Why Causes Hypertension:
Hypertension (High blood pressure) is a common condition in which the force of the blood against arterial walls is high enough that it may eventually cause health problems, such as heart disease.
Blood pressure is determined by the amount of blood pumped by the heart and the amount of resistance to blood flow in the arteries. The more blood pumped by the heart and narrower the arteries, the higher will be the blood pressure.
Hypertension may not show any symptoms for many years. Uncontrolled high blood pressure increases the risk of serious health problems, including heart attack and stroke.
High blood pressure typically develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once one knows that he has high blood pressure, he can work with his doctor to control it.
Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.
Although a few people with early-stage high blood pressure may have dull headaches, dizzy spells or a few more nosebleeds than normal, these signs and symptoms typically don’t occur until high blood pressure has reached a severe–even life-threatening–stage.
There are two types of high blood pressure.
Primary (essential) hypertension
For most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure, called essential hypertension or primary hypertension, tends to develop gradually over many years.
Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:
– Kidney problems
– Adrenal gland tumors
– Certain defects in blood vessels since birth( congenital )
– Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
– Illegal drugs, such as cocaine and amphetamines
High blood pressure has many risk factors, including:
– Age. The risk of high blood pressure increases with age. Through early middle age, high blood pressure is more common in men. Women are more likely to develop high blood pressure after menopause.
– Race. High blood pressure is particularly common in blacks, often developing at an earlier age than it does in whites. Serious complications, such as stroke and heart attack, also are more common in Blacks.
– Family history. High blood pressure tends to run in families.
– Being overweight or obese. The more one weighs, the more blood one needs to supply oxygen and nutrients to his tissues. As the volume of blood circulated through the blood vessels increases, so does the pressure on the arterial walls.
– Not being physically active. People who are inactive tend to have higher heart rates. The higher one’s heart rate, the harder one’s heart must work with each contraction–and the stronger the force on the arteries. Lack of physical activities also increases the risk of being overweight.
– Using tobacco. Not only does smoking or chewing tobacco immediately raise blood pressure temporarily, but the chemicals in tobacco can damage the lining of arterial walls. This can cause arteries to narrow, increasing blood pressure. Secondhand smoke also can increase blood pressure.
– Too much salt (sodium) in diet. Too much sodium in diet can cause body to retain fluid, which increases blood pressure.
– Too little potassium in diet. Potassium helps balance the amount of sodium in cells. If one doesn’t get enough potassium in his diet or retain enough potassium, he may accumulate too much sodium in his blood.
– Too little vitamin D in the diet.It is uncertain if having too little vitamin D in the diet can lead to high blood pressure. Vitamin D may affect an enzyme produced by the kidneys that affects the blood pressure.
– Drinking too much alcohol. Over time, heavy drinking can damage the heart. Having more than two drinks a day can raise the blood pressure.
– Stress. High levels of stress can lead to a temporary, but dramatic, increase in blood pressure. If one tries to relax by eating more, using tobacco or drinking alcohol, one may only increase problems with high blood pressure.
– Certain chronic conditions. Certain chronic conditions also may increase the risk of high blood pressure, including high cholesterol, diabetes, kidney disease and sleep apnea. Sometimes pregnancy contributes to high blood pressure, as well.
Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids poor lifestyle habits–such as an unhealthy diet and lack of exercise–contribute to high blood pressure.
The excessive pressure on the arterial walls caused by high blood pressure can damage the blood vessels,as well as organs in the body.The higher the blood pressure and the longer it goes Uncontrolled ,the greater the damage.
Uncontrolled high blood pressure can lead to:
– Heart attack or stroke.High blood pressure can cause hardening and thickening of the arteries (atherosclerosis),which can lead to a heart attack,stroke or other complications.
– Aneurysm.Increased blood pressure can cause the blood vessels to weaken and bulge,forming an aneurysm.If the aneurysm ruptures,it can be life threatening.
– Heart failure.To pump blood against the higher pressure in the vessels,the heart muscle thickens. Eventually,the thickened muscle may have ahard time pumping enough blood to meet the body’s needs,which can lead to heart failure.
– Weakened and narrowed blood vessels in your kidneys.This can prevent these organs from functioning normally.
– Thickened,narrowed or torn blood vessels in the eyes.This can result in vision loss.
– Metabolic syndrome.This syndrome is a cluster of disorders of the body’s metabolism–including increased waist circumference,high triglycerides,low high-density lipoprotein (HDL),or “good”, cholesterol,high blood pressure,and high insulin levels.If one has high blood pressure,he is more likely to have other components of metabolic syndrome.The more components one has,the greater the risk of developing diabetes,heart disease or stroke.
– Trouble with memory or understanding.Uncontrolled high blood pressure may also affect the ability to think, remember and learn.Trouble with memory or understanding concepts is more common in people who have high blood pressure.
