Blog
High Blood Pressure
25/06/2011 23:53High Blood Pressure
Introduction
Hypertension (high blood pressure) is the most
common reason that patients see their doctors.
This article will provide information about what
high blood pressure is and how it can be
treated. Importantly, it will tell you what you
can do to make your treatment successful.
Hypertension is just the medical term for high
blood pressure. Hypertension does NOT suggest
too much tension or nervousness. Throughout
this article we will use the words hypertension
and high blood pressure interchangeably.
What is Blood Pressure?
What is it?
Blood pressure is the force exerted by the blood
against the walls of arteries. We need some
pressure in our blood vessels to get blood to our
organs and muscles. Normally, each time our
heart beats (about 60-80 times a minute at rest),
it pushes blood out into the larger arteries,
which are the tubes that carry blood from the
heart. The blood then flows into smaller arteries
to various parts of the body, such as the kidney
or the brain, and then returns to the heart
through the veins. The smaller arteries, called
arterioles, can open wide or close.
The beating action of the heart may be
compared to a pump. The arteries may be
compared to the tubing of a hose. The arterioles
are like a nozzle. If the nozzle is kept open,
water will flow freely through the hose, and
little pressure is built up on the walls of the
hose. If, however, the nozzle is clamped down,
pressure is built up on the sides of the hose and
the pump must work harder. In the same way, if
the small blood vessels remain open as the heart
beats, blood pressure in the arteries remains
fairly low or normal. If they narrow, higher
blood pressure results.
Blood pressure can vary widely. It can rise
when you are excited or nervous or while you
exercise. The blood pressure is high during the
day and decreases during sleep. Blood pressure
may vary within the course of a day by as much
as 20-30 points in someone with “normal” blood
pressure and even more in someone with
untreated hypertension. Therefore, a single
reading should not be used to make a diagnosis
of high blood pressure.
What is Measured?
Blood pressure is recorded in two numbers as
millimeters of mercury (mm Hg). For example,
120 mm Hg systolic (pumping pressure) and 80
mm Hg diastolic (resting pressure). The
measurement above would be spoken of as “120
over 80,” with the systolic (higher) number
always given first, followed by the diastolic
number.
What Is Normal Blood Pressure?
The normal blood pressure may be as low as
70/50 mm Hg in infants, or as high as 135/85
mm Hg in adults. “Normal” blood pressure for
people under 18 is below 120/80 mm Hg. Over
the age of 18, a reading up to 130-135/80-85 mm
Hg is considered within the normal range. A
diastolic reading between 85-90 mm Hg is
considered “high-normal.” A systolic upper
number) reading of 135-139 mm Hg is also
considered “high-normal.” If an adult's blood
pressure is consistently 140/90 mm Hg or higher, he
or she has high blood pressure or hypertension. The
higher the pressure, the greater the risk.
What About Low Blood Pressure?
People used to believe that low blood pressure
(e.g., about 110/70 mm Hg or below, in an adult)
was dangerous. Except in rare cases, this is not
true. In some cases, people with low blood
pressure may tire easily or faint when standing
in a hot room, but in most cases they have no
symptoms.
Myths and Facts about High
Blood Pressure
MYTH: Hypertension means that a person is
tense or anxious. FALSE
FACT: Hypertension means high blood pressure.
You do not have to be nervous, tense, or jumpy
to develop high blood pressure. Many calm
people suffer from hypertension. Stressful
situations may temporarily elevate blood
pressure but this is not always the case.
MYTH: Loss of excess weight is by itself
enough to cure blood pressure. FALSE
FACT: Obesity (being fat) is associated with
hypertension. More overweight people have
high blood pressure than thinner people. Losing
weight, however, does not guarantee that blood
pressure will return to normal levels, but it will
decrease to some degree. Too often an
overweight person with hypertension is told to
lose weight as his only treatment. Thin people
also can have high blood pressure.
MYTH: Hypertension is a disease of old age.
FALSE
FACT: Most people develop high blood pressure
between 35-50 years of age. Some serious cases
may actually begin at younger ages.
MYTH: Once you have high blood pressure,
and it affects your brain or heart, there is
nothing you can do about it. FALSE
FACT: Just the opposite. Lowering your blood
pressure by proper treatment will often prevent
further brain and heart problems. As blood
pressure is lowered, an enlarged heart becomes
smaller, and therefore, healthier.
MYTH: Hypertension significantly restricts a
person's life. DEFINITELY FALSE
FACT: A person with high blood pressure
should and can lead a normal life, if they are
treated.
