Hypertension, symptoms and cure.
- Renal parenchymal diseases (2.5-6%),
- Vascular causes (.2-4%),
- Endocrine causes (1-2%)
- exogenous(administration of steroids, oral contraceptive use),
- endogenous( primary hyperaldosteronism, cushing syndrome, pheochromocytoma, congenital adrenal hyperplasia),
- drugs and toxins (alcohol, cocaine, non-steroidal anti-inflammatory drugs(NSAID), nicotine, decongestant containing ephedrine, herbal remedies containing licorice or ephedrine).
- Other causes include pregnancy induced hypertension, Obstructive sleep apnea.
- Family history-High blood pressure can run in a family.
- Advanced age-Risk of high blood pressure increases with age.
- Gender- High blood pressure is more common in young and middle aged men, while higher proportion of women suffer from hypertension late in life due to post-menopausal changes.
Modifiable risk factors-
- Lack of physical activity.
- Poor diet- consumption of food containing too much salt and fat, and not eating enough fruits and vegetables.
- Overweight and obesity.
- Heavy and too much consumption of alcohol.
- Possible contributing factors- poor stress management, smoking and second hand smoke, sleep apnea.
- Pre-hypertension (blood pressure slightly higher than normal) increases the risk of developing hypertension in the future.
- Diabetes mellitus-About 60% of people who have diabetes also have high blood pressure.
Blood Pressure Levels
Diastolic: less than 80 mmHg
Diastolic: 80–89 mmHg
Diastolic: 90 mmHg or higher
DAIGNOSISAll adults should know their blood pressure levels. There are different types of devices that are used to measure blood pressure. These are electronic, mercury and aneroid devices.
- WHO recommends the use of affordable and reliable electronic devices that have the option to select manual readings. Semi-automatic devices enable manual readings to be taken when batteries run down.
- It is recommended by WHO that mercury devices should be phased out in favour of electronic devices (as mercury is a toxic material).
- Aneroid devices such as sphygmomanometers should be used only if they are calibrated every six months and users should be trained in measuring blood pressure using such devices.
Routine laboratory tests are also recommended before initiating therapy. These include an electrocardiogram; urine analysis; blood glucose and hematocrit; serum potassium, creatinine (or the corresponding estimated glomerular filtration rate [GFR]), calcium; and a lipid profile, after 9 to12 hour fast, that includes high-density lipoprotein cholesterol and low-density lipoprotein cholesterol, and triglycerides.
Digital blood pressure measurement machines can be used outside clinic settings. Self-monitoring of blood pressure is recommended for the management of hypertension in patients where measurement devices are affordable and who have limited access to health services due to geographic, physical or economic reasons.
- Salt restriction - reducing salt intake to less than 5 g of salt per day(typical salt intake is 9 -12 g per day)
- Limit intake of alcohol.
- High consumption of vegetables and fruits and low-fat diet.
- Reducing weight and maintaining it.
- Regular physical exercise - hypertensive patients should participate in at least 30 min of moderate-intensity dynamic aerobic exercise (walking, jogging, cycling or swimming) on 5 to 7 days a week.
- Stop Smoking and use of other tobacco products.
Dietary Approaches to Stop Hypertension (DASH)-The DASH eating plan requires no special foods and instead provides daily and weekly nutritional goals. This plan recommends:
- Eating vegetables, fruits, and whole grains.
- Including fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oil
- Limiting foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils.
- Limiting sugar-sweetened beverages and sweets.
When following the DASH eating plan, it is important to choose foods that are:
- Low in saturated and trans fats
- Rich in potassium, calcium, magnesium, fiber, and protein
- Lower in sodium
Antihypertensive Medicines- Antihypertensive drugs (drugs lowering the BP) work in several ways, such as removing excess salt and fluid from the body, slowing the heartbeat or relaxing and widening the blood vessels. Medicines to lower blood pressure include:
- Diuretics (Water or Fluid Pills): Flush excess sodium from the body, which reduces the amount of fluid in blood and helps to lower your blood pressure.
- Beta Blockers: Help heart to beat slower and with less force. As a result, heart pumps less blood through blood vessels, which can help to lower blood pressure.
- Angiotensin-Converting Enzyme (ACE) Inhibitors: Angiotensin-II is a hormone that narrows blood vessels, increasing blood pressure. ACE converts Angiotensin I to Angiotensin II. ACE inhibitors block this process, which stops the production of Angiotensin II, lowering blood pressure.
- Angiotensin II Receptor Blockers (ARBs): Block angiotensin II hormone from binding with receptors in the blood vessels. When angiotensin II is blocked, the blood vessels do not constrict or narrow, which can lower your blood pressure.
- Calcium Channel Blockers: Keep calcium from entering the muscle cells of heart and blood vessels. This allows blood vessels to relax, which can lower blood pressure.
- Alpha Blockers: Reduce nerve impulses that tighten blood vessels. This allows blood to flow more freely, causing blood pressure to go down.
- Alpha-Beta Blockers: Reduce nerve impulses and also slow the heartbeat. As a result, blood pressure goes down.
- Central Acting Agents: Act in the brain to decrease nerve signals that narrow blood vessels, which can lower blood pressure.
- Vasodilators: Relax the muscles in blood vessel walls, which can lower blood pressure.
- Heart: left ventricular hypertrophy, angina/previous myocardial infarction, and heart failure
- Brain: stroke or transient ischemic attack, dementia
- Chronic kidney disease
- Peripheral arterial disease, aneurysms
- Cognitive changes
- promoting a healthy lifestyle with emphasis on proper nutrition for infants and young people;
- reducing salt intake to less than 5 g of salt per day (just under a teaspoon);
- eating five servings of fruit and vegetables a day;
- reducing saturated and total fat intake.
2. Avoiding harmful use of alcohol i.e. limit intake to no more than one standard drink a day
- Regular physical activity and promotion of physical activity for children and young people (at least 30 minutes a day five times a week).
- Maintaining a normal body weight: every 5 kg of excess weight lost can reduce systolic blood pressure by 2 to 10 points.