Hypertension: Epidemiology, Classification and White Coat Hypertension

00:00 So, who is affected? It's a remarkably common disease, 1 in 4 adults is affected by hypertension. As I talk about, the risk increases with age and this probably has a lot to do with increasing rigidity or stiffness of the aorta. 65% of men and 75% of women will have hypertension by the time they're 70 years of age. And although I'm not quite there, I have hypertension. Fortunately, I'm treated so I feel fine. The rates are highest in African Americans and lowest in Asian Americans. If you're less than 45 years of age, the most common personnel with hypertension is a woman. After 45 years of age, the sex ratio becomes relatively equal. So, other risk factors, things that you can't do anything about. Positive family history, hypertension as you can imagine because of the small genetic polymorphisms tends to occur and reoccur in families. So a positive family history, ethnicities or I said African Americans, are more prone to hypertension versus Asian Americans. And advancing age can't do a darn thing about any of those. Things that you can affect are obesity, diabetes, smoking, excessive alcohol or caffeine intake, high sodium intake, low potassium intake, physical inactivity, psychological stress. So all these things you can potentially impact. And in event that's not effective, then you can always take antihypertensive meds. So, what is hypertension. We've been talking about it. Now for about 30 minutes, what is it? Oh my gosh. Okay, so a normal blood pressure is considered to be a systolic blood pressure less than 120 mmHg and a diastolic blood pressure less than 80 mmHg. So that's kind of normal. This is a little bit of a moving target and in some current formulations 110/70 is considered to be normal blood pressure or upper limits of normal. Elevated, for the most part, is somewhere between 120 to 180 mmHg systole and 80-120 mmHg diastole. And then hypertensive crisis where you need to do something immediately you're going to suffer a stroke. That's blood pressures in excess of 180 mmHg systolic and excess of 120 mmHg diastolic. There is an entity probably related to stress and anxiety that is at a factitious form of hypertension so called white coat hypertension. It's seen in the clinical setting. So you go to see your doctor, they show up with a stethoscope and white coat and you get a little anxious and your blood pressure goes up. It's a normal response but it may be an artifactually high blood pressure caused by anxiety. So what do you do if you suspected that's the case? Well, you can do blood pressure measurements several minutes apart theoretically after the people have calm down, you can do it on several different visits. In fact, you should not make a diagnosis of hypertension on your first visit. You need to see it recurrently over time.

03:18 You can have ambulatory blood pressure monitoring or you can have the patient just periodically take the blood pressure themselves. The machines, the sphygmomanometers that can do this are reasonably cheap and most motivated patients will be only too happy to take their blood pressure at home.