August 2014

High Blood Pressure - Hypertension

 

High Blood Pressure - Hypertension

Hypertension is the medical term for high blood pressure. It does not refer to being tense, nervous or hyperactive. You can be a calm, relaxed person and still have high blood pressure. High blood pressure usually has no symptoms. In fact, many people have high blood pressure for years without knowing it. That's why it's so dangerous. Hypertension is one of the most common and potentially dangerous medical problem in our society. There are basically two kinds of hypertension:

 

1) Essential or Labile Hypertension

2) Organic Hypertension or Secondary Hypertension

 

In both of these conditions blood pressure is elevated above normal. However, in each the cause of the elevation of blood pressure is different. Essential Hypertension refers to the kind of hypertension that does not have a specific cause. Often when doctors are asked what essential hypertension is, they ultimately tell us that medical science has no answer. That there with no indication as to why blood pressure is elevated. Other doctors may say that blood pressure is elevated because of stress within that individual's life. Organic Hypertension occurs when there is a specific known cause such as related to or caused by diseases or tumors of the kidneys, heart, vascular or hormonal systems.

Essential or Labile Hypertension is a diagnosis of exclusion. That is, one cannot clearly make this diagnoses until all other forms of organic causes for elevated blood pressure have been eliminated.

Organic hypertension is a general category made up of many different and unrelated problems that have at least one common symptom, high blood pressure. Each of these independent conditions have other symptoms but the only thing they may have in common is elevation of the blood pressure. The diagnoses of hypertension must be made by taking a careful medical history and performing a careful physical examination. Appropriate laboratory and diagnostic testing are used to confirm or reject the suspected causes of the elevated blood pressure. In most of these conditions hypertension is the end result of physical changes in the body that lead to elevated blood pressure.

Essential hypertension differs in that there is, by definition, no disease or pathologic condition causing it. There are, however, causes but they are not of organic origin. While many physicians disagree as to what these specific causes are there is agreement on the fact that true essential hypertension is often related to stress within the individual, or their life. Other factors such a diet, obesity, and lack of exercise frequent factors that must be considered as predisposing factors.

 

What Are the Effects of High Blood Pressure?

High blood pressure (hypertension) killed 39,981 Americans in 1995 and contributed to the deaths of another 190,000 persons.

  • As many as 50 million Americans aged 6 and older have high blood pressure.
  • Of those people with high blood pressure, 35% don't know they have it.
  • Of all hypertensive people, 52% are not on therapy (special diet or drugs), 27% are on inadequate therapy, and only 21% are on adequate therapy which controls their blood pressure.
  • The cause of 90-95% of the cases of high blood pressure isn't known; however, high blood pressure is easily detected and usually controllable.
  • From 1985 to 1995 the death rate from high blood pressure remained the same.
  • Blacks, Puerto Ricans, and Cuban and Mexican Americans are more likely to suffer from high blood pressure than are non-Hispanic whites.
  • People with lower educational and income levels also tend to have higher levels of blood pressure.
  • In 1995 the death rates from high blood pressure were 6.8 per 100,000 white males, 31.0 per 100,000 black males, 5.0 per 100,000 white females and 22.2 per 100,000 black females.
  • Cardiovascular disease (heart attacks, stroke) claims more lives annually than all cancers combined, killing approximately one million people in the U.S. each year. It disables countless others. Hypertension is often intimately involved in this process
  • Individuals with uncontrolled high blood pressure are:
        
    ο Seven times more likely to have a stroke.
        
    ο Six times more likely to develop congestive heart failure.
        
    ο Three times more likely to have a heart attack
     
  • What Factors Increase the Chance That a Person Will Develop High Blood Pressure?

    Heredity

  • Race-African Americans are more likely to have high blood pressure than white Americans.
  • Male sex
  • Age
  •  

    What Controllable Factors Contribute to High Blood Pressure?

  • Sodium (salt) sensitivity
  • Obesity and overweight
  • Heavy alcohol consumption
  • Use of oral contraceptives and some other medications
  • Sedentary or inactive lifestyle
  •  

    Because medical science doesn't understand the causes of most cases of high blood pressure, it's hard to say how to prevent it. Still, several factors may contribute to it. Being overweight or using excessive salt are two avoidable factors.

    Age is one risk factor that can't be changed. Generally speaking, hypertension is more common in middle age and the elderly, but children can also have elevated blood pressure. Generally, the older people get, the more likely they are to develop high blood pressure.

