(HTN) or high blood pressure, sometimes called
arterial hypertension, is a chronic
in which the blood
pressure in the arteries
is elevated. Blood pressure is summarised by two measurements,
which depend on whether the heart muscle is contracting
(systole) or relaxed between beats (diastole). This equals
the maximum and minimum pressure, respectively. Normal blood
pressure at rest is within the range of 100–140mmHg systolic
(top reading) and 60–90mmHg diastolic (bottom reading).
High blood pressure is said to be present if it is often
at or above 140/90 mmHg.
is classified as either primary
(essential) hypertension or secondary
hypertension; about 90–95% of cases are categorized
as "primary hypertension" which means high blood pressure
with no obvious underlying medical cause.
The remaining 5–10% of cases (secondary hypertension) are
caused by other conditions that affect the kidneys, arteries,
heart or endocrine system.
puts strain on the heart, leading to hypertensive
heart disease and coronary
artery disease if not treated. Hypertension is also
a major risk
factor for stroke,
of the arteries (e.g. aortic
arterial disease and is a cause of chronic
kidney disease. A moderately high arterial blood pressure
is associated with a shortened life
expectancy while mild elevation is not. Dietary and
lifestyle changes can improve blood pressure control and
decrease the risk of health complications, although drug
treatment is still often necessary in people for whom lifestyle
changes are not enough or not effective.
is rarely accompanied by any symptoms, and its identification
is usually through screening,
or when seeking healthcare for an unrelated problem. A proportion
of people with high blood pressure report headaches
(particularly at the back
of the head and in the morning), as well as lightheadedness,
(buzzing or hissing in the ears), altered vision or fainting
These symptoms, however, might be related to associated
than the high blood pressure itself.
examination, hypertension may be suspected on the basis
of the presence of hypertensive
retinopathy detected by examination of the optic
fundus found in the back of the eye using ophthalmoscopy.
Classically, the severity of the hypertensive retinopathy
changes is graded from grade I–IV, although the milder types
may be difficult to distinguish from each other.
Ophthalmoscopy findings may also give some indication as
to how long a person has been hypertensive.
additional signs and symptoms may suggest secondary
hypertension, i.e. hypertension due to an identifiable
cause such as kidney
diseases or endocrine
diseases. For example, truncal obesity, glucose
face, a "buffalo hump" and purple stretch
marks suggest Cushing's
disease and acromegaly
can also cause hypertension and have characteristic symptoms
An abdominal bruit
may be an indicator of renal
artery stenosis (a narrowing of the arteries supplying
the kidneys), while decreased blood pressure in the lower
extremities and/or delayed or absent femoral
arterial pulses may indicate aortic
coarctation (a narrowing of the aorta shortly after
it leaves the heart). Labile
or paroxysmal hypertension accompanied by headache, palpitations,
pallor, and perspiration should prompt suspicions of pheochromocytoma.
elevated blood pressure (equal to or greater than a systolic
180 or diastolic of 110—sometimes termed malignant or accelerated
hypertension) is referred to as a "hypertensive crisis",
as blood pressure at this level confers a high risk of complications.
People with blood pressures in this range may have no symptoms,
but are more likely to report headaches (22% of cases)
and dizziness than the general population.
Other symptoms accompanying a hypertensive crisis may include
visual deterioration or breathlessness due to heart failure
or a general feeling of malaise
due to renal failure.
Most people with a hypertensive crisis are known to have
elevated blood pressure, but additional triggers may have
led to a sudden rise.
"hypertensive emergency", previously "malignant hypertension",
is diagnosed when there is evidence of direct damage to
one or more organs as a result of the severely elevated
blood pressure. This may include hypertensive
encephalopathy, caused by brain swelling and dysfunction,
and characterized by headaches and an altered
level of consciousness (confusion or drowsiness). Retinal
and/or fundal hemorrhages
are another sign of target organ damage. Chest
pain may indicate heart
muscle damage (which may progress to myocardial
infarction) or sometimes aortic
dissection, the tearing of the inner wall of the aorta.
cough, and the expectoration of blood-stained sputum are
characteristic signs of pulmonary
edema, the swelling of lung tissue due to left
ventricular failure an inability of the left
ventricle of the heart to adequately pump blood from
the lungs into the arterial system.
deterioration of kidney function (acute kidney injury)
hemolytic anemia (destruction of blood cells) may also
In these situations, rapid reduction of the blood pressure
is mandated to stop ongoing organ damage.
