Hypertension: How is it Classified?

Hypertension is classified into Primary and Secondary; systolic or diastolic, and true systemic.

1. Systolic hypertension: This is common among the elderly especially where there are other disease conditions. The systolic blood pressure is persistently raised above 160mmHg.

2. Diastolic hypertension:In this case the diastolic blood pressure is elevated and sustained, and is severe in most cases. The difference between this and primary hypertension is that there is a noticeable change in the walls and inside of the arteries in diastolic hypertension whereas primary hypertension does not show any such change.

3. True systemic hypertension: In this particular condition both the systolic and diastolic blood pressures are equally elevated and sustained. Note that for one to be said to be hypertensive, his/her blood pressure must be taken repeatedly for at least one to two weeks.

4. Primary hypertension: This accounts for about 85% of known cases. There are no known underlying causes for this to develop. There is a persistent elevation of the diastolic blood pressure above 95mmHg. In most cases it is common within the family hence the general consensus that it is hereditary. Other factors that have been implicated in the development of primary hypertension include obesity, emotional stress, personality variables, etc.

5. Secondary hypertension: This is caused by a disease condition in the system. The pathological changes in the body lead to the surfacing of this condition. Some of the conditions that can lead to secondary hypertension include: Renal (kidney) disease, thyrotoxicosis, Toxaemia of pregnancy, Phaeochromocytoma (tumour of the adrenal gland), Arteriosclerosis, Coarctation of the aorta, Cushing syndrome, Renal artery stenosis and Oral contraceptives.

Joseph Ezie Efoghor is a professional nurse with years of practical experience. He writes on variety of topics which you may find beneficial to you. For more on his write-ups visit http://bloodpressureandmore.blogspot.com

Curing Hypertension through Surgical Operation

The hope of curing hypertension through surgical operation is increasing as the first attempt to reduce and permanently cure a persistently elevated blood pressure was made in Britain recently. All attempts before now seemed to only offer a palliative rather than curative hope for the hypertensive patient. Recently however, a renal surgery was carried out for the first time in Britain which already is yielding a positive result.
The one-hour surgical operation was carried out on one Mr. Anthony Henry and its objective is to attempt to disrupt the signals from the brain that have persistently kept the blood pressure high. Disrupting these signals is hoped to permanently cure the hypertension. The operation which is otherwise known as ‘Renal sympathetic-nerve ablation’ involves inserting a wire into a blood vessel close to the kidneys to burn through the nerves that stimulate high blood pressure.
The patient’s blood pressure is reportedly down only two weeks after the successful surgical operation. The 68 year old retired chef from Stratford already has started to enjoy the benefit this surgical procedure hopes to offer all sufferers of hypertension, and also enjoys the privilege of being the first Briton to undergo this operation.
The benefits of this operation could become apparent within 3 months, and there is the hope that the patient would stop taking anti-hypertensive drugs for life. It is also hoped that this procedure would reduce the blood pressure significantly as well as reduce the stroke mortality by as much as 50%.
In a world where there are millions of people suffering from hypertension this scientific innovation could just be the scientific achievement of the century. We do hope that it truly gives a permanently cure to hypertension and stop the untold hardship patients are suffering in the hands of this seemingly incurable health monster.

What is Hypertensive Crisis and How is it Managed?

Hypertensive crisis is the sudden rise in the blood pressure of the hypertensive patient beyond 250/150mmHg. The onset is usually with little or no warning signs, and it is characterized by severe headache, nausea, vomiting, dizziness, visual disturbances and disorientation. In some cases these symptoms are accompanied by a cerebral spasm which brings about cerebral ischaemia, oedema, and thrombosis. Hypertensive crisis is such a dangerous medical condition that an immediate medical intervention would be needed to save the patient’s life. It is therefore medical emergency.
Hypertensive crisis is managed through the administration of administration of a vasodilator such as Hydralazine (Apresoline) intravenously to help dilate the blood vessel, and a diuretic e.g. Furosemide (Lasix) intravenously to help to help patient lose excess fluids and sodium.
The patient should be placed on strict bed rest and the vital signs –blood pressure, pulse and respiration monitored every 5-10 minutes. His neurological signs should also be monitored. Patient’s fluid intake and output should also be monitored to determine the level of progress made. The possibility of acute hypotensive reaction is quite high as a result the anti-hypertensive drugs hence patient should be strictly monitored and not allowed to get up suddenly from bed.
Everything medically possible should be done to see that the patient does not suffer any further stress as this is capable of making the patient suffer more complication such as stroke. Therefore, patient should be keep in a quiet environment with visitors restricted to allow for both physical and mental rest and aid speedy recovery. His physical care should be taken care of by the nurses.

