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ntroductionHypertensive heart disease is a condition caused by high blood pressure. High blood pressure is a condition resulting from a persistently increased pressure of blood flow through the blood vessels requiring the heart to work harder than normal. Ibekwe, 2005, alludes that it is sometimes informally called the “silent killer” due to its ability to present no apparent symptoms and hence an individual can have hypertension without realizing. Hypertension is a major risk factor for cardiovascular disease, and contributes significantly to the morbidity and mortality rates in the world. It is a global concern of public health importance, and as such, its control would improve the overall public health outcome.  Hypertension can be classified into two groups namely primary/essential and secondary hypertension (Rodriguez-Cruz, 2009; Carretero & Opari, 2000). There is no known cause for primary hypertension and it affects about 90 to 95 % of the general population (Rodriguez-Cruz, 2009; Carretero & Opari, 2000). Primary hypertension causes about 90% of all cases of hypertension and despite having no identifiable cause, it is prevented by modifying its associated risk factors (Klingbeil, Schneider, Martus, Messerli, & Schmieder, 2003). Secondary hypertension however is caused by underlying medical conditions such as kidney disease, cardiovascular disease (CVD), coronary heart disease, which alters the homeostatic pathway of regulating blood pressure (Williams, 2010).The exact cause of primary hypertension is unknown however, there are several risk factors associated with this condition (Ibekwe, 2005). These risk factors can be broadly categorized into two main sections, modifiable and non-modifiable factors (Sani et al., 2010). The modifiable risk factors of hypertension include smoking, diet, obesity, sedentary life style and alcohol consumption (Ibekwe, 2005). The non-modifiable risk factors are age, sex, race, family history, genetic composition (Ibekwe, 2005).Hypertension is one of the leading causes of mortality and morbidity worldwide. It is a huge public health pandemic as it affects the economic productivity by causing time loss to individuals due to health effects associated with its presence. EpidemiologyHypertensive heart disease globally affects about 1 billion individuals and causes about 7.1 million deaths per year (Chobanian, et al., 2003). High blood pressure (HPB) causes about 7.5 million deaths accounting for 12.8% of total deaths worldwide (National Center for Health Statistics, 2017). The overall prevalence in adults aged 25 and above is about 40% as of 2008(World Health Organization, 2017). This accounts for 3.7% of disability adjusted life in individuals all over the world and can be crippling to public health (World Health Organization, 2017).One in three adults in the United States with HBP are at an increased risk for other cardiovascular disease and cerebrovascular which are leading causes of death in the United States (Sistino, 2017).  From 2006 to 2010, hypertension was the primary contributing factor in the cause of death for about 326,000 Americans. From ages 45–54 and 55–64, the percentage of men and women is similar; after that a much higher percentage of women than men have high blood pressure due to menopause (National Center for Health Statistics, 2017). Post-menopausal women record higher blood pressures than the men (Lima, R., Wofford, M., & Reckelhoff, J., 2012). The post-menopausal spike in blood pressure is attributed to various causes, including autonomic nervous system changes, weight-gain, and post-menopausal hormonal/psychological changes (Lima, R., Wofford, M., & Reckelhoff, J., 2012).The African-American population has a higher prevalence of high blood pressure more when compare to any other racial background in the United States (American Heart Association, 2017). Primary hypertension is more prevalent as people advance in age and may increase up to 75% in people aged over 75 (Rodriguez-Cruz, 2009; Carretero & Opari, 2000). With an increase in age, the blood vessels gradually lose some of their elastic quality, which can contribute to increased blood pressure (National Center for Health Statistics, 2017). However, children can also develop high blood pressure ( Sani et al., 2010). Nawrot et al. 2004, suggest that the systolic blood pressure is the greater risk predictor in patients between the ages of 50 to 60.  