Hypertension (HTN) / High Blood Pressure

High blood pressure (HBP) or hypertension means high pressure (tension) in the arteries. Arteries are vessels that carry blood from the pumping heart to all the tissues and organs of the body. High blood pressure does not mean excessive emotional tension, although emotional tension and stress can temporarily increase blood pressure. Normal blood pressure is below 120/80; blood pressure between 120/80 and 139/89 is called "pre-hypertension", and a blood pressure of 140/90 or above is considered high. Persistent hypertension is one of the risk factors for stroke, myocardial infarction, heart failure and arterial aneurysm, and is a leading cause of chronic kidney failure. Moderate elevation of arterial blood pressure leads to shortened life expectancy. Dietary and lifestyle changes can improve blood pressure control and decrease the risk of associated health complications, although drug treatment may prove necessary in patients for whom lifestyle changes prove ineffective or insufficient.

Causes Of High Blood Pressure

Two forms of high blood pressure have been described: essential (or primary) hypertension and secondary hypertension. Essential hypertension is a far more common condition and accounts for 95% of hypertension. The cause of essential hypertension is multifactorial, that is, there are several factors whose combined effects produce hypertension. In secondary hypertension, which accounts for 5% of hypertension, the high blood pressure is secondary to (caused by) a specific abnormality in one of the organs or systems of the body. (Secondary hypertension is discussed further in a separate section later.
In over 90% of cases, the cause of high blood pressure (hypertension) is unknown but several factors can increase your risk of developing the condition.
Where there is no specific cause, high blood pressure is referred to by doctors as primary high blood pressure (or essential high blood pressure).
Factors that can raise the risk of developing primary high blood pressure include:-

•Aging: the risk of developing high blood pressure increases as you get older
•Genetic: a family history of high blood pressure
•Being of African or Caribbean origin
•High intake of salt - exceeding 5.8 grams daily
•Lack of exercise
•Being overweight
•Smoking
•Drinking large amounts of alcohol
•Stress

About 1 in 10 cases of high blood pressure are the result of an underlying condition or cause. These cases are referred to as secondary high blood pressure. Common causes of secondary high blood pressure include:-

•Kidney disease
•Diabetes
•Narrowing of the arteries (large blood vessels) supplying the kidneys
•Hormonal conditions, such as Cushing's syndrome (body produces excess of steroid hormones)
•Conditions that affect the body’s tissue, such as lupus
•Oral contraceptive pill
•Painkillers known as Non-Steroidal Anti-Inflammatory drugs (NSAIDs), such as ibuprofen
•Recreational drugs, such as cocaine, amphetamines and crystal methamphetamine


2.0 Treatment For High Blood Pressure

Basically, there’re two main treatment which can deal with high blood pressure. The treatment goal is blood pressure below 140/90 and lower for people with other conditions, such as diabetes and kidney disease. Adopting healthy lifestyle habits is an effective first step in both preventing and controlling high blood pressure. If lifestyle changes alone are not effective in keeping your pressure controlled, it may be necessary to add blood pressure medications. Below is about blood pressure-lowering lifestyle habits and blood pressure medications:-

Lifestyle Treatment

Lose weight => Losing some excess weight can make a big difference. Blood pressure can fall by up to 2.5/1.5 mm Hg for each excess kilogram which is lost. Losing excess weight has other health benefits too.

Regular physical activity => Do some physical activity on five or more days of the week, for at least 30 minutes. For example, brisk walking, swimming, cycling, dancing, etc. Regular physical activity can lower blood pressure in addition to giving other health benefits. Doing regular physical activity five times a week, can reduce systolic blood pressure by 2-10 mm Hg.

Healthy diet =>

~ Ideally 7-9 portions, of a variety of fruit and vegetables per day.

~ The bulk of most meals should be starch-based foods (cereals, wholegrain bread, potatoes, rice, pasta), plus fruit and vegetables.

