High Blood Pressure (Hypertension)
High Blood Pressure(Hypertension)
DEFINITION
High blood pressure (hypertension) is an abnormal increase in blood pressure in the arteries.
Often there is no cause of high blood pressure which can be identified, but sometimes occur as a result of underlying renal impairment or hormonal disorders.
Obesity, sedentary lifestyle, stress, smoking, and alcohol or excessive salt in the diet can all play a role of high blood pressure in people who have children with hypertension.
Almost everyone, hypertension has no symptoms.
Physician determines diagnostic for high blood pressure after measuring blood pressure of two or more.
Everyone is advised to lose weight, quit smoking, and reduce the amount of salt and fat in their diet.
After being awarded an antihypertensive drug.
For many people, the word hypertension suggests excessive tension, nervousness, or stress. In medical terms, hypertension refers to high blood pressure, regardless of cause. Because it usually causes no symptoms for years, until a vital organ is damaged, so-called "silent killer." High blood pressure uncontrolled increase the risk of problems such as stroke, aneurysm, heart failure, heart attacks, and kidney damage ..
On examination the blood pressure will get two points. Higher figure obtained when the heart contracts (systolic), a lower number obtained when the heart relaxes (diastolic).Blood pressure is written as systolic pressure diastolic pressure slash, eg 120/80 mmHg, read a hundred and twenty over eighty.It said high blood pressure if the systolic pressure when sitting up to 140 mmHg or more, or diastolic pressure reached 90 mmHg or more, or both.On high blood pressure, usually an increase in systolic and diastolic pressures.
On isolated systolic hypertension, systolic blood pressure reached 140 mmHg or more, but the diastolic pressure of less than 90 mmHg and diastolic pressure was still within normal range. Hypertension is often found in the elderly.With age, almost everyone has increased blood pressure: systolic pressure continues to increase until age 80 years and diastolic pressures continue to increase until age 55-60 years, then decrease slowly or even decreased.
Malignant hypertension is a very severe hypertension, which if untreated, will cause death within 3-6 months.Hypertension is rare, only 1 of every 200 people with hypertension.
Blood pressure in one's life varies naturally. Babies and children normally have a blood pressure that is much lower than the adult.Blood pressure is also influenced by physical activity, which will be higher at the time of activity and lower when resting.Blood pressure in a single day is different; highest in the morning and lowest during nighttime sleep.
Blood Pressure Classification in AdultsCategory Systolic Blood Pressure Diastolic Blood PressureBelow Normal Below 80 mmHg 120 mmHgPre-hypertension 120-139 mmHg 80-89 mmHgStage 1140-159 mmHg 90-99 mmHgStage 2160 mmHg or more100 mmHg or more
Urgent Hypertension
(Without any symptoms of organ damage)above 180 mmHgabove 110 mmHg
Malignant hypertension
(Accompanied by symptoms of organ damage)220 mmHg or 120 mmHg or more
BLOOD PRESSURE CONTROL
Increased blood pressure in the arteries can occur in several ways:
Stronger heart pumps more fluid so that the drain on every second
Large arteries lose elasticity and become rigid, so that they can not inflate when the heart pumps blood through the arteries. Because of that blood on each heartbeat forced through narrow vessels than usual and cause a rise in pressure. This is what happens in the elderly, where the artery wall has been thickened and rigid due to arteriosclerosis.
In the same way, blood pressure also increased in the event of vasoconstriction, ie, if the small arteries (arterioles) to temporarily shrink due to stimulation of nerves or hormones in the blood.
Increased fluid in the circulation can cause increased blood pressure. This occurs if there are abnormalities of renal function and is unable to throw some salt and water from the body. Increased volume of blood in the body, so blood pressure is also increasing.
Conversely, if:
reduced heart pumping activity
widening the artery had
a lot of fluid out of circulation
the blood pressure will decrease.
Adjustment for these factors are implemented by changes in renal function and autonomic nervous system (part of the nervous system which regulates many bodily functions automatically).
Changes in renal function
The kidneys control blood pressure in several ways:
- If blood pressure rises, the kidneys will increase the expenditure of salt and water, which will cause a reduction in blood volume and blood pressures return to normal.
- If the blood pressure drops, the kidneys will reduce the discharge of salt and water, thereby increasing blood volume and blood pressure returned to normal.
