QUEEN VICTORIA
Age: 124
7819 days old here
Total Posts: 26285
Points: 0
Location:
Lahore, Pakistan
Examination
Examination is usually geared towards confirming the blood pressure on several occasions. The heart and general circulation needs to be examined well and signs of rare conditions will usually be checked for by doctors. This is especially so in cases of very high blood pressure in young patients, who will be more likely to have an underlying cause (secondary hypertension).
Investigations and tests
These are important to check for other risk factors such as diabetes (sugar) and high cholesterol (lipids).
Other blood tests are needed to exclude kidney problems and other hormonal problems mentioned.
Urine tests - testing of the urine is needed to exclude an underlying kidney problem.
An ECG (electrocardiogram) and chest X-ray are often ordered as part of diagnosing an enlarged heart or other underlying heart problems.
An echocardiogram (echo) is a useful test to tell accurately whether the heart muscle is enlarged or thickened (this may indicate a need for specific or more urgent treatment).
Treatment
The aim of treatment is not just to simply lower blood pressure, but to actually substantially reduce the risk of heart attacks and strokes and other circulation problems and make the person live a longer healthier life. If the best results are to be achieved, it is vital that all the vascular risk factors are treated e.g. lowering cholesterol and giving up smoking will add a substantial further benefit to any blood pressure treatment.
In general, lifestyle measures should be tried first before considering medication. For example a young person (say around 40) with mild hypertension (of around 143/92) and no other risk factor would be advised to vigorously try lifestyle changes for possibly up to a year, before considering medication.
If there were other problems such as a previous heart attack, diabetes or very high cholesterol, a move to medication would likely be advised earlier.
Regardless of whether medication is tried either initially or later, lifestyle changes have a great impact and should be continued.
Lifestyle
Stopping smoking. This is probably the most important, as smoking is such a powerful vascular risk factor (for both heart attack and stroke) and greatly increases the risks associated with high blood pressure.
Diet. The key issue is to have a healthy low fat diet which results in a gradual weight loss. The help of a dietitian should not be underestimated to help with a programme and support to achieve this. A very high proportion (over 50 %) of overweight patients may be able to control blood pressure with weight loss alone. As a general rule of thumb, each pound of weight loss can result in a 1mm Hg reduction of blood pressure. This means many overweight people could avoid the need for medication altogether by achieving a modest weight loss of 10-15 pounds.
Achieving as close to possible a normal weight is highly desirable.
Sodium. Very low salt diets are not very well tolerated, but it is wise to have moderate salt restriction. For example do not add a lot of salt and avoid very salty foods. Most dietary sodium comes from meats (including poultry and fish), grains and dairy foods, so being overly restrictive could have adverse effects on overall nutritional needs and is probably not necessary.
Potassium - in practice this means eating plenty of fruit (aim for five pieces per day and vegetables).
Exercise - regular exercise has been shown to lower blood pressure and will also help with weight loss. If you are not used to exercise, it is best to start gradually and increase slowly. Exercise can be gentle and yet still beneficial - aim for the equivalent of 30-45 minutes per day on most or all days of the week.
It is wise to be evaluated carefully if there are risk factors before undertaking any vigorous programme of exercise, particularly if you are over the age of 40. An exercise test may be advised as a precaution in some cases.
Medication
If blood pressure levels remain elevated despite lifestyle changes, medication may be needed and discussed with your doctor. There is pretty unanimous agreement amongst doctors that drugs should be used if blood pressure is severely elevated e.g. 160/100 at age 20, 160/110 at age 50.
In fact there is good evidence that treating even mild hypertension with medication is beneficial e.g.160/95 at age 50 is effective in reducing complications like stroke.
In patients at greater risk because of other risk factors, medication may be started at relatively lower levels e.g. 140/90.
Such patients may include those with diabetes, previous heart attack or stroke, high cholesterol and heart failure: In such patients, the baseline risk of further problems is much higher, so treatment is relatively more beneficial.
It has been shown that it is beneficial to treat isolated systolic hypertension (e.g.165/85), where only the top level is elevated.
Trials have also confirmed that it is beneficial to treat hypertension in older people as well. In fact it may be particularly beneficial as the risk of problems increases with age.
The aim of medication is to reduce blood pressure with minimal side effects and inconvenience. All medications may take a month or two to exert their full effect, so most doctors will "start low" and "go slow" until the desired blood pressure level is reached.
There are a number of suitable and effective medications for safely lowering blood pressure and reducing the risk of complications.
The most studied over many trials include thiazide diuretics and B-blockers, which have been convincingly shown to reduce complications.
Unless there is a reason not to, most doctors will choose one of these when starting therapy.
