nursece4less.com nursece4less.com nursece4less.com nursece4less.com 1 HYPERTENSION: AN OVERVIEW Dana Bartlett, BSN, MSN, MA, CSPI Dana Bartlett is a professional nurse and author. His clinical experience includes 16 years of ICU and ER experience and over 20 years of as a poison control center information specialist. Dana has published numerous CE and journal articles, written NCLEX material and textbook chapters, and done editing and reviewing for publishers such as Elsevier, Lippincott, and Thieme. He has written widely on the subject of toxicology and was recently named a contributing editor, toxicology section, for Critical Care Nurse journal. He is currently employed at the Connecticut Poison Control Center and is actively involved in lecturing and mentoring nurses, emergency medical residents and pharmacy students. ABSTRACT Primary hypertension, sometimes called essential hypertension, is far more common than secondary hypertension. There are many distinct and separate causes of secondary hypertension, which requires a more thorough discussion than would be possible in a short study. Primary hypertension is primarily discussed, as well as the topics of hypertensive emergencies, isolated diastolic hypertension, and isolated systolic hypertension is briefly highlighted.
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HYPERTENSION: AN OVERVIEW - NurseCe4Less.com AN OVERVIEW Dana Bartlett, BSN, MSN, MA, ... Hypertension, often referred to as ... have no characteristic signs or symptoms except for
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Dana Bartlett is a professional nurse and author. His clinical experience includes 16 years of ICU and ER experience and over 20 years of as a poison control center information specialist. Dana has published numerous CE and journal articles, written NCLEX material and textbook chapters, and
done editing and reviewing for publishers such as Elsevier, Lippincott, and Thieme. He has written widely on the subject of toxicology and was recently named a contributing editor, toxicology section, for Critical Care Nurse journal. He is currently employed at the Connecticut Poison Control Center and is actively involved in lecturing and mentoring nurses, emergency medical residents and pharmacy students.
ABSTRACT Primary hypertension, sometimes called essential hypertension, is far
more common than secondary hypertension. There are many distinct
and separate causes of secondary hypertension, which requires a more
thorough discussion than would be possible in a short study. Primary
hypertension is primarily discussed, as well as the topics of
hypertensive emergencies, isolated diastolic hypertension, and isolated
1. Elevated blood pressure that does not have an identifiable cause is known as
a. primary hypertension. b. isolated diastolic hypertension. c. secondary hypertension. d. systolic hypertension.
2. Elevated blood pressure that is caused by heart and lung
disease, or other illness, is known as
a. primary hypertension. b. chronic hypertension. c. secondary hypertension. d. acute hypertension.
3. If only the diastolic blood pressure is elevated when
measured, then the patient is understood to have
a. primary hypertension. b. isolated diastolic hypertension. c. secondary hypertension. d. systolic hypertension.
4. The majority of people who have hypertension have:
a. primary hypertension. b. isolated diastolic hypertension. c. secondary hypertension. d. acute hypertension.
5. Primary hypertension is defined as:
a. SBP > 110 mm Hg or DBP > 70 mm Hg. b. SBP ≥ 160 mm Hg or DBP ≥ 110 mm Hg. c. SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg. d. SBP 120-139 mm Hg, DBP 80-89 mm Hg.
knowledge about how lifestyle factors can influence hypertension, and
how well they understand their role in self-care.
Nursing considerations appropriate for the patient with hypertension
address the following concerns: 1) deficient knowledge regarding the
relationship between the treatment regimen and control of the disease
process, 2) ineffective therapeutic regimen management related to
medication adverse effects and difficult lifestyle adjustments, 3)
ineffective coping, and 4) noncompliance with the therapeutic regimen.
The following table addresses key points for patient education. Key Points for Patient Teaching
• Know the blood pressure goal – ideally less than 120/80 mmHg.
• Understand which lifestyle changes are helpful in treating and preventing
hypertension. • Hypertension cannot be cured but it can be managed and patient involvement
and self-care are absolutely critical. • Know how often to follow up with the health care provider; typically, monthly
until blood pressure is well controlled and every three to six months thereafter. • Know which blood tests are important to monitor based on the medications
taken. • Maintain a record of blood pressure readings. • Contact the healthcare provider for signs/symptoms of end-organ damage. • To change or stop medications, or for side effects difficult to tolerate, contact
the primary health care provider. • Understand common side effects and report them to the health care provider. • For a missed dose of medication, contact the primary health care provider, or
pharmacist. Do not take an extra dose to “catch up” as this could be dangerous.
Hypertension significantly increases the risk for developing
cardiovascular diseases, which include atherosclerosis, cardiac
arrhythmias, congestive heart failure, myocardial infarction, stroke and
organ disease. Morbidity and mortality are directly related to the
duration and severity of hypertension. Hypertension is typically
classified as primary or secondary. Primary hypertension accounts for
the great majority of the cases of hypertension. Whereas, secondary
hypertension is much less common than primary hypertension, and
identifiable causes of secondary hypertension are multifactorial, such
as endocrine, neurologic, renal, and vascular diseases, medical
conditions (i.e., obstructive sleep apnea), pregnancy, and drug-
induced.
