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What is blood pressure ?
Blood pressure is actually the pressure of blood against the walls of your
arteries. This is a result of two forces. One force is that which is created by
the heart. The heart pushes the blood towards the arteries. And the other force
comes from the arteries as they resist the blood flow.
Blood pressure is measured in mm Hg. If your blood pressure is below 120 over 80
mm Hg, then it is in acceptable limits. On the other hand, if your systolic pressure is in the range of 120 and 139 mm
Hg and your diastolic pressure is in the range of 80 and 89 mm Hg, it means, you
are suffering from pre-hypertension. It also means that you need to keep a close
watch on your blood pressure level. But, if your blood pressure reading is equal to or above 140 over 90 mm Hg, then
that means you are suffering from high blood pressure or hypertension. |
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WHAT IS HIGH BLOOD PRESSURE?
High blood pressure, also called hypertension, is, simply, elevated
pressure of the blood in the arteries. Hypertension results from two
major factors, which can be present independently or together.
The heart pumps blood with excessive force.
The body's smaller blood vessels (known as the arterioles) narrow,
so that blood flow exerts more pressure against the vessels' walls. |
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High blood pressure (hypertension) means that the pressure of the blood in your
arteries (blood vessels) is too high. Blood pressure is recorded as two figures.
For example, 150/95 mmHg. This is said as '150 over 95'. Blood pressure is
measured in millimeters of mercury (mmHg).
The top (first) number is the systolic
pressure. This is the pressure in the arteries when the heart contracts.
The systolic pressure (the higher and first number) measures the force
that blood exerts on the artery walls as the heart contracts to pump
out the blood. In the systolic phase the heart contracts, blood
pressure rises and blood moves out along the vessel.
The bottom (second) number is the diastolic
pressure. This is the pressure in
the arteries when the heart rests between each heartbeat.
The
diastolic pressure (the lower and second number) is the measurement of
force as the heart relaxes to allow the blood to flow into the heart.
In the diastolic phase the heart relaxes, blood pressure falls and blood fills the heart.
Health dangers from blood pressure may
vary among different age groups and depending on whether systolic or
diastolic pressure (or both) is elevated. High systolic blood pressure
(the first and higher number) appears to be a significant indicator
for heart complications, including death, in all ages, but especially
in middle-aged and older adults. High diastolic pressure (the second
and lower number) is a strong predictor of heart attack and stroke in
young adults and in people of any age with essential hypertension .
Pulse pressure is the difference between the systolic and the
diastolic readings. It appears to be an
indicator of stiffness and inflammation in the blood-vessel walls. The
greater the difference between systolic and diastolic numbers, the
stiffer and more injured the vessels are thought to be.
Blood pressure is measured in millimeters
of mercury (mm Hg). For example, excellent blood pressure would be
less than 120/80 mm Hg (systolic/diastolic). |
Systolic
pressure is the pressure in the arteries when the heart contracts.
Diastolic
pressure is the pressure in the arteries when the heart rests between each heartbeat. |
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Hypertension Categories:
Blood pressure is now categorized as optimal, normal, high normal, and
hypertensive.
The hypertensive category is further divided, according to severity. Some experts categorize hypertension into the following types:
Primary Hypertension:
Primary hypertension is also known as essential or idiopathic hypertension . About 90% of all high blood
pressure cases are this type. The causes of essential hypertension
are unknown but are certainly based on complex processes in all major organs and systems.
Secondary Hypertension: Secondary hypertension comprises about
5% of high blood pressure cases. In this condition, the cause has been identified.
Isolated Systolic Hypertension: This occurs when systolic
hypertension is over 160 mm Hg but diastolic pressure is normal.
Pregnancy Induced Hypertension: This condition occurs during
pregnancy if blood pressure increases by more than 15 mm Hg above normal.
White Coat Hypertension: This form of hypertension is elevated
blood pressure that occurs only during a visit to the doctor's office.
