Hypertension (High Blood Pressure)

Hypertension can serious damage the arteries and lead to serious complications. the arteries are blood vessels that distribute oxygenated blood ejected by the ventricles of your heart to various tissues in your body. The vessels must be normally open to facilitate the distribution of oxygen and nutrients to all living cells. In addition, the arteries must be able to handle pressures – systolic pressure and diastolic pressure- caused by certain cardiac activities. To achieve this vital job, the arteries are internally and externally surrounded by smooth muscle fibers that able to regularly contract (vasoconstriction) and relax (vasodilation), upon receive certain nervous and hormonal signals.  When this circulation is not well done, you develop a medical condition called hypertension (high blood pressure).

Hypertension (HBP), also called high blood pressure, is an abnormal permanent or paroxysmal rise of your blood pressure at rest.

High blood pressure is a normal condition of your cardiovascular system in response to physical activities. It becomes a problem when it remains elevated at rest and impacts your well-being. You should be concerned if your hypertension, when at rest, constantly equals or exceeds 140 mmHg (140 millimeters of mercury) systolic and 90 mmHg (90 millimeters of mercury) diastolic. A normal blood pressure should be equal or lower than 120 millimeters of mercury (systolic) and 80 millimeters of mercury (diastolic). A simple way to remember it is 120/80 mmHg – MmHg represents the units used in the medical jargon to measure blood pressure. However, these measurements can be higher in an elderly person (because blood pressure increases with age) and lower in a child.

Causes

High blood pressure is classified into two groups:  essential hypertension and secondary hypertension:

 In essential hypertension, you have the disease without obvious cause. Your doctor can do numerous exams without being able to detect specific medical conditions leading to the hypertension.

In secondary hypertension, in the other hands, the factors leading to the disease are obvious. Some of those factors include:

• Adrenal Gland Disorders – such as hypercortisolism (also known as Cushing’s syndrome), Conn’s syndrome and pheochromocytoma, a rare form of tumor of the medulla of the adrenal glands.
• Vasoconstriction, reduction of size of your blood vessels
• Certain medications such as Phenacetin (also called acetophenetidin, Saridon), nonsteroidal anti-inflammatory drugs (NSAIDs or NAIDs), cyclosporine (used for nasal vasoconstrictors rhinitis, psoriasis or chronic migraine), certain contraception pills, extended use of corticosteroids.
  

• Kidney diseases such as :
  

1) TB renal, also known as renal tuberculosis or tuberculosis of kidney

2) Diabetic glomerulopathy – fibrosis and scarring of one or the two kidneys due to diabetes complications

3) Glomerulonephritis – inflammation of the internal blood vessels of the kidneys (glomeruli), which can result in high blood pressure, proteinuria, hematuria, or nephrotic syndrome

4) Interstitial nephritis – a rare form of inflammation of the kidney that can cause hypertension, gout, hypercalcemia, etc

5) Polycystic kidney disease (also known as polycystic kidney syndrome), noncancerous development of clusters of cysts within the kidneys

6) chronic pyelonephritis, persistent renal inflammation or infection

7) Renal ischemia, also known as nephric ischemia, is an insufficient blood flow in one or both kidneys, which can cause high renin levels in your bloodstream. Combined with angiotensinogen, increased renin levels can cause narrowing of blood vessels, leading eventually to high blood pressure.

Hypertension Risk Factors:

• Age
• Stress
• Sleep apnea
• Alcoholism
• Physical inactivity
• Professional or social problems
• Obesity – being obese increases considerably your risk of suffering from  hypertension
• Cigarette smoke – besides cancer, smoking tends to narrow your arteries, and cause cardiovascular disease, including hypertension
• Pregnancy – hypertension can be caused by pregnancy (mostly after 20 weeks) in some women, especially twins. This specific condition is called Gestational hypertension or pregnancy-induced hypertension.   
• Genetic – hypertension can also be linked to an imbalance in the secretion of prostaglandins or genetic factors.
• High-salt diet – Too much salt tends to cause abnormal arterial concentration, leading to resistance to blood flow.  This also increases the risk of stomach disorders, heart attack, and duodenal ulcers.
  

Hypertension Signs and Symptoms

Hypertension is often called the “silent killer” the fact that it silently damages your organs without obvious medical signs. Most people who have high blood pressure do not feel any symptoms, even when the disease is in the process of destroying their arteries and organs.  It is discovered during routine medical exams or diagnosis of other diseases.

Usually, when your doctor discovers for the first time that you have hypertension, he controls it several times under different conditions: rest, exercise, change of diet, before he confirms you have it, and prescribe you medications. In some people, however, hypertension shows enough medical signs and symptoms to declare its existence. In general, hypertension symptoms include:

• fatigue
• dizziness
• difficulty breathing (Dyspnea)
• decreased sexual desire
• muscle cramps or weakness Nosebleeds (epistaxis)
• bleeding in the eye(subconjunctival Hemorrhage), only when there is complication
• frequent need to urinate(pollakiuria)
• visual disturbance or decreased visual acuity
• headache on the top or behind the head (mostly in the morning).
  

Diagnosis

Sometimes, hypertension is discovered during medical exam for other cardiovascular disease or kidney disorders. Regular monitoring of your blood pressure by a health care provider is an easy way to diagnose a possible high blood pressure. Hypertension is diagnosed if your blood pressure is greater than or equal to 140/90mmHg at rest. To confirm the diagnostic, these levels must be permanent or found at several measurements after several minutes of rest in a normal position.

