions. Diabetes may leave you more prone to infections of the skin and mouth. These include bacterial and fungal infections. Gum disease and dry mouth also are more likely.
• Pregnancy complications. High blood sugar levels can be dangerous for both the parent and the baby. The risk of miscarriage, stillbirth and birth defects increases when diabetes isn't well-controlled. For the parent, diabetes increases the risk of diabetic ketoacidosis, diabetic eye problems (retinopathy), pregnancy-induced high blood pressure and preeclampsia.

There's no known way to prevent type 1 diabetes. But researchers are working on preventing the disease or further damage of the islet cells in people who are newly diagnosed.

Ask your provider if you might be eligible for one of these clinical trials. It is important to carefully weigh the risks and benefits of any treatment available in a trial.

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