Hypertension I.

Definition Hypertension means high blood pressure (raised pressure of the circulating blood), but since there is a wide range of normal blood pressure in the population, a precise level of pressure above, which an individual is, deemed hypertensive is arbitrary. (A healthy young adult would be expected to have a systolic pressure of around 120 mm Hg and a diastolic of 80 mm Hg, recorded as 120/80.) Hypertension is not a disease as such but a quantitative deviation from the norm. A person with a pressure higher than the average for his or her age group is usually symptomless although sometimes such people may develop headaches. The identification of people with hypertension is important because it is a signal that they will be more likely to have a stroke or myocardial infarct (coronary thrombosis or heart attack) than someone whose pressure is in the normal range. Despite the grey area between normal and raised blood pressure, the World Health Organization (WHO) has defined hypertension as a blood pressure consistently greater than 160 mm Hg (systolic) and 95 mm Hg (diastolic). Young children have readings well below these, but blood pressure rises with age and a healthy person may well live symptom free with a systolic pressure above the WHO figure. A useful working definition of hypertension is the figure at which the benefits of treating the condition outweigh the risks and costs of the treatment. Many peoples blood pressure rises when they are anxious or after exercise, so if someones pressure is above normal at the first testing, It should be taken again after, say, 10 minutes rest, by which time the reading should have settled to the persons regular level. Over 90 per cent of hypertensive people have no immediately identifiable cause for their condition. They are described as having essential hypertension. In those patients with an identifiable cause, the hypertension is described as secondary.

41st edition published 2005 A & C Black Publishers Limited 37 Soho Square, London W1D 3QZwww.acblack.com

II.

Anatomy and physiology Hypertension, or high blood pressure, is persistently elevated arterial pressure. It is one of the more common diseases of the cardiovascular system in industrialized nations. In some individuals, high sodium intake leads to vasoconstriction, raising blood pressure. Obesity also is a risk factor for hypertension because it increases peripheral resistance. Psychological stress, which activates sympathetic nerve impulses that cause generalized vasoconstriction, may also lead to hypertension. Yet another cause of hypertension may be an inability of endothelium to respond to a relaxing factor, leading to vasoconstriction. Hypertension is called a "silent killer" because it may not have direct symptoms, yet can set the stage for serious cardiovascular complications. For example, as the left ventricle works harder to pump blood at a higher pressure, the myocardium thickens, enlarging the heart- If the coronary blood vessels cannot support this overgrowth, parts of the heart muscle die and become replaced with fibrous tissue. Eventually, the enlarged and weakened heart dies. Hypertension also contributes to the development of atherosclerosis. As arteries accumulate plaque, a coronary thrombosis or a coronary embolism may occur, similar changes in the arteries of the brain increase the chances of a cerebral vascular accident (CVA), or stroke, due to a cerebral thrombosis, embolism, or hemorrhage. When an embolus or hemorrhage causes a stroke, paralysis and other functional losses appear suddenly. A thrombus caused stroke is slower. It may begin with clumsiness, progress to partial visual loss, and then affect speech. One arm becomes paralyzed, then a day later, perhaps an entire side of the body is affected. A transient ischemic attack (TIA, or "ministroke")is a temporary block in a small artery.

HOLE'S (2007) HUMAN ANATOMY & PHYSIOLOGY. ELEVENTH EDITION

III.

Etiology Though the exact causes of hypertension are usually unknown, there are several

factors that have been highly associated with the condition. One of these is the smoking which is a major cause of coronary artery disease, especially in younger people. The risk of heart attack is greatly increased depending on the number of cigarettes the person takes. The nicotine present in the cigarette or tobacco products causes decrease oxygen in the blood, increase blood pressure and heart rate, increase blood clotting and damage to the cells that line coronary arteries and other blood vessels. Women who also take contraceptives like birth control pills increased the risk of having heart attack, stroke, and peripheral heart disease. Next, is being overweight individuals may have a higher blood volume and an increased production of insulin. Blood pressure is also increased by raised sodium levels and thickening of the arteries. High blood pressure may additionally be caused by a sedentary lifestyle Another is when a person has diabetes which increases risk of developing high blood pressure and other cardiovascular problems, because diabetes adversely affects the arteries, predisposing them to atherosclerosis (hardening of the arteries). Atherosclerosis can cause high blood pressure, which if not treated, can lead to blood vessel damage, stroke, heart failure, heart attack, or kidney failure. A lack of regular physical activity also increases your risk for many heart conditions, including high blood pressure. Daily exercise is a remedy or preventive measure for cardiovascular problems. By increasing blood flow and promoting cardiovascular efficiency,

