Editing Cardiology (section)

=== Hypertension ===
{{Main|Hypertension}}

[[Hypertension]], also known as "high blood pressure", is a [[Chronic (medicine)|long term]] [[Disease|medical condition]] in which the [[blood pressure]] in the [[artery|arteries]] is persistently elevated.<ref name=Nai2014>{{cite book|last1=Naish|first1=Jeannette|last2=Court|first2=Denise Syndercombe|title=Medical sciences|date=2014|isbn=9780702052491|page=562|publisher=Elsevier Health Sciences |edition=2|url=https://books.google.com/books?id=K21_AwAAQBAJ&pg=PA562}}</ref> High blood pressure usually does not cause symptoms.<ref name=CDC2015>{{cite web|title=High Blood Pressure Fact Sheet|url=https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_bloodpressure.htm|website=CDC|access-date=6 March 2016|date=February 19, 2015}}</ref> Long term high blood pressure, however, is a major risk factor for [[coronary artery disease]], [[stroke]], [[heart failure]], [[peripheral vascular disease]], [[vision loss]], and [[chronic kidney disease]].<ref>{{cite journal|last1=Lackland|first1=DT|last2=Weber|first2=MA|title=Global burden of cardiovascular disease and stroke: hypertension at the core|journal=The Canadian Journal of Cardiology|date=May 2015|volume=31|issue=5|pages=569–71|pmid=25795106|doi=10.1016/j.cjca.2015.01.009}}</ref><ref name=WHO2011a>{{cite book|last1=Mendis|first1=Shanthi|last2=Puska|first2=Pekka|last3=Norrving|first3=Bo|title=Global atlas on cardiovascular disease prevention and control|date=2011|publisher=World Health Organization in collaboration with the World Heart Federation and the World Stroke Organization|location=Geneva|isbn=9789241564373|page=38|edition=1st|url=http://whqlibdoc.who.int/publications/2011/9789241564373_eng.pdf?ua=1}}</ref>

<!-- Causes -->
Lifestyle factors can increase the risk of hypertension. These include [[Salt and cardiovascular disease|excess salt]] in the diet, [[overweight|excess body weight]], [[smoking]], and alcohol consumption.<ref name=CDC2015/><ref name=Lancet2015/> Hypertension can also be caused by other diseases, or occur as a side-effect of drugs.<ref>{{cite web|url=https://www.nhlbi.nih.gov/health-topics/high-blood-pressure|title=High Blood Pressure|date=8 May 2020|website=[[National Heart, Lung, and Blood Institute]]|access-date=11 October 2021}}</ref>