In contrast there is no evidence that blood pressure needs
to be lowered rapidly in hypertensive urgencies where there
is no evidence of target organ damage and over aggressive
reduction of blood pressure is not without risks.
Use of oral medications to lower the BP gradually over 24
to 48h is advocated in hypertensive urgencies.
occurs in approximately 8–10% of pregnancies.
Two blood pressure measurements six hours apart of greater
than 140/90 mm Hg is considered diagnostic of hypertension
Most women with hypertension in pregnancy have pre-existing
primary hypertension, but high blood pressure in pregnancy
may be the first sign of pre-eclampsia,
a serious condition of the second half of pregnancy and
Pre-eclampsia is characterised by increased blood pressure
and the presence of protein
in the urine.
It occurs in about 5% of pregnancies and is responsible
for approximately 16% of all maternal
Pre-eclampsia also doubles the risk of perinatal
Usually there are no symptoms in pre-eclampsia and it is
detected by routine screening. When symptoms of pre-eclampsia
occur the most common are headache, visual disturbance (often
"flashing lights"), vomiting, epigastric
pain, and edema.
Pre-eclampsia can occasionally progress to a life-threatening
condition called eclampsia,
which is a hypertensive
emergency and has several serious complications including
edema, and disseminated
intravascular coagulation (a blood clotting disorder).
to thrive, seizures,
lack of energy,
can be associated with hypertension in neonates and young
infants. In older infants and children, hypertension can
cause headache, unexplained irritability, fatigue,
to thrive, blurred
(essential) hypertension is the most common form of hypertension,
accounting for 90–95% of all cases of hypertension.
In almost all contemporary societies, blood pressure rises
and the risk of becoming hypertensive in later life is considerable.
Hypertension results from a complex interaction of genes
and environmental factors. Numerous common genetic variants
with small effects on blood pressure have been identified
as well as some rare genetic variants with large effects
on blood pressure
but the genetic basis of hypertension is still poorly understood.
Several environmental factors influence blood pressure.
Lifestyle factors that lower blood pressure include reduced
dietary salt intake,
increased consumption of fruits and low fat products (Dietary
Approaches to Stop Hypertension (DASH
and reduced alcohol
Stress appears to play a minor role
with specific relaxation
techniques not supported by the evidence.
The possible role of other factors such as caffeine consumption,
and vitamin D deficiency
are less clear cut. Insulin
resistance, which is common in obesity and is a component
X (or the metabolic
syndrome), is also thought to contribute to hypertension.
Recent studies have also implicated events in early life
(for example low
birth weight, maternal
smoking and lack of breast
feeding) as risk factors for adult essential hypertension,
although the mechanisms linking these exposures to adult
hypertension remain obscure.
hypertension results from an identifiable cause. Renal disease
is the most common secondary cause of hypertension.
Hypertension can also be caused by endocrine conditions,
such as Cushing's
syndrome or hyperaldosteronism,
Other causes of secondary hypertension include obesity,
of the aorta, excessive liquorice
consumption and certain prescription medicines, herbal remedies
and illegal drugs.
depicting the effects of high blood pressure
most people with established essential
(primary) hypertension, increased resistance to blood
peripheral resistance) accounts for the high pressure
output remains normal.
There is evidence that some younger people with prehypertension
or 'borderline hypertension' have high cardiac output, an
elevated heart rate and normal peripheral resistance, termed
hyperkinetic borderline hypertension.
These individuals develop the typical features of established
essential hypertension in later life as their cardiac output
falls and peripheral resistance rises with age.
Whether this pattern is typical of all people who ultimately
develop hypertension is disputed.
The increased peripheral resistance in established hypertension
is mainly attributable to structural narrowing of small
arteries and arterioles,
although a reduction in the number or density of capillaries
may also contribute.
Hypertension is also associated with decreased peripheral
which may increase venous
return, increase cardiac preload
and, ultimately, cause diastolic
dysfunction. Whether increased active vasoconstriction
plays a role in established essential hypertension is unclear.
pressure (the difference between systolic and diastolic
blood pressure) is frequently increased in older people
with hypertension. This can mean that systolic pressure
is abnormally high, but diastolic pressure may be normal
or low — a condition termed isolated
The high pulse pressure in elderly people with hypertension
or isolated systolic hypertension is explained by increased
stiffness, which typically accompanies aging and may
be exacerbated by high blood pressure.
mechanisms have been proposed to account for the rise in
peripheral resistance in hypertension. Most evidence implicates
either disturbances in renal salt and water handling (particularly
abnormalities in the intrarenal renin-angiotensin
and/or abnormalities of the sympathetic
These mechanisms are not mutually exclusive and it is likely
that both contribute to some extent in most cases of essential
hypertension. It has also been suggested that endothelial
dysfunction and vascular inflammation
may also contribute to increased peripheral resistance and
vascular damage in hypertension.
