High Blood Pressure (Hypertension)


 

Blood Pressure is force exerted by the blood on the inner walls of the blood vessels, and is related to the elasticity and diameter of the vessels and the force of the heartbeat.

 

The upper (systolic) value reflects the force with which the heart pumps blood around the body and the bottom (diastolic) value is the pressure in the blood vessels when they are relaxed. Normal blood pressure reading for women are in the regions of 120/80.

 

 

HOW HIGH IS YOUR BLOOD PRESSURE?

Every women should have her blood pressure checked regularly. A blood pressure test is simple, painless, and fast.

 

Ask your doctor to explain your blood pressure reading. The chart below shows different blood pressure ranges and how they are classified. Find your systolic pressure (the first or top number in your reading) in the first column or numbers and your diastolic pressure (the second or bottom number in your reading) in the second column. Look in the left column to find what the numbers mean. For example, if your blood pressure is 120/80, it is considered normal.

 

BLOOD PRESSURE CLASSIFICATIONS FOR PEOPLE OVER 18

CATEGORY

SYSTOLIC (mm Hg)

DIASTOLIC (mm Hg)

Normal

Under 130

Under 85

High Normal

130-139

85-89

Mild hypertension

140-159

90-99

Moderate hypertension

160-179

100-109

Severe hypertension

180-209

110-119

Very severe hypertension

Over 209

Over 119

 

CAUSES OF HIGH BLOOD PRESSURE

In about 5-10% of cases, hypertension can be shown to be a consequence of a specific disease or abnormality.

 

(1) Coarctation of the Aorta.

 

(2) Renal Diseases.

  • Parechymal renal disease e.g. glomerulonephritis

  • Chronic pyelonephritis, Collagen vascular disease

  • Polycystic kidney disease.

  • Renal artery stenosis.

(3) Endocrine Disorders:-

  • Phaeochromocytoma- due to increased cardiac output and/or a raised peripheral resistance due to excessive catecholamines.

  • Conn`s syndrome is associated with sodium retention and alteration in the reactivity of Vascularsmooth muscles.

  • Hyper-parathyrodism.

  • Cushing's syndrome.

(4) Alcohol:- Researches have linked a rise in high blood pressure to a daily intake exceeding two drinks.

 

(5) Drugs: e.g. Oral contraceptives containing Oestrogens, anabolic steroid, corticosteroids, non-steroidal anti-inflammatory drugs, carbenoxlone, sympathommetic agents.

 

(6) Pregnancy- some women, get temporary high blood pressure during pregnancy. It is vital to treat this for the health of both mother and baby.

If you had high blood pressure before you became pregnant you can safely carry a pregnancy as long as you have frequent checkups to monitor your blood pressure closely. Mild high blood pressure that is controled with exercise, diet, low doses of medication may cause no complication at all during pregnancy.

 

(7) Hereditary- high blood pressure tends to run in the family.

 

(8) Age- High blood pressure is more common among older people, partly because arteries tend to harden with age, making them less resilient to the force of heart's contraction.

 

(9) Stress- Although this is a difficult risk factor to measure, but there is a growing evidence that stress contributes to high blood pressure.

 

(10) Dietary Deficits- diet inadequate in potassium can lead to salt retention within the body.

 

SYMPTOMS OF HIGH BLOOD PRESSURE

Hypertension occasionally causes headaches or polyuria, but provided there are no complications, most patients remain asymptomatic.

 

Non-specific physical pain may include left ventricular hypertrophy, accentuation of aortic component of the second heart sound, a fourth heart sound and a short early diastolic murmur.

 

Other complaints by the patient may include dizziness, palpitations, easy fatiquability and impotence.

 

Symptoms related to increased hypertension vasculardis may include epistoxis, hematuria, blurring of vision, episodes of dizziness or weakness due to ischema, Angina pectoris, dyspnea due to cardiac failure.

 

EFFECT OF HIGH BLOOD PRESSURE

INVESTIGATION OF HYPERTENSION
  • Urine analysis for protein (may indicate renal disease) glucose (diabetes may coexist and is a risk factor for vascular disease)

  • Plasma urea/creatinine to assess renal function.