Other classes of medications which have been shown to safely and effectively lower blood pressure include ACE inhibitors, calcium channel blockers and alpha blockers.
All these medications have pros and cons and need to be chosen for their potential benefits in a given patient.
Often a second or even occasionally a third medication may be required to achieve adequate control.
QUEEN VICTORIA
Age: 124
7819 days old here
Total Posts: 26285
Points: 0
Location:
Lahore, Pakistan
Why is high blood pressure so important?
Although high blood pressure usually causes no symptoms at all, it acts as a major cardiovascular risk factor over time. Having high blood pressure substantially increases the risk of having a stroke or heart attack in the future.
As a high proportion of people will eventually suffer from some form of cardiovascular disease, it is an important public health issue to try and reduce the risk of this.
The actual risk of an actual problem occurring in a younger person is usually small, but if blood pressure remains elevated, it will continue increasing the risk of future events such as heart attacks and strokes.
The risk associated with high blood pressure increases with age and is further increased in the presence of other risk factors such as smoking, high cholesterol and diabetes.
The following specific conditions are specifically related to high blood pressure:
Coronary heart disease
Hypertension is an important risk factor for heart attacks. Having high blood pressure may double the risk of a heart attack. The risk of heart attacks is further increased if other risk factors are present. Treating high blood pressure reduces the risk of heart attacks substantially (approximately 20 %). This risk is further reduced if other risk factors are also treated.
The reasons that treating high blood pressure does not lead to as great a reduction of heart attacks and stroke, are not well understood.
In patients who have already had a heart attack, it is vitally important to gain good control of blood pressure to try and help reduce the risk of further problems.
Congestive heart failure
Many elderly people develop congestive heart failure - this may be as a result of heart attacks damaging the heart muscle, or as a result of years of uncontrolled hypertension placing undue stress on the heart muscle.
Stroke
Hypertension is a major risk factor for all types of stroke, and effectively treating it can reduce the risk by approximately 30-40 percent.
Kidney problems
Hypertension may lead to kidney damage. If there is already a kidney problem (e.g. due to diabetes), hypertension will accelerate the damage.
In the presence of kidney failure or even mild kidney impairment, it is vitally important to control hypertension, to minimise ongoing kidney damage.
Eyes
The small vessels at the back of the eyeball can sometimes be damaged by raised blood pressure leading to visual problems.
What symptoms does high blood pressure cause?
The vast majority of people with hypertension have no symptoms at all and in fact would have no idea at all that their blood pressure was raised, unless it was measured. This is why it is sometimes referred to as the "silent killer".
Feelings of tension and stress are not automatically linked to high blood pressure and many people with high blood pressure are in fact perfectly calm and relaxed.
This is why some people may find it difficult to accept that there may be a potential problem, as they feel absolutely normal.
Very rarely a condition called malignant hypertension is associated with extremely high pressures and headache may be a feature of this.
For the vast majority of people with high blood pressure, headaches are not a feature of the condition.
However, a painful headache (like anything painful) may cause a slight increase in blood pressure.
Often the symptoms are of complications of the long term effects of hypertension e.g. angina, strokes and heart failure.
QUEEN VICTORIA
Age: 124
7819 days old here
Total Posts: 26285
Points: 0
Location:
Lahore, Pakistan
Secondary Hypertension
This includes specific medical conditions which lead to hypertension as a result of the underlying illness/condition and include the following. Secondary causes account for only about 5% of cases of hypertension, but they are worth considering as they may be cured by treating the underlying cause. A secondary cause may be more likely in a young person with very high blood pressure.
Kidney problems
Conditions which damage the kidneys, such as previous infection/reflux, polycystic kidneys may lead to hypertension.
Increasingly, renal artery stenosis (narrowing of the kidney artery) is being recognised as an important cause of hypertension.
Hormonal syndromes
Hyperthyroidism - an overactive thyroid gland may cause raised blood pressure.
Phaeochromocytoma - this is a very rare problem, where adrenaline-like chemicals are secreted by a tumour in the adrenal gland; some cases are associated with headache, sweating and palpitations.
Hyperaldosteronism - this results from the secretion of a chemical called aldosterone by the adrenal gland. A clue to this condition may be a low potassium level in the blood.
Cushing's syndrome - this is from a variety of conditions which result in an increased production of cortisol (a steroid, either from tumours or problems in the adrenal gland). Features include truncal obesity, striae (stretch marks in skin), hirsuitism (excess hair).
Sleep apnoea
This is characterised by loud snoring, which may be followed by apnoea (no breathing) and then gasping or snorting. The changes and stress this puts on the body may lead to high blood pressure. Daytime sleepiness may be a feature and morning headaches.
Special sleep studies (a polysomnograph) is needed to diagnose it.
