Essential hypertension

From Wikipedia, the free encyclopedia

"Idiopathic hypertension" redirects here. For the condition of raised blood pressure within the skull, see Idiopathic intracranial hypertension. Essential hypertension (also called primary hypertension or idiopathic hypertension) is the form of hypertension that by definition, has no identifiable cause. It is the most common type of hypertension, affecting 95% of hypertensive patients,[1][2][3][4] it tends to be familial and is likely to be the consequence of an interaction between environmental and genetic factors. Prevalence of essential hypertension increases with age, and individuals with relatively high blood pressures at younger ages are at increased risk for the subsequent development of hypertension. Hypertension can increase the risk of cerebral, cardiac, and renal events.[5]

Classification

The variation in pressure in the left ventricle (blue line) and the aorta (red line) over two cardiac cycles ("heart beats"), showing the definitions of systolic and diastolic pressure.

A recent classification recommends blood pressure criteria for defining normal blood pressure, prehypertension, hypertension (stages I and II), and isolated systolic hypertension, which is a common occurrence among the elderly. These readings are based on the average of seated blood pressure readings that were properly measured during 2 or more office visits. In individuals older than 50 years, hypertension is considered to be present when a person's blood pressure is consistently at least 140 mmHg systolic or 90 mmHg diastolic. Patients with blood pressures over 130/80 mmHg along with Type 1 or Type 2 diabetes, or kidney disease require further treatment.[6] Systolic pressure Classification mmHg kPa (kN/m2) mmHg kPa (kN/m2) Diastolic pressure

Normal

90119 1215.9

6079 8.010.5

Prehypertension 120139 16.118.5

8189 10.811.9

Stage 1

140159 18.721.2

9099 12.013.2

Stage 2

160

21.3

100

13.3

Isolated systolic 140 hypertension

18.7

<90

<12.0

Source: American Heart Association (2003).[6]

Resistant hypertension is defined as the failure to reduce blood pressure to the appropriate level after taking a three-drug regimen.[6]Guidelines for treating resistant hypertension have been published in the UK, and US.[7]

Risk factors
Hypertension is one of the most common complex disorders. The etiology of hypertension differs widely amongst individuals within a large population.[8] And by definition, essential hypertension has no identifiable cause. However, several risk factors have been identified. Hypertension may be secondary to other diseases but over 95% of patients have essential hypertension which is of unknown origin. It is observed though that:

Having a personal family history of hypertension increases the likelihood that an individual develops HPT.[9] Essential hypertension is four times more common in black than white people, accelerates more rapidly and is often more severe with higher mortality in black patients.[9][10][11][12]

More than 50 genes have been examined in association studies with hypertension, and the number is constantly growing. One of these genes is the angiotensinogen (AGT) gene, studied extensively by Kim et al. They showed that increasing the number of AGT increases the blood pressure and hence this may cause hypertension.[8] Twins have been included in studies measuring ambulatory blood pressure; from these studies it has been suggested that essential hypertension contains a large genetic influence.[8] Supporting data has emerged from animal studies as well as clinical studies in human populations. The majority of these studies support the concept that the inheritance is probably multifactorial or that a number of different genetic defects each has an elevated blood pressure as one of its phenotypic expressions. However, the genetic influence upon hypertension is not fully understood at the moment. It is believed that linking hypertension-related phenotypes with specific variations of the genome may yield definitive evidence of heritability.[13] Another view is that hypertension can be caused by mutations in single genes, inherited on a Mendelian basis.[14] Hypertension can also be age related, and if this is the case, it is likely to be multifactorial. One possible mechanism involves a reduction in vascular compliance due to the stiffening of the arteries. This can build up due to isolated systolic hypertension with a widened pulse pressure. A decrease in glomerular filtration rate is related to aging and this results in decreasing efficiency of sodium excretion. The

developing of certain diseases such as renal microvascular disease and capillary rarefaction may relate to this decrease in efficiency of sodium excretion. There is experimental evidence that suggests that renal microvascular disease is an important mechanism for inducing salt-sensitive hypertension.[15]