Hypertension: How Dangerous are The Complications?

The complications of hypertension are so dangerous that a lot has to be done to get them prevented. There are a few complications that gradually set in when one is hypertensive and with time they affect several organs of the body thereby posing a serious health threat to the sufferer.
Some of these known complications are:
1. Myocardial infarction: This is the necrosis or death of a part of the myocardium due to sustained inadequate blood supply to that portion. When the coronary arteries become narrowed as a result of changes in their walls and lumen it becomes increasingly difficult for blood to get to the myocardium of the heart. This subsequently leads to the death of the myocardium, a complication otherwise referred to as myocardial infarction.
2. Enlargement of the heart: This complication is brought about by an attempt made by the heart to overcome the peripheral resistance put up by the blood vessels. As the heart stresses itself to supply more blood to the organs the myocardium becomes enlarged (a condition known as myocardial hypertrophy), this eventually leads to overall enlargement of the heart (cardiomegaly) and its inability to pump out blood efficiently and effectively.
3. Heart failure: The inability of the heart to effectively and efficiently pump out blood to the rest parts of the body as a result of a weakness in the contractility of the myocardium leads to its failure. The failure of the heart brings about a further short supply in oxygen and nutrients supply to the organs.
4. Stroke: This is bleeding into the brain as a result of a rupture in the blood vessels of the brain. When stroke or cerebro-vascular accident occurs in a part of the cerebrum, the side of the body opposite the affected part becomes partially or totally paralyzed, leading to difficulty in movement, slurred and incoherent speech, etc.
5. Kidney problem: Poor blood supply to and changes within the blood vessels of the kidneys also bring about renal complication such as nephrosclerosis and chronic pyelonephritis.
6. Retinal damage: The retina of the eyes may also suffer one form of complication or the other. The chronic pathological changes in the tiny vessels of the eyes coupled with increasing blood pressure lead to a rupture and bleeding into the retina. This in the long run may lead to partial or total blindness or other form of retinopathy.

Hypertension: The Pathophysiology

Arterioles and large blood vessels become hardened and constricted leading to an abnormal resistance to blood flow and subsequently an elevated blood pressure. The heart responds by trying to overcome the peripheral resistance. There is therefore an increased cardiac output as the heart tries to pump more blood to the different parts of the body. The continuous resistance puts a greater demand on the heart to increase its pressure thereby leading to an increase in the size of the tissue of the myocardium, a condition known in medical term as myocardial hypertrophy and then cardiomegaly (enlargement of the heart) and coronary insufficiency.
The abnormal resistance to blood flow leads to decrease in blood supply to vital organs such as the heart, brain, kidneys and the lower extremities. This brings about mental confusion, headache, oliguria (a deficiency in the secretion of urine), angina pectoris, dyspnoea, fatigue, etc. The changes in the blood vessels may lead to haemorrhage and intravascular coagulation bringing about occlusion of the blood vessels.
Coronary insufficiency results in myocardial infarction (MI) and subsequently the heart fails. Inability of the heart to pump out blood from the left ventricle into the aorta gradually leads to pulmonary congestion. The kidneys fail as a result of poor blood supply. Arteriosclerotic changes in the tiny vessels make them susceptible to rupture. Rupture occurs as the pressure continues to increase within the vessels. This brings about haemorrhage. Should the rupture occur in the brain there would be stroke (CVA). Epistaxis (nose bleed)occurs as a result of rupture of the tiny vessels of the nose. Bleeding into the retina brings about blurred vision and subsequently blindness. These effects on organs are referred to as “End-Organ damage”.

What Role Do Hormones Play in Hypertension?