Blood pressure is measured with an inflatable arm cuff and a pressure-measuring gauge.A blood pressure reading, given in millimeters of mercury ( mm Hg ), has two numbers. the first, or upper, number measures the pressure in the arteries when the heart beats ( systolic pressure ). the second, or lower, number measures the pressure in the arteries between beats ( diastolic pressure ).
Blood pressure measurements fall into four general categories:
– Normal blood pressure.Blood pressure is normal if it’s below 120/80 mmHg.However, some doctors recommend 115/75 mmHg as a better goal.Once blood pressure rises above 115/75 mmHg, the risk of cardiovascular disease begins to increase.
– Prehypertension. Prehypertension is a systolic pressure ranging from 120 to 139 mmHg or a diastolic pressure ranging from 80 to 89 mmHg.Prehypertension tends to get worse over time.
– Stage 1 hypertension.Stage1 hypertension is a systolic pressure ranging from 140 to 159 mmHg or a diastolic pressure ranging from 90 to 99 mmHg.
– Stage 2 hypertension. More severe hypertension, stage 2 hypertension is a systolic pressure of 160 mmHg or higher or a diastolic pressure of 100 mmHg or higher. Both numbers in a blood pressure reading are important.But after age 50, the systolic reading is even more significant.Isolated systolic hypertension–when diastolic pressure is normal but systolic pressure is high–is the most common type of high blood pressure among people older than 50.
Two to three blood pressure readings are taken each at two or more separate appointments before diagnosing high blood pressure.This is because blood pressure normally varies throughout the day–and sometimes specifically during visits to the doctor, a condition called white coat hypertension.Blood pressure may be recorded at home and at work to provide additional information.
If anyone have any type of blood pressure,doctor may recommend routine tests, such as a urine test ( urinalysis ), blood tests and an electrocardiograph ( ECG )– a test that measures the heart’s electrical activity. Doctor may also recommend additional tests, such as a cholesterol test, to check for more signs of heart disease.
Taking the blood pressure at home:
An important way to check if the blood pressure treatment is working, or to diagnose worsening high blood pressure, is to monitor the blood pressure at home. Home blood pressure monitors are widely available. Talk to your doctor about how to get started.
The blood pressure treatment goal depends on how healthy the patient is.
Blood pressure treatment goals:
140/90 mm Hg or lower- if the patient is a healthy adult.
130/80 mm Hg or lower – if the patient has chronic kidney disease, diabetes or coronary artery disease or is at high risk of coronary artery disease.
120/80 mm Hg or lower – if the heart isn’t pumping as well as it should ( left ventricular dysfunction or heart failure ) or the patient has severe chronic kidney disease.
If the patient is an adult age 80 or older and the blood pressure is very high, doctor may set a target blood pressure goal for the patient that is slightly higher than 140/90 mm Hg.
Changing the lifestyle can go a long way toward controlling high blood pressure. But sometimes lifestyle changes aren’t enough. In addition to diet and exercise, doctor may recommend medication to lower the blood pressure. Which category of medication doctor prescribes depends on the stage of high blood pressure and associated other medical problems.
Medications to treat high blood pressure:
– Thiazides diuretics. Diuretics, sometimes called water pills, are medications that act on the kidneys to
help the body eliminate sodium and water, reducing blood volume. Thiazides diuretics are often the first — but not the only — choice in high blood pressure medications.
– Beta blockers. These medications reduce the workload on the heart and open the blood vessels, causing the heart to beat slower and with less force. When prescribed alone, beta blockers don’t work as well in older adults — but they’re effective when combined with a thiazides diuretic.
– Angiotensin-converting enzyme ( ACE ) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels.
– Angiotensin II receptor blockers (ARBs ). These medications help relax blood vessels by blocking the action — not the formation — of a natural chemical that narrows blood vessels.
– Calcium channel blockers. These medications help relax the muscles of the blood vessels. Some slow the heart rate. Calcium channel blockers may work better for older adults than do ACE inhibitors or beta blockers alone. If the patient is having trouble reaching the blood pressure goal with combinations of the above medications, the doctor may prescribe:
– Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels.
– Alpha – beta blockers. In addition to reducing nerve impulses to blood vessels, alpha – beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the blood vessels.
– Central – acting agents. These medications prevent the brain from signaling your nervous system to increase the heart rate and narrow the blood vessels.
– Vasodilators. These medications work directly on the muscles in the walls of the arteries, preventing the muscles from tightening and the arteries from narrowing. Once the blood pressure is under control, doctor may advise to take a daily aspirin to reduce the risk of cardiovascular disorders.
To reduce the number of daily medication doses, doctor may prescribe a combination of low- dose medications rather than larger doses of one single drug. In fact, two or more blood pressure drugs often work better than one. Sometimes, finding the most effective medication– or combination of drugs — is a matter of trial and error.