BLOOD PRESSURE RANGES
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| Blood Pressure Category |
Ranges for Most Adults(systolic/diastolic) |
Actions Taken after Initial Diagnosis |
| 1.Optimal Blood Pressure |
Systolic below 120 mm Hg
Diastolic below 80 mm Hg |
No action |
| 2. Normal Blood Pressure |
Systolic 120 to 130 mm Hg
Diastolic 80 to 85 mm Hg |
Rechecked every two years |
3. High Normal Blood
Pressure |
Systolic 130 to 139 mm Hg
Diastolic 85 to 89 mm Hg |
Blood pressure monitored at home and medical advice. |
4.Hypertension (High Blood
Pressure) |
Systolic above 140 mm Hg
Diastolic above 90 mm Hg |
In middle age and older people,
systolic pressure above 140 mm Hg suggests higher health risks. |
5.Mild Hypertension
(Stage 1) |
Systolic 140 to 159 mm Hg
Diastolic 90 to 99 mm Hg |
If no organ damage, retesting at
least twice a week for several weeks. If organ damage present, start drug therapy. |
6. Moderate Hypertension
(Stage 2) |
Systolic 160 to 179 mm Hg
Diastolic 100 to 109 mm Hg |
Same as stage 1 |
7. Severe Hypertension
(Stage 3) |
Systolic 180 to 209 mm Hg
Diastolic 110 to 119 mm Hg |
Consider immediate drug therapy regardless of organ damage evidence. |
8. Very Severe Hypertension
(Stage 4) |
Systolic greater than 210 mm Hg
Diastolic greater than 120 mm Hg |
Consider immediate drug therapy regardless
of organ damage evidence. |
THE SYMPTOMS OF HIGH BLOOD PRESSURE
Hypertension has aptly been called the "silent
killer" because it usually produces no symptoms. Untreated
hypertension increases slowly over the years. It is important,
therefore, for anyone with risk factors to have their blood pressure
checked regularly and to make appropriate lifestyle changes.
Symptoms of Malignant Hypertension:
In rare cases the blood pressure rises
quickly (with diastolic pressure usually rising to 130 or higher),
resulting in malignant or accelerated hypertension. This is a
life-threatening condition and must be treated immediately. The general
symptoms may occur in high blood pressure as
Drowsiness.
Confusion.
Headache.
Nausea.
Loss of vision.
CAUSES HIGH BLOOD PRESSURE (Risk factors)
1. Genetic Factors.
A number of genetic factors or interactions between genes play a major
role in essential hypertension.
2.Abnormalities in the Angiotensin-Renin-Aldosterone System.
This system influences all aspects of blood pressure control, including
blood vessel contraction, sodium and water balance, and cell development
in the heart. With industrialization, this system wreaks havoc on modern
humans by intensifying the effects of our high-salt diets and sedentary
lifestyle. Of particular importance in these harmful responses are the
hormone aldosterone and a peptide (which are components of proteins)
called angiotensin II.Inherited Abnormalities in the Sympathetic Nervous
System. Hypertension is strongly associated with diabetes, both
type 1 and 2. Kidney damage is generally the cause of high blood
pressure in diabetes type 1. Obesity and insulin resistance are the
factors associated with hypertension in type 2 diabetes, the more common type.
3.Obesity.
About one-third of patients with high blood pressure are overweight. Obesity on its own has a number of possible effects that could lead to
hypertension. It may blunt certain actions of insulin that open blood
vessels, and it may cause structural changes in the kidney and abnormal
handling of sodium. It is also associated with alterations in the
systems that regulate blood flow.
4. Nitric oxide:
The gas nitric oxide can be produced in the body, where it affects the
smooth muscles cells that line blood vessels; it helps keep them
relaxed, flexible. It may also help prevent blood clotting. Low levels
of nitric oxide have been observed in people with high blood pressure
and may be an important factor in essential hypertension.
5.Sleep apnea: It is a disorder in which breathing halts briefly
but repeatedly during sleep, is now highly
associated with hypertension. A weak but still higher than normal
association with high blood pressure has even been observed in those who snore or have mild sleep apnea.
6. Other medical conditions that contribute to temporary
hypertension are pregnancy, cirrhosis, and Cushing's disease. Long-term
use of nonsteroidal anti-inflammatory drugs (NSAIDs) may injure the
kidney and is an important cause of secondary
hypertension in the elderly population. Such drugs include aspirin,
ibuprofen (Advil, Motrin, Rufen), naproxen (Anaprox, Naprosyn, Aleve),
and many others. Of these drugs, aspirin appears to have the least
detrimental effect on blood pressure. Cold medicines containing
pseudoephedrine have also been found to increase blood pressure in
hypertensive people, although they appear to pose no danger for those
with normal blood pressure. Malignant hypertension, an
emergency condition resulting from untreated primary hypertension, can be lethal.
7. Alcohol, Coffee, and Cigarettes:
Alcohol. An estimated 10% of hypertension cases are caused by alcohol abuse
Smoking. Smoking is a major risk factor. One study reported that smokers
have blood pressures up to 10 points higher than nonsmokers. Caffeine.