While there is no cure for hypertension, certain lifestyle modifications
and antihypertensive drug therapy can help to control it. Screening for
hypertension is key to identifying those individuals at risk for having
hypertension. Additionally, patient knowledge of and compliance with
hypertension drug therapy and the needed lifestyle changes are
important to successful treatment. Nurses have a fundamental role in
educating patients on the prevention and treatment of hypertension,
and in closing gaps in patient knowledge to obtain appropriate care.
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1. Elevated blood pressure that does not have an identifiable cause is known as
a. primary hypertension. b. isolated diastolic hypertension. c. secondary hypertension. d. systolic hypertension.
2. Elevated blood pressure that is caused by heart and lung
disease, or other illness, is known as
a. primary hypertension. b. chronic hypertension. c. secondary hypertension. d. acute hypertension.
3. If only the diastolic blood pressure is elevated when
measured, then the patient is understood to have
a. primary hypertension. b. isolated diastolic hypertension. c. secondary hypertension. d. systolic hypertension.
4. The majority of people who have hypertension have:
a. primary hypertension. b. isolated diastolic hypertension. c. secondary hypertension. d. acute hypertension.
5. Primary hypertension is defined as:
a. SBP > 110 mm Hg or DBP > 70 mm Hg. b. SBP ≥ 160 mm Hg or DBP ≥ 110 mm Hg. c. SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg. d. SBP 120-139 mm Hg, DBP 80-89 mm Hg.
6. In the beginning stages of hypertension
a. most people experience chest pain and shortness of breath. b. most people are asymptomatic. c. most people have blurred vision and dizziness. d. most have mild and non-specific symptoms.
7. True or False: African Americans suffer disproportionately from hypertension.
a. True b. False
8. Which of the following answers lists correctly the risk
factors for hypertension?
a. Age < 20 years, obesity, and diet high in fiber. b. Heavy drinking, high level of physical activity, and age. c. Family history, sedentary lifestyle, and abstinence from
tobacco. d. Obesity, smoking, and excessive sodium intake.
9. Complications of primary hypertension include:
a. Hepatic and pulmonary damage. b. Stroke and kidney damage. c. Atherosclerosis and hypokalemia. d. Thyroid disorders and retinopathy.
10. A diagnosis of hypertension is confirmed if the patient’s
blood pressure is elevated
a. and orthostatic changes are present. b. and risk factors for hypertension are present. c. on at least 3 separate occasions, separated by the
appropriate length of time. d. with readings of SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg.
11. Isolated systolic hypertension is very common in
a. the elderly. b. African Americans c. people < 40 years of age. d. men.
12. The first intervention when treating and controlling hypertension is
a. aggressive diuresis with a thiazide diuretic. b. starting therapy with an ACEI and a CCB. c. starting therapy with low-dose aspirin and a beta-blocker. d. lifestyle modifications.
13. The first-line drug(s) of choice for treating patients who
have hypertension is/are:
a. ACEIs and ARBs. b. Thiazide diuretics. c. Beta-blockers and loop diuretics. d. Vasodilators and alpha1 blockers.
14. Hypertension can be ________ with lifestyle modifications
and anti-hypertensive drug therapy.
a. cured b. controlled c. diagnosed d. eliminated
15. Which of the following defines pre-hypertension?
a. SBP ≥ 160 mm Hg or DBP ≥ 100 mm Hg b. SBP ≥ 140 mm HG and DBP < 90 mm Hg c. SBP 120-139 mm Hg, DBP 80-89 mm Hg d. SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg
16. True or False: A patient who has elevated blood pressure is
considered to be in a hypertension emergency.
a. True b. False
17. Patients in whom the blood pressure elevation is
considered to be urgent may be managed with
a. hospitalization and rapid control of blood pressure. b. rapid control of blood pressure. c. maintaining the same anti-hypertensive therapy. d. initiation of anti-hypertensive therapy.
23. Studies show that with the development of hypertension in an individual, genetic
a. factors are primary causes of the disease. b. factors play no role. c. factors will predict hypertension in over half the cases. d. identification of those at risk is not feasible at this time.
24. Hypertensive emergencies are a spectrum of clinical
presentations that are usually characterized by
a. SBP ≥ 160 mm Hg or DBP ≥ 100 mm Hg b. SBP ≥ 140 mm HG and DBP < 90 mm Hg c. SBP > 220 mm Hg or a DBP > 120 mm Hg d. SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg
25. True or False: Until age 45 men are more likely than
women to have hypertension.
a. True b. False
26. Other factors that have been identified as possible
independent contributors to the development of primary hypertension include(s)
a. high-fiber diet. b. Vitamin D deficiency. c. decreased activity of the sympathetic nervous system. d. All of the above
27. The incidence of retinopathy in patients who have
hypertension has been reported to be a. due to Vitamin D deficiency. b. statistically insignificant because retinopathy is usually caused
by diabetes. c. below 20%. d. as high as 66.3% to 80.3%.