- The kidneys can also increase blood pressure by producing an enzyme called renin, which triggers the formation of the hormone angiotensin, which in turn will trigger the release of the hormone aldosterone.
The kidney is an important organ in controlling blood pressure and therefore a variety of diseases and disorders of kidney pda can cause high blood pressure.
For example, narrowing of the arteries leading to one of the kidneys (renal artery stenosis) can lead to hypertension.
Inflammation and injury to one or both kidneys can also cause a rise in blood pressure.
Sympathetic nervous system is part of the autonomic nervous system, which for the time being will be:
- Increased blood pressure during the fight-or-flight response (the body's physical reaction to external threats)
- Increase the speed and strength of heart rate; too narrow majority of the arterioles, but the widening of the arterioles in certain areas (such as skeletal muscle, which require more blood supply)
- Reduce the discharge of water and salt by the kidneys, thereby increasing the volume of blood in the body
- Release the hormone epinephrine (adrenaline) and norepinephrine (noradrenaline), which stimulates the heart and blood vessels.
Blood pressure regulation: Renin Angiotensin Aldosterone System
The renin-angiotensin-aldosterone system is a series of reactions designed to help regulate blood pressure.
When blood pressure falls (for systolic, to 100 mm Hg or lower), the kidneys release the enzyme renin into the blood stream.
Renin split angiotensinogen, a large protein that circulates in the bloodstream, into pieces. One part is angiotensin I.
Angiotensin I, which is relatively inactive, is divided into pieces by angiotensin-converting enzyme (ACE). One part is angiotensin II, a hormone that is very active.
Angiotensin II causes the muscular walls of small arteries (arterioles) to constrict, increasing blood pressure. Angiotensin II also triggers the release of the hormone aldosterone from the adrenal gland and antidiuretic hormone from the pituitary gland.
Aldosterone causes the kidneys to retain expenditure salt (sodium) and potassium. Sodium causes water to be retained, thus increasing blood volume and blood pressure.
CAUSE
In about 90% of patients with hypertension, the cause is unknown and the condition is known as essential hypertension or primary hypertension.Essential hypertension is likely to have many causes, some of the changes on the heart and blood vessels together likely cause increased blood pressure.
If the cause is unknown, it is called secondary hypertension.In about 5-10% of patients with hypertension, the cause was kidney disease.In about 1-2%, the cause is a hormonal disorder or the use of certain medications (eg birth control pills).
Other rare causes of hypertension are pheochromocytoma, the tumors in the adrenal gland that produces hormones epinephrine (adrenaline) or norepinephrine (noradrenaline).
Overweight (obesity), an inactive lifestyle (exercise lazy), stress, alcohol or salt in food, can lead to hypertension in people who have reduced sensitivity.Stress tends to cause rise in blood pressure for a while, if the stress has passed, the blood pressure usually returns to normal.
Some causes of secondary hypertension:
Kidney Disease
- Renal artery stenosis
- Pyelonephritis
- Glomerulonephritis
- Kidney Tumors
- Kidney disease polikista (usually inherited)
- Trauma to the kidneys (the renal lesions)
- Radiation therapy to the kidney
Hormonal abnormalities
- Hyperaldosteronism
- Cushing's syndrome
- Phaeochromocytoma
Drugs
- Birth control pills
- Corticosteroids
- Cyclosporine
- Erythropoietin
- Cocaine
- Abuse of alcohol
- Cinnamon (very large amounts)
Other Causes
- Aortic coarctation
- Preeclampsia in pregnancy
- Acute Intermittent Porphyria
- Acute lead poisoning.
SYMPTOMS
In the majority of patients, hypertension causes no symptoms, although accidentally some symptoms occur simultaneously and reliably associated with high blood pressure (but not really).Symptom in question is a headache, bleeding from the nose, dizziness, flushed face and fatigue, which could have occurred either in patients with hypertension, as well as to a person with normal blood pressure.
If hypertension is severe or chronic and untreated, may develop the following symptoms:- Headache- Fatigue- Nausea- Vomiting- Shortness of breath- Anxiety- Blurred visionwhich occurs because of damage to the brain, eyes, heart and kidneys.