The easiest way you can measure your blood pressure is using a Self-Monitoring Home Blood Pressure kit. This allows you to control your tension constantly at home or in office without the supervision of a doctor.

In case of doubt, your doctor may suggest an especial review called ambulatory blood pressure monitoring (ABPM). The ABPM can measure your blood pressure at regular intervals over a 24-hour period.

Your physician can go further to recommend complementary tests such as blood culture, electrocardiogram, and kidney x-ray. If he suspects that the hypertension is secondary – it is linked to another disease- he can do an etiology (study of causes or origins of your medical condition) in search of disease responsible for the hypertension. 

Hypertension Treatment  

There is no cure for hypertension; however, it is probably the disease for which there are more treatments. Besides hypertension in pregnancy that can be completely cured, treatments of hypertension aim at normalizing your blood pressure to prevent complications, and help you live a normal life. Therefore, most hypertension treatments must be followed for life.  Along with all form of therapies, a healthy diet and lifestyle are always recommended:

• Avoid overwork and effort
• Quit smoking, avoidance of stress
• Lose weight if you are obese
• Exercise regularly
• Eat a healthy diet low in salt and artificial sweeteners, etc.

In severe hypertension or in case there are complications such as brain hemorrhage or hemiplegia (a form of cerebral palsy), rest is strongly necessary. You can control all forms of hypertension, as long as you live a healthy lifestyle and take your medications the way you are supposed to. Once you stop or deviate the prescription, the hypertension will resume, which can make it resistant to the treatments, and presents major complications.

Some of medications often used in the treatment of high blood pressure include:

Peripheral vasodilators – causing dilatation of blood vessels by increasing their size and promotes heart rates and kidney functioning. They may cause dizziness, orthostatic hypotension (postural hypotension), difficulty breathing, headache, stomach upset, flushing, swollen face or lips, etc.

Beta-blockers – this group of drugs are used in the treatment of high blood pressure, glaucoma and migraines. When used as indicated by your doctor, they can help reduce your blood pressure levels to normal. Beta-blockers have property to slow heartbeat; however, they are not recommended in cases of bradycardia (heart rate below 60 beats per minute) and asthma.

Common side effects may include fatigue, cold hands and feet, dizziness, dry mouth, dry skin and eyes, difficulty breathing, decreased heartbeat, impotence, insomnia, etc.

Angiotensin Converting Enzyme (ACE) Inhibitors– this class of medications prevents formation of angiotensin (a molecule composed of a few amino acids that participating in the rise of your blood pressure) and inhibit the secretion of aldosterone, a hormone that causes the kidneys to retain sodium and water.

ACE Inhibitors side effects may include dry cough, skin rash, increased potassium levels in your bloodstream (hyperkalemia), Kidney problems, hypotension, swelling of feet, etc.

Calcium channel blockers – when there is blockage within your arteries wall, the blood flow is reduced or stopped, leading to hypertension and other major cardiovascular problems.  Calcium channel blockers have a vasodilating action on your arteries; along with a healthy lifestyle, they remove the blockage within the arteries wall, and allow a better circulation. They are used in the treatment of high blood pressure, heart failure, and angina.

Side effects of calcium channel blockers may include fatigue, flushing, inflammation of the abdomen, swelling of feet, shortness of breath, wheezing, dizziness, upset stomach, constipation, heartburn, headache, etc.

Thiazide diuretics – those drugs are also effective in controlling your blood pressure. They work in decreasing the amount of sodium and water in your body. However, their action on potassium must be controlled. Side effects may include fatigue, dizziness, Blurred vision, loss of appetite, itching, stomach upset, and headache.

Antihypertensive Drugs – those medications act on the brainstem (headquarter of the central regulator of blood pressure) and promote relaxation and sleep. Common side effects include headache, dizziness, diarrhea, fever, decreased coordination, cramps, drowsiness, stomach disorders, loss of appétit, fatigue, hypotension, etc.

Your doctor may also prescribe you Alpha1 blockers, Potassium-sparing diuretics, and Angiotensin II receptor blockers. All these drugs are prescribed either to take unique or in combination.

Complications

To avoid hypertension complications it is essential to treat it, even if it causes no major symptoms. If left untreated, hypertension can lead to major health problems including but not limited to:

• Stroke
• Heart attack
• Heart failure
• Aneurysm; abnormal widening or bulging in your blood vessel
• kidney failure
• pulmonary edema, fluid accumulation in your lungs
• haematuria, presence of blood in your urine
• Impotence, inability to have or sustain an erection

Even moderate hypertension should not be neglected; it can shorten your life expectancy.

Hypertension Prevention  

To prevent hypertension or its complication, follow these tips:

• Avoid too much salt in your diet
• Lose weight if you are obese
• Stop or do not drink alcohol
• Eat fruits and cruciferous vegetable abundantly
• Do not use saturated fat; use unsaturated fat such as flax seed oil, fish oil and virgin olive oil
• Have regular (safe) sexual intercourse
• Avoid commercial cakes and pastry, replace them by cakes made at home, without salt lot of sugar or baking powder
• Use moderately medications containing salt such as effervescent tablets Alka-Seltzer Effervescent Tablets, Pro Endorphin, lozenges, etc.
• Reduce your consumption of coffee
• Avoid canned foods; replace them by fresh or frozen foods
• Quit or do not smoke
• Avoid stress as long as you can
• Exercise regularly

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