exercise provides benefits to your entire circulatory system. Additionally, regular exercise trains your heart to respond quickly and efficiently to external physical stresses. Drinking too much alcohol can raise blood pressure to unhealthy levels. Higher concentrations of alcohol will have faster absorption. The liver, which cleanses the body of poisons, can be overwhelmed by sudden high alcohol content, resulting in imbalances throughout the rest of the body, including a buildup of fats in the bloodstream that may lead to heart problems Another is the stress because it can cause hypertension through repeated blood pressure elevations as well as by stimulation of the nervous system to produce large amounts of vasoconstriction hormones that increase blood pressure. Factors affecting blood pressure through stress include job strain, race, social environment, and emotional distress. Lastly, Age is also a factor that can affect or cause hypertension (High blood pressure) Reasons why age increase high blood pressure risk: arteries become hardened, also the patient becomes less active, kidney function decreases, body does not process salt as well, body more sensitive to salt and other factors hormonal changes such as menopause. http://www.medicalnewstoday.com/articles/150109.php

IV.

Sign and Symptoms The symptoms of hypertension include high blood pressure if the reading goes above

140/90, then you should consider yourself hypertensive. Between 120 and 140 is a pre hypertensive stage which can be controlled even by natural measures like exercise, low intake of salt, avoidance of smoking, maintaining lower levels of cholesterol and by consuming fresh fruits and vegetables. Common symptoms are breathlessness, headache, fatigue, confusion or dizziness, profuse sweating, blurred vision, pounding in your chest, neck or ears and Irregular heartbeat.

V.

Complications When treated properly, hypertension may net lead to a serious complications. But

when left untreated, hypertension may cause serious complications. Complications of hypertension may include heart attack, because of hardening and thickening of the arteries. Aneurysms, because of your blood vessel weaken and bulge forming a blood-filled balloonlike bulge in the wall of a blood vessel. Heart failure, the blood pumps higher pressure to meet the bodys needs. Weakened and narrowed blood vessels in your kidney prevent organs from functioning normally. Thickened, narrowed or torn blood vessel in the eyes can result in vision loss. http://www.mayoclinic.com/health/high-blood pressure/DS00100/DSECTION=complications

VI.

Interrelationship Hypertension (high blood pressure) is one of the most common illnesses nowadays.

To simply put hypertension is an increase in blood pressure. Each year thousands of people around the world are told by their doctors and physicians that they have hypertension. Blood pressure is the force of blood pushing up against the blood vessel walls. The higher the pressure the harder the heart has to pump. Hypertension can lead to damaged organs, as well as several illnesses, such as renal failure (kidney failure), aneurysm, heart failure, stroke, or heart attack. The main goal of treatment for hypertension is to lower blood pressure to less than 140/90 or even lower in some groups such as people with diabetes, and people with chronic kidney diseases. Treating hypertension is important for reducing the risk of stroke, heart attack, and heart failure.

VII.

Risk Factors

High blood pressure has many risk factors, including: Age, The risk of high blood pressure increases as you age. Through early middle age, high blood pressure is more common in men. Women are more likely to develop high blood pressure after menopause. Race, High blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites. Serious complications, such as stroke and heart attack, also are more common in blacks. Family history, High blood pressure tends to run in families. Being overweight or obese, the more you weigh, the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls. Not being physically active, People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight. Using tobacco, Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow, increasing your blood pressure. Secondhand smoke also can increase your blood pressure. Too much salt (sodium) in your diet, too much sodium in your diet can cause your body to retain fluid, which increases blood pressure. Too little potassium in your diet, Potassium helps balance the amount of sodium in your cells. If you don't get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood. Too little vitamin D in your diet, its uncertain if having too little vitamin D in your diet can lead to high blood pressure. Vitamin D may affect an enzyme produced by your kidneys that affects your blood pressure. Drinking too much alcohol, over time, heavy drinking can damage your heart. Having more than two drinks a day can raise your blood pressure. Stress, High levels of stress can lead to a temporary, but dramatic, increase in blood pressure. If you try to relax

by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure. Certain chronic conditions, certain chronic conditions also may increase your risk of high blood pressure, including high cholesterol, diabetes, kidney disease and sleep apnea.Sometimes pregnancy contributes to high blood pressure, as well.Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits such as an unhealthy diet and lack of exercise contribute to high blood pressure. http://www.mayoclinic.com/health/high-blood-pressure/DS00100/DSECTION=risk-factors

VIII. Diagnostic and Laboratory Examination Tests will be ordered to check for causes of high blood pressure and to assess any organ damage from high blood pressure or its treatment. These tests may include the following: Blood tests- including measurement of electrolytes, blood urea, and creatinine levels (to assess kidney involvement) Lipid profile-for levels of various kinds of cholesterol, Special tests for hormones of the adrenal gland or thyroid gland, Urine tests for electrolytes and hormones A noninvasive, painless eye examination with an ophthalmoscope will look for ocular damage. Ultrasound of the kidneys, CT scan of the abdomen, or both may be done to assess damage or enlargement of the kidneys and adrenal glands. Any of the following may be performed to detect damage to the heart or blood vessels:

Electrocardiogram (ECG) - is a noninvasive test that detects the electrical activity of the heart and records it on paper. ECG is helpful for quantitating any damage of the heart muscle,

such as heart attack, and/or thickening/hypertrophy of the heart wall/muscle, common complications of high blood pressure.

