Epidemiology of Risk Factors for Hypertension

Abstract

We review the present knowledge of risk factors for arterial hypertension. Both genetic and environmental factors as well as their interaction and biological plausibility are reviewed. Recent data confirm that the interaction of genetics with multiple environmental risk factors explains the high prevalence of hypertension in the industrialised countries. The most important modifiable environmental risk factors are high salt intake, alcohol intake, obesity and low physical activity. The role of stress in the aetiology of high blood pressure is still under investigation, but recent clinical experimental and epidemiological data have shed light on how stress could be related to hypertension. The implications for prevention and treatment are discussed both at the population and individual levels. The population approach involves a public health policy aiming at modification of the major risk factors. The individual approach involves nonpharmacological measures to prevent the development of hypertension and to treat high normal blood pressure and mild hypertension with no additional cardiovascular risk factors. Pharmacological treatment of hypertension in most individuals should use agents that have been proven to be effective in randomised controlled trials with 'hard' endpoints such as cardiovascular and cerebrovascular morbidity and mortality.

Road traffic noise and hypertension: results from a cross-sectional public health survey in southern Sweden

“…Even though there are well-known definitions of hypertension used in Sweden, one could expect that the actual diagnostic threshold varies between physicians and over time. A study from 2003 reported hypertension prevalence in Sweden being approximately twice as high as in our study[17] In a recent study from the Netherlands, somewhat lower effect estimates associated with road noise exposure were seen when self-reported antihypertensive treatment were used rather than actual blood pressure measurements and pharmacy reports[15]…”

“…The coherence was lower among younger respondents and among men. We investigated confounding from variables a priori considered to be possible risk factors for hypertension: [19] sex, age, BMI, exercise, education, alcohol consumption, smoking and socioeconomic status. Smoking was included even though there is some controversy whether it leads to hypertension or not.…”

“…It is also conceivable, however, that effects are more marked at higher exposure levels, in certain age groups or in other subgroups of the population, but investigating such associations generally requires large population studies. In a large pooled European population sample based on blood pressure measurements, the prevalence of hypertension increased from 27% in the age group 35 - 44 years to 78% among subjects 65 - 74 years old[17] Given this dramatic increase in the prevalence of hypertension with age, it is most unlikely that the relative effect of road noise exposure is constant across age groups, but few studies have used exposure - disease models that allow for effect modification by age[15]…”

Association between hemoglobin variability and incidence of hypertension over 40 years: a Korean national cohort study

“…Hypertension is a multifactorial disease caused by various environmental and genetic factors. Aging, obesity, drinking, and lack of exercise are regarded as risk factors for hypertension 5 . Identifying the potential risk factors and predicting hypertension can help us understand the physiological mechanisms associated with blood pressure, improve the treatment of hypertension, and prevent hypertension.…”

Open-label randomized trial of titrated disease management for patients with hypertension: Study design and baseline sample characteristics

“…Counseling is tailored to individuals who are diabetic, 56–58 African American, 59, 60 recently diagnosed with hypertension, and/or have hypertensive relatives 61, 62 because these factors confer specific risks for worse health outcomes.…”