RAKMHSU

RAKCON
BSN 4th yr

Hypertension
[ assignment 1 ]

Introduction

The World Health Organization has identified hypertension, or high blood pressure, as the leading
cause of cardiovascular mortality. The World Hypertension League (WHL), an umbrella organization of
85 national hypertension societies and leagues, recognized that more than 50% of the hypertensive
population worldwide are unaware of their condition. To address this problem, the WHL initiated a
global awareness campaign on hypertension in 2005 and dedicated May 17 of each year as World
Hypertension Day (WHD). Over the past three years, more national societies have been engaging in
WHD and have been innovative in their activities to get the message to the public.

What is hypertension (high blood pressure)?

Blood pressure is the force exerted by the blood against the walls of blood vessels, and the magnitude
of this force depends on the cardiac output and the resistance of the blood vessels.
Hypertension is having a blood pressure higher than 140 over 90 mmHg, a definition shared by all the
medical guidelines.
This means the systolic reading (the pressure as the heart pumps blood around the body) is over 140
mmHg (millimeters of mercury) or the diastolic reading (as the heart relaxes and refills with blood) is
over 90 mmHg.
While this threshold has been set to define hypertension, it is for clinical convenience and because
achieving targets below this level brings benefits for patients.
But rather than being marked by a particular cut-off point, the medical expert committees on the
condition actually see high blood pressure as having a continuous relationship to cardiovascular
health.
They believe that, to a point (down to levels of 115-110 mmHg systolic, and 75-70 mmHg diastolic) the
lower the blood pressure the better.
This view has led the American Heart Association (AHA), for example, to define the following ranges of
blood pressure (in mmHg):

Normal blood pressure is below 120 systolic and below 80 diastolic

Prehypertension is 120-139 systolic or 80-89 diastolic

Stage 1 high blood pressure (hypertension) is 140-159 systolic or 90-99 diastolic

Stage 2 high blood pressure (hypertension) is 160 or higher systolic or 100 or higher diastolic

Hypertensive
crisis
(a
medical
emergency)
is
when
blood
pressure
is
above 180 systolic or above 110 diastolic.
4

1,5

1,6

Causes of hypertension
High blood pressure leading to a diagnosis of hypertension will occur only when readings stay above
normal all of the time. Having high blood pressure for a short amount of time is normal.
Blood pressure has a natural variation - it lowers during sleep and rises on awakening. It also rises in
response to excitement, anxiety and physical activity.
The disease burden of high blood pressure is a growing problem worldwide. The increases are blamed
on lifestyle factors, including:

Physical inactivity
A salt-rich diet through processed and fatty foods
Alcohol and tobacco use.

Certain diseases and medications are specific causes of high blood pressure (detailed below). There
are general risk factors that can be responsible for raising anyone's risk of hypertension, however.
These include:

Age - everyone is at greater risk of high blood pressure as they get older. Prevalence of
hypertension is higher in people over 60 years of age
Race - African-American adults are at higher risk than white or Hispanic American adults

Size - being overweight or obese is a key risk factor

Sex - men and women have different risk profiles. While they have the same lifetime risks, men
are more prone at younger ages while women are more prone at older ages

Lifestyle - as mentioned above, this is to blame for growing rates of hypertension, from greater
uptakes of dietary salt, excessive alcohol, low dietary potassium, and physical inactivity.
Other risk factors are a family history of the disease and chronic stress.

Kidney disease

Pheochromocytoma (a cancer)

Cushing syndrome (which can be caused by use of corticosteroid drugs)

Congenital adrenal hyperplasia (disorder of the adrenal glands, which secrete the hormone
cortisol)

Hyperthyroidism (overactive thyroid gland).

Symptoms of hypertension

High blood pressure itself is usually experienced by patients without any symptoms at all
(asymptomatic). It can do its damage silently.
Hypertension can lead to problems in the organs affected by high blood pressure. Long-term
hypertension can lead to the following complications via arteriosclerosis, which causes narrowing of
blood vessels by forming plaques:

An enlarged or weakened heart, to a point where it may fail to pump enough blood ( heart
failure)

Aneurysm - an abnormal bulge in the wall of an artery

Blood vessel narrowing - in the kidneys, leading to possible kidney failure; also in the heart,
brain and legs, leading to potential heart attack, stroke or amputation, respectively

Blood vessels in the eyes my rupture or bleed, leading to vision problems or blindness
(hypertensive retinopathies, which can be classified by worsening grades one through four).

Diagnosis and tests for hypertension

Diagnosis of high blood pressure is made by measuring it, over a number of clinic visits, via a
sphygmomanometer - the familiar upper-arm cuff device. An isolated high reading is not taken - rather,
diagnosis can be made after measurement on at least three separate days.
Measurements at the doctor's office may be both while seated and after standing, to look for
orthostatic or postural hypotension.
Reliability of blood pressure readings may be improved by taking a series of measurements outside the
doctor's office, by doing self-measurement at home with standardized devices.
We have more detailed information about measuring blood pressure.
Doctors take a history (ask questions, such as about cardiovascular problems) and do a physical
examination in addition to classifying high blood pressure using sphygmomanometer.
Other tests also help to identify the cause and determine whether there have been any complications these may include urine tests, kidney ultrasound imaging, blood tests, ECG and possibly
echocardiography.

