About High Blood Pressure
In most adults who get high blood pressure (Hypertension) the cause is usually unknown though there is a hereditary tendency. When younger people develop high blood pressure, there is a higher chance that this is because of an underlying cause. These causes need to be looked for by various tests as correction of the underlying problem can normalize blood pressure. For example various conditions involving the kidney, such as stones, or other kidney diseases such as nephritis, vascular diseases of kidney etc. can cause high blood pressure. Kidney disease is the main cause of hypertension in the younger patient. High blood pressure can also be due to excessive production of certain types of hormones ( produced by an organ called the suprarenal gland situated just above the kidneys), as seen in tumors such as pheochromocytoma or a condition called Cushing's syndrome. Pregnancy can sometimes be associated with high blood pressure. Narrowing of certain arteries from the heart -a condition called coarctation of aorta- can cause hypertension. Often there may not be any cause.
High blood pressure needs to be treated because mortality (death rate) is high with persistently high blood pressure. This high mortality rate is reduced drastically when the blood pressure is controlled and brought to normal. Very high blood pressure usually gives rise to paralysis or hemiplegia (stroke). A reduction of blood pressure by just 10 mm would reduce the incidence of a stroke by as much as 40%. High blood pressure can also lead to angina (chest pain) and heart attacks. Even a moderate rise increases the incidence of heart problems. High blood pressure in pregnancy is associated with poorer outcomes for baby and mother.
Measurement of high blood pressure:
One has to measure the blood pressure using a blood pressure measuring instrument known as a manometer. A lot of people think that if they have no symptoms at all, their pressure is normal. They could be wrong. Only a meter will show the correct blood pressure. It may be too late by the time symptoms develop. Hence regular blood pressure measurement -at least every month or more often-when high , and yearly if normal is advisable.
Usually every time the blood pressure is taken, two components are measured. The lower reading is called the diastolic pressure and and the higher one, the systolic pressure. Normally, diastolic blood pressure should be less than 90 and systolic blood pressure less than 140.For diabetics, diastolic should be less than 85 and systolic less than 130. If the blood pressure is borderline, then it should be checked every week for 6 weeks.
Tests to be done for high blood pressure:
Tests are done mainly to
i) find out the cause of hypertension when it is first detected.
ii) know how long the patient has been suffering from it.
iii) know whether one has developed any complications.
iv) select the best drug to be used.
Treatment for high blood pressure
Patients with mild or borderline high blood pressure can benefit from weight reduction -if overweight- and lifestyle modification. If the pressure is moderately high or if the ECG is abnormal then drugs are required. There are several types of blood pressure medicines and your doctor will decide on the appropriate one for you depending on your clinical picture and test results. The different groups of medications used for High BP include betablockers (atenolol,metaprolol, propranolol etc), Diuretic group(Chlorthiazide, Ditide, Biduret, Lasix etc), calcium blockers(Nifidepine, Diltiazam, or Amlodepine etc), ACE Inhibitors (Enalapril, Lisinopril, or Losartan etc),Alpha methyl Dopa, Dihydrallazine etc, and others.
Your doctor will choose the right drug and dose for you.
Duration of treatment:Blood pressure should be maintained within normal limits at any cost. The medicine(s) can be reduced after 6 months or a year, if weight reduction and lifestyle modification have been achieved, and in some selected cases it may be possible to stop it. Most people need continuation of the medication for years, mostly life long. Some patients, after correction of the underlying cause, such as renal stone, nephritis etc, will be able to maintain normal pressure without drugs. Your doctor will make appropriate changes in dose according to your blood pressure. Some patients may need an increase in the dose after years while many may need combination of drugs.
If you are otherwise okay, you can have normal activities. These include games, races, normal work load. You can travel freely, but ensure that you take your medicines regularly. Though most of the drugs can be taken at any time, you should try and take it at a specific time every day-only diuretics need to be taken in the morning. But if you have other ailments such as Angina or Heart Disease or Kidney failure, you have to follow the restrictions for the respective problem.
Discuss these issues freely with your doctor and clear your doubts.
This is a general overview on this topic and may not apply to everyone. To find out if this handout applies to you and to get more information, talk to your doctor.
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