Caffeine causes a temporary increase in blood pressure, which has been
thought to be harmless in people with normal blood pressure. Studies are
suggesting, however, that regular, heavy coffee drinking (an average of
5 cups per day) can boost blood pressure, and there is growing evidence
that a high intake of coffee may be harmful in people with hypertension
and may even increase their risk for stroke.
8. Mental Stress: Recent evidence confirms the association
between stress and hypertension (high blood pressure). Job stress and
lack of career success have been specifically linked to high blood pressure in both men and women.
Anxiety.
Studies suggest that anxiety is risk factor for hypertension, particularly in women.
Depression.
There is increasing evidence that depression has actual physiological
effects that impair the heart, as well as contributing to destructive
behaviors, such as weight gain, smoking, or alcohol abuse.
9.Stress. Intense workouts (eg,
snow shoveling, jogging, speed walking, tennis, heavy lifting, heavy
gardening). Long-term consumption of large amounts
of licorice. Exposure to even low levels of lead also appears to cause
hypertension in adults. |
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Measuring Blood
Pressure
Monitoring Equipment.
A number of home tests are available for checking blood pressure
between doctor visits.
Cuffs and Stethoscopes. Manual cuffs and stethoscopes are fairly
accurate, but they require practice to use, and the cuff must be the
right size (one size does not fit all). Devices that use a digital
readout and a cuff that can be electronically inflated and deflated are
proving to be as accurate as a stethoscope.
The standard instrument used to measure
blood pressure is called a mercury sphygmomanometer.
(Electronic devices are also available.) An
inflatable cuff with a meter attached is placed around the patient's arm
over the artery, while the patient is seated. The person taking the
blood pressure listens through a stethoscope. If a first blood pressure
reading is above normal, the health professional may take two or more
measurements separated by two minutes with the patient sitting or lying
down, as well as one measurement taken after the patient has been
standing for two minutes. Although this test has
been used for more than 90 years, it is not completely accurate or sensitive. |
Cuffs and Stethoscopes
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Laboratory and Other Tests
Additional laboratory tests may help to
determine whether it is secondary hypertension or essential
hypertension (no other disorder is present) and whether organ damage
is present. If you are diagnosed as having high blood pressure then you are likely to be
examined by your doctor and have some routine tests which include:
A urine test to check if you have protein or blood in your urine.
A blood test to check that your kidneys are working fine, and to check your
cholesterol level and sugar (glucose) level.
A heart tracing (an ECG).
The purpose of the examination and tests is to:
Rule out (or diagnose) a 'secondary' cause of high blood pressure such as kidney disease.
To check to see if the high blood pressure has affected the heart.
To check if you have other 'risk factors' such as a high cholesterol level or diabetes.
HOW SERIOUS IS HIGH BLOOD PRESSURE
Hypertension can cause certain organs (called target organs),
including the kidney, eyes, and heart, to deteriorate over time.
Malignant hypertension, an emergency condition resulting from
untreated primary hypertension, can be lethal. It may cause the following damage :
1 Stroke: About two-thirds of people who
suffer a first stroke have moderate elevated blood pressure (160/95 mm
Hg or above). Hypertensive people have up to ten times the normal risk
of stroke, depending on the severity of the blood pressure.
Hypertension is also an important cause of so-called
silent cerebral infarcts, which are blockages in the blood vessels in
the brain that may predict major stroke or progression to dementia over time.
2. Mental Problems and Dementia: Uncontrolled
chronic high blood pressure is also associated with reduced short-term
memory and mental abilities. Isolated systolic hypertension may pose a
particular risk for complications in the brain.
3.Heart Disease: Among
older patients, high blood pressure is the major risk factor for heart disease.
(i).Heart Attack: About half of
people who suffer their first heart attack have moderate (160/95 mm
Hg) over above hypertension. High blood pressure increases the risk
for a heart attack by up to five times, depending on the severity of the hypertension.
(ii) Heart Failure. Hypertension precedes
congestive heart failure in between 75% and 90% of heart failure
cases. High blood pressure has various effects that cause the heart to
fail, including the following: To compensate for increased blood
pressure, the heart must work harder to pump blood, and so its muscles
thicken (called hypertrophy), usually in the left side (called
left-ventricle dysfunction). These thickened muscles pump
inefficiently, and over time, the force of their contractions weakens.
The heart muscles then have difficulty relaxing and filling the heart with blood.
(iii) The heart begins to fail. The
failing heart then triggers a number of hormonal and petrochemical mechanisms to correct imbalances in blood pressure and flow. This
response, called remodeling, is helpful in the short run but very destructive and irreversible over time.
