High blood pressure damages blood vessels

Blood pressure is the force exerted by circulating blood in blood vessels. Raised blood pressure causes damage to the inside walls of arterial blood vessels and leads to hardening of the arterial walls. High blood pressure is medically termed as hypertension. Hypertension is usually defined as blood pressure exceeding a certain threshold. Two main types of hypertension can be distinguished. In a large majority of cases (95%), no underlying medical cause of hypertension can be identified and essential hypertension is diagnosed. A small minority of cases is secondary to other medical conditions.

The prevalence of high blood pressure in Europe is generally high with substantial differences between countries

Hypertension is a very common condition, particularly in industrialised societies. The prevalence of hypertension among adults aged 35-74 years is estimated to range from about 30 to 60% in European countries. At age 65-74 years, 50 to 80% of the general population in European and North American countries exhibit hypertension. Generally, there is a north-south and east-west gradient in mean population blood pressure with higher levels in northern and eastern European countries. Mean population blood pressure decreased in most European countries over the last two decades but ageing of the population and the increasing prevalence of obesity may stop this trend. Awareness of the condition among individuals with high blood pressure has been shown to be relatively low ranging from about 30 to 70% in different countries. Blood pressure is generally lower among women than among men until the sixth decade of life and may become the same or slightly higher from age 60 onwards.

High blood pressure is a major cardiovascular risk factor

The risk of vascular disease increases progressively with rising blood pressure. Any threshold for the definition of high blood pressure, or hypertension, is therefore arbitrary though commonly applied in clinical practice. High blood pressure is a major risk factor for an array of vascular diseases. Ischaemic heart disease (IHD) and stroke are the most common consequences of high blood pressure and the most frequent cardiovascular diseases in the population. It has been estimated that globally about 47% of IHD and 54% of stroke may occur due to suboptimal blood pressure. High blood pressure is very commonly accompanied by additional risk factors such as high cholesterol or smoking which also determine vascular risk. It is therefore important to consider high blood pressure not as an isolated risk factor but rather in the context of the total cardiovascular risk.

High blood pressure is a leading cause of morbidity and mortality worldwide

Estimates indicate that globally about one quarter of the adult population suffers from hypertension. About 13% of worldwide mortality may be attributable to high blood pressure. In developed countries, like in the European region, this figure amounts to approximately 20% of the total mortality burden. In terms of loss of healthy life expressed in disability adjusted life years (DALYs), high blood pressure is the second leading cause of disability worldwide and the leading cause in developed countries. Estimations indicate that about 13% of total DALYs lost in the WHO European region are due to high blood pressure.

Unhealthy lifestyle promotes high blood pressure

Several causal factors for high blood pressure related to lifestyle have been identified. Weight gain leads to blood pressure increase. Physical inactivity is associated with higher blood pressure. Alcohol consumption is almost linearly related to blood pressure, though light to moderate drinking does not seem to raise blood pressure permanently. Dietary factors including excess sodium intake, insufficient intake of fruits and vegetables, high consumption of saturated fat, low fish consumption, and low potassium intake contribute to high blood pressure.

High blood pressure is treatable and can be partly prevented

The primary aim of medical treatment of established hypertension is to reduce long-term risk of vascular disease as much as possible which requires lowering of blood pressure itself and treatment of all other modifiable vascular risk factors. A variety of effective pharmacological agents for blood pressure lowering is available. Medication therapy and lifestyle interventions are complementary approaches in hypertension treatment. Lifestyle interventions that have proved to effectively lower blood pressure are: weight loss, increased physical exercise, moderation of alcohol consumption, dietary sodium restriction, and other dietary changes such as increased fruit and vegetable intake, less consumption of saturated fat, or increased fish and potassium intake. Lifestyle interventions are crucial in primary prevention and may prevent the onset of hypertension.

A public health strategy is warranted in primary prevention of hypertension

A small decrease in population blood pressure is likely to result in a substantial reduction in cardiovascular disease and mortality. Because of the high prevalence of high blood pressure and the high lifetime risk of hypertension, a population-based strategy aiming at a downward shift of blood pressure in the general population is an important component of hypertension prevention. A high-risk approach aiming at blood pressure reductions in those who are at particular risk to develop hypertension is recommended to complement the population approach.