Echocardiogram - is an ultrasound examination of the heart taken through the chest. Sound waves take a picture of the heart as it beats and relaxes and then transmits these images to a video monitor. The echo can detect problems with the heart such as enlargement, abnormalities in motion of the heart wall, blood clots, and heart valve abnormalities. It also gives a good measurement of the strength of the heart muscle (ejection fraction). The echo is more accurate than an ECG, but also more expensive.

Chest x-ray- A plain chest x-ray primarily provides an estimate of the size of the heart, but it is much less specific than echocardiography, which looks inside the heart.

Doppler ultrasound - is used to check blood flow through arteries at pulse points in your arms, legs, hands, and feet. This is an accurate way to detect peripheral vascular disease, a common finding in people with high blood pressure. It also can depict the arteries to both kidneys and sometimes depicts narrowing that can lead to high BP in a minority of patients.

http://www.webmd.com/hypertension-high-blood-pressure/guide/high-blood-pressure-tests

IX.

Prevention Cut down on the amount of salt in food and eat plenty of fruit and vegetables. Salt

raises blood pressure. The more salt a person eats, the higher his blood pressure. Aim to eat less than less than 6g (0.2oz) of salt a day, which is about a teaspoonful. Regularly drinking alcohol will raise blood pressure over time. Staying within the recommended levels is the best way to reduce risk of developing high blood pressure.

Men should not regularly drink more than three-to-four units a day. (equivalent to a pint and a half of 4% beer) Women should not regularly drink more than two-to-three units a day (equivalent to a 175 ml glass of wine). Alcohol is also high in calories, which will make you gain weight. Drinking more than four cups of coffee a day may increase blood pressure. If you are a big fan of coffee, tea or other caffeine-rich drinks (such as cola and some energy drinks), consider cutting down. It is fine to drink tea and coffee as part of a balanced diet but it is important that these drinks are not your only source of fluid. Being overweight forces your heart to work harder to pump blood around your body, which can raise your blood pressure. It is worth remembering that just losing a few pounds will make a big difference to your blood pressure and overall health. Being active and taking regular exercise lowers blood pressure by keeping heart and blood vessels in good condition. Regular exercise can also help lose weight, which will also help lower blood pressure. Adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity (i.e. cycling or fast walking) every week. For it to count, the activity should make you feel warm and slightly out of breath. Someone who is overweight may only have to walk up a slope to get this feeling. Physical activity can include anything from sport to walking and gardening. Smoking doesn't directly cause high blood pressure but it puts a person at much higher risk of a heart attack and stroke. Smoking, like high blood pressure, will cause arteries to narrow. If you smoke and have high blood pressure, arteries will narrow much more quickly and your risk of a heart or lung disease in the future is dramatically increased.

Relaxation therapy and exercise can reduce blood pressure such as stress management, meditation or yoga. Cognitive behavior therapy (CBT), which focuses on how thoughts and beliefs can affect the way, you feel and how you cope with problems. Biofeedback, where a small monitor constantly shows you your heartbeat or blood pressure, and is used to help try to control your blood pressure. http://www.nhs.uk/Conditions/Blood-pressure-(high)/Pages/Prevention.aspx

X.

Prognosis The prognosis of hypertension is generally very good if it is caught early and properly

monitored and treated. It typically takes many years for high blood pressure to become severe enough to cause serious complications, although uncontrolled hypertension over time is related to an increased risk of heart attack, stroke, and death. The majority of patients with hypertension, however, can keep it under control and can expect to live a full life when proper lifestyle changes are implemented. Overall, the prognosis of hypertension is highly positive because it is almost always treatable with dietary and lifestyles changes combined with medication. Most patients can go on to lead full lives without suffering any severe consequences, so long as high blood pressure is caught early and treated. Patients will need to be monitored several times a year to ensure that blood pressure has not spiked again and that any treatments being used are still working. Sometimes medications or dietary habits will need to be tweaked for optimum results. The prognosis of hypertension that has not been controlled is not as good. High blood pressure that is allowed to escalate, either due to a patient not knowing it exists or refusing proper medical treatment, may lead to heart disease, stroke, and death. These issues usually

do not occur until many years after high blood pressure first appears. Some patients may never experience these serious side effects if hypertension is mild and stable.