Hormones are chemical substances which are produced in an organ (usually a gland) and are transported by the blood to another target organ where they excite their activities. Some of the hormones are transported through a duct to their target organs while others pass directly into the blood stream.
Hormones are produced in order to help perform certain specific function for the body, but when certain things go wrong with their production or their discharge process there could be problems. Some hormonal activities therefore have been known to contribute to the development of hypertension. Some of the hormones cause hypertension through their direct effect on blood vessels while others cause hypertension indirectly.
1. Pituitary hormone: The pituitary gland otherwise known as the master gland regulates the activities of other glands by producing hormones which act on these glands. One of such hormones is the adrenocorticotrophic hormone (ACTH) which regulates the production of corticosteroids by the adrenal cortex. When there is a fault in the regulation process the corticosteroid could produce excess of its substances such as the mineralocorticocoids e.g. aldosterone which is known to retain sodium and subsequently fluid. Excessive retention of fluid by this hormone eventually leads to hypertension.
2. Thyroid hormone: The thyroid gland produces thyroxine which helps to regulate the body’s metabolic processes. Over stimulation of the thyroid gland by the thyroid stimulating hormone (TSH) which is produced by the anterior pituitary gland leads to excessive secretion of thyroxine. This eventually brings about hyperthyroidism; and one of the known effects of hyperthyroidism is hypertension.
3. Adrenal hormone: Adrenaline (epinephrine) is a major hormone secreted by the adrenal medulla. It exerts action similar to that of the sympathetic nervous system. It causes vasoconstriction of the peripheral blood vessels. When there is a problem with the kidneys the regulation of this hormone is altered thereby bringing about its excess production. This in the long run leads to hypertension.

What is Acute Hypotensive Reaction?

Patients treated with anti-hypertensive drugs have the tendency to develop acute hypotensive reactions which are usually characterized by fainting, weakness, nausea and vomiting. This condition is equally dangerous and needs to handled properly so that the patient does suffer any harm
The patient should be taught how to prevent acute hypotensive reaction and what to do if they should occur.
i.In case of acute hypotensive reaction, patient should lie down immediately with his feet elevated above the head; flex the thigh and wriggle the toes to increase blood flow to the brain. This would help to increase blood and oxygen supply to brain cells
ii.Patient should get up slowly from lying position to a sitting position before standing. This is to allow the vascular system adjust to changes in position. Otherwise there could sudden drop in blood pressure which would make the to slump and get injured.
iii.Patient should avoid standing motionless, especially within the first 2 hrs of taking anti-hypertensive drugs. Standing motionless causes drainage of blood from the brain and other organs thereby leading to a fainting attack. It also makes the vessels of the legs to relax causing a pooling of blood in the lower extremities.
iv.Constipation should be avoided because it causes increased or irregular absorption of anti-hypertensive drugs. This can lead to critical hypotensive reactions.
v.Driving within 2 hours of taking anti-hypertensive drugs should be done carefully to avoid accidents.There could be pooling of blood from the brain and this eventually could make the patient experience dizziness or confusion and when this happen an accident may be inevitable. Accident is a major in acute hypotensive reaction.
vi.Avoid hot baths and excessive alcohol which can cause vasodilatation and fainting.A patient who is likely to experience acute hypotensive reaction or a patient who has actually experienced it before must try and avoid alcohol because the alcohol will produce a state of hypotension (lowered blood arterial pressure)and when its effect combines with the effect of the anti-hypertensive drugs acute hypotensive reaction would surely occur.

13 Possible Causes of Hypertension

Hypertension is caused by one of several factors. Primary hypertension for example, develops when there are predisposing factors which is the hereditary link and for this to cause hypertension to come up other factors known as precipitating factors have to combine with them. The causes of hypertension therefore are discussed below:
1.Heredity: Primary hypertension is known to run in families. This can be directly passed on from parents to their offspring or from the grand parents to other generations even though there are no underlying diseases.
2.Obesity: Excessive weight gain can also trigger off primary hypertension. When an individual begins to add much weight extra work is added to the heart and the system is also stressed. This in the long run leads to primary hypertension.
3.Emotional stress: Emotional stress is known to release adrenaline which increases heartbeat, constrict surface blood vessels and lead to increase in blood pressure. Emotional stress, if not controlled can be a good source of primary hypertension.
4.Excessive salt intake: Excessive consumption of table salt (sodium chloride) by predisposed individuals makes the kidneys to retain more fluid and subsequently lead to hypertension.
5.Nervous activities: Over activity of the autonomic nervous system also leads to the over secretion adrenaline from the adrenal gland. This system is not under the control of the individual. If it keeps stimulating the adrenal glands to produce more adrenaline a state of hypertension would occur.
6.Certain drugs: Some tablets which are routinely taken by women to prevent pregnancy are known to lead to an increase in blood pressure. Other drugs which can lead to hypertension include anabolic steroids and corticosteroids.
7.Poor exercise: Poor physical exercise leads to poor muscle tone which make the muscles to over relax on peripheral blood vessels given little or no chance to expand.
8.Kidney disease: Some forms of kidney diseases which cause inflammation of the kidney nephrons lead to the release of certain enzymes into the blood stream which eventually brings about the constriction of the blood vessels. This is one of the major causes of secondary hypertension.
9.Tetanus infection: The organism that causes tetanus in man is also known to release a chemical that is capable of causing hypertension. When it infects man, this chemical or exotoxin affects the brain and the heart thereby causing hypertension.
10.Thyroid activity: The thyroid gland secrets hormones that regulate metabolic activities. But when it becomes over active it can bring about secondary hypertension.
11.Pregnancy: Some women develop hypertension during pregnancy. During their pregnancy there is raised level of protein in urine, swelling of the hands and feet, and also there is hypertension. This condition is usually referred to as toxaemia of pregnancy.
12.Tumour of Pituitary gland: The pituitary gland which is situated in the brain controls the activities of other glands in the body. When there is tumour of the pituitary gland it causes the adrenal gland to produce excess of its hormone and this eventually results in hypertension.
13.Phaeochromocytoma: This condition which is the tumour of the adrenal medulla leads to over production of adrenaline thereby bringing about constriction of the peripheral blood vessels as well increasing cardiac output. This in turn leads to secondary hypertension.