MYTH: Medicines that lower blood make
people cause sexual problems. FALSE
FACT: Fewer than 10% of people experience
annoying side effects, which may include sexual
problems. Changing medication or doses of
medication can minimize these effects.
MYTH: Herbal substances and plants, such as
garlic, are effective in lowering blood
pressure. FALSE
FACT: Careful studies have not proven this.
What Causes Hypertension?
In more than 90% of cases we do not know what
causes hypertension! However, there are some
theories. For some reason, in certain people the
small blood vessels at the end of the arteries
seem to contract more forcefully than in other
people. This causes an increase in pressure
within the arteries. This may be due to an
increase in certain nerve impulses with release
of too many blood vessel constricting
substances. In some other people, the kidneys
are unable to wash out enough salt (sodium). As
sodium and fluid build up in the body, the heart
must pump an increasing amount of blood with
each beat. This also increases the blood
pressure. It is not known why these things begin
to happen. Hypertension can be treated even if
it is not known what causes it.
Does Heredity Affect Blood
Pressure?
Children with one parent with high blood
pressure have a greater chance of developing
the disease than those with no high blood
pressure in the family. When both parents have
high blood pressure, the odds are greater still.
This does not mean, however, that all children of
parents with high blood pressure will develop it.
Dietary Factors That May Affect
Blood Pressure
Salt. Eating extra amounts of salt may cause
trouble in some people. There are people who
are 'Salt Sensitive' and others who can eat lots of
salt and not notice a change in blood pressure.
In some people with a family history of
hypertension, a high salt diet starting at infancy
may increase the risk of developing high blood
pressure at a later age. Infants and young
children from these families should be
encouraged to go on a low salt diet at as early
an age as possible.
Fatty foods-Cholesterol. Animal fats tend to
raise our blood cholesterol levels. (An elevated
cholesterol level is, in addition to high blood
pressure, is a major risk factor for heart disease.)
People with hypertension should be careful to
keep their cholesterol levels under control.
What are the Effects of High
Blood Pressure?
Enlarged heart
The heart muscle enlarges if it has to work
harder to push blood out into the body. As the
heart muscle stretches too much or gets too
thick, the heart is no longer able to function
properly. Blood is not pumped forward into the
rest of the body. Some of it backs up in the
lungs. The heart fails.
When the blood pressure is lowered, the heart
does not have to pump as hard each time it
beats. After blood pressure has returned to
normal for a year or two, there is a good chance
that the heart muscle will return toward its
normal size. Heart failure is rare in people whose
blood pressure has been controlled.
Stroke
As blood pressure increases, damage occurs to
the lining of the blood vessels in the brain
forming little blisters called aneurysms. These
aneurysms may rupture suddenly. This causes a
“stroke,” with bleeding i nto the brain and
weakness on one side of the body or a loss of
speech.
Failure of the kidneys to function properly
In the kidney, continued high blood pressure
may cause narrowing and thickening of the
arteries. This reduces the amount of fluid that
the kidney can filter out into the urine building
up waste products in the body. The result can
be kidney failure with 'uremia'. Some uremic
patients may need regular dialysis or undergo
kidney transplants. Many patients on dialysis
programs start out with “sli ghtly elevated blood
pressure” which was not treated effectively.
Early treatment of hypertension will often delay
further damage to the kidney.
Atherosclerosis (Hardening of the arteries)
If blood pressure is not controlled, some of the
fat that normally circulates in our body is
pushed more rapidly into the walls of the
damaged arteries. Plaques (collections of fatty
material) build up in the arteries, like rust on the
inside of a pipe. This condition is called
atherosclerosis or “hardening of the arterie s.”
The higher the blood pressure and the more the
fat (cholesterol) in the bloodstream, the faster
the process. People with untreated high blood
pressure get atherosclerosis at an earlier age.
Heart attack
If the arteries that supply blood to the heart
itself, the “coronary arteries,” become clogged
with fatty material, the blood flow to portions of
heart is reduced. When a vessel is completely
closed, there is a stoppage of blood to that part
of the heart. Portions of that heart muscle are
damaged and a “ heart attack” occurs.
What You Can Do to Reduce the
Complications?
Lose weight
Lose weight if you are overweight. Even small
amounts of weight loss may lower blood
pressure in some people. Losing weight is
probably the single most important non-drug
treatment for high blood pressure.
Watch your salt and fat intake.
Reduce your intake of salty foods and high
cholesterol, high fat foods. Eat balanced meals,
with fruits, vegetables, grains. Weight reduction
and salt restriction may eliminate the need for
specific medication in about 20%-25% of
individuals with less severe degrees of
hypertension, especially in the elderly.
