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Hypertension
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Hypertension

Hypertension

Most people can't tell when their blood pressure is high, which is why hypertension is called the "silent killer." In this case, what you don't know can hurt you. Elevated blood pressure can lead to a greatly increased risk of heart attack, stroke, and many other serious illnesses. Along with high cholesterol and smoking, hypertension is one of the most important causes of atherosclerosis. In turn, atherosclerosis causes heart attacks, strokes, and other diseases of impaired circulation.

The mechanism by which high blood pressure produces atherosclerosis is similar to a hose fitted with a high-pressure nozzle. All such nozzles come with a warning label that states, "Make sure to discharge pressure in hose after using." Unfortunately, many people frequently fail to pay attention to the warning and leave the hose puffed up with full pressure overnight.

This rather common practice does not produce any immediate consequences. The hose doesn't develop leaks at the seams or burst outright on the first occasion you leave it untended. However, a garden hose that is frequently left under pressure will begin to age more rapidly than it would otherwise. Its lining will begin to crack, its flexibility will diminish, and within a season or two the hose will be sprouting leaks in all directions.

When blood vessels are exposed to constantly high pressure, a similar process is set in motion. Blood pressures as elevated as 220/170 (systolic pressure/diastolic pressure), quite common during activities such as weight lifting, do no harm. Only when excessive pressure is sustained day and night do blood vessel linings begin to be injured and undergo those unhealthy changes known as atherosclerosis.

Thus, although it is important to lower blood pressure with all deliberate speed, only rarely does it need to be lowered instantly. In most situations, you have plenty of time to work on bringing down your blood pressure. However, that doesn't mean that you should ignore it. Over time, high blood pressure can damage nearly every organ in the body.

The best way to determine your blood pressure is to take several readings at different times during the day and on different days of the week. Blood pressure readings will vary quite a bit from moment to moment; what matters most is the average blood pressure. Thus, if many low readings balance out a few high readings, the net result may be satisfactory.

However, it is essential not to ignore a high value by saying, "I was just stressed then." Stress is part of life, and if it raises your blood pressure once, it will do so again. To come up with an accurate number, you must include every measurement in your calculations. 

In most cases, the cause of hypertension is unknown. The kidneys play an important role in controlling blood pressure, and the level of squeezing tension in the blood vessels makes a large contribution as well.

 Lifestyle changes can dramatically reduce blood pressure. Increasing exercise, stopping smoking, and losing weight can all be highly effective. For many years doctors advised patients with hypertension to cut down on salt in the diet. Today, however, the value of this difficult dietary change has undergone significant questioning. Considering how rapidly our knowledge is evolving, we suggest consulting your physician to learn the latest recommendations.

If lifestyle changes fail to reduce blood pressure, or if you can't make these alterations, many effective drugs are available. Sometimes you need to experiment with a few to find one that agrees with you.

Principal Proposed Natural Treatments The supplement CoQ10 and the therapy biofeedback have shown some promise for hypertension. However, keep in mind that if your blood pressure is more than mildly elevated, it is unlikely that any natural treatment (other than significant lifestyle changes) is likely to produce an adequate effect.

Biofeedback Biofeedback, a technique for gaining conscious control over involuntary bodily functions, has shown considerable promise for the treatment of mild hypertension. One review of the literature found 23 controlled trials on the subject of acceptable quality.63 Taken as a whole, these studies suggest that biofeedback can reduce blood pressure by approximately 5%, a modest but useful improvement.

For more information, see the biofeedback article.

Other Proposed Natural Treatments Various natural treatments have shown some promise for hypertension.

The Iranian herb Achillea wilhelmsii was tested in a double-blind trial of 60 men and women with mild hypertension. 38 The results showed that treatment with an A. wilhelmsii extract significantly reduced blood pressure readings. In a double-blind study of 43 men and women with hypertension, use of a proprietary Ayurvedic herbal combination containing Terminali arjuna and about 40 other herbs proved approximately as effective for controlling blood pressure as the drug methyldopa.

Although the research record is mixed,15–21 it appears that fish oil may reduce blood pressure at least slightly.56 Some evidence suggests that it is the DHA in fish oil, but not the EPA, that is responsible for this benefit.

Several studies have found that glucomannan, a dietary fiber derived from the tubers of Amorphophallus konjac, may improve high blood pressure.

Milk fermented by certain probiotics (friendly bacteria) may contain substances that have a blood pressure–lowering effect.

People who are deficient in calcium may be at great risk of developing high blood pressure. Among people who already have hypertension, increased intake of calcium intake might slightly decrease blood pressure, according to some, but not all studies.

 Several flawed studies hint that the herb garlic may lower blood pressure slightly, perhaps by 5 to 10%.

Getting adequate vitamin D may help prevent the development of hypertension.