4. Kidney Disease: High blood pressure makes your heart work harder and, over time, can damage blood vessels throughout your body. If the blood vessels in your kidneys are damaged, they may stop removing wastes and extra fluid from your body. The extra fluid in your blood vessels may then raise blood pressure even more. It's a dangerous cycle.
High blood pressure is one of the leading causes of kidney failure, also commonly called end-stage renal disease (ESRD). People with kidney failure must either receive a kidney transplant or go on
dialysis. Men with high blood pressure may also have a higher risk of kidney cancer.
5. Effect on the Eyes: High blood pressure can injure the eyes,
causing a condition called retinopathy.
6. Bone Loss: Hypertension also increases
the elimination of calcium in urine that may lead to loss of bone
mineral density, a significant risk factor for fractures, particularly
in elderly women. In one study of Englishwomen, those with the highest
blood pressure lost bone density at nearly twice the rate of those in
the lowest range. It is not clear whether this effect occurs in men or in non-Caucasian women.
7. Sexual Dysfunction: Sexual dysfunction
is more common and more severe in men with hypertension, and
particularly in smokers, than it is in the general population. Many of
the drugs used to treat hypertension are thought to cause impotence as
a side effect; in these cases, it is reversible when the drugs are
stopped. More recent evidence is suggesting, however, that the disease
process that causes hypertension itself is the major cause of erective
dysfunction in these men. Newer anti-hypertensive agents, including
angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor
blockers (ARBs), are less associated with erectile dysfunction. In
fact, ARBs, such as losartan (Cozaar), may be particularly effective
in restoring erective function in men with high blood pressure who
suffer from impotence. Sildenafil (Viagra) was reported to be
successful in achieving erections in almost two-thirds of patients
with controlled high blood pressure, but at this time its safety for
men with uncontrolled hypertension in unclear.
8. Pregnancy and Preeclampsia: Severe,
sudden high blood pressure in pregnant women is one component of a
condition called preeclampsia (commonly called toxemia) that can be
very serious for both mother and child. It occurs in up to 10%
of all pregnancies, usually in the third trimester of a first
pregnancy, and resolves immediately after delivery. Other symptoms and
signs of preeclampsia include protein in the urine, severe headaches, and swollen ankles.
Treatment of Blood Pressure
There are two ways in which blood pressure can be lowered.
1. Modifications to lifestyle
2. Medication
1 Modification of lifestyle:
(i) Lose weight if you are overweight.
Losing some excess weight can make a big difference. Blood pressure can fall by
up to 2.5/1.5 mmHg for each excess kilogram which is lost. Losing excess weight
has other health benefits too.
(ii) Exercise regularly If possible, aim to do some exercise on five or more days of the week, for at
least 30 minutes. For example, brisk walking, swimming, cycling, dancing, etc.
Regular exercise can lower blood pressure in addition to giving other health
benefits. If you previously did little exercise, and change to doing regular
exercise five times a week, it can reduce systolic blood pressure by 2-10 mmHg.
(iii) Have a low salt intake. The amount of salt that we eat can have an effect on our blood pressure.
We should have no more than 5-6 grams of salt per day. To reduce salt include:
Use herbs and spices to flavour food rather than salt.
Limit the amount of salt used in cooking, and do not add salt to food at the table.
Choose foods labeled 'no added salt', and avoid processed foods as much as possible.
(iv) Eat a healthy diet, which means at
least five portions, and ideally 7-9 portions, of a variety of fruit and
vegetables per day. Most of meals should be starch-based foods (such as cereals, wholegrain bread, potatoes, rice, pasta), plus fruit and vegetables.
Not much fatty food such as fatty meats, cheeses, full-cream milk, fried food, butter, etc. Use low fat, mono-, or poly-unsaturated spreads.
A healthy diet provides health benefits in different ways. For example, it can
lower cholesterol, help control your weight, and has plenty of vitamins,
fibre, and other nutrients which help to prevent certain diseases. Some aspects of a
healthy diet also directly affect blood pressure. For example, if you have a
poor diet and change to a diet which is low-fat, low-salt, and high in fruit and
vegetables, it can lower systolic blood pressure by up to 11 mmHg.
Choose whole grains over white flour or pasta products.
