failure.

[6] Even moderate elevation of arterial

Hypertension blood pressure leads to shortened life
expectancy. At severely high pressures, defined
From Wikipedia, the free encyclopedia as mean arterial pressures 50% or more above
Jump to: navigation, search average, a person can expect to live no more than
For other forms of hypertension, see Hypertension a few years unless appropriately treated.[7]
(disambiguation). Beginning at a systolic pressure (which is peak
pressure in the arteries, which occurs near the
Hypertension end of the cardiac cycle when the ventricles are
contracting) of 115 mmHg and diastolic pressure
Classification and external resources (which is minimum pressure in the arteries,
which occurs near the beginning of the cardiac
cycle when the ventricles are filled with blood)
of 75 mmHg (commonly written as
115/75 mmHg), cardiovascular disease (CVD)
risk doubles for each increment of 20/10 mmHg.
[8]

Contents
Automated arm blood pressure meter showing arterial [hide]
hypertension (shown a systolic blood pressure 158 mmHg,
• 1 Classification
diastolic blood pressure 99 mmHg and heart rate of 80 beats per • 2 Signs and symptoms
minute). • 3 Causes
o 3.1 Essential hypertension
ICD-9 401.x o 3.2 Secondary hypertension
OMIM 145500  3.2.1 Adrenal
 3.2.2 Kidney
DiseasesDB 6330  3.2.3 Medications
 3.2.4 Pregnancy
MedlinePlus 000468
 3.2.5 Sleep
eMedicine med/1106 ped/1097 emerg/267 disturbances
• 4 Pathophysiology
MeSH D006973 • 5 Diagnosis
o 5.1 Measuring blood pressure
Hypertension is a chronic medical condition in which o 5.2 Laboratory tests
the blood pressure is elevated. It is also referred to as • 6 Prevention
high blood pressure or shortened to HT, HTN or • 7 Treatment
HPN. The word "hypertension", by itself, normally o 7.1 Lifestyle modifications
refers to systemic, arterial hypertension.[1]
o 7.2 Biofeedback
o 7.3 Medications
Hypertension can be classified as either essential
 7.3.1 Choice of initial
(primary) or secondary. Essential or primary
medication
hypertension means that no medical cause can be found
• 8 Prognosis
to explain the raised blood pressure. It is common.
o 8.1 Complications
About 90-95% of hypertension is essential
hypertension.[2][3][4][5] Secondary hypertension indicates • 9 Epidemiology
that the high blood pressure is a result of (i.e., o 9.1 Children and adolescents
secondary to) another condition, such as kidney disease • 10 History
or tumours (adrenal adenoma or pheochromocytoma). • 11 Society and culture
o 11.1 Economics
Persistent hypertension is one of the risk factors for o 11.2 Awareness
strokes, heart attacks, heart failure and arterial • 12 References
aneurysm, and is a leading cause of chronic renal • 13 Further reading
 • 14 External links 200 and 230 mm Hg.[14] Exercise hypertension
may be regarded as a precursor to established
o 14.1 Major studies hypertension at rest.[13][14]

[edit] Classification [edit] Signs and symptoms

Mild to moderate essential hypertension is

usually asymptomatic.[15][16][17][18][19] Accelerated
hypertension is associated with headache,
The variation in pressure in the left ventricle (blue line) somnolence, confusion, visual disturbances, and
and the aorta (red line) over two cardiac cycles ("heart nausea and vomiting (hypertensive
beats"), showing the definitions of systolic and diastolic encephalopathy). Retinas are affected with
pressure. narrowing of arterial diameter to less than 50%
of venous diameter, copper or silver wire
appearance, exudates, hemorrhages, or
A recent classification recommends blood pressure
papilledema.[20] Some signs and symptoms are
criteria for defining normal blood pressure,
especially important in infants and neonates such
prehypertension, hypertension (stages I and II), and
as failure to thrive, seizure, irritability or
isolated systolic hypertension, which is a common
lethargy, and respiratory distress.[21] While in
occurrence among the elderly. These readings are based
children hypertension may cause headache,
on the average of seated blood pressure readings that
fatigue, blurred vision, epistaxis, and bell palsy.
were properly measured during 2 or more office visits. [21]
In individuals older than 50 years, hypertension is
considered to be present when a person's blood pressure
is consistently at least 140 mmHg systolic or 90 mmHg
diastolic. Patients with blood pressures over
130/80 mmHg along with Type 1 or Type 2 diabetes, or
kidney disease require further treatment.[8]