~ Reduce fatty food such as fatty meats, cheeses, full-cream milk, fried food, butter, etc. Use low-fat, mono-unsaturated or polyunsaturated spreads.

~ Limit salt in daily meals, the amount of salt that we consume can have an effect on our blood pressure. Government guidelines recommend that we should have no more than 5-6 grams of salt per day.

~ Drink alcohol in moderation. A small amount of alcohol (1-2 units per day) may help to protect you from heart disease. One unit is in about half a pint of normal-strength beer, or two thirds of a small glass of wine, or one small pub measure of spirits.

•Men should drink no more than 21 units of alcohol per week (and no more than four units in any one day).
•Women should drink no more than 14 units of alcohol per week (and no more than three units in any one day).Study showed that cutting back alcohol consumption to the recommended limits can lower a high systolic blood pressure by up to 10 mm hg.

A healthy diet provides benefits in different ways. For example, it can lower cholesterol, help control body weight, and has plenty of vitamins, fibre, and other nutrients which help to prevent certain diseases. Some aspects of a healthy diet also directly affect blood pressure. For instance, if you have a poor diet and change to a diet which is low-fat, low-salt, and high in fruit and vegetables, it can lower systolic blood pressure by up to 11 mm Hg.

Medication Treatment

Medication to lower blood pressure is usually advised for:

- All people who have a blood pressure that remains at 160/100 mm Hg or above after a trial of any relevant lifestyle changes.
- People with a blood pressure that remains at 140/90 mm Hg or above after a trial of any relevant lifestyle changes and who have: Diabetes; existing Cardiovascular disease
- People with a blood pressure of 130/80 mm Hg or more who have certain diseases. For example, people who have certain complications from diabetes, people who have had a recent heart attack, stroke or transient ischaemic attack (TIA) - sometimes called a mini-stroke. Also, some people with certain chronic kidney diseases.

Medicine for high blood pressure as below:

Diuretics - sometimes called "water pills" because they work in the kidney and flush excess water and sodium from the body.
Beta-blockers - reduce nerve impulses to the heart and blood vessels. This makes the heart beat slower and with less force. Blood pressure drops and the heart works less hard.
ACE inhibitors - Angiotensin converting enzyme (ACE) inhibitors prevent the formation of a hormone called angiotensin II, which normally causes blood vessels to narrow. The ACE inhibitors cause the vessels to relax and blood pressure goes down.
Angiotensin antagonists - shield blood vessels from angiotensin II. As a result, the vessels become wider and blood pressure goes down.
Calcium channel blockers (CCBs) - keep calcium from entering the muscle cells of the heart and blood vessels. This causes the blood vessels to relax and pressure goes down.
Alpha-blockers - reduce nerve impulses to blood vessels, which allows blood to pass more easily, causing the blood pressure to go down.
Alpha-beta-blockers - work the same way as alpha-blockers but also slow the heartbeat, as beta-blockers do. As a result, less blood is pumped through the vessels and the blood pressure goes down.
Nervous system inhibitors - relax blood vessels by controlling nerve impulses. This causes the blood vessels to become wider and the blood pressure to go down.
Vasodilators - directly open blood vessels by relaxing the muscle in the vessel walls, causing the blood pressure to go down.
In most cases, medication is needed for life. However, in some people whose blood pressure has been well controlled for three years or more, medication may be able to be stopped.
If you stop medication, you should have regular blood pressure checks. In some cases the blood pressure remains normal. However, in others it starts to rise again. If this happens, medication can then be started again.


Notes:
§ Reader’s Digest Asian health survey indicates that 61.6% of Malaysian respondents are affected by high blood pressure followed by high cholesterol (48.2%), obesity (40.7%) and diabetes (36.6%).
§ High blood pressure is often called the silent killer because in the initial stages it presents with no symptoms. It is only after an organ in the body is irritated or damaged, that the consequences of high blood pressure are realized.