Treatments for Hypertension :

Lifestyle changes are important for both treatment and prevention of high blood pressure, and they
can be as effective as a drug treatment. 6 The added advantage is that there are wider effects on heart
health.
The lifestyle measures that are recommended by experts and shown to reduce blood pressure are:

Salt restriction - typical salt intake is between 9 and 12 g a day and modest blood pressure
reductions can be achieved even in people with normal levels by lowering salt to around 5 g a day with a bigger effect in hypertensive people
Moderation of alcohol consumption - expert guidelines say moving from moderate to excessive
drinking is "associated both with raised blood pressure and with an increased risk of stroke"

High consumption of vegetables and fruits and low-fat - the Mediterranean diet has been found
to be protective, and people with high blood pressure are advised to eat fish at least twice a week
and between 300 and 400 g of fruit and vegetables a day
Reducing weight and maintaining it - hypertension is closely correlated with excess body
weight, and weight reduction is followed by a fall in blood pressure
Regular physical exercise - guidelines say "hypertensive patients should participate in at least
30 min of moderate-intensity dynamic aerobic exercise (walking, jogging, cycling or swimming) on 5
to 7 days a week."

The DASH diet

The US National Heart Lung and Blood Institute recommends the DASH diet for people with high blood
pressure.
Standing for Dietary Approaches to Stop Hypertension, DASH is a flexible and balanced eating plan
based on research studies sponsored by the institute, which says the diet:

Lowers high blood pressure

Improves levels of blood lipids (fats in the bloodstream)
Reduces the risk of developing cardiovascular disease.

Drug treatments for hypertension

Doctors will prescribe medication alongside lifestyle measures to lower blood pressure in people with a
level above 140 over 90, although lifestyle measures are usually pursued first.
Drugs are usually started as monotherapy (just one drug) and at a low dose initially. If there are any
side-effects associated with drugs, they are usually minor.
A number of different classes of drug are available and all are suitable for lowering blood pressure:

Diuretics (including thiazides, chlorthalidone and indapamide), which have been a cornerstone
of treatment since 1977
Beta-blockers
Calcium antagonists
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin receptor blockers.

Health education for hypertension :

Dietary changes and blood pressure

Making changes in what you eat can help to control high blood pressure.
Reduce sodium The main source of sodium in the diet is the salt contained in packaged and
processed foods and in foods from restaurants. Reducing the amount of sodium you consume can
lower blood pressure if you have high or borderline high blood pressure.
The body requires a small amount of sodium in the diet. However, most people consume more sodium
than they need. A low-sodium diet contains fewer than 2 grams (2,000 milligrams) of sodium each day.

A detailed discussion of low-sodium diets is available separately.

Reduce alcohol Drinking an excessive amount of alcohol increases your risk of developing high
blood pressure. People who have more than two drinks per day have an increased risk of high blood
pressure compared to nondrinkers; the risk is greatest when you drink more than five drinks per day.
On the other hand, drinking one (for women) or two (for men) alcoholic beverages per day appears to
benefit the heart in people greater than 40 years old. This protective effect applies to people with
preexisting high blood pressure.
Eat more fruits and vegetables Eating a vegetarian diet may reduce high blood pressure and
protect against developing high blood pressure. A strict vegetarian diet may not be necessary; eating
more fruits and vegetables and low-fat dairy products may also lower blood pressure.
Eat more fiber Eating an increased amount of fiber may decrease blood pressure. The
recommended amount of dietary fiber is 20 to 35 grams of fiber per day. Many breakfast cereals are
excellent sources of dietary fiber.
Eat more fish Eating more fish may help to lower blood pressure, especially when combined with
weight loss .
Caffeine Caffeine may cause a small rise in blood pressure, although this effect is usually
temporary. Drinking a moderate amount of caffeine (less than 2 cups of coffee per day) does not
increase the risk of high blood pressure in most people.

Exercise
Regular aerobic exercise (walking, running) for 20 to 30 minutes most days of the week can lower your
blood pressure, although the effect is not as pronounced among older adults. To maintain this benefit,
you must continue to exercise; stopping exercise will allow your blood pressure to become high again.

Weight loss and blood pressure

Being overweight or obese increases your risk of having high blood pressure, diabetes, and
cardiovascular disease. The definition of overweight and obese are based upon a calculation called
body mass index (BMI). You are said to be overweight if your BMI is greater than 25, while a person
with a BMI of 30 or greater is said to be obese. People who are overweight or obese can benefit from
losing weight so to lose weight you must eat less and exercise more.

What if i still have high blood pressure?

If you continue to have high blood pressure despite making changes in your diet, exercising more, and
losing weight, you may need a medication to reduce your blood pressure.

Conclusion
Dietary and lifestyle changes can lower blood pressure and decrease the risk of health complications,
although treatment with medication is still often necessary in people for whom lifestyle changes are not
enough or not effective. The treatment of moderately high arterial blood pressure (defined as >160/100
mmHg) with medications is associated with an improved life expectancy. The benefits of treatment of
blood pressure that is between 140/90 mmHg and 160/100 mmHg are less clear, with some reviews
finding absence of a proven benefit and others finding benefit.

References
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Lewington, S; Clarke, R; Qizilbash, N; Peto, R; Collins, R; Prospective Studies, Collaboration (Dec 14,
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Carretero OA, Oparil S; Oparil (January 2000). "Essential hypertension. Part I: definition and
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elderly.".
Diao, D; Wright, JM; Cundiff, DK; Gueyffier, F (Aug 15, 2012). "Pharmacotherapy for mild hypertension.".