Hypertension
Hypertension is the medical term for high
blood pressure.
This means that the blood applies too much
force against the walls of the blood vessels.
Here are some key points about hypertension. More detail is in the main
article.
• Normal blood pressure is 120 over 80 mm of mercury
(mmHg), but hypertension is higher than 130 over 80
mmHg.
• Acute causes of high blood pressure include stress,
but it can happen on its own, or it can result from an
underlying condition, such as kidney disease.
• Unmanaged hypertension can lead to a heart attack,
stroke, and other problems.
• Lifestyle factors are the best way to address high
blood pressure.
Blood pressure can be measured by a
sphygmomanometer, or blood pressure monitor.
Having high blood pressure for a short time can be a
normal response to many situations. Acute stress and
intense exercise, for example, can briefly elevate blood
pressure in a healthy person.
For this reason, a diagnosis of hypertension normally
requires several readings that show high blood pressure
over time.
The systolic reading of 130 mmHg refers to the pressure as
the heart pumps blood around the body. The diastolic
reading of 80 mmHg refers to the pressure as the heart
relaxes and refills with blood.
Symptoms
A person with hypertension may not notice any
symptoms, and it is often called the "silent
killer." While undetected, it can cause damage
to the cardiovascular system and internal
organs, such as the kidneys.
high blood pressure causes
• sweating,
• anxiety,
• sleeping
• problems, and
• blushing. However, in most cases, there will
be no symptoms at all.
If blood pressure reaches the level of a
hypertensive crisis, a person may experience
headaches and nosebleeds.
Causes
There are two types of high blood pressure.
Primary (essential) hypertension
For most adults, there's no identifiable cause of high blood pressure. This type of high blood
pressure, called primary (essential) hypertension, tends to develop gradually over many years.95%
Secondary hypertension
Some people have high blood pressure caused by an underlying condition. This type of high blood
pressure, called secondary hypertension, tends to appear suddenly and cause higher blood
pressure than does primary hypertension. Various conditions and medications can lead to
secondary hypertension, including:5%
• Obstructive sleep apnea
• Kidney problems
• Adrenal gland tumors
• Thyroid problems
• Certain defects you're born with (congenital) in blood vessels
• Certain medications, such as birth control pills, cold remedies, decongestants, over-the-
counter pain relievers and some prescription drugsIllegal drugs, such as cocaine and
amphetamines
Risk factors
High blood pressure has many risk factors, including:
• Age. The risk of high blood pressure increases as age. Until about age 64, high blood pressure is more common in men.
Women are more likely to develop high blood pressure after age 65.
• Race. High blood pressure is particularly common among people of African heritage, often developing at an earlier age than it
does in whites. Serious complications, such as stroke, heart attack and kidney failure, also are more common in people of
African heritage.
• Family history. High blood pressure tends to run in families.
Being overweight or obese. The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the
volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
• Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder
your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases
the risk of being overweight.
• Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the
chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk
of heart disease. Secondhand smoke also can increase your heart disease risk.
• Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood
pressure.
• Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you don't get enough
potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.
• Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than one drink a day for women
and more than two drinks a day for men may affect your blood pressure. If you drink alcohol, do so in moderation. For healthy
adults, that means up to one drink a day for women and two drinks a day for men. One drink equals 12 ounces- (354.882ml)of
beer, 5 ounces-(147.868ml) of wine or 1.5 ounces- (44.3603 ml)of 80-proof liquor.
• Sometimes pregnancy contributes to high blood pressure, as well.
• Although high blood pressure is most common in adults, children may be at risk, too. For some children,
high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor
lifestyle habits, such as an unhealthy diet, obesity and lack of exercise, contribute to high blood pressure.
• Complications
• The excessive pressure on artery walls caused by high blood pressure can damage r blood vessels, as well .
The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.
• Uncontrolled high blood pressure can lead to complications including:
• Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries
(atherosclerosis), which can lead to a heart attack, stroke or other complications.
• Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an
aneurysm. If an aneurysm ruptures, it can be life-threatening.
Heart failure. To pump blood against the higher pressure in vessels, the heart has to work
harder. This causes the walls of the heart's pumping chamber to thicken (left ventricular
hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to
meet your body's needs, which can lead to heart failure.
Weakened and narrowed blood vessels in kidneys. This can prevent these organs from
functioning normally.
Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
Metabolic syndrome. This syndrome is a cluster of disorders of body's metabolism, including
increased
• . waist circumference;
• high triglycerides;
• low high-density lipoprotein (HDL) cholesterol, the "good" cholesterol;
• high blood pressure and high insulin levels
• These conditions make you more likely to develop diabetes, heart disease and stroke.
Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your
ability to think, remember and learn. Trouble with memory or understanding concepts is more
common in people with high blood pressure.
Dementia. Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain
Diagnosis
Blood pressure can be measured by a
sphygmomanometer, or blood pressure monitor.
• Having high blood pressure for a short time can be a
normal response to many situations. Acute stress
and intense exercise, for example, can briefly
elevate blood pressure in a healthy person.
• For this reason, a diagnosis of hypertension
normally requires several readings that show high
blood pressure over time.
• The first, or upper, number measures the pressure
in arteries when heart beats (systolic pressure)-
refers to the pressure as the heart pumps blood
around the body. The second, or lower, number
measues the pressure in your arteries between
beats (diastolic pressure).-the heart relaxes and
refills with blood.