The vitamin folate may help decrease blood pressure (as well as provide other heart healthy effects) in smokers.67

The herb hawthorn is often said to reduce blood pressure, but its effects appear to be marginal at best.

The herbs astragalus, Coleus forskohlii, and maitake, and the supplements beta-carotene, flaxseed oil, and taurine are sometimes recommended for high blood pressure, but as yet there is no meaningful evidence that they work.

Yoga has shown some promise for reducing high blood pressure.

Hypertension Means High Blood Pressure. This generally means:

  • Systolic blood pressure is consistently over 140 (systolic is the "top" number of your blood pressure measurement, which represents the pressure generated when the heart beats)

  • Diastolic blood pressure is consistently over 90 (diastolic is the "bottom" number of your blood pressure measurement, which represents the pressure in the vessels when the heart is at rest)

Either or both of these numbers may be too high.

Pre-hypertension is when your systolic blood pressure is between 120 and 139 or your diastolic blood pressure is between 90 and 99 on multiple readings. If you have pre-hypertension, you are likely to develop high blood pressure at some point. Therefore, your doctor will recommend lifestyle changes to bring your blood pressure down to normal range.

Causes, incidence, and risk factors   Blood pressure is determined by the amount of blood pumped by the heart, and the size and condition of the arteries. Many other factors can affect blood pressure, including volume of water in the body; salt content of the body; condition of the kidneys, nervous system, or blood vessels; and levels of various hormones in the body.

"Essential" hypertension has no identifiable cause. It may have genetic factors and environmental factors, such as salt intake or others. Essential hypertension comprises over 95% of all high blood pressure.

"Secondary" hypertension is high blood pressure caused by another disorder. This may include:

  • Adrenal gland tumors
  • Cushing's syndrome
  • Kidney disorders
  • Glomerulonephritis (inflammation of kidneys)
  • Renal vascular obstruction or narrowing
  • Renal failure
  • Use of medications, drugs, or other chemicals
  • Oral contraceptives
  • Hemolytic-uremic syndrome
  • Henoch-Schonlein purpura
  • Periarteritis nodosa
  • Radiation enteritis
  • Retroperitoneal fibrosis
  • Wilms' tumor
  • Other disorders

Symptoms: Usually, no symptoms are present. Occasionally, you may experience a mild headache. If your headache is severe, or if you experience any of the symptoms below, you must be seen by a doctor right away. These may be a sign of dangerously high blood pressure (called malignant hypertension) or a complication from high blood pressure.

  • Tiredness
  • Confusion
  • Vision changes
  • Angina-like chest pain (crushing chest pain)
  • Heart failure
  • Blood in urine
  • Nosebleed
  • Irregular heartbeat
  • Ear noise or buzzing

Signs And Tests   Hypertension may be suspected when the blood pressure is high at any single measurement. It is confirmed through blood pressure measurements that are repeated over time. Blood pressure consistently elevated over 140 systolic or 90 diastolic is called hypertension. Your doctor will look for signs of complications to your heart, kidneys, eyes, and other organs in your body.

Systolic blood pressure consistently between 130 and 139 or diastolic blood pressure consistently between 80 and 89 is called pre-hypertension. Your doctor will recommend and encourage lifestyle changes including weight loss, exercise, and nutritional changes.

Tests for suspected causes and complications may be performed. These are guided by the symptoms presented, history, and results of examination.

Treatment The goal of treatment is to reduce blood pressure to a level where there is decreased risk of complications. Treatment may occur at home with close supervision by the health care provider, or may occur in the hospital.

Medications may include diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or alpha blockers. Medications such as hydralazine, minoxidil, diazoxide, or nitroprusside may be required if the blood pressure is very high.

Have your blood pressure checked at regular intervals (as often as recommended by your doctor.)Lifestyle changes may reduce high blood pressure, including weight loss, exercise, and dietary adjustments.

Expectations (prognosis)

Hypertension is controllable with treatment. It requires lifelong monitoring, and the treatment may require adjustments periodically.

Complications

  • Hypertensive heart disease
  • Heart attacks
  • Congestive heart failure
  • Blood vessel damage (arteriosclerosis)
  • Aortic dissection
  • Kidney damage
  • Kidney failure
  • Stroke
  • Brain damage
  • Loss of vision
    Calling Your Health Care Provider: Even if you have not been diagnosed with high blood pressure, it is important to have your blood pressure checked at annual exams, especially if you have a history of high blood pressure in your family.

    If you have high blood pressure, you will have regularly scheduled appointments with your doctor. In between appointments, if you have any of the symptoms listed below or your blood pressure remains high even with treatment (this assumes the use of a home blood pressure monitor), then call your doctor right away.