Obesity can increase the risk of hypertension to fivefold as compared with normal weight, and up to twothirds of hypertension cases can be attributed to excess weight.[16] More than 85% of cases occur in those with a Body mass index greater than 25.[16] A definitive link between obesity and hypertension has been found using animal and clinical studies; from these it has been realized that many mechanisms are potential causes of obesity-induced hypertension. These mechanisms include the activation of the sympathetic nervous system as well as the activation of the reninangiotensin-aldosterone system.[17] Another risk factor is salt (sodium) sensitivity which is an environmental factor that has received the greatest attention. Approximately one third of the essential hypertensive population is responsive to sodium intake.[18] When sodium intake exceeds the capacity of the body to excrete it through the kidneys, vascular volume expands secondary to movement of fluids into the intra-vascular compartment. This causes the arterial pressure to rise as the cardiac output increases. Local autoregulatory mechanisms counteract this by increasing vascular resistance to maintain normotension in local vascular beds. As arterial pressure increases in response to high sodium chloride intake, urinary sodium excretion increases and the excretion of salt is maintained at expense of increased vascular pressures.[9] The increased sodium ion concentration stimulates ADH and thirst mechanisms, leading to increased reabsorption of water in the kidneys, concentrated urine, and thirst with higher intake of water. Also, the water movement between cells and the interstitium plays a minor role compared to this. The relationship between sodium intake and blood pressure is controversial. Reducing sodium intake does reduce blood pressure, but the magnitude of the effect is insufficient to recommend a general reduction in salt intake. [19]

Renin elevation is another risk factor. Renin is an enzyme secreted by the juxtaglomerular apparatus of the
kidney and linked with aldosterone in a negative feedback loop. In consequence, some hypertensive patients have been defined as having low-renin and others as having essential hypertension. Low-renin hypertension is more common in African Americans than white Americans, and may explain why African Americans tend to respond better to diuretic therapy than drugs that interfere with the Renin-angiotensin system. High renin levels predispose to hypertension by causing sodium retention through the following mechanism: Increased renin Increased angiotensin II Increased vasoconstriction, thirst/ADH and aldosterone Increased sodium reabsorption in the kidneys (DCT and CD) Increased blood pressure. Hypertension can also be caused by Insulin resistance and/or hyperinsulinemia, which are components of syndrome X, or the metabolic syndrome. Insulin is a polypeptide hormone secreted by cells in the islets of Langerhans, which are contained throughout the pancreas. Its main purpose is to regulate the levels of glucose in the body antagonistically with glucagon through negative feedback loops. Insulin also exhibits vasodilatory properties. In normotensive individuals, insulin may stimulate sympathetic activity without elevating mean arterial pressure. However, in more extreme conditions such as that of the metabolic syndrome, the increased sympathetic neural activity may over-ride the vasodilatory effects of insulin.

It has been suggested that vitamin D deficiency is associated with cardiovascular risk factors.[20] It has been observed that individuals with a vitamin D deficiency have higher systolic and diastolic blood pressures than average. Vitamin D inhibits renin secretion and its activity, it therefore acts as a "negative endocrine regulator of the renin-angiotensin system". Hence a deficiency in vitamin D leads to an increase in renin secretion. This is one possible mechanism of explaining the observed link between hypertension and vitamin D levels in the blood plasma.[21] Also, some authorities claim that potassium might both prevent and treat hypertension. [22] Recent studies claims that obesity is a risk factor for hypertension because of activation of the reninangiotensin system (RAS) in adipose tissue,[23][24] and also linked renin-angiotensin system with insulin resistance, and claims that any one can cause the other.[25] Cigarette smoking, a known risk factor for other cardiovascular disease, may also be a risk factor for the development of hypertension.[26]

Pathophysiology

A diagram explaining factors affecting arterial pressure

Cardiac output and peripheral resistance are the two determinants of arterial pressure. and so
blood pressure is normally dependent on the balance between cardiac output and peripheral resistance.[27] Cardiac

output is determined by stroke volume and heart rate; stroke

volume is related to myocardial contractility and to the size of the vascular compartment. Peripheral resistance is determined by functional and anatomic changes in small arteries and arterioles. The pathophysiology of essential hypertension is an area of research, and until now remains not well understood, but many theories have been proposed to explain this. What is known is that cardiac output is raised early in the disease course, with total peripheral resistance (TPR) normal; over time cardiac output drops to normal levels but TPR is increased. Three theories have been proposed to explain this:

An overactive Renin-angiotensin system leads to vasoconstriction and retention of sodium and water. The increase in blood volume leads to hypertension.

An overactive sympathetic nervous system, leading to increased stress responses.

It is also known that hypertension is highly heritable and polygenic (caused by more than one gene) and a few candidate genes have been postulated in the etiology of this condition.

Essential hypertension
Hypertension is the term used to describe high blood pressure. Essential hypertension means that the cause of high blood pressure is not known. Blood pressure measures the force against the walls of your arteries as your heart pumps blood through your body. Blood pressure readings are usually given as two numbers -- for example, 120 over 80 (written as 120/80 mmHg). One or both of these numbers can be too high. The top number is called the systolic blood pressure, and the bottom number is called the diastolic blood pressure. Normal blood pressure is when your blood pressure is 120/80 mmHg or lower most of the time. High blood pressure (hypertension) is when your blood pressure is 140/90 mmHg most of the time. If your blood pressure numbers fall between 120/80 and 140/90, it is called pre-hypertension.

