HYPERTENSION
INTRODUCTION Hypertension is one of the major public health burden in the recent times. Hypertension remains a challenging medical condition among the noncommunicable diseases of ever growing population. Efforts to control HT include 1. Increasing public knowledge and 2. Awareness about the risks associated with high BP.
NORMAL AND HIGH BLOOD PRESSURE Normal blood pressure: An optimal blood pressure level is under 120/80 mmhg. Readings over 120/80mmHg and up to 139/89mmHg are in the normal to high range. Ideal blood pressure should be based on your circumstances. High blood pressure: Blood pressure exceeding 140/90mmHg is usually considered to be high. When your blood pressure is high your heart and arteries can become overloaded
HYPERTENSION It is defined as values 140 mmhg systolic blood pressure and/or 90 mmhg diastolic blood pressure, based on the evidence from RCTs(randomized controlled trials) that in patients with these BP values treatment-induced BP reductions are beneficial.
U S I N G T H I S B L O O D P R E S S U R E C H A RT To work out what your blood pressure readings mean, just find your top number (systolic) on the left side of the blood pressure chart and read across, and your bottom number (diastolic) on the bottom of the blood pressure chart. Where the two meet is your blood pressure.
CLASSIFICATION OF BLOOD PRESSURE LEVELS Category Systolic Diastolic Optimal <120 <80 Normal 120 129 80 84 High normal 130 139 85 89 Grade 1 hypertension 140 159 90 99 Grade 2 hypertension 160 179 100 109 Grade 3 hypertension 180 110 Isolated systolic hypertension 140 <90 The blood pressure (BP) category is defined by the highest level of BP, whether systolic or diastolic. Isolated systolic hypertension should be graded 1, 2, or 3 according to systolic BP values in the ranges indicated.
PREVALENCE Hypertension is a major public health problem and important area of research due to its high prevalence and being major risk factor for cardiovascular diseases and other complications. Overall the prevalence of hypertension appears to be around 30 45% of the general population, with a steep increase with ageing Close relationship between prevalence of hypertension and mortality for stroke has been reported.
BLOOD PRESSURE MEASUREMENT For a comprehensive assessment of blood pressure multiple measurements are taken on several separate occasions, at least twice,one or more weeks apart. The apparatus used are 1) Mercury sphygmomanometer: The mercury sphygmomanometer has traditionally been used in the measurement of clinic blood pressure,as it is most reliable and provides accurate non invasive readings. 2) Electronic Devices: Electronic devices are increasingly being used in hospitals and primary care. Electronic devices can be used to perform automated office blood pressure measurement.
CAUSES AND FACTORS OF HIGH BLOOD PRESSURE There are several factors which leads to hypertension. These factors vary from country to country and even there is difference between urban and rural regions of the same place Some of the contributing factors for epidemiological transition of hypertension in world are Lack of physical activity Too much alcohol consumption Older age Chronic kidney disease Sleep apnea Adrenal and thyroid disorders Stress Overweight and obesity Urbanization Genetics Smoking Too much salt consumption
SYMPTOMS Although majority of patients with hypertension remain asymptomatic, some people with HTN reports Headaches, Lightheadedness Vertigo, altered vision Fainting episode Irregular heartbeat Blood in the urine Pounding in the chest, neck, or ear
LOW BLOOD PRESSURE SYMPTOMS Symptoms of low blood pressure or hypotension may include: Fainting (syncope) Dizziness A feeling of lightheadedness Chest pain Blurred vision Increased thirst Nausea
RISKS AND COMPLICATIONS It is an important risk factor for Stroke, Coronary heart diseases, Peripheral vascular disease, Heart failure, and chronic kidney disease Heart failure, Peripheral vascular disease, Renal impairment, Retinal hemorrhage, and visual impairment
APPROCHES TO CONTROL HYPERTENSION Applying these approaches to the general population as a component of public health and clinical practice can help prevent blood pressure from increasing and can help decrease elevated blood pressure levels for those with high normal blood pressure or hypertension. Lifestyle changes: Engage in moderate physical activity Maintain normal body weight Limit alcohol consumption Reduce sodium intake Maintain adequate intake of potassium And consume a diet rich in fruits, vegetables, and low-fat dairy products and reduced in saturated and total fat. Patient Counseling Guide : To optimize hypertension control, patient education and counseling can be an important component
MEDICATION THERAPY There is evidence that, in high-risk individuals, BP control is more difficult and more frequently requires the combination of antihypertensive drugs with other therapies, such as aggressive lipid-lowering treatments. As the blood pressure increases it is more difficult to control with lifestyle modification alone and antihypertensive medication becomes necessary.
DIFFERENT CLASSES OF ANTIHYPERTENSIVE DRUGS Initial drug therapy Life style modification Without Compelling Indication Prehypertension Yes No hypertensive drug indicated Stage 1 Yes Thiazide-type diuretics for most. May consider ACEI, ARB, BB, CCB, or combination Stage 2 Yes Two-drug combination for most (usually thiazide-type diuretic and ACEI or ARB or BB or CCB)