Hypertension

Overview

What you don't know can affect you

Despite its name, hypertension, or high blood pressure, doesn't have anything to do with hyperactivity, nervousness, or being tense. In fact, you can be a calm and relaxed person and still have hypertension. Many people who have high blood pressure don't even know it.

And that's what makes it so dangerous. High blood pressure is called the "silent killer" because it has no symptoms. Without regular medical screening, this condition may go undetected until vital organs are damaged. Although there is no cure for hypertension, there are many proven ways to control it. Medication, diet, exercise, and stress reduction are the major remedies that can reduce the risk of this serious, potentially life-threatening disease.

Detailed Description

Blood pressure is the result of two forces:

• Force created by the heart as it pushes blood into the arteries and through the circulatory system
• Force of the arteries as they resist the blood flow

Your blood pressure is not a constant figure. It varies naturally with activity, weight, age, and even time of day. Infants and children generally have lower blood pressure; adults, with their larger bodies, have higher pressures. Your readings may also be highest in the morning and lowest when you sleep.

Hypertension comes into the picture when the pressure in your arteries increases to unsafe levels. High blood pressure is measured in the weight of a column of mercury (mm Hg) and is determined by two readings:

• The first value, systolic, measures maximum pressure, when the heart is at work (beating)
• The second value, diastolic, measures minimum pressure, when the heart is at rest (between beats)

For an adult, a normal systolic reading is in the 100 to 135 mm Hg range. Normal diastolic pressure should be from 60 to 80 mm Hg. When you have your blood pressure checked, you will be given the systolic reading over the diastolic. A common normal reading is 100/75 or 110/80 and so on. The greater these readings — especially the diastolic value — the greater the threat to your health. Thus, a blood pressure reading above 140/90 requires monitoring and possible further evaluation by your doctor.

How Common Is Hypertension?

The American Heart Association estimates that as many as 50 million Americans have high blood pressure. That works out to one in five Americans (and one in four adults), and more than 31% of them don't know they have it. High blood pressure occurs more often in African-Americans, and at any given blood pressure level, the consequences of high blood pressure are worse in African Americans.

Conventional Treatment

Goals of Treatment

The goal of treatment for hypertension is to reduce high blood pressure readings to a normal range — below 140/90. Primary hypertension, the most common type, is incurable. However, with proper treatment, it can be effectively controlled, thus reducing the risk factors associated with other, possibly fatal conditions. In secondary hypertension, the specific medical reason for the increased blood pressure can be identified and possibly corrected, sometimes with surgery.

Treatment Overview

Mild hypertension can be controlled quite well through adjustments in your diet and lifestyle:

• If you smoke, stop. Nicotine constricts arteries and raises your blood pressure.
• Lose weight if necessary. Obesity affects hypertension.
• Reduce the amount of salt in your diet to less than 2.3 grams of sodium or 6 grams of sodium chloride per day.
• Cut back on alcohol. Drinking two or more ounces of alcohol a day can raise your blood pressure. That's the amount typically found in four ounces (two shots) of 100-proof whiskey, 16 ounces (two glasses) of wine, or 48 ounces (four cans or bottles) of beer.
• Exercise regularly.
• Lower your stress level.

If your hypertension is moderate to severe, many medications are available to help control it. Often, your physician may prescribe a combination of treatments.