  • Plasma electrolytes-hypokalaemic alkalosis may indicate primary or secondary hyperaldosteronism (NB diuretic therapy is the commonest cause)

  • Plasma cholesterol -hypercholesterolaemia is an important risk factor for vascular disease.

  • Chest X-ray - look for cardiomegaly, heart failure, rib notching in coarctation

  • ECG-left ventricular hypertrophy.

Special Investigation

  • 24-hour urine collection for metanephrine or vanillylmandelic acid (VMA) excretion-if history suggests phaeochromocytoma.

  • Intravenous urogram-if renal diesease is suspected.

  • Radionuclide renography or renal arteriography-if there is evidence of renal artery stenosis.

  • Lying plasma renin activity and aldosterone-if Conn`s syndrome suspected due to hypokalaemic.

  • Urinary cortisol, dexamethasone suppression test - (if there are signs of Cushing`s syndrome

 

TREATMENT OF HIGH BLOOD PRESSURE

High blood pressure is not the end of the world. It is easily detected and, though not curable, it is usually controllable. Millions of women continue to lead normal lives after being diagnosed with hypertension. You can. too. These are some steps, only you can take. So don't sit back - get involved.

 

1. DROP THAT LOAD
If you lose excess weight you immediately ease the strain on your heart- blood pressure can fall within weeks of excess weight being shed.

 

2. CUT OUT SMOKING
We've already told you what it does to your heart.

 

3. LIMIT ALCOHOL Since research findings indicate that drinking alcohol in excess may increase your blood pressure, if you do drink limit your intake to a maximum of two drinks a day (or, better yet, follow your doctor's advice).

 

4. GET PHYSICAL
Exercise appears to have a modest effect on hypertension, especially borderline hypertension, though it is seldom enough by itself. But check with your doctor before beginning an exercise program. Keep the intensity light to moderate. Different kinds of exercise (ranging from aerobic, such as brisk walking or cycling, to strength training with light weights) appear to be beneficial. But strenuous exercise, such as isometric exercises (pushing against a wall or pressing palms together to build strength) is not advisable; studies have shown it can cause a dramatic rise in blood pressure.

Change in Body weight (pounds)

If you are overweight, losing weight is the most important way to reduce your blood pressure. Even a moderate weight loss can significantly decrease your blood pressure. Conversely a weight gain can increase your blood pressure.

 

5. EASE OFF
Meditation has been shown in studies, and by WF members to help lower blood pressure. There are various routes to meditation. Transcendental Meditation is one of them; it involves clearing the mind of all thoughts while silently repeating a mantra. Yoga and breathing exercise have also been shown to be useful routes to relaxation. According to Herbert Benson, MD, a professor at Harvard Medical School and author of the popular book, The Relaxation Response, repeating words during prayer-and then using that repetition to quell anxious thoughts-produces a peaceful, tranquil state of mind. Dr. Benson explains: " There's a fight or flight response that people have a stress. When elicited, it increases the secretion of adrenaline and other stress hormones into our body. Those hormones lead to anxiety, depression, anger, high blood pressure, heart arrhythmias, and insomnia, among other ills. But repetitive prayer, such as occurs with going through the Catholic rosary or davening ( a swaying, standing kind of prayer used in Orthodox Judaism or repeating the words 'Om' or 'Allah' can elicit the relaxation response-and that, in turn, evokes physiological changes in the body, slowing or lowering metabolism, blood pressure, heart rate, and breathing,".

 

6. GET REGULAR MEDICAL CHECK-UP
Even if you take regular pressure readings at home, it's important to also visit your doctor as a back-up. Also, you need to know what your target blood pressure is and how soon you should try to reach it. The goal of drug therapy is not necessarily to lower pressure as much as possible; in one study it was found that fewer women had heart attacks when they had a moderate-rather than a large- drug induced drop in pressure. Tell your doctor about any side-effect or other problem you may be having with the prescribed medication or with any other aspect of the therapy. If one drug or drug combination isn't working, he may be able to prescribe another. Or you may need to do some tests.