Stop Smoking
Smoking injures blood vessel walls and speeds
up hardening of the arteries. Smoking is a major
risk factor for a heart attack. The smoke itself
causes much damage to blood vessels.
The risk of a heart attack in a person who once
smoked but who has stopped is almost the same
as it is for a person who has never smoked.
Exercise Is Good For You
Go ahead! Do whatever you like to do, but do it
at least 3 or 4 times a week for at least 30-40
minutes, if possible.
Exercise alone may help lower blood pressure in
some people with hypertension. Dynamic or
motion exercises are much better for you than
exercises such as weight lifting. These may help
you develop bigger muscles, but they may not
help you live longer.
Lessening Of Tension
Do things that relax you (other than taking a
tranquilizer). Read. Take up a hobby. Take long
walks. Such activities help to decrease the levels
of adrenaline in the blood and allow the blood
vessels to open up lowering the blood pressure
temporarily. But do not depend solely on relaxation
techniques or vacations to lower your blood pressure.
Drinking and High Blood Pressure
Limit daily alcohol intake to one drink of 80
proof liquor, or 1-2 glasses of beer or 2 glasses of
wine a day. Because women are smaller than
men, one half of the above amount is
appropriate for women. Pregnant women
should not drink alcohol.
All of the above strategies good for you. But,
except in some less severe cases, these may not
by themselves lower blood pressure over time.
In most cases, you must use medications and
usually continue to take them indefinitely.
Facts to Remember
1. High blood pressure may not cause
symptoms. Usually the only way to find out is
to have your blood pressure measured.
2. Tests to evaluate elevated blood pressure are
simple, and hospitalization is rarely necessary.
When blood pressure is under control, doctor
visits need not be frequent (twice a month).
3. The outlook for people with high blood
pressure is excellent. They can look forward to a
long life, free of many of the fears that used to
accompany this diagnosis, as long as they
continue treatment.
4. Being heavy or obese may go along with
having high blood pressure, but losing weight
alone may not control blood pressure in many
people. Losing weight if you are heavy is a good
idea for many other reasons, even if it does not
completely control your blood pressure.
5. You should stop smoking to prevent heart
disease. But stopping smoking by itself will not
lower blood pressure.
6. If you are very anxious, relaxing may help to
lower blood pressure in some less severe cases,
but these treatments will not work in the
majority of patients.
7. A low salt diet may help to lower blood
pressure in some people with less severe
hypertension. A modified low salt and high
potassium diet, however, should be followed in
all cases.
8. Although side effects or annoying symptoms
may occur with some blood pressure lowering
drugs, these usually can be eliminated by
changing doses or switching to another drug.
9. Above all, remember that being on treatment
does not mean that your blood pressure is
controlled. Normal blood pressure cannot be
achieved in everyone, but about 80%-85% of
people with high blood pressure can be
successfully treated regardless of the severity of
their disease.
Heart Disease
19/06/2011 15:46
Heart disease is the nation's number one cause
of death among older adults. The disease takes
many forms in its effect on the human body,
such as heart attack, heart failure and sudden
death. Although the risk of dying from many of
these conditions has been reduced, it is
necessary for older adults to be aware of the
heart disease and its warning signs.
As I get older, what is my risk of heart
disease?
On average, men age 65 and over have a 25%
chance of developing heart disease over ten
years. However, if no additional risk factors are
present, such as diabetes, high blood pressure,
high cholesterol, or smoking (or if these
conditions are controlled by medications), the
chance of developing heart disease is 11% over
ten years. Women of the same age, on average,
have a 13% chance of developing heart disease
over ten years. The risk is only 8% over ten
years if no other risk factors are present.
What is cholesterol? Should I be
concerned if my cholesterol level is
high?
Cholesterol is a soft, waxy substance found
among the fats in the bloodstream and in all
your body's cells. Cholesterol is produced by
the body, but also comes to us from animal
products we eat, such as meats, fish, eggs,
butter, cheese and whole milk. Low-density
lipoprotien, or LDL, is known as the "bad"
cholesterol. Too much LDL cholesterol can clog
the arteries to your heart and increase your risk
of heart attack. High -density lipoprotein, or
HDL, is known as the "good" cholesterol. There
is strong evidence that we should reduce our
LDL cholesterol when it is abnormally high.
What is coronary artery disease?
Coronary artery disease is the hardening of the
vessels that supply blood to the muscles of the
heart. The hardening is the most often caused
by a buildup of plague (deposits of the fat-like
substances) in the arteries. This condition
reduces the blood supply to the heart and cause
a heart attack. When permanent damage occurs
to the heart muscle it is called a myocardial
infarction (MI).