For patients under 50 years of age, the diastolic pressure is a stronger indicator of disease severity (Franklin et. al 2001). Hypertension accounts for 68% of heart failure problems in the elderly. (Dawber, et al. 1951). The cost of managing cardiovascular diseases costs the United States of about $200 billion yearly and still have the tendency to increase in the near future(National Center for Health Statistics, 2017; Sistino.2017).The occurrence of hypertension is increasing each day, with projections estimating a 30% increase in prevalence by the year 2025 (Ibekwe, 2005). HPB will cost the United States $76.6 billion in health care services, medications, and missed days of work. DiagnosisAccording to the American Heart Association, the best way to diagnose High Blood Pressure (HBP) is to take a measure reading by a high blood pressure machine (American Heart Association, 2017). Three different blood pressure readings should be taken, separated by at least one week apart (Eguchi et al., 2009). Caffeine and smoking should be avoided about an hour and 30 minutes, respectively, before BP assessment (Bitar et al., 2015). The higher recording always determines the severity of the disease especially in patients above 65 years old (American Heart Association, 2014). Ambulatory blood pressure monitoring over 12 to 24 hours is the most accurate method to confirm the diagnosis (Grossman, 2013). High blood pressure diagnose needs to be confirmed by a physician always (American Heart Association, 2017).The American Heart Association, suggests these definitive guidelines based on the average of two or more blood pressure recordings during each of two or more office visits. Figure 1: The blood pressure reading guidelines by the American Heart AssociationPathophysiologyThe arterial blood pressure is calculated by the following equations: Blood Pressure (BP) = Cardiac Output (CO) x Systemic and Vascular Resistance (SVR) Cardiac Output (CO) = Heart Rate (HR) x Stoke Volume (SV). The renin–angiotensin–aldosterone system is a hormone system responsible for maintaining vascular volume homeostasis and systemic vascular resistance. Renin is a vasoactive, proteolytic enzyme produced by the kidneys due to certain stimuli that cause tissue hypo perfusion, or a reduction of intravascular volume. Such inciting factors could be; sympathetic nerve activation, renal artery hypotension/stenosis, as well as a reduction in sodium delivery to the distal renal tubules.The renal glomerulus houses the afferent arterioles and juxtaglomerular (JG) cells where renin is stored and released. Beta1-adrenoceptors on the JG cells respond to sympathetic stimuli by releasing renin (Freeman, Davis, & Villarreal, 1984). Reduction in afferent arteriolar pressure decreases glomerular filtration which in turn reduces NaCl in the distal tubule. Renin is released, acts on a circulating proenzyme, angiotensinogen, which undergoes proteolysis to derive angiotensin I (Ye et al., 2006). Furthermore, the pulmonary vascular epithelium releases, angiotensin converting enzyme (ACE), which converts angiotensin I to angiotensin II, a generally potent vasoconstrictor. It raises blood pressure by several mechanisms, especially through direct vasoconstriction of resistance vessels, NaCl reabsorption through aldosterone release from the adrenal cortex, and antidiuretic hormone (ADH) release from the posterior pituitary gland. It also stimulates vascular smooth muscle hypertrophy, and a major culprit in the development of left ventricular hypertrophy in hypertensive patients as suggested in a study by, Klingbeil, Schneider, Martus, Messerli, & Schmieder, 2003, which also asserted that blockage of the ACE activity causes more regression in left ventricular hypertrophy.Certain medical conditions have been known to cause persistently increased blood pressure (Sani et al., 2010). In these cases, adequate blood pressure control will not be achieved if the primary source is left untreated (Ibekwe,2015). This is called secondary hypertension (Ibekwe, 2015). Major causes of secondary hypertension include: oral contraceptives, steroids, non-steroidal anti-inflammatory medications, stimulants, anti-depressants, Reno-vascular hypertension, stress, and various endocrine disorders (Sani et al., 2010). Anxiety and stress enhance the sympathetic pathway leading to sustained vasoconstriction and elevated peripheral vascular resistance(Schneider et al. 2003).Public Health Management/InnovationManagement of HHD and HBP have been a major public health challenge over the years.  