Hypertension

Hypertension (High Blood Pressure)

Hypertension is the condition in which force of the blood pushing against artery vessel walls is too high. It is measured in millimeters of mercury  (mmHg). Hypertension or high blood pressure (HTN) means the pressure in arteries is consistently above normal 140/90 mmHg, or high than it should be resulting in excessive pressure on the walls of the arteries. Hypotension is an abnormally low blood pressure, which may be caused by emotional or traumatic shock; hemorrhage and chronic wasting disease. Persistent reading of 90/60 mmHg or lower usually is considered hypotension orthostatic hypotension can cause patients to experience vertigo or syncope.

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Hypertension is the common life-threatening disease among American. It is estimated that one in four American has high blood pressure. The incidence of hypertension in the United States has increased as a result of an aging population and the increased incidence of obesity. Nearly half of the American Population over age 20 has hypertension, and many do not even know it. Not treating high blood pressure is dangerous. Hypertension increases the risk of heart attack and stroke.

Blood pressure is written as two numbers, such as 120/70 mmHg. The highest occurring persistent health disorder blood pressure. About 30% of the people, population around the globe has an increased blood pressure with systolic and diastolic equivalent or more than 140/90 mmHg. Blood pressure gently and continuously upswing with age growth. The escalation of the hypertension notice in the different age groups 20% of 20 years of age, 40% of 40 years of age, 60% of 60 years of age and 80% of 80 years of age. 

Etiology (Causes of hypertension)

In about 90% of cases, the precise cause of high blood pressure is unknown. This type of hypertension is known as essential or primary hypertension. High blood pressure caused by an underlying condition. This type of blood pressure is known as secondary hypertension, which tends to appear suddenly and cause high blood pressure, the condition such as obstructive sleep apnea, kidney disease, and medications. Certain factors seem to increase the risks of developing essential hypertension including.

Family history:  High blood pressure runs in families. Studies of twins have shown that inheritance accounts for 25% of the variability in blood pressure. Genetic factors play a role in the development of hypertension, and can, in particular, be expressed as the diminished ability of the kidney to excrete salt.

Weight:There is a significant association between obesity and hypertension that cannot be fully accounted for by an overestimation of blood pressure arising from the use of an inappropriately sized cuff. In clinical trials, weight loss almost always causes a fall in blood pressure.

Ethnicity: Research has shown that Black or African American have high risks or develop high blood pressure than white American.

Salt Intake:  this is the main element, which cause increase blood pressure due to extreme salt consumption.

Potassium intake: A high potassium intake protests against some of the effects of high salt intake on blood pressure and much epidemiological evidence also suggests that high dietary potassium intake is associated with lower blood pressure. Studies of black people in the United States of America have shown that, where salt intake is similar to that of white people the higher prevalence of increased blood pressure is associated with lower potassium intake.

Age: Blood pressure normally increases, as one grows older. Men are more likely to develop High blood pressure at the age 50 and above. Women are more likely to develop high blood pressure at the age 60 and above.

Chronic stress: Research indicates that people who are under continuous stress tend to develop more heart and circulatory problems than people who are not under stress. Acute stress causes an increase in blood pressure.

Smoking: Smoking tobacco constricts blood vessels thus cause an increase in high blood pressure.

Alcohol consumption:  Heavy alcohol consumption is associated with increased blood pressure. However, it appears that this relationship is quite transient because, if alcohol is withdrawn there is an immediate fall in blood pressure. It most likely that the alcohol-related rise in blood pressure results from either a direct vasoconstrictive effect or an increase in sympathetic tone as blood alcohol level rise.

Physical inactivity: In addition to contributing to the rapid increase in obesity in all developed countries, physical inactivity is associated with a high incidence of hypertension. Regular aerobic activity may lower blood pressure.

Signs and symptoms

Hypertension is largely symptomless or no sign is a silent killer. Hypertension often is discovered during medical treatment for other problems. Approximately one-third of people who have high blood pressure are unaware of it because there are few or no symptoms and as a result, an individual with hypertension may go undiagnosed for many years. If symptoms occur, they may include one or more of the following: 

Blurred or loss of vision

Severe headaches especially pounding headaches behind the eyes

Nausea and vomiting unrelated to indigestion or other food or medication-related causes.