Systolic Diastolic
pressure pressure
Classification Image showing patient with growth hormone
kPa kPa
mmHg mmHg excess
(kN/m2) (kN/m2)
Normal 90–119 12–15.9 60–79 8.0–10.5 Some signs and symptoms are especially
Prehypertensio 120– 16.0– 10.7– important in suggesting a secondary medical
80–89
n 139 18.5 11.9 cause of chronic hypertension, such as
140– 18.7– 12.0– centripetal obesity, "buffalo hump," and/or wide
Stage 1 90–99 purple abdominal striae and maybe a recent onset
159 21.2 13.2
of diabetes suggest glucocorticoid excess either
Stage 2 ≥160 ≥21.3 ≥100 ≥13.3 due to Cushing's syndrome or other causes.
Isolated systolic Hypertension due to other secondary endocrine
≥140 ≥18.7 <90 <12.0
hypertension diseases such as hyperthyroidism,
Source: American Heart Association (2003).[8] hypothyroidism, or growth hormone excess show
symptoms specific to these disease such as in
hyperthyrodism there may be weight loss,
Resistant hypertension is defined as the failure to tremor, tachycardia or atrial arrhythmia, palmar
reduce blood pressure to the appropriate level after erythema and sweating.[22] Signs and symptoms
taking a three-drug regimen (include thiazide diuretic). associated with growth hormone excess such as
[8]
Guidelines for treating resistant hypertension have coarsening of facial features, prognathism,
been published in the UK,[9] and US.[10] macroglossia,[23] hypertrichosis,
hyperpigmentation, and hyperhidrosis may occur
Excessive elevation in blood pressure during exercise is in these patients.[24]:499. Other endocrine causes
called exercise hypertension.[11][12][13] The upper normal such as hyperaldosteronism may cause less
systolic values during exercise reach levels between specific symptoms such as numbness, polyuria,
polydipsia, hypernatraemia, and metabolic alkalosis.[25]
A systolic bruit heard over the abdomen or in the flanks
suggests renal artery stenosis. Also radiofemoral delay
or diminished pulses in lower versus upper extremities
suggests coarctation of the aorta. Hypertension in
patients with pheochromocytomas is usually sustained
but may be episodic. The typical attack lasts from
minutes to hours and is associated with headache,
anxiety, palpitation, profuse perspiration, pallor, tremor,
and nausea and vomiting. Blood pressure is markedly
elevated, and angina or acute pulmonary edema may
occur. In primary aldosteronism, patients may have
muscular weakness, polyuria, and nocturia due to
hypokalemia. Chronic hypertension often leads to left
ventricular hypertrophy, which can present with
exertional and paroxysmal nocturnal dyspnea. Cerebral
involvement causes stroke due to thrombosis or
hemorrhage from microaneurysms of small penetrating
intracranial arteries. Hypertensive encephalopathy is
probably caused by acute capillary congestion and
exudation with cerebral edema, which is reversible.[20]
Signs and symptoms associated with pre-eclampsia and
eclampsia, can be proteinuria, edema, and hallmark of
eclampsia which is convulsions, Other cerebral signs
may precede the convulsion such as nausea, vomiting,
headaches, and blindness.[26]
[edit] Causes
[edit] Essential hypertension
Main article: Essential hypertension
Hypertension is one of the most common complex
disorders. The etiology of hypertension differs widely
amongst individuals within a large population.[27]
Essential hypertension is the form of hypertension that
by definition, has no identifiable cause. It is the more
common type and affects 90-95% of hypertensive
patients,[2][3][4][5] and even though there are no direct
causes, there are many risk factors such as sedentary
lifestyle,[28] obesity[29][30][31][32][33] (more than 85% of
cases occur in those with a body mass index greater
than 25),[33] salt (sodium) sensitivity,[34][35][36][37] alcohol
intake,[38][39] and vitamin D deficiency.[40][41][42] It is also
related to aging[43] and to some inherited genetic
mutations.[27][44][45][46][47][48] Family history increases the
risk of developing hypertension.[49][50] Renin elevation is
another risk factor, Renin is an enzyme secreted by the
juxtaglomerular apparatus of the kidney and linked with
aldosterone in a negative feedback loop.[30][51] Also
sympathetic overactivity is implicated.[32][52][53][54][55]
Insulin resistance which is a component of syndrome X,
or the metabolic syndrome is also thought to cause
hypertension.[30][52][56] Recently low birth weight has
been questioned as a risk factor for adult
essential hypertension.[31][57]
[edit] Secondary hypertension
Main article: Secondary hypertension
On the other hand, secondary hypertension by
definition results from an identifiable cause. This
type is important to recognize since its treated
differently than essential type by treating the
underlying cause.
Many secondary cause can cause hypertension,
some are common and well recognized
secondary causes such as Cushing's syndrome,[58]
which is a condition where both adrenal glands
can overproduce the hormone cortisol.
Hypertension results from the interplay of
several pathophysiological mechanisms
regulating plasma volume, peripheral vascular
resistance and cardiac output, all of which may
be increased. More than 80% of patients with
Cushing's syndrome have hypertension.[58]
Another important cause is the congenital
abnormality coarctation of the aorta.
[edit] Adrenal
A variety of adrenal cortical abnormalities can
cause hypertension, In primary aldosteronism
there is a clear relationship between the
aldosterone-induced sodium retention and the
hypertension.[59] Another related disorder that
causes hypertension is apparent
mineralocorticoid excess syndrome which is an
autosomal recessive disorder results from
mutations in gene encoding 11β-hydroxysteroid
dehydrogenase which normal patient inactivates
circulating cortisol to the less-active metabolite
cortisone.[60] Cortisol at high concentrations can
cross-react and activate the mineralocorticoid
receptor, leading to aldosterone-like effects in
the kidney, causing hypertension.[61] This effect
can also be produced by prolonged ingestion of
liquorice(which can be of potent strength in
liquorice candy), can result in inhibition of the
11β-hydroxysteroid dehydrogenase enzyme and
cause secondary apparent mineralocorticoid
excess syndrome.[62][63][64] Frequently, if liquorice
is the cause of the high blood pressure, a low
blood level of potassium will also be present.[63]
Yet another related disorder causing
hypertension is glucocorticoid remediable
aldosteronism, which is an autosomal dominant
disorder in which the increase in aldosterone secretion
produced by ACTH is no longer transient, causing of
primary hyperaldosteronism, the Gene mutated will
result in an aldosterone synthase that is ACTH-
sensitive, which is normally not.[65][66][67][68][69] GRA
appears to be the most common monogenic form of
human hypertension.[70] Compare these effects to those
seen in Conn's disease, an adrenocortical tumor which
causes excess release of aldosterone,[71] that leads to
hypertension.[72][73][74]
Another adrenal related cause is Cushing's syndrome
which is a disorder caused by high levels of cortisol.
Cortisol is a hormone secreted by the cortex of the
adrenal glands. Cushing's syndrome can be caused by
taking glucocorticoid drugs, or by tumors that produce
cortisol or adrenocorticotropic hormone (ACTH).[75]
More than 80% of patients with Cushing's syndrome
develop hypertension.[58], which is accompanied by
distinct symptoms of the syndrome, such as central
obesity, buffalo hump, moon face, sweating, hirsutism
and anxiety.[76]
[edit] Kidney
Other well known causes include diseases of the
kidney. This includes diseases such as polycystic
kidney disease which is a cystic genetic disorder of the
kidneys, PKD is characterized by the presence of
multiple cysts (hence, "polycystic") in both kidneys,
can also damage the liver, pancreas, and rarely, the
heart and brain.[77][78][79][80] It can be autosomal dominant
or autosomal recessive, with the autosomal dominant
form being more common and characterized by
progressive cyst development and bilaterally enlarged
kidneys with multiple cysts, with concurrent
development of hypertension, renal insufficiency and
renal pain.[81] Or chronic glomerulonephritis which is a
disease characterized by inflammation of the glomeruli,
or small blood vessels in the kidneys.[82][83][84]
Hypertension can also be produced by diseases of the
renal arteries supplying the kidney. This is known as
renovascular hypertension; it is thought that decreased
perfusion of renal tissue due to stenosis of a main or
branch renal artery activates the renin-angiotensin
system.[85][86][87] also some renal tumors can cause
hypertension. The differential diagnosis of a renal
tumor in a young patient with hypertension includes
Juxtaglomerular cell tumor, Wilms' tumor, and renal
cell carcinoma, all of which may produce renin.[88]
Neuroendocrine tumors are also a well known cause of
secondary hypertension. Pheochromocytoma[89] (most
often located in the adrenal medulla) increases secretion
of catecholamines such as epinephrine and
norepinephrine, causing excessive stimulation of
adrenergic receptors, which results in peripheral
vasoconstriction and cardiac stimulation. This
diagnosis is confirmed by demonstrating
increased urinary excretion of epinephrine and
norepinephrine and/or their metabolites
(vanillylmandelic acid).
[edit] Medications
Certain medications, especially NSAIDs
(Motrin/Ibuprofen) and steroids can cause
hypertension.[90][91][92][93][94] High blood pressure
that is associated with the sudden withdrawal of
various antihypertensive medications is called
Rebound Hypertension.[95][96][97][98][99][100][101] The
increases in blood pressure may result in blood
pressures greater than when the medication was
initiated. Depending on the severity of the
increase in blood pressure, rebound hypertension
may result in a hypertensive emergency.
Rebound hypertension is avoided by gradually
reducing the dose (also known as "dose
tapering"), thereby giving the body enough time
to adjust to reduction in dose. Medications
commonly associated with rebound hypertension
include centrally-acting antihypertensive agents,
such as clonidine[102] and beta-blockers.[101]
[edit] Pregnancy
Few women of childbearing age have high blood
pressure, up to 11% develop hypertension of
pregnancy.[103] While generally benign, it may
herald three complications of pregnancy: pre-
eclampsia, HELLP syndrome and eclampsia.
Follow-up and control with medication is
therefore often necessary.[104][105]
[edit] Sleep disturbances
Another common and under-recognized cause is
sleep apnea,[106][107] which is often best treated
with nocturnal nasal continuous positive airway
pressure, but other approaches include the
Mandibular advancement splint (MAS), UPPP,
tonsilectomy, adenoidectomy, septoplasty, or
weight loss. Another cause is an exceptionally
rare neurological disease called Binswanger's
disease, causing dementia; it is a rare form of
multi-infarct dementia, and is one of the
neurological syndromes associated with
hypertension.[108]
[edit] Pathophysiology
Main article: Pathophysiology of hypertension
A diagram explaining factors affecting arterial pressure
Most of the mechanisms associated with secondary
hypertension are generally fully understood. However,
those associated with essential (primary) hypertension
are far less understood. What is known is that cardiac
output is raised early in the disease course, with total
peripheral resistance (TPR) normal; over time cardiac
output drops to normal levels but TPR is increased.
Three theories have been proposed to explain this:
• Inability of the kidneys to excrete sodium,
resulting in natriuretic factors such as Atrial
Natriuretic Factor being secreted to promote
salt excretion with the side effect of raising
total peripheral resistance.
• An overactive Renin-angiotensin system leads
to vasoconstriction and retention of sodium
and water. The increase in blood volume leads
to hypertension.[109][110][111][112][113][114]
• An overactive sympathetic nervous system,
leading to increased stress responses.[115][116][117]
[118]
It is also known that hypertension is highly heritable
and polygenic (caused by more than one gene) and a
few candidate genes have been postulated in the
etiology of this condition.[119][120][121]
[edit] Diagnosis
Initial assessment of the hypertensive patient should
include a complete history and physical examination to
confirm a diagnosis of hypertension. Most patients with
hypertension have no specific symptoms referable to
their blood pressure elevation. Although popularly
considered a symptom of elevated arterial pressure,
headache generally occurs only in patients with severe
hypertension. Characteristically, a "hypertensive
headache" occurs in the morning and is localized to the
occipital region. Other nonspecific symptoms that may
be related to elevated blood pressure include
dizziness, palpitations, easy fatiguability, and
impotence.[21]
[edit] Measuring blood pressure
Main article: Blood pressure
Conventional (mechanical) sphygmomanometer
with aneroid manometer and stethoscope, used to
measure blood pressure
Diagnosis of hypertension is generally on the
basis of a persistently high blood pressure.
Usually this requires three separate
measurements at least one week apart.
Exceptionally, if the elevation is extreme, or end-
organ damage is present then the diagnosis may
be applied and treatment commenced
immediately.
Obtaining reliable blood pressure measurements
relies on following several rules and
understanding the many factors that influence
blood pressure reading.[122]
For instance, measurements in control of
hypertension should be at least 1 hour after
caffeine, 30 minutes after smoking or strenuous
exercise and without any stress. Cuff size is also
important. The bladder should encircle and cover
two-thirds of the length of the (upper) arm. The
patient should be sitting upright in a chair with
both feet flat on the floor for a minimum of five
minutes prior to taking a reading. The patient
should not be on any adrenergic stimulants, such
as those found in many cold medications.
When taking manual measurements, the person
taking the measurement should be careful to
inflate the cuff suitably above anticipated
systolic pressure. The person should inflate the
cuff to 200 mmHg and then slowly release the
air while palpating the radial pulse. After one
minute, the cuff should be reinflated to
30 mmHg higher than the pressure at which the
radial pulse was no longer palpable. A
stethoscope should be placed lightly over the
brachial artery. The cuff should be at the level of the
heart and the cuff should be deflated at a rate of 2 to
3 mmHg/s. Systolic pressure is the pressure reading at
the onset of the sounds described by Korotkoff (Phase
one). Diastolic pressure is then recorded as the pressure
at which the sounds disappear (K5) or sometimes the
K4 point, where the sound is abruptly muffled. Two
measurements should be made at least 5 minutes apart,
and, if there is a discrepancy of more than 5 mmHg, a
third reading should be done. The readings should then
be averaged. An initial measurement should include
both arms. In elderly patients who particularly when
treated may show orthostatic hypotension, measuring
lying sitting and standing BP may be useful. The BP
should at some time have been measured in each arm,
and the higher pressure arm preferred for subsequent
measurements.
BP varies with time of day, as may the effectiveness of
treatment, and archetypes used to record the data should
include the time taken. Analysis of this is rare at
present.
Automated machines are commonly used and reduce
the variability in manually collected readings.[123]
Routine measurements done in medical offices of
patients with known hypertension may incorrectly
diagnose 20% of patients with uncontrolled
hypertension.[124]
Home blood pressure monitoring can provide a
measurement of a person's blood pressure at different
times throughout the day and in different environments,
such as at home and at work.[125] Home monitoring may
assist in the diagnosis of high or low blood pressure. It
may also be used to monitor the effects of medication
or lifestyle changes taken to lower or regulate blood
pressure levels. Home monitoring of blood pressure can
also assist in the diagnosis of white coat hypertension.
The American Heart Association[126] states, "You may
have what's called 'white coat hypertension'; that means
your blood pressure goes up when you're at the doctor's
office. Monitoring at home will help you measure your
true blood pressure and can provide your doctor with a
log of blood pressure measurements over time. This is
helpful in diagnosing and preventing potential health
problems."
Some home blood pressure monitoring devices also
make use of blood pressure charting software. These
charting methods provide printouts for the patient's
physician and reminders to take a blood pressure
reading. However, a simple and cheap way is simply to
manually record values with pen and paper, which can
then be inspected by a doctor.
Systolic hypertension is defined as an elevated
systolic blood pressure. If systolic blood pressure
is elevated with a normal diastolic blood
pressure, it is called isolated systolic
hypertension. Systolic hypertension may be due
to reduced compliance of the aorta with
increasing age.[127]
[edit] Laboratory tests
Once the diagnosis of hypertension has been
made it is important to attempt to exclude or
identify reversible (secondary) causes.
Secondary hypertension is more common in
preadolescent children, with most cases caused
by renal disease. Primary or essential
hypertension is more common in adolescents and
has multiple risk factors, including obesity and a
family history of hypertension.[49] Tests are
undertaken to identify possible causes of
secondary hypertension, and seek evidence for
end-organ damage to the heart itself or the eyes
(retina) and kidneys. Diabetes and raised
cholesterol levels being additional risk factors
for the development of cardiovascular disease
are also tested for as they will also require
management.[2] Tests done are classified as
follows:
System Tests
Microscopic urinalysis, proteinuria,
Renal serum BUN (blood urea nitrogen)
and/or creatinine
Serum sodium, potassium, calcium,
Endocrine
TSH (thyroid-stimulating hormone).
Fasting blood glucose, total
Metabolic cholesterol, HDL and LDL cholesterol,
triglycerides
Hematocrit, electrocardiogram, and
Other
Chest X-ray
Sources: Harrison's principles of internal
medicine[50] others[128][129][130][131][132][133]
Creatinine (renal function) testing is done to
identify both the underlying renal disease as a
cause of hypertension and, conversely,
hypertension causing the onset of kidney
damage. It is a baseline for monitoring the
possible side-effects of certain antihypertensive
drugs later. Glucose testing is done to identify
diabetes mellitus. Additionally, testing of urine
samples for proteinuria detection is used to pick
up an underlying kidney disease or evidence of diet (dietary approaches to stop
hypertensive renal damage. Electrocardiogram hypertension), which is rich in fruits
(EKG/ECG) testing is done to check for evidence of the and vegetables and low-fat or fat-free
heart being under strain from working against a high dairy foods. This diet has been shown to
blood pressure. It may also show a resulting thickening be effective based on research
of the heart muscle (left ventricular hypertrophy) or of sponsored by the National Heart, Lung,
the occurrence of a previously silent cardiac disease and Blood Institute.[137] In addition, an
(either a subtle electrical conduction disruption or even increase in daily calcium intake has the
a myocardial infarction). A chest X-ray might be used benefit of increasing dietary potassium,
to observe signs of cardiac enlargement or evidence of which theoretically can offset the effect
cardiac failure. of sodium and act on the kidney to
decrease blood pressure. This has also
[edit] Prevention been shown to be highly effective in
reducing blood pressure.
The degree to which hypertension can be prevented • Discontinuing tobacco use and alcohol
depends on a number of features including: current consumption has been shown to lower
blood pressure level, changes in end/target organs blood pressure. The exact mechanisms
(retina, kidney, heart - among others), risk factors for are not fully understood, but blood
cardiovascular diseases and the age at presentation. pressure (especially systolic) always
Unless the presenting patient has very severe transiently increases following alcohol
hypertension, there should be a relatively prolonged or nicotine consumption. Besides,
assessment period within which repeated measurements abstention from cigarette smoking is
of blood pressure should be taken. Following this, important for people with hypertension
lifestyle advice and non-pharmacological options because it reduces the risk of many
should be offered to the patient, before any initiation of dangerous outcomes of hypertension,
drug therapy. such as stroke and heart attack. Note
that coffee drinking (caffeine ingestion)
also increases blood pressure transiently
The process of managing hypertension according the
but does not produce chronic
guidelines of the British Hypertension Society suggest
hypertension.
that non-pharmacological options should be explored in
• Reducing stress, for example with
all patients who are hypertensive or pre-hypertensive.
relaxation therapy, such as meditation
These measures include;
and other mindbody relaxation
techniques,[138] by reducing
• Weight reduction and regular aerobic exercise environmental stress such as high sound
(e.g., walking) are recommended as the first levels and over-illumination can be an
steps in treating mild to moderate additional method of ameliorating
hypertension. Regular exercise improves blood hypertension. Jacobson's Progressive
flow and helps to reduce resting heart rate and Muscle Relaxation and biofeedback are
blood pressure.[134] Several studies indicate that also used,[139] particularly, device-
low intensity exercise may be more effective guided paced breathing,[140][141] although
in lowering blood pressure than higher meta-analysis suggests it is not effective
intensity exercise.[135] These steps are highly unless combined with other relaxation
effective in reducing blood pressure, although techniques.[142]
drug therapy is still necessary for many
patients with moderate or severe hypertension
[edit] Treatment
to bring their blood pressure down to a safe
level.
[edit] Lifestyle modifications
• Reducing dietary sugar intake.
• Reducing sodium (salt) in the diet may be
Unless hypertension is severe, lifestyle changes
effective: It decreases blood pressure in about
such as those discussed in the preceding section
33% of people (see above). Many people use a
are strongly recommended before initiation of
salt substitute to reduce their salt intake.[136]
drug therapy. Adoption of the DASH diet is one
• Additional dietary changes beneficial to
example of lifestyle change repeatedly shown to
reducing blood pressure includes the DASH
effectively lower mildly-elevated blood pressure.
If hypertension is high enough to justify immediate use There are many classes of medications for
of medications, lifestyle changes are initiated treating hypertension, together called
concomitantly. antihypertensives, which — by varying means
— act by lowering blood pressure. Evidence
A series of UK guidelines advocate treatment initiation suggests that reduction of the blood pressure by
thresholds and desirable targets to be reached as set out 5–6 mmHg can decrease the risk of stroke by
in the following table. Of particular note is that for 40%, of coronary heart disease by 15–20%, and
patients with blood pressures between 140-159/80-99 reduces the likelihood of dementia, heart failure,
and without additional factors, that only lifestyle and mortality from vascular disease.
actions and regular blood pressure and risk-factor
review is proposed. The aim of treatment should be blood pressure
control to <140/90 mmHg for most patients, and
UK Hypertension guidelines[9] lower in certain contexts such as diabetes or
Thresholds kidney disease (some medical professionals
Target of recommend keeping levels below
for starting Group
treatment 120/80 mmHg).[147] Each added drug may reduce
treatment
the systolic blood pressure by 5–10 mmHg, so
all those with such
>160/100 <140/90 often multiple drugs are often necessary to
persisting readings
[9]
achieve blood pressure control.
If also:
Cardiovascular risk
Commonly used drugs include the typical groups
>20% per 10 years
of:[9]
Or have established
cardiovascular disease
>140/90 <140/90 • ACE inhibitors such as captopril,
Or have evidence end
organ damage enalapril, fosinopril (Monopril),
Or chronic kidney lisinopril (Zestril), quinapril, ramipril
disease without high (Altace)
levels albuminuria[143] o Angiotensin II receptor
Type 2 Diabetes antagonists may be used where
>130/80 <130/80 ACE inhibitors are not
alone[144]
Type 1 Diabetes tolerated: eg, telmisartan
>135/85 <130/80 (Micardis, Pritor), irbesartan
alone[145]
(Avapro), losartan (Cozaar),
Type 1 Diabetes with
valsartan (Diovan),
microalbuminuria[145]
candesartan (Amias),
Or Type 2 Diabetes
>130/80 <130/80 olmesartan (Benicar, Olmetec)
with kidney, eye or
cerebrovascular • Calcium channel blockers such as
damage[146] nifedipine (Adalat)[148] amlodipine
(Norvasc), diltiazem, verapamil
chronic kidney disease
• Diuretics: eg, bendroflumethiazide,
>130/80 with high levels <125/75
chlortalidone, hydrochlorothiazide (also
albuminuria[143]
called HCTZ)
[edit] Biofeedback
Other additionally used groups include:
Biofeedback devices can be used alone or in
conjunction with lifestyle changes or medications to • Additional diuretics such a furosemide
monitor and possibly reduce hypertension. One or low-dosages of spironolactone
example is Resperate, a portable, battery-operated • Alpha blockers such as prazosin, or
personal therapeutic medical device, sold over the terazosin. Doxazosin has been shown to
counter (OTC) in the United States. increase risk of heart failure, and to be
less effective than a simple diuretic.[149]
[edit] Medications • Beta blockers such as atenolol,
labetalol, metoprolol (Lopressor,
Main article: Antihypertensive drugs
Toprol-XL), propranolol. Whilst once
 first line agents, now less directly used for this
in the United Kingdom due to the risk of
diabetes.[150]
• Direct renin inhibitors such as aliskiren
(Tekturna)
Finally several agents may be given simultaneously:
• Combination products (which usually contain
HCTZ and one other drug). The advantage of
fixed combinations resides in the fact that they
increase compliance with treatment by
reducing the number of pills taken by the
patients. A fixed combination of the ACE
inhibitor perindopril and the calcium channel
blocker amlodipine, recently been proved to be
very effective even in patients with additional
impaired glucose tolerance and in patients with
the metabolic syndrome.[151]
[edit] Choice of initial medication
Unless the blood pressure is severely elevated,
consensus guidelines call for medically-supervised
lifestyle changes and observation before recommending
initiation of drug therapy. All drug treatments have side
effects, and while the evidence of benefit at higher
blood pressures is overwhelming, drug trials to lower
moderately-elevated blood pressure have failed to
reduce overall death rates.
If lifestyle changes are ineffective or the presenting
blood pressure is critical, then drug therapy is initiated,
often requiring more than one agent to effectively lower
hypertension. Which type of many medications should
be used initially for hypertension has been the subject
of several large studies and various national guidelines.
The largest study, Antihypertensive and Lipid-
Lowering Treatment to Prevent Heart Attack Trial
(ALLHAT), concluded that thiazide-type diuretics are
better and cheaper than other major classes of drugs at
preventing cardiovascular disease, and should be
preferred as the starting drug. ALLHAT used the
thiazide diuretic chlorthalidone.[152] (ALLHAT showed
that doxazosin, an alpha-adrenergic receptor blocker,
had a higher incidence of heart failure events, and the
doxazosin arm of the study was stopped.)
A subsequent smaller study (ANBP2) did not show the
slight advantages in thiazide diuretic outcomes
observed in the ALLHAT study, and actually showed
slightly better outcomes for ACE-inhibitors in older
white male patients.[153]
Thiazide diuretics are effective, recommended as
the best first-line drug for hypertension by many
experts, and are much more affordable than other
therapies, yet they are not prescribed as often as
some newer drugs. Hydrochlorothiazide is
perhaps the safest and most inexpensive agent
commonly used in this class and is very
frequently combined with other agents in a
single pill. Doses in excess of 25 milligrams per
day of this agent incur an unacceptable risk of
low potassium or Hypokalemia. Patients with an
exaggerated hypokalemic response to a low dose
of a thiazide diuretic should be suspected to have
Hyperaldosteronism, a common cause of
secondary hypertension.
The consensus recommendations of thiazide
diuretics as first-line therapy for hypertension
stand against the backdrop that all blood pressure
treatments have side-effects. Potentially serious
side effects of the thiazide diuretics include
hypercholesterolemia, and impaired glucose
tolerance with consequent increased risk of
developing Diabetes mellitus type 2. The
thiazide diuretics also deplete circulating
potassium unless combined with a potassium-
sparing diuretic or supplemental potassium. On
this basis, the consensus recommendations to
prefer use of thiazides as first line treatment for
essential hypertension have been repeatedly and
strongly questioned.[154][155][156] However as the
Merck Manual of Geriatrics notes, "thiazide-type
diuretics are especially safe and effective in the
elderly."[157]
Current UK guidelines suggest starting patients
over the age of 55 years and all those of
African/Afrocaribbean ethnicity firstly on
calcium channel blockers or thiazide diuretics,
whilst younger patients of other ethnic groups
should be started on ACE-inhibitors.
Subsequently if dual therapy is required to use
ACE-inhibitor in combination with either a
calcium channel blocker or a (thiazide) diuretic.
Triple therapy is then of all three groups and
should the need arise then to add in a fourth
agent, to consider either a further diuretic (eg
spironolactone or furosemide), an alpha-blocker
or a beta-blocker.[9] Prior to the demotion of
beta-blockers as first line agents, the UK
sequence of combination therapy used the first
letter of the drug classes and was known as the
"ABCD rule".[9][158]
[edit] Prognosis

Diagram illustrating the main complications of
persistent high blood pressure.
It is based upon several factors including genetics,
dietary habits, and overall lifestyle choices. If an
individual conscious of their condition takes the
necessary preventive measures to lower their blood
pressure, they are more likely to have a much better
outcome than someone who does not.
[edit] Complications
Main article: Complications of hypertension
Hypertension is a risk factor for all clinical
manifestations of atherosclerosis since it is a risk factor
for atherosclerosis itself.[159][160][161][162][163] It is an
independent predisposing factor for heart failure,[110][164]
coronary artery disease,[165][166][167] stroke,[91] renal
disease,[168][169][170] and peripheral arterial disease.[171][172]
[173]
it is the most important risk factor for
cardiovascular morbidity and mortality, in
industrialized countries.[174] The risk is increased for:
• Cerebrovascular accident (CVAs or strokes)[91]
[166][175][176][177][178][179]
• Myocardial infarction (heart attack)[91][175][180]
• Hypertensive cardiomyopathy (heart failure
due to chronically high blood pressure)[180][181]
[182][183]
• Left ventricular hypertrophy - thickening of
the myocardium (muscle) of the left ventricle
of the heart.[59][166][184][185][186]
• Hypertensive retinopathy - damage to the
retina[187][188][189][190][191][192][193][194][195][196][197][198][199]
• Hypertensive nephropathy[175][200][201] - chronic
renal failure due to chronically high blood
pressure "benign nephrosclerosis".
• Hypertensive encephalopathy - confusion,
headahe, convulsion due to vasogenic edema
in brain due to high blood pressure.
[edit] Epidemiology
Graph showing, prevalence of awareness,
treatment and control of hypertension compared
between the four studies of NHANES[202]
It is estimated that nearly one billion people are
affected by hypertension worldwide, and this
figure is predicted to increase to 1.5 billion by
2025.[203] The level of blood pressure regarded as
deleterious has been revised down during years
of epidemiological studies. A widely quoted and
important series of such studies is the
Framingham Heart Study carried out in an
American town: Framingham, Massachusetts.[204]
The results from Framingham and of similar
work in Busselton, Western Australia have been
widely applied. To the extent that people are
similar this seems reasonable, but there are
known to be genetic variations in the most
effective drugs for particular sub-populations.
Recently (2004), the Framingham figures have
been found to overestimate risks for the UK
population considerably. The reasons are
unclear. Nevertheless the Framingham work has
been an important element of UK health policy.
Over 90-95% of adult hypertension is of the
essential hypertension type.[2][3][4][5] It is estimated
that 43 million people in the United States have
hypertension or are taking antihypertensive
medication, which is almost 24% of the adult
population.[205] This proportion changes with
race, being higher in blacks and lower in whites
and Mexican Americans ; second it changes with
age, because in industrialized countries systolic
BP rises throughout life, whereas diastolic BP
rises until age 55 to 60 years and thus the greater
increase in prevalence of hypertension among
the elderly is mainly due to systolic
hypertension; also geographic patterns, because
hypertension is more prevalent in the
southeastern United States; another important
one is gender, because hypertension is more
prevalent in men (though menopause tends to
abolish this difference); and finally
socioeconomic status, which is an indicator of
lifestyle attributes and is inversely related to the
prevalence, morbidity, and mortality rates of
hypertension.[2] A series of studies and surveys
conducted by National Health and Nutrition
Examination Survey (NHANES) between 1976 and
2004 to assess the trends in hypertension prevalence,
blood pressure distributions and mean levels, and
hypertension awareness, treatment, and control among
US adults, aged more than 18 years, showed that there
is an increasing pattern of awareness, control and
treatment of hypertension, and that prevalence of
hypertension is increasing reaching 28.9% as of 2004,
with the largest increases among non-Hispanic women.
[202][206]
For the secondary hypertension its known that primary
aldosteronism is the most frequent endocrine form of
secondary hypertension.[129] The incidence of exercise
hypertension is reported to range from 1 to 10% of the
total population.[14]
Hypertension often is part of the metabolic "syndrome
X" its co-occurring with other components of the
syndrome. The other components are, diabetes mellitus,
combined hyperlipidemia, and central obesity.[111][207][208]
[209]
This is especially occurring among women.[111] And
this co-occurrence will increase the risk of
cardiovascular disease and cardiovascular events.[209]
[edit] Children and adolescents
As with adults, blood pressure is a variable parameter in
children. It varies between individuals and within
individuals from day to day and at various times of the
day. And the population prevalence of high blood
pressure in the young is increasing.[210] The epidemic of
childhood obesity,[52] the risk of developing left
ventricular hypertrophy, and evidence of the early
development of atherosclerosis in children would make
the detection of and intervention in childhood
hypertension important to reduce long-term health
risks.[210] Most childhood hypertension, particularly in
preadolescents, is secondary to an underlying disorder.
Renal parenchymal disease is the most common (60 to
70%) cause of hypertension. Adolescents usually have
primary or essential hypertension, making up 85 to 95%
of cases.[211]
[edit] History
Some cite the writings of Sushruta in the 6th century
BC as being the first mention of symptoms like those of
hypertension.[212]
Our modern understanding of hypertension began with
the work of physician William Harvey (1578-1657). It
was then recognized as a disease a century later
by Richard Bright in (1789-1858). The first ever
elevated blood pressure in a patient without
kidney disease was reported by Frederick
Mahomed (1849-1884).[213]
[edit] Society and culture
[edit] Economics
The National Heart, Lung, and Blood Institute
(NHLBI) estimated in 2002 that hypertension
cost the United States $47.2 billion dollars.[214]
High blood pressure is the most common chronic
medical problem prompting visits to primary
health care providers, yet it is estimated that only
34% of the 50 million American adults with
hypertension have their blood pressure
controlled to a level of <140/90 mm Hg. Thus,
about two thirds of Americans with hypertension
are at increased risk for cardiovascular events.
The medical, economic, and human costs of
untreated and inadequately controlled high blood
pressure are enormous. Adequate management of
hypertension can be hampered by inadequacies
in the diagnosis, treatment, and/or control of
high blood pressure.[215] Health care providers
face many obstacles to achieving blood pressure
control among their patients, including a limited
ability to adequately lower blood pressure with
monotherapy and a typical reluctance to increase
therapy (either in dose or number of
medications) to achieve blood pressure goals.
Patients also face important challenges in
adhering to multidrug regimens and accepting
the need for therapeutic lifestyle changes.
Nonetheless, the achievement of blood pressure
goals is possible, and, most importantly,
lowering blood pressure significantly reduces
cardiovascular morbidity and mortality, as
proved in clinical trials[citation needed]. The medical
and human costs of treating preventable
conditions such as stroke, heart failure, and end-
stage renal disease can be reduced by
antihypertensive treatment[citation needed]. The
recurrent and chronic morbidities associated with
hypertension are costly to treat.
Pharmacotherapy for hypertension therefore
offers a substantial potential for cost savings.[216]
Recent studies proved that the use of angiotensin
receptor blockers for treatment of hypertension is
cost-saving and cost-effective treatment
compared with other conventional treatment.[217]
[218]
[edit] Awareness