Are any groups of people more likely
to develop coronary artery disease?
Yes. There are certain risk factors for the
development of atherosclerotic coronary artery
disease. However, since the peak occurence of
the coronary artery disease in the 1960s, deaths
due to ischemic heart disease have been
decreasing. This decrease has occurred most
likely because of the identification and
reduction of the specific risk factors. The risk
factors for the development of atherosclerotic
coronary artery disease include:
· Family history
· Male sex
· High level of lipids(fats) in blood
· Diabetes mellitus
· Hypertension
· No physical activity
· Cigarette smoking
· Personality type or behavior pattern
· Ending of Menstrual cycle
· Pills preventing pregnancy
· Obesity
· Excessive alcohol intake
What are the symptoms of a heart
attack?
Common warning signs of a heart attack
include:
· An uncomfortable pressure, fullness.
squeezing or pain in the center of the chest
that lasts for more than a few minutes, or
goes away and comes back;
· Pain that spreads to the shoulders, neck or
arms
· Chest discomfort with light head ness,
fainting, sweating, nausea or shortness of
breath.
Less common warning signs of heart attack
include: back or shoulder pain; stomach or
abdominal pain; nausea or dizziness(without
chest pain); shortness of breath and difficulty
breathing(without chest pain); unexplained
anxiety, weakness or fatigue; and palpitations,
cold sweat or paleness. Chest pain associated
with the heart is often called angina or angina
pectoris.
What are the risk factors for coronary
artery disease?
Risk factors for CAD often include:
· High blood cholesterol
· High blood pressure (hypertension)
· Physical inactivity
· Smoking
· Obesity
How is coronary artery disease
diagnosed?
In addition to a complete medical history and
physical examination, diagnostic procedures
for coronary artery disease may include any, or
a combination of, the following:
· Electrocardiogram (ECG) - a test that
records the electrical activity of the heart,
shows abnormal rhythms (arrhythmias or
dysrhythmias), and detects heart muscle
damage.
· Stress test (usually with ECG; also called
treadmill or exercise ECG)- a test that is
given while a patient walks on a treadmill
to monitor the heart during exercise.
Breathing and blood pressure rates are also
monitored. A stress test may be used to
detect coronary artery disease, and/or to
determine safe levels of exercise following
a heart attack or heart surgery.
· Coronary arteriogram (or angiogram) -
with this procedure, x-rays are taken after a
contrast agent is injected into an artery - to
locate the narrowing, occlusions, and other
abnormalities of specific arteries.
· Nuclear scanning - radioactive material is
injected into a vein and then is observed
using a camera as it is taken up by the
heart muscle. This indicates the healthy
and damaged areas of the heart.
Treatment for Coronary Artery
Disease
Treatment of Coronary Artery Disease is not
simple. A patient's heart and life depend upon
its successful treatment. For some people,
careful lifestyle changes and medications can
control the disease. In more serious cases,
surgery may be required. In any case, the
disease requires lifelong management.
Lifestyle changes
One of the best ways to treat coronary artery
disease is to change one's habit. The most
beneficial changes include the following:
· Diet change: Many foods that taste good
are not necessarily good for healthy bodies,
especially bodies predisposed to
developing atherosclerosis. fats,
particularly saturated fats, cause high
levels of blood cholesterol, a primary
ingredient of the deposits that clog arteries.
· Being overweight also leads to high blood
cholesterol; therefore, losing weight is a
major step to a healthier heart and blood
vessels. Patients should concentrate on
adding fruits and vegetables to their diet.
One or two servings of fish per week are
beneficial.
· Exercise: In the calories in - calories out
equation, exercise helps to take off excess
body weight. More importantly, moderate
amounts of physical exercise help build a
stronger circulatory system and decrease
the risk of death from coronary artery
disease. Patients with advanced forms of
the disease may need to limit their exercise,
and should check with their doctor for
special advice.
· Quit smoking
Medications
Medications can also help prevent the
progression of coronary artery disease. Other
drugs can improve blood flow to the heart if
the disease is already present. Some of the
more common medications include:
· Cholesterol lowering drugs: By decreasing
the amount of cholesterol, especially LDL
(the "bad" form of cholesterol), these drugs
decrease the primary material that make
up deposits that narrow or plug coronary
arteries. Examples of the these drugs are
niacin, statins, fibrates, and bile acid
sequestrants. And now a novel drugezetimibe
which you have been prescribed.
Some foods and butter are now available
with special cholesterol-lowering
ingredients.