Harrison's principles of internal medicine
is diagnosed on the basis of a persistent high blood pressure.
this requires three separate sphygmomanometer measurements
at one monthly intervals.
Initial assessment of the hypertensive people should include
a complete history
examination. With the availability of 24-hour ambulatory
blood pressure monitors and home
blood pressure machines, the importance of not wrongly
diagnosing those who have white
coat hypertension has led to a change in protocols.
In the United Kingdom, current best practice is to follow
up a single raised clinic reading with ambulatory measurement,
or less ideally with home blood pressure monitoring over
the course of 7 days.
in the elderly or noncompressibility artery syndrome
may also require consideration. This condition is believed
to be due to calcification of the arteries resulting in
abnormally high blood pressure readings with a blood pressure
cuff while intra arterial measurements of blood pressure
the diagnosis of hypertension has been made, physicians
will attempt to identify the underlying cause based on risk
factors and other symptoms, if present. Secondary
hypertension is more common in preadolescent children,
with most cases caused by renal
disease. Primary or essential
hypertension is more common in adolescents and has multiple
risk factors, including obesity and a family history of
Laboratory tests can also be performed to identify possible
causes of secondary hypertension, and to determine whether
hypertension has caused damage to the heart,
and kidneys. Additional
tests for diabetes
cholesterol levels are usually performed because these
conditions are additional risk factors for the development
disease and may require treatment.
is measured to assess for the presence of kidney disease,
which can be either the cause or the result of hypertension.
Serum creatinine alone may overestimate glomerular
filtration rate and recent guidelines advocate the use
of predictive equations such as the Modification
of Diet in Renal Disease (MDRD) formula to estimate
glomerular filtration rate (eGFR).
eGFR can also provides a baseline measurement of kidney
function that can be used to monitor for side effects of
certain antihypertensive drugs on kidney function. Additionally,
testing of urine samples for protein
is used as a secondary indicator of kidney disease. Electrocardiogram
(EKG/ECG) testing is done to check for evidence that the
heart is under strain from high blood pressure. It may also
show whether there is thickening of the heart muscle (left
ventricular hypertrophy) or whether the heart has experienced
a prior minor disturbance such as a silent heart attack.
X-ray or an echocardiogram
may also be performed to look for signs of heart enlargement
or damage to the heart.
people aged 18 years or older hypertension is defined as
a systolic and/or a diastolic blood pressure measurement
consistently higher than an accepted normal value (currently
139 mmHg systolic, 89 mmHg diastolic: see table
—Classification (JNC7)). Lower thresholds are used (135 mmHg
systolic or 85 mmHg diastolic) if measurements are
derived from 24-hour ambulatory or home monitoring.
Recent international hypertension guidelines have also created
categories below the hypertensive range to indicate a continuum
of risk with higher blood pressures in the normal range.
uses the term prehypertension for blood pressure in the
range 120-139 mmHg systolic and/or 80-89 mmHg
diastolic, while ESH-ESC Guidelines (2007)
and BHS IV (2004)
use optimal, normal and high normal categories to subdivide
pressures below 140 mmHg systolic and 90 mmHg
diastolic. Hypertension is also sub-classified: JNC7 distinguishes
hypertension stage I, hypertension stage II, and isolated
systolic hypertension. Isolated systolic hypertension refers
to elevated systolic pressure with normal diastolic pressure
and is common in the elderly.
The ESH-ESC Guidelines (2007)
and BHS IV (2004),
additionally define a third stage (stage III hypertension)
for people with systolic blood pressure exceeding 179 mmHg
or a diastolic pressure over 109 mmHg. Hypertension
is classified as "resistant" if medications
do not reduce blood pressure to normal levels.
is rare, occurring in around 0.2 to 3% of neonates, and
blood pressure is not measured routinely in the healthy
Hypertension is more common in high risk newborns. A variety
of factors, such as gestational
age, postconceptional age and birth
weight needs to be taken into account when deciding
if a blood pressure is normal in a neonate.
occurs quite commonly in children over the age of 3 years
and adolescents (2-9% depending on age, sex and ethnicity)
and is associated with long term risks of ill-health.