Research into physical activity, has demonstrated that sedentary lifestyle is associated with an increase in risk of hypertension (Vasiliki et. al, 2010). It is any bodily movement produced by contraction of skeletal muscles that increases energy expenditure above resting levels for 30-45 minutes (Diaz et. al, 2013). Physical activity decreases the risk of obesity (Body Mass Index – BMI- of ? 30) which contributes to the development of hypertension and leads to its exacerbation (cite). He, Li, & MacGregor, 2013, demonstrated a connection between obesity, insulin resistance, and renin-angiotensin-aldosterone- system in the development of end-organ damage in hypertension.Excessive weight gain puts an extra strain on the heart and circulatory system making one susceptible to cardiovascular diseases, diabetes and high blood pressure (He, Li, & MacGregor, 2013).Data put forth by public health has helped many work places trying to help their employees by creating mobile work places which promotes physical activity and prevents sedentary behavior (siting at a desk for 8 hours). The new tax law has a fitness deduction program which is allows employers to pay for gym memberships (Internal Revenue Service 2017). This incentive increases the zeal for fitness activity among the population as it no longer comes out of the individuals’ income.  This is a great way public health is helping prevent incidence of hypertension in the population. Teaching kids on healthy food choices early on in life can prevent obesity a modifiable risk factor of hypertension later in life. The affordable care act mandates that every consumable product that is sold in the United States should be appropriately labelled (Food and Drug Administration, 2014). Labeling of food products educates the general population to making a good and informed decision on what they are consuming. It allows for informed and controlled caloric intake. A diet in high in fruits and vegetables and low salt can also help lower blood pressure (Association, 2009).There are 6 classes of medications that are available on the market to assist with disease control (Oparil et. al, 2005). These medications however are sometimes unaffordable and only effectively administered in multiple pills and multiple times in a day.  When cost of drugs is high, and there are lots of pills to take, compliance easily becomes a problem. Complementary to ambulatory blood pressure monitoring; care providers should make better informed clinical decisions by digitally obtaining real-time transmission of every home-taken BP reading by the patient. The High Blood Pressure Clinical Practice Guideline by Whelton PK, et al., 2017, proposed a once a day medication dosing, and medication combination regiment as a strategy for improving medication adherence. For the future, researchers should create a device which will automatically send the recorded vital signs to the patients’ Electronic Health Record (EHR) or a patients’ monitoring system. This way, the doctor has an accurate reading and can monitor the progression of the condition in an individual. Electronically transmitted BP readings can also prevent patients that are lost to follow-up, or those patients who do not come for follow up after initial diagnosis.  The new product should include a GPS or tracking system that allows health officials to easily track their patient’s location. The new device should be made affordable and easily accessible since HBP is more prevalent in low socio-economic areas (World Health Organization, 2017). ConclusionAlthough there are numerous efforts to prevent and control hypertensive heart disease, the prevalence of hypertension has not decreased. A major challenge in its research is to find the main pathophysiological determinant factors responsible for long-term blood pressure elevation and to articulate how these determinants can be exploited to reduce morbid blood pressure complications.           Medication compliance, in my opinion, has remained the most prominent limiting factor in the management and control of hypertension and hypertensive heart diseases. Moving forward, more research effort should be directed toward creating a system for monitoring medication compliance as well and also ensuring affordability to the population.ReferencesBerk, B. C., Fujiwara, K., & Lehoux, S. (2007). ECM remodeling in hypertensive heart disease. Journal of Clinical Investigation, 117(3), 568.Bitar, A., Mastouri, R., & Kreutz, R. P. (2015). Caffeine Consumption and Heart Rate and Blood Pressure Response to Regadenoson. PLoS ONE, 10(6), e0130487. for Disease Control and Prevention, National Center for Health Statistics. 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