HYPERTENSION

1.What is Hypertension(High Blood Pressure)?

  • Blood pressure(BP) is defined as a pressure applied by the blood against the wall of blood vessels through which it flows. The rise in the blood pressure than the normal value(we generally consider it ; 120 mm Hg systolic and 80 mm Hg diastolic) is called high blood pressure(ie.Hypertension).

To understand this,following details are to be defined:

In our body,heart is one of the important organ.It acts as a pump to circulate the blood throughout our body. When the heart contracts(systole),blood flows from the heart to the vessels  and when it dialates(diastole),blood flows towards the heart. During this process , definite amount of pressure is applied by the flowing blood against the wall of blood vessels,this pressure is called blood pressure. It is measured in unit as mm of Hg(ie. mercury). The systolic pressure is up pressure and diastolic pressure is down pressure.thus, wriiten as systolic pressure/diastolic pressure.eg 120/80 mm Hg.

Increase in blood pressure beyond the level of (120-129)/(80-89) mm Hg is called high blood pressure. And, the decrease in blood pressure below the level of (110-120)/(70-80) mm Hg is considered as low blood pressure(called hypotension).

 

2. Classification of Hypertension:

There are mainly two types of hypertension:-

  1. Primary hypertension

  2. Secondary hypertension

a.Primary hypertension:-

  • This hypertension is seen in adults and after age of 18 years.

  • 90-95% of hypertension cases are primary hypertension.

  • Dietary and lifestyle imbalance , genetic influence are considered the cause of primary hypertension.

b.Secondary hypertension:-

  • This hypertension is seen in children below 18 years of age.

  • About 5-10% hypertension cases are secondary hypertension.

  • This case of hypertension is due to disease conditions like; kidney damage,renal artery stenosis(narrowing of blood vessel of kidney), renin producing tumor,urinary tract obstruction,etc.

3.Classification of hypertension stages:

Based on recommendations of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), the classification of BP for adults aged 18 years or older has been as follows :

  1. Normal: Systolic lower than 120 mm Hg, diastolic lower than 80 mm Hg

  2. Prehypertension: Systolic 120-139 mm Hg, diastolic 80-89 mm Hg

  3. Stage 1: Systolic 140-159 mm Hg, diastolic 90-99 mm Hg

  4. Stage 2: Systolic 160 mm Hg or greater, diastolic 100 mm Hg or greater


 

4. What are the signs and symptoms of hypertension?

  • 96-98% patients donot show any signs and symptoms in general.Thus, hypertension is also considered as a silent killer . A patient with blood pressure as high as 180/130 mm Hg might not show any symptoms and may die suddenly.

  • Only 2-4% patients present the signs and symtopms.Generally seen signs and symptoms are as follow:

  • Chronic headaches that lasts for days

  • Dizziness or vertigo

  • Blurry or double vision

  • Drowsiness

  • Nausea

  • Shortness of breath,usually this occurs when people start to get a little concerned.

  • Heart Palpitation(irregular heart beats)

  • Nose bleeds(due to breakdown of blood vessels in nose)

  • Redness of eyes(due to rupture of blood vessels in eyes)

  • Tinnitus

  • A flushed face

  • Fatigue(general tiredness)

  • A strong need to urinate often(especially during the night)


 

5.What are the dietary and lifestyle modifications to be considered for hypertension patients?

Primary hypertension is mainly caused due to imbalance in diet and lifestyle.Following are the recommendations for patients of hypertension:-

 

  • Weight management; reduction of body weight by 10 kg reduces blood pressure approximately by 10/8 mm Hg.

  • Reduction in dietary salt consumption(daily salt requirement for our body is only 6 gm,this may reduce BP by 10-12 mm Hg)

  • Increase physical exercise/activity to 30-45 minutes,4 times a week(this can lower BP by 8/4 mm Hg and helps in weight management also).

  • Increase consumption of fruits and green vegetables(at least 4 serving per day but without salt, this can lower BP by 6/3 mm Hg)

  • Limit alcohol intake to no more than 1 oz(ie .30 ml) of ethanol per day for men or 0.5 oz(ie.15 ml) for women. Because alcohol intake imediately increases blood pressure resulting in complications like coma,paralysis.

  • Avoid tobacco and cigarette smoking

  • Also reduce intake of dietary saturated fat and cholesterol for overall healthy heart.

  • Stress management

6. What are the health complications of high blodd pressure?

  • The most dangerous complication of hypertension is Brain stroke(ie.brain haemorrhage). Excessive increase in blood pressure causes rupture of blood vessels in brain causing brain haemorrhage which may result in paralysis and even cause sudden death.

  • Heart attack and Heart failure

  • Blindness ,ie. retinopathy(due to breakdown of blood vessels in eys and if bleeding occurs inside retina,this may lead to blindness)

  • Kidney failure

  • Artherosclerosis

7. is there any chance of hypertension in pregnancy?

  • Yes, there is. At the third trimester(sixth to ninth months),some pregnant women shows increase in blood pressure, along with swollen feet and presence of protien in urine. This condition is called Pre-eclampsia.

This condition needs immediate medical check up to avoid the fatal complications for both mother and foetus.

 

8. Medicines causing hypertension?

  • Yes, some medicines cause increase in blood pressure as a side effect. Following are few of them:

  • Contraceptive pills (levonorgestrel)

  • Depot and Norplant used for temporary family planing also may cause increase in bloof pressure in some patients.

  • Steroids used in asthma (fluticasone,Beclomethasone)

  • NSAIDs/Painkillers (declofenac,Ibuprofen)

9.Does a hypertension patient need to take medicine for lifetime?

  • Yes, if his/her blood pressure is not controlled.

  • No, if patients’ blood pressure is controlled and reduced to the normal level. If a patient followed his/her lifestyle,dietary modification and  his/her blood pressure controlled and reduced to normal ,the dose of medicine may be reduced and even stopped .But, this must be done only under medical professionals supervision otherwise this may lead to even the worse case scenarios.

10. Are there any side effects of medicines that are used to lower  blood pressure?

  • Yes ,there are and these side effects should be reported to the doctor.

  • Some of such side effects are as follow:

  • Swollen feet in amlodipine use(20 % patients show this side effect)

  • ACE inhibitors(enalapril,captopril,lisinopril) may cause dry cough in some.

  • Beta blocker medinces(atenolol,metoprolol,prapranolol) may increase asthma attack in asthamatic patients.

 

  • These side effects should be reported to the doctor and he/she will switch other medicine(drugs).

11. What is White Coat Hypertension?

  • A transient increase in blood pressure in normal individuals,when blood pressure is recorded in physician’s room or in hospital, is called white coat hypertension.

  • This is due to anxiety toward the personnel wearing/with white coat,such as Doctor,Nurse,Pharmacist.