Hypertension Appearing As Silent Alarm

Hypertension Appearing As Silent Alarm

Hypertension or High Blood Pressure is a repeatedly elevated blood pressure of more than 140/90 mmHg. Blood pressure is one of the vital signs and it should be measured in every patient irrespective of his or her complaint. Hypertension occasionally causes headache, but most of times it remains silent. So most patients suffering from hypertension are unaware of their increased blood pressure.

Hypertension (High Blood Pressure)

”Repeatedly elevated blood pressure of more than 140/90 mmHg i.e. systolic blood pressure more than 140mmHg and diastolic more than 90mmHg”.

Stages of High Blood Pressure:

Normal:

Systolic less than 120mmHg

Diastolic less than 80mm Hg

1. Pre-hypertensive stage:

Systolic 120-139 mmHg

Diastolic 80-89 mmHg

2. Hypertension stage 1:

Systolic 140-159mmHg

Diastolic 90-99mmHg

3. Hypertension stage 2:

Systolic 160-179mmHg

Diastolic 100-109mmHg

4. Hypertension stage 3:

Systolic more than or equal to 180 mmHg

Diastolic more than or equal to 110 mmHg

Hypertensive emergency (Malignant hypertension/ Hypertension in Cancer) is a life threatening situation in which diastolic blood pressure is more than 150 mm Hg with systolic blood pressure of more than 210 mmHg in an otherwise healthy individual.

Etiology (Causes) of Hypertension:

A. Primary or Essential hypertension:

95% patients suffering from hypertension have no underlying cause i.e. essential hypertension.

B. Secondary hypertension:

1. Renal causes of hypertension:

a. Renal artery stenosis

b. Polycystic kidney disease

c. Acute glomerulonephritis

d. Chronic renal disease

e. Renin producing tumours

f. Renal artery fibromuscular dysplasia

g. Renal vasculitis

2. Cardiovascular causes:

a. coarctation of aorta

b. Rigidity of aorta(e.g in oldage)

c. Increased cardiac output

d. Increased cardiovascular volume

e. Polyarterits nodosa and other vasculitis

3. Neurological causes:

a. Increased intracranial pressure

b. Psychological

c. Sleep apnea

d. Stress very less likely can cause HTN.

4. Endocrine causes:

a. Cushing syndrome

b. Hyperaldosteronism

c. Pheochromocytoma

d. Hperthyroidism

e. Hpothyroidism

f. Acromegaly

g. Pregnancy induced hypertension

h. Exogenous hormones e.g. estrogens including oral contraceptive,

Tyramine containing foods, monoamine oxidase inhibitors, sympathomimetics.

Predisposing factors:

1. High dietary intake of sodium i.e. high salt intake

2. Obesity

3. Stressful life style

4. Smoking

5. Physical inactivity.

NOTE:

Blood pressure is one of the vital signs and it should be measured in every patient irrespective of his or her complaint.

How Hypertension Develops (Pathogenesis):

Arterial blood pressure is directly proportional to the product of cardiac output and peripheral vascular resistance, so arterial hypertension results when the relationship between cardiac output and peripheral vascular resistance is altered.

‘’Baroreceptors and sympathetic nervous system’ and ‘’kidney (renin-angiotensin –aldosterone system)’’ plays an important role in the auto regulation of blood pressure.

In secondary forms the pathogenesis of hypertension is well understood e.g. in pheochromocyoma, a tumor of adrenal medulla there is increased secretion of catecholamine’s that cause episodic vasoconstriction and thus induce hypertension.

In Renal artery stenosis, there is decreased blood supply towards kidney so there is activation of renin angiotensin aldosterone system. Renin secreted from juxtaglomerular cells of kidney converts plasma angiotensinogen to angiotensin 1 which is converted to angiotensin by angiotensin converting enzyme. This angiotensin then raises blood pressure by acting on vascular smooth muscles thus increasing peripheral vascular resistance, and also by increasing blood volume (stimulation of aldosterone secretion, increase in tubular reabsorption of sodium).

However essential hypertension is a complex multifactorial disorder that results from an interaction of genetic and environmental factors that affect cardiac output and peripheral vascular resistance. More likely essential hypertension results from the combined effect of mutations or polymorphisms at several gene loci that influence blood pressure interacting with variety of environmental factors e.g stress, salt intake. These environmental factors are the exogenous factors that modify expression of genetic determinants of increased pressure.

In both essential and secondary hypertension, heavy sodium intake augments the condition.

Hypertension-a silent Killer

Hypertension occasionally causes headache, but most of times it remains silent. So most patients suffering from hypertension are unaware of their increased blood pressure. And unfortunately among those who are aware of their status, mostly do not take it serious as it causes no interruption in their daily activities. An important thing to know is that chronic hypertension can lead to:

1. Congestive heart failure.

2. Myocardial infarction.

3. Cerebrovascular accidents.

4. Renal damage.

5. Cardiomegaly.

6. Retinopathy.

So every person should have regular measurement of his blood pressure with an interval of five years if it is normal, and should take proper medication as prescribed by a Doctor if it is within abnormal range.

Non-Pharmacological Treatment Of Hypertension:

The Dash Diet:

The DASH diet (Dietary Approaches to Stop  Hypertension) is a diet promoted by the National Heart,  Lung, and Blood Institute (part of the NIH, a United  States government organization) to control hypertension. The diet reduced systolic blood pressure by 6 mmHg and diastolic blood pressure by 3mmHg in patients with normal blood pressure. Those with hypertension dropped SBP by 11mmHg and DBP by 6mmHg. The DASH diet is recommended by physicians for people with hypertension and pre-hypertension. The DASH eating plan has been proven to lower blood pressure in just 14 days, even without lowering sodium intake. Best response came in people whose blood pressure was only moderately high, including those with pre-hypertension. For people with more severe hypertension, who may not be able to eliminate medication, the DASH diet can help improve response to medication, and help lower blood pressure. The book, The DASH Diet Action Plan, provides real life solutions to make it easy for people to follow the DASH diet. Mostly Dash diet includes fruits, vegetables, grains and grain products low fat or non fat diary products and very limited sweets. Other measures to stop Hypertension:

1. Lose extra weight.

2. Exercise regularly.

3. Eat healthy diet.

4. Reduce sodium in diet.

5. Limit amount of alcohol you drink.

Contributed by

Shahnawaz Daud

Batch 36

Chandka Medical College Larkana