    Heredity is another factor. People whose parents have high blood pressure are more likely to develop it than those whose parents don't. African Americans are also more likely to have high blood pressure than whites.

    While the incidence of high blood pressure isn't directly related to a person's sex, hypertension is more common in men. Women may be more prone to hypertension blood pressure during pregnancy or when she is taking oral contraceptives. Some women who have never had high blood pressure develop it during pregnancy. Similarly, a woman taking oral contraceptives are more likely to develop high blood pressure if she's overweight, has had high blood pressure during pregnancy, has a family history of high blood pressure or has mild kidney disease.

    Some medications also can raise blood pressure and/or interfere with the effectiveness of antihypertensive drugs. If you have high blood pressure, you should tell your doctor all of the prescribed and over-the-counter medicines you are taking. Drugs as steroids, non-steroidal anti-inflammatory drugs (NSAIDs), nasal decongestants and other cold remedies, appetite suppressants (diet pills), cyclosporine, erythropoetin, tricyclic antidepressants, and monoamine oxidase inhibitors are often associated with hypertension.

     

    What Is Blood Pressure?

    Blood pressure is the result of two forces. One is created by the heart as it pushes blood into the arteries and through the circulatory system. The other is the force of the arteries as they resist the blood flow.


    What Do Our Blood Pressure Numbers Tell Us?

    The higher (systolic) number represents the pressure while the heart is beating.

    The lower (diastolic) number represents the pressure when the heart is resting between beats.

    The systolic number is always stated first and the diastolic number is listed second. For example, 122/76 (122 over 76); systolic = 122, diastolic = 76.

    Blood pressure of less than 140 over 90 is considered a normal blood pressure reading for adults. A diastolic pressure of 85 to 89 needs to be watched carefully. A blood pressure reading equal to or greater than 140 over 90 is considered elevated or high (See Table-1).

    Blood pressure is measured in millimeters of mercury (mm Hg). The classifications in the following table are for persons who are not taking antihypertensive drugs and are not acutely ill. When systolic and diastolic pressures fall into different categories, the physician will select the higher category to classify the person's blood pressure status. Diagnosis of high blood pressure is based on the average of two or more readings taken at each of two or more visits after an initial screening.

    Classification of blood pressure for adults, age 18 years and older, with recommended follow-up:

    Category

    Systolic (mm Hg)

     

    Diastolic (mm Hg)

    Follow-up recommended

    Optimal

    <120

    and

    <80

    Recheck in 2 years

    Normal

    < 130

    and

    < 85

    Recheck in 2 years

    High normal

    130 - 139

    or

    85-89

    Recheck in 1 year


    Hypertension (High Blood Pressure)

    STAGE 1 (Mild)

    140 - 159

    or

    90 - 99

    Confirm within 2 months

    STAGE 2 (Moderate)

    160 - 179

    or

    100 - 109

    Evaluate within 1 month

    STAGE 3 (Severe)

    180

    or

    110

    Evaluate immediately or within 1 week depending on clinical situation

    The above table was taken from the Sixth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure, NIH publication, 1997.

    Table -1

     

    How Can You Tell If You Have High Blood Pressure?

    A single elevated blood pressure reading doesn't mean you have high blood pressure, but it's a sign that further observation is required. Ask your doctor how often you should check it or have it checked.

    Your doctor or other qualified health professional should check your blood pressure at least once every two years. The only way to find out if you have high blood pressure is to have your blood pressure checked.

    When high blood pressure is severe symptoms do appear. Warning signs can include nosebleeds, racing or irregular heartbeat, headaches, and dizziness. However, it's a mistake to conclude that you don't have high blood pressure if you do not have any symptoms. As we suggested above this may not be true and can be a dangerous and inaccurate assumption.


    How Does Diet Relate to Hypertension?

    Diet has long been considered a primary factor in hypertension. The foods most commonly associated are foods that are high in fat (especially those that causes elevation of cholesterol and triglycerides), refined foods (processed and sugary foods), and foods high in salt or sodium.

     

    How Do Salt and Sodium Affect High Blood Pressure?

    Most Americans consume far more salt (sodium) than their bodies need. Heavy sodium consumption increases blood pressure in many people, leading to high blood pressure. People who are diagnosed with high blood pressure are often placed on restricted-sodium diets.