· Aspirin: This common medication, and
other blood thinners, can reduce the
tendency of blood to clot, and the
likelihood of a blocked coronary artery and
heart attack. Other antiplatelet agents or
antioagulants may be prescribed as well.
· Beta-blockers: These drugs help to slow
heart rates and decrease blood pressure,
which lowers the heart's demand for
oxygen.
· Nitroglycerin: This medication, as a tablet,
spray, or skin patch, controls chest pain
(angina) by opening coronary arteries and
reducing heart's demand for oxygen .
· Calcium channel blockers: These drugs
also help to open coronary arteries to
increase blood flow to the heart muscle.
They also control high blood pressure.
Angiotension-converting enzyme (ACE)
these drugs allow blood to flow from the
heart more easily, decreasing the workload
on the heart.
Procedures involving opening or
cutting of skin
In specific situations, there are other dietary
supplements that may be prescribed such as Larginine
and Omega-3 fatty acids. Coronary
angioplasty - with this procedure, a catheter is
used to create a bigger opening in th vessel to
increase blood flow. Although angioplasty is
performed in other blood vessels. Percutaneous
Transluminal Coronary Angioplasty (PTCA)
refers to angioplasty in the coronary arteries to
permit more blood flow into the heart. There
are several types of PTCA procedures,
including:
· Balloon Angioplasty: a small balloon is
inflated inside the blocked artery to open
the blocked area.
· Atherectomy: the blocked area inside the
artery is "shaved " away by a tiny device on
the end of the catheter.
· Laser angioplasty: a laser used to
"vaporize" the blockage in the artery.
· Coronary Artery Stent: a tiny coil is
expanded inside the blocked artery to open
the blocked area ans is left in place to keep
the artery open.
· Gene therapy: Genes and growth factor
proteins may be injected directly into the
heart or through a catheter-delivery
system. These material may stimulate new
vessels to grow (angiogenesis) to restore
blood flow to the heart.
· Brachytherapy: prevent restenosis,
radiation may be directed to the lining of
the artery to eliminate the regrowth of
deposits that would clog the artery.
· Coronary artery bypass grafting (CABG):
Another way to manage a coronary
blockage is to create an alternative route for
the blood to go around the blockage. This
is the principal of coronary artery bypass
grafting (CABG). In this procedure, a short
piece of blood vessel is taken from some
other location in the body and placed onto
the heart muscle, around the obstructed
artery. Blood flows through the new vessel
to nourish the heart. If more then one
artery is blocked, a bypass can be
performed on each. This type of operation
was first done in 1969; it is now a common
procedure the world-over.
· Laser revascularization: In this new type of
surgery, the surgeon uses a laser beam to
make tiny new channels in the wall of the
heart muscle. New vessels may grow
through these channels and into the heart
to provide additional blood flow paths.
This procedure is considered only for
people in whom standard treatments are
no longer effective
What is heart failure ?
Heart Failure is a condition in which the heart
cannot pump enough blood to meet the body's
needs. This condition occurs when the heart
muscle has been damaged by a past heart
attack or other conditions, such as high blood
pressure or diseased heart valves. People with
heart failure cannot extra themselves because
they become short of breath and tired. Other
common signs of heart failure are swollen leg
or ankles and weight gain due to a buildup of
fluid in the body.
Doctor tells me I have High blood
pressure. What steps can I take to
reduce it ?
To help control mild to moderate high blood
pressure, your doctor may prescribe dietary
and lifestyle change such as : reducing your
salt intake ; eating more fruit, vegetables, and
fat-free and low-fat dairy products; reducing
alcohol consumption; incorporating exercise
into your daily activates; and maintaining a
healthy weight. in some cases, lifestyle changes
are not enough to bring blood pressure down
and your doctor must prescribe medication to
help control your blood pressure.
What dose it mean if I get lightheaded
when I stand up in the morning?
Having low pressure can cause a dizzy feeling
upon rising. As we age, blood vessels becomes
less responsive to change in position and the
body takes longer to adjust to gravity. To help
alleviate this feeling and to avoid a possible
fall, take your time when getting up so that
your system can adjust to an upright position.
Certain medications can also cause a
lightheaded feeling. You should speak with
your doctor to determine the exact cause of
your feeling.
Why does my heart occasional skip a
beat and sometimes beat really fast?
Occasional missed heartbeats are fairly
common, even in young people. When the
heart takes up a persistent irregular rhythm it
may be a sign of atrial fibrillation or another
more serious abnormality. If the rhythm
disturbance is accompanied by symptoms of
weakness, fatigue, dizziness, chest pain or
tightness, fainting or shortness of breath, seek
medical attention immediately.