If you have pre-hypertension, you are more likely to develop high blood pressure. If you have heart or kidney problems, or if you had a stroke, your doctor may want your blood pressure to be even lower than that of people who do not have these conditions. Causes Many factors can affect blood pressure, including: How much water and salt you have in your body The condition of your kidneys, nervous system, or blood vessels The levels of different body hormones

You are more likely to be told your blood pressure is too high as you get older. This is because your blood vessels become stiffer as you age. When that happens, your blood pressure goes up. High blood pressureincreases your chance of having a stroke, heart attack, heart failure, kidney disease, and early death. You have a higher risk of high blood pressure if you:

Are African American Are obese Are often stressed or anxious Drink too much alcohol (more than one drink per day for women and more than two drinks per day for men) Eat too much salt in your diet Have a family history of high blood pressure Have diabetes Smoke

Most of the time, no cause is identified. This is called essential hypertension.

High blood pressure that is caused by another medical condition or medication is called secondary hypertension. See also: Hypertension Symptoms Most of the time, there are no symptoms. In most people, high blood pressure is found when they visit their health care provider and have it measured. Because there are no symptoms, people can develop heart disease and kidney problems without knowing they have high blood pressure. If you have a severe headache, nausea or vomiting, confusion, changes in vision, or nosebleeds you may have a severe and dangerous form of high blood pressure called malignant hypertension. Exams and Tests Your health care provider will check your blood pressure several times. It is normal for your blood pressure to be different at different times of the day. Blood pressure readings that you take at home may be a better measure of your current blood pressure than those taken at your doctor's office. Make sure you get a good quality, well-fitting home device. It will probably have a cuff with a stethoscope or a digital readout. Practice with your health care provider or nurse to make sure you are taking your blood pressure correctly. See also: Blood pressure monitors for home Your doctor will perform a physical exam to look for signs of heart disease, damage to the eyes, and other changes in your body. Tests may be done to look for: Heart disease (echocardiogram or electrocardiogram) High cholesterol levels Kidney disease (basic metabolic panel, urinalysis, or ultrasound of the kidneys)

Treatment The goal of treatment is to reduce blood pressure so that you have a lower risk of complications. You and your health care provider should set a blood pressure goal for you. Your health care provider may also recommend that you exercise, lose weight, and follow a healthier diet. If you have prehypertension, your health care provider will recommend the same lifestyle changes to bring your blood pressure down to a normal range. You can do many things to help control your blood pressure, including: Eat a heart-healthy diet, including potassium and fiber, and drink plenty of water. See: High blood pressure and diet Exercise regularly -- at least 30 minutes a day. If you smoke, quit -- find a program that will help you stop. Limit how much alcohol you drink -- one drink a day for women, two a day for men. Limit the amount of sodium (salt) you eat -- aim for less than 1,500 mg per day. Reduce stress -- try to avoid things that cause you stress. You can also try meditation or yoga. Stay at a healthy body weight -- find a weight-loss program to help you, if you need it.

Your health care provider can help you find programs for losing weight, stopping smoking, and exercising. You can also get a referral from your doctor to a dietitian, who can help you plan a diet that is healthy for you. Many different medicines can be used to treat high blood pressure. See: High blood pressure medicines. Often, a single blood pressure drug may not be enough to control your blood pressure. You may need to take two or more drugs. It is very important that you take the medications you were prescribed. If you have side effects, your health care provider can substitute a different medication. Outlook (Prognosis) Most of the time, high blood pressure can be controlled with medicine and lifestyle changes. Possible Complications If your blood pressure is not well controlled, you are at risk for: Bleeding from the aorta, the large blood vessel that supplies blood to the abdomen, pelvis, and legs Chronic kidney disease Heart attack or heart failure Poor blood supply to the legs Problems with your vision Stroke

When to Contact a Medical Professional If you have essential hypertension, you will have regular appointments with your doctor. Even if you have not been diagnosed with high blood pressure, it is important to have your blood pressure checked during your yearly check-up, especially if someone in your family has or had high blood pressure. Call your health care provider right away if home monitoring shows that your blood pressure is still high. Prevention Adults over 18 should have their blood pressure checked regularly. Lifestyle changes may help control your blood pressure. Follow your health care provider's recommendations to treat your essential hypertension. Alternative Names Hypertension - essential

Symptoms
Most of the time, there are no symptoms. Symptoms that may occur include:

Confusion Ear noise or buzzing Fatigue Headache Irregular heartbeat Nosebleed Visual changes

If you have a severe headache or any of the symptoms above, see your doctor right away. These may be signs of a complication or dangerously high blood pressure called malignant hypertension.

