Hypertension: Causes, Symptoms and Treatment

Hypertension (High Blood Pressure)

Hypertension is the condition in which force of the blood pushing against artery vessel walls is too high. It is measure 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 are considered hypotension orthostatic hypotension can cause patients to experience vertigo or syncope. 

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 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 top, systolic number is the pressure when the heart beats. The bottom, diastolic number is the pressure when the heart rests between beats. Normal blood pressure is below 120/80 mmHg. If and adult and the systolic pressure is 120 to 129, and diastolic pressure is less than 80, you have elevated blood pressure.  High blood pressure is a pressure of 130 systolic or higher, or 80 diastolic or higher, that stays high over time.

High blood pressure usually has no signs or symptoms. That is why it is so dangerous. But it can be managed.

Causes of hypertension

In about 90% of cases, the precise cause of high blood pressure in 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, 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 development of hypertension, and can in particular be expressed as 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 of develop high blood pressure than white American.

Salt Intake: for many people, the important factor that can cause a rise in blood pressure is excessive salt intake. Evidence for this comes from epidemiological studies clearly demonstrates that salt intake is related to the rise in blood pressure. 

Potassium intake.  A high potassium intake protests against some of the effects of a high salt intake on blood pressure, and much epidemiological evidence also suggests that a high dietary potassium intake is associated with a 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 increasing 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 result 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 signs, is silent killer. Hypertension often is discovered during medical treatment for another 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 lost 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, heat 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 a sa 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 physician 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 type 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 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 associate with a brisk carotid upstroke also suggests the presence of a hyperdynamic and possibly enlarged lest ventricle. 

Hypertension stages

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 life times, 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

Reducing salt intake. Considering the difficulty of achieving significant weight loss, reducing salt intake may be the most effective non-pharmacological way of lowering blood pressure.

Obesity and weight reduction. Many patients with high blood pressure are overweight and it has been shown that if obese patients los weight, there is an associated fall in blood pressure. All hypertension patients who are overweight should therefore be encourage to loss weight.

Increasing potassium intake. Increasing potassium intake also lowers blood pressure. Hypertension patients should therefore be advice to eat more fresh fruit, vegetables, and fish to increase their potassium intake. Healthier diet has the advantage only of increasing potassium intake, but of being low in salt and saturated fat and high in fiber.

Reduction of alcohol intake. There is strong epidemiological evidence of a relationship between blood pressure and alcohol. The effect is, however short term, and moderate intake of alcohol has protective cardiovascular effects. Patients should therefore be advised to limit their alcohol intake.

Physical activity. Regular physical activity (that is to say 30 mintues of aerobic exercise there to five times a week) may reduce blood pressure. Clearly, patients who are unfit should start with a low level of exercise such as walking.  More intensive physical activity will help to achieve weight loss and reduce high blood pressure.

Smoking. It is of vital importance that other cardiovascular risk factors, such as smoking are addressed when treating high blood pressure. It is very powerful independent risk factor for coronary heart disease thrombotic stroke. This risk is markedly increased if associated with high blood pressure and raised cholesterol. All patients with hypertension must stop smoking.

Pharmacological treatment.

The patient’s blood pressure level will determine how quickly drug therapy is initiated. All those with mil to moderate hypertension should be encourage 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 decrease in extracellular volume, resulting in a fall in blood pressure.

Calcium antagonists

Angiotensin-converting enzyme (ACE) inhibitors..

Angiotensin-receptor blockers (ARBs)

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

Complications of hypertension

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.

Left ventricular hypertrophy. The work of the heart increases as blood pressure rises, leading to compensatory enlargement of the heart, particularly the left ventricular.

Heart failure. With the additional load it places on the heart, raised blood pressure is now recognized as the major cause of heart failure, particularly if there is associated chronic heart disease.

Micro vascular aneurysms. Charcot bouchard aneurysms can develop in intracerebral arteries. Rupture of these aneurysms leads to intracerebral hemorrhage.

Lacunar infarcts. High blood pressure can also lead to damage to the very small braches of the middle cerebral arteries with the formation of lacunar infarcts, particularly in the thalamus mid brain and pons.

Renal failure. Severe hypertension in the accelerated or malignant form can lead to progressive renal damage and, ultimately to renal failure.

Prognosis of hypertension

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 of to develop hypertension.

Obesity is an established risk factor for hypertension

Conclusion:

Your lifestyle is your health          

Changing your lifestyle can go a long way toward controlling high blood pressure. In conclusion, 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. Retrieved from http://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 from http://search.ebscohost.com.asa.idm.oclc.org/login.aspx?direct=true&db=nlebk&AN=502211&site=ehost-live
• Wexler, B., & Frey, R. J. (2013). Hypertension. In B. Narins (Ed.), The Gale Encyclopedia of Nursing and Allied Health (3rd ed., Vol. 3, pp. 1699-1705). Detroit, MI: Gale. Retrieved from http://link.galegroup.com.asa.idm.oclc.org/apps/doc/CX2760400536/GVRL?u=nysl_me_asai&sid=GVRL&xid=b41011e0
• Hypertension. (2001). In C. M. Levchuck, A. McNeill, R. Nagel, D. Newton, B. Des Chenes, M. Drohan, …J. K. Kosek (Eds.), UXL Complete Health Resource (Vol. 7, pp. 406-413). Detroit, MI: UXL. Retrieved from http://link.galegroup.com.asa.idm.oclc.org/apps/doc/CX3437000163/GVRL?u=nysl_me_asai&sid=GVRL&xid=4d280ee1