Sometimes patients with severe hypertension decreased consciousness and even coma due to brain swelling.This situation is called hypertensive encephalopathy, which requires immediate treatment.
Hypertension who are not treatedDiagnosis
Blood pressure was measured after a person is sitting or lying down for 5 minutes.Number 140/90 mmHg or more can be defined as hypertension, but diagnosis can not be enforced only by a single measurement.
If the first measurement gives high yields, the blood pressure was measured again and then measured 2 times in the next 2 days to assure the existence of hypertension.The measurement results are not only determine the presence of high blood pressure, tetepi also used to characterize the severity of hypertension.
Once the diagnosis is established, conducted an examination of major organs, especially the blood vessels, heart, brain and kidney.
The retina (the light sensitive membrane at the surface in the back of the eye) is the only body part that could indicate a direct effect of hypertension on arterioles (small blood vessels). Assuming that the changes that occur in the retina similar to the changes that occur in other blood vessels in the body, such as the kidneys.To examine the retina, use an ophthalmoscope. By determining the degree of retinal damage (retinopathy), it can be determined the severity of hypertension.
Changes in the heart, especially the enlargement of the heart, can be found on electrocardiography (ECG) and chest x-rays.In the early stages, these changes can be found through echocardiography examination (examination by ultrasonic waves to describe the state of the heart).
An abnormal heart sound (called a fourth heart sound), can be heard through a stethoscope and a change of heart that results from the initial high blood pressure.
Early indication of kidney damage can be known primarily through the examination of the urine.The presence of blood cells and albumin (a protein) in urine may be an indication of kidney damage.
Tests to determine the cause of hypertension is mainly performed on young patients.These checks can include x-rays and radioisotopes kidney, chest X-rays and blood tests and urine for certain hormones.
To find the presence of renal abnormalities, asked about previous history of renal disease.A stethoscope placed over the belly to hear a bruit (noise that occurs due to blood flow through the arteries to the kidneys, which are narrowed).Performed urine analysis and X-rays or ultrasound of kidney.
If the cause is a pheochromocytoma, then in the urine can be found any material decomposition hormones epinephrine and norepinephrine.Usually, these hormones also cause symptoms of headache, anxiety, palpitations (heart pounding), excessive sweating, tremor (shaking) and pale.
Other causes can be found through a certain routine.For example, measuring blood levels of potassium in the hyperaldosteronism can help find and measure blood pressure in both arms and legs can help find a coarctation of the aorta.TREATMENT
Essential hypertension can not be cured but can be given treatment to prevent complications.
First step usually is to change the pattern of life of patients:
Hypertensive patients who are overweight are encouraged to lose weight to the ideal limit.
Changing diet in diabetes, obesity or high blood cholesterol levels.
Reduce salt consumption to less than 2.3 grams of sodium or 6 grams of sodium chloride per day (along with calcium, magnesium and potassium are sufficient) and reduce alcohol.
Aerobic exercise is not too heavy.
Patients with essential hypertension need not limit their activities during their blood pressure under control.
Quit smoking.
GRANT OF MEDICINES
Thiazide diuretics are usually the first drug given to treat hypertension.
Diuretics help the kidneys get rid of salt and water, which will reduce the volume of fluid throughout the body resulting in lower blood pressure.
Diuretics also cause blood vessel dilation.
Diuretics cause loss of potassium through the urine, so sometimes given extra potassium or potassium styptic.
Diuretics are very effective at:
- Black people
- Elderly
- Obesity
- Patients with heart failure or chronic kidney disease
For example: Hydrochlorothiazide, chlorthalidone, Metolazone, Indapamide, Spironolactone, amiloride, triamterene, Furosemide, Bumetanide, ethacrynic acid
Adrenergic inhibitors are a group of drugs consisting of alpha-blockers, beta-blockers, and alpha-beta-blocker labetalol, which blocks the effects of the sympathetic nervous system.
Sympathetic nervous system is the nervous system which will immediately provide a response to stress, by increasing blood pressure.
The most commonly used are beta-blockers, which effectively granted to:
- Young patients
- Patients who have had heart attack
- Patients with a rapid heartbeat
- Angina pectoris (chest pain)
- Migraine headaches.
