CHAPTER 4

HYPERTENSION
 Blood pressure
• Blood pressure (BP) is the pressure of circulating blood on the walls of blood vessels.

• Most of this pressure is due to work done by the heart by pumping blood through
the circulatory system.

• Used without further specification, "blood pressure" usually refers to the pressure in
large arteries of the systemic circulation.

• Blood pressure is usually expressed in terms of the systolic pressure (maximum during

one heartbeat) over diastolic pressure (minimum in between two heartbeats) and is
measured in millimeters of mercury (mmHg), above the surrounding atmospheric pressure.
• Blood pressure is one of the vital signs, along with respiratory rate, heart
rate, oxygen saturation, and body temperature.

• Normal resting blood pressure, in an adult is approximately 120 millimetres

of mercury (systolic), and 80 millimetres of mercury (diastolic), abbreviated
"120/80 mmHg". Globally, the average blood pressure, age standardized,
has remained about the same since 1975 to the present, at approx. 127/79
mmHg in men and 122/77 mmHg in women, although these average data
mask quite large different regional movements.
• Blood pressure that is too low is called Hypotension, pressure that is consistently
high is called Hypertension and normal levels of blood pressure is called
normotension.

•  Both hypertension and hypotension have many causes and may be of sudden
onset or of long duration.

• Long-term hypertension is a risk factor for many diseases, including heart

disease, stroke and kidney failure.

• Long-term hypertension is more common than long-term hypotension, which is

usually only diagnosed when it causes symptoms.
 Disorders of blood pressure
• Disorders of blood pressure control include high blood pressure, low blood
pressure, and blood pressure that shows excessive or maladaptive fluctuation.

1) High blood pressure:

Arterial hypertension can be an indicator of other problems and may have long-

term adverse effects. Sometimes it can be an acute problem, for
example hypertensive emergency.
• Levels of arterial pressure put mechanical stress on the arterial walls.
Higher pressures increase heart workload and progression of
unhealthy tissue growth that develops within the walls of arteries.

• The higher the pressure, the more stress that is present and the heart
muscle tends to thicken, enlarge and become weaker over time.

• Persistent hypertension is one of the risk factors for strokes, heart

attacks, heart failure, and arterial aneurysms, and is the leading
cause of chronic kidney failure
• Even moderate elevation of arterial pressure leads to shortened life expectancy.

• At severely high pressures, mean arterial pressures 50% or more above average, a

person can expect to live no more than a few years unless appropriately treated

• In the past, most attention was paid to diastolic pressure; but nowadays it is

recognized that both high systolic pressure and high pulse pressure (the numerical

difference between systolic and diastolic pressures) are also risk factors
• In some cases, it appears that a decrease in excessive diastolic pressure
can actually increase risk, due probably to the increased difference
between systolic and diastolic pressures (see the article on pulse
pressure). If systolic blood pressure is elevated (>140 mmHg) with a
normal diