Hypertension- a systolic blood pressure (SBP) of ≥140 mm Hg, or a diastolic blood pressure (DBP) of ≥90 mm Hg - affects between 50-60 million adult individuals in the United States, 42.3 million in China, and approximately 1 billion individuals worldwide. Hypertension is a significant risk factor for coronary heart disease and cerebrovascular disease.

In 2008 high blood pressure in adults aged 25 and over in the world was 40%.Cambodia is currently challenged by the escalating burden of high blood pressure, together with other associated non-communicable diseases. The prevalence of high blood pressure in adults aged 25 to 64 was 11.2% in 2010. This means that one in every ten people has high blood pressure. By gender, the prevalence of high blood pressure in men and women is 12.8% and 9.6% respectively. In urban areas the prevalence of high blood pressure was16.9% while in the rural areas the prevalence of high blood pressure was 10%.However, there is an opportunity to prevent increasing burden of high blood pressure in Cambodia. To reduce the burden of high blood pressure and premature deaths due to heart disease and stroke in Cambodia, tobacco control and salt reduction programs need to be strengthened. In addition, those with hypertension including lifestyle modification and medications need to be better managed, and prevention of complications enhanced. It is important to look for co-morbidities in those with high blood pressure, to provide enhanced care in the community that facilitates compliance to drug treatment, and to encourage lifestyle modifications.

The causes of high blood pressure are mostly unknown. 2 types of hypertensions are: essential or primary and secondary. The essential hypertension without identified causes represents 90 – 95%, and their pathogenesis is multifactorial and complex. Various renal and endocrinal diseases and medications are the causes of secondary hypertension.

Correct measurement of blood pressure is essential in the diagnosis and management of hypertension. Having a blood pressure machine with the proper-sized cuff is crucial, as are the correct procedural steps in taking the reading. This article outlines the steps in measuring blood pressure, to ensure that accurate readings are taken.

Uncontrolled blood pressures (BPs) lead to progressive or impending end-organ dysfunction (EOD), which falls under the category of hypertensive emergencies or hypertensive crisis. In these conditions, the BP should be lowered aggressively over minutes to hours. Neurologic end-organ damage due to uncontrolled BP may include hypertensive encephalopathy, cerebral vascular accident/cerebral infarction; subarachnoid hemorrhage, and/or intracranial hemorrhage.[1] Cardiovascular end-organ damage may include myocardial ischemia/infarction, acute left ventricular dysfunction, acute pulmonary edema, and/or aortic dissection. Other organ systems may also be affected by uncontrolled hypertension, which may lead to acute renal failure/insufficiency, retinopathy, eclampsia, or microangiopathic hemolytic anemia. With the advent of antihypertensives, the incidence of hypertensive emergencies has declined from 7% to approximately 1% of patients with hypertension.

Despite efforts at lifestyle modifications, most hypertensive patients require pharmacologic treatment. The primary goals of treatment are to achieve maximum reduction in long-term total and cardiovascular risk.

The days have long gone that a physician or a nurse could hope to control a patient’s blood pressure just by prescribing the right medication. This article talks about various aspects of the treatment that must be taken care of as well, for the patient’s blood pressure to remain well controlled in the many years to come.

Hypertensive women can get pregnant or, alternatively, hypertension can start in pregnancy. Hypertension in a pregnant woman can cause the fetus to grow slowly, and also lead to pre-eclampsia or eclampsia, which is life threatening. Monitoring of blood pressure in pregnancy is an essential part of antenatal care. Managing hypertension in pregnancy requires much experience, especially if there is proteinuria (pre-eclampsia/eclampsia). Health center staff must rely on hospital staff once pregnancy hypertension is diagnosed.

The relationship between high blood pressure and other conditions is not only with pregnancy, but also with obesity and older age. Obesity causes an increase in the cardiac output and the blood volume, and in the arterial resistance. Blood pressure increases with age because the arteries harden. An overweight child that has a family history of hypertension is at greater risk of hypertension.