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With hypertension affecting up to 75 million people in America alone, at a cost of $76 billion, it is one of the major medical issues facing us in the 21st century. The problems that hypertension present to the biomedical community are complex and varied. This is driving new and exciting research in different directions.
The epidemiology of hypertension has indicated a number of very important lifestyle factors, implicated in increasing risk of getting Hypertension; obesity, increased dietary salt intake, high cholesterol, high alcohol consumption and smoking. Old age is also implicated, and although unavoidable, is significant given the aging populations of the developing world. Traditionally associated with men, hypertension is now becoming increasing common in women. Diabetes, an increasingly common condition, through atherosclerotic processes, increases blood pressure in up to 80% of diabetic patients.
It is the complications of hypertension that is a real cause for concern. Hypertension itself is a risk factor numerous conditions including atherosclerosis, which is a major risk factor for cardiovascular diseases.
In the heart, the increased blood pressure against which the heart has to work can cause left ventricular hypertrophy, and coronary artery disease may develop, further hindering the physiological function of the heart. Strokes (cerebrovascular accidents) can cause potentially lethal damage to the brain, and result from possible complications of hypertension. Vision can be damaged in cases of hypertensive retinopathy, macroaneurysms and branch-vein occlusions. Hypertension in the kidneys can cause nephropathies as aspects of the kidneys are remodelled to accommodate the increased blood pressure, at the expense of physiological function. Because of the systematic importance of the kidneys in homeostasis, deterioration of their function can further increase risk of progression of diseases of the cardiovascular system. Further issues are the often co-existing morbidities of these patients; for example, obesity.
This hypertension epidemic must be combated from several different angles using the full breadth of the medical profession.
One approach is to implement strong educational programs encouraging lifestyle changes to prevent the preventable cases of hypertension, and keep treatment in the primary care arena. A recent study looked into the effectiveness of this; the findings were that a combination of education about healthy lifestyles and medication adherence was successful in lowering BP. This is further reiterated in recent updates to the American Heart Association's cardiovascular disease prevention guidelines for women (2011), which focus on the day-to-day practicalities of managing risk factors or hypertension. It picks up on differences in wealth, literacy level and visual and hearing skills between women participating in trials and those not, and the consequences of these differences in approaching their health and adhering to medications. In addition to this, the updates also stress the importance of self-awareness and supports ‘cause initiatives’.
Pharmaceutical approaches are well utilized, as illustrated by the range of new drugs being developed in each class of anti-hypertensive drugs; diuretics, beta-blockers, ACE inhibitors and Calcium channel blockers. Because of the challenges of lifestyle changes, the pharmaceutical market for anti-hypertensive drugs is growing; up to 20% in some part of China in 2008, and lucrative, because of the endemicity of the disease.
The complications of hypertension are testing and allowing expansion of knowledge of techniques in vascular surgery. Recent developments by Ziehm (Smart Vascular) allow better visualisation of the operation, reducing the invasiveness of an operation and associated risks. We are also increasing our knowledge of self-repair mechanisms the body can activate to repair the damage done by high blood pressure (for full article click here). Branches of already established medical fields are emerging to cope with hypertension and its associated problems. This included the use of imaging techniques such as MRI, CT or X-ray for diagnosis (using angiography) and interventional radiology.
Although the complications of hypertension discussed above are possibilities not certainties, the number of people with hypertension makes their prevalence significant, and warrants the depth of research currently being done to tackle this growing problem.
Reflecting the research drives in this area, BioPortfolio have developed a RSS and Twitter feed (see below), to keep you up to date with the latest news, reports, research papers and clinical trials in this area.
To see the latest clinical trials on Hypertension click here.
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