The World Health Organization attributes hypertension,

or high blood pressure, as the leading cause of
cardiovascular mortality. The World Hypertension
League (WHL), an umbrella organization of 85 national
hypertension societies and leagues, recognized that
more than 50% of the hypertensive population
worldwide are unaware of their condition.[219] To
address this problem, the WHL initiated a global
awareness campaign on hypertension in 2005 and
dedicated May 17 of each year as World Hypertension
Day (WHD). Over the past three years, more national
societies have been engaging in WHD and have been
innovative in their activities to get the message to the
public. In 2007, there was record participation from 47
member countries of the WHL. During the week of
WHD, all these countries – in partnership with their
local governments, professional societies,
nongovernmental organizations and private industries –
promoted hypertension awareness among the public
through several media and public rallies. Using mass
media such as Internet and television, the message
reached more than 250 million people. As the
momentum picks up year after year, the WHL is
confident that almost all the estimated 1.5 billion
people affected by elevated blood pressure can be
reached.[220]

Deep Vein Thrombosis

An estimated 1 out of every 1,000 Americans
develops deep vein thrombosis each year.
This is a blood clot that forms in a vein deep
in the body. Deep vein thrombosis in the
thigh is more serious than in the lower leg,
because blood clots in the thigh are more
likely to travel to the lungs, which can lead
to serious complications
What Is Deep Vein Thrombosis?
A deep vein thrombosis (DVT) is a blood clot that forms
It is important that you see your healthcare
in a vein deep in the body. Most occur in the leg or hip
provider right away if you experience any possible
veins. However, a deep vein thrombosis also can occursymptoms.
in other parts of the body. Although blood clots are How Is It Diagnosed?
nature's way of trying to prevent bleeding, they canIn order to diagnose deep vein thrombosis, your
become dangerous when precautions are not taken.doctor will need to obtain your medical history and
perform a physical exam. He or she may also order
A blood clot that develops in a vein in the thigh is usually
certain tests to make a diagnosis.
more serious than one that develops in a vein in the
lower leg. Approximately 1 out of every 1,000 AmericansSome of the more common tests used in
develops this condition each year. diagnosing DVT include:

Possible Risk Factors

Many conditions can increase your risk for deep vein • Duplex ultrasound
thrombosis. Although some of these conditions alone can • Venography.
increase your risk, your chances for developing DVT
increases further when several risk factors are
combined. (Click Deep Vein Thrombosis Diagnosis for
more information about the tests used to diagnose
(Click DVT Risk Factors for more information.) the condition.)