Exams and Tests

Your health care provider will perform a physical exam and check your blood pressure. If the measurement is high, your health care provider may think you have high blood pressure. The measurements need to be repeated over time, so that the diagnosis can be confirmed. If you monitor your blood pressure at home, you may be asked the following questions: What was your most recent blood pressure reading? What was the previous blood pressure reading? What is the average systolic (top number) and diastolic (bottom number) reading? Has your blood pressure increased recently? Other tests may be done to look for blood in the urine or heart failure. Your doctor will look for signs of complications in your heart, kidneys, eyes, and other organs in your body. These tests may include: Blood tests Echocardiogram Electrocardiogram Urinalysis Ultrasound of the kidneys

Treatment
The goal of treatment is to reduce blood pressure so that you have a lower risk of complications. You and your health care provider should set a blood pressure goal for you. There are many different medicines that can be used to treat high blood pressure, including:

Alpha blockers Angiotensin-converting enzyme (ACE) inhibitors Angiotensin receptor blockers (ARBs) Beta blockers Calcium channel blockers Central alpha agonists Diuretics Renin inhibitors, including aliskiren (Tekturna) Vasodilators
Your health care provider may also tell you to exercise, lose weight, and follow a healthier diet. If you have prehypertension, your health care provider will recommend the same lifestyle changes to bring your blood pressure down to a normal range. Often, a single blood pressure drug may not be enough to control your blood pressure, and you may need to take two or more drugs. It is very important that you take the medications prescribed to you. If you have side effects, your health care provider can substitute a different medication. In addition to taking medicine, you can do many things to help control your blood pressure, including:

Eat a heart-healthy diet, including potassium and fiber, and drink plenty of water. Exercise regularly -- at least 30 minutes a day. If you smoke, quit -- find a program that will help you stop. Limit how much alcohol you drink -- 1 drink a day for women, 2 a day for men. Limit the amount of sodium (salt) you eat -- aim for less than 1,500 mg per day. Reduce stress -- try to avoid things that cause stress for you. You can also try meditation or yoga. Stay at a healthy body weight -- find a weight-loss program to help you, if you need it.
Your health care provider can help you find programs for losing weight, stopping smoking, and exercising. You can also get a referral from your doctor to a dietitian, who can help you plan a diet that is healthy for you. Your health care provider may ask you to keep track of your blood pressure at home. Make sure you get a good quality, well-fitting home device. It will probably have a cuff with a stethoscope or a digital readout. Practice with your health care provider or nurse to make sure you are taking your blood pressure correctly.

Possible Complications

Aortic dissection Blood vessel damage (arteriosclerosis) Brain damage Congestive heart failure Chronic kidney disease Heart attack Hypertensive heart disease Peripheral artery disease Pregnancy complications Stroke Vision loss
Prevention
Adults over 18 should have their blood pressure checked routinely. Lifestyle changes may help control your blood pressure:

Avoid smoking. (See: Nicotine withdrawal) Do not consume more than 1 drink a day for women, 2 a day for men. Eat a diet rich in fruits, vegetables, and low-fat dairy products while reducing total and saturated fat intake (the DASH diet is one way of achieving this kind of dietary plan). (See: Heart disease and diet) Exercise regularly. If possible, exercise for 30 minutes on most days. If you have diabetes, keep your blood sugar under control. Lose weight if you are overweight. Excess weight adds to strain on the heart. In some cases, weight loss may be the only treatment needed. Try to manage your stress. Follow your health care provider's recommendations to modify, treat, or control possible causes of secondary hypertension.

Hypertension - Causes and Risk Factors of High Blood Pressure

The typical image of a person with hypertension (high blood pressure) is an overweight, overworked male executive with a very short fuse. The truth is, high blood pressure affects people of all ages, races, social classes, sizes and shapes, women as well as mean and even children. Although great strides have been made in recent years to control this condition, often it still goes untreated or uncontrolled.