 

7. CUT BACK ON SALT
It is now known, that only half of all hypertensive are salt-sensitive, (that is, their blood pressure is significantly affected by their salt intake). Still, physicians advise all hypertensive, and in fact all those at risk for hypertension, to restrict salt intake.

 

Here are practical ways to wage war on sodium:

  • Toss away your salt-shaker.

  • Use less- or no- salt in cooking or preparing dishes like salads, sauces and dips . Flavor up instead with a whole kitchen shelf of other options: herbs like coriander, parsley and mint, spices like pepper, cardamom, nutmeg, mustard, flavors like vinegar, lime juice and wine.

  • Cut back on processed foods which are a prime source of sodium in our diets today; wafers, ketchup and sauces (some, like Soya sauce, more particularly), pickles, packaged soups, baked beans, cheeses, breakfast cereals, cold cuts. The list is endless.

  • Read food labels carefully. Sodium goes under many names, 'salt or 'common salt' being only one of them. If any of the following ingredients appears high up on a food label, that item is avoidably high in sodium; monosodium glutamate (or aji-on-moto, the name we more familiarly know it by), baking soda, soda bicarbonate, sodium bicarbonate.

  • Include more fruits and vegetables in your diet. They are naturally low in sodium and have flavors of their own go compensate.

  • Slowly does it... give yourself time to get used to a low-salt diet. In a few weeks, you'll be pleasantly surprised to find that most foods taste better- it's just that you're beginning to savor their natural flavors, unquenched by the over-powering taste of salt. In fact it's a safe bet that you'll begin to find salty foods unpleasant to the taste!

8. GO BANANAS
Four bananas a day can help to keep your heart healthy, says American cardiac specialist Milton Packer of Mount Sinai Medical School, predicting that warnings to hypertensive against potassium deficiency will soon rival those against excessive salt. Besides bananas, other good sources of potassium are beans, potatoes cooked with their skins, water melons, oranges, apricots and chicken.

 

9. POTASSIUM INTAKE
Studies of large populations show that the lower the average intake of potassium, the higher the average blood pressure. The thinking is that insufficient amounts of this mineral may promote sodium retention in the body, which can lead to hypertension in the long run.

(If you're on one type of B.P. drugs known as diuretics, you may even need a potassium supplement because this drug can deplete potassium stores-but first check it dour with your doctor.)

 

10. DRUG THERAPY
There is a possibility that a patient might benefit from a single antihypertensive drug or might require a combination of two or three antihypertensive agents to gain control with a low level of side-effects.

 

The Principal agents used in single drug treatment of hypertension are

  • Thiazide diuretics:- The mechanism of their hypotensive action is incompletely understood, besides it may take a month for the maximum effects to be observed. A daily dose of 5 mg bendrofluazide or 0.5 mg cyclopenthiazide is appropriate.

  • Beta adrenoceptor antagonist:- A large number of beta blockers are available varying in their mode of action. Metabolic side-effects of beta-blocking drugs include a tendency to increase plasma concentrations of cholestrol in low density lipoproteins.

  • Angiotensin Converting Enzyme (ACE) inhibitors:- They have proved beneficial in the treatment of moderate to severe hypertension. They need to be used with care in patients with impaired renal function or bilateral renal artery stenosis. It is best to start with a small dose and then build up to an effective maintenance dose.

  • Calcium Antagonist:- They are particularly useful when hypertension co-exists with angina.

  • Drug combinations:- In some respects the drugs have complementary actions; thiazides increases renin production, while beta blockers depress it and the hypokalaemic effect of thiazides may be countered by hyperkalaemic effect of nonselective beta blockers.

Whatever treatment is adopted, careful supervision by the Physician is necessary. Your Physician will constantly need to monitor and examine you before any drug is prescribed for hypertension.


References :

  • American Medical Association- Complete Guide to Women's health by Kathleen Cahil Allison

  • Principles and Practice of Medicine by Davidson Sixth Edition, Oxford University Press.

  • Body Foods For Women-Jane Clarke copyright Jane� Clarke1996






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