Symptoms of Deep Vein Thrombosis
DVT symptoms vary, depending on the amount of blood
flow that is blocked in the legs by blood clots. Large are
may cause more noticeable symptoms, while smaller
clots may cause fewer symptoms or no symptoms at all.
In fact, only about half of the people with deep vein
thrombosis have symptoms.
Common symptoms may include:
• Swelling of the leg
Current Treatment for Deep Vein Thrombosis
The main goals for deep vein thrombosis treatment
clots
to:
• Stop the clot from getting bigger
• Stop the clot from breaking off in
your vein and moving to your lungs
• Decrease your chance of having
another deep vein thrombosis.

• Pain or tenderness in the leg (the painThe

is condition is usually treated with medication.
usually in one leg and may only be present DVT medications include:
when standing or walking)

• Feeling of increased warmth in the area of • Anticoagulants

the leg that is swollen or hurts • Thrombolytics
• Thrombin inhibitors.
• Red or discolored skin.
Other treatments include a vena cava filter or graduatedWhat Is Raynaud's Phenomenon?
compression stockings. Raynaud's phenomenon is a condition that affects
the blood vessels in the fingers, toes, ears, and
(Click DVT Treatments for more information.) nose. The most common form of Raynaud's
phenomenon, Raynaud's disease, is
Associated Complications characterized by episodic attacks, called
One complication of DVT is pulmonary embolism, which vasospastic attacks, that cause the blood vessels in
occurs when a blood clot in a vein breaks off, travelsthe digits (fingers and toes) to constrict (narrow).
through your bloodstream, and lodges in your lung. Raynaud's phenomenon can occur on its own, or it
Pulmonary embolism is a serious condition that can can be secondary to another condition, such as
cause death. Superficial venous thrombosis (phlebitis) scleroderma
is or lupus.
a blood clot in a vein that is close to the surface of the
skin. Blood clots in superficial veins cannot travel toHow
the Common Is It?
lungs. Although estimates vary, recent surveys show that
Raynaud's phenomenon may affect 5 to 10 percent
Another potential complication of DVT is postphlebiticof the general population in the United States.
syndrome, which is a permanent condition that is caused
Women are more likely than men to have the
by valves in the leg veins that do not work properly.disorder. Raynaud's phenomenon appears to be
Although the body has mechanisms within itself to more common in people who live in colder
dissolve clots, the process is slow. Throughout this climates. However, people with Raynaud's who live
process, an inflammatory reaction occurs that can scarin milder climates may have more attacks during
the veins, especially the valves. The valves then failperiods
to of colder weather.
prevent blood from flowing backwards, which allows the
blood to pool in the leg veins and cause pain, swelling,
Different Types of Raynaud's Phenomenon
and sometimes varicose veins and skin ulcerations. Doctors classify Raynaud's phenomenon as either:

Other Names for Deep Vein Thrombosis

Other names used for deep vein thrombosis include: • Primary Raynaud's phenomenon
• Secondary Raynaud's phenomenon.

• DVT
• Venous thrombosis
In medical literature, "primary Raynaud's
• Blood clot in the legs. phenomenon" may also be called Raynaud's
disease, idiopathic Raynaud's phenomenon, or
primary Raynaud's syndrome. The terms
Raynaud's Phenomenon "idiopathic" and "primary" both mean that the
Raynaud's phenomenon is a condition that is cause is unknown.
characterized by the contraction of blood vessels
in the extremities (fingers and toes). Raynaud's
Most people who have Raynaud's phenomenon
disease, the most common form of the disorder, haveis the primary form (the milder version).
defined by episodic attacks that cause small
What Causes It?
blood vessels to constrict. Although there is no
No one knows the exact cause of Raynaud's
cure for the condition, treatment typically focuses
on reducing the number and severity of attacks,phenomenon and why there is a sudden
as well as preventing tissue damage and loss.spasmodic contraction of the small blood vessels
when exposed to cold. Finding the cause or causes of
When making a Raynaud's phenomenon diagnosis,
this condition continues to be an active area of the doctor will first gather a detailed medical
Raynaud's research. history, which includes asking questions about a
person's:
What Triggers Raynaud's Phenomenon?
For most people, an attack is usually triggered by
exposure to cold or emotional stress. In general, attacks • General health
affect the fingers or toes, but may also affect the nose, • Symptoms
lips, or ear lobes. • Family medical history
• Alcohol consumption
Symptoms
During an attack, the symptoms of Raynaud's • Smoking
phenomenon are caused by reduced blood supply to the • Use of drugs or medications.
extremities.

Once the attack begins, a person may experience The doctor will also perform a complete physical
symptoms to the affected area that includes: exam to check for other signs of Raynaud's
phenomenon and recommend certain tests.

• Coldness Treatment for Raynaud's Phenomenon

• Changes in skin color At this point, there is no cure for Raynaud's
phenomenon. Therefore, the goals of Raynaud's
• Numbness
treatment are to reduce the number and severity
• Throbbing of attacks and to prevent tissue damage and loss in
• Tingling. the fingers and toes.

Most doctors are conservative with treatment

During an attack, symptoms can last from less than recommendations
a for this condition that is, they
minute to several hours. recommend non-drug treatments and self-help
measures first. Doctors may prescribe medications
for some patients, usually those with secondary
The period of exposure to the cold is extremely critical,
because it only takes about 20 to 30 minutes of Raynaud's phenomenon. In addition, patients are
exposure to the cold to cause potentially serious treated for any underlying disease or condition that
causes secondary Raynaud's phenomenon.
problems, such as tissue damage. This can lead to ulcers
on the fingertips and, if left untreated, even gangrene.
Bone damage may also ensue. (Click Raynaud's Self-Help Strategies for more
information on treatment methods that do not
Frequency of Raynaud's Phenomenon Attacks require medication.)
The frequency of attacks varies from patient to patient.
Some people get attacks as often as daily or severalOther Medical Conditions
times a week. While not a cause of Raynaud's phenomenon,
certain factors can increase the chances of
Making a Diagnosis developing secondary Raynaud's phenomenon.
Secondary Raynaud's phenomenon risk factors include
While spider veins are similar to varicose veins,
people with: they are smaller and closer to the surface of the
skin. These veins are often red or blue, and they
can look like tree branches or spider webs with
• Systemic lupus erythematosus (lupus)their short, jagged lines. Spider veins can be found
• Scleroderma on the legs and face. They can cover either a small
or large area of skin.
• Thyroid disease
• Rheumatoid arthritis About 50 to 55 percent of American women and 40
• Sjorgren's syndrome to 45 percent of American men suffer from some
• Mixed connective tissue disease form of vein problem (spider veins or varicose
veins).
• Peripheral vascular disease
• Atherosclerosis What Causes Spider Veins?
• Stroke The backing up of blood in the veins is the cause of
• Syringomyelia spider veins.