What causes Hypertension? In some people, the system that regulates blood pressure goes awry: arterioles throughout the body stay constricted, driving up the pressure in the larger blood vessels. Sustained high blood pressure - above 140/90 mm Hg, according to most experts - is called hypertension. About 90 percent of all people with high blood pressure have "essential" hypertension - meaning that it has no identifiable cause. In the remaining 10 percent of cases, the elevated blood pressure is due to kidney disease, diabetes, or another underlying disorder. Hypertension is known as the "silent killer" because it doesn't produce any symptoms - at least none that most people are aware of - until considerable damage has already been done. Untreated high blood pressure is the leading cause of strokes, which occur at a rate of a half a million a year in the United States. As a result of hypertension, the heart, because it has to work harder, may become enlarged and less efficient. Risk factors you can't change Certain unalterable conditions put you at greater risk for developing hypertension. If you fall into one of the following categories, you can avoid compounding your risk by making lifestyle changes. Heredity
Those with a family history of hypertension are twice as likely to develop it as others. Many children of hypertensive parents have slightly elevated blood pressure even as infants.

Race
Hypertension is more common and generally more severe among blacks than among whites. For reasons not completely understood, blacks - especially males - tend to develop high blood pressure earlier in life, and much more often with fatal results.

Pregnancy
Hypertension is not related to a person's sex. However, during pregnancy, some women - even those who have never had high blood pressure - develop it.

Risk factors you can change There's no guarantee that the dietary and lifestyle changes described below will prevent hypertension or lower elevated blood pressure. However, a reduction in risk factors for cardiovascular disease will occur.

Exercise
Exercise strengthens the cardiovascular system and reduces the risk of heart disease. Most experts recommend aerobic exercise for twenty to thirty minute at least three times a week.

Calcium
Some studies suggest that eating too little calcium may result in high blood pressure readings. Low fat dairy products and some leafy green vegetables are the best sources of calcium.

Magnesium
A magnesium deficiency may be linked to hypertension. Get your magnesium from foods such as low-fat dairy products and grains.

Potassium
An adequate potassium intake may help prevent or lower high blood pressure. A dietthat contains grains, fruits, and vegetables will supply plenty of potassium since it is abundant in these foods.

Polyunsaturated fats

Replacing saturated fats in the diet with polyunsaturated fats may cause a reducing in blood pressure.

Relaxation techniques
Biofeedback, hypnosis, mediation, and other relaxation techniques may produce a modest, temporary reduction in blood pressure in some people.

What is "White-Coat" Hypertension? "White-Coat" Hypertension is a condition where the patient's blood pressure goes up when he/she goes to visit the doctor. Somehow the White Lab Coat of the physician taking the blood pressure seems to jack up anxiety and the adrenalin level in the waiting patient, leading to a rise in the blood pressure of this patient, but only temporarily if the patient is really not a hypertensive. And when a nurse takes the blood pressure, it is back down to normal. What are the signs or symptoms of hypertension? Not all persons with high blood pressure have symptoms. As a matter of fact, many of them do not have symptoms, especially the mild to moderate hypertensives. This is why it is called the "silent killer." Some simply develop a stroke or a heart attack, before learning they have hypertension. Classically, though, some of the symptoms might include headaches, feeling of "wanting to explode," being short-tempered, of being flushed; and nervousness, irritability, impatience, etc. What is Primary and Secondary Hypertension? Primary Hypertension, also called Essential Hypertension, is one where the cause is not known. Heredity is implicated in its etiology but there are other probable causes that medical science still does not fully understand. Todate, we still do not know what causes high blood pressure. Secondary Hypertension is high blood pressure caused by certain conditions or diseases, like bilateral kidney disease, pheochromocytoma (tumor of adrenal gland), hyperthyroidism, etc., or ingestion of contraceptives or excessive alcohol intake. The most common high blood pressure condition is the Primary or Essential Hypertension. How common is high blood pressure? About 20% or 50 million of the population of the United States have high blood pressure (systolic higher than 140 and diastolic higher than 90 mm. Hg). Hypertension occurs more in black than in white Americans. This writer does not have statistics on the prevalence of hypertension in the Philippines. In a northern province of Japan, inhabitants consume the highest amount of salt per capita, and the incident of hypertension in that area is the highest in the country. Since we Filipinos love to eat salty food, I would not be Page Three High Blood Pressure surprised if the incidence of high blood pressure in the Philippines is at least like that of the United States, about 20% of the population. Does ingesting salty food really aggravate high blood pressure? Yes, because when one eats salty food, water is retrained in the body, increasing the volume of total body fluids, which leads to elevation of blood pressure, especially among hypertensive persons. There is another mechanism, a chemical one, that goes into effect when the person with high blood pressure ingests salt or salty food, aggravating the high blood pressure. This is why physicians strongly recommend a low-salt diet as an essential part of the treatment strategy for patients with high blood pressure. Are the so-called Salt Substitutes better?

