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Introduction
Hypertension is the medical term for high blood pressure.
Epidemiology
The World Health Organization (WHO) estimated hypertension to
occur in 1.28 billion adults aged 30-79 years old and two-thirds of these are
living in low- and middle-income countries. About 46% of adults with
hypertension are not aware that they have hypertension while about 42% of
adults with hypertension are diagnosed and managed.
The global prevalence of hypertension using the 2017 American
College of Cardiology (ACC) and American Heart Association (AHA) definition of
hypertension was estimated in 2019 at 1.3 billion. However, most epidemiological
data in Asia still utilized the old definition cut-offs of ≥140/90 mmHg.
The overall crude
prevalence of hypertension in China based on the 2012-2015 national survey was
27.9% among those ≥18 years old, directly correlated with increasing age. In
Hong Kong, hypertension is one of the most common diseases with prevalence
rates ranging between 27.7-29.5% among those ≥15 years old. In Korea,
approximately 30% of Koreans aged ≥30 years old have hypertension.
Over one-third of the population of Indonesia is diagnosed
with hypertension. The prevalence rate was 34.5%
based on the May Measurement Month in 2017 and 34.1%
based on previous surveys in 2018. The National
Health and Morbidity Survey in Malaysia reported that there was an increasing
trend in the overall prevalence of hypertension which were 34.6% in 2006, 33.6%
in 2011, and 35.3% in 2015 among those ≥18 years old.
The Philippine
Heart Association’s
PRESYON-4 reported that the point prevalence in the Philippines increased to
34% in 2020 from 28% in 2013. Nevertheless, the National
Nutrition Survey reported that the prevalence decreased from 23.9% in 2013 to
19.2% in 2018 among those 20-59 years old and 41.2% in 2015 to 35% among the
elderly in 2018. The WHO reported that the prevalence of
hypertension in Myanmar was 30.1% among those 25-64 years old in 2014, which was similar to the prevalence rate reported by a
cross-sectional study that utilized data from a survey in 2009.
The Singapore National Health Survey (NHS) in 2010 reported
that the crude prevalence of hypertension in Singapore was decreasing from
27.3% in 1998, 24.9% in 2004, and 23.5% in 2010 among those 30-69 years old.
Among 18-69 years old, the prevalence was 18.9% in 2010. In Thailand, however, the overall
prevalence of hypertension increased from 21% in 2003 to 25% in 2014. In Vietnam, the prevalence was
25.1% based on a national survey from 2001-2008 among those aged ≥25 years old.
Based on the May Measurement Month, the prevalence of hypertension was
increasing with prevalence rates of 28.7% in 2017, 30.3% in 2018, and 33.8% in
2019.
In India, the
prevalence rate of hypertension was estimated to be between 20-30%, without
considering the updated definition by the ACC/AHA. However, a study in 2017 concluded that applying the updated
definition caused a significant increase in the prevalence rate to 40.6%.
Hypertension
remains to be one of the top causes of morbidity and mortality in these
countries and although the level of awareness, treatment, and control are
steadily increasing, they remain to be low.
Pathophysiology
Blood pressure maintenance is complex and involves several physiological mechanisms including arterial baroreceptors, the renin-angiotensin-aldosterone system, atrial natriuretic peptide, endothelins, and mineralocorticoid and glucocorticoid steroids, which together manage the degree of vasoconstriction or vasodilation within the systemic circulation, and the retention of water and sodium to maintain adequate circulating blood volume and dysfunction in any of these processes can lead to hypertension development.
Sympathetic neural activation modulates hypertension by enhancing vasoconstriction and vascular remodeling, producing renal renin via beta 1 adrenergic receptors in the juxtaglomerular apparatus and increasing renal sodium resorption and inflammation.
Classification
The classification must be based on the average of ≥2 properly measured, seated blood pressure readings on each of ≥2 office visits. Various consensus guidelines are available as standard references for the definition of hypertension.1
BP Classification Based on 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA* |
SBP (mmHg) DBP (mmHg) |
Normal |
|
Elevated |
|
Hypertension Stage 1 |
|
Hypertension Stage 2 |
|
BP Classification Based on 2023 ESH** | SBP (mmHg) DBP (mmHg) |
Optimal |
|
Normal |
|
High Normal |
|
Grade 1 hypertension |
|
Grade 2 hypertension |
|
Grade 3 hypertension |
|
Isolated systolic hypertension (ISH)2 |
|
*Reference: 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. This guideline updates prior JNC reports.
**Reference: 2023 European Society of Hypertension (ESH) Guidelines for the management of arterial hypertension.
2Graded 1, 2, or 3 according to the systolic blood pressure values in the indicated ranges.
Stages of Hypertension
- Stage 1: Uncomplicated hypertension (without hypertension-mediated organ damage [HMOD], diabetes, established cardiovascular disease [CVD] or chronic kidney disease [CKD] stage ≥3)
- Stage 2: Presence of HMOD, diabetes, or CKD stage 3
- Stage 3: Presence of established CVD or CKD stage 4 or 5