Cardiology
Hypertension
고혈압
Persistently elevated arterial pressure (≥130/80 mmHg)
- How common
- Adults 30–40%
- Typical age
- Increases after age 40
What is it?
Increased peripheral resistance and/or cardiac output raise BP; RAAS and sympathetic system are key mediators.
Commonly affected: Systemic arteries, LV, kidneys, brain, retina
How it develops
- Genetic/environmental factorsAge, obesity, salt intake, family history
- RAAS activationAngiotensin II generation → vasoconstriction
- Increased SVRArterial smooth muscle hypertrophy/intimal thickening
- End-organ damageLVH, CKD, stroke, retinopathy
Symptoms
- HeadacheMorning occipital headache when very high
- DizzinessIntermittent vertigo
- Blurred visionWith hypertensive retinopathy
- Often asymptomaticCalled the silent killer
- EpistaxisNosebleed during BP surges
How it is examined
- Accurate BP measurementBoth arms, 5 min rest, proper cuff size
- 24-hr ambulatory BPDifferentiate white-coat/masked HTN
- End-organ assessmentECG (LVH), fundoscopy, renal function, urinalysis
Imaging
CXR may show cardiomegaly or aortic notching.
- Cardiomegaly
- Possible aortic dilatation
Cardiac MRI/echo evaluates LV hypertrophy.
- LV hypertrophy
- Diastolic dysfunction
Non-surgical care
- Lifestyle modificationDASH diet, salt <5g/day, weight loss
- Aerobic exercise150 min/week moderate intensity
- Stop smoking, limit alcoholSmoking cessation, alcohol restriction
- ACEi/ARBLisinopril, valsartan, etc.
- CCB/diureticAmlodipine, hydrochlorothiazide
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Resistant HTN or treatable secondary cause
Procedures that may be discussed
- Renal denervation (investigational)
- Adrenalectomy for Cushing/aldosteronoma
- Renal artery stenting
Outlook
Good control reduces complications >50%; untreated → high stroke/MI risk.