33. Common side effects of Angiotensin II Receptor Blockers (ARBs) include
a. cough. b. angioedema. c. dizziness. d. All of the above
34. The nurse should assess these patients to determine if
there is/are ________________________________ that increase(s) the risk for developing hypertension.
a. a family history of hypertension b. lifestyle issues such as obesity c. lifestyle issues such as smoking d. All of the above
35. True or False: Beta-blockers must be used very cautiously
in patients who have asthma, diabetes, or peripheral vascular disease. a. True b. False
CORRECT ANSWERS:
1. Elevated blood pressure that does not have an identifiable cause is known as
a. primary hypertension. p. 5: “The etiology of primary hypertension is not known. There is a genetic component to the development of the disease, but age and lifestyle factors contribute significantly to its development and progression. Secondary hypertension is much less common than primary hypertension, and in secondary hypertension there are identifiable causes.”
2. Elevated blood pressure that is caused by heart and lung disease, or other illness, is known as
c. secondary hypertension. p. 5: “The etiology of primary hypertension is not known. There is a genetic component to the development of the disease, but age and lifestyle factors contribute significantly to its development and progression. Secondary hypertension is much less common than primary hypertension, and in secondary hypertension there are identifiable causes.”
3. If only the diastolic blood pressure is elevated when measured, then the patient is understood to have
b. isolated diastolic hypertension. p. 6: “If only the diastolic blood pressure is elevated when measured, then the patient is understood to have isolated diastolic hypertension.”
4. The majority of people who have hypertension have:
a. primary hypertension. p. 5: “Primary hypertension accounts for the great majority of the cases of hypertension.”
5. Primary hypertension is defined as:
c. SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg. p. 7: “Stage I Hypertension: SBP ≥ 140 mm Hg or DBP ≥ 90 mm Hg.”
6. In the beginning stages of hypertension
b. most people are asymptomatic. pp. 5-6: “The majority of people who have hypertension (aside from secondary hypertension) have no characteristic signs or symptoms except for an elevated blood pressure, and this is one of the most harmful features of the disease.”
p. 16: “Pre-hypertension is a condition in which the blood pressure is elevated above normal levels but not to the measurements that define hypertension. In addition, the patient is asymptomatic and he or she has not yet developed organ damage.”
7. True or False: African Americans suffer disproportionately
from hypertension.
a. True p. 10: “The incidence and severity of hypertension is higher in African Americans than in other ethnic groups in the U.S.”
8. Which of the following answers correctly lists risk factors for hypertension?
d. Obesity, smoking, and excessive sodium intake. See discussion at pages 9-12.
9. Complications of primary hypertension include:
b. Stroke and kidney damage. pp. 16-17: “Complications of primary hypertension include … Kidney disease. Hypertension is a major risk factor for the development of chronic kidney disease, and the risk of chronic kidney disease increases in direct proportion to elevations in blood pressure. Hypertension is the second leading cause of kidney failure in the U.S.”
10. A diagnosis of hypertension is confirmed if the patient’s blood pressure is elevated
c. on at least 3 separate occasions, separated by an appropriate length of time. p. 15: “At least three measurements should be taken. It is very important that multiple readings should be taken and these readings must be separated by the appropriate length of time.”
11. Isolated systolic hypertension is very common:
a. in the elderly. p. 18: “Isolated systolic hypertension is caused by reduced compliance and elasticity of large arteries, and it is quite common in the elderly.”
12. The first intervention when treating and controlling hypertension is
d. lifestyle modifications. p. 20: “Lifestyle modifications are the first intervention when treating and controlling hypertension.”
13. The first-line drugs of choice for treating patients who have hypertension are:
b. Thiazide diuretics. p. 27: “The thiazide diuretics are the first choice for the treatment of primary hypertension, and those currently available in the U.S., include chlorothiazide, hydrochlorothiazide, and methylchlothiazide.”
14. Hypertension can be ________ with lifestyle modifications and anti-hypertensive drug therapy.
b. controlled p. 6: “Hypertension cannot be cured but it can be controlled with lifestyle modifications and anti-hypertensive drug therapy.”
15. Which of the following defines pre-hypertension?
c. SBP 120-139 mm Hg, DBP 80-89 mm Hg p. 7: “Pre-hypertension: SBP 120-139 mm Hg, DBP 80-89 mm Hg.”
16. True or False: A patient who has elevated blood pressure is considered to be in a hypertension emergency.
b. False p. 7: “Hypertensive emergencies are a spectrum of clinical presentations that are usually characterized by a systolic blood pressure > 220 mm Hg or a diastolic blood pressure > 120 mm Hg. The situation is considered urgent (not necessarily an emergency) if the patient has no significant signs and symptoms and no evidence of end-organ damage.”