Salt substitutes are Potassium, and not Sodium. It is the Sodium in the regular table salt that is harmful to hypertensives and to persons with heart disease. Potassium is medically acceptable for these patients, Potassium salt tastes a bit bitter. Do we really need to eat salt? No, unless the person has lost an abnormal amount of Sodium from severe diarrhea, dehydration, or other illnesses that lower the serum sodium level in the person. In these cases, sodium chloride ingestion, or even intravenous infusion of sodium chloride might be needed. There is really no need to start shaking the salt shaker, because the fruits, vegetables, fish, meat, etc. that Mother Nature has given us all contain the "perfect" amount of sodium already. Adding salt to our food, even before we even taste it, is just a bad habit that many of us have developed over the years. Indeed, it is best to be on a low-salt diet, especially as we grow older than 30. What else is bad for a person with high blood pressure? Smoking, lack of exercise, eating eggs and red meats (pork, beef, etc.), stress, lack of rest and relaxation, are some of the aggravating factors in a patient with hypertension. Page Four High Blood Pressure Is hypertension curable? No, there is no cure for high blood pressure. The only exception to this are conditions or tumors in the adrenal glands (located on top of the kidneys), where the high blood pressure ceases after surgery. The commonest high blood pressure condition---called Essential Hypertension or Primary Hypertension---is not curable. It is controllable with medications. Can a person with high blood pressure live normally? Yes, with current day treatment, a person with high blood pressure who is under effective management with pills, low-salt and low-fat diet, exercise and no smoking, can live a normal life. As long as the treatment is taken daily, and as long as the blood pressure is controlled well, the person could even have a normal life span. With several medications available today in the physician's armamentarium against hypertension, persons with high blood pressure nowadays, who are compliant with the treatment, can be as "healthy" as the next person who does not have high blood pressure. However, there are some persons with the so-called malignant hypertension, who are resistant to the conventional treatment. These are the ones whose blood pressure is not well-controlled and these inidviduals are prone to develop complications of hypertension. How often should the blood pressure be checked? It depends. If the blood pressure is erratic or hard to control, like when the patient is starting on a new medication for hypertension, the blood pressure should be taken once a day until the medication is adjusted and the blood pressure is basically controlled. If the blood pressure is within normal limits (as described above), as a response to treatment, the medications should be continued for life, and the blood pressure could be taken once a week. If it is really stable at the normal range, then it could be done once every two weeks or once a month. It is important to continue taking medications daily or regularly (as prescribed by the physician) for life, even if the blood pressure is well-controlled and now normal. What is keeping it "normal" is the medication! So, do not stop, unless ordered by your physician. Hypertensive Crisis is a dramatic and dynamic situation where the blood pressure of a person drastically shoots up to a critically high level causing severe a headache, neck pains, dizziness, or even syncope (passing out). Sometimes, the tremendously high blood pressure could cause an artery in the brain to burst resulting in a stroke

Pulmonary Hypertension The pulmonary artery is the main vessel that carries blood from the heart to the lungs. For a person at rest, blood pressure in a normal pulmonary artery is about 15 millimeters of mercury (mm Hg). In an individual with pulmonary hypertension, the average pressure in the pulmonary artery can be more than 25 mm Hg. This increase in pulmonary artery pressure occurs when the small arteries of the lungs become abnormally narrow. This condition can eventually lead to heart failure and death. Pulmonary hypertension can be idiopathic (unknown cause), familial (runs in families and is often linked to a genetic cause), or associated with other medical conditions. The October 7, 2009, issue of JAMA includes an article about the effects of iron supplementation on pulmonary hypertension due to low oxygen levels at high altitudes. This Patient Page is based on one published in the January 23, 2008, issue of JAMA. Low oxygen levels due to high altitude or heart or lung disorders Connective tissue diseases (autoimmune diseases such as scleroderma, sarcoidosis, or lupus) Portal hypertension (resulting from liver disease) HIV infection Drugs and toxins (appetite suppressants, cocaine, amphetamines) Thyroid disorders Myeloproliferative disorders (overproduction of red or white blood cells) Hemoglobinopathies (abnormal oxygen-carrying proteins in red blood cells, such as

found in sickle cell anemia) Blood clots in pulmonary arteries SYMPTOMS OF PULMONARY HYPERTENSION Initial symptoms may be minor and diagnosis may be delayed for several years until symptoms worsen. Typical symptoms may include DIAGNOSIS OF PULMONARY HYPERTENSION There is not one specific way to diagnose pulmonary hypertension. A doctor usually runs a series of tests to measure blood pressure in the pulmonary arteries, determine how well the heart and lungs are working, and rule out other diseases. Shortness of breath following exertion Excessive fatigue Dizziness and fainting Ankle swelling Bluish lips and skin Chest pain

Alpha blockers
Alpha blockers, also called alpha-adrenergic antagonists, treat a variety of conditions, such as high blood pressure, benign prostatic hyperplasia and Raynaud's disease. Find out more about this class of medication.
By Mayo Clinic staff

Alpha blockers relax certain muscles and help small blood vessels remain open. They work by keeping the hormone norepinephrine (noradrenaline) from tightening the muscles in the walls of smaller arteries and veins. Blocking that effect causes the vessels to remain open and relaxed. This improves blood flow and lowers blood pressure. Because alpha blockers also relax other muscles throughout the body, these medications can help improve urine flow in older men with prostate problems.

