|
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.
|