17. Patients in whom the blood pressure elevation is considered to be urgent may be managed with
d. initiation of anti-hypertensive therapy. pp. 7-8: “Patients in whom the blood pressure elevation is considered to be urgent may be managed with initiation of anti-hypertensive therapy or a change to the existing anti-hypertensive therapy and outpatient follow up.”
18. Hospitalization and rapid control of blood pressure would be required in cases where a patient has significant signs and symptoms such as
a. chest pain. b. evidence of end-organ damage such as aortic dissection. c. hypertensive encephalopathy. d. All of the above
p. 8: “If the patient has significant signs and symptoms such as chest pain, headache, or shortness of breath, or evidence of end-organ damage such as aortic dissection, hypertensive encephalopathy, intracranial hemorrhage, myocardial infarction, papilledema, or retinal hemorrhages, hospitalization and rapid control of blood pressure would be required.”
19. The most important factor related to obesity, which contributes to an increased risk of developing hypertension, appears to be
b. distribution of body fat. p. 11: “It may be the distribution of body fat, not body weight, which is the factor that determines who will or will not become hypertensive.”
20. The incidence of hypertension is increased in people who smoke because smoking increases the risk of developing
a. atherosclerosis. p. 11: “Smoking increases the risk of developing atherosclerosis and atherosclerosis contributes to the development of hypertension.”
21. The incidence of retinopathy in hypertension patients may be skewed by the presence of
c. diabetes. pp. 17-18: “The incidence of retinopathy in patients who have hypertension has been reported to be as high as 66.3% to 80.3%, and the level of systolic blood pressure and the duration of hypertension are significant risk factors for developing retinal damage. The presence of diabetes in many hypertensive patients and the particular methods used to detect retinal damage may skew these figures but, even when these factors are considered, hypertensive retinopathy is still a problem of considerable magnitude.”
22. The high prevalence of hypertension in the elderly can be explained physiological factors that occur during aging such as
a. increased arterial stiffness. pp. 9-10: “The high prevalence of hypertension in the elderly can be explained by a diet high in sodium, obesity, and a sedentary lifestyle. Hypertension in this age group can also be explained by physiological factors that occur during aging such as increased arterial stiffness, decreased baroreceptor sensitivity, increased activity of the sympathetic nervous system, and a decreased ability of the kidneys to excrete sodium.”
23. Studies show that with the development of hypertension in
an individual, genetic
d. identification of those at risk is not feasible at this time. p. 9: “Genetic abnormalities have been identified in people who have hypertension but these have not been shown to be a primary cause of the disease and because environmental factors clearly contribute to the development of primary hypertension, genetic identification of those at risk is not feasible at this time and may not be.”
24. Hypertensive emergencies are a spectrum of clinical presentations that are usually characterized by
c. SBP > 220 mm Hg or a DBP > 120 mm Hg p. 7: “Hypertensive emergencies are a spectrum of clinical presentations that are usually characterized by a systolic blood pressure > 220 mm Hg or a diastolic blood pressure > 120 mm Hg.”
25. True or False: Until age 45 men are more likely than
women to have hypertension.
a. True p. 8: "Until age 45 men are more likely than women to have hypertension.”
26. Other factors that have been identified as possible independent contributors to the development of primary hypertension include(s)
b. Vitamin D deficiency. p. 12: “Other factors that may be risk factors for the development of primary hypertension are Vitamin D deficiency, dyslipidemia, low dietary intake of calcium and magnesium and fruits and vegetables, and psycho-social variables such as depression, occupational stress, personality type, sleep quality, and the individual’s level of isolation and social support.”
27. The incidence of retinopathy in patients who have hypertension has been reported to be
d. as high as 66.3% to 80.3%. pp. 17-18: “The incidence of retinopathy in patients who have hypertension has been reported to be as high as 66.3% to 80.3%, and the level of systolic blood pressure and the duration of hypertension are significant risk factors for developing retinal damage. The presence of diabetes in many hypertensive patients and the particular methods used to detect retinal damage may skew these figures but, even when these factors are considered, hypertensive retinopathy is still a problem of considerable magnitude.”
28. _________________________ is the most common form of hypertension in adults less than age 40.
a. Isolated diastolic blood pressure p. 18: “Isolated diastolic blood pressure primarily affects adults and young men who are obese, and it is the most common form of hypertension in adults less than age 40.”
c. reduced compliance and elasticity of large arteries. p. 18: “Isolated systolic hypertension is caused by reduced compliance and elasticity of large arteries, and it is quite common in the elderly.”
30. True or False: An alcohol consumption of more than 30
grams a day is associated with an increased risk for hypertension.
a. True p. 22: “The association between alcohol consumption and hypertension is strong and well established, and an alcohol consumption of more than 30 grams a day (a drink of alcohol is 14 grams - this is the amount of alcohol in 6 ounces of wine) is associated with an increased risk for hypertension.”