Lifestyle changes to treat high blood pressure:
No matter what medications doctor prescribes to treat the high blood pressure, the patient will need to make lifestyle changes to lower the blood pressure. These changes usually include eating a healthier diet with less salt ( the Dietary Approaches to Stop Hypertension, or DASH, diet ), exercising more, quitting smoking and losing weight.
Resistant hypertension: When the blood pressure is difficult to control?
If the blood pressure remains stubbornly high despite taking at least three different types of high blood pressure drugs, one of which should be a diuretic, patient may has resistant hypertension. Resistant hypertension is blood pressure that’s resistant to treatment. People who have controlled high blood pressure but are taking four different types of medications at the same time to achieve that control also are considered to have resistant hypertension.
Having resistant hypertension doesn’t mean the blood pressure will never get lower. In fact, if the patient and the doctor can identify what is behind the persistently high blood pressure, there’s a good chance the patient can meet the goal with the help of treatment that’s more effective.
The doctor or hypertension specialist can evaluate whether the medications and doses the patient is taking for the high blood pressure are appropriate. The patient may has to fine- tune the medications to come up with the most effective combination and doses.
In addition, the patient and the doctor can review medications the patient is taking for other conditions. Some medications, foods or supplements can worsen high blood pressure or prevent the high blood pressure medications from working effectively. The patient should be open and honest with the doctor about all the medications or supplements.
If the patient doesn’t take the high blood pressure medications exactly as directed, the blood pressure can pay the price. If the patient skips doses because the patient can’t afford the medication, because the patient has side effects or because the patient simply forget to take the medications, the patient should talk to the doctor about solutions. Patient should not change the treatment without the guidance of doctor.
Lifestyle and home remedies:
Lifestyle changes can help to control and prevent high blood pressure — even if the patient is not taking blood pressure medication. Here is what a patient can do:
– Eat healthy foods.Try the Dietary Approaches to stop hypertension ( DASH ) diet, which emphasizes fruits,vegetables, whole grains and low fat dairy foods. Get plenty of potassium, which can help prevent and control high blood pressure. Eat less saturated fat and total fat.
– Decrease the salt in the diet. A Lower sodium level — 1,500 milligrams ( mg ) a day — is appropriate for people 51 years of age or older, and individuals of any age who have hypertension,diabetes or chronic kidney disease. Otherwise healthy people can aim for 2,300 mg a day or less.
– Maintain a healthy weight. If a patient is overweight, losing even 5 pounds ( 2.3 kilograms ) can lower the blood pressure.
– Increase physical activity. Regular physical activity can help lower the blood pressure and keep the weight under control. Strive for at least 30 minutes of physical activity a day.
– Limit alcohol. Even if the patient is healthy, alcohol can raise the blood pressure.If the patient chooses to drink alcohol, it should be done in moderation — up to one drink a day for women and everyone older than age 65, and two drinks a day for men.
– Don’t smoke. Tobacco injures blood vessel walls and speeds up the process of hardening of the arteries.
– Manage stress. Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation and deep breathing. Getting plenty of sleep can help, too.
– Monitor the blood pressure at home. Home blood pressure monitoring can help to keep closer tabs on the blood pressure,show if medication is working,even alert the patient and the doctor to potential complications. If the blood pressure is under control, the patient may be able to make fewer visits to the doctor if the patient monitor the blood pressure at home.
– Practice relaxation or slow, deep breathing. Practice taking deep, slow breaths to help relax. There are some devices available that can help guide your breathing for relaxation; however, it’s questionable whether these devices have a significant effect on lowering the blood pressure.
Coping and support:
High blood pressure isn’t a problem that one can treat and ignore. It is a condition the patient needs to manage for the rest of the life. To keep the blood pressure under control:
– Take the medications properly. If side effects or costs pose problems, don’t stop taking the medications. Ask the doctod about other options.
– Schedule regular doctor visits. It takes a team effort to treat high blood pressure successfully. Doctor can’t do it alone, and neither can the patient. Work with the doctor to bring the blood pressure to a safe level — and keep it there.
– Adopt healthy habits. Eat healthy foods, lose excess weight and get regular physical activity. Limit alcohol. Quit smoking.
– Manage stress. Say no to extra tasks, release negative thoughts, maintain good relationships, and remain patient and optimistic.
Sticking to lifestyle changes can be difficult — especially if the patient doesn’t see or feel any symptoms of high blood pressure. If the patient needs motivation, patient should be reminded about the risks associated with Uncontrolled high blood pressure. It may help to enlist the support of the family and friends as well. Thanks a lot everybody.
Dr. A.K.M. Aminul Hoque
Associate Prof. (Medicine)
Dhaka Medical College & Hospital,