Hypertension

HYPERTENSION

Definition:

Hypertension  is defined as a consistently elevated blood pressure exceeding 140/90 mm Hg. Hypertension (HTN) sometimes called arterial hypertension .  This requires the heart to work harder than normal to circulate blood through the blood vessels. Blood pressure involves two measurements, systolic and diastolic.

Signs and symptoms:

• Headaches
• Vertigo
•  Tinnitu
•  Fainting
•  palpitations

Type Of Hypertension:

There are two major types of hypertension and four less frequently found types.The two major types are:

Primary or essential hypertension:

Primary or essential hypertension that has no known cause, is diagnosed in the majority of people.95% of reported high blood pressure cases in theunderlying cause cannot be determined. This type of high blood pressure is called essential hypertension or primary hypertension.  It has been linked to certain risk factors. High blood pressure tends to run in families and is more likely to affect men than women. Age and race also play a role.  Essential hypertension is also greatly influenced by diet and lifestyle. The link between salt and high blood pressure is especially compelling . The majority of all people with high blood pressure are "salt sensitive," meaning that anything more than the minimal bodily need for salt is too much for them and increases their blood pressure. Other factors that can raise the risk of having essential hypertension include obesity; diabetes; stress; insufficient intake of potassium, calcium, and magnesium; lack of physical activity; and chronic alcohol consumption.

Secondary hypertension:

Some additional signs and symptoms may suggest secondary hypertension, i.e. hypertension due to an identifiable cause such as kidney diseases or endocrine diseases. For example, truncal obesity, glucose intolerance, moon facies, a "buffalo hump" and purple striae suggest Cushing's syndrome. Thyroid disease and acromegaly can also cause hypertension and have characteristic symptoms and signsAn abdominal bruit may be an indicator of renal artery stenosis (a narrowing of the arteries supplying the kidneys), while decreased blood pressure in the lower extremities and/or delayed or absent femoral arterial pulses may indicate aortic coarctation (a narrowing of the aorta shortly after it leaves the heart). Labile or paroxysmal hypertension accompanied by headache, palpitations, pallor, and perspiration should prompt suspicions of pheochromocytoma.

The other types include:

• Malignant Hypertension.
• Isolated Systolic Hypertension
• White Coat Hypertension
• Resistant Hypertension

Cause Of Hypertension:

• People with family members who have high blood pressure
• Smokers
• Pregnant women
• Women who take birth control pills
• People over the age of 35
• People who are overweight or obese
• People who are not active
• People who drink alcohol excessively
• People who eat too many fatty foods or foods with too much salt
• People who have sleep apnea.

Related Diseases & Conditions:

• Congestive Heart Failure

Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to meet the body's needs. A poor blood supply resultingfrom congestive heart failure may cause the body's organ systems to fail, leading to a weakened heart muscle and fluid accumulation in the lungs and body tissue. There are many diseases that can impair pumping efficiency and symptoms of congestive heart failure including fatigue, diminished exercise capacity, shortness of breath, and swelling. Treatments include lifestyle modifications, medications, heart transplant, and therapy.

•  Anxiety

Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses .

•  Headache 

Headaches can be divided into two categories: primary headaches and secondary headaches.  Migraine headaches, tension headaches, and cluster headaches are  considered primary headaches. Secondary headaches are caused by disease. Headache symptoms vary with the headache type. Over-the-counter pain relievers provide short-term relief for most headaches.

• Edema

Edema is the swelling of tissues as a result of excess water accumulations. Peripheral edema occurs in the feet and legs. There are two types of edema,  non-pitting edema and pitting edema. Causes of pitting edema is caused by systemic diseases, most commonly involving the heart, liver, and kidneys. Local conditions that cause edema are thrombophlebitis and varicose veins. Edema is generally treated with medication.

•  Diabetes (Type 1 and Type 2) 

Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type ,type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.

• Stroke

A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.

• Alcoholism

Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting such as losing a job or getting into trouble with the law.

• Palpitations

Palpitations are unpleasant sensations of irregular and/or forceful beating of the heart. Palpitations can be relieved in many patients by stress reduction,   stopping cigarettes, and reduction of caffeine and alcohol.

• Abdominal Aortic Aneurysm

Abdominal aortic aneurysm is a ballooning or widening of the main artery (the aorta) as it courses down through the abdomen. The most common cause of aortic aneurysms is "hardening of the arteries" called arteriosclerosis.

• Heart Attack

Heart attack happens when a blood clot completely obstructs a coronary artery supplying blood to the heart muscle. A heart attack can cause chest pain,, heart failure, and electrical instability of the heart.

• Nausea and Vomiting

Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases,

but they are symptoms of many conditions. Thecauses of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting. 

• Chest Pain

Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia,pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.