    Reducing sodium (or salt) consumption may help lower blood pressure in some people. Your doctor may recommend a sodium (salt) restricted diet. This will mean you'll have to avoid salty foods and cut down on the amount of salt you use in cooking and at the table.

    The American Heart Association suggests that in order to reduce your risk of hypertension to reduce your sodium intake to no more than 2400 milligrams per day. This is about 1¼ teaspoons of sodium chloride (salt). To illustrate, the following are sources of sodium in the diet.

    ¼ teaspoon salt = 500 mg sodium
    ½ teaspoon salt = 1000 mg sodium
    ¾ teaspoon salt = 1500 mg sodium
    1 teaspoon salt = 2000 mg sodium
     

    What Are the Common Sources of Sodium?

    When you must watch how much sodium (salt) you eat, you must be aware of both natural sodium content and added sodium content. Ordinary table salt is sodium chloride -- 40 percent sodium by weight. When you buy prepared and packaged foods, read the labels and look for the different sodium compounds that are added to foods. Watch for the words "soda" (soda refers to sodium bicarbonate, or baking soda) and "sodium" and the symbol "Na" on labels. These are products that contain sodium compounds.

    Some drugs contain large amounts of sodium. Make it a practice to read carefully the labels on all over-the-counter drugs. Look at the ingredient list and warning statement to see if sodium is in the product. A statement of sodium content must appear on labels of antacids containing 5 mg or more per dosage unit (tablet, teaspoon, etc.) Some companies are now producing low-sodium over-the-counter products. If in doubt, ask your physician or pharmacist if the drug is appropriate for your use.

    Most spices naturally contain sodium in very small amounts and hence can be used in place of sodium to flavor and "spice up" your diet.


    How Does Body Weight Affect Hypertension?

    Studies have shown that body weight, changes in body weight over time, and skinfold thickness are related to changes in blood pressure levels. These factors have been linked to the subsequent rise and development of high blood pressure. People who are overweight are more likely to have high-normal to mild high blood pressure.

    Statistics show that most people who have high blood pressure are also overweight. If you are overweight or have gained weight over time, you'll be advised to cut down on calories and lose weight. Your doctor can prescribe a diet that's right for you.

    If you're given a diet, follow it closely, including any recommendations about reducing your consumption of alcohol. Alcoholic drinks are high in non-nutritious calories, so if you're trying to lose weight, avoid alcoholic beverages. Often when people lose weight, their blood pressure drops as well.

     

    How Does Exercise or Lack of Exercise Affect Hypertension?

    Physical inactivity is a risk factor for heart disease. In addition, a sedentary or inactive lifestyle tends to contribute to obesity, a risk factor for both high blood pressure and heart disease. Regular exercise helps control weight and lower blood pressure. Don't be afraid to be active -- exercise should definitely be part of your daily program. Besides helping to reduce your risk of heart attack, it can also help you lose weight or maintain a healthy weight.

     

    What is the Relationship Between Stress and Hypertension?

    Clearly we know that stress is often connected with hypertension, but how does stress lead to hypertension? We all have stresses in our daily life, but everyone does not end up having hypertension. Therefore stress itself could not be the cause of hypertension. This is true, it is not stress itself that causes hypertension, but rather the way that we - our bodies, nervous system and cardiovascular system - handle the stresses that seem to be important. In order to understand this we must first understand what stress really is and how it affects the body.

    The basis of the stress reaction is a reflex that occurs in every animal, including humans, that has ever existed, the Flight or Fight Response. This response is an automatic process based on natures' desire to protect the individual from predators. This reflex is designed to protect us by creating the individual to respond to a threat by either fighting or turning and running from the danger. This reflex is in breed into us and cannot be turned on and turned off by intention or desire. The reflex works and works well. Consider our ancient ancestor who was moving through the jungle, he hears a noise, if he ignores the noise and it is a tiger, the tiger could have jumped on him and eaten him. If, on the other hand, he either turns and fights the tiger or runs to get away from the tiger he might have a greater chance of surviving.

    The Fight or Flight Reflex is not smart, and it cannot always determine the difference between real and imagined dangers. The reflex cannot always differentiate between that which is life threatening and that which is just a threat. Hence, since these reflexes are automatic and not under our control, the fight or flight responses can be triggered by even imaginary or non-life threatening events, even those which are normal events of our everyday life.