31. Common side effects of Angiotensin Converting Enzyme Inhibitors (ACEIs) include
d. All of the above p. 25: “Common side effects of the ACEIs include cough, hyperkalemia, hypersensitivity reactions, and skin rash.”
32. The Angiotensin II Receptor Blockers (ARBs) lower blood pressure by their effect on
a. the renin-angiotensin system. p. 25: “The ARBs lower blood pressure by their effect on the renin-angiotensin system.”
33. Common side effects of Angiotensin II Receptor Blockers (ARBs) include
c. dizziness. pp. 25-26: “The ARBs lower blood pressure by their effect on the renin-angiotensin system, …. Common side effects of these drugs include dizziness, headache, lightheadedness, and nasal congestion. Cough and angioedema are uncommon, unlike the ACEIs.”
34. The nurse should assess these patients to determine if
there is/are ________________________________ that increase(s) the risk for developing hypertension.
d. All of the above
p. 29: “The nurse should assess these patients to determine if there is a family history of hypertension and if the patient has lifestyle issues such as poor diet, obesity, sedentary lifestyle, or smoking that increase the risk for developing hypertension. If these or other risk factors are present, the nurse should provide the patient with information about such deleterious lifestyle choices and with the education, referrals, resources, and support needed to make needed changes, such as setting up an exercise program, making proper dietary changes, losing weight, and for smoking cessation.”
35. True or False: Beta-blockers must be used very cautiously in patients who have asthma, diabetes, or peripheral vascular disease.
a. True p. 26: “Beta-blocker side effects include bradycardia, bronchospasm, depression, dizziness, exercise intolerance, fatigue, hypotension, and sexual dysfunction. These drugs must be used very cautiously in patients who have asthma, diabetes, or peripheral vascular disease as they can cause bronchospasm, blunt the signs and symptoms of hypoglycemia, and aggravate and/or cause arterial insufficiency.”
The reference section of in-text citations includes published works
intended as helpful material for further reading. Unpublished works
and personal communications are not included in this section, although
may appear within the study text.
1. Basile J, Bloch MJ. Overview of hypertension in adults. UpToDate. March 2, 2016. Retrieved September 23, 2016 from http://www.uptodate.com/contents/overview-of-hypertension-in-adults.
2. Sutters M. Systemic hypertension. In: Papadakis MA, McPhee SJ, Rabow MW, eds. Current Medical Diagnosis & Treatment 2016. 55rd ed. New York, NY: McGraw-Hill Education; 2016. Online edition, retrieved September 23, 2016 from www.UCHC.edu.
3. Kaplan NM. Prehypertension. UpToDate. July 2, 2014. Retrieved September 19, 2014 from http://www.uptodate.com/contents/prehypertension?source=search_result&search=prehypertension&selectedTitle=1%7E29.
4. Kotchen TA. Hypertensive vascular disease. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison’s Principles of Internal Medicine. 19th ed. New York, NY: McGraw-Hill; 2015. Online edition, retrieved September 23, 2016 from www.UCHC.edu.
5. Mann JFE, Hilgers KF. Hypertension: Who should be treated? UpToDate. September 16, 2014. Retrieved September 19, 2014 from http://www.uptodate.com/contents/hypertension-who-should-be-treated?source=search_result&search=isolated+diastolic+hypertension&selectedTitle=1%7E4.
6. Cooper CM, Fenves AZ. Hypertensive urgencies and emergencies in the hospital setting. Hosp Pract (1995). 2016;44(1):21-27.
7. Taylor DA. Hypertensive crisis: A review of pathophysiology and treatment. Crit Care Nurs Clin North Am. 2015;27(4):439-447.
8. Natekar A, Olds RL, Lau MW, Min K, Imoto K, Slavin TP. Elevated blood pressure: Our family’s fault? The genetics of essential hypertension. World J Cardiol. 2014;26:327-337.
9. Syed Q, Messinger-Rapport. B Hypertension. In: Williams BA, Chang A, Ahalt C, Chen H, Conant R, Landefeld CS, Ritchie C,
Yukawa M, eds. Current Treatment & Diagnosis: Geriatrics, 2nd ed. New York, NY: McGraw-Hill; 2014.
10. Supiano MA. Hypertension. In: Halter JB, Ouslander JG, Tinetti ME, Studenski S, High KP, Asthana S, eds. Hazzard’s Geriatric Medicine and Gerontology. 6th ed. New York, NY: McGraw-Hill; 2009. Online edition, retrieved September 18, 2014 from www.UCHC.edu.
11. Kaplan NM. Hypertensive complications in blacks. UpToDate. January 2, 2014. Retrieved September 20, 2014 from http://www.uptodate.com/contents/hypertensive-complications-in-blacks?source=search_result&search=Hypertensive+complications+in+blacks&selectedTitle=1%7E150.
