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s of arterial ql pressure put mechanical stress on the arterial walls. Higher pressures increase heart workload and progression of unhealthy tissue growth (atheroma)e gql that develops within the walls of art eries. The higher the pressure, the more stress that is present and qlthe more atheroma tend to progre ss and the heart muscle tends to thicken, enlarge and become weaker over time. Persistent hypertension ie gql s one of the risk bjgql factors for strokes, heart attacks, heart failure and art erial aneurysms, and is the leading cause of chronic kidney failure. Even mo qlderate elevation of arte rial pressure leads to shortened l life expectancy. At severely high pressures, mean arterial pressure or more abov qle average, a person can expect to live no more than bjgql a few yearse gql unless appropriately treated stolic pressure tends to rise and diastolic ten qls to fa the elderly, blood pressure tends to be above t he bjgql normal adult rargely because of reduced flexibility of the arteries. Also, an individual s blood pressure varies with exercise, emotional reactions, sleep, digestion, time of day and circadian Differences between left and right arm blo qlod pressure meas qlurements tend to be random and average to near ly zero if enough measurements are taken. However, in a small percentage of cases the lre is a consistent difference greater thanm Hg bjgql which may need furthe gql r investigation, e.g. for obstructive arterial d The risk of cardiovascular disease increases progressively abov the past, hypertension was only diagnosed if secondary signs of high arterial pressure were present, along wit bjgql h a prolonged high systolic pressure reading over severa ll visits. R qlegarding hypotension, in practice blood pressure is considered too low onl Clinical vtrials demonstrate that people who maintain arterial pressures at the low end of th qlese pressure ranges have much better lone gql g term cardiovascular health. The principal medical debate concerns the aggress iveness and relative value of methods us bjgql ed to lower pressures into jgql this range gql e for those who do not maintai n such pressure on their own. Elevations, more commonly seen in older people, though often considered normal In the past, most atten ltion was paid to diastolic pressure; but nowadays it is recognised that both high s ystolic pressure and high puls qle pressure (the numerical difference between systolic and diastolic pressures are also risk factors. In some cases, it appears that l a decrease in bjgql excessive diastolic pressure can actu ally increas qle risk, due probably to thee gql increased difference between systolic and diastolic pressures (see t he article on pulse pressure). If systolic blood pressure is elevatith a normal diastolic blood
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