HYPERTENSION-THE SILENT KILLER

HYPERTENSION

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HYPERTENSION

Hypertension means high blood pressure. Blood pressure is pressure exerted per unit area by blood against the walls of arteries.
Blood pressure (B.P.) is recorded in two values systolic value pressure when heart contracts and a diastolic value when heart relaxes. Naturally systolic is greater than diastolic. So a BP reading of 120/80 means systolic value of 120 & diastolic value of 80.

How to measure BP

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How to measure BP
You need a Sphygmomanometer & a stethoscope. Sphygmomanometer is used to monitor BP. A cuff is tied around the arm and is inflated. This cuff is connected to a mercury barometer. Person measuring BP uses a stethoscope to hear sound over brachial artery. Keep stethoscope over brachial artery and start inflating the cuff. You will hear sound of pulse beat, keep inflating till you do not hear any sound around 170 mm of Hg. Slowly deflate the cuff now & now note the point where you start hearing pulse beat sound in stethoscope. This is systolic value. Further deflating will lead to a point where you will again do not hear any sound this is your diastolic value.

Once high BP develops it usually lasts life long. Most of them are asymptomatic and require treatment which may prolong life long, so one should be very carefully labeled as Hypertensive. Not just one reading is enough for the purpose. At least 3 readings taken after 15 minutes of rest over 3 days are necessary

Defining hypertension

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Defining hypertension
Category -----------------------Systolic-----------Diastolic

Optimum-------------------------<120------------- <80
Normal----------------------------<130 ------------ <85
High normal----------------------130-139 ---------85-89
Mild hypertensive---------------140-159 ---------90-99
Moderate hypertensive----------160-179-------- 100-109
Severe hypertensive ------------180-209 ---------110-119
Systolic selective --------------->140-------------- <90

Types of hypertension

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Types of hypertension
1) Essential hypertension for which no cause is defined 90% of cases belong to this group
2) Secondary hypertension in which an under lying disease is present
Causes of secondary hypertension
Alcohol consumption
Smoking
Renal disorders like glomerluonephritis renal vascular disease, polycystic kidney disease
Endocrine disorders hyperaldosteronism, Cushing syndrome, pheochromacytoma, hyperthyroidism, hypothyroidism, adrenal hyperplasia, and acromegaly
Drugs like oral contraceptives (estrogen containing), steroids, aspirin ibuprofen other NSAIDS.
3) White coat hypertension .About 20% of patients gets their BP reading high when a doctor is taking the value, probably because of anxiety. If their BP is recorded by some one else at home the value is correct.
4) Accelerated hypertension. Signifies recent increase in previous levels of BP associated with vascular damage. Swelling of optic nerve may occur. pappiloedema
5) Malignant hypertension. It is a dangerous condition where BP rises to very high values, usually 200/130 or more. It is accompanied with very high level of damage to multiple organs. Retinal hemorrhage in both eyes may occur.

Risk factors

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Risk factors
Non modifiable risk factors
a) Age risk of hypertension increases with age.
b) Genetic factors risk is more in black Americans & in Japanese. also children to hypertensive parents are more vulnerable

Modifiable risk factors
a) Obesity greater the weight greater the risk of high BP.
b) Salt intake a very important factor. People taking high salt intake usually have higher readings.
c) Diet rich in saturated fatty acids increases risk of hypertension. It also leads to development of atherosclerosis further worsening the condition.
d) Physical activity. If you are sedentary worker we advise you to go for at least 20 minutes walk daily, it decreases risk of hypertension by 80%. Toning of muscles increases cardiac muscle efficiency. Plus you will also loose some weight

Risk factors

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Complications with hypertension

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Complications with hypertension
1. Stroke major cause of death in hypertensive patients. Cerebral ischemia or hemorrhage can occur
2. Hypertensive encephalopathy it includes neurological symptoms like transient disturbance of speech, vision, disorientation, abnormal sensation seizures, unconsciousness & many more.
3. Hypertensive retinopathy includes hemorrhage and areas of ischemia may lead to loss of vision or diminished vision because of attack.
4. Cardiac complications hypertension leads to LVH (left ventricular hypertrophy) but corresponding blood supply does not increases as a result there is risk of angina, myocardial infraction also it leads to increase in load on heart, damages the endothelium & valves.
5. Kidney long standing hypertension can lead to proteinuria, haematuria, increased frequency of micturation

Management of hypertension

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Management of hypertension
Well, secondary hypertension needs correction of underlying cause of disease along with antihypertensive therapy
You must consult your doctor for antihypertensive therapy.

Other important therapeutic measures are as follows

Diet. Reduce alcohol & salt intake. Fatty foods should be avoided take plenty of fiber & fruit rich diet avoid extra table salt

Smoking should be stopped

Exercise & relaxation walking is helpful meditation yoga can relieve stress related hypertension.

Management of hypertension

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Investigations to be done time to time

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Investigations to be done time to time
Urine analysis for proteins, blood, glucose
Serum creatinine & urea levels
Plasma cholesterol or Lipid profile
Chest x –ray
ECG
Plasma electrolytes