<!-- Diagnosis -->
Blood pressure is expressed by two measurements, the [[Systole (medicine)|systolic]] and [[diastolic]] pressures, which are the maximum and minimum pressures, respectively.<ref name=CDC2015/> Normal blood pressure when at rest is within the range of 100–140 [[Millimeter of mercury|millimeters mercury]] (mmHg) systolic and 60–90 mmHg diastolic.<ref name="EU2013">{{cite journal|last1 = Giuseppe|first1 = Mancia|title = 2013 ESH/ESC Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC)|journal = European Heart Journal|date = July 2013|volume = 34|issue = 28|pages = 2159–219|pmid = 23771844|doi = 10.1093/eurheartj/eht151|first2 = R|last3 = Narkiewicz|first3 = K|last4 = Redon|first4 = J|last5 = Zanchetti|first5 = A|last6 = Bohm|first6 = M|last7 = Christiaens|first7 = T|last8 = Cifkova|first8 = R|last9 = De Backer|first9 = G|last10 = Dominiczak|first10 = A|last11 = Galderisi|first11 = M|last12 = Grobbee|first12 = DE|last13 = Jaarsma|first13 = T|last14 = Kirchhof|first14 = P|last15 = Kjeldsen|first15 = SE|last16 = Laurent|first16 = S|last17 = Manolis|first17 = AJ|last18 = Nilsson|first18 = PM|last19 = Ruilope|first19 = LM|last20 = Schmieder|first20 = RE|last21 = Sirnes|first21 = PA|last22 = Sleight|first22 = P|last23 = Viigimaa|first23 = M|last24 = Waeber|first24 = B|last25 = Zannad|first25 = F|last26 = Redon|first26 = J|last27 = Dominiczak|first27 = A|last28 = Narkiewicz|first28 = K|last29 = Nilsson|first29 = PM|last30 = Burnier|first30 = M|last2 = Fagard|display-authors = 29|hdl = 1854/LU-4127523|url = https://academic.oup.com/eurheartj/article-pdf/34/28/2159/17895598/eht151.pdf}}</ref> High blood pressure is present if the resting blood pressure is persistently at or above 140/90 mmHg for most adults.<ref name=Lancet2015/> Different numbers apply to children.<ref name=JNC8>{{Cite journal  |last1 = James|first1 = PA.|last2 = Oparil|first2 = S.|last3 = Carter|first3 = BL.|last4 = Cushman|first4 = WC.|last5 = Dennison-Himmelfarb|first5 = C.|last6 = Handler|first6 = J.|last7 = Lackland|first7 = DT.|last8 = Lefevre|first8 = ML.|last9 = Mackenzie|first9 = TD.|last10 = Ogedegbe|first10 = Olugbenga|last11 = Smith|first11 = Sidney C.|last12 = Svetkey|first12 = Laura P.|last13 = Taler|first13 = Sandra J.|last14 = Townsend|first14 = Raymond R.|last15 = Wright|first15 = Jackson T.|last16 = Narva|first16 = Andrew S.|last17 = Ortiz|first17 = Eduardo|title = 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8)|journal = JAMA|volume = 311|issue = 5|pages = 507–20|date = Dec 2013|doi = 10.1001/jama.2013.284427|pmid = 24352797|display-authors = 8|doi-access = free}}</ref> When diagnosing high blood pressure, [[ambulatory blood pressure monitoring]] over a 24-hour period appears to be more accurate than "in-office" [[blood pressure measurement]] at a physician's office or other blood pressure screening location.<ref name=Nai2014/><ref name=Lancet2015/><ref name="Stergiou-Kollias">{{cite journal | last1=Stergiou | first1=George | last2=Kollias | first2=Anastasios | last3=Parati | first3=Gianfranco | last4=O’Brien | first4=Eoin | title=Office Blood Pressure Measurement | journal=Hypertension | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=71 | issue=5 | year=2018 | issn=0194-911X | pmid=29531176 | doi=10.1161/hypertensionaha.118.10850 | pages=813–815| s2cid=3853179 | doi-access=free }}</ref>

<!-- Treatment and epidemiology -->
Lifestyle changes and medications can lower blood pressure and decrease the risk of health complications.<ref name=NIH2015Tx>{{cite web|title=How Is High Blood Pressure Treated?|url=http://www.nhlbi.nih.gov/health/health-topics/topics/hbp/treatment|website=National Heart, Lung, and Blood Institute|access-date=6 March 2016|date=September 10, 2015}}</ref> Lifestyle changes include weight loss, decreased salt intake, physical exercise, and a healthy diet.<ref name=Lancet2015/> If changes in lifestyle are insufficient, [[blood pressure medication]]s may be used.<ref name=NIH2015Tx/> A regimen of up to three medications effectively controls blood pressure in 90% of people.<ref name=Lancet2015>{{cite journal|last1=Poulter|first1=NR|last2=Prabhakaran|first2=D|last3=Caulfield|first3=M|title=Hypertension.|journal=Lancet|date=22 August 2015|volume=386|issue=9995|pages=801–12|pmid=25832858|doi=10.1016/s0140-6736(14)61468-9|s2cid=208792897}}</ref> The treatment of moderate to severe high arterial blood pressure (defined as >160/100 mmHg) with medication is associated with an improved [[life expectancy]] and reduced [[morbidity]].<ref>{{Cite journal|last1=Musini|first1=Vijaya M|last2=Tejani|first2=Aaron M|last3=Bassett|first3=Ken|last4=Puil|first4=Lorri|last5=Wright|first5=James M|date=2019-06-05|editor-last=Cochrane Hypertension Group|title=Pharmacotherapy for hypertension in adults 60 years or older|journal=Cochrane Database of Systematic Reviews|volume=6|issue=6 |pages=CD000028|language=en|doi=10.1002/14651858.CD000028.pub3|pmid=31167038|pmc=6550717}}</ref> The effect of treatment for blood pressure between 140/90&nbsp;mmHg and 160/100&nbsp;mmHg is less clear, with some studies finding benefits<ref>{{cite journal|last1=Sundström|first1=Johan|last2=Arima|first2=Hisatomi|last3=Jackson|first3=Rod|last4=Turnbull|first4=Fiona|last5=Rahimi|first5=Kazem|last6=Chalmers|first6=John|last7=Woodward|first7=Mark|last8=Neal|first8=Bruce|title=Effects of Blood Pressure Reduction in Mild Hypertension|journal=Annals of Internal Medicine|date=February 2015|pmid=25531552|doi=10.7326/M14-0773|volume=162|issue=3|pages=184–91}}</ref><ref>{{cite journal|last1=Xie|first1=X|last2=Atkins|first2=E|last3=Lv|first3=J|last4=Bennett|first4=A|last5=Neal|first5=B|last6=Ninomiya|first6=T|last7=Woodward|first7=M|last8=MacMahon|first8=S|last9=Turnbull|first9=F|last10=Hillis|first10=GS|last11=Chalmers|first11=J|last12=Mant|first12=J|last13=Salam|first13=A|last14=Rahimi|first14=K|last15=Perkovic|first15=V|last16=Rodgers|first16=A|title=Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: updated systematic review and meta-analysis|journal=Lancet|date=30 January 2016|pmid=26559744|doi=10.1016/S0140-6736(15)00805-3|volume=387 |issue=10017|pages=435–43|s2cid=36805676|url=http://www.med-sovet.pro/jour/article/view/1765}}</ref> while others do not.<ref name=Diao2012>{{cite journal|last1=Diao|first1=D|last2=Wright|first2=JM|last3=Cundiff|first3=DK|last4=Gueyffier|first4=F|title=Pharmacotherapy for mild hypertension|journal=The Cochrane Database of Systematic Reviews|date=Aug 15, 2012|volume=8|issue=8|pages=CD006742|pmid=22895954|doi=10.1002/14651858.CD006742.pub2|pmc=8985074}}</ref> High blood pressure affects between 16% and 37% of the population globally.<ref name=Lancet2015/> In 2010, hypertension was believed to have been a factor in 18% (9.4 million) deaths.<ref>{{cite journal|last1=Campbell|first1=NR|last2=Lackland|first2=DT|last3=Lisheng|first3=L|last4=Niebylski|first4=ML|last5=Nilsson|first5=PM|last6=Zhang|first6=XH|title=Using the Global Burden of Disease study to assist development of nation-specific fact sheets to promote prevention and control of hypertension and reduction in dietary salt: a resource from the World Hypertension League|journal=Journal of Clinical Hypertension|date=March 2015|volume=17|issue=3|pages=165–67|pmid=25644474|doi=10.1111/jch.12479|pmc=8031937|s2cid=206028313}}</ref>

