Hypertension –various aspects
- Eitiology of Hypertension,
- Signs and Symptoms of Hypertension,
- Investigations in Hypertension,
- Treatment of Hypertension
- Eitiology of Hypertension –
has several important perspectives which are discussed in detail below-
Normal blood pressure is 120/80 mm Hg or lower.
Elevated blood pressure. The top number which is called systolic blood pressure ranges from 120 to 129 mm Hg and the bottom number which is called diastolic blood pressure should be is below, not above, 80 mm Hg.
Stage 1 hypertension. The top number ranges from 130 to 139 mm Hg or the bottom number is between 80 and 89 mm Hg.
Stage 2 hypertension. The top number is 140 mm Hg or higher or the bottom number is 90 mm Hg or higher.
Ideal blood pressure normal range is considered to be between 90/60mmHg and 120/80mmHg. High blood pressure(Hypertension) is considered to be 140/90mmHg or higher. Low blood pressure is considered to be 90/60mmHg or lower.
Isolated systolic hypertension can be caused by the following conditions –
An overactive thyroid (hyperthyroidism)
Heart valve disease.
What are the reasons for diastolic blood pressure to be high?
High-sodium diet. A diet that’s high in salt disrupts your body’s natural sodium balance, causing your body to retain water. …
Not enough physical activity. …
Excessive alcohol consumption. …
Anxiety and stress. Hypertension is mainly either Essential hypertension or Secondary hypertension
Essential hypertension is a major risk factor for several cardiovascular diseases especially if early diagnosis and treatment is not done.This signifies the importance of health check ups. Most people say that they do not have any problem, so why to do not have any problem, so why to do health check ups, but mild hypertension does not have any signs and symptoms. It is only during routine check up, that it is detected.
By routine check up we mean– blood pressure assessment, ECG, random blood sugar, lipid profile, serum creatinine, SGOT ,SGPT. The cause of essential hypertension is not known-this thing is partially true and partially untrue.
The reason for this is that we have little information on genetic variations or genes that are overexpressed or underexpressed as well as regarding the intermediary phenotypes that they regulate to cause elevation of blood pressure(Hypertension).
Certain genes in DNA are linked to a higher risk for hypertension. Almost nothing can be done to change our genetics, it’s important to know about family history. If family members have hypertension, you may also be at greater risk of developing hypertension. There are also certain physical conditions that you may be born with that can raise your blood pressure like problems with the aorta and other blood vessels, which are usually diagnosed in childhood.
Following are the various factors that increase the blood pressure –
Obesity can cause hypertension by causing fluid retention.
Obesity can do the following things –
Harm the kidneys
Problems with hormone balance
Cause inflammation and injury to the blood vessels
Contribute to sleep apnea, which is a risk factor for hypertension
(2) insulin resistance,
(3) high alcohol intake,
(4) high salt intake (in salt-sensitive patients),(5) aging and perhaps
(6) sedentary lifestyle,
(8) low potassium intake, and
(9) low calcium intake.
(10)-Gender -Males under the age of 60 are more likely to have hypertension than women. After 60, females start to take the lead.
Older people tend to experience higher rates of hypertension. For example, nearly 75% of people ages 65 and older are estimated to have hypertension. In contrast, only about 27% of men and 12% of women in their 20s have hypertension.
Black and South Asian Americans are more likely to have hypertension compared with other racial groups.
(13)Eating too much salt(sodium chloride)
Taking too much of salt in diet may raise your risk of hypertension. Processed foods and restaurant food are having more salt content. Less than 2300 mg of sodium per day should be consumed.
Too much salt can raise the risk of stroke, heart problems, and other health issues.
(14)-Some people may have more sensitivity to salt. –
Adults over 65
People with obesity
People living with diabetes
People with kidney problems
Information is not available on which genes cause BP to vary . Inherited BP can range from low normal BP to severe hypertension.
Eating too little potassium
Not enough potassium can cause problems. We get potassium from fruits and vegetables. Minimum 4700 mg of potassium per day should be consumed
Always cosult your physician (MD General Medicine) before trying potassium supplements.
8. Sedentary (inactive) lifestyle
The less active you are, the higher your risk of developing high blood pressure. Regular physical exercise should be done.
9. Chronic, excessive alcohol consumption
Excessive alcohol use is a significant cause of high blood pressure(Hypertension). Drinking too much alcohol can also raise your cholesterol and triglyceride levels. Alcohol intake should be less than two drinks a day for men and less than one drink a day for women.
