As the heart pumpes the blood through the arteries, the flow force exerts pressure on arterial walls. Over time, high blood pressure causes damage to the arteries. If the force with which the heart pumpes blood through the circulation system is much greater than necessary to maintain a steady flow then you, as doctors say, have a hypertension (high blood pressure). It burdens the entire blood flow system.
Blood pressure is very variable. It differs from man to man, and varies even in various parts of the body; for example, it is higher in the lower extremities than in the upper. Doctors usually measure it on the upper arm, on one of the major arteries. Two types of pressure are measured, systolic (maximal) and diastolic (minimal). Systolic pressure is the pressure at the moment when the heart contracts while pumping out the blood; diastolic pressure is the pressure at the moment when the heart relaxes to allow inflow of the blood.
Therefore, the systolic value, which represents the moment of the highest pressure, is always higher than the diastolic value. When they talk about the patient’s blood pressure, doctors usually say, for example, “120 through 80”. This means that the value of systolic pressure 120, and the value of diastolic is 80. These are roughly normal values for a healthy young adult. Whether a person has a high blood pressure or not depends mainly on the medical judgment of each particular case. The doctor reasonably believes that, for example, an elderly person with 140/90 values has a normal pressure, since the pressure increases with age. But, if you are physically and mentally relatively calm and the value exceeds 150/100, you probably have reasons to be worried. Even when only one of two values is high (especially diastolic value), the doctor will tell you that you have a slightly increased pressure.
There are two types of hypertension – “essential” and “secondary” hypertension. In patients with essential hypertension, there is no clear cause of high blood pressure, while secondary hypertension is the result of some other disease – e.g. kidney disease, hormonal disorders such as Cushing’s syndrome and hyperaldosteronism, or changes in the body due to oral contraceptives or pregnancy. Essential hypertension is more frequent than secondary. It is unclear why is essential hypertension occuring, but it seems that the tendency towards this disorder is inherited. In other words, both legacy and the way of life have effects on blood pressure. Likewise, it seems that young fat people are more likely to suffer from hypertension in their middle years than their thin peers, and there is a hypertension connection with large amounts of salt. It is certainly true that fat people with hypertension can lower the pressure by reducing the amount of salt in food, either by avoiding salty food or just by not adding salt at all. In most cases, blood pressure is rising steadily over years if not treated. However, occasionally, a very high blood pressure develops very quickly. This dangerous condition (which may be essential or secondary) is known as “malignant” hypertension; it is most common among smokers.
Hypertension is almost always a disease without symptoms; a person with hypertension can feel good without having the slightest sign of an internal disease. Symptoms, such as headaches, heartburn, and generally bad feelings, usually occur only when the pressure is already dangerously high. Therefore, it is dangerous to wait for the symptoms to appear, and then treat it. It is more likely that these symptoms will be felt by people with malignant hypertension.
Always be aware of the potential high blood pressure, especially if you are over the age of 40, if there is a person with hypertension in your family history or if you are too fat.
Hypertension is very common, especially in developed countries. It is believed that, for example, in Scotland, 15% of adults have high blood pressure, and one study from the United States states that every tenth American has a hypertension; the frequency grows abruptly with age and it appears to be higher among black people. This study also shows that men are at greater risk of hypertension than women, but in some countries hypertension in women is more common. Approximately 95% of all cases, except those where hypertension is caused due to pregnancy or the use of oral contraceptives, indicates that they had essential hypertension. Malignant hypertension is, fortunately, a rare form of this disease.
If not treated, mild hypertension will somewhat shorten life expectancy, and strong hypertension will shorten it quite a bit. Untreated malignant hypertension is a severe disease and can cause death after 6 to 8 months.
Increased pressure in the blood flow system forces the heart to work harder to keep blood circulation and thus damage the inner lining of the coronary arteries. Over the years, a fatty tissue that is called an atheroma is formed on the damaged site, which may cause narrowing or even a completely closing of the coronary arteries. The consequence of this may be coronary thrombosis. Congestive cardiac decompensation is also a possible consequence; in people with hypertension heart failure occurs six times more often than in people with normal blood pressure.
Additionally, if you have high blood pressure, the chance that you will get a stroke is four times higher than in people with normal pressure. As with coronary circulation, high blood pressure can lead to formation of the atheroma in the artery that supplies the brain with blood. And kidneys can be damaged, especially in some cases of malignant hypertension. Damaged kidneys lead to further increasing of blood pressure, thus creating a vicious circle. Brain, eyes and other organs can be affected if their blood veins are damaged.
Hypertension in pregnancy must always be treated. If not treated, hypertension may reduce the effectiveness of the placenta, and the baby will not get the supplies it needs.
What to do?
Let your doctor measure the pressure once in three to five years. Large stores and department stores today sell sphygmomanometers that you can use to measure your blood pressure. It is important to choose the middle path, that is, between ignoring hypertension and worrying about it. However, if you are taking contraceptive pills or estrogen, control your blood pressure more often.
