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Tuesday, June 19, 2012

High Blood Pressure (Hypertension)


High blood pressure(hypertension)

Hypertension or high blood pressure is a condition in which the blood pressure in the arteries is chronically elevated. With every heart beat, the heart pumps blood through the arteries to the rest of the body. Blood pressure is the force of blood that is pushing up against the walls of the blood vessels. If the pressure is too high, the heart has to work harder to pump, and this could lead to organ damage and several illnesses such as heart attack, stroke, heart failure, aneurysm, or renal failure.

The normal level for blood pressure is below 120/80, where 120 represents the systolic measurement (peak pressure in the arteries) and 80 represents the diastolic measurement (minimum pressure in the arteries). Blood pressure between 120/80 and 139/89 is called prehypertension (to denote increased risk of hypertension), and a blood pressure of 140/90 or above is considered hypertension.

People with blood pressure readings of 140/90 or higher, taken on at least two occasions, are said to have high blood pressure. If the pressure remains high, your doctor will probably begin treatment. People with blood pressure readings of 200/130 or higher need treatment immediately. People with diabetes are treated if their blood pressure rises above 130/80, because they already have a high risk of heart disease.
If you have high blood pressure, you'll probably find out about it during a routine checkup. Or, you may have noticed a problem while taking your own blood pressure. Be sure to see your doctor for a definite diagnosis, and take the opportunity to learn what you can do to bring your blood pressure under control.

Causes of hypertension

Primary Hypertension

In 9 out of 10 people, there is no identifiable cause of high blood pressure. This is called "primary hypertension" or "essential hypertension." Most people with primary hypertension don't even realize that they have it; the majority of people with this type of high blood pressure feel no different from those who have normal blood pressure. That's why hypertension is often referred to as "the silent killer."

Secondary Hypertension

In just 1 out of 10 people, the cause of high blood pressure is known.
this is called secondary hypertension. Some conditions that can cause secondary hypertension include
  •       Preeclamci
  •      Pheochromocytoma(a tumor of the adrenal gland)
  •       Aldosteronism(a condition in which adrenal glans produce too much of the aldosteron cthormone)
  •       Hypothyroidism(the thyroid does not produce enough hormones)
  •       Hyperthyroidism(the thyroid produces an excess of hormones)
  •         Coarctation of the aorta (narrowing of the aorta)
  •          Hyperparathyroidism (excessive production of parathyroid hormone by the parathyroid glands
  •          Acromegaly (a metabolic disorder caused by too much growth hormone)
  •          Chusing’s syndroms(a hormonal disorder)
  •          Kidney disease (such aspolycystic kidney disease or glomerulonephritis)
  •          Certain medicines, such as birth control pills.
 Essential hypertension risks
  
There are a number of risk factors that increase a person's chance of developing high blood pressure. Some of these cannot be controlled, such as:
  •     Being African American
  •    Family history with high blood pressure
  •    Male over age of 45 and female over age of 55
There are a number of risk factors can be controlled,such as:
  •        Having diabetes 
  •        Overweight or obese
  •       Consuming to much salt and sodium
  •       Excessive alcohol concumption
  •       Not getting enough potassium

High Blood Pressure Symptoms

High blood pressure usually causes no symptoms and high blood pressure often is labeled "the silent killer." People who have high blood pressure typically don't know it until their blood pressure is measured.
Sometimes people with markedly elevated blood pressure may develop: 
  • headach
  •  dizzines
  •  blurred vision
  •  nausea and vomiting
  •  chest pain and shortness of breath
People often do not seek medical care until they have symptoms arising from the organ damage caused by chronic (ongoing, long-term) high blood pressure. The following types of organ damage are commonly seen in chronic high blood pressure: 
  • Heart attack
  • Heart failure 
  • Stroke or transient ischemic attack (TIA)  
  • Kidney failure 
  • Eye damage with progressive vision loss 
  • Peripheral arterial disease causing leg pain with walking (claudication) 
  • Outpouchings of the aorta, called aneurysms

Detection and Diagnosis

Blood Pressure Assessment

A baseline blood pressure (BP) should be established in all adults and reassessed periodically, commensurate with age and the presence of other risk factors

Investigations and Risk Assessment
  • Urinalysis
  • Blood chemistry (potassium, sodium, creatinine/estimated glomerular filtration rate [eGFR])
  • Fasting blood glucose
  • Fasting total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides
  • Standard 12 lead electrocardiogram (ECG)
  • Microalbuminuria or albumin/creatinine ratio (ACR)

Management of hypertension

Lifestyle interventions

Advise lifestyle measures in patients with hypertension and high normal blood pressure (BP), i.e. clinic BP 130-139/85-89 mm Hg. Inform about any local initiatives, and supplement advice with leaflets or audiovisual information.

Preventing or treating obesity

Weight reduction should be suggested if necessary, to maintain ideal body mass index (BMI) of 20-25 kg/m2. Offer a diet sheet and/or dietetic appointment. Dietary self-help, e.g. dieting clubs, may be appropriate.
  • The National Institute for Health and Clinical Excellence (NICE) recommends basing meals on starchy foods (potatoes, bread, rice and pasta) - using wholegrain bread, and brown rice if possible, but watch the portion size of meals and cut down on snacks.
  • Eat foods rich in fibre, i.e. cereals, pulses (beans, peas, lentils, grains, seeds), fruit and vegetables.
  • Have at least five portions of fruit and vegetables a day.

  • Select low-fat foods - avoid foods containing a lot of fat and sugar (e.g. fried food, sweetened drinks, crisps, confectionery).
  • Reduce any excessive caffeine consumption and have a low dietary sodium intake (reduce or substitute any sodium salt). Calcium, magnesium or potassium supplements are not recommended.
  • Ensure you eat breakfast.
  • Cut alcohol intake to no more than 21 units (male) or 14 units (female) of alcohol per week. Be careful not to take too many calories in the form of alcohol.

Stopping smoking

Patients should stop smoking

Encouraging exercise

  • Make physical activities part of everyday life (e.g. walk or cycle to work, use stairs instead of lift, walk at lunchtime), and build in enjoyable activities to leisure time every week (e.g walking, cycling, gardening, swimming, aerobics, etc.) .
  • Minimise sedentary activities, e.g limit television watching or sitting at a computer or playing video games.
  • Once more, look for local activities, join a sporting group, take advantage of taster sessions and get used to exercising regularly, ideally several times a week.
The others treatment or management for hypertension is antihypertensive medicine. The goal of treatment is to reduce blood pressure so that you have a lower risk of complications. You and your health care provider should set a blood pressure goal for you.
There are many different medicines that can be used to treat high blood pressure, including:
  • Alpha blockers
  • Angiotensin-converting enzyme (ACE) inhibitors
  • Angiotensin receptor blockers (ARBs)
  • Beta blockers
  • Calcium channel blockers
  • Central alpha agonists
  • Diuretics
  • Renin inhibitors, including aliskiren (Tekturna)
  • Vasodilators
For further information follow up with the doctor.

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