HYPERTENSION


Introduction- High blood pressure (hypertension) is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.
Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure. A blood pressure reading is given in millimeters of mercury (mm Hg). It has two numbers.

Top number (systolic pressure)- The first, or upper, number measures the pressure in your arteries when your heart beats.
Bottom number (diastolic pressure)- The second, or lower, number measures the pressure in your arteries between beats.


Causes:-
There are two types of high blood pressure.
Primary (essential) hypertension –
For most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years.

Secondary hypertension –
Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:

  • Obstructive sleep apnea
  • Kidney disease
  • Adrenal gland tumors
  • Thyroid problems
  • Certain defects you’re born with (congenital) in blood vessels
  • Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
  • Illegal drugs, such as cocaine and amphetamines


Risk factors –
High blood pressure has ma8ny risk factors, including:
Age – The risk of high blood pressure increases as you age. Until about age 64, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
Family history – High blood pressure tends to run in families.
Being overweight or obese – The more you weigh, the more blood you need to supply oxygen and nutrients to your tissues. As the amount of8 blood flow through your blood vessels increases, so does the pressure on your artery walls. Not being physically active.
Using tobacco – Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart disease. Secondhand smoke also can increase your heart disease risk.
Too much salt (sodium) in your diet – Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
Too little potassium in your diet –Potassium helps balance the amount of sodium in your cells. A proper balance of potassium is critical for good heart health. If you don’t get enough potassium in your diet, or you lose too much potassium due to dehydration or other health conditions, sodium can build up in your blood.
Drinking too much alcohol – Over time, heavy drinking can damage your heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure.
Stress – High levels of stress can lead to a temporary increase in blood pressure. Stress-related habits such as eating more, using tobacco or drinking alcohol can lead to further increases in blood pressure.
Certain chronic conditions – Certain chronic conditions also may increase your risk of high blood pressure, including kidney disease, diabetes and sleep apnea.

SYMPTOMS :-
– headaches
– shortness of breath or
– nosebleeds.

Complications :-
The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels as well as your organs. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.
Uncontrolled high blood pressure can lead to complications including:
1. Heart attack or stroke – High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
2. Aneurysm
3. Heart failure
4. Weakened and narrowed blood vessels in your kidneys – This can prevent these organs from functioning normally.
5. Thickened, narrowed or torn blood vessels in the eyes – This can result in vision loss.
6. Metabolic syndrome
7. Trouble with memory or understanding.
8. Dementia.

Blood pressure measurements fall into several categories:-
Normal blood pressure – Your blood pressure is normal if it’s below 120/80 mm Hg.

Elevated blood pressure – Elevated blood pressure is a systolic pressure ranging from 120 to 129 mm Hg and a diastolic pressure below (not above) 80 mm Hg. Elevated blood pressure tends to get worse over time unless steps are taken to control blood pressure. Elevated blood pressure may also be called prehypertension.

Stage 1 hypertension – Stage 1 hypertension is a systolic pressure ranging from 130 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg.

Stage 2 hypertension – More-severe hypertension, stage 2 hypertension is a systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher.

Hypertensive crisis – A blood pressure measurement higher than 180/120 mm Hg is an emergency situation that requires urgent medical care.

Tests:-
If you have high blood pressure, your doctor may recommend tests to confirm the diagnosis and check for underlying conditions that can cause hypertension.
Ambulatory monitoring – This 24-hour blood pressure monitoring test is used to confirm if you have high blood pressure. The device used for this test measures your blood pressure at regular intervals over a 24-hour period and provides a more accurate picture of blood pressure changes over an average day and night.

Lab tests – Your doctor may recommend a urine test (urinalysis) and blood tests, including a cholesterol test.

Electrocardiogram (ECG or EKG) – This quick and painless test measures your heart’s electrical activity.

Echocardiogram – Depending on your signs and symptoms and test results, your doctor may order an echocardiogram to check for more signs of heart disease. An echocardiogram uses sound waves to produce images of the heart.

Treatment:-
Changing your lifestyle can help control and manage high blood pressure. Your doctor may recommend that you make lifestyle changes including:

  • Eating a heart-healthy diet with less salt
  • Getting regular physical activity
  • Maintaining a healthy weight or losing weight if you’re overweight or obese
  • Limiting the amount of alcohol you drink

Medications used to treat high blood pressure include:
Diuretics – Diuretics, sometimes called water pills, are medications that help your kidneys eliminate sodium and water from the body. These drugs are often the first medications tried to treat high blood pressure.
Diuretics commonly used to treat blood pressure include chlorthalidone, hydrochlorothiazide (Microzide) and others.

Angiotensin-converting enzyme (ACE) inhibitors – These medications — such as lisinopril (Prinivil, Zestril), benazepril (Lotensin), captopril and others — help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels.

Angiotensin II receptor blockers (ARBs) – These medications relax blood vessels by blocking the action, not the formation, of a natural chemical that narrows blood vessels. ARBs include candesartan (Atacand), losartan (Cozaar) and others.

Calcium channel blockers – These medications — including amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and others — help relax the muscles of your blood vessels. Some slow your heart rate.

Lifestyle and home remedies :-

  • Decrease the salt in your diet.
  • Maintain a healthy weight.
  • Eat Healthy food.
  • Increase physical activity.
  • Limit alcohol.
  • Don’t smoke.
  • Manage stress.
  • Practice relaxation or slow, deep breathing.

Dr. Gaurav Shrivastava (PT), Assistant Professor, Department of Physiotherapy, Career Point University, Kota

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