Even when signs of hypertension have been shown at first examination, the doctor may want to re-measure the pressure before starting treatment. Since effort, excitement or other physical or mental factors can give the pressure values that doctors ”read” as high at a given moment, they will not react abruptly. At a second examination, your doctor will probably pay special attention to your chest and pulse, and may be even check your eyes with an ophthalmoscope for a few minutes, because only the blood vessels on the retina can be seen without complex equipment and their condition provides useful information on the consequences of abnormally high blood pressure.
Further studies depend on the age and type of hypertension, i.e. whether it is essential or secondary hypertension. Tests include an X-ray examination to determine the possible extension of the heart, the ECG, and the blood and urine tests to exclude renal disease. If your doctor needs some more information you will be taking X-rays on the kidneys, and before that you will be given a contrast agent; this is called intravenous pyelography (IVP).
Self-help: the problem of secondary hypertension will be resolved when and if the problem of the primary cause is solved. If the primary cause can not be resolved, the treatment must be the same as treating essential hypertension which may, although incurable, be kept under control.
In many cases, if a person is thoroughly controlling his own weight, food, and lifestyle, there may be a satisfactory reduction in blood pressure without drugs. Particular attention should be paid to the following:
a) Stop smoking or reduce the amount of cigarettes to a minimum. For now, there is no complete confirmation of the association of cigarettes with hypertension, but there is a connection between smoking and coronary sclerosis. Since the likelihood of heart disease increases with cigarettes and high blood pressure, why not cut the risk instead of doubling it?
b) If you are overweight, choose a weight loss diet and follow it until you lose weight until that weight is ideal for your age, sex, and height, and then maintain that weight. There is no solid evidence that hypertension can only be controlled by lowering body weight, but we certainly know that among people with hypertension there are less slim than fat people and that slim people are less affected by some of the severe diseases associated with hypertension. There are, therefore, convincing reasons to lose weight to normal weight.
c) Reduce the ammount of salt intake. That means, do not put too much salt on your food and avoid food that has too much salt in it (pickled vegetables, for example).
d) Do not exaggerate either in work or in recreation. Avoid hard physical activity and avoid crisis situations.
e) Drink alcohol moderately. Optimists argue that small amounts of alcoholic beverages lower the pressure. There is no solid evidence that so, but a small amounts of alcohol will not harm you.
Professional help: if those self-help measures can not help you, you will need medication therapy. Hypertension drugs must always be administered under the supervision of a physician. However, you should continue with self-help measures because all of these medications cause side effects; the smaller the dose of the drug, the better.
Since essential hypertension usually occurs without symptoms, you may be complaining to a doctor if you are told that you must take the medication even if you do not feel ill. You’ll still be bothered by the fact that you will probably need to take regular doses of medicine forever, and you know that high blood pressure can not be cured. This means you are exposed to unwanted side effects, although today there are fewer side effects. Nonetheless, some of these drugs are are affecting on the normal body reaction to sudden changes in body position. For example, if you suddenly stand up from your chair, there may be a small delay in brain circulation to adjust position change. As a result, you may be a temporary feeling that you will faint (this is called postural hypotension or orthostatic hypotension). Other side effects include dry mouth, clogged nose, and headache and drowsiness.
Because of these side effects, your doctor will not give you any medication if he is not convinced that you really need them. Studies indicate that it is best to prescribe lifelong medication proportionally to young people with diastolic blood pressure of 105 or higher. In some cases, however, it is recommended to give medicines if the average diastolic blood pressure is above 90. The physician will determine the treatment based on a number of factors, e.g. age, general health, and gender (women seem to be less prone to complications from hypertension than men). It is important to accept the decision made by the doctor. Most likely, he will prescribe you beta-blocker agents that lower blood pressure by reducing heart beat. These medications should be taken exactly as directed and you should never stop taking them (as your doctor will warn you). They are usually not given to people with asthma, diabetes and to pregnant women. A person who takes beta-blockers may feel the cold on the fingers of hands and feet. They can slow the pulse too much and, if that happens, the doctor will gradually lower the doses and switch to another therapy (where different medications are used).
Beta blockers are often used with diuretics in the treatment of hypertension. Diuretics allow the fluid to flow out of the body, thereby reducing the volume of blood. To reduce the frequent urination at night, it is better to take diuretics in the morning than taking them at night. Some diuretics also excrete potassium that needs to be replaced by potassium tablets. If the beta blocker or beta blocker in combination with diuretics are unsuitable for treating high blood pressure, there are many other medications that also lower blood pressure. In any case, you should consult with your doctor.
Health outcomes in the future depend largely on one’s own measures to alleviate the discomfort: accept healthier nutrition and healthier lifestyle, take the medicines exactly as you’re told, go to checkups whenever your doctor tells you, inform your physician immediately and accurately about any change in condition so that he can adjust the type and dose of medication accordingly.
Careful control of high blood pressure will prevent almost all of the risk of cardiac decompensation and will give you 75% of the chance to avoid stroke. The effect of control on the possibility of occurrence of coronary thrombosis is not so pronounced, probably due to the influence of many other factors; in addition, coronary circulation with high blood pressure is permanent. Nevertheless, the next conclusion is certainly logical: as long as your heart is working normally (when you lower your blood pressure), you are less likely to get a heart attack.