Who Are At Risk Of Blood Pressure ?
About 43 million Americans have high blood pressure. Less than half of these people are on medication, however, and,worse, only about half of this group have their blood pressure under good control with such agents. Older people are less likely to be treated adequately. The majority of people with high blood pressure have the mild type, but even this condition requires attention.
Age and Gender
Age is the major risk factor of hypertension. Blood pressure increases with age in both men and women, and in fact, the lifetime risk for hypertension is nearly 90%. More men than women have hypertension until age 55. After that the ratio reverses, and over time women gain on men and finally overtake them. In all, mortality rates from hypertension are higher in women than in men.
Ethnicity
Compared to Caucasians, they have 1.8 times the rate of fatal stroke, 1.5 times the risk for fatal heart disease, and 4.2 times the rates of end−stage kidney disease. In general, about 36% of African American men and women have hypertension; it may account for over 40% of all deaths in this group.
In fact, the prevalence of high blood pressure among African Americans is among the highest in the world. The rates of hypertension in Hispanic Americans, Caucasians, and Native Americans are about equivalent (ranging from 24% to 27%). (Individuals of Mexican descent, compared to Spanish descent, may have a lower risk.) The rate is much lower in Asian/ Pacific Islanders (9.7% in men and 8.4% in women). Of note, however, nearly three quarters of older Japanese American men are hypertensive.
A number of theories have addressed the reasons for this difference:
*Some studies have indicated that African Americans may have lower levels of nitric oxide and higher levels of a peptide called endothelin−1 (ET−1) than Caucasians. (Nitric oxide keeps blood vessels flexible and open and ET−1 narrows blood vessels.)
*African Americans have a higher risk for an impaired response to angiotensin (Ang II), which is a peptide important in regulating salt and water balances. (African Americans are more likely to be salt−sensitive than other groups.)
*Social and income disparities and dietary issues may explain many of the differences in blood pressure rates observed between ethnic groups. For example, while African Americans have a disproportionately high rate of hypertension, one study in rural African villages, where diets are rich in fish, reported only a 3% rate of high blood pressure among inhabitants. Another study reported that Caucasian as well as African Americans in the Southeast have a higher incidence of hypertension and stroke than people in other US regions. The Southeast also has a higher rate of obesity, stress, anxiety, and depression, and diets low in potassium and high in salt, all related to a lower socioeconomic level.
*In any case, hypertension appears to be dangerously undertreated in major minority groups Inadequately controlled hypertension is the major factor for the higher mortality rate from heart disease among African Americans.
Weight
Obesity. About one−third of patients with high blood pressure are overweight. Even moderately obese adults have double the risk of hypertension than people with normal weights. In fact, the increase in blood pressure in aging Americans may be due primarily to weight gain. (In other cultures old age does not necessarily coincide with weight gain or high blood pressure.) Children and adolescents who are obese are at greater risk for high blood pressure when they reach adulthood.
Thinness. Interestingly, thin people with hypertension are at higher risk for heart attacks and stroke than obese people with high blood pressure. Experts surmise that thin people with hypertension are likely to have conditions such as an enlarged heart or stiff arteries that cause the high blood pressure and also pose greater dangers to health.
Low Birth Weight. Low birth weight, particularly in girls, has been associated with high blood pressure in both childhood and adulthood. (One study suggested that breast−feeding these babies may help reduce this risk.) Another study reported high levels of stress hormones in babies with low birth weight, which could increase the risk for high blood pressure later on. Low birth weight is also associated with subsequent obesity, a major contributor to hypertension.
Diabetes
Up to 75% of cardiovascular problems in people with diabetes may be due to hypertension. There are strong biologic links between insulin resistance (with or without diabetes) and hypertension. And, it is not altogether clear which condition causes the other. Some experts believe angiotensin may be the common factor linking diabetes and high blood pressure. This natural chemical not only influences all aspects of blood pressure control but it also interferes with insulin’s normal metabolic signaling. Studies are now suggesting the people with diabetes need to control their blood pressure to 130/85 mm Hg or lower to protect the heart and help prevent other complications common to both diseases.
Lowering systolic pressure may be particularly important for diabetics.
Effects of Family
Spouses. Studies suggest that spouses of people with high blood pressure have a much higher risk for it as well. Such findings suggest that dietary and environmental factors play a role in this disease. Some evidence also indicates that higher risk in spouses may be due to the fact that many people mate with those who are similar to them.
Family History and Genetics. Some experts now believe that essential hypertension may be inherited in 30% to 60% of cases. According to one study, being a brother or sister of someone with premature coronary artery disease is a greater risk factor for hypertension than having a parent with the disease. A family history of heart disease is considered to be a major risk factor for high blood pressure in younger adults (under 65).
Emotional Factors
People who are anxious or depressed may have over twice the risk for high blood pressure than those without these problems.
Mental Stress. Recent evidence confirms the association between stress and hypertension (high blood pressure). In one 20−year study, for example, men who periodically measured highest on the stress scale were twice as likely to have high blood pressure as those with normal stress. The effects of stress on blood pressure in women were less clear. Job stress and lack of career success have been specifically linked to high blood pressure in both men and women.
Anxiety. Studies suggest that anxiety is risk factor for hypertension, particularly in women.
Depression. There is increasing evidence that depression has actual physiological effects that impair the heart, as well as contributing to destructive behaviors, such as weight gain, smoking, or alcohol abuse. In a 2000 study of young African Americans and Caucasians, those who scored highest on a depression test had about twice the risk of high blood pressure as those with the lowest score. This link was particularly strong in African Americans. In fact, depression was the strongest risk factor in this group.
Seasonal Factors
Seasonal changes may influence variations in blood pressure, with hypertension increasing during cold months and declining during the summer, particularly in smokers. While cold may narrow blood vessels, lack of light has also been associated with higher blood pressure.
Very useful information . Thanks for sharing. Many people have similar situations in their lives.