• Dermatomyositis
The heart pumps blood filled with oxygen and
• Polymyositis nutrients to the body. Arteries carry blood from the
• Diabetes heart toward the body parts. Veins carry oxygen-
• Carpal tunnel syndrome poor blood from the body back to the heart.

• Myeloproliferative disorder.
The squeezing of leg muscles pumps blood back to
the heart from the lower body. Veins have valves
that act as one-way flaps. These valves prevent the
Other Names for Raynaud's Phenomenon blood from flowing backwards as it moves up the
Other names for the condition include: legs. If the one-way valves become weak, blood
can leak back into the vein and collect there. This
problem is called venous insufficiency.
• Raynaud's disease
• Raynaud's syndrome Where Are They Located?
• Raynaud's The force of gravity, the pressure of body weight,
and the task of carrying blood from the bottom of
• Idiopathic Raynaud's phenomenon.
the body up to the heart make legs the primary
location for spider veins. Compared with other
Spider Veins veins in the body, leg veins have the toughest job
Spider veins are smaller and less severe than of carrying blood back to the heart and endure the
varicose veins. In addition, they do not generally
most pressure. This pressure can be stronger than
lead to serious health problems. Risk factors for
the veins' one-way valves.
spider veins include sun exposure, hormonal
changes, and standing for long periods of time.
Risk Factors for Spider Veins
They are often treated with sclerotherapy or laser
surgery, and most people experience success Riskwithfactors are things that increase the chances of
these methods. developing a health condition. The more risk
What Are Spider Veins? factors you have for a particular condition, the
greater your chances of developing it. Risk factors for
same things can help ease discomfort from the
spider veins include: spider veins you already have:

• Increasing age. • Wear sunscreen to protect your skin

from the sun and to limit spider veins on
the face.

• Having family members with vein

problems or being born with weak vein valves.
• Hormonal changes. These occur during
puberty, pregnancy, and menopause. Taking
birth control pills and other medicines
containing estrogen and progesterone also
increases the risk of varicose or spider veins.
• Exercise regularly to improve your
leg strength, circulation, and vein
strength. Focus on exercises that work
your legs, such as walking or running.
• Control your weight to avoid placing
too much pressure on your legs.

• Pregnancy. During pregnancy, there is a

huge increase in the amount of blood in the • Do not cross your legs when sitting.
body, which can cause veins to enlarge. The
expanding uterus also puts pressure on the
veins. Spider veins usually improve within three
months after delivery. A growing number of • Elevate your legs when resting as
abnormal veins usually appear with each much as possible.
additional pregnancy.

• Do not stand or sit for long periods of

• Obesity, leg injury, prolonged standing,
and other things that weaken vein valves.
• Sun exposure, which can cause spider
veins on the cheeks or nose of a fair-skinned
person.
time. If you must stand for a long time,
shift your weight from one leg to the
other every few minutes. If you must sit
for long periods of time, stand up and
move around or take a short walk every
30 minutes.

• Wear elastic support stockings, and

avoid tight clothing that constricts your
Preventing Spider Veins
waist, groin, or legs.
Not all spider veins can be prevented, but some things
can reduce your chances of getting new ones. These
 sclerotherapy, endovenous
techniques, or various surgeries.
• Most people experience good
Eat a low-salt diet rich in high-fiber foods.
results from treatment, although
High-fiber foods include fresh fruits and
some varicose veins will come
vegetables and whole grains, like bran. Eating
back.
too much salt can cause you to retain water or
What Are Varicose Veins?
swell.
Varicose veins are enlarged veins that
can be flesh-colored, dark purple, or
Diagnosis and Treatment
blue. They often look like cords, and
Your doctor can diagnose spider veins by looking at
appear twisted and bulging. They are
them. In addition to a physical exam, your doctor can
swollen and raised above the surface
take x-rays or ultrasound pictures of the vein to
of the skin. Varicose veins are
determine the cause and severity. You may want to
commonly found on the backs of the
speak with a doctor who specializes in vein diseases
calves or on the inside of the leg.
(phlebologist).
During pregnancy, varicose veins
called hemorrhoids can form in the
Talk to your doctor about what treatment options are
vagina or around the anus.
best for your spider veins and lifestyle. Not all cases are
the same.
About 50 to 55 percent of American
women and 40 to 45 percent of
If treatment is recommended or desired to get rid of
American men suffer from some form
spider veins, some available options include:
of vein problem. Varicose veins affect
1 out of 2 people age 50 and older.

• Sclerotherapy
What Causes Varicose Veins?
• Laser surgery. The cause of varicose veins is a
weakening of one-way valves within
the veins. When these valves weaken,
Recurrence of Spider Veins blood can leak back in the vein and
Current treatments for spider veins have high successcollect there and enlarge the vein.
rates. Over a period of years, however, more abnormal
veins can develop. There is no cure for weak vein valves,
Gravity and Varicose Veins
and over time, pressure gradually builds up in the leg
The force of gravity, the pressure of
veins. Ultrasound can be used to keep track of how body weight, and the task of carrying
badly the valves are leaking (venous insufficiency). blood from the bottom of the body up
Ongoing treatment can help keep this problem under to the heart make legs the primary
control. location for varicose and spider
Varicose Veins veins. Compared with other veins in
A common problem in people age 50 the body, leg veins have the toughest
and older, varicose veins are enlarged job of carrying blood back to the heart.
veins most commonly found on the They endure the most pressure. This
inside of the leg or on the backs of the pressure can be stronger than the
calves. Pregnant women may also have
veins' one-way valves.
them near the vagina or anus.
Treatment for may involve
What Are the Risk Factors?
While not causes of varicose veins, there
are a number of factors that increase a
person's chances for developing weakened
valves. These are known as risk factors. The
more risk factors a person has, the greater
their chances for developing the condition.
Risk factors for varicose veins include:
• Increasing age
• Genetics
• Hormonal changes
• Pregnancy
• Obesity
• Leg injury
Prolonged standing. Health Conditions
Related to Varicose Veins
Varicose veins usually enlarge and worsen
over time. In severe cases, they can cause
health problems. These include:
• Ongoing irritation,
swelling, and painful rashes
on the legs.
Prognosis
Current treatments for varicose veins
have high success rates compared to
traditional surgical treatments. Over a
period of years, however, more
varicose veins can develop. The major
reason for this is that there is no cure
for weak vein valves.
The single most important thing a
person can do to slow down the
development of new varicose veins is
to wear graduated compression
support stockings as much as possible
during the day.
Preventing Varicose Veins
Prevention of varicose veins begins by:

• Severe venous insufficiency.

This severe pooling of blood in the • Knowing the risk factors
veins slows the return of blood to and the ones that apply to
the heart. This condition can cause you (see Cause of Varicose
blood clots and severe infections. Veins)
Blood clots can be dangerous,
because they can move from leg
veins and travel to the lungs.
Blood clots in the lungs are life- • Making lifestyle changes
threatening, because they can to decrease your risk factors
keep the heart and lungs from
functioning properly.

• Sores or skin ulcers can occur

on skin tissue around varicose
veins.