  • Severe headache
  • Excessive tiredness
  • Confusion
  • Visual changes
  • Nausea and vomiting
  • Chest pain
  • Shortness of breath
  • Significant sweating
    Prevention  Lifestyle changes may help control high blood pressure:

    • Lose weight if you are overweight. Excess weight adds to strain on the heart. In some cases, weight loss may be the only treatment needed.
    • Exercise to help your heart.
    • Adjust your diet as needed. Decrease fat and sodium -- salt, MSG, and baking soda all contain sodium. Increase fruits, vegetables, and fiber.
    Follow your health care provider's recommendations to modify, treat, or control possible causes of secondary hypertension.

    Untreated Hypertension:  Hypertension is a disorder characterized by chronically high blood pressure. It must be monitored, treated and controlled by medication, lifestyle changes, or a combination of both.

    Ocular Hypertension Overview:

    The term ocular hypertension usually refers to any situation in which the pressure inside the eye, called intraocular pressure, is higher than normal. Eye pressure is measured in millimeters of mercury (mm Hg). Normal eye pressure ranges from 10-21 mm Hg. Ocular hypertension is an eye pressure of greater than 21 mm Hg.

    Although its definition has evolved through the years, ocular hypertension is commonly defined as a condition with the following criteria:

    • An intraocular pressure of greater than 21 mm Hg is measured in one or both eyes on 2 or more occasions. Pressure inside the eye is measured using an instrument called a tonometer.
    • The optic nerve appears normal.
    • No signs of glaucoma are evident on visual field testing, which is a test to assess your peripheral (or side) vision.
    • To determine other possible causes for your high eye pressure, an ophthalmologist (a medical doctor who specializes in eye care and surgery) assesses whether your drainage system (called the "angle") is open or closed. The angle is seen using a technique called gonioscopy. This technique involves the use of a special contact lens to examine the drainage angles (or channels) in your eyes to see if they are open, narrowed, or closed.
    • No signs of any ocular disease are present. Some eye diseases can increase the pressure inside the eye.
    Ocular hypertension should not be considered a disease by itself. Instead, ocular hypertension is a term that is used to describe individuals who should be observed more closely than the general population for the onset of glaucoma. For this reason, another term that may be used to refer to an increase in intraocular pressure is glaucoma suspect. A glaucoma suspect is a person whom the ophthalmologist is concerned may have or may develop glaucoma because of the elevated pressure inside the eyes.

    As mentioned above, increased intraocular pressure can result from other eye conditions. However, within this article, ocular hypertension primarily refers to increased intraocular pressure but without any optic nerve damage or vision loss. Glaucoma occurs when increased intraocular pressure, optic nerve damage, and vision loss are present.

    As of the year 2000, an estimated 2.47 million people in the United States have glaucoma and more than 130,000 are legally blind because of this disease. These statistics alone emphasize the need to identify and closely monitor people who are at risk of developing glaucoma, particularly those with ocular hypertension.

    • Studies estimate that 3-6 million people in the United States alone, including 4-10% of the population older than 40 years, have intraocular pressures of 21 mm Hg or higher, without detectable signs of glaucomatous damage using current tests.
    • Studies over the last 20 years have helped to characterize those with ocular hypertension. o Recent data on people with ocular hypertension from the Ocular Hypertension Treatment Study have shown that they have an average estimated risk of 10% of developing glaucoma over 5 years. This risk may be decreased to 5% (a 50% decrease in risk) if eye pressure is lowered by medications or laser surgery. However, the risk may become even less than 1% per year because of significantly improved techniques for detecting glaucomatous damage. This could allow treatment to start much earlier, before vision loss occurs. Future studies will help to further assess this risk of glaucoma development.
    • Patients with thin corneas may be at a higher risk for glaucoma development; therefore, your ophthalmologist may use a measuring device, called a pachymeter, to determine your corneal thickness.

    • Ocular hypertension is 10-15 times more likely to occur than primary open-angle glaucoma, a common form of glaucoma. That means that out of every 100 people older than 40 years about 10 will have pressures higher than 21 mm Hg, but only 1 of those people will have glaucoma.

    • Over a 5-year period, several studies have shown the incidence of glaucomatous damage in people with ocular hypertension to be about 2.6-3% for intraocular pressures of 21-25 mm Hg, 12-26% for intraocular pressures of 26-30 mm Hg, and approximately 42% for those higher than 30 mm Hg.

    • In approximately 3% of people with ocular hypertension, the veins in the retina can become blocked (called a retinal vein occlusion), which could lead to vision loss. Because of this, keeping pressures below 25 mm Hg in people with ocular hypertension and who are older than 65 years is often suggested.
    Some studies have found that the average intraocular pressure in blacks is higher than in whites, while other studies have found no difference.

