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Hypertension

Know Your Numbers and Target Your Blood Pressure

Hypertension (High Blood Pressure) Definition

Blood pressure is the amount of force (pressure) that blood exerts on the walls of the blood vessels as the heart pumps blood through the body. There are two kinds of numbers that make up a blood-pressure reading, i.e. 80\130 mm Hg. The top number refers to systolic blood pressure (while the heart is beating), and the bottom number measures the diastolic blood pressure (while the heart is at rest).

Normal numbers for blood pressure changes frequently throughout the day. Things that can make diastolic blood pressure change within a few minutes include posture, level of exercise and amount of stress. Usually, blood pressure returns to normal range when the above-mentioned factors disappear.

Arterial Hypertension

Hypertension occurs when your average blood-pressure readings continue to be high even when you are in a state of relaxation. Some patients suffer from hypothyroid hypertension, in which blood pressure readings are occasionally high, but are normal most of the time.

Arterial hypertension may affect men and women from any racial background or age category. The incidence rates of hypertension across a given population group may range from between 10% and 40%.

Causes

About 90–95% of cases are categorized as "primary hypertension," which means high blood pressure with no obvious medical cause.

The remaining 5–10% of cases are known as “secondary hypertension” and may be caused by a variety of medical conditions, including:

Kidney problems: frequent kidney and urinary tract infections, kidney stones or renal artery stenosis

Adrenal gland problems due to hormonal disorders or birth control pills

Neurological conditions

Other reasons, such as aortic stenosis, polyarteritis nodosa, pregnancy, connective tissue disease or hypercalcemic

Hypertension Risk Factors

Although a large number of people are affected by hypertension for an unknown reason, there still are certain risk factors that either entail or accompany hypertension, including:

Heredity: which plays a decisive role in the incidence of the disease.

Environment: with its pivotal effect on blood pressure.

Too much salt (sodium).

Overweight or obesity: Obese people are more likely than others to develop hypertension, arteriosclerosis and cardiovascular disease.

Alcohol: Drinking alcohol is linked with hypertension and damage to the heart muscle, increased blood flow and heart rate.

Smoking: is seen as a major reason for the increased incidence of hypertension, heart problems, cardiac and brain strokes.

Physical non-activity.

Diabetes: Diabetics are more likely to develop hypertension than others. Suffering from diabetes and hypertension simultaneously may increase risks of heart problems, coronary diseases or high cholesterol.

Steps Taken to Diagnose Causes of Hypertension

Check your blood pressure over the course of several separate visits to your physician's office.

Your physician will attempt to identify the underlying cause based on family history, risk factors and other symptoms.

Clinical tests will be performed, including an eye examination.

Laboratory tests can also be performed to identify possible causes, including:

Blood tests to check kidney function, sodium, sugar, cholesterol, triglycerides and hemoglobin rates in your blood

Urine tests for protein, blood and glucose levels

Electrocardiogram testing is done to check for evidence of stress to the heart from high blood pressure.

A chest X-ray may be performed to look for signs of heart and aortic enlargement.

Laboratory tests can also be performed to identify secondary causes of hypertension; these tests may include:

Ultrasound of kidneys and adrenal gland

Hysterosalpingogram test for kidneys

Magnetic resonance angiography

Tests for hormone levels in blood and urine

CT scan or MRI of the kidneys and adrenal gland, if needed

Nuclear rays for kidneys, adrenal gland or tumors expected to cause hypertension

Detection of some diseases, i.e., asthma and angina pectoris which affect the efficacy of hypertension medication

Detection of risk factors for arteriosclerosis, such as diabetes, high cholesterol, Homocysteine levels in blood, obesity and smoking.

