Essential (primary) hypertension and hypertensive renal disease (hypertension)
                                                    # 13. cause of death in 2005

In 2008, doctors admit, in many cases they still do not know what causes high blood pressure. That
was also the case 80 years ago.

" the term essential (primary ) hypertension is used to include all chronic hypertension of unknown etiology. Although
this is probably not a homogeneous group, most of the cases are similar clinically and pathologically. They are all
characterized by (I) a persistent systolic blood pressure of I50 mn. or more, and (2) a definite left ventricular hypertrophy
not associated with any of the disease known to cause hypertrophy.The material consists of all the 1927 and 1928
Boston City Hospital autopsy cases which have a history of chronic high blood pressure. After exuding the cases of
secondary hypertension due to glomerulonephritis, toxemia of pregnancy, urinary obstruction, nephrosis and aortic
insufficiency, there remain fifty-one cases of primary hypertension."

"The series is subdivided according to the cause of death into (I) a cerebral group (apoplexy) of i6 cases, (2) a cardiac
group (myocardial insufficency and coronary disease) of I9 cases, (3) a renal group (uremia) of 14 cases, and (4) a
miscellaneous group (rupture of aorta and diabetes) of 2 cases."

Secondary hypertension
The other 5 to 10 percent of high blood pressure cases are caused by an underlying condition. This type of high blood
pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does
primary hypertension. Various conditions and medications can lead to secondary hypertension, including:
  • Kidney abnormalities
  • Tumors of the adrenal gland
  • Certain congenital heart defects
  • Certain medications, such as birth control pills, cold remedies, decongestants,
over-the-counter pain relievers and some prescription drugs
  • Illegal drugs, such as cocaine and amphetamines

Also see renal -- Kidney disease

Barium has the potential to cause the following effects from a lifetime exposure at levels above the
high blood pressure.

Hypertension. 1989 May;13(5 Suppl):I80-93.Links
Prognostic value of serum creatinine and effect of treatment of hypertension on renal function. Results
from the hypertension detection and follow-up program. The Hypertension Detection and Follow-up
Program Cooperative Group
.Shulman NB, Ford CE, Hall WD, Blaufox MD, Simon D, Langford HG, Schneider KA.
Emory University School of Medicine, Atlanta, Georgia.

The Hypertension Detection and Follow-up Program followed up 10,940 persons for 5 years in a community-based,
randomized, controlled trial of treatment for hypertension. Participants were randomized to one of two treatment groups,
stepped care and referred care. The primary end point of the study was all-cause mortality, with morbid events involving
the heart, brain, and kidney as secondary end points. Loss of renal function, ascertained by a change in serum
creatinine, was among these secondary events. Baseline serum creatinine concentration had a significant prognostic
value for 8-year mortality. For persons with a serum creatinine concentration greater than or equal to 1.7 mg/dl, 8-year
mortality was more than three times that of all other participants. The estimated 5-year incidence of substantial decline
in renal function was 21.7/1,000 in the stepped-care group and 24.6/1,000 in the referred-care group. Among persons
with a baseline serum creatinine level between 1.5 and 1.7 mg/dl, the 5-year incidence of decline was 113.3/1,000
(stepped care) and 226.6/1,000 (referred care) (p less than 0.01). The incidence of decline in renal function was
greater in men, blacks, and older adults, as well as in those with higher entry diastolic blood pressure. Among persons
with a baseline serum creatinine level greater than or equal to 1.7 mg/dl, serum creatinine concentration declined by
25% or more in 28.6% of stepped-care and 25.2% of referred-care participants. Although the incidence of clinically
significant hypercreatininemia in a hypertensive population is low, an elevated serum creatinine concentration is a very
potent independent risk factor for mortality. The slightly lower rate of development of hypercreatininemia and the higher
rate of improvement in stepped-care compared with referred-care participants is consistent with the belief that
aggressive treatment of hypertension may reduce renal damage and the associated increased risk of death.