Drug Therapy

Drugs most commonly prescribed
Depending on the severity of your hypertension, a combination of drugs may be necessary, although at least 50% of all hypertension cases (irrespective of race, gender, or age) are effectively managed through a program using a single antihypertensive drug. The list of medications is extensive, but nine major categories are relevant, which classify the drugs based on their method of action. These functionally distinct categories are: Diuretics Beta-blockers Alpha-blockers Alpha/beta-blockers Calcium-channel blockers Angiotensin converting enzyme (ACE) inhibitors Vasodilators peripherally and centrally acting drugs Like most drug therapy programs, drug treatment for hypertension can cause side effects. Common symptoms may include sedation, impotence, dizziness, fatigue, nightmares, and depression. The categories are listed below followed by a short description and a list of commonly prescribed drugs.
Diuretics
Diuretics increase the removal of salt and water from the body, leading to an overall decrease in body fluids and a reduction in blood pressure. They have proven especially to be effective for treating hypertension in African-American and elderly populations. However, the majority of these drugs can lower potassium levels possibly resulting in such symptoms as leg cramps, muscle weakness, and muscle spasms. Alternatives to the potassium-wasting diuretics are potassium-sparing diuretics or including a daily potassium supplement and potassium-rich foods in your diet to prevent potassium deficiency.
Lasix http://www.nmihi.com/f/furosemide.html
Aldactone
Beta-blockers
These drugs interfere with nerve receptors in your heart and cause it to beat less forcefully, thereby reducing the amount of blood pumped during each beat. This causes a reduction in your blood pressure. Most older patients respond very well to beta-blockers. One study indicated that the beta-blocker class was the most effective antihypertensive drug class in older Caucasian patients. This is also an appropriate treatment for young patients. These drugs are not as effective in African-American patients and should be avoided by those suffering from asthma, insulin-dependent diabetes, peripheral vascular disease, or congestive heart failure (CHF) caused by systolic dysfunction.
Inderal
Zebeta
Lopressor
Tenormin
Calcium channel-blockers
This antihypertensive drug prevents the influx of calcium into arteriole muscle cells which renders them unable to maintain a contraction. This facilitates increased blood flow resulting in reduced blood pressure. These drugs have proven as effective monotherapy in African-American populations.
Adalat
Isoptin
Norvasc
Cardizem
Plendil
Angiotensin-converting enzyme (ACE) inhibitors
This drug inhibits the production of angiotensin II, a chemical that causes arteriole wall contraction. These drugs cannot be taken during pregnancy.
Accupril
Altace
Capoten
Lotensin
Monopril
Vasotec
Zestril
Angiotensin converting enzyme receptor blockers
These drugs block the vasoconstrictor and aldosterone-secreting effects of angiotensin II by blocking the binding of the angiotensin II receptor.
Atacand
Avapro
Cozaar
Diovan
Alpha-blockers
These drugs block receptors located on blood vessel walls that, when stimulated, cause contraction, thereby increasing blood flow and lowering blood pressure.
Cardura
Hytrin
Minipress
Alpha/beta adrenergic-blockers
Trandate
Direct vasodilators
These drugs act directly on blood vessels, causing them to relax and dilate.
Apresoline
Rogaine
Centrally acting drugs
These drugs lower blood pressure by reducing nerve impulses from the brain.
Aldomet
Catapres

Surgery

In some cases, surgery can offer an effective means of eliminating or correcting the principal cause of secondary hypertension. Surgical measures include removal of thyroid gland tissue, excision of a pheochromocytoma (a tumor that produces adrenaline-like hormones that can cause very high blood pressure), or repair of damaged blood vessels (angioplasty).

Appropriate Healthcare Setting

Inpatient care is only necessary for people who need surgery to correct a case of secondary hypertension or for people who experience a hypertensive emergency.

Activity & Diet Recommendations

Any exercise that is aerobic can be helpful in lowering your blood pressure. These include walking, swimming, bicycling. Avoid isometric exercises such as bodybuilding, weight lifting, or push-ups. These raise blood pressure. Never start an exercise regime without first consulting your physician.

Relaxation exercises can be helpful in reducing hypertension. These activities may include mediation, reading, painting, and gardening. Some people benefit from biofeedback programs. Anything that can reduce the stress in your daily life is worthwhile.

Reducing your intake of sodium is also important. Here is some general information related to reducing sodium in your diet:

• Table salt is about 40% sodium — and the main culprit
• Americans consume 20 times more salt than their bodies need — 2,000 mg is the average daily recommended amount
• About 75% of your salt needs are already in the foods you eat and drink
• The recommended amount of salt for people with hypertension is the equivalent of just one teaspoon a day — You can easily reach this without adding any more salt to your food.
• For some people who are especially sensitive to the sodium, even a moderate amount of salt can raise their blood pressure.

Avoid salty foods and snacks such as bacon, sausage, pretzels, potato chips, mustard, olives, pickles, and some cheeses. (Obviously, picnics can be hazardous to your low-salt diet.) Buy more fresh meats, fruits, and vegetables instead of canned, frozen, or processed ones. Avoid fast foods or convenience foods.

Be aware of hidden sodium — foods and beverages that contain salt you might not have considered. These include many carbonated drinks, nondairy creamers, cookies, and cakes.

Get to know what's in the foods you buy and eat. Learn to read the labels on all processed and packaged foods. Sodium levels are printed on the back, along with other nutritional information. Many over-the-counter medicines also contain high levels of sodium, such as alkalizers for stomach indigestion, aspirin, cough medicine, mouthwash, and even toothpaste.