==== Essential vs Secondary hypertension ====
{{Main|Essential hypertension|Secondary hypertension}}

Essential hypertension is the form of [[hypertension]] that by definition has no identifiable cause. It is the most common type of hypertension, affecting 95% of hypertensive patients,<ref name="pmid10645931-a">{{cite journal |vauthors=Carretero OA, Oparil S |title=Essential hypertension. Part I: definition and etiology |journal=[[Circulation (journal)|Circulation]] |volume=101 |issue=3 |pages=329–35 |date=January 2000 |pmid=10645931 |doi=10.1161/01.CIR.101.3.329 |doi-access=free }}</ref><ref name="pmid14597461">{{cite journal |vauthors=Oparil S, Zaman MA, Calhoun DA |title=Pathogenesis of hypertension |journal=[[Ann. Intern. Med.]] |volume=139 |issue=9 |pages=761–76 |date=November 2003 |pmid=14597461 |doi= 10.7326/0003-4819-139-9-200311040-00011|s2cid=32785528 }}</ref><ref name="isbn0-7216-0240-1">{{cite book |author1=Hall, John E. |author2=Guyton, Arthur C. |title=Textbook of medical physiology |publisher=Elsevier Saunders |location=St. Louis, Mo |year=2006 |pages=228 |isbn=978-0-7216-0240-0 }}</ref><ref name="urlHypertension: eMedicine Nephrology">{{cite web |url=http://emedicine.medscape.com/article/241381-overview |title=Hypertension: eMedicine Nephrology |access-date=2009-06-05}}</ref> it tends to be familial and is likely to be the consequence of an interaction between [[Environment (biophysical)|environmental]] and [[genetics|genetic]] factors. [[Prevalence]] of essential hypertension increases with [[Ageing|age]], and individuals with relatively high blood pressure at younger ages are at increased risk for the subsequent development of hypertension.
Hypertension can increase the risk of [[cerebrum|cerebral]], [[cardiac]], and [[renal]] events.<ref name="pmid17707755">{{cite journal | vauthors = Messerli FH, Williams B, Ritz E | title = Essential hypertension | journal = Lancet | volume = 370 | issue = 9587 | pages = 591–603 | date = August 2007 | pmid = 17707755 | doi = 10.1016/S0140-6736(07)61299-9 | s2cid = 26414121 }}</ref>

