Stage II type of Hypertension

Hypertension is defined as systolic BP above 140 mm Hg or diastolic BP above 90 mm Hg. In Stage II type of Hypertension, the Systolic Pressure is greater than 160 mm Hg or the Diastolic Pressure greater than 100 mm Hg.

For this category of patients, High Blood Pressure Medication, a Diuretic and an ACE Inhibitor is recommended. The two drug formula works faster and keeps blood pressure in control.

In this category, other High Blood Pressure Medications include Beta Blockers, CCBs and Angiotensin II receptor blockers.

Patients with stage 2 hypertension should begin diet and lifestyle changes. Lifestyle changes are a first line weapon in the fight against high blood pressure.

Rather than making a single change, a combination of behavioral changes including losing weight eating heart-hearty foods, reducing sodium, and exercise more, yields the best result.
Stage II type of Hypertension

Stage I type of Hypertension

In Stage I type of Hypertension, there are no other major health problems. Stage 1 hypertension is defined as either a systolic blood pressure of 140 to 159 mm Hg or a diastolic blood pressure of 90 to 99 mm Hg.

Patients with stage 1 hypertension should begin diet and lifestyle changes and should receive one antihypertensive medication, usually a thiazide diuretic.

Consideration is made to give angiotensin converting enzyme inhibitor, angiotensin receptor blocker, beta blocker, calcium channel blocker or a combination of these of the individual is still not meeting the goal blood pressure.

All person classified with either stage 1 hypertension or stage 2 hypertension should be treated and have a therapeutic goal of achieving a BP of less than 140/90 mm Hg.
Stage I type of Hypertension

Isolated diastolic hypertension

Systolic blood pressure rises in a linear fashion with age, whereas diastolic pressure increases until the age of 50 then levels off and even begins to fall.

When hypertension is diagnosed in middle age, the most common blood pressure pattern is elevated diastolic pressure with systolic pressure being either normal or elevated (combined systolic/diastolic hypertension).

Isolated diastolic hypertension is more common in men and often associated with middle-age weight gain and the metabolic syndrome. It is also linked to a high heart rate and cardiac output suggesting high sympathetic nerve activity. It may account for up to 14% of hypertension in the elderly.

Isolated diastolic hypertension is thought to evolve primarily from normal or high-normal blood pressure. Follow up suggest that individuals with isolated diastolic hypertension later develop mixed systolic diastolic hypertension.

Isolated diastolic hypertension does not have any significant impact on the clinical sequelae of hypertension. Beyond the age of 60, a decrease in diastolic blood pressure and a wide pulse pressure have correlated with an increased cardiovascular risk.
Isolated diastolic hypertension

Diastolic blood pressure

The World Health Organization guidelines define hypertension as a blood pressure >140 mmHg and-or a diastolic blood pressure of >90 mmHg. Isolated systolic hypertension (blood pressure > 140 mmHg with a diastolic blood pressure < 90 mmHg) is even more common in older person.

Diastolic blood pressure is defined as the minimum pressure recorded during the cardiac cycle. It is recorded during diastole. Therefore, it is called diastolic pressure. It indicates the load against which heart has to work.

Diastolic blood pressure is the bottom reading. After the heart empties the blood from the ventricle, the aortic valve shuts to prevent blood from returning into the heart from the rest of body. The heart muscles then relax and the ventricle expands as blood fills it up from the left atrium, which has received it from the lungs.

Within the arteries, the blood pressure rapidly falls until it reaches its lowest point. The diastolic blood pressure reflects this lowest point of blood pressure. During this time the ventricles relax between contraction. Before pressure falls further, the ventricle contracts again and the blood pressure starts to rise back up to the systolic level.

As arteriosclerosis sets in there is a relative drop in diastolic blood pressure due to reduced arterial compliance.

Diastolic blood pressure 

Definition of Hypertension

Definition of Hypertension
The World Health Organization defined hypertension as: systolic blood pressure > or equal 160mmHg and/or diastolic blood pressure > or equal 95mmHg and border line hypertension as systolic <160 and diastolic pressure 90-94mmHg or systolic 141-159 and diastolic pressure < 90 mmHg. The remainder of the population was considered ‘normotensive’.

Such definitions however are arbitrary because of the continuous nature of the blood pressure distribution. For most cases of hypertension, no underlying clinical case is found on investigation i.e., so called ‘essential’ hypertension. Essential hypertension is type of disease not hitherto recognized in medicine in which the defect is one of degree not of kind, quantitative not qualitative. It is apparently difficult for doctors to understand because it is departure from the ordinary process of binary thought to which they are brought up.

Definitions of hypertension are essentially pragmatic. They may be used to characterize groups of individuals that may benefit from specific treatment regimens – no pharmacologic and pharmacologic. For example, the cut points for ‘hypertension’ may be chosen at the level of blood pressure for which evidence of a treatment benefit is supported by data from randomized controlled clinical trials, and benefits of treatment outweighs risk. However these criteria will exclude the large numbers of people at excess risk from their blood pressure levels, but who are at or below the threshold for therapeutic intervention.
Definition of Hypertension

Blood Pressure and Age Relationship

Blood Pressure and Age Relationship
In most westernized cultures blood pressure rises with age but this trend depends on gender, race and initial level of blood pressure, as well as on an individual’s genetic background and environmental.

Systolic and diastolic blood pressures are approximately 70 to 50 mmHg respectively at birth. Systolic blood pressure on average rises to 94 mmHg at the end of the 1st year, and diastolic blood pressure to 52mmHg. Blood pressure is then unchanged for the next 2-3 years but rises through out childhood and adolescence. Systolic blood pressure (1-2 mmHg) rises more rapidly than diastolic blood pressure so that pulse pressure slowly increases during childhood. Blood pressure in both sexes remains the same until teenage years when girl’s blood pressure rise more slowly than boy’s, so that by 18 years boys have a blood pressure 10mmHg systolic and 5 mmHg diastolic higher than girls.

During adulthood both systolic and diastolic blood pressure rise steadily, although systolic tends to increase more rapidly than diastolic. The age related rise in blood pressure in adults is slightly steeper for women so that by the 7th decade blood pressure in the two sexes is equal: beyond this age it is slightly higher than women. While some of this differential may be explained by selective survival of women with higher blood pressures, the longitudinal study indicates that the same difference is seen in individuals. Similar longitudinal studies indicate that the flattening and slight fall in diastolic blood pressure observed in the elderly is also genuine sequential change.
Blood Pressure and Age Relationship