• blood pressure generally should be measured
in both arms to determine if there is a
difference. It's important to use an
appropriate-sized arm cuff.
• doctor may ask pts to record blood
pressure at home to provide additional
information and confirm if you have high
blood pressure
• doctor may recommend a 24-hour blood
pressure monitoring test called ambulatory
blood pressure monitoring to confirm if you
have high blood pressure. The device used
for this test measures blood pressure at
regular intervals over a 24-hour period and
provides a more accurate picture of blood
pressure changes over an average day and
night
Both numbers in a blood pressure reading are
important. But after age 50, the systolic
reading is even more significant. Isolated
systolic hypertension is a condition in which
The AHA 2017 guidelines define the following the diastolic pressure is normal (less than 80
ranges of blood pressure: mm Hg) but systolic pressure is high (greater
than or equal to 130 mm Hg). This is a
common type of high blood pressure among
people older than 65.
Normal blood pressure Less than 120 Less than 80
Elevated Less than 80
Between 120 and 129
Stage 1 hypertension Between 130 and 139 Between 80 and 89
Stage 2 hypertension At least 140 At least 90
Hypertensive crisis Over 180 Over 120
• Systolic blood
pressure (the
first number) –
indicates how
much pressure
your blood is
exerting against
your artery walls
when the heart
beats.
diastolic reading, or the
bottom number, is the
pressure in the arteries when
the heart rests between
beats. this is the time when
the heart fills with blood
When the systolic and diastolic levels fall in different categories, use the
higher category!!!!
For example, 170/92 mm Hg is Stage 2 hypertension; 135/100 mm Hg is
Stage 1 hypertension.
Assessment of hypertension also includes its effects on target “end organs”—
the eyes, heart, brain, and kidneys. Look for hypertensive retinopathy, left
ventricular hypertrophy, and neurologic deficits suggesting stroke. Renal
assessment requires urinalysis and blood tests
of renal function.
In isolated systolic hypertension, systolic blood pressure is ≥140 mm Hg, and
diastolic blood pressure is <90 mm Hg.
Causes: artery stiffness (aging), left ventricular hypertrophy, coronary
ischemia, heart failure.
Isolated systolic hypertension can lead to serious health problems, such as:
Stroke
Heart disease
Chronic kidney disease
Treatment of isolated systolic hypertension in patients 60 years or older
reduces total mortality and both mortality and complications from
cardiovascular disease.
Low Blood Pressure
Relatively low levels of blood pressure should always be
interpreted in the light of past readings and the patient’s
present clinical state.
A pressure of 110/70 mm Hg would usually be normal but could
also indicate significant hypotension if past pressures have been
high.
Orthostatic hypotension is a drop in systolic blood pressure of
20 mm Hg or greater or in diastolic blood pressure of 10 mm
Hg or greater within 3 minutes of standing.
Measure blood pressure and heart rate in two positions—
supine after the patient is resting from 3 to 10 minutes, then
within 3 minutes after the patient stands up. Normally, as the
patient rises from the horizontal to the standing position,
systolic pressure drops slightly or remains unchanged, while
diastolic pressure rises slightly.
White Coat Hypertension
describes hypertension in people whose
blood preausre measurement are higher in
the office then at home or in more relaxed
sitting, usually >140/90.
This phenomenon occurs in 10% to 25% of
patients, especially women and anxious
individuals and may last for several visits.
Try to relax the patient and remeasure the
blood pressure later in the encounter.
Treatment
• Regular physical exercise-People should exercise on at least 5 days of the week.
Examples of activities include walking, jogging, cycling, or swimming. Stress reduction
• Avoiding stress, or developing strategies for managing unavoidable stress, can help
with blood pressure control.
Using alcohol, drugs, smoking, and unhealthy eating to cope with stress will add to
hypertensive problems. These should be [Link] can raise blood pressure.
Giving up smoking reduces the risk of hypertension, heart conditions, and other health
issue
• Medications—
• diuretics, including thiazides, chlorthalidone, and indapamide
• beta-blockers and alpha-blockers
• calcium-channel blockers
• central agonists
• peripheral adrenergic inhibitor
• vasodilators
• A hypertensive crisis
• is a severe increase in blood pressure that can lead to a stroke. Extremely high blood
pressure — 180/120 and higer
• Causes of a hypertensive emergency include:
• Forgetting to take blood pressure medication
• Stroke
• Heart attack
• Heart failure
• Kidney failure
• Rupture of your body's main artery (aorta)
• Interaction between medications
• Convulsions during pregnancy (eclampsia)
• A hypertensive crisis is divided into two categories: urgent and emergency.
• In an urgent hypertensive crisis, blood pressure is extremely high, but doctor doesn't
suspect you have any damage to your organs.
• In an emergency hypertensive crisis, blood pressure is extremely high and has caused
damage to organs. An emergency hypertensive crisis can be associated with life-threatening
complications.
Signs and symptoms of a hypertensive crisis
that may be life-threatening may include:
• Severe chest pain
• Severe headache, accompanied by confusion
and blurred vision
• Nausea and vomiting
• Severe anxiety
• Shortness of breath
• Seizures
• Unresponsiveness