[[Secondary hypertension]] is a type of [[hypertension]] which is caused by an identifiable underlying secondary cause. It is much less common than essential hypertension, affecting only 5% of hypertensive patients. It has many different causes including [[endocrine diseases]], [[kidney diseases]], and [[tumors]]. It also can be a [[Adverse effect|side effect]] of many [[medications]].<ref>{{Cite web |title=Secondary hypertension |url=https://www.mayoclinic.org/diseases-conditions/secondary-hypertension/symptoms-causes/syc-20350679 |access-date=2024-07-21 |website=Mayo Clinic |language=en}}</ref>

==== Complications of hypertension ====
[[Image:Main complications of persistent high blood pressure.svg|thumb|right|250px|Main complications of persistent [[high blood pressure]]]]
{{Main|Complications of hypertension}}

[[Complications of hypertension]] are clinical outcomes that result from [[hypertension|persistent elevation]] of blood pressure.<ref name="pmid19393824">{{cite journal |author=White WB |title=Defining the problem of treating the patient with hypertension and arthritis pain |journal=[[The American Journal of Medicine]] |volume=122 |issue=5 Suppl |pages=S3–9 |date=May 2009 |pmid=19393824 |doi=10.1016/j.amjmed.2009.03.002 }}</ref> Hypertension is a risk factor for all clinical manifestations of [[atherosclerosis]] since it is a risk factor for atherosclerosis itself.<ref name="pmid19110086">{{cite journal |author=Insull W |title=The pathology of atherosclerosis: plaque development and plaque responses to medical treatment |journal=[[The American Journal of Medicine]] |volume=122 |issue=1 Suppl |pages=S3–S14 |date=January 2009 |pmid=19110086 |doi=10.1016/j.amjmed.2008.10.013 }}</ref><ref name="pmid19394559">{{cite journal |vauthors=Liapis CD, Avgerinos ED, Kadoglou NP, Kakisis JD |title=What a vascular surgeon should know and do about atherosclerotic risk factors |journal=[[Journal of Vascular Surgery]] |volume=49 |issue=5 |pages=1348–54 |date=May 2009 |pmid=19394559 |doi=10.1016/j.jvs.2008.12.046 |doi-access=free }}</ref><ref name="pmid19275607">{{cite journal |author=Riccioni G |title=The effect of antihypertensive drugs on carotid intima media thickness: an up-to-date review |journal=[[Current Medicinal Chemistry]] |volume=16 |issue=8 |pages=988–96 |year=2009 |pmid=19275607 |doi=10.2174/092986709787581923 |url=http://www.bentham-direct.org/pages/content.php?CMC/2009/00000016/00000008/0006C.SGM |access-date=2009-06-20 |archive-url=https://archive.today/20130112181214/http://www.bentham-direct.org/pages/content.php?CMC/2009/00000016/00000008/0006C.SGM |archive-date=2013-01-12 |url-status=usurped }}</ref><ref name="pmid19138169">{{cite journal |vauthors=Safar ME, Jankowski P |title=Central blood pressure and hypertension: role in cardiovascular risk assessment |journal=[[Clinical Science (journal)|Clinical Science]] |volume=116 |issue=4 |pages=273–82 |date=February 2009 |pmid=19138169 |doi=10.1042/CS20080072 }}</ref><ref name="pmid19124420">{{cite journal | vauthors = Werner CM, Böhm M | title = The therapeutic role of RAS blockade in chronic heart failure | journal = Therapeutic Advances in Cardiovascular Disease | volume = 2 | issue = 3 | pages = 167–77 | date = June 2008 | pmid = 19124420 | doi = 10.1177/1753944708091777 |s2cid = 12972801 |doi-access = free}}</ref> It is an independent predisposing factor for [[heart failure]],<ref name="pmid19427498">{{cite journal |vauthors=Gaddam KK, Verma A, Thompson M, Amin R, Ventura H |title=Hypertension and cardiac failure in its various forms |journal=[[The Medical Clinics of North America]] |volume=93 |issue=3 |pages=665–80 |date=May 2009 |pmid=19427498 |doi=10.1016/j.mcna.2009.02.005 |url=http://journals.elsevierhealth.com/retrieve/pii/S0025-7125(09)00020-0|access-date=2009-06-20}}</ref><ref