Hypertension-Eitiology of Hypertension


Hypertensionvarious 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 –
Artery stiffness.
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. …
Obesity. …
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 –
(1) obesity,
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,
(7) stress,
(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.
(11)-Older age
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.
(12)Race –
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
Black Americans
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.
11. Smoking
 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.
https://healthuseful.com/ is the link for this website.
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
Swimming .
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 –
Beta blockers,
Central  agonists,
Calcium  channel  blockers ,vasodilators,
Ace  inhibitors,
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.

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