11 Steps to Diagnosing hypertension

Hypertension can be properly diagnosed by carrying out detailed medical/laboratory investigations on the patient. The following the under-listed 12 steps can really be of great help in trying to establish whether or not an individual has hypertension:
1.Detailed health history of the patient should be obtained. Information such as the lifestyle, economic status and past medical history should be obtained so as to get a clue as to the probable type of hypertension, or any condition that is responsible for secondary hypertension.
2.Physical examination (palpation) to detect any signs of adrenal mass or cardiac enlargement. The radial and femoral pulses should also be palpated to determine the rate and quality. Blood pressure readings should be obtained from both arms and legs while the patient is in supine position.
Other forms of investigations to detect secondary hypertension include:
3.Urinalysis: To detect epithelial cell cast: this is indicative of chronic glomerular lesions. Presence of pus cells also suggests the presence of proteinuria (presence of protein in urine) or pyelonephritis.
4.Blood Urea Nitrogen (BUN) and creatinine clearance tests should be carried out to ascertain renal dysfunction. An elevation of BUN and creatinine is indicative of renal problem which may have secondarily elevated the blood pressure.
5.Serum electrolytes evaluation may be done to detect the presence of primary aldosteronism, hypercalcaemia, hyperkalaemia and chronic renal disease.
6.Intravenous Pyelogram: This is a procedure whereby an x-ray of the renal system is carried out following the intravenous injection of a radio-opaque dye, in order to check the status of the kidneys.This could help in arriving at a proper diagnoses of secondary hypertension since renal disease is known to be a contributory factor.
7.Renin assays: Helps to evaluate the level of renin in the blood stream. The enzyme is usually released into the blood stream when there is ischaemia of the kidneys. This enzyme causes vasoconstriction and eventually leads to hypertension in the long run or worsen an already existing hypertension.
8.Urinary steroid excretion: An increase in the urinary steroid excretion shows a link between the steroid production and secondary hypertension.
9.Serum thyroxine: This may give clue to the presence of hyperthyroidism which is also one of the causes of secondary hypertension.
10.Plasma cholesterol/triglycerides: This also helps to establish the link between plasma cholesterol level and artheriosclerosis which is contributory to the development of secondary hypertension
11.ECG (to detect left ventricular hypertrophy: This will help to determine whether or not there already an enlargement of the left ventricle of the heart, which one of the major complications of hypertension.

