High Blood Pressure (cont.)
The metabolic syndrome and obesity
Genetic factors play a role in the constellation of findings that make up the "metabolic syndrome." Individuals with the metabolic syndrome have insulin resistance and a tendency to have type 2 diabetes mellitus (non-insulin-dependent diabetes).
Obesity, especially associated with a marked increase in abdominal girth, leads to high blood sugar (hyperglycemia), elevated blood lipids (fats), vascular inflammation, endothelial dysfunction (abnormal reactivity of the blood vessels), and hypertension all leading to premature atherosclerotic vascular disease. The American Obesity Association states the risk of developing hypertension is five to six times greater in obese Americans, age 20 to 45, compared to non-obese individuals of the same age. The American Journal of Clinical Nutrition reported in 2005 that waist size was a better predictor of a person's blood pressure than body mass index (BMI). Men should strive for a waist size of 35 inches or under and women 33 inches or under. The epidemic of obesity in the United States contributes to hypertension in children, adolescents, and adults.
What are the symptoms of high blood pressure?
Uncomplicated high blood pressure usually occurs without any symptoms (silently) and so hypertension has been labeled "the silent killer." It is called this because the disease can progress to finally develop any one or more of the several potentially fatal complications of hypertension such as heart attacks or strokes. Uncomplicated hypertension may be present and remain unnoticed for many years, or even decades. This happens when there are no symptoms, and those affected fail to undergo periodic blood pressure screening.
Some people with uncomplicated hypertension, however, may experience symptoms
such as headache, dizziness, shortness of breath, and blurred vision. The
presence of symptoms can be a good thing in that they can prompt people to
consult a doctor for treatment and make them more compliant in taking their
medications. Often, however, a person's first contact with a
physician may be after significant damage to the end-organs has occurred. In
many cases, a person visits or is brought to the doctor or an emergency room
with a heart attack, stroke, kidney failure, or impaired vision (due to damage
to the back part of the retina). Greater public awareness and frequent blood
pressure screening may help to identify patients with undiagnosed high blood
pressure before significant complications have developed.
About one out of every 100 (1%) people with hypertension is diagnosed with
severe high blood pressure (accelerated or malignant hypertension) at their
first visit to the doctor. In these patients, the diastolic blood pressure (the
minimum pressure) exceeds 140 mm Hg! Affected persons often experience severe
headache, nausea, visual symptoms, dizziness, and sometimes kidney failure.
Malignant hypertension is a medical emergency and requires urgent treatment to
prevent a stroke (brain damage).
Next: How is end-organ damage assessed in the patient with high blood pressure? »
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