Example: Atenolol, Metoprolol, Propranolol, Nebivolol, esmolol, Labetalol, Carvedilol, Bisoprolol
Angiotensin converting enzyme inhibitors (ACE-inhibitor) causes a decrease in blood pressure by expanding the arteries.
This drug is effective given to:
- The white
- A young age
- Patients with heart failure
- Patients with a protein in the urine caused by chronic kidney disease or diabetic kidney disease
- Men who suffer impotence as a side effect of other drugs.
For example: captopril, enalapril, Ramipril, lisinopril, aliskiren, Benazepril, Moexipril, perindopril
Angiotensin-II-blockers cause a decrease in blood pressure by a mechanism similar to the ACE-inhibitor.
For example: Losartan, Valsartan, Olmesartan, Eprosartan, Azilsartan, irbesartan, Candesartan, Telmisartan
Calcium antagonists cause widening of blood vessels by a mechanism that is completely different.
Very effective is given to:
- Black people
- Elderly
- Patients with angina pectoris (chest pain)
- Rapid heartbeat
- Migraine headaches.
For example: Nifedipine, Amlodipine, Clevidipine, felodipine, Diltiazem, Verapamil
Vasodilators directly cause the widening of blood vessels.
Drugs of this class is almost always used as an adjunct to other antihypertensive drugs.
Hypertensive emergencies (eg malignant hypertension) requiring medication that lowers high blood pressure immediately.
Some drugs can lower blood pressure quickly and largely administered intravenously (through veins):
- Diazoxide
- Nitroprusside
- Nitroglycerin
- Labetalol.
Nifedipine is a calcium antagonist with a very fast working and can be given by mouth (swallowed), but these drugs can cause hypotension, so the administration must be closely monitored.
MANAGEMENT OF SECONDARY HYPERTENSION
Treatment depends on the cause of secondary hypertension.Cope with kidney disease sometimes can restore blood pressure to normal or at least lowering blood pressure.
Narrowing of the arteries can be overcome by inserting a hose attached to the ends of the balloon and the balloon develop.Or it could be done surgically to create a shortcut (bypass surgery).
Tumor that causes hypertension (eg phaeochromocytoma) are usually removed surgically.PREVENTION
Lifestyle changes can help control high blood pressure.
Changes in lifestyle
DEFINITION
High blood pressure (hypertension) is an abnormal increase in blood pressure in the arteries.
Often there is no cause of high blood pressure which can be identified, but sometimes occur as a result of underlying renal impairment or hormonal disorders.
Obesity, sedentary lifestyle, stress, smoking, and alcohol or excessive salt in the diet can all play a role of high blood pressure in people who have children with hypertension.
Almost everyone, hypertension has no symptoms.
Physician determines diagnostic for high blood pressure after measuring blood pressure of two or more.
Everyone is advised to lose weight, quit smoking, and reduce the amount of salt and fat in their diet.
After being awarded an antihypertensive drug.
For many people, the word hypertension suggests excessive tension, nervousness, or stress. In medical terms, hypertension refers to high blood pressure, regardless of cause. Because it usually causes no symptoms for years, until a vital organ is damaged, so-called "silent killer." High blood pressure uncontrolled increase the risk of problems such as stroke, aneurysm, heart failure, heart attacks, and kidney damage ..
On examination the blood pressure will get two points. Higher figure obtained when the heart contracts (systolic), a lower number obtained when the heart relaxes (diastolic).Blood pressure is written as systolic pressure diastolic pressure slash, eg 120/80 mmHg, read a hundred and twenty over eighty.It said high blood pressure if the systolic pressure when sitting up to 140 mmHg or more, or diastolic pressure reached 90 mmHg or more, or both.On high blood pressure, usually an increase in systolic and diastolic pressures.
On isolated systolic hypertension, systolic blood pressure reached 140 mmHg or more, but the diastolic pressure of less than 90 mmHg and diastolic pressure was still within normal range. Hypertension is often found in the elderly.With age, almost everyone has increased blood pressure: systolic pressure continues to increase until age 80 years and diastolic pressures continue to increase until age 55-60 years, then decrease slowly or even decreased.
Malignant hypertension is a very severe hypertension, which if untreated, will cause death within 3-6 months.Hypertension is rare, only 1 of every 200 people with hypertension.
