High blood pressure
November 28, 2021
Hypertension (hypertension, English: Hypertension) is a condition in which blood pressure is maintained above the normal range. Although there are often no subjective symptoms of hypertension itself, it is a clinically serious condition because it causes the onset of ischemic heart disease, stroke, renal failure, and the like.
It is regarded as one of the lifestyle-related diseases, and the Ministry of Health, Labor and Welfare (2013) has announced that it has the highest outpatient rate for both men and women (second place is diabetes for men and back pain for women).
In the United States in 1995, 24% of all adults had hypertension, and 53% of them were taking antihypertensive drugs. According to the Japanese Society of Hypertension, it is estimated that there are 40 million people with hypertension in Japan. Obesity, dyslipidemia, and complications with diabetes were referred to as death quartet, syndrome X, and insulin resistance syndrome. These are now called metabolic syndromes.
The Japanese Society of Hypertension has set the criteria for hypertension as follows.
That is, hypertension is defined as a state in which systolic blood pressure is 140 mmHg or higher or diastolic blood pressure is 90 mmHg or higher. However, recent studies have shown that the higher the blood pressure, the higher the risk of complications, so a systolic blood pressure of less than 120 mmHg is considered to be a blood pressure level that is less burdensome to the blood vessels of the living body.
The point to note here is that the problem is that the high blood pressure remains high, and it is not a reference to transient hypertension such as when exercising or when nervous. The diagnostic criteria for hypertension are the average of several measurements. A transient increase in blood pressure due to exercise or mental excitement is a physiological response, which is different from the concept of hypertension.
Blood pressure fluctuates throughout the day. Therefore, although the measurement time zone meets the normal value standard, hypertension may occur in most other time zones. This is called masked hypertension. Even if an antihypertensive drug is prescribed, it may be out of the safe range during the time when the effect has expired, and it is necessary to keep this in mind. On the contrary, although it is usually in a normal blood pressure state, when measured by a doctor in a doctor's office, the blood pressure may rise and a diagnosis of hypertension may occur, which is called white coat hypertension.
Since there are cases of orthostatic hypotension in diabetic patients, measurement is performed not only in the sitting position but also in the lying and standing positions.
The blood pressure measurement result of the upper arm may cause a difference in blood pressure between the left and right. The difference in blood pressure is thought to be due to lesions in the brachial or subclavian artery, and patients with a difference of 10 mmHg or more have a significantly higher risk of death from cardiovascular disease. In addition, when measuring at home, it is recommended to measure with the higher arm.
According to the Japanese Society of Hypertension, the measurement site: upper arm is recommended in the "Guidelines for setting home blood pressure measurement conditions". Avoid using wrist and finger sphygmomanometers.
In the morning, measure within 1 hour after waking up, after urination, before taking medication, at rest before breakfast, and 1 to 2 minutes after sitting.
In the case of night, it is measured at rest before bedtime and 1 to 2 minutes after sitting.
Evaluated by the mean and standard deviation of any period, morning and night.
Home blood pressure is 135/85 mmHg or more for treatment, and less than 125/75 mmHg is normal blood pressure. And so on.
About classification designation
In the conventional classification name, it was mild / moderate / severe, but "even mild hypertension is judged to be high risk when the risk is stratified, and there is a possibility that treatment similar to severe hypertension may be required. Is assumed ", so mild is I degree / moderate is II degree / severe