12. Lackland DT. Racial differences in hypertension: implications for high blood pressure management. Am J Med Sci. 2014;348(2):135-138.
13. Chandraa A, Neeland IJ, Berry jd, ET AL. The relationship of body mass and fat distribution with incident hypertension. J Am Coll Cardiol. 2014;64(10):997-1002.
14. Kokubo Y. Prevention of hypertension and cardiovascular diseases: A comparison of lifestyle factors in Westerners and East Asians. Hypertension. 2014;63:655-660.
15. Kaplan NM. Obesity and weight reduction in hypertension. UpToDate. June 30, 2014. Retrieved September 19, 2014 from http://www.uptodate.com/contents/obesity-and-weight-reduction-in-hypertension?source=search_result&search=Obesity+and+weight+reducton+in+hypertension&selectedTitle=1%7E150.
16. Yu-Jie W, Hui-Lang L, Lu, Z, Zhi-Geng J. Impact of smoking and smoking cessation on arterial stiffness in healthy participants. Angiology. 2013;64(4):273-280.
17. Kaplan NM. Smoking and hypertension. UpToDate. February 5, 2014. Retrieved September 19, 2014 from http://www.uptodate.com/contents/smoking-and-hypertension?source=search_result&search=smoking+and+hypertension&selectedTitle=1%7E150.
18. Mostofsky E, Mukamal KJ, Giovannucci EL, Stampfer MJ, Rimm EB. Key findings on alcohol consumption and a variety of health outcomes from the nurses' health study. Am J Public Health. 2016;106(9):1586-1591.
19. Tangney CC, Rosenson RS. Cardiovascular benefits and risks of moderate alcohol consumption. UpToDate. July 8, 2015.
20. Lawlor DA, Nordestgaard BG, Benn M, Zuccolo L, Tybjaerg-Hansen A, Davey Smith G. Exploring causal associations
between alcohol and coronary heart disease risk factors: findings from a Mendelian randomization study in the Copenhagen General Population Study. Eur Heart J. 2013; 34(32):2519-2528.
21. Sharman JE, La Gerche A, Coombes JS. Exercise and cardiovascular risk in patients with hypertension. Am J Hypertens. 2015;28(2):147-158.
22. Christofaro DG, De Andrade SM, Cardoso JR, Mesas AE, Codogno JS, Fernandes RA. High blood pressure and sedentary behavior in adolescents are associated even after controlling for confounding factors. Blood Press. 2015;24(5):317-323.
23. Leyvraz M, Taffé P, Chatelan A, et al. Sodium intake and blood pressure in children and adolescents: protocol for a systematic review and meta-analysis. BMJ Open. 2016 Sep 21;6(9):e012518. doi: 10.1136/bmjopen-2016-012518.
24. He FJ, Li J, Macgregor GA. Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials. BMJ. 2013 Apr 3;346:f1325. doi: 10.1136/bmj.f1325.
25. Van Ballegooijen A, Van Schoor N, Brouwer I, Visser M, Beulens J. OS 06-09 THE Synergistic association between vitamin D and vvitamin K with incident hypertension. J Hypertens. 2016;34 Suppl 1:e64
26. Tamez H, Kalim S, Thadhani RI. Does vitamin D modulate blood pressure? Curr Opin Nephrol Hypertens. 2013;22(2):204-209.
27. Vimaleswaran KS, Cavadino A, Berry DJ, et al. Association of vitamin D status with arterial blood pressure and hypertension risk: a mendelian randomisation study. Lancet Diabetes Endocrinol. 2014;2(9):719-729.
28. Otsuka T, Takada H, Nishiyama Y, et al. Dyslipidemia and the risk of developing hypertension in a working-age male population. J Am Heart Assoc. 2016 Mar 25;5(3):e003053. doi: 10.1161/JAHA.115.003053.
29. Wu L, Sun D, He Y. Fruit and vegetables consumption and incident hypertension: dose-response meta-analysis of prospective cohort studies. J Hum Hypertens. 2016;30(10):573-580.
30. Cuffee Y, Ogedegbe C, Williams NJ, Ogedegbe G, Schoenthaler A. Psychosocial risk factors for hypertension: an update of the literature. Curr Hypertens Report. 2014; 16:483. doi: 10.1007/s11906-014-0483-3.
31. Zambrana RE, López L, Dinwiddie GY, et al. Association of baseline depressive symptoms with prevalent and incident pre-hypertension and hypertension in postmenopausal Hispanic
women: Results from the Women's Health Initiative. PLoS One. 2016 Apr 28;11(4):e0152765. doi: 10.1371/journal.pone.0152765. eCollection 2016.
32. Jackson CA, Pathirana T, Gardiner PA. Depression, anxiety and risk of hypertension in mid-aged women: a prospective longitudinal study. J Hypertens. 2016;34(10):1959-1566.