Dizziness or syncope episodes

Tinnitus (a sensation of ringing or buzzing in the ears)

Flushed face, fatigue, epistaxis, excessive perspiration, heart palpitations, frequent urination, and cramping in the legs with walking. The only way to know whether you have hypertension is to have checked regularly.

Diagnosis

Hypertension affects more the 75 million people in the United States of America, many whom are not even aware they have the disease. In addition, the prevalence of hypertension is on the rise as a result of the growing obesity epidemic.  American Heart Association guideline for diagnosis and management of hypertension include three categories for diagnostic and treatment purposes. The diagnosis of hypertension may include the following.

Medical history will provide the physician with a significant proportion of the information needed to assess cardiovascular risk. Relevant past medical history includes evaluation for comorbid risk factors, including type 1 or types 2 diabetes mellitus, dyslipidemia, obesity, smoking history, diet and exercise regime, and presence of vascular disease, including coronary artery disease, congestive heart failure, chronic kidney disease, stroke, and cardiac arrhythmias. In addition, it is helpful to characterize non-cardiovascular disease that may either be associated with hypertension disease such as bronchial asthma, chronic lung disease psychiatric disease. Characterization of the family history is relevant for the assessment of the newly diagnosed hypertension patients.

Physical examination. A thorough physical examination is essential in the diagnosis of a patient with hypertension. The physical examination should include accurate measurement and recording of the blood pressure, evaluation of general appearance, height, weight, waist circumference calculation of the body mass index, fat distribution and skin changes.

Funduscopic examination is of utmost importance in assessing for target organs damage and for risk stratification.

The cardiovascular examination is essential in the evaluation of hypertension patients and includes determination of cardiac rate and rhythm, auscultation of the heart and evaluation of peripheral pulses. Auscultation of a loud brisk first heart sound associated with a brisk carotid upstroke also suggests the presence of a hyperdynamic and possibly enlarged left ventricle. 

Hypertension stages

Blood pressure category

Systolic (mmHg)

Diastolic (mmHg)

Prehypertension

120 – 139

80 – 89

Stage 1 hypertension (mild)

140 – 159

90 – 99

Stage 2 hypertension (Moderate)

160 – 179

100 – 109

Stage 3 hypertension (severe)

180 and above

110 and above

Treatment of hypertension

The overall aim when treating individuals with consistently raise blood pressure is to lower their blood pressure and maintain this for the rest of their lifetimes, whole keep them feeling complexly well. Given the modern therapeutic approach to high blood pressure, with both non-pharmacological advice and the large range of drugs available, it is possible to achieve this aim for the majority of people. All individuals should be properly assessed for sustained hypertension and overt secondary causes. In addition, all patients regardless of blood pressure level should be given non- pharmacological advice and attention should be paid to other cardiovascular risks factors.

Non-pharmacological treatments

Decrease too much consumption of table salt.  Examine the hardship of realizing remarkable body mass loss, minimizing too much uptake of salt will be the efficacious method or way of decreasing hypertension.

The overweight cutback is also one of the greatest ways of treating or controlling hypertension among people. Many people with hypertension are linked to body overweight for height. Cutting back or down the body weight may control hypertension.  Therefore, all hypertension people who obese or overweight should be advised to consider cutting down their weight to control hypertension.

Consider raising potassium consumption: high or moderate uptake of potassium is considering one of the best ways to treat or lower hypertension. Patients with hypertension should be encouraged to consume extra garden fresh fruits, bananas, beans and fish.  Healthy food has benefits not exclusively maximize potassium consumption. Healthier diet has the advantage only of increasing potassium intake, however, it also reduces high salt, drenches fat and excessive fiber.

Considering reducing too much alcohol consumption may help in controlling hypertension because there is some link between alcohol and hypertension but the effects are less. Average alcohol consumption can help to control cardiovascular consequences.

