HYPERTENSION

HYPERTENSION

Hypertension is another name for high blood pressure. It can lead to severe complications and increases the risk of heart disease, stroke, and death.

High blood pressure is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.

Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.

Medical guidelines define hypertension as a blood pressure higher than 130 over 80 millimeters of mercury (mm Hg), according to guidelines issued by the American Heart Association (AHA) in November 2017.

More than 10 million cases per year (India)

Hypertension and heart disease are global health concerns. The World Health Organization (WHO) suggests that the growth of the processed food industry has impacted the amount of salt in diets worldwide, and that this plays a role in hypertension.

Treatable by a medical professional

Requires a medical diagnosis

Lab tests or imaging not required

Chronic: can last for years or be lifelong

Fast facts on hypertension:

Normal blood pressure is 120 over 80 mm of mercury (mm Hg), but hypertension is higher than 130 over 80 mm Hg.
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.

Treatment

While blood pressure is best regulated through the diet before it reaches the stage of hypertension, there is a range of treatment options.

Lifestyle adjustments are the standard first-line treatment for hypertension

Regular physical exercise

Doctors recommend that patients with hypertension engage in 30 minutes of moderate-intensity, dynamic, aerobic exercise. This can include walking, jogging, cycling, or swimming on 5 to 7 days of the week.

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 avoided.

Smoking can raise blood pressure. Giving up smoking reduces the risk of hypertension, heart conditions, and other health issues.

Medications

People with blood pressure higher than 130 over 80 may use medication to treat hypertension.

Drugs are usually started one at a time at a low dose. Side effects associated with antihypertensive drugs are usually minor.

Eventually, a combination of at least two antihypertensive drugs is usually required.

A range of drug types are available to help lower blood pressure, including:

diuretics, including thiazides, chlorthalidone, and indapamide
beta-blockers and alpha-blockers
calcium-channel blockers
central agonists
peripheral adrenergic inhibitor
vasodilators
angiotensin-converting enzyme (ACE) inhibitors
angiotensin receptor blockers

The choice of drug depends on the individual and any other conditions they may have.

Anyone taking antihypertensive medications should be sure to carefully read labels, especially before taking any over-the-counter (OTC) medications, such as decongestants.

These may interact with medications used to lower blood pressure.

Causes

The cause of hypertension is often not known.

Around 1 in every 20 cases of hypertension is the effect of an underlying condition or medication.

Chronic kidney disease (CKD) is a common cause of high blood pressure because the kidneys do not filter out fluid. This fluid excess leads to hypertension.

Risk factors

A number of risk factors increase the chances of having hypertension.

Age: Hypertension is more common in people aged over 60 years. With age, blood pressure can increase steadily as the arteries become stiffer and narrower due to plaque build-up.

Ethnicity: Some ethnic groups are more prone to hypertension. 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.

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 of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.

Stress. High levels of stress can lead to a temporary increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure.

Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease, diabetes and sleep apnea.

Sex: The lifetime risk is the same for males and females, but men are more prone to hypertension at a younger age. The prevalence tends to be higher in older women.

Existing health conditions: Cardiovascular disease, diabetes, chronic kidney disease, and high cholesterol levels can lead to hypertension, especially as people get older.

Other contributing factors include:

physical inactivity
a salt-rich diet associated with processed and fatty foods
low potassium in the diet
alcohol and tobacco use
certain diseases and medications
A family history of high blood pressure and poorly managed stress can also contribute.

Signs

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.

	Systolic (mmHg)		Diastolic (mmHg)
Normal blood pressure		Less than 120		Less than 80
Elevated		Between 120 and 129		Less than 80
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

If the reading shows a hypertensive crisis when taking blood pressure, wait 2 or 3 minutes and then repeat the test.

If the reading is the same or higher, this is a medical emergency.

The person should seek immediate attention at the nearest hospital.

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.

Regularly checking your blood pressure is vital, as there will usually be no symptoms to make you aware of the condition.

It is maintained that 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.

Complications

The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. 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 your 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 your 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 your 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 type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular dementia.

Long-term hypertension can cause complications through atherosclerosis, where the formation of plaque results in the narrowing of blood vessels. This makes hypertension worse, as the heart must pump harder to deliver blood to the body

Hypertension-related atherosclerosis can lead to:

heart failure and heart attacks
an aneurysm, or an abnormal bulge in the wall of an artery that can burst, causing severe bleeding and, in some cases, death
kidney failure
stroke
amputation
hypertensive retinopathies in the eye, which can lead to blindness
Regular blood pressure testing can help people avoid the more severe complications.

Diet

Some types of hypertension can be managed through lifestyle and dietary choices, such as engaging in physical activity, reducing alcohol and tobacco use, and avoiding a high-sodium diet.

Reducing the amount of salt

Average salt intake is between 9 grams (g) and 12 g per day in most countries around the world.