Although high blood pressure usually takes years to develop into a life-threatening condition, patients are encouraged to seek medical attention immediately to ensure that treatments are started and that they are effective. Certain lifestyle changes, such as cutting back on particular foods and activities, may also be needed to improve the prognosis of hypertension for an individual patient. The presence of hypertension does have some additional health risks which may affect the prognosis. Those who have high blood pressure are also more likely to have other potentially serious conditions or to engage in risky behaviors. For instance, smokers are more likely than the average person to have high blood pressure, and they also are at higher risk for clogged arteries, blocked airways, and lowered immunity. This could make having a heart attack or stroke more likely to occur sooner than for those who do not have these issues. For these reasons, doctors and patients should take all health matters into consideration when choosing treatment options. Ideally, patients will stay away from high risk substances and improve their overall health. This is not always the case, and hypertension treatments should be given accordingly. http://www.wisegeek.net/what-is-the-prognosis-of-hypertension.htm

XI.

Management Treatment of hypertension varies and may include exercising regularly, controlling

weight, reducing stress, and limiting the diet to foods that are low in sodium. Drugs, such as diuretics and/or inhibitors of sympathetic nerve activity, may help control blood pressure. Diuretics increase urinary excretion of sodium and water, reducing the volume of body fluids.

Sympathetic inhibitors block the synthesis of neurotransmitters, such as norepinephrine, or block receptor sites of effector cells. HOLE'S (2007) HUMAN ANATOMY & PHYSIOLOGY. ELEVENTH EDITION XII. Local It is known that 25% of Filipino adults, or about 14 million of current adult population, have high blood pressure. It is believed that a large majority of them are not accessing adequate health care, and as people often have no symptoms and unaware of their high blood pressure and associated health risks, many causes often are undiagnosed. Many who are diagnosed often do not have access to treatment, and their conditions not adequately controlled. Heart disease and stroke remains the leading causes of mortality, comprising 35% of total deaths, among Filipinos. Philippine Health Statistics data show that in 2009, about 167,000 Filipinos died from heart disease and stroke. Half of these tragic deaths are likely related to high blood pressure. An analysis done by the Philippine Institute for Development Studies (PIDS) further reveals that 34% of all cardiovascular deaths are happening prematurely or at age below 60 years, ending the life of many Filipinos during their supposedly most productive years. This has implications to labor, productivity, and economic development. http://www.doh.gov.ph/top/node/8909%20.html Statistics

In the Philippines, heart attack is the most common cause of death among Filipinos. This may be attributed to continuous neglect on the danger of hypertension and its complications, said Dr. Morales. A study conducted by PSH found out that the prevalence of hypertension in the country is increasing. In 2003, data showed that 16 percent or approximately 7 million Filipino adults 20 years and above has hypertension. The incidence increased to 10 million or 21 percent of Filipino adults 20 years and above in 2008. Based on the data, we are expecting the incidence to increase more in the next survey in 2013, said Dr. Morales. He reminded the public to be aware of the food they eat and encouraged them to have at least 30 minutes exercise a day to reduce the risk of hypertension. Because our lifestyle has direct impact on our health, added Dr. Morales. http://www.pchrd.dost.gov.ph/index.php/2012-05-23-07-46-36/2012-05-24-00-01-11/5047prevalence-of-hypertension-among-filipinos-increasing-psh

International Having high blood pressure puts you at risk for heart disease and stroke, leading causes of death in the United States. People of all ages and backgrounds can develop high blood pressure. Fortunately, it's mostly preventable. There are 67 million American adults (31%) who have high blood pressurethats 1 in every 3 American adults. 69% of people who have a first heart attack, 77% of people who have a first stroke, and 74% of people with chronic heart failure have high blood pressure.3 High blood pressure is also a major risk factor for kidney disease. More than 348,000 American deaths in 2009 included high blood pressure as a primary or contributing cause. High blood pressure costs the nation $47.5 billion annually in direct medical expenses and $3.5 billion each year in lost productivity. About half (47%) of people with high blood pressure have their condition under control. Almost 30% of American adults have prehypertensionblood pressure numbers that are higher than normal, but not yet in the high blood pressure range. Prehypertension raises your risk of developing high blood pressure. Reducing average population sodium intake from 3,300 mg to 2,300 mg per day may reduce cases of high blood pressure by 11 million and save 18 billion health care dollars annually. http://www.cdc.gov/bloodpressure/facts.htm

Global Hypertension is considered as the biggest single risk factor for deaths worldwide. According to the World Health Organization (WHO), hypertension causes 7 million deaths every year while 1.5 billion people suffer due to its complications

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XIV. Pathophysio