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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.
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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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