10. Medication side effects
Certain medications can raise your blood pressure as a side effect. If your blood pressure goes up (Hypertension) suddenly then you need to consult your physician (MD General Medicine) doctors as a simple alteration in your medications can make a difference.
Smoking contributes to hypertension, especially in men over the age of 45.
12. High blood sugar
If an individual has high blood sugar, for prolonged periods, he may be at risk for developing hypertension later in life.
Some medical conditions can cause hypertension. In some of these cases, treating problems can treat hypertension. Following are a few examples of this-
13. Kidney problems
The kidneys are responsible for excretion of waste products through the urine. When the kidneys don’t work properly they are less able to flush out fluid and toxins. This can lead to hypertension .Narrowing of arteries to the kidneys can lead to hypertension. Blood and urine tests , ultrasound, CT-Scan imaging testing is needed to confirm the diagnosis.
14. Obstructive sleep apnea
Many individuals with sleep apnea will develop hypertension. If you experience disrupted sleep or heavy snoring, it is important to consult a chest physician. A sleep study is necessary for diagnosis of sleep apnea. and SOS a breathing device (known as a CPAP machine) or a special mouth guard to use at night. Treatment of sleep apnea may help to bring hypertension under control .
15. Hormonal changes
Many hormones work together to control blood pressure. When the balance of these hormones is not maintained blood pressure is elevated. Problems with the thyroid gland and adrenals can lead to elevated blood pressure(Hypertension). With a few simple blood tests, like T3,T4,TSH your physican help you confirm if your hormone levels are out of balance.
16 Pegnancy and birth control pills may also affect blood pressure for some women, especially when other risk factors are present.
17 Secondary hypertension
Causes of secondary hypertension in children are renal parenchymal disease and coarctation of the aorta. In adults 65 years and older, atherosclerotic renal artery stenosis, renal failure, hypothyroidism are some of the causes of secondary hypertension. In such cases Nephrologist ,Endocrinologist should be consulted.
Secondary hypertension should be considered in the presence of suggestive symptoms and signs, such as severe or resistant hypertension, age of onset younger than 30 years (especially before puberty), malignant or accelerated hypertension, and an acute rise in blood pressure from previously stable readings. Additionally, renovascular hypertension should be considered in patients with an increase in serum creatinine of at least 50% occurring within one week of initiating angiotensin-converting enzyme inhibitor treatment or angiotensin receptor blocker treatment
Severe hypertension is seen in unilateral smaller kidney or difference in kidney size greater than 1.5 cm; or recurrent flash pulmonary edema.
Other underlying causes of secondary hypertension include hyperaldosteronism, obstructive sleep apnea, pheochromocytoma, Cushing syndrome, thyroid disease, coarctation of the aorta, and use of certain medications.
First the patient consults a physician, who then directs the patient for higher opinion to Nephrologist ,Endocrinologist, depending on the case.
Secondary hypertension is a type of hypertension with an underlying and potentially reversible cause. It contributes to only a small fraction (5% to 10%) of hypertensive patients. Extensive testing for secondary hypertension is not advisable in all patients with hypertension because of cost, low yield, and the potential for false-positive results; however, testing is advisable in patients younger than 30 years.
Factors like obesity and high alcohol and salt intake which increase the blood pressure (Hypertension) are called “hypertensinogenic factors.” Some of these factors have inherited, behavioral, and environmental components.
Inherited BP could be considered core BP, whereas hypertensinogenic factors cause BP to increase above the range of inherited BPs, thus creating 4 main possibilities:(1) patients who have inherited BP in the optimal category (120/80 mm Hg); if 1 or more hypertensinogenic factors are added, BP would probably increase but remain in the normal range (135/85 mm Hg);(2) patients who have inherited BP in the normal category (130/85 mm Hg)
if 1 or more hypertensinogenic factors are added, BP will probably increase to the high normal range (130 to 139/85 to 89 mm Hg) or
to stage 1 of the hypertensive category (140 to 159/90 to 99 mm Hg)
(3) patients who have inherited BP(Hypertension) in the high normal category (130 to 139/85 to 89 mm Hg); if 1 or more hypertensinogenic factors are added, BP will increase to the hypertensive range (140/90 mm Hg
(4) patients who have inherited BP in the hypertensive range; addition of 1 or more hypertensinogenic factors will make hypertension more severe, changing it from stage 1 to stage 2 or 3 .
Theoretically, in a population unaffected by hypertensinogenic factors, BP will have a normal distribution; it will be skewed to the right and will have a narrow base or less variance .