Blood pressure in one's life varies naturally. Babies and children normally have a blood pressure that is much lower than the adult.Blood pressure is also influenced by physical activity, which will be higher at the time of activity and lower when resting.Blood pressure in a single day is different; highest in the morning and lowest during nighttime sleep.
Blood Pressure Classification in AdultsCategory Systolic Blood Pressure Diastolic Blood PressureBelow Normal Below 80 mmHg 120 mmHgPre-hypertension 120-139 mmHg 80-89 mmHgStage 1140-159 mmHg 90-99 mmHgStage 2160 mmHg or more100 mmHg or more
Urgent Hypertension
(Without any symptoms of organ damage)above 180 mmHgabove 110 mmHg
Malignant hypertension
(Accompanied by symptoms of organ damage)220 mmHg or 120 mmHg or more
BLOOD PRESSURE CONTROL
Increased blood pressure in the arteries can occur in several ways:
Stronger heart pumps more fluid so that the drain on every second
Large arteries lose elasticity and become rigid, so that they can not inflate when the heart pumps blood through the arteries. Because of that blood on each heartbeat forced through narrow vessels than usual and cause a rise in pressure. This is what happens in the elderly, where the artery wall has been thickened and rigid due to arteriosclerosis.
In the same way, blood pressure also increased in the event of vasoconstriction, ie, if the small arteries (arterioles) to temporarily shrink due to stimulation of nerves or hormones in the blood.
Increased fluid in the circulation can cause increased blood pressure. This occurs if there are abnormalities of renal function and is unable to throw some salt and water from the body. Increased volume of blood in the body, so blood pressure is also increasing.
Conversely, if:
reduced heart pumping activity
widening the artery had
a lot of fluid out of circulation
the blood pressure will decrease.
Adjustment for these factors are implemented by changes in renal function and autonomic nervous system (part of the nervous system which regulates many bodily functions automatically).
Changes in renal function
The kidneys control blood pressure in several ways:
- If blood pressure rises, the kidneys will increase the expenditure of salt and water, which will cause a reduction in blood volume and blood pressures return to normal.
- If the blood pressure drops, the kidneys will reduce the discharge of salt and water, thereby increasing blood volume and blood pressure returned to normal.
- The kidneys can also increase blood pressure by producing an enzyme called renin, which triggers the formation of the hormone angiotensin, which in turn will trigger the release of the hormone aldosterone.
The kidney is an important organ in controlling blood pressure and therefore a variety of diseases and disorders of kidney pda can cause high blood pressure.
For example, narrowing of the arteries leading to one of the kidneys (renal artery stenosis) can lead to hypertension.
Inflammation and injury to one or both kidneys can also cause a rise in blood pressure.
Sympathetic nervous system is part of the autonomic nervous system, which for the time being will be:
- Increased blood pressure during the fight-or-flight response (the body's physical reaction to external threats)
- Increase the speed and strength of heart rate; too narrow majority of the arterioles, but the widening of the arterioles in certain areas (such as skeletal muscle, which require more blood supply)
- Reduce the discharge of water and salt by the kidneys, thereby increasing the volume of blood in the body
- Release the hormone epinephrine (adrenaline) and norepinephrine (noradrenaline), which stimulates the heart and blood vessels.
Blood pressure regulation: Renin Angiotensin Aldosterone System
The renin-angiotensin-aldosterone system is a series of reactions designed to help regulate blood pressure.
When blood pressure falls (for systolic, to 100 mm Hg or lower), the kidneys release the enzyme renin into the blood stream.
Renin split angiotensinogen, a large protein that circulates in the bloodstream, into pieces. One part is angiotensin I.
Angiotensin I, which is relatively inactive, is divided into pieces by angiotensin-converting enzyme (ACE). One part is angiotensin II, a hormone that is very active.
Angiotensin II causes the muscular walls of small arteries (arterioles) to constrict, increasing blood pressure. Angiotensin II also triggers the release of the hormone aldosterone from the adrenal gland and antidiuretic hormone from the pituitary gland.
Aldosterone causes the kidneys to retain expenditure salt (sodium) and potassium. Sodium causes water to be retained, thus increasing blood volume and blood pressure.
CAUSE
In about 90% of patients with hypertension, the cause is unknown and the condition is known as essential hypertension or primary hypertension.Essential hypertension is likely to have many causes, some of the changes on the heart and blood vessels together likely cause increased blood pressure.
