Hypertension

Overview of hypertension – Hypertension is a condition in which the  force of the blood against your artery walls is high. If left untreated will eventually cause health problems including heart attack and stroke.

Systolic blood pressure is the pressure of blood when the heart beats.

When your heart is at rest, between beats, your blood pressure falls. This is called diastolic pressure.

Usually the systolic number comes before or above the diastolic number.

Blood pressure is determined by resistance of arteries to blood flow and the amount of blood pumped by the heart. The higher the amount of blood that is pumped from the heart the narrower the arteries get, and higher is the pressure of the blood.

 Symptoms – High blood pressure usually has no symptoms. 

Measurements and stages – are based upon appropriately measured blood pressure techniques.

  • Normal blood pressure – Systolic <120 mmHg and diastolic <80 mmHg (120/80 mmHg).
  • Elevated blood pressure – Systolic 120 to 129 mmHg and diastolic <80 mmHg
  • Hypertension:
  • Stage 1 – Systolic 130 to 139 mmHg or diastolic 80 to 89 mmHg
  • Stage 2 – Systolic at least 140 mmHg or diastolic at least 90 mmHg 

(If there is a disparity in category between the systolic and diastolic pressures, the higher value determines the stage) 

Isolated systolic hypertension is defined as blood pressure ≥130/<80 mmHg.

Isolated diastolic hypertension is defined as a blood pressure <130/≥80 mmHg.

Systolic blood pressure above and equal to 180 mmHg and/or diastolic pressure ≥120 mmHg requires immediate medical attention. 

 

Types of hypertension – Primary hypertension and secondary hypertension.

  • Primary hypertension also called essential hypertension develops over time as you get older.This is the most common type and is most likely the result of numerous genetic and environmental factors.
  • Secondary hypertension is caused by another medical condition or use of certain medicines.

Risk factors – Risk factors for primary hypertension are age, obesity, family history of hypertension, high sodium diet, excessive alcohol consumption, physical inactivity. 

 

Complications of hypertension –

  • Heart failure
  • Ischemic stroke (stroke is a medical emergency and is usually caused by a blood clot that blocks or plugs a blood vessel in the brain)
  • Intracerebral hemorrhage (Intracerebral hemorrhage is a medical emergency that occurs when the blood vessel within the brain bursts, allowing blood to leak inside the brain)
  • Ischemic heart disease (A condition that occurs when the arteries of the heart cannot deliver enough oxygen-rich blood to the heart)
  • Chronic kidney disease and end stage kidney disease
  • Hypertensive retinopathy (Retina is damaged by high blood pressure levels over time. The retina is light-sensitive tissue at the back of your eye) 

Watch out for signs and symptoms of complications and progression of hypertension –

Stroke is one of the complications of hypertension.

Seek immediate medical help or call 911 if you experience any signs and symptoms of stroke –

  • Face drooping on one side of the face when you smile
  • One arm drift downwards or is if one arm is unable to rise up
  • Speech is slurred or strange

 

Lifestyle management – People with hypertension have to learn to balance the meals and make the healthiest food choices. Consume the number of calories recommended by your doctor or dietician.

– A reasonable goal is to reduce daily sodium intake to <100 mEq (2.3 g of sodium or 6 g of sodium chloride)/day.

-Diet rich in fruits, vegetables, legumes, and low-fat dairy products and low in snacks, sweets, meats, and saturated and total fat (this combination diet is called the “”DASH diet””). The DASH diet is comprised of four to five servings of fruit, four to five servings of vegetables, two to three servings of low-fat dairy per day, and <25 percent fat.

-Trans fat (hydrogenated fats) are atherogenic, while mono- and polyunsaturated fats (particularly omega-3 fatty acids) – eg, those found in fish, olive oil, nuts are protective and prevent and treat cardiovascular disease

-The usual daily intake of protein should be approximately 10 to 20 percent of total caloric intake. Higher levels of dietary protein intake (>20 percent of calories from protein or >1.3 g/kg/day) have been associated with increased albuminuria, more rapid kidney function loss, and cardiovascular disease (CVD) mortality and therefore should be avoided

-Fiber intake should be at least 14 grams per 1000 calories daily

-Potassium may moderately lower the BP. Talk to your doctor before taking potassium supplements or potassium rich foods.Hypertensive patients should consume at least 120 mEq (4.7 g) of dietary potassium/day provided they do not have a predisposition to hyperkalemia (high blood potassium levels)

-Alcohol – For women, no more than one drink per day; For men, no more than 2 drinks per day is recommended (one drink is equal to 12- oz beer, 5-oz glass of wine, or 1.5 oz distilled spirits)

-High – dose fish oils may reduce the BP. Talk to your doctor before taking these.

Diet recommendations for complications of hypertension such as chronic kidney disease, end stage kidney disease, refractory heart failure which requires fluid restriction, may vary from those recommended for hypertension. Also the diet recommendations may be different if you have other medical conditions along with hypertension.

Physical activity – Before starting any exercise regimen, talk to your doctor. Your doctor may do a physical examination and tests to see if you are fit for starting an exercise regimen.

-After advice from your doctor the recommendation that all adults should engage in two hours and 30 minutes per week of moderate-intensity physical activity, or one hour and 15 minutes per week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity. Aerobic activity should be performed in episodes of at least 10 minutes, preferably spread throughout the week.

Do not exercise and call your doctor immediately or seek immediate medical help if systolic blood pressure is ≥180 and/or diastolic blood pressure is ≥120 mm Hg.

 

Pharmacologic treatment – Initial therapy is chosen from among the following four classes of medications. The choice of medication/medications also depends on the comorbidities.

  • Thiazide type or thiazide like diuretics – Hydrochlorothiazide, Chlorthalidone, Metolazone, Indapamide, Methyclothiazide, Chlorothiazide.
  • Calcium channel blockers – Amlodipine, Clevidipine, Nifedipine, Diltiazem, Verapamil, Isradipine, Nisoldipine, Felodipine
  • Angiotensin-converting enzyme (ACE) inhibitors – Benazepril, Captopril, Enalapril, Fosinopril, Lisinopril, Quinapril, Moexipril.
  • Angiotensin II receptor blockers (ARB) – Azilsartan, Candesartan, Eprosartan, Irbesartan, Losartan, Olmesartan, Telmisartan, Valsartan.


Lifestyle modifications and medications will help you keep your blood pressure within the goals set by your doctor. Blood pressure targets are based upon the patient’s risk for having a future cardiovascular event, comorbidities, and age. Blood pressure targets depend in part upon the method by which the blood pressure is measured. Talk to your doctor about the best technique and device to measure the blood pressure.

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