When 1 hypertensinogenic factor for hypertension is added to this population, such as increased body mass, one would expect the normal distribution curve to be further skewed to the right; consequently the base will be wider (more variance) and the curve will be flatter .
If a second hypertensinogenic factor such as alcohol intake is added to increased body mass, the curve will be skewed more to the right and the variance will increase further, with more subjects classified as hypertensive .
Discovering which genetic variations place BP on the left or right side of the distribution curve is of both theoretical and practical importance. Recognition of the hypertensinogenic factors for hypertension may allow nonpharmacological prevention, treatment, or cure of hypertension.
Hypertensinogenic factors such as obesity, insulin resistance, or high alcohol intake have an important genetic component.
Furthermore, there are interactions between genetic and environmental factors that influence intermediary phenotypes such as sympathetic nerve activity, the renin-angiotensinaldosterone and renal kallikrein-kinin systems .
Ultimately we have to stress that importance of health check ups is high. If early diagnosis and treatment is made a lot can be done to prevent disastrous complications.
Investigations in hypertension –
Testing & Diagnosis
As soon as you visit your doctor, he/she will review your medical history, along with conducting a physical exam of your body and running some usual lab tests.
First, the doctor will assess your blood pressure.
Nowadays, the blood pressure measurement can be done by an automatic BP measuring instrument. And this device makes it even easy to measure one’s BP at home.
The normal systolic blood pressure range is between 110-155 mm Hg, and the diastolic blood pressure range lies between 60-90 mm Hg.
After coming to the physician’s clinic, the patient should sit relaxed for at least 10 minutes and then get his/ her blood pressure checked. Otherwise, there are chances of getting a false high reading -false hypertension .Blood pressure should be measured once daily and for 5 consecutive days.
If persistent high readings for the first 5 days are noticed, the patient will require an antihypertensive medication from a qualified doctor (MD Medicine).
If too high blood pressure is witnessed, the patient might need to get hospitalized as decided by the treating physician (MD-General Medicine).
Ambulatory care (24 hours blood pressure monitoring) might also be necessary but only in selected cases, as decided by the physician (MD-Medicine), who is in charge of facilitating the proper treatment to the concerned patient of hypertension.
Doctors usually advise the following blood tests to be conducted on the patient.
Fasting and post-prandial blood sugar
Lipid Profile – Serum cholesterol, HDL Cholesterol, LDL cholesterol, VLDL Cholesterol, HDL/LDL ratio, and total triglyceride level
Thyroid function tests – T3, T4, and TSH
Serum creatinine and blood urea nitrogen
Serum electrolytes like – Sr Sodium and Serum Potassium.
Here are a few other tests that will help to determine the real cause of your heart-related symptoms.
An electrocardiogram helps to record and monitor the heart’s electrical activity.
An echocardiogram helps to take a detailed picture of the heart using ultrasound to know the effects of hypertension on the heart.
Coronary angiography is primarily done to examine the blood flow through coronary arteries.
An exercise stress test is typically done to look at how your heart responds to exercises.
A nuclear stress test helps to examine the flow of blood into the heart.
Signs of hypertension and treatment of hypertension –
Theses have many important perspectives .These are discussed in detail in this article.
Hypertension is said to be a silent killer.
In early stage there are no symptoms of hypertension.
Heart disease and stroke are resulted only in prolonged ,untreated cases.
In early ,mild cases of hypertension there are no clinical features such as headache, epistaxis (Epistaxis is bleeding through the nose which occurs when the blood pressure rises to very high levels due to which the capillaries of the nasal septum cannot withstand so much high blood pressure –hypertension and they rupture resulting in bleeding through the nose) , giddiness.
So there are no warning signs at all in early mild hypertension. So our suggestion is that any individual of or above 40 yrs of age should get his blood pressure checked by a qualified and experienced MD General medicine specialist doctor.
Just as we have mentioned in our article on symptoms of diabetes on healthuseful.com
that all individual of or above the age of 40 yrs should get their Random blood sugar done, whether or not he has any symptoms. As we should not wait for the day when symptoms arise, rather we should know the things well in advance rather than face the problem when it is too late. healthuseful.com
helps to increase the awareness among the people. So you may visit this website every 10-15 days as new health related articles are posted in it in this duration by MD General Medicine and ENT specialist doctors.
You can purchase automatic BP measuring instrument at home -Trade name -Omron-is very popular in India.
Normal range of systolic blood pressure-systolic hypertension should not be more than 120 mm Hg and normal diastolic blood pressure -diastolic hypertension should be below 80 mm Hg.
