Hypertension is defined as sustained levels of blood pressure greater than 160/95 mm Hg. The World Health Organization defines normotension as blood pressure less than 140/90 mm Hg, and hypertension as sustained levels greater than 160/95 mm Hg. Life expectancy is reduced noticeably, however, when the blood pressure is over 120/80 mm Hg.
Hypertension is an important problem world-wide, a typically asymptomatic disease that frequently leads to cardiovascular disease and death. Hypertension may affect 15-20% of all adults. The identification of hypertension is not enough; the adequate control of blood pressure is of crucial significance. It has been shown in the USA that in a hypertensive population about 40% of hypertensives remain unidentified as the disease is asymptomatic, 40% are identified but remain untreated or inadequately treated, and only 20% receive adequate treatment.
Causes, Effects, And Implications
Hypertension may be:
- primary (essential), for which no cause can be determined.
- secondary, in which the light blood pressure is secondary to another condition such as
- kidney disease
- endocrine disorder-disease affecting the hormone producing glands
- coarctation (narrowing) of the aorta
- drug induced hypertension:
- the prolonged administration of corticosteroids
- the use of amphetamine or excessive thyroxine
- oral contraceptive agents
Patients with even borderline hypertension are at increased risk of cardiovascular disease. For them the risk of a fatal heart attack is two to three times greater than in normotensive people, the risk of a stroke is three to five times greater, and the risk of congestive heart failure six times greater.
Most hypertensive patients do not require an extensive or costly set of investigative procedures. Only about one hypertensive patient in 20 has secondary hypertension, and sufficient evidence can usually be found during a careful history, physical examination, and minimal laboratory tests to identify the few patients who need further studies. The tests provide baseline values for drug therapy, help determine the risk profiles, and may reveal other diseases or conditions that require management.
The onset of hypertension usually occurs when a person is between 30 to 40 years of age (although it does occur in children also), but because it may be many years before it is discovered significant damage may be caused to organs: weakening of the arteries, accelerating atherogenesis, and damage to the brain, eyes, heart, and kidneys resulting in stroke, paralysis, loss of vision, congestive heart failure, and kidney failure.
Management of Hypertension Role of Diet
In general, the guidelines for adult hypertension are appropriate for your although a longer trial of weight reduction and sodium restriction is recommended before drug treatment is begun.
Every effort should be made to encourage patients to stop smoking or cut down patients who decide to switch to cigars or pipes should be warned to avoid inhaling the smoke out of force of habit. Non-smokers should be advised, not start smoking.
When an obese patient loses weight, a drop in blood pressure often follows weight loss is frequently associated with a decrease in serum glucose, lipid levels of uric acid.
A severe restriction of sodium is not necessary for most patients with hypertension. Avoiding foods to which salt has been added during processing and avoid from adding salt at the table is usually sufficient. Patients should aware that some foods are heavily salted- particularly soups, nuts, pickles, chutneys, potato crisps, soy sauce, and (in some countries) bread.
Other Dietary Measures
Patients with hyperglycemia require dietary restrictions; dietary advice is also recommended for those suffering from hypercholesterolemia.
Regular exercise is recommended unless a patient has an impaired kidney or heart example, diving into water or taking a sauna bath followed by a cold shower because of the sudden rise in blood pressure that may result.
Stress may increase a patient's blood pressure in acute situations. However, it is important for hypertensive patients to realize that hard work is not indicative of future cardiovascular disease.
Various groups of anti-hypertensive drugs are available for the effective control of hypertension, including diuretics, ACE inhibitors, beta-blockers, central inhibitors, peripheral inhibitors, direct vasodilators, and calcium antagonists. Depending on the severity of the hypertension, drugs are prescribed singly or in combination. Effective control can be achieved for most patients if the drug therapy regularly reduces weight to normal and restricts sodium intake.