Examples of alpha blockers

Many alpha blockers are available, in either short-acting or long-acting forms. Short-acting medications work quickly, but their effects last only a few hours. Long-acting medications take longer to start working, but their effects last longer. Which one is best for you depends on your health and the condition being treated.

Alpha blockers are also called alpha-adrenergic blocking agents, alpha-adrenergic antagonists, adrenergic blocking agents and alpha-blocking agents. Examples of alpha blockers include:

Alfuzosin (Uroxatral) Doxazosin (Cardura) Prazosin (Minipress) Terazosin Tamsulosin (Flomax)

Uses for alpha blockers

Doctors prescribe alpha blockers to prevent, treat or improve symptoms in conditions such as:

High blood pressure Enlarged prostate (benign prostatic hyperplasia) Some circulatory conditions, such as Raynaud's disease Hardening and thickening of the skin (scleroderma) Adrenal gland tumors (pheochromocytoma)

Though alpha blockers are commonly used to treat high blood pressure, they're typically not preferred as the first treatment option. Instead, they're used in combination with other drugs, such as diuretics, when your high blood pressure is difficult to control.

Side effects and cautions

Alpha blockers may have what's called a "first-dose effect." When you start taking an alpha blocker, you may develop pronounced low blood pressure and dizziness, which can make you suddenly faint when you rise from a sitting or lying position. Other side effects include headache, pounding heartbeat, nausea, weakness, weight gain and small decreases in low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol). Alpha blockers can increase or decrease the effects of other medications you take. Tell your doctor if you take any other medications, such as beta blockers, calcium channel blockers or medications used for erectile dysfunction, if you're prescribed an alpha blocker. Some research has found that some alpha blockers can increase the risk of heart failure with longterm use. While more research is needed to confirm this finding, talk to your doctor if you're concerned.

Vasodilators
By Mayo Clinic staff

Original Article: http://www.mayoclinic.com/health/high-blood-pressuremedication/HI00057

Vasodilators
Vasodilators treat a variety of conditions, including high blood pressure. Find out more about this class of medication.
By Mayo Clinic staff

Vasodilators are medications that open (dilate) blood vessels. They work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and the walls from narrowing. As a result, blood flows more easily through your arteries, your heart doesn't have to pump as hard and your blood pressure is reduced.

Examples of vasodilators
Several vasodilators are available. Which one is best for you depends on your health and the condition being treated. Examples of vasodilators include:

Hydralazine Minoxidil (in pill form)

Uses for vasodilators

Doctors prescribe vasodilators to prevent, treat or improve symptoms in a variety of conditions, such as:

High blood pressure High blood pressure during pregnancy or childbirth (preeclampsia or eclampsia) Heart failure High blood pressure that affects the arteries in your lungs (pulmonary hypertension)

Side effects and cautions

Vasodilators are strong medications and are generally used only as a last resort, when other medications haven't adequately controlled your blood pressure. These medications have a number of side effects, some of which require taking other medications to counter those effects. Side effects include:

Chest pain Rapid heartbeat (tachycardia) Heart palpitations Fluid retention (edema) Nausea Vomiting Dizziness Flushing Headache Nasal congestion Excessive hair growth

In addition, some vasodilators can increase your risk of developing lupus, a connective tissue disease.
References

Exercise: A drug-free approach to lowering high blood pressure

Having high blood pressure and not getting enough exercise are closely related. Discover how small changes in your daily routine can make a big difference.
By Mayo Clinic staff

Your risk of high blood pressure (hypertension) increases with age, but getting some exercise can make a big difference. And if your blood pressure is already high, exercise can help you control it. Don't think you've got to run a marathon or join a gym. Instead, start slow and work more physical activity into your daily routine.