name="pmid19427502">{{cite journal |vauthors=Reisin E, Jack AV |title=Obesity and hypertension: mechanisms, cardio-renal consequences, and therapeutic approaches |journal=[[The Medical Clinics of North America]] |volume=93 |issue=3 |pages=733–51 |date=May 2009 |pmid=19427502 |doi=10.1016/j.mcna.2009.02.010 |url=http://journals.elsevierhealth.com/retrieve/pii/S0025-7125(09)00025-X|access-date=2009-06-20}}</ref> [[coronary artery disease]],<ref name="pmid19363848">{{cite journal | vauthors = Agabiti-Rosei E | title = From macro- to microcirculation: benefits in hypertension and diabetes | journal = J Hypertens Suppl | volume = 26 | issue = 3 | pages = S15–9 | date = September 2008 | pmid = 19363848 | doi = 10.1097/01.hjh.0000334602.71005.52}}</ref><ref name="pmid19427499">{{cite journal |vauthors=Murphy BP, Stanton T, Dunn FG |title=Hypertension and myocardial ischemia |journal=[[The Medical Clinics of North America]] |volume=93 |issue=3 |pages=681–95 |date=May 2009 |pmid=19427499 |doi=10.1016/j.mcna.2009.02.003 |url=http://journals.elsevierhealth.com/retrieve/pii/S0025-7125(09)00018-2|access-date=2009-06-20}}</ref> [[stroke]],<ref name="pmid19393824"/> [[renal disease]],<ref name="pmid12728683">{{cite journal |vauthors=Tylicki L, Rutkowski B |title=[Hypertensive nephropathy: pathogenesis, diagnosis and treatment] |language=pl |journal=[[Polski Merkuriusz Lekarski]] |volume=14 |issue=80 |pages=168–73 |date=February 2003 |pmid=12728683 }}</ref><ref name="pmid19195963">{{cite journal |vauthors=Truong LD, Shen SS, Park MH, Krishnan B |title=Diagnosing nonneoplastic lesions in nephrectomy specimens |journal=[[Archives of Pathology & Laboratory Medicine]] |volume=133 |issue=2 |pages=189–200 |date=February 2009 |pmid=19195963 |doi= 10.5858/133.2.189|url=https://www.archivesofpathology.org/doi/full/10.1043/1543-2165-133.2.189|access-date=2009-06-20}}</ref><ref name="pmid11842376">{{cite journal |vauthors=Tracy RE, White S |title=A method for quantifying adrenocortical nodular hyperplasia at autopsy: some use of the method in illuminating hypertension and atherosclerosis |journal=[[Annals of Diagnostic Pathology]] |volume=6 |issue=1 |pages=20–9 |date=February 2002 |pmid=11842376 |doi= 10.1053/adpa.2002.30606}}</ref> and [[peripheral arterial disease]].<ref name="pmid18672184">{{cite journal |author=Aronow WS |title=Hypertension and the older diabetic |journal=[[Clinics in Geriatric Medicine]] |volume=24 |issue=3 |pages=489–501, vi–vii |date=August 2008 |pmid=18672184 |doi=10.1016/j.cger.2008.03.001 |url=http://journals.elsevierhealth.com/retrieve/pii/S0749-0690(08)00012-8|access-date=2009-06-20}}</ref><ref name="pmid19008688">{{cite journal |vauthors=Gardner AW, Afaq A |journal=[[Journal of Cardiopulmonary Rehabilitation and Prevention]] |volume=28 |issue=6 |pages=349–57 |year=2008 |pmid=19008688 |doi=10.1097/HCR.0b013e31818c3b96 |pmc=2743684|title=Management of Lower Extremity Peripheral Arterial Disease }}</ref> It is the most important [[Risk factor (epidemiology)|risk factor]] for [[cardiovascular]] [[morbidity]] and [[mortality rate|mortality]], in [[industrialized countries]].<ref name="pmid19149532">{{cite journal |vauthors=Novo S, Lunetta M, Evola S, Novo G |title=Role of ARBs in the blood hypertension therapy and prevention of cardiovascular events |journal=[[Current Drug Targets]] |volume=10 |issue=1 |pages=20–5 |date=January 2009 |pmid=19149532 |doi=10.2174/138945009787122897 |url=http://www.bentham-direct.org/pages/content.php?CDT/2009/00000010/00000001/0003J.SGM |access-date=2009-06-20 |archive-url=https://archive.today/20130112095900/http://www.bentham-direct.org/pages/content.php?CDT/2009/00000010/00000001/0003J.SGM |archive-date=2013-01-12 |url-status=usurped }}</ref>