     

    Why Is High Blood Pressure Harmful?

    Elevated blood pressure indicates that the heart is working harder than normal, putting both the heart and the arteries under a greater strain. This may contribute to heart attacks, strokes, kidney failure, damage to the eyes (blindness) and hardening of the arteries or atherosclerosis. If high blood pressure isn't treated, the heart may have to work progressively harder to pump enough blood and oxygen to the body's organs and tissues to meet their needs.

    When the heart is forced to work harder than normal for an extended time, it tends to enlarge. A slightly enlarged heart may function well, but one that's significantly enlarged has a hard time meeting the demands put on it.

    Arteries and arterioles also suffer the effects of elevated blood pressure. Over time they become scarred, hardened and less elastic. This may occur as people age, but elevated blood pressure speeds this process, probably because hypertension accelerates atherosclerosis.

    Arterial damage is bad because hardened or narrowed arteries may be unable to supply the amount of blood the body's organs need. If the body's organs don't get enough oxygen and nutrients, they can't function properly. There's also the risk that a blood clot may lodge in an artery narrowed by atherosclerosis, depriving part of the body of its normal blood supply. The heart, brain and kidneys are particularly susceptible to damage by high blood pressure.

     

    How Can We Treat Hypertension?

    There are many different methodologies for treating hypertension. Some are simple and easy to do while others are complicated and require the use of medications. The simplest forms of treatment are usually reserved for the lower level, Stage I or even early Stage II hypertension. These include salt reduction and dietary changes, meditation, relaxation and/or breathing exercises, physical exercise, changing our lifestyle such as changing jobs, problem solving or eliminating situations or contact with people who stress us and cause our blood pressure to go up.

     

    What Can I Do To Prevent Having High Blood Pressure?

    The following factors can help you to prevent hypertension or lower your blood pressure if you already suffer from hypertension:

  • Watch your weight. If you weigh 30 percent or more above your ideal body weight, you are more likely to develop hypertension.
  • Drink no more than 3 drinks or 3 oz. of alcohol a day. (Remember, one beer, one high ball or one glass of wine each contain 1 oz. of alcohol.)
  • Eat foods that are low in fat, cholesterol and salt. Avoid fried food and red meat. Limit the use of butter, oil and fat in cooking.
  • Eat more fruits, vegetables, whole grain cereals, rice and breads.
  • Don't smoke. Although smoking doesn't cause hypertension, it can increase your risk of heart disease and stroke.
  • Exercise regularly. Try to get 30 minutes of activity at least three to four times a week. Without exercise, it is easier to become overweight, increasing your blood pressure.
  • If you often feel stressed, take time to relax.
  •  

    How Can You Can Reduce the Sodium in Your Diet?

  • Choose fresh, frozen or canned food items without added salts.
  • Select unsalted nuts or seeds, dried beans, peas and lentils.
  • Avoid adding salt and canned vegetables to homemade dishes.
  • Select unsalted, fat-free broths, bouillons or soups.
  • Select skim milk or low-fat milk, low-sodium, low-fat cheeses, as well as low-fat yogurt.
  • When dining out, be specific about what you want and how you want it prepared. Request preparation of your dish without salt.
  • Learn to use spices and herbs to enhance the taste of your food.
  •  

    In many cases, especially the higher end of Stage II and Stage III hypertension, the above listed treatments even when performed in combinations may not be enough. In such cases, antihypertensive medications may have to be added to the treatment program.

     

    How Does Medicine Help Control High Blood Pressure?

    For some people, weight loss, sodium reduction and other lifestyle changes won't lower high blood pressure as much as it needs to be lowered. If that's your situation, you will probably need to take medication. Many medications are available to reduce high blood pressure. Some get rid of excess fluid and sodium (salt). Others relax constricted blood vessels. Others prevent blood vessels from constricting and narrowing. Because there is usually no cure for high blood pressure, treatment generally must be carried out for life. If treatment is stopped, the pressure may rise again.

     

    Remember:

  • Have your blood pressure checked regularly (See Table-1). If you are at high risk because of your weight or other medical conditions make sure that your doctor is aware of you and following you at regular intervals.
  • If you are already on medication be sure that you are following your doctor's instructions precisely, if you are unsure of what your treatment program is discuss it with your doctor before any problems arise.
  • Hypertension and its long term effects are preventible, but only if you know exactly what to do.
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