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Hypertension

Overview

Overview

Hypertension

Hypertension, or high blood pressure, is the most common cardiovascular disorder affecting populations across the world. Blood pressure actually indicates the force of blood pushing against artery walls as it flows through the arteries or blood vessels in the human body. Blood vessels get filled by blood up to a certain capacity. Too much pressure of blood on the vessel wall, or high blood pressure, can threaten healthy arteries and lead to life-threatening conditions such as heart disease and stroke. High blood pressure is hazardous due to its propensity to cause strokes, heart attacks, heart failure, or kidney disease. Everybody should be aware about his/her blood pressure.

Generally, high blood pressure is categorized as:

  • Normal blood pressure: less than 120/80
  • Prehypertension: 120-139/80-89
  • Hypertension: greater than 140/90
  • Stage 1 Hypertension:140-159/90-99
  • Stage 2 Hypertension: 160 or greater/100 or greater

Treatment strategies to manage high blood pressure include changing lifestyle suitably and possibly drug therapy to lower blood pressure to less than 140/90. For patients who have diabetes or chronic kidney disease the recommended blood pressure is less than 130/80. Aim of management is to lower high blood pressure and protect important organs, like the brain, heart, and kidneys from damage. Research has found that treatment for hypertension causes a significant reduction in stroke (reduced an average of 35%-40%), heart attack (20%-25%), and heart failure (more than 50%).

Causes

Causes

It is not known exactly what causes high blood pressure. But, there exist several factors and conditions that may play a role in its development. These factors include:

  • History of Smoking
  • Being overweight
  • Sedentary lifestyle with less physical activity
  • Increased salt intake
  • Alcohol consumption (more than 1 to 2 drinks per day)
  • Stress
  • Increasing age
  • Genetics
  • Family history of high blood pressure
  • Chronic kidney disease
  • Adrenal and thyroid disorders

As per the guidelines the normal blood pressure should remain within 120/80 mm Hg. A very stringent life style modification is recommended in terms of diet control & modest exercise if the blood pressure ranges in between 120-139/ 80-89 mm Hg & medical treatment is recommended if the blood pressure is more than 140/90 mm Hg. High blood pressure tends to run in families and is more likely to affect men than women. Increasing age and race also play a role in causation. Diet and lifestyle also greatly affect es hypertension. Other factors that can raise the risk of having hypertension include obesity; diabetes; stress; insufficient intake of potassium, calcium, and magnesium; lack of physical activity; and chronic alcohol consumption.

Symptoms

Symptoms

Most of the patients may not even know that they have hypertension. The only way to know if your blood pressure is high is through regular checkups. Some patients do have certain symptoms, especially if their blood pressure is extremely high. These are:

  • Fatigue or confusion
  • Headache, especially in the back of head
  • Problems with vision
  • Chest pain
  • Breathing difficulty
  • Irregular heartbeat
  • Pounding beats in your chest, neck, or ears

In case anybody has these symptoms, a doctor should be consulted immediately. Hypertension that is not treated or poorly treated can lead to stroke, heart disease, kidney failure and eye problems.

Diagnosis

Diagnosis

Hypertension is often called a “silent disease” as the patient usually doesn’t know about it. There may be no symptoms or signs. But, it keeps on damaging your body. So, it’s important to regularly monitor your blood pressure. Tests should be conducted for heart disease as hypertension is a risk factor for heart disease.

Measuring Blood Pressure

Blood pressure is measured in mm hg. Most often, blood pressure is measured with a device known as a sphygmomanometer. Blood pressure is measured in two ways: systolic and diastolic. Systolic blood pressure is the maximum pressure during a heartbeat. Diastolic blood pressure is the lowest pressure between heartbeats.

According to the most recent guidelines, a normal blood pressure is less than 120/80 mm Hg. Hypertension is blood pressure that is greater than 140/90, while prehypertension consists of blood pressure that is 120 to 139/80 to 89.

Apart from BP measurement, your doctor will ask about your medical history (whether you’ve had heart problems before), assess your risk factors (whether you smoke, have high cholesterol, diabetes, etc.), and talk about your family history (whether any members of your family have had high blood pressure or heart disease).

A physical examination of the whole body will also be conducted by your doctor. If you’re diagnosed with high blood pressure, your doctor may recommend other tests, such as:

  • Electrocardiogram (EKG or ECG): This test measured the electrical activity, rate, and rhythm of your heartbeat via electrodes attached to your arms, legs, and chest. The results are recorded on graph paper.
  • Echocardiogram: In this test, ultrasound waves with the help of a device are used to provide pictures of the heart’s valves and chambers so the pumping action of the heart can be studied and measurement of the chambers and wall thickness of the heart can be made.

