Hypertension

Hypertension

Hypertension is high blood pressure in the arteries that is a long term (chronic) disease usually affecting people of middle aged or elderly age group. However, there is increasing trend to develop high blood pressure in relatively younger age population due to changed eating habits, smoking, alcohol, increased body weight and mental stress. There could be a history of high blood pressure in the family (parents, grandparents, brother, sister).  

High blood pressure generally does not cause any symptoms unless it is dangerously elevated. However, hypertension is a major risk factor for heart disease, stroke (brain involvement), eye disorder in form of visual disturbances, kidney diseases and dementia (long term memory loss).

High blood pressure is categorized into two types:

A): Primary (Essential) Hypertension): This is most common category found in 90-95% of patients with hypertension. The exact cause is not known but could be due to life styles factors or genetic.

B) Secondary Hypertension): 5-10% of patients with high blood pressure may have identifiable known cause like kidney disease, hormonal changes or use of certain drugs including birth control pills. Hypertension may be due to pregnancy,  excess thyroid function, tumor of adrenal gland or other hormonal diseases.   

Measurement of BP:

 Blood Pressure can be measured at home by automatic BP monitor or in clinic by the doctor. There are two reading that are shown in BP recording. Higher reading (upper value) is called a Systolic BP and lower reading (lower value) is called as Diastolic BP. The normal BP for an adult is between 100-140 mm of mercury for Systolic BP and 60-90 mm of mercury for Diastolic BP. Thus, the normal range of BP in an adult is between 100-140/60-90 mm of mercury.  Blood pressure can transiently increase after any physical exercise, smoking, coffee, tea and acute mental stress. However, BP becomes normal after few minutes or hours.  In case the BP is persistently elevated above 140 mm systolic and 90 mm diastolic during resting phase, the person should be evaluated for the diagnosis of hypertension. It can be further confirmed by measuring 24 hour ambulatory blood pressure monitoring for better accuracy and diagnosis.

Once the diagnosis od hypertension is made patients should be fully investigated for blood sugar, serum cholesterol, kidney function, heart function (ECG, ECHO), and eye disorders,  

Symptoms of Hypertension:

Hypertension usually does not have any symptoms and is diagnosed during routine medical check up or seeking advice for some other unrelated disease. Few patients with high blood pressure report headache, giddiness, lightheadedness, altered vision or fainting episodes. However, most of these symptoms may be related to associated anxiety than hypertension itself.

Long standing uncontrolled high blood pressure may cause eye disorders, kidney dysfunction, heart diseases or brain disorders.               

Hypertensive Crisis:

Severely elevated BP (> 180/110) is referred as hypertensive crisis. It could be either hypertensive urgency (BP> 180/110) or hypertensive emergency (BP>180/110 with presence of organ damage like kidney, heart, lungs & brain). These two conditions require immediate hospitalization of the patient.

 Risk Factors:

  1. Age: The risk of hypertension increases with age.
  2. Family history: Hypertension tend to run in families.
  3. Obesity or Overweight
  4. Physically inactive or sedentary life style
  5. Use of Tobacco or smoking
  6. Use of excess salt in diet
  7. Reduced intake of potassium in diet.
  8. Excess alcohol
  9. Mental stress
  10. Certain other disease: Diabetes, kidney disease or sleep apnea are some of the high risk factors to cause hypertension.        

Treatment of Hypertension:

The treatment of high blood pressure is targeted to bring down the BP <140/90 mm. First approach in the treatment of hypertension is life style changes including dietary control, physical exercise, weight control and restriction of salt intake.  Besides green vegetables, fruits and green tea consumption have shown to have favorable effects on BP control. The patient is advised to practice meditation as an add on treatment to help reduce mental stress.  

Medications:

There are various categories of medicines that are used in the treatment of hypertension. Most of these drugs are classified as vasodilators (dilates the blood vessel thus reduce the BP) and reduce both systolic and diastolic blood pressure. Other categories of medicine include diuretics (increases water & sodium excretion through urine), beta-blockers (reduce load on the heart thus decrease in BP). The medicines for hypertension are prescribed in step care approach. The patient may be prescribed single drug or more than one drug in combinations depending on the severity of hypertension and response of the patient. Sometimes patient may be prescribed three or four medicines to control the BP. Patient should be advised to take antihypertensive medicines regularly and monitor blood pressure at regular intervals.  

Complications:

  1. Heart Attack: Patient may develop heart attack due to reduced blood supply to heart. This is due to hardening and thickening of blood vessels.
  2. Stroke: Reduced blood supply to brain leading to loss of consciousness, brain damage or paralysis.
  3. Heart failure: The heart may fail to pump normal amount of blood due to high pressure and overload. The heart also enlarges in size that further reduce the pumping action of heart.
  4. Kidney Dysfunction or failure
  5. Altered or loss of vision due to damage of retinal vessels in the eyes.
  6. Trouble with memory or understanding