Hypertension or increase in blood pressure is one of the leading cause of death around the world. It is considered as a silent killer, patients having high blood pressure are usually unaware of their condition because mostly there are no specific symptoms experience by the patients.
Blood pressure is measured as systolic and diastolic blood pressure. Systolic blood pressure is the pressure exerted by the blood against wall of arteries when heart muscles contract, whereas diastolic blood pressure is pressure exerted by the blood against wall of arteries when heart muscles relax. As a person ages his blood vessels start losing elasticity and become rigid ,these rigid blood vessels are unable to dilate in accordance with the increase flow of blood which results in building up of pressure.
* (The purpose of this post is general awareness about the condition, this is not a substitute for medical treatment, in case of any health concern do not self-medicate but consult your doctor )
CLASSIFICATION OF BLOOD PRESSURE :
(For adults age18 and older)
Classification is based on average of two or more properly measured blood pressure readings taken on several occasions.
Normal blood pressure:
Systolic blood pressure less than120 mmHg
Diastolic blood pressure less than 80 mmHg
Pre-hypertension:
Systolic blood pressure : 120-139mmHg
Diastolic blood pressure : 80-89mmHg
Stage 1 Hypertension :
Systolic blood pressure : 140-159mmHg
Diastolic blood pressure : 90-99mmHg
Stage 2 Hypertension:
Systolic blood pressure equals to or greater than 160mmHg
Diastolic blood pressure equals to or greater than 100mmHg.
Patients with pre-hypertension are at increased risk for progression to hypertension.
Higher the blood pressure ,greater are the chances of heart attack, heart failure, stroke and kidney diseases.
TYPES OF HYPERTENSION:
1. Essential Hypertension ( without any specific cause)
2.Secondary Hypertension ( due to underlying cause)
Although in majority of patients, hypertension is essential but there are certain features that may lead to suspicion of an underlying cause i.e secondary hypertension. Factors that increase suspicion of secondary hypertension are following
* Young patient , age < 40 years
* Rapid onset of hypertension
* Resistant hypertension that is unresponsive to pharmacological therapy (i.e antihypertensive medication)
If secondary cause is suspected then presence of specific symptoms may suggest particular cause.
CAUSES OF SECONDARY HYPERTENSION:
Swelling and hypertension in a pregnant patient may suggest pre-eclampsia( condition during which blood pressure rises during pregnancy)
Swelling ,hypertension and a foamy urine in a non-pregnant patient may suggest nephrotic syndrome.
Hypertension along with history of renal impairment may be due to chronic kidney disease.
Hypertension with kidney stones raise possibility of hyperparathyroid.
Family history of polycystic kidney disease or intracranial aneurysm or sub-arachnoid hemorrhage in young patient with hypertension may suggest polycystic kidney disease.
Hypertension with sweating, palpitations and panic attack may be due to phaeochromocytoma.
Hypertension with weight gain, hirsutism and easy bruising may suggest Cushing syndrome.
Hypertension with heat intolerance, palpitations and weight loss increases possibility of hyperthyroid.
Use of oral contraceptive pills, steroids or alcohol excess can raise blood pressure.
Hypertension with excessive day time sleepiness in obese patient with history of loud snoring indicates obstructive sleep apnea.
Hypertension can be secondary to coarctation of aorta ( i.e narrowing of largest artery of the body)
Check with your doctor if you find any of the above mentioned symptoms along with hypertension for further workup.
EVALUATION OF PATIENT:
Evaluation of patient with documented hypertension has three objectives
1. To assess life style and identify other cardiovascular risk factors or concomitant disorders that may affect prognosis and guide treatment.
2.To reveal identifiable causes of high blood pressure.
3.To assess presence or absence of target organ damage. Now what is target organ damage? It is explained in the next section.
Hypertension is a major risk factor for cardiovascular diseases.
TARGET ORGAN DAMAGE:
High blood pressure produces harmful effects on vital organs like heart, kidneys, brain etc.
On Heart
Hypertension causes increase in size of heart, angina, heart attack, (myocardial infarction) heart failure.
On brain
Stroke or transient ischemic attack.
On kidneys
Chronic kidney disease.
On Arteries
Peripheral arterial disease
On Retina
Retinopathy
ROUTINE LABORATORY TESTS :
(Recommended before initiating therapy)
*ECG
*Urine analysis
*Blood glucose
*Hematocrit
*Serum potassium and creatinine
*Lipid profile
MANAGEMENT:
Pre-hypertension:
pre-hypertensive patients require life style modification. No antihypertensive drug indicated.
Stage 1 hypertension:
Patients with stage 1 hypertension require life style modification plus antihypertensive drug.
Stage 2 hypertension:
Patients with stage 2 hypertension require life style modification plus two-drug combination antihypertensive therapy.
LIFE STYLE MODIFICATION TO MANAGE HYPERTENSION :
weight reduction:
Maintain normal body weight ( body mass index 18.5-24.9 kg/m2)
Adopt DASH (dietary approaches to stop hypertension) eating plan:
Consume a diet rich in fruits, vegetables like tomatoes, carrots ,green vegetables. Eat high fibre diet ,whole grains, brown rice, brown bread. Food rich in potassium, calcium ,magnesium helps to reduce blood pressure. Avoid trans fat, found in processed foods as crackers, baked and fried items. Avoid saturated fat, found in meat, butter, cheese, whole milk, eggs.
Dietary sodium reduction:
Reduce dietary sodium intake to no more than 100 mmol/day.
Physical activity:
Engage in regular aerobic physical activity such as brisk walking ( at least 30 min per day, most days of the week)
For overall cardiovascular risk reduction ,stop smoking and limit alcohol consumption.
ANTI-HYPERTENSIVE DRUG THERAPY:
Commonly prescribed anti-hypertensive drugs are
Angiotensin converting enzyme inhibitor ( ACE I), Angiotensin receptor blocker (ARB), beta-blocker, calcium channel blocker, thiazide type diuretic.
For hypertensive women who become pregnant , methyl dopa, beta blocker are preferred medication . ACE I and ARB should not be used in those who are pregnant or likely to become pregnant.
FOLLOW UP AND MONITORING:
People with normal blood pressure require follow up 2 yearly
People with pre-hypertension require follow up yearly
Those with hypertension ,once antihypertensive drug therapy is started ,patient should return for follow up and adjustment of medication at approximately monthly intervals until goal blood pressure is reached . More frequent visits will be necessary for patient with stage 2 hypertension or with complicating co-morbids conditions.
Once goal blood pressure is achieved, follow up can usually be at 3-6 months interval.
According to Joint National Committee (JNC) guidelines 8 :
For younger patients, age < 60 years, drug therapy should be considered for diastolic blood pressure greater than or equal to 90mmHg or systolic blood pressure of greater than or equal to 140mmHg. The goal blood pressure is less than 140/90mmHg
For older patients, age greater than or equal to 60 years, drug therapy should be considered for diastolic blood pressure of greater than or equal to 90mmHg or systolic blood pressure of greater than or equal to 150mmHg. The goal is less than 150/90mmHg.
For hypertensive patients with diabetes or chronic kidney disease, drug therapy should be initiated at 140/90mmHg, goal blood pressure is less than 140/90mmHg.
You can have better control of your blood pressure by becoming aware of the causes, symptoms, stages of hypertension and management. Make healthy living a priority ,then you can prevent or manage hypertension effectively.