Blood pressure rises with age in childhood and, in children,
hypertension is defined as an average systolic or diastolic
blood pressure on three or more occasions equal or higher
than the 95th percentile appropriate for the sex, age and
height of the child. High blood pressure must be confirmed
on repeated visits however before characterizing a child
as having hypertension.
Prehypertension in children has been defined as average
systolic or diastolic blood pressure that is greater than
or equal to the 90th percentile, but less than the 95th
In adolescents, it has been proposed that hypertension and
pre-hypertension are diagnosed and classified using the
same criteria as in adults.
value of routine screening for hypertension in children
over the age of 3 years is debated.
In 2004 the National High Blood Pressure Education Program
recommended that children aged 3 years and older have blood
pressure measurement at least once at every health care
and the National Heart, Lung, Blood Institute’s and American
Academy of Pediatrics made a similar recommendation.
However the American Academy of Family Physicians
support the view of the U.S. preventive Services Task Force
that evidence is insufficient to determine the balance of
benefits and harms of screening for hypertension in children
and adolescents who do not have symptoms.
of the disease burden of high blood pressure is experienced
by people who are not labelled as hypertensive.
Consequently, population strategies are required to reduce
the consequences of high blood pressure and reduce the need
for antihypertensive drug therapy. Lifestyle changes are
recommended to lower blood pressure, before starting drug
therapy. The 2004 British Hypertension Society guidelines
proposed the following lifestyle changes consistent with
those outlined by the US National High BP Education Program
for the primary prevention of hypertension:
normal body weight for adults (e.g. body mass index
dietary sodium intake to <100 mmol/ day (<6
g of sodium chloride or <2.4 g of sodium per day)
in regular aerobic physical activity such as brisk walking
(>30 min per day, most days of the week)
alcohol consumption to no more than 3 units/day in men
and no more than 2 units/day in women
a diet rich in fruit and vegetables (e.g. at least five
portions per day);
lifestyle modification may lower blood pressure as much
an individual antihypertensive drug. Combinations of two
or more lifestyle modifications can achieve even better
first line of treatment for hypertension is identical to
the recommended preventive lifestyle changes
and includes dietary changes,
physical exercise, and weight loss. These have all been
shown to significantly reduce blood pressure in people with
Their potential effectiveness is similar to using a single
If hypertension is high enough to justify immediate use
of medications, lifestyle changes are still recommended
in conjunction with medication.
change such as a low
sodium diet is beneficial. A long term (more than 4
weeks) low sodium diet in Caucasians
is effective in reducing blood pressure, both in people
with hypertension and in people with normal blood pressure.
Also, the DASH
diet, a diet
rich in nuts, whole grains, fish, poultry, fruits and vegetables
lowers blood pressure. A major feature of the plan is limiting
intake of sodium,
although the diet is also rich in potassium,
well as protein.
Some programs aimed to reduce psychological stress such
meditation may be reasonable add-ons to other treatment
to reduce hypertension. However several techniques such
as yoga, relaxation and other forms of meditation do not
appear to reduce blood pressure.
Of the techniques with supportive evidence, the quantity
of this is generally low.
exercise regimes—including isometric resistance exercise,
dynamic aerobic exercise, dynamic resistance exercise and
device-guided breathing—may be useful in reducing blood
classes of medications, collectively referred to as antihypertensive
drugs, are currently available for treating hypertension.
Use should take into account the person's cardiovascular
risk (including risk of myocardial infarction and stroke)
as well as blood pressure readings, in order to gain a more
accurate picture of the person's cardiovascular profile.
Evidence in those with mild hypertension (SBP less than
160 mmHg and /or DBP less than 100 mmHg) and no
other health problems does not support a reduction in the
risk of death or rate of health complications from medication
Medications are not recommended for people with prehypertension
or high normal blood pressure.
drug treatment is initiated the Joint National Committee
on High Blood Pressure (JNC-7)
recommends that the physician not only monitor for response
to treatment but should also assess for any side effects
resulting from the medication. Reduction of the blood
pressure by 5 mmHg can decrease the risk of stroke
by 34%, of ischaemic
heart disease by 21%, and reduce the likelihood of dementia,
failure, and mortality
For most people, recommendations are to reduce blood pressure
to less than or equal to somewhere between 140/90 mmHg
to 160/100 mmHg.
Attempting to achieve lower levels have not been shown to
In those with diabetes or kidney disease some recommend
levels below 120/80 mmHg;
however, these are not proven.