The WHO recommends reducing intake to under 5 g a day, to help decrease the risk of hypertension and related health problems.

This can benefit people both with and without hypertension, but those with high blood pressure will benefit the most.

Moderating alcohol consumption

Moderate to excessive alcohol consumption is linked to raised blood pressure and an increased risk of stroke.

The American Heart Association (AHA) recommend a maximum of two drinks a day for men, and one for women.

The following would count as one drink:

12 ounce (oz.) bottle of beer
4 oz. of wine
1.5 oz. of 80-proof spirits
1 oz. of 100-proof spirits

A healthcare provider can help people who find it difficult to cut back.

Eating more fruit and vegetables and less fat

People who have or who are at risk of high blood pressure are advised to eat as little saturated and total fat as possible.

Recommended instead are:

whole-grain, high-fiber foods
a variety of fruit and vegetables
beans, pulses, and nuts
omega-3-rich fish twice a week
non-tropical vegetable oils, for example, olive oil
skinless poultry and fish
low-fat dairy products

It is important to avoid trans-fats, hydrogenated vegetable oils, and animal fats, and to eat portions of moderate size.

Managing body weight

Hypertension is closely related to excess body weight, and weight reduction is normally followed by a fall in blood pressure. A healthy, balanced diet with a calorie intake that matches the individual's size, sex, and activity level will help.

The DASH diet

The U.S. National Heart Lung and Blood Institute (NHLBI) recommends the DASH diet for people with high blood pressure. DASH, or "Dietary Approaches to Stop Hypertension," has been specially designed to help people lower their blood pressure.

It is a flexible and balanced eating plan based on research studies sponsored by the Institute, which says that the diet:

lowers high blood pressure
improves levels of fats in the bloodstream
reduces the risk of developing cardiovascular disease
Some evidence suggests that using probiotic supplements for 8 weeks or more may benefit people with hypertension.

DASH Guidelines

6 to 8 servings of grains per day
4 to 5 servings of fresh fruits per day
4 to 5 servings of fresh vegetables per day
2 to 3 servings of low-fat dairy per day
6 or less servings of lean protein per day
4 to 5 servings of legumes or nuts/seeds per week
Limited fats and sweets

Types

High blood pressure that is not caused by another condition or disease is called primary or essential hypertension. If it occurs as a result of another condition, it is called secondary hypertension.

Primary hypertension can result from multiple factors, including blood plasma volume and activity of the hormones that regulate of blood volume and pressure. It is also influenced by environmental factors, such as stress and lack of exercise.

Secondary hypertension has specific causes and is a complication of another problem.

It can result from:

diabetes, due to both kidney problems and nerve damage
kidney disease
pheochromocytoma, a rare cancer of an adrenal gland
Cushing syndrome, which can be caused by corticosteroid drugs
congenital adrenal hyperplasia, a disorder of the cortisol-secreting adrenal glands
hyperthyroidism, or an overactive thyroid gland
hyperparathyroidism, which affects calcium and phosphorous levels
pregnancy
sleep apnea
obesity
CKD

Treating the underlying condition should see an improvement in blood pressure.

Can Too Much Salt Damage Blood Vessels?

Yes

Excessive salt intake can damage blood vessels, as well as raising the risk of developing hypertension (high blood pressure)

people with normal blood pressure, a diet high in salt has virtually no acute effect on blood pressure. However, for reasons which are not fully understood, high sodium (salt) intake over the long-term can lead to hypertension.

What is the difference between salt and sodium?

Salt (NaCl) consists of two components:

Sodium (Na) - it is this element that is thought to lead to health problems. 6g of salt contains 2.4g of sodium.

Chloride (Cl) - this is, in fact, chlorine, but when its electrons bind to the sodium (create a bond), a new compound is created, called sodium chloride (salt) - the chlorine becomes chloride.

Over time, higher sodium intake is associated with increases in serum uric acid (SUA) and urine albumin excretion (UAE). Among individuals with higher SUA and urine UAE, a higher sodium intake is an independent risk factor for developing hypertension.

GUIDELINES

Maintaining weight is the main goal.
Salt is restricted in diet as sodium is already high and it can aggravate the condition more
Diet should be low fat diet as there are chances of dyslipidemia in obese individual
It should be a well balanced diet with moderation of fat and increased amounts of fiber and protein in diet. Potassium rich fruits like Bananas, oranges, apricots, grapefruit (some dried fruits, such as raisins, and dates, are also high in potassium) should be included.
Medication has to be followed with balanced diet and regular exercise
Aerobics, cardio wt training is suggested along with yoga and mediation
As far as possible restrict packed products as they contain added preservatives which are rich in sodium and outside foods
Diet should be rich in potassium so that excess sodium is thrown out of the body

Nutrition science - easy learning

Tuesday 3 July 2018