If your doctor prescribed a diuretic (water pill) to help control your blood pressure, you may need to add potassium to your diet because some of these medications lower potassium levels. Foods low in sodium and high in potassium include chicken and turkey, veal, many type of fish (halibut, fresh sardines, scallops), fruits (bananas, plums, raisins, nectarines), fresh vegetables (carrots, lima beans, potatoes, and spinach), orange juice, unsalted peanuts and peanut butter, and dry milk.

Monitoring the Condition

The best means of controlling hypertension is through monitoring your own blood pressure on a regular basis and periodic visits to your doctor for evaluation of your progress, adjustment to medication, and status of target organs (at-risk organs such as your heart, brain, kidney, and eyes). Once your condition stabilizes, your status should be monitored at least once every three to six months. A yearly urine sample analysis and an assessment of your creatine and potassium levels are generally appropriate as part of a healthy follow-up plan.

Possible Complications

Unchecked, sustained hypertension causes damage to your blood vessels, which leads to a reduction in blood flow. This, in turn, can lead to widespread organ damage, especially to your heart, brain, kidney, and eyes. Untreated hypertension may eventually cause the formation of aneurysms in various parts of the body, especially the brain (which can cause brain hemorrhage), eyes (which can cause blindness), and aorta (a large blood vessel emanating from the heart, the rupture of which could result in death). Cardiac damage results in heart attack, heart failure, and thickening of the muscles of the heart (hypertrophy), which may be fatal.

Hypertension is the number one cause of strokes. Strokes themselves could be caused by the plugging of the arteries to the brain due to increased fatty deposits, blood clot formation, and blood clots coming from distal arteries supplying the brain.

Hypertension also causes kidney damage and eventually kidney failure.

Abruptly discontinuing your medication without your doctor's approval can result in rebound high blood pressure that could possibly precipitate a condition called hypertensive crisis. This is a rare but life-threatening complication where blood pressure can rise sharply to 200/120 and beyond. A hypertensive emergency exists if this sudden rise in blood pressure is also accompanied by acute target-organ injury as characterized by one or more of the following conditions:

• Encephalopathy
• Intracranial hemorrhage
• Left ventricular failure accompanied with fluid buildup in the lungs (pulmonary edema)
• Abnormal dilation of the aortic wall (aortic aneurysm)
• Eclampsia
• Spasmodic attacks of suffocating pain (unstable angina)

Quality of Life

All drugs prescribed to treat hypertension have side effects. Be sure to ask your doctor which drugs have the least problematic side effects for you.

Considerations for Women

Hypertension affects more women as people age. Women over age 65 especially need to have their blood pressure checked regularly.

Oral contraceptives are the most frequent reversible cause of secondary high blood pressure. If you are on birth control pills, you are two to six times more likely to suffer from high blood pressure. If your OB/GYN recommends discontinuing oral contraception, your blood pressure will probably return to normal within three months.

Hypertension also can occur in a small number of postmenopausal women taking estrogen replacement therapy. If you fall into this category, have your doctor check your blood pressure regularly.

Pregnancy

Approximately 2% of pregnant women have chronic hypertension. Often this is of a mild form (140/90 to 150/100), and is not of great concern. If you are planning on becoming pregnant, or already are, consult your family doctor or obstetrician the possible need for a blood-pressure-lowering drug that will not harm your fetus.

About 5% of first-time pregnant women who have preexisting hypertension are at increased risk of developing a condition known as preeclampsia. This may occur between the 20th week of pregnancy and week after delivery of the baby. Preeclampsia is accompanied by a 30 mm increase in systolic pressure or 15 mm in diastolic pressure. There may also be swelling in the face or hands and the presence of albumin (protein) in the urine. Preeclampsia is a very serious condition that may threaten the health of both the mother and the fetus, and force a premature birth. Your physician may prescribe a drug that is safe for pregnant women.

Nursing mothers

If you are breastfeeding your baby and know you have high blood pressure, consult with your doctor regarding which therapies are safe — or if you should discontinue nursing while taking any medications.

Considerations for Older People

Older people with hypertension need to be especially careful with when taking any drugs for their condition. As with any medications, be sure to let your doctor or pharmacist know which additional drugs you may already be taking to prevent any adverse reactions from inappropriately combined drugs. Isolated systolic hypertension (above 160/85 to 160/90) is usually found in older people.