Complications

Complications

High blood pressure which is not managed or is uncontrolled can lead to:

  • Heart attack or stroke
  • Aneurysm (blood vessels weaken and bulge, forming an aneurysm)
  • Heart failure (inability of the heart to pump blood against the higher pressure in your vessels)
  • Weakened and narrowed blood vessels in your kidneys
  • Thickened, narrowed or torn blood vessels in the eyes leading to vision loss
  • Metabolic syndrome (a cluster of disorders of your body’s metabolism — including increased waist circumference, high triglycerides, low high-density lipoprotein (HDL), or “good,” cholesterol, high blood pressure, and high insulin levels)
  • Trouble with memory or understanding.

Treatment

Treatment

Any patient with BP readings greater than 120/80 should be encouraged to enroll for treatment planning. This includes lifestyle modifications, such as eating a healthier diet, quitting smoking, and getting more exercise. Treatment with medication is recommended to lower blood pressure to less than 140/90. For patients who have diabetes or chronic kidney disease the recommended blood pressure is less than 130/80.

Treating high blood pressure involves lifestyle changes and possibly drug therapy.

Lifestyle Changes
  • If your weight is more than normal, try losing weight, 2-4 kgs in a month. Do not use fad or rigid diets as they are detrimental to your health. To lower blood pressure and to correct other risk factors for heart disease like diabetes and abnormal amounts of cholesterol in the blood the single most non drug method is losing weight.
  • Decrease your intake of salt. This can be done effectively by avoiding processed foods, canned soups, tomato juice and sauces, and obviously salty foods such as pickles, flavoring agents etc. Read the food labels to look for their salt content and avoid them.
  • Try to formulate a regular exercise regimen. It could be a simple as walking for 30–45 minutes 3–4 times a week or climbing extra stairs. Taking part in sports that you enjoy will help to reduce your heart attack risk and may lower blood pressure.
  • Limit your intake of alcohol. Enjoying an occasional glass of wine, beer or a cocktail is fine provided you don’t have alcohol sensitivity. Daily intake should be limited to 1–2 drinks a day.
  • Quit smoking if you still smoke. Smoking cessation will lower your blood pressure and will eliminate one of the most important heart attack risk factors.
  • Discuss the use of medication with your doctor if your blood pressure remains above 140/90 mm Hg despite weight reduction, a lower salt diet, and an exercise program. Scientific research has shown that lowering even a slightly elevated blood pressure will reduce the risk of stroke, heart attack, or kidney failure. Some medication will be required by most people with hypertension to lower blood pressure to normal levels. There are many safe and effective medications available.
  • Take the medication as prescribed and regularly. Skipping you medication on your own won’t do you any good.
  • Rush to your doctor in case of a reaction to a medication. Do not stop taking the medication just after listening to dramatic stories by other patients or news. Check everything with the doctor who is treating you, not with a TV anchorperson. Most blood pressure-lowering drugs do not cause significant side effects.
  • Controlling BP adequately with lifestyle measures and medication is possible in more than 80–85% of patients. The complications rate in hypertensive patients was high in the past but have been reduced these days as more and more people are being treated for this disease. Do remember that aim is not to just take the medication or improve lifestyle. The ultimate goal is to ensure that your blood pressure reduces to below 140/90 and even lower if you have diabetes or heart disease.

Medication

Medication

Your doctor may prescribe one or more prescription medicines to help lower your blood pressure in addition to taking steps such as losing weight and exercising. Most of the medications prescribed for treatment of hypertension help lower your chances of developing health problems such as stroke, kidney disease, or heart attack.

In these times, a lot of drugs from various categories of antihypertensives are available that can effectively help most people lower their blood pressure and reach the blood pressure goal set by their health care provider.

Different medications prescribed for control of blood pressure work in many different ways. Some remove extra fluid and salt from the body. Others slow down your heartbeat or relax and widen your blood vessels.
In market, there are more than 100 blood pressure–lowering drugs available. Some of them, like diuretics, have been in use for more than 50 years.

Many pills prescribed for high blood pressure contain a combination of two different types of medicines. Combining two different types of drugs can make it easier to control blood pressure by two different mechanisms. These combination pills also keep track of taking your medicines.

Do keep in mind that since combination pills contain more than one medicine, they also have the potential for more side effects than pills that contain just one medicine. Report anything unusual to your doctor while you are taking pills for hypertension.

Different types of medications work differently for different types of patients, with varying age and body profile. In fact, some medicines have been found to provide more benefits for men than women or younger than in older populations. Your doctor will provide a medicine that is right for you.

Reduction of blood pressure with medication will prevent progression from less severe to more severe hypertension, will prevent enlargement of the heart and heart failure, and will dramatically reduce strokes, stroke deaths, and heart attack deaths. Getting blood pressure down to below 140/90 mm Hg, or below 130/80 mm Hg if you have diabetes or kidney disease, if at all possible, is a good idea at all ages.
Do remember that even if you are taking your medications regularly, it is important to keep on exercising and eating as advised by your health care provider.

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