Choose fresh fruits and vegetables every
day. Many of these foods are rich in fiber, which may help lower blood
pressure. Important foods include most fruits (especially
potassium-rich fruits including bananas, oranges, prunes, and
cantaloupes) and vegetables (especially carrots, spinach, celery,
alfalfa, mushrooms, lima beans, potatoes, avocados, broccoli). Note:
Grapefruit and bitter oranges (also called Seville of sour oranges)
boost the effects of calcium-channel blocking drugs, which are often used for hypertension.
Include nuts, seeds, or legumes (dried beans or peas) daily.
(v) Avoid Caffeine Intake, Alcohol, and Smoking:
Everyone should quit smoking and, if they drink alcohol, should do so
in moderation. In healthy people with normal blood pressure, drinking
a couple of cups of coffee a day is unlikely to do any harm. Caffeine
drinkers, however, might do better to choose tea, which may have
beneficial nutrients, and people with existing hypertension should avoid caffeine altogether.
2. Treatment with medication
There are several medicines that can lower blood pressure. The one chosen
depends on such things as: if you have other medical problems; if you take other
medication; possible side-effects of the medicine; your age; your ethnic origin;
etc. Some medicines work well in some people, and not so well in others. One or
two medicines may be tried before one is found to suit.
One medicine reduces high blood pressure to the target level in less than half
of cases. It is common to need two or more different medicines to reduce high
blood pressure to a target level. In about a third of cases, three medicines or
more are needed to get blood pressure to the target level. In some cases,
despite treatment, the target level is not reached. However, although to reach a
target level is ideal, you will benefit from any reduction in blood pressure.
Medication for High Blood Pressure is advised by your doctor after suitable tests.
The general medication to lower your blood cholesterol level is
a daily low dose of aspirin. This reduces the risk of blood clots forming in the blood vessels (which cause strokes and heart attacks).
In most cases, medication is needed for life. However, in some people whose
blood pressure has been well controlled for three years or more, medication may
be able to be stopped. In particular, in people who have made significant
changes to lifestyle (such as lost a lot of weight, or stopped heavy drinking,
etc). Your doctor can advise. If you stop medication, you should have regular
blood pressure checks. In some cases the blood pressure remains normal. However,
in others it starts to rise again. Medication can then be started again.
Ayurvedic
Cures: Lasuna or
Garlic is an excellent drug. Garlic produces a heating effect on the
body when taken raw. Garlic made into paste and mixed with buttermilk
is very effective in the treatment of blood pressure. To begin with
about one gram of garlic should be admininistered three times a day.
This should gradually be increased to 3 gms. three times a day.
Another method which is popularly followed is to fry the garlic in
ghee. Arjuna bark powder is also helpful with the combination garlic bulb cloves.
Sarpagandha is commonly used in the treatment of
high blood pressure by Ayurvedic physicians. This drug is also used
very widely in the allopathic system. Many alkaloids have been
isolated from this drug and they are formed to be effective in
reducing blood pressure. In Ayurveda the root of this drug is
used in its raw state. The powder of the drug is given to an adult patient
in a dose of half teaspoon three times a day.
Stem of Tinospora cordifolia 5 grame powder twice
a day with Garlic reduces blood cholesterol and risk of stoke. The market preparations is Guduchi churna.
For patient suffering from chronic hypertension, dhara therapy
is considered to be the most effective. Medicated oil boiled with bala
and milk is used in the therapy.
Diet: The patient should not be given hot and spicy food
and should avoid salt. Fatty oil should be strictly avoided. The
patient should take such vegetables as could help him in keeping his
bowels clear. Bitter gourd, drumsticks, patola and bimbi ar most
useful vegetable. |
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New
Research
Grapes may help lower blood pressure: study
Grapes helped lower blood pressure and improve heart function in lab rats fed an otherwise salty diet, U.S. researchers say.
The findings, published in the Journal of Gerontology: Biological Sciences, may help people with high blood pressure, they said.
"These findings support our theory that something within the grapes themselves has a direct impact on cardiovascular risk, beyond the simple blood
pressure- lowering impact that we already know can come from a diet rich in fruits and vegetables," Mitchell Seymour of the
Cardioprotection Research Laboratory at the University of Michigan said in a statement. |
Grapes helped lower blood pressure and improve heart function |
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Migration to cities causes blood
pressure a study
Migration to urban areas is an important contributor to high blood pressure and hypertension, as has been found among people in the Indian capital in a new study conducted by
AIIMS. "Living in urban areas is associated with hypertension and migration to urban areas is in itself a risk factor for developing hypertension," says the study carried out by the Centre for Community Medicine at the premier All India Institute of Medical Sciences
(AIIMS) here. |
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