How exercise can lower your blood pressure

How are high blood pressure and exercise connected? Regular physical activity makes your heart stronger. A stronger heart can pump more blood with less effort. If your heart can work less to pump, the force on your arteries decreases, lowering your blood pressure. Becoming more active can lower your systolic blood pressure the top number in a blood pressure reading by an average of 5 to 10 millimeters of mercury (mm Hg). That's as good as some blood pressure medications. For some people, getting some exercise is enough to reduce the need for blood pressure medication. If your blood pressure is at a desirable level less than 120/80 mm Hg exercise can keep it from rising as you age. Regular exercise also helps you maintain a healthy weight, another important way to control blood pressure. But to keep your blood pressure low, you need to keep exercising. It takes about one to three months for regular exercise to have an impact on your blood pressure. The benefits last only as long as you continue to exercise.

How much exercise do you need?

Flexibility and strengthening exercises such as lifting weights are an important part of an overall fitness plan, but it takes aerobic activity to control high blood pressure. And you don't need to spend hours in the gym every day to benefit. Simply adding moderate physical activities to your daily routine will help. Any physical activity that increases your heart and breathing rates is considered aerobic exercise, including:

Household chores, such as mowing the lawn, raking leaves or scrubbing the floor Active sports, such as basketball or tennis Climbing stairs Walking Jogging Bicycling Swimming

Aim for at least 30 minutes of aerobic activity most days of the week. If you can't set aside that much time at once, remember that shorter bursts of activity count, too. You can break up your workout into three 10-minute sessions of aerobic exercise and get the same benefit as one 30-minute session.

Weight training and high blood pressure

Weight training can cause a temporary increase in blood pressure. This increase can be dramatic depending on how much weight you lift. But, weightlifting can also have long-term benefits to blood pressure that outweigh the risk of a temporary spike for most people.

If you have high blood pressure and want to include weight training in your fitness program, remember:

Learn and use proper form when lifting to reduce the risk of injury. Don't hold your breath. Holding your breath during exertion can cause dangerous spikes in blood pressure. Instead, breathe easily and continuously during each lift.

Lift lighter weights more times. Heavier weights require more strain, which can cause a greater increase in blood pressure. You can challenge your muscles with lighter weights by increasing the number of repetitions you do.

Listen to your body. Stop your activity right away if you become severely out of breath or dizzy or if you experience chest pain or pressure.

If you'd like to try weight training exercises, make sure you have your doctor's OK.

When you need your doctor's OK

Sometimes it's best to check with your doctor before you jump into an exercise program, especially if:

You're a man older than age 40 or a woman older than age 50 You smoke You're overweight or obese You have a chronic health condition, such as high blood pressure or high cholesterol You've had a heart attack You have a family history of heart-related problems before age 55 You feel pain in your chest or become dizzy with exertion You're unsure if you're in good health

If you take any medication regularly, ask your doctor if exercising will make it work differently or change its side effects or if your medication will affect the way your body reacts to exercise.

Keep it safe
To reduce the risk of injury while exercising, start slowly. Remember to warm up before you exercise and cool down afterward. Build up the intensity of your workouts gradually. Stop exercising and seek immediate medical care if you experience any warning signs during exercise, including:

Chest pain or tightness

Dizziness or faintness Pain in an arm or your jaw Severe shortness of breath An irregular heartbeat Excessive fatigue

Monitor your progress

The only way to detect high blood pressure is to keep track of your blood pressure readings. Have your blood pressure checked at each doctor's visit, or use a home blood pressure monitor. If you already have high blood pressure, home monitoring can let you know if your fitness routine is helping to lower your blood pressure, and may make it so you don't need to visit the doctor to have your blood pressure checked as often. If you decide to monitor your blood pressure at home, you'll get the most accurate readings if you check your blood pressure before you exercise, or at least one hour after exercising.
Background
Hypertension is the number one attributable risk factor for death throughout the world and a major contributor to morbidity, mortality, and increasing health care expenditures in the Philippines. Lack of access to outpatient antihypertensive medicines leads to avoidable disease progression and costly inpatient admissions. We estimated the cost to the Philippine Health Insurance Corporation (PhilHealth), which generally does not cover outpatient medicines, for inpatient care for hypertension and its sequelae. Hypertension has become a major contributor to morbidity, mortality, and increased health care expenditures in the Philippines. Two out of 10 Filipinos above 20 years of age, an estimated 7.76 million in 2003, have diagnosed hypertension [3]. Sixty-one deaths per 100,000 Filipinos were attributed to hypertension in 1996 [4]. If not properly treated, hypertension leads to strokes, heart attacks, heart failure, and/or kidney disease [5]. Hypertension is amenable to lifestyle changes for some patients but often requires life-long treatment with one or more antihypertensive medications. Medication treatment of hypertension can reduce the incidence of stroke (by about 35%40%), heart attack (by 20%25%), and heart failure (by more than 50%) [6] and thus prevent costly inpatient care for complications due to disease progression.