If the blood pressure goal is not met, a change in treatment
should be made as therapeutic
inertia is a clear impediment to blood pressure control.
best first line agent is disputed.
Health Organization and the United States guidelines
supports low dose thiazide-based
diuretic as first line treatment.
The UK guidelines emphasise calcium
channel blockers (CCB) in preference for people over
the age of 55 years or if of African or Caribbean family
origin, with angiotensin
converting enzyme inhibitors (ACE-I) used first line
for younger people.
In Japan starting with any one of six classes of medications
including: CCB, ACEI/ARB, thiazide diuretics, beta-blockers,
is deemed reasonable, while in Canada and Europe all of
these but alpha-blockers are recommended as options.
majority of people require more than one drug to control
their hypertension. In those with a systolic blood pressure
greater than 160 mmHg or a diastolic blood pressure
greater than 100 mmHg the American Heart Association
recommends starting both a thiazide and an ACEI, ARB or
An ACEI and CCB combination can be used as well.
combinations are non-dihydropyridine calcium blockers (such
as verapamil or diltiazem) and beta-blockers, dual renin–angiotensin
system blockade (e.g. angiotensin converting enzyme inhibitor
+ angiotensin receptor blocker), renin–angiotensin system
blockers and beta-blockers, beta-blockers and centrally
Combinations of an ACE-inhibitor or angiotensin
II–receptor antagonist, a diuretic and an NSAID
(including selective COX-2 inhibitors and non-prescribed
drugs such as ibuprofen) should be avoided whenever possible
due to a high documented risk of acute renal failure. The
combination is known colloquially as a "triple whammy" in
the Australian health industry.
Tablets containing fixed combinations of two classes of
drugs are available and while convenient for the people,
may be best reserved for those who have been established
on the individual components.
moderate to severe hypertension decreases death rates and
and mortality in people aged 60 and older.
There are limited studies of people over 80 years old but
a recent review concluded that antihypertensive treatment
reduced cardiovascular deaths and disease, but did not significantly
reduce total death rates.
The recommended BP goal is advised as <150/90 mm
Hg with thiazide
diuretic, CCB, ACEI, or ARB being the first line medication
in the United States,
and in the revised UK guidelines calcium-channel
blockers are advocated as first line with targets of
clinic readings <150/90, or <145/85 on ambulatory
or home blood pressure monitoring.
hypertension is defined as hypertension that remains above
goal blood pressure in spite of concurrent use of three
antihypertensive agents belonging to different antihypertensive
drug classes. Guidelines for treating resistant hypertension
have been published in the UK
It has been proposed that a proportion of resistant hypertension
may be the result of chronic high activity of the autonomic
nervous system; this concept is known as "neurogenic
of 2000, nearly one billion people or ~26% of the adult
population of the world had hypertension.
It was common in both developed (333 million) and undeveloped
(639 million) countries.
However rates vary markedly in different regions with rates
as low as 3.4% (men) and 6.8% (women) in rural India and
as high as 68.9% (men) and 72.5% (women) in Poland.
In Europe hypertension occurs in about 30-45% of people
as of 2013.
1995 it was estimated that 43 million people in the United
States had hypertension or were taking antihypertensive
medication, almost 24% of the adult United States population.
The prevalence of hypertension in the United States is increasing
and reached 29% in 2004.
As of 2006 hypertension affects 76 million US adults
(34% of the population) and African American adults have
among the highest rates of hypertension in the world at
It is more common in blacks,
Americans and less in whites
Americans, rates increase with age, and is greater in
Hypertension is more common in men (though menopause tends
to decrease this difference) and in those of low socioeconomic
prevalence of high blood pressure in the young is increasing.
Most childhood hypertension, particularly in preadolescents,
is secondary to an underlying disorder. Aside from obesity,
kidney disease is the most common (60–70%) cause of hypertension
in children. Adolescents usually have primary or essential
hypertension, which accounts for 85–95% of cases.
illustrating the main complications of persistent
high blood pressure
is the most important preventable
risk factor for premature death worldwide.
It increases the risk of ischemic
and other cardiovascular diseases, including heart
aneurysms, diffuse atherosclerosis,
Hypertension is also a risk factor for cognitive
impairment and dementia,
Other complications include hypertensive
retinopathy and hypertensive
of veins from Harvey's Exercitatio Anatomica de
Motu Cordis et Sanguinis in Animalibus
understanding of the cardiovascular system began with the
work of physician William
Harvey (1578–1657), who described the circulation of
blood in his book "De motu cordis". The English clergyman
Hales made the first published measurement of blood
pressure in 1733.