Hypertension Symptoms

Hypertension may cause no overt symptoms for years. People who have high blood pressure typically don't know it until their blood pressure is measured. It is necessary to note that many people think that headache is a significant sign of hypertension. However, hypertension-associated headache typically does not occur until blood pressure readings have reached severely high levels.
Some hypertension patients may suffer from dizziness, palpitation, fatigue, nosebleeds, blood in the urine or blurred vision. Still other patients who have had hypertension for secondary causes, may suffer from the symptoms of the disease entailing hypertension.

Hypertension Complications on Different Bodily Systems

Physicians will attempt to identify the underlying cause and resulted complications on the bodily organs:

Heart: Hyperextension can cause hardening and thickening of the heart, which can lead to cardiomegaly or other complications.

Kidneys: Kidney disorder may occur and can lead to kidney failure.

Neural System: Severe arthritis headaches, particularly during morning hours, may result from severe hypertension. Some patients may suffer from dizziness and fainting due to cerebral bleeding.

Eye: Minor hypertension may cause vision problems. Severe hypertension can causes serious complications to eyes which need immediate medical intervention.

Aorta: Damage to aortal tissues may occur, causing severe chest pain and serious, life-threatening complications to the heart, kidneys and limbs.

Treatment

Non-pharmacological treatment:

Aim for a healthy weight loss. You’re body mass index must be between 19 to 24.9 kg/m2.

Avoid fatty foods, particularly statured fat such as corn oil, sunflower oil, olive oil and soybean oil.

Reduce your salt intake. 2-3 gm. of salt daily is enough. Avoid fast food because of its high salt and fat content.

Dates are helpful for hypertension patients, but not for those who are also diabetic. Dates are rich in potassium and magnesium which reduce blood pressure.

Exercise or increase physical activity. Get active with any exercise you love for 20 – 30 minutes three times a week. Avoid heavy exercise such as lifting weight, pulling or pushing heavy objects.

Quit smoking, and eliminate consumption of alcohol and non-prescribed narcotics.

Prevent constipation by avoiding urinary incontinence medications, particularly for enlarged prostate.

Avoid stress and exhaustion as much as possible. Get enough sleep and practice relaxation exercise.

Avoid being subjected to high temperatures, such as from saunas.

Control risk factors for arteriosclerosis.

Pharmacological treatment:

The main goal of hypertension medication, even if symptoms or signs don’t occur, is to reduce the risk of stroke, heart disease, arteriosclerosis and kidney problems.

Factors Determining Types of Hypertension Medication Prescribed

Blood pressure levels and family history

Gender (male or female)

High blood pressure at early age

Patients with dark-colored skin

Existence of serious changes in the retina of the eye.

Complications due to long-standing, severe hypertension

Presence of asthma and/or diabetes

Due to the side-effects of hypertension medications, some patients may attempt to stop taking their medications without their doctor’s approval, especially those who experience a decrease in sexual function who don’t suffer from any noticeable symptoms or other indications of the disease. It is our duty as physicians to inform hypertonic patients about the risks of either stopping or cutting down on their dosage without their doctor’s advice. Sudden interruption of hypertension medications can lead to serious health consequences including damage to vital organs, and may be life-threatening.

Resistant Hypertension

Reasons for non-response to pharmacological treatment:

Insufficient medication doses

Not taking medications regularly as prescribed

Drug interactions which affect the efficacy of hypertension medications

High intake of sodium or low intake of potassium and magnesium

Hypertension complications, such as heart failure, renal failure and adrenal gland disorder

Drinking alcohol or taking narcotic pills

Being overweight and not being physically active

How to Measure Your Blood Pressure

A sphygmomanometer, or mercury blood pressure meter, is considered the best device to use to achieve accurate blood pressure readings. You can measure your blood pressure level at home. First, wrap the cuff around your upper arm or your thigh. Place the stethoscope ear pieces in your ears and the round metal end underneath the end of the sphygmomanometer cuff.

