HYPERTENSION – ITS MANAGEMENT AND COMPLICATION IN HYPERTENSIVE PATIENTS, RISK FACTORS AND COMPLICATIONS
[i]Hypertension or high blood pressure is a chronic cardiac medical condition in which the systemic arterial blood pressure is elevated. There are two classifications of hypertension: the primary or essential hypertension and the secondary hypertension. Primary hypertensions are those hypertensions with no medical causes while secondary hypertensions are caused by medical conditions of either the kidney, arteries, heart, and/or the endocrine system. Although some hypertensive patients are asymptomatic, some patients experience symptoms as severe headaches, vision disorders, fatigue, irregular heartbeat, drowsiness, nosebleed, chest pain, shortness of breath, excessive sweating, nausea and vomiting, and confusion.
Sedentary lifestyle, alcohol intake, obesity, deficiency in potassium and vitamin D, stress or anxiety, unhealthy eating habits, family history, and smoking and excessive alcohol intake are some other causes of hypertensions.
Complications due to hypertension are brain damage, congestive heart failure, stroke, vision loss or disorders, pregnancy complications, blood vessel damages, arteriosclerosis, heart attack, kidney disease, insulin resistance, and artery diseases. Silent stroke is usually caused by untreated hypertension and does not have any symptoms. Since this is asymptomatic, the patient is not aware that he has suffered a stroke and therefore does not get medical attention. However, it can still cause damages to the brain and since this is not treated, makes the patient vulnerable to a major stroke. Risk also increases with aging as blood vessels get more rigid and stiff as one ages. During pregnancy, systemic vascular resistance and blood pressure decrease. To compensate, the body increases blood volume for sufficient circulation in the utero-placental arterial bed. An exercising individual having an excessively higher elevation than 200 – 230 mmHg is considered at a high risk of developing high blood pressure at rest. Stroke, arterial aneurysm, myocardial infarction, and heart failure are mostly due to persistent hypertension.
Diagnosing hypertension is based on high blood pressure measurement, usually on a three-week monitoring period using a sphygmomanometer measuring device. Readings of blood pressure are in millimeters of mercury (mmHg) and given in two numbers which dictate whether blood pressure reading is low, high or normal. [ii]Systolic blood pressure is the blood pressure in vessels during a heartbeat while diastolic pressure is the pressure between heartbeats. Laboratory tests as blood tests, echocardiograms, electrocardiograms, urinalysis, and/or kidney ultrasounds can sometimes be performed to source out possible medical causes. Likewise, these tests can also determine if hypertension has caused some damage to body organs.
Non-medical prevention consists of weight reduction through regular exercise of at least 30 minutes a day which improves blood flow and reduces blood pressure and heart rate; reducing salt and sugar intake while increasing intake of omega-3 fatty acids that helps excrete water and sodium from the body; abstaining from cigarette smoking; limiting alcohol intake to less than 2 drinks a day; reducing stress including those that are due to high-sound levels and over-illumination; and staying at a healthy body weight. DASH (Dietary Approaches to Stop Hypertension) is a diet strongly recommended for hypertensive patients. It is a diet rich in nuts, fruits, vegetables and low-fat dairy products while reducing total and saturated fat intake. It is also a diet rich in magnesium, calcium, and protein.
Medical prevention includes antihypertensive drugs as alpha blockers, beta blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, diuretics, rennin inhibitors, and vasodilators. The patient’s cardiovascular risks as well as blood pressure readings should be taken into account for an accurate profile.
Blood pressure reduction of even 5 mmHg can lower the risk of stroke, ischemic heart disease, and can even reduce heart failure, and cardiovascular mortality. For most individuals, blood pressure should be reduced to a blood pressure reading of less than 140/90 mmHg. But for those patients with other chronic diseases as kidney and diabetes, blood pressure reading should be lower than individuals with no existing medical condition.