Descriptions of hypertension as a disease came among others
Young in 1808 and especially Richard
Bright in 1836.
The first report of elevated blood pressure in a person
without evidence of kidney disease was made by Frederick
Akbar Mahomed (1849–1884).
However hypertension as a clinical entity came into being
in 1896 with the invention of the cuff-based sphygmomanometer
Riva-Rocci in 1896.
This allowed the measurement of blood
pressure in the clinic. In 1905, Nikolai
Korotkoff improved the technique by describing the Korotkoff
sounds that are heard when the artery is ausculated
with a stethoscope while the sphygmomanometer cuff is deflated.
the treatment for what was called the "hard pulse disease"
consisted in reducing the quantity of blood by bloodletting
or the application of leeches.
This was advocated by The Yellow
Emperor of China, Cornelius
In the 19th and 20th centuries, before effective pharmacological
treatment for hypertension became possible, three treatment
modalities were used, all with numerous side-effects: strict
sodium restriction (for example the rice diet),
(surgical ablation of parts of the sympathetic
nervous system), and pyrogen therapy (injection of substances
that caused a fever, indirectly reducing blood pressure).
The first chemical for hypertension, sodium
thiocyanate, was used in 1900 but had many side effects
and was unpopular.
Several other agents were developed after the Second
World War, the most popular and reasonably effective
of which were tetramethylammonium
chloride and its derivative hexamethonium,
(derived from the medicinal plant Rauwolfia
serpentina). A major breakthrough was achieved with
the discovery of the first well-tolerated orally available
agents. The first was chlorothiazide,
the first thiazide
developed from the antibiotic sulfanilamide,
which became available in 1958.
channel blockers, angiotensin
converting enzyme (ACE) inhibitors, angiotensin
receptor blockers and renin
inhibitors were developed as antihypertensive agents.
showing, prevalence of awareness, treatment and control
of hypertension compared between the four studies
World Health Organization has identified hypertension,
or high blood pressure, as the leading cause of cardiovascular
World Hypertension League (WHL),
an umbrella organization of 85 national hypertension societies
and leagues, recognized that more than 50% of the hypertensive
population worldwide are unaware of their condition.
To address this problem, the WHL initiated a global awareness
campaign on hypertension in 2005 and dedicated May 17 of
each year as World
Hypertension Day (WHD).
Over the past three years, more national societies have
been engaging in WHD and have been innovative in their activities
to get the message to the public. In 2007, there was record
participation from 47 member countries of the WHL. During
the week of WHD, all these countries – in partnership with
their local governments, professional societies, nongovernmental
organizations and private industries – promoted hypertension
awareness among the public through several media
and public rallies. Using mass
media such as Internet
the message reached more than 250 million people. As the
momentum picks up year after year, the WHL is confident
that almost all the estimated 1.5 billion people affected
by elevated blood pressure can be reached.
blood pressure is the most common chronic medical problem
prompting visits to primary health care providers in USA.
The American Heart Association estimated the direct and
indirect costs of high blood pressure in 2010 as $76.6 billion.
In the US 80% of people with hypertension are aware of their
condition, 71% take some antihypertensive medication, but
only 48% of people aware that they have hypertension adequately
Adequate management of hypertension can be hampered by inadequacies
in the diagnosis, treatment, and/or control of high blood
care providers face many obstacles to achieving blood
pressure control, including resistance to taking multiple
medications to reach blood pressure goals. People also face
the challenges of adhering to medicine schedules and making
lifestyle changes. Nonetheless, the achievement of blood
pressure goals is possible, and most importantly, lowering
blood pressure significantly reduces the risk of death due
to heart disease and stroke, the development of other debilitating
conditions, and the cost associated with advanced medical
of the nerves supplying the kidneys, which employs a catheter-based
device to cause thermal injury to the nerves surrounding
the renal artery without affecting other sympathetic nerves,
may lower blood pressure. So far, major side effects have
been relatively infrequent, although cases of renal artery
dissection, femoral artery pseudoaneurysm, excessive decreases
in blood pressure and heart rate are among the reported
adverse effects. It has been suggested that renal nerve
ablation may have a role in the management of resistant
hypertension but its long term efficacy and safety have
not been evaluated. However, a 2014 trial failed to confirm
a beneficial effect.