Hold and squeeze the bulb until the pressure to the sphygmomanometer becomes higher than the blood in your arteries. Release the bulb’s stopcock slowly and gradually. This will let the air out of the cuff, allowing you to take a blood pressure reading. Note the systolic number on the meter when you first hear your pulse through the stethoscope. Then note the diastolic blood pressure number when the last pulse sound comes through the stethoscope. Record these two numbers by placing the higher number over the lower number to determine your current blood pressure.

Categories For Blood Pressure Levels In Adults
Normal Blood Pressure	130/85 mm Hg or lower
High Normal Blood Pressure	193-130/89-85 mm Hg
Minor High Blood Pressure	159-140/99-90 mm Hg
Medium High Blood Pressure	179-160/119-110mm Hg
Very High Blood Pressure	209-180/119-110 mm Hg
Severe High Blood Pressure	210/120 mm Hg or higher

Important Tips

It is better to have your blood pressure readings taken by a doctor or other trained health professional.

If you suffer from variable blood pressure readings, you may need to have24-hour (ambulatory) blood pressure monitoring done.

Mercury manometers are considered to be the gold standard, due to their accuracy, but they require regular calibration checks.

Using the correct-size of cuff is important for an accurate reading.

You need to be relaxed and comfortably seated. Keep your arms supported on a hard surface with the upper arm at rest. Older patients, diabetics and patients who have just taken their hypertension medication should be standing while their blood pressure is being measured.

Don’t drink caffeinated beverages or smoke within 30 minutes before measuring your blood pressure.

When you need to re-measure your blood pressure, it is better to do that at least two minutes after the previous try.

Take another blood pressure reading if there are differences of at least 5 – 10 mmHg from previous readings.

It is normal that readings will differ based on which arm is cuffed.

1Note that the surrounding environment may affect your blood pressure level. Therefore, you should not change your medication dosage without asking your doctor.

If your systolic number is more than 200 and your diastolic number is more than 120, go to the hospital as soon as possible, especially if you suffer from severe chest pain, severe headache, dizziness, palpitations, body cramps or confusion.

It is very important to take your hypertension medication regularly, even if you’ve never had symptoms, to prevent severe stages of hypertension which may cause damage to vital organs.

Monitoring Blood Pressure levels

Blood Pressure Level	Suggested period to reexamine
130/85 mm Hg or lower	Every two years
130-139 / 85-89 mm Hg	Every two months
140-159 / 90- 99 mm Hg	Every two months
160-179 / 100-109 mm Hg	Full medical tests every month performed by a healthcare professional
180-209 / 110-119 mm Hg	Full medical tests every week performed by a healthcare professional; begin taking hypertension medication
210 / 120 mm Hg or higher	Hospitalization and immediate emergency medical treatment are needed, along with medical evaluation by a healthcare professional

We suggest that every hospital or clinic give each hypertonic patient a blood pressure record which provides his/her medical information, address and medication doses, including recording of all readings taken at different times of the day at least twice a week. It is important to increase the number of readings when any of the following symptoms occur:

Severe headache

Chest pain and troubles in breathing while relaxing or doing any minor physical activity

Dizziness with no earache

We recommend that hypertonic patients take medication on time, to share their blood pressure records with their healthcare specialists, and to check blood pressure readings at different times of the day.

Adopting a healthy lifestyle that maintains blood pressure within the healthy limits:

Lifestyle and daily behaviors have an evident effect on the blood pressure level. There are three major elements for prevention of high blood pressure (hypertension), shown as follows:

Keep a close eye on your weight: overweight and obesity increases the potential of hypertension incidence. It is highly recommended, therefore, to keep your weight within the natural limits.
Eat healthy food that is rich in the important nutrients; by way of reducing the quantity of food, good chewing, reading the nutritional card at the package, avoiding salty foods, as well as fast and processed foods such as sweets, cakes, hamburger and pizza, and, instead, eating vegetables and fruits. And salt could be replaced with vinegar, lemon and some herbs.
Exercise for 20-30 minutes every day.

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