Physical activity: Regular physical activity (that is to say 30 minutes of aerobic exercise for four to five times a week) is also another way to treat or controlling hypertension. obviously, a person with hypertension condition or unhealthy person should begin with the moderate level of exercises such as walking or bike riding. Being physically active will help to reduce or control hypertension complication.

Hypertension patients should be encouraged to quit smoking cigar/tobacco and drugs this may help to treat or control hypertension with other related long-term complication such as thrombotic stroke and coronary heart disease.

Pharmacological treatment.

The patient’s blood pressure level will determine how quickly drug therapy is initiated. All those with mild to moderate hypertension should be encouraged for non-pharmacological treatment. The four principal drug classes currently used in the treatment of high blood pressure are:

Diuretics. There are three major groups of diuretics:

Thiazide diuretics (hydrochlorothiazide, bendroflumethiazide) act by inhibiting tubular sodium and chloride resorption, thereby causing loss of sodium chloride and a decrease in extracellular volume, resulting in a fall in blood pressure.

Calcium antagonists

Hypertension usually asymptomatic and treatment will need to be continued for a long time, usually for life.

Complications of hypertension

If hypertension is not brought under control, it can cause severe damage to vital organs, such as the heart, brain, kidneys, and eyes. This damage can result in a heart attack or heart failure, stroke, kidney damage, or damage vision.

Hypertension causes damage and complication to the blood vessels, heart, brain, and kidneys. This damage is either a direct consequence of high blood pressure or the result of accelerated atherosclerosis and destabilization of plaques that high blood pressure causes.

Abnormal enlargement (hypertrophy) of Ventricular, the labor of heart has to expand as blood pressure hike result to an expansion of the heart especially the left side of the ventricular.

Heart destruction (failure), due to extra work hypertension leave on the heart, the increase hypertension has been considered as one of the crucial source or cause of chronic heart disease.

Myocardial infarction (heart attack), when there is an increased demand due to hypertension the heart may not supply oxygen-rich blood to the heart muscle can block the blood may clot in a coronary artery.

Hypertension can lead to a stroke when the blood flow to the brain is unexpectedly blocked off because stroke occurs from the blocked or break a blood vessel in the brain.

Kidneys damage acute hypertension in the precipitate or cruel form can cause accelerating kidneys damage eventually lead to renal dysfunction or failure. 

Prognosis of hypertension

Hypertension is common and independent risk factors if it is untreated, it can lead to the development of chronic condition such as coronary artery disease, cerebrovascular disease, and heart failure. It plays a dominant role in the development and progression of atherosclerotic vascular disease. Hypertension predisposing risk factors that lead to the development of hypertension chronic kidney disease, coronary heart disease, and diabetes.  Everyone in the community is at risk to develop hypertension.

Conclusion:

Most patients with hypertension require two or more medication to achieve desired blood pressure levels. The goals of treatment are to maintain blood pressure below 140/90 mmHg or below 130/80 mmHg. A patient-centered treatment approach should be implemented to motivate patients and to maintain compliance with hypertension management. A medical assistant can play an active role in establishing a therapeutic relationship with the patients by providing ongoing health education. Your lifestyle is your health. Changing your lifestyle can go a long way toward controlling high blood pressure. Staying healthy has the best impact on our bodies and it also plays an important role in our daily activities. It is said, “your lifestyle is your health”. So, eat healthy food, do not consume too much alcohol, do not smoke, exercise daily, and always have a positive attitude

References

MacGregor, G. A., & Kaplan, N. K. (2010). Hypertension (Vol. 4th ed). Abingdon: Health Press. Retrievedhttp://search.ebscohost.com.asa.idm.oclc.org/login.aspx?direct=true&db=nlebk&AN=412341&site=ehost-live

Bakris, G. L., & Baliga, R. R. (2012). Hypertension. Oxford: Oxford University Press. Retrieved fromhttp://search.ebscohost.com.asa.idm.oclc.org/login.aspx?direct=true&db=nlebk&AN=502211&site=ehost-live

Lip, G. Y. H., & Nadar, S. (2009). Hypertension. Oxford: OUP Oxford. Retrieved from http://search.ebscohost.com.asa.idm.oclc.org/login.aspx?direct=true&db=nlebk&AN=467661&site=ehost-live