• Aneurysm (Brain)

Brain aneurysm (cerebral aneurysm) is caused by microscopic damage to artery walls, infections of the artery walls, tumors, trauma, drug abuse. Symptoms  headache, numbness of the face, dilated pupils, changes in vision, a painful stiff neck. Immediate treatment for a brain aneurysm is crucial for patient survival.

• Low Potassium (Hypokalemia)

Potassium is an essential electrolyte necessary for cell function. Low potassium (hypokalemia) may be caused by diarrhea, vomiting, ileostomy, colon polyps, laxative use, diuretics, elevated corticosteroid levels, renal artery stenosis, and renal tubular acidosis, or other medications. Symptoms of low potassium include weakness, aches, and cramps of the muscles. Treatment is dependant upon the cause of the low potassium (hypokalemia).

• Seizure (Epilepsy)

Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.

• Insulin Resistance

Insulin resistance is the diminished ability of cells to respond to the action of insulin in transporting glucose (sugar) from the bloodstream into muscle and other tissues. Causes of insulin can include conditions such as stress, obesity, metabolic syndrome, and steroid use. Some of the risk factors for insulin resistance include fatty liver, heart disease, strokes, peripheral vascular disease, high cholesterol, and smoking. Treatment for insulin resistance are lifestyle changes and if necessary, medication.

• Obesity

Obesity is the state of being well above one's normal weight. A person has traditionally been considered to be obese if they are more than 20 percent   over their ideal weight. That ideal weight must take into account the person's height, age, sex, and build.

• Atrial Fibrillation

Atrial fibrillation is an abnormality in the heart rhythm which involves irregular and often rapid beating of the heart.

• Abnormal Heart Rhythms (Heart Rhythm Disorders)

Heart rhythm disorders vary from minor palpitations, premature atrial contractions (PACs), premature ventricular contractions (PVCs), sinus tachycardia,  and sinus brachycardia, to abnormal heart rhythms such as tachycardia, ventricular fibrillation, ventricular flutter, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia (PSVT), Wolf-White-Parkinson syndrome, brachycardia, or heart blocks. Treatment is dependant upon the type of heart rhythm disorder.

• Hyperglycemia

Hyperglycemia is a serious health problem for diabetics. There are two types of hyperglycemia, 1) fasting, and 2)postprandial or after meal hyperglycemia. .Hyperglycemia can also lead to ketoacidosis or hyperglycemic hyperosmolar nonketotic syndrome (HHNS). There are a variety of causes of hyperglycemia in people with diabetes. Symptoms include increased thirst, headaches, blurred vision, frequent urination and more. Treatment can be achieved through lifestyle changes or medications changes. Carefully monitoring blood glucose levels is key to prevention.

• Encephalopathy

Encephalopathy means brain disease, damage, or malfunction. Causes of encephalopathy are varied and numerous. The main symptom of encephalopathy is an altered mental state. Other symptoms include lethargy, dementia, seizures, tremors, and coma. Treatment of encephalopathy depends on the type of encephalopathy (anoxia, diabetic, Hashimoto's, hepatic, hyper - hypotensive, infectious, metabolic, infections, uremic, or Wernicke's) are examples of types of encephalopathy. 

Diagnosis:

Serum creatinine is measured to assess for the presence of kidney disease, which can be either the cause or the result of hypertension. Serum creatinine alone may overestimate glomerular filtration rate and recent guidelines advocate the use of predictive equations such as the Modification of Diet in Renal Disease (MDRD) formula to estimate glomerular filtration rate (eGFR) eGFR can also provides a baseline measurement of kidney function that can be used to monitor for side effects of certain antihypertensive drugs on kidney function. Additionally, testing of urine samples for protein is used as a secondary indicator of kidney disease. Electrocardiogram (EKG/ECG) testing is done to check for evidence that the heart is under strain from high blood pressure. It may also show whether there is thickening of the heart muscle (left ventricular hypertrophy) or whether the heart has experienced a prior minor disturbance such as a silent heart attack. A chest X-rayor an echocardiogram may also be performed to look for signs of heart enlargement or damage to the heart.

Hypertension is diagnosed on the basis of a persistently high blood pressure. Traditionally this requires three separate sphygmomanometer measurements at one monthly intervals Initial assessment of  the hypertensive people should include a complete history and physical examination. With the availability of 24-hour ambulatory blood pressure monitors and home blood pressure machines, the importance of not wrongly diagnosing those who have white coat hypertension has led to a change in protocols.

Prevention :

• Maintain normal body weight for adults (e.g. body mass index 20–25 kg/m2)
• Reduce dietary sodium intake to <100 mmol/ day (<6 g of sodium chloride or <2.4 g of sodium per day)
• Engage in regular aerobic physical activity such as brisk walking (≥30 min per day, most days of the week)
• Limit alcohol consumption to no more than 3 units/day in men and no more than 2 units/day in women.
• Consume a diet rich in fruit and vegetables (e.g. at least five portions per day).
• Cnsume a diet with reduced content of saturated and total fat.