33. Lin CL, Liu TC, Lin FH, Chung CH, Chien WC. Association between sleep disorders and hypertension in Taiwan: a nationwide population-based retrospective cohort study. J Hum Hypertens. 2016 Aug 11. doi: 10.1038/jhh.2016.55. [Epub ahead of print]
34. Siu AL; U.S. Preventive Services Task Force. Screening for high blood pressure in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2015;163(10):778-786.
35. Kaplan NM, Thomas G, Pohl MA. Blood pressure measurement in the diagnosis and management of hypertension in adults. UpToDate. July 26, 2016. https://www.uptodate.com/contents/blood-pressure-measurement-in-the-diagnosis-and-management-of-hypertension-in-adults. Accessed September 25, 2016.
36. Piper MA, Evans CV, Burda BU, et al. Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2015;162(3):192-204.
37. Kang YY, Li Y, Huang QF, Song J, et al. Accuracy of home versus ambulatory blood pressure monitoring in the diagnosis of white-coat and masked hypertension. J Hypertens. 2015 Aug;33(8):1580-7. doi: 10.1097/HJH.0000000000000596.
38. Niiranen TJ, Johansson JK, Reunanen A, Jula AM. Optimal schedule for home blood pressure measurement based on prognostic data: the Finn-Home Study. Hypertension. 2011; 57(6):1081-1086.
39. Pickering TG, Hall JE, Appel LJ, et al. Recommendations for blood pressure measurement in humans and experimental animals: part 1: blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Circulation. 2005; 111(5):697-716.
40. Gupta P, Nagaraju SP, Gupta A, Mandya Chikkalingaiah KB. Prehypertension - time to act. Saudi J Kidney Dis Transpl. 2012; 23(2):223-233.
41. Sulayma Albarwani, Sultan Al-Siyabi, Musbah O Tanira. Prehypertension: Underlying pathology and therapeutic options. World J Cardiol. 2014; 26(8):728-743.
42. Huang Y, Cai X, Li Y, Su L, Mai W, Wang S, et al. Prehypertension and the risk of stroke: a meta-analysis. Neurology. 2014; 82:153-1161.
43. Rodriguez CJ, Swett K, Agarwal SK, Folsom AR, Fox ER, Loehr LR, et al. Systolic blood pressure levels among adults with hypertension and incident cardiovascular events: the Atherosclerosis Risk in Communities Study. JAMA Inter Med. 2014; 174(8):1252-1261.
44. Ogedebge G, Pickering TG. Epidemiology of hypertension. In: Fuster V, Walsh A, Harrington RA, eds. Hurst’s The Heart, 13th ed. New York, NY: McGraw-Hill; 2011. Online edition, retrieved September 26, 2016 from www.UCHC.edu.
45. Im TS, Chun EJ, Lee MS, Adla T, Kim JA, Choi SI. Grade-response relationship between blood pressure and severity of coronary atherosclerosis in asymptomatic adults: assessment with coronary CT angiography. Int J Cardiovasc Imaging. 2014 Dec;30 Suppl 2:105-12. doi: 10.1007/s10554-014-0522-9. Epub 2014 Sep 2.
46. Xie W, Liu J, Wang W, Wang M, Li Y, Sun J, et al. Five-year change in systolic blood pressure is independently associated with carotid atherosclerosis progression: a population-based cohort study. Hypertens Res. 2014;37(10):960-965.
47. Gorgui J, Gorshkov M, Khan N, Daskalopoulou SS. Hypertension as a risk factor for ischemic stroke in women. Can J Cardio. 2014; 30(7):774-782.
48. Carnethon MR, Evans NS, Church TS, et al. Joint associations of physical activity and aerobic fitness on the development of incident hypertension: coronary artery risk development in young adults. Hypertension. 2010;56(1):49-55.
49. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). High blood pressure and kidney disease. Retrieved September 22, 2014 from http://kidney.niddk.nih.gov/kudiseases/pubs/highblood/.
50. Bakalli A, Koçinaj D, Bakalli A, Krasniqi A. Relationship of hypertensive retinopathy to thoracic aortic atherosclerosis in patients with severe arterial hypertension. Clin Expl Hypertens. 2011; 33(2):89-94.
51. Erden S. Bicaki B. Hypertensive retinopathy. Incidence, risk factors, and co-morbidities. Clin Exp Hypertens. 2012;34(6):397-401.
52. Mann JFE, Hilgers KF. Hypertension: Who should be treated? UpToDate. September 16, 2014. Retrieved September 22, 2014 from http://www.uptodate.com/contents/hypertension-who-should-be-treated?source=search_result&search=Hypertension%3A+Who+should+be+treated%3F&selectedTitle=1%7E150.
53. Franklin SS, Pio JR, Wong ND, et al. Predictors of new-onset diastolic and systolic hypertension: the Framingham Heart Study. Circulation. 2005;111(9):1121-1127.