12 warning signs of hypertension

Quite a number of persons walk the streets with hypertension but are never aware they have the problem. This is because sometimes the warning signs come up too lately. Sometimes too, people do not go to have their blood pressure checked in a health facility.
When an individual has hypertension, there are several signs and symptoms that would make him/her know or at least suspect that he/she may have become hypertensive. A combination of two or more of these signs should actually give the individual some concern and make him/her to want to see the doctor. Some of the signs include:
1. HEADACHE: The individual who has hypertension begins to feel unusual headache on the back of of the head especially on waking up in the morning. This kind of headache is very discomforting.
2. WEAKNESS: One of the signs of hypertension is weakness. So when you begin to feel unusually weak you should see the doctor.
3. NERVOUSNESS: Another sign of hypertension is nervousness. The individual experiences a state of mental and physical restlessness or unrest.
4. DIZZINESS: This is also one of the signs that accompany hypertension. It is a feeling of unsteadiness accompanied by tension or anxiety.
5. RINGING IN THE EARS: One other thing that would make you suspect you may have hypertension is when you begin to experience a ringing, buzzing or roaring sound in your ears.
6. LOSS OF SLEEP: Hypertension can interfere with your sleep. Because of the involvement of the brain you may be unable to sleep at night when you have hypertension. This condition is known as insomnia.
7. NOSE BLEED: Bleeding from the nose otherwise known as epistaxis also accompanies hypertension. When the small vessels in the nose rupture as a result of their raised pressure, the individual bleeds from the nose.
8. LIGHT-HEADED: A hypertensive also may feel lightness of the head.
9. SHORTNESS OF BREATH: The individual with hypertension may also experience some difficulty with breathing. The person feels as if his/her breathing is going to cease.
10. CHEST PAIN: Chest pain especially on the left chest wall or around the shoulder or neck may be present. The pain is usually provoked by physical exertion as the heart muscles are deprived of sufficient blood and oxygen supply.
11. FAINTING: The individual may also experience a fainting attack. In some cases there is a feeling of rotation of objects in the surrounding environment or within oneself.
12. CHANGES IN VISION: Hypertension is also accompanied by changes in vision. This includes poor vision, cloudy vision, or blindness. This occurs as a result of changes in the capillary blood vessels in the eyes.
NOTE: All these signs do not occur in just one person. However, one person may have several of these signs if adequate measure is not taken on time to detect and treat the condition.

10 sure ways to prevent hypertension

Hypertension is a condition nobody desires to have because of the attendant complications or problems that come with it. Hypertension is really dangerous and could shorten one's life span by as much as 20 years if nothing concrete is done to control it.
There are a lot of things you can really do to help prevent this condition from developing in your life, or prevent the complications if you already have it. Certain factors known as 'Triggering factors' like the trigger of a pistol help to launch the condition if the predisposing factors (especially heredity) are already there in you. Here are some steps you can take to avoid developing hypertension:
1. REDUCE SALT INTAKE: Your dietary salt (sodium chloride) intake should be reduced to about 4grams per day. You must avoid the temptation to add more salt to your food or soup after it is prepared because salt retains fluid in your system and therefore would elevate your blood pressure.
2. AVOID STIMULANTS: Foods which stimulate the system should be avoided. Some of them include coffee, tea, alcohol, kola nuts and some drugs with caffeine. They increase heart rate and discharge adrenaline thereby raising further the blood pressure.
3. HAVE ENOUGH REST: You should have adequate rest; this includes both physical and mental rest. Avoid excess workload or watching movies late into the night. You should have time to sleep in the night and also take naps during the day. Excessive physical exertion should be avoided.
4. REDUCE WEIGHT: If you are obese or you are gaining more weight than is necessary you should try and reduce your weight because obesity increases the body surface area and increases the oxygen demand on the heart thereby making the heart work harder than necessary.
5. MEDICAL CHECK-UP: Always visit the clinic at least once in three months to have your blood pressure checked. But if you are hypertensive already you should check your blood pressure at least once every two weeks. Regular medical examination should be conducted to detect complications.
6. AVOID SATURATED FATS: Saturated fats are those fats or oils that become congealed at room temperature. They contain cholesterol which can become deposited on the walls of your arteries thereby elevating your blood pressure.
7. AVOID CONSTIPATION: Frequent constipation should be avoided by taking enough water and by adding fibres to your food because straining on defecation increases your blood pressure. You can also reduce constipation and hypertension by eating more fruits and vegetables.
8. REGULAR EXERCISES: You should exercise regularly for at least 30 minutes per day and several times a week. This improves blood circulation and proper functioning of the heart and blood vessels. The exercise should however be done moderately each time.
9. TREAT ILLNESSES: Diseases of the kidney and other organs should be treated promptly by visiting the hospital or clinic. Early treatment helps to prevent complications that would lead to hypertension in the long run.
10. FIND OUT THE CAUSE: If your blood pressure begins to rise rapidly in a short time find out the cause. If it is caused by oral contraceptive drugs, alcohol, stress, etc. they should be eliminated to prevent further worsening the condition.