    • A 4-year study showed that blacks with ocular hypertension were 5 times more likely to develop glaucoma than whites. Findings suggest that, on average, blacks have thinner corneas, which may account for this increased likelihood to develop glaucoma, as a thinner cornea may cause pressure measurements in the office to be falsely low.
    • In addition, blacks are considered to have a 3-4 times greater risk of developing primary open-angle glaucoma. They are also believed to be more likely to have optic nerve damage.
    Although some studies have reported a significantly higher average intraocular pressure in women than in men, other studies have not shown any difference between men and women.

    • Some studies suggest that women could be at a higher risk for ocular hypertension, especially after menopause.
    • Studies also show that men with ocular hypertension may be at a higher risk for glaucomatous damage.
    Intraocular pressure slowly rises with increasing age, just as glaucoma becomes more prevalent as you get older.

    • Being older than 40 years is considered to be a risk factor for the development of both ocular hypertension and primary open-angle glaucoma.

    Elevated pressure in a young person is a cause for concern. A young person has a longer time to be exposed to high pressures over a lifetime and a greater likelihood of optic nerve damage. 

    A general physician can treat BP.

    What is systolic blood pressure? Systolic pressure is the force of blood in the arteries as the heart beats. It is shown as the top number in a blood pressure reading.

    What is diastolic blood pressure? Diastolic pressure is the force of blood in the arteries as the heart relaxes between beats. It's shown as the bottom number in a blood pressure reading.

    How do I know if I have high blood pressure? High blood pressure often has no signs or symptoms. The only way to find out if you have high blood pressure is to be tested for it.

    How Is Blood Pressure Tested? Having your blood pressure tested is quick and easy. Blood pressure is measured in millimeters of mercury (mm Hg) and recorded as two numbers systolic pressure "over" diastolic pressure.

    Do mineral supplements reduce blood pressure? Potassium helps to prevent and control blood pressure. Some good sources are various fruits, vegetables, dairy foods, and fish.

    Pulmonary Hypertension: Pulmonary hypertension is a disorder of the blood vessels in the lungs. "Pulmonary" means "in the lungs," and "hypertension" means "high blood pressure."

    Pulmonary hypertension happens when the blood pressure in the pulmonary arteries (the vessels that carry blood from the heart to the lungs) becomes higher than normal. This puts strain on the right side of the heart. Pulmonary hypertension is a serious problem. 

    Signs of Pulmonary Hypertension Common signs of pulmonary hypertension are shortness of breath with activity, feeling tired, fainting and chest pain. Symptoms usually limit exercise and other activities. 

    Causes Pulmonary Hypertension: Pulmonary hypertension can have many causes. Sometimes the cause is not known. When the cause of pulmonary hypertension isn't known, the disorder is called "primary" pulmonary hypertension.

    "Secondary" pulmonary hypertension has a known cause. Common causes are emphysema and chronic bronchitis (breathing problems). Other causes are congestive heart failure, birth defects in the heart, chronic pulmonary thromboembolism (old blood clots in the pulmonary arteries), HIV infection (AIDS), and certain medicines, including the diet drugs fenfluramine and dexfenfluramine. (These diet drugs are no longer available.)

  • Both primary and secondary types are usually permanent conditions, although treatment can improve symptoms and long-term outcomes in some people. 

      The signs of pulmonary hypertension can be like the signs of many health problems. To find out if you have pulmonary hypertension, your doctor may do an echocardiogram. For this test, an instrument called a "probe" is placed on the outside of your chest. The probe sends out sound waves. These sound waves are used to form pictures of your heart and estimate the blood pressure in your pulmonary arteries.

    Treatment Of Pulmonary Hypertension: If the cause of your pulmonary hypertension is known, treating the cause may help. Sometimes, medicines called calcium-channel blockers, breathing oxygen from a tank, or a blood-thinning medicine may help. In primary pulmonary hypertension, a medicine that is given through a vein, called prostacyclin (brand name: Flolan), may lower the blood pressure in your pulmonary arteries.

    Glossary

    • Antihypertensive - Counteracting high blood pressure.
    • Arteries - Blood vessels that carry blood away from the heart
    • Blood pressure - The pressure of the blood on the walls of the arteries, dependent on the energy of the heart action, the elasticity of the walls of the arteries, and the volume and viscosity (resistance) of the blood.
    • Blood vessel - Any channel that carries blood; includes arteries, arterioles, capillaries, venules, and veins.
    • Congestive heart failure - A condition in which the heart is unable to pump blood at an adequate rate or in adequate volume.
    • mmHg - Millimeter of mercury, a unit of pressure equal to that exerted by a column of mercury at 0 degrees C one millimeter high at sea level.
    • Pre-eclampsia - An illness of pregnancy characterized by high blood pressure, swelling or edema, and proteinuria.

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