If the cause is unknown, it is called secondary hypertension.In about 5-10% of patients with hypertension, the cause was kidney disease.In about 1-2%, the cause is a hormonal disorder or the use of certain medications (eg birth control pills).
Other rare causes of hypertension are pheochromocytoma, the tumors in the adrenal gland that produces hormones epinephrine (adrenaline) or norepinephrine (noradrenaline).
Overweight (obesity), an inactive lifestyle (exercise lazy), stress, alcohol or salt in food, can lead to hypertension in people who have reduced sensitivity.Stress tends to cause rise in blood pressure for a while, if the stress has passed, the blood pressure usually returns to normal.
Some causes of secondary hypertension:
Kidney Disease
- Renal artery stenosis
- Pyelonephritis
- Glomerulonephritis
- Kidney Tumors
- Kidney disease polikista (usually inherited)
- Trauma to the kidneys (the renal lesions)
- Radiation therapy to the kidney
Hormonal abnormalities
- Hyperaldosteronism
- Cushing's syndrome
- Phaeochromocytoma
Drugs
- Birth control pills
- Corticosteroids
- Cyclosporine
- Erythropoietin
- Cocaine
- Abuse of alcohol
- Cinnamon (very large amounts)
Other Causes
- Aortic coarctation
- Preeclampsia in pregnancy
- Acute Intermittent Porphyria
- Acute lead poisoning.
SYMPTOMS
In the majority of patients, hypertension causes no symptoms, although accidentally some symptoms occur simultaneously and reliably associated with high blood pressure (but not really).Symptom in question is a headache, bleeding from the nose, dizziness, flushed face and fatigue, which could have occurred either in patients with hypertension, as well as to a person with normal blood pressure.
If hypertension is severe or chronic and untreated, may develop the following symptoms:- Headache- Fatigue- Nausea- Vomiting- Shortness of breath- Anxiety- Blurred visionwhich occurs because of damage to the brain, eyes, heart and kidneys.
Sometimes patients with severe hypertension decreased consciousness and even coma due to brain swelling.This situation is called hypertensive encephalopathy, which requires immediate treatment.
Hypertension who are not treatedDiagnosis
Blood pressure was measured after a person is sitting or lying down for 5 minutes.Number 140/90 mmHg or more can be defined as hypertension, but diagnosis can not be enforced only by a single measurement.
If the first measurement gives high yields, the blood pressure was measured again and then measured 2 times in the next 2 days to assure the existence of hypertension.The measurement results are not only determine the presence of high blood pressure, tetepi also used to characterize the severity of hypertension.
Once the diagnosis is established, conducted an examination of major organs, especially the blood vessels, heart, brain and kidney.
The retina (the light sensitive membrane at the surface in the back of the eye) is the only body part that could indicate a direct effect of hypertension on arterioles (small blood vessels). Assuming that the changes that occur in the retina similar to the changes that occur in other blood vessels in the body, such as the kidneys.To examine the retina, use an ophthalmoscope. By determining the degree of retinal damage (retinopathy), it can be determined the severity of hypertension.
Changes in the heart, especially the enlargement of the heart, can be found on electrocardiography (ECG) and chest x-rays.In the early stages, these changes can be found through echocardiography examination (examination by ultrasonic waves to describe the state of the heart).
An abnormal heart sound (called a fourth heart sound), can be heard through a stethoscope and a change of heart that results from the initial high blood pressure.
Early indication of kidney damage can be known primarily through the examination of the urine.The presence of blood cells and albumin (a protein) in urine may be an indication of kidney damage.
Tests to determine the cause of hypertension is mainly performed on young patients.These checks can include x-rays and radioisotopes kidney, chest X-rays and blood tests and urine for certain hormones.
To find the presence of renal abnormalities, asked about previous history of renal disease.A stethoscope placed over the belly to hear a bruit (noise that occurs due to blood flow through the arteries to the kidneys, which are narrowed).Performed urine analysis and X-rays or ultrasound of kidney.
If the cause is a pheochromocytoma, then in the urine can be found any material decomposition hormones epinephrine and norepinephrine.Usually, these hormones also cause symptoms of headache, anxiety, palpitations (heart pounding), excessive sweating, tremor (shaking) and pale.