At risk or pre –hypertension means systolic blood pressure of
120-139 mm Hg and diastolic blood pressure between 80-89 mm Hg . If systolic blood pressure is 140 mm Hg or more and if diastolic blood pressure is 90 mm Hg or more then it is hypertension .
Headache ,epistaxis occur in hypertensive crises.
Hypertensive crisis occurs when the systolic blood pressure rises above 180 mm Hg and the diastolic blood pressure rises above 120 mmHg .
Epistaxis ,headache,chest,pain, seizures ,difficulties in breathing, bleeding through urine, irregular heartbeat, pounding in neck, ears, chest, dizziness, nervousness,bleeding spots in eyes, facial flushing, sweating,organ damage, pulmonary oedema, heart attack, bleeding into brain(stroke),aneurysm (aortic dissection), can occur in this situation hypertension in the stage of hypertensive crisis.
In such cases an ambulance should be called for which has oxygen facility, with minimum 2 wardboys and attitude to shift the patient in hospital of a qualified and experienced MD General Medicine doctors.
SCAD-Spontaneous coronary artery dissection is a condition which can occur in cases of extreme hypertension in which there is tear of coronary artery-thereby reducing the blood supply to the heart.
Symptoms of SCAD are almost same as myocardial infarction.
In such cases, an ambulance should be called which has an oxygen facility, with minimum 2 ward boys and attitude to shift the patient in the hospital of a qualified and experienced MD General Medicine doctor.
A brief introduction to Hypertension-
What is blood pressure?
Basically, all have blood pressure.
Blood pressure is the pressure exerted by the flowing blood on the walls of the blood vessels. It also helps to counteract the atmospheric blood pressure which is acting on us.
In India when we say that some individual has blood pressure problem then it means that his blood pressure is elevated.
Blood pressure should always remain in the normal range. If it is above or below the normal range, it can cause problems. Hypertension means elevated blood pressure .Diastolic blood pressure -diastolic hypertension increases as the resistance of peripheral blood vessels increases due to increase in hardness, decrease in elasticity ,elevated cholesterol levels elevated blood sugar levels and various other reasons that we can discuss later in this article.
Treatment of hypertension.-
Life style change is important in this.
Hurry, worry and curry are the three things that should be avoided.
Nowadays all want to achieve success in very small amount of time.
Perseverance and patience are not known or acceptable to most of the people.
Certain philosophy things are also important in this.
Always do the ethical things.
People doing unethical things, for them their inner subconsciousness always does criticism to them.
So although they may become successful, they never become happy.
On the contrary an individual doing ethical things may not earn much in life, but definitely he has got peace of mind.
Always try to remain satisfactory in life.
Our work is to do efforts only, whether we will receive reward order not it is entirely in the hands of God, so always do ethical things and forget about the result .
Afterall if you have lot of wealth but no health then the wealth is totally useless.
Peace of mind is extremely important in life.
Physical exercise –
High intensity exercise for 75 minutes per week
OR 150 minutes moderate exercise per week is recommended for hypertension patients.
Before that aged patients or patients above age of 40 yrs should undergo an ECG, or Stress ECG to avoid untoward things, as per consultantation of your qualified and experienced MD General Medicine doctor.
Activities suggested -walking at least 45 minutes per day
Stress relaxation techniques like-
To give up addictions like
Running behind addictions to reduce stress should be avoided
These things can elevate the blood pressure-cause hypertension.
Smoking can also result in heart problems .
Nowadays we find people making diagnosis and treatment directly from Google -which should not be done at all.
These things are just to increase your knowledge.
We always recommend treatment from qualified experienced MD General Medicine doctor.
Investigations in hypertension-
For investigations in hypertension pl click on this link given below
Treatment of Hypertension –
Medications for hypertension –
Calcium channel blockers ,vasodilators,
Blood pressure should always remain in the normal range. If it is above or below the normal range, it can cause problems. Hypertension means elevated blood pressure .Diastolic blood pressure increases as the resistance of peripheral blood vessels increases due to increase in hardness, decrease in elasticity ,elevated cholesterol levels elevated blood sugar levels and various other reasons that we can discuss later in this article.
What is benign hypertension heart disease?
Definition. A condition of mild to moderate high blood pressure (hypertension) that has no identifiable cause.This signifies the importance of health check ups .Very mild hypertension does not have any signs and symptoms,only when it reaches moderate or advanced stage it starts showing signs and symtoms. So health check ups are very impotant in which BP assesment,ECG ,lipid profile,blood sugar are done ,for further details pl through this article above.