Hypertension

admin Pormoll

INTRODUCTION
Blood pressure is the force exerted by circulating blood against the walls of the body’s arteries, the major blood vessels in the body. Hypertension is when blood pressure is too high.Hypertension is a serious medical condition that significantly increases the risks of heart, brain, kidney and other diseases.An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension, most (two-thirds) living in low- and middle-income countries.Blood pressure is written as two numbers. The first (systolic) number represents the pressure in blood vessels when the heart contracts or beats. The second (diastolic) number represents the pressure in the vessels when the heart rests between beats.


RISK FACTORS
They include:
● A diet high in salt, fat, and/or cholesterol.
● Chronic conditions such as kidney and hormone problems, diabetes, and high cholesterol.
● Family history, especially if your parents or other close relatives have high blood pressure.
● Lack of physical activity.
● Older age (the older you are, the more likely you are to have high blood pressure).
● Being overweight or obese.
● Race (non-Hispanic black people are more likely to have high blood pressure than people of other races).
● Some birth control medicines and other medicines.
● Stress.
● Tobacco use or drinking too much alcohol.

One can have high blood pressure for years without any symptoms. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke. Fortunately, high blood pressure can be easily detected.

SIGNS AND SYMPTOMS
Hypertension is called a “silent killer”. Most people with hypertension are unaware of the problem because it may have no warning signs or symptoms. For this reason, it is essential that blood pressure is measured regularly.When symptoms do occur, they  can include:

  • Early morning headaches
  • Nosebleeds
  • Irregular heart rhythms
  • Vision changes
  • Buzzing in ears

Severe hypertension can cause fatigue, nausea, vomiting, confusion, anxiety, chest pain, and muscle tremors.

COMPLICATIONS
Among the complications hypertension causes serious damage to the heart. Excessive pressure can harden arteries, decreasing the flow of blood and oxygen to the heart. This elevated pressure and reduced blood flow can cause:

  •  Chest pain, also called angina.
  • Heart attack, which occurs when the blood supply to the heart is blocked and heart muscle cells die from lack of oxygen. The longer the blood flow is blocked, the greater the damage to the heart.
  • Heart failure, which occurs when the heart cannot pump enough blood and oxygen to other vital body organs.
  •  Irregular heart beat which can lead to a sudden death.
  • Hypertension can also burst or block arteries that supply blood and oxygen to the brain, causing a stroke.
  •  Hypertension can also cause kidney damage, leading to kidney failure.

DIAGNOSIS:

  • High blood pressure is diagnosed with a blood pressure monitor. This is a common test for all doctor visits. A band (cuff) is placed around the arm. The band is attached to a small pump and a meter.
  • On squeezing the pump, there is a feeling of tightness around the arm. Following this the meter is observed for the readings. This provides us with 2 numbers that make up your blood pressure.
  • The top number is your systolic reading (the peak blood pressure when your heart is squeezing blood out). The bottom number is your diastolic reading (the pressure when your heart is filling with blood.

Hypertension is diagnosed if, when it is measured on two different days, the systolic blood pressure readings on both days is ≥140 mmHg and/or the diastolic blood pressure readings on both days is ≥90 mmHg.

Laboratory Blood tests employed:
These include tests to determine any causative factors and also to rule out any complications
1. Renal function tests: includes tests like Blood Urea and Serum Creatinine.
2. Lipid Profile: Lipid deposits in blood vessels seen in patients with high cholesterol could be one of the causative factors of hypertension and can also cause complications like Heart attack etc.
3. Blood Sugar levels: Fasting, Post Prandial, Random.4. HbA1C Other tests include: ECG, Cardiac Echocardiogram, Urine analysis, Eye checkup

PREVENTIVE MEASURES AND TREATMENT
If your high blood pressure is caused by lifestyle factors, you can take steps to reduce your risk:

  • Lose weight.
  • Stop smoking.
  • Eat properly.
  • Exercise.
  • Lower your salt intake.
  • Reduce your alcohol consumption.
  • Learn relaxation methods.

One of the steps to lower your high blood pressure is to start using the DASH diet. DASH stands for Dietary Approaches to Stop Hypertension (high blood pressure).

The diet is simple:

  • Eat more fruits, vegetables, and low-fat dairy foods.
  • Cut back on foods that are high in saturated fat, cholesterol, and trans fats.
  • Eat more whole-grain foods, fish, poultry, and nuts.
  • Limit intake of salt, sweets, sugary drinks, and red meats.

– If your high blood pressure is caused by disease or the medicine you take, taking a different medicine may help.

– Treating any underlying disease (such as controlling your diabetes) can help reduce your high blood pressure.

– additionally, you will need to get used to regular blood pressure checks and eye check ups to evaluate the need to adjust the dose of the medications if the blood pressure is still not in control.

MEDICATIONS

  • The goal of medicines is to reduce your blood pressure to normal levels. Your doctor may prescribe medicine that’ easy to take and has few, if any, side effects.
  • If your blood pressure can only be controlled with medicine, you’ll need to take the medicine for the rest of your life.
  • It is common to need more than one medicine to help control your blood pressure.
  • One has to take these medications lifelong, unless told by the doctor to stop.

 Dr. Noel Menezes M.D
Associate Professor
Department of Biochemistry
Goa Medical College