Other causes can be found through a certain routine.For example, measuring blood levels of potassium in the hyperaldosteronism can help find and measure blood pressure in both arms and legs can help find a coarctation of the aorta.TREATMENT
Essential hypertension can not be cured but can be given treatment to prevent complications.
First step usually is to change the pattern of life of patients:
Hypertensive patients who are overweight are encouraged to lose weight to the ideal limit.
Changing diet in diabetes, obesity or high blood cholesterol levels.
Reduce salt consumption to less than 2.3 grams of sodium or 6 grams of sodium chloride per day (along with calcium, magnesium and potassium are sufficient) and reduce alcohol.
Aerobic exercise is not too heavy.
Patients with essential hypertension need not limit their activities during their blood pressure under control.
Quit smoking.
GRANT OF MEDICINES
Thiazide diuretics are usually the first drug given to treat hypertension.
Diuretics help the kidneys get rid of salt and water, which will reduce the volume of fluid throughout the body resulting in lower blood pressure.
Diuretics also cause blood vessel dilation.
Diuretics cause loss of potassium through the urine, so sometimes given extra potassium or potassium styptic.
Diuretics are very effective at:
- Black people
- Elderly
- Obesity
- Patients with heart failure or chronic kidney disease
For example: Hydrochlorothiazide, chlorthalidone, Metolazone, Indapamide, Spironolactone, amiloride, triamterene, Furosemide, Bumetanide, ethacrynic acid
Adrenergic inhibitors are a group of drugs consisting of alpha-blockers, beta-blockers, and alpha-beta-blocker labetalol, which blocks the effects of the sympathetic nervous system.
Sympathetic nervous system is the nervous system which will immediately provide a response to stress, by increasing blood pressure.
The most commonly used are beta-blockers, which effectively granted to:
- Young patients
- Patients who have had heart attack
- Patients with a rapid heartbeat
- Angina pectoris (chest pain)
- Migraine headaches.
Example: Atenolol, Metoprolol, Propranolol, Nebivolol, esmolol, Labetalol, Carvedilol, Bisoprolol
Angiotensin converting enzyme inhibitors (ACE-inhibitor) causes a decrease in blood pressure by expanding the arteries.
This drug is effective given to:
- The white
- A young age
- Patients with heart failure
- Patients with a protein in the urine caused by chronic kidney disease or diabetic kidney disease
- Men who suffer impotence as a side effect of other drugs.
For example: captopril, enalapril, Ramipril, lisinopril, aliskiren, Benazepril, Moexipril, perindopril
Angiotensin-II-blockers cause a decrease in blood pressure by a mechanism similar to the ACE-inhibitor.
For example: Losartan, Valsartan, Olmesartan, Eprosartan, Azilsartan, irbesartan, Candesartan, Telmisartan
Calcium antagonists cause widening of blood vessels by a mechanism that is completely different.
Very effective is given to:
- Black people
- Elderly
- Patients with angina pectoris (chest pain)
- Rapid heartbeat
- Migraine headaches.
For example: Nifedipine, Amlodipine, Clevidipine, felodipine, Diltiazem, Verapamil
Vasodilators directly cause the widening of blood vessels.
Drugs of this class is almost always used as an adjunct to other antihypertensive drugs.
Hypertensive emergencies (eg malignant hypertension) requiring medication that lowers high blood pressure immediately.
Some drugs can lower blood pressure quickly and largely administered intravenously (through veins):
- Diazoxide
- Nitroprusside
- Nitroglycerin
- Labetalol.
Nifedipine is a calcium antagonist with a very fast working and can be given by mouth (swallowed), but these drugs can cause hypotension, so the administration must be closely monitored.
MANAGEMENT OF SECONDARY HYPERTENSION
Treatment depends on the cause of secondary hypertension.Cope with kidney disease sometimes can restore blood pressure to normal or at least lowering blood pressure.
Narrowing of the arteries can be overcome by inserting a hose attached to the ends of the balloon and the balloon develop.Or it could be done surgically to create a shortcut (bypass surgery).
Tumor that causes hypertension (eg phaeochromocytoma) are usually removed surgically.PREVENTION
Lifestyle changes can help control high blood pressure.
Changes in lifestyle
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