54. Staessen JA, Gasowski J, Wang JG, Thijs L, Den Hond E, Boissel JP, et al. Risks of untreated and treated isolated systolic hypertension in the elderly: meta-analysis of outcome trials. Lancet. 2000; 355(9207):865-872.
55. James PA, Oparil S, Carter BL, et al. 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). JAMA. 311;(5) (2014), pp. 507-520.
56. Millar PJ, Goodman JM. Exercise as medicine: Role in the management of primary hypertension. Appl Physiol Nutr Metab. 2014; 39(7):856-858.
57. Brook RRD, Appel LJ, Rubenfire M, Ogedegbe G, Bisognano JD, Elliot WJ, et al. Beyond medications and diet: alternative approaches to lowering blood pressure: a scientific statement from the American Heart Association. Hypertension. 2013; 61(6):1360-1383.
58. Eckell RH, Jakicic JM, Ard JD, Miller NH, Hubbard VS, Nonas CA, et al. 2013 AHA/ACC Guideline on Life Style Management to Reduce Cardiovascular Risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 129(25 Suppl 2):576-599.
59. Rossi AM, Moullec G, Lavoie KL, Gour-Provençal G, Bacon SL. The evolution of the Canadian Hypertension Education Program recommendation: The impact of resistance training on resting blood pressure in adults as an example. Can J Cardiol. 2013; 29(5):622-627.
60. Saneei P, Salehi-Abargouei A, Esmaillzadeh A, Azadbakht L. Influence of Dietary Approaches to Stop Hypertension (DASH) diet on blood pressure: A systematic review and meta-analysis on randomized controlled trials. Nutr Metabol Cardiovasc Dis. 2014;24(12):1253-1261.
61. Chiu S, Bergeron N, Williams PT, Bray GA, Sutherland B, Krauss RM. Comparison of the DASH (Dietary Approaches to Stop
Hypertension) diet and a higher-fat DASH diet on blood pressure and lipids and lipoproteins: a randomized controlled trial. Am J Clin Nutr. 2016;103(2):341-347.
62. Ho AK, Bartels CM, Thorpe CT, Pandhi N, Smith MA, Johnson HM. Achieving Weight Loss and Hypertension Control Among Obese Adults: A US Multidisciplinary Group Practice Observational Study. Am J Hypertens. 2016;29(8):984-991.
63. Poorolajal J, Hooshmand E, Bahrami M, Ameri P. How much excess weight loss can reduce the risk of hypertension? J Public Health (Oxf). 2016 Aug 13. [Epub ahead of print]
64. Oren S, Isakov I, Golzman B, et al. The influence of smoking cessation on hemodynamics and arterial compliance. Angiology. 2006;57(5):564-568.
65. Takeshi Takami T, Saito Y. Effects of smoking cessation on central blood pressure and arterial stiffness. Vasc Health Risk Manag. 2011; 7:633-638.
66. Oncken CA, White WB, Cooney JL, Van Kirk JR, Ahluwalia JS, Giacco S. Impact of smoking cessation on ambulatory blood pressure and heart rate in postmenopausal women. Am J Hypertens. 2001; 14(9 Pt 1):942-949.
67. Husain K, Ansari RA, Ferder L. Alcohol-induced hypertension: Mechanism and prevention. World J Cardiol. 2014;6(5):245-252.
68. Marchi KC Muniz JJ, Tirapelli CR. Hypertension and chronic ethanol consumption: What do we know after a century of study? World J Cardiol. 2014;6(5):283-294.
69. Eckell RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC Guideline on Life Style Management to Reduce Cardiovascular Risk: A report of the American College of Cardiology/American Heart Association Task Force. Circulation. 2014 129:576-599.
70. Posadzki P, Cramer H, Kuzdzal A, Lee MS, Ernst E. Yoga for hypertension: a systematic review of randomized clinical trials. Complement Ther Med. 2014; 22(3):511-522.
71. Cramer H, Haller H, Lauche R, Steckhan N, Michalsen A, Dobos G. A systematic review and meta-analysis of yoga for hypertension. Am J Hypertens. 2014; 27(9):1146-1151.
72. Blom K, Baker B, How M, Dai M, Irvine J, Abbey S, et al. Hypertension analysis of stress reduction using mindfulness meditation and yoga: results from the HARMONY randomized controlled trial. Am J Hypertens. 2014; 27(1):122-129.
73. Wang J, Xiong X, Liu W. Acupuncture for essential hypertension. Int J Cardiol. 2013; 169(5):317-326.
74. Li DZ, Zhou Y, Yang YN, Ma YT, Li XM, Yu J, et al. Acupuncture for ssential hypertension: a meta-analysis of randomized sham-
controlled clinical trials. Evid Based Complement Alt Med. 2014; 279478. doi: 10.1155/2014/279478. Ep2014 Mar 4.
75. Centers for Disease Control and Prevention. High blood pressure facts. February 19, 2015. Retrieved September 26, 2016 from http://www.cdc.gov/bloodpressure/facts.htm.
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