PMID: 2490833 [PubMed - indexed for MEDLINE]

(Hypertension. 2004;44:398.)
© 2004 American Heart Association, Inc.   --------------------------------------------------------------------------------   
Scientific Contributions    
The Burden of Adult Hypertension in the United States 1999 to 2000  A Rising Tide  
Larry E. Fields; Vicki L. Burt; Jeffery A. Cutler; Jeffrey Hughes; Edward J. Roccella; Paul Sorlie   From the Office of the
Secretary’s Office of Public Health and Science (L.E.F.), U.S. Department of Health and Human Services, Washington,
DC; the Cardiovascular Division (L.E.F.), Department of Medicine, Washington University School of Medicine, St. Louis,
Mo; National Center for Health Statistics (V.L.B.), Centers for Disease Control and Prevention, US Department of Health
and Human Services, Hyattsville, Md; National Heart, Lung, and Blood Institute (J.A.C., E.J.R., P.S.), National Institutes
of Health, US Department of Health and Human Services, Bethesda, Md; and The Orkand Corporation (J.H.), Falls
Church, Va.    Correspondence to Larry E. Fields, MD, MBA, FACC, Senior Executive Advisor to the Assistant Secretary
for Health, US Department of Health and Human Services, 200 Independence Avenue, Washington, DC 20201. E-mail  

This study aims to estimate the absolute number of persons with hypertension (the hypertension burden) and time
trends using data from the National Health and Nutrition Examination Survey of United States resident adults who had
hypertension in 1999 to 2000. This information is vitally important for health policy, medical care, and public health
strategy and resource allocation. At least 65 million adults had hypertension in 1999 to 2000. The total hypertension
prevalence rate was 31.3%. This value represents adults with elevated systolic or diastolic blood pressure, or using
antihypertensive medications (rate of 28.4%; standard error [SE], 1.1), and adults who otherwise by medical history
were told at least twice by a physician or other health professional that they had high blood pressure (rate of 2.9%; SE,
0.4). The number of adults with hypertension increased by 30% for 1999 to 2000 compared with at least 50 million for
1988 to 1994. The 50 million value was based on a rate of 23.4% for adults with elevated blood pressure or using
antihypertensive medications and 5.5% for adults classified as hypertensive by medical history alone (28.9% total; P<0.
001). The 30% increase in the total number of adults with hypertension was almost 4-times greater than the 8.3%
increase in total prevalence rate. These trends were associated with increased obesity and an aging and growing
population. Approximately 35 million women and 30 million men had hypertension. At least 48 million non-Hispanic white
adults,  9 million non-Hispanic black adults, 3 million Mexican American, and 5 million other adults had hypertension in
1999 to 2000.

(Hypertension. 1995;25:305-313.)
© 1995 American Heart Association, Inc.

Prevalence of Hypertension in the US Adult Population
Results From the Third National Health and Nutrition Examination Survey, 1988-1991
Vicki L. Burt; Paul Whelton; Edward J. Roccella; Clarice Brown; Jeffrey A. Cutler; Millicent Higgins; Michael J. Horan;
Darwin Labarthe

From the National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md (V.L.B.);
Johns Hopkins Medical Institutions, Baltimore, Md (P.W.); the National Heart, Lung, and Blood Institute, National
Institutes of Health, Bethesda, Md (E.J.R., C.B., J.A.C., M.H., M.J.H.); and the University of Texas, Houston Health
Science Center, School of Public Health (D.L.).

Correspondence to Vicki L. Burt, ScM, RN, Division of Health Examination Statistics, National Center for Health
Statistics, Centers for Disease Control and Prevention, 6525 Belcrest Rd, Room 1070, Hyattsville, MD 20782.

Abstract The purpose of this study was to estimate the current prevalence and distribution of hypertension and to
determine the status of hypertension awareness, treatment, and control in the US adult population. The study used a
cross-sectional survey of the civilian, noninstitutionalized population of the United States, including an in-home interview
and a clinic examination, each of which included measurement of blood pressure. Data for 9901 participants 18 years of
age and older from phase 1 of the third National Health and Nutrition Examination Survey, collected from 1988 through
1991, were used. Twenty-four percent of the US adult population representing 43 186 000 persons had hypertension.
The age-adjusted prevalence in the non-Hispanic black, non-Hispanic white, and Mexican American populations was
32.4%, 23.3%, and 22.6%, respectively. Overall, two thirds of the population with hypertension were aware of their
diagnosis (69%), and a majority were taking prescribed medication (53%). Only one third of Mexican Americans with
hypertension were being treated (35%), and only 14% achieved control in contrast to 25% and 24% of the non-Hispanic
black and non-Hispanic white populations with hypertension, respectively. Almost 13 million adults classified as being
normotensive reported being told on one or more occasions that they had hypertension; 51% of this group reported
current adherence to lifestyle changes to control their hypertension. Hypertension continues to be a common finding in
the general population. Awareness, treatment, and control of hypertension have improved substantially since the 1976-
1980 National Health and Nutrition Examination Survey but continue to be suboptimal, especially in Mexican Americans.
Consideration should be given to revision of the criteria for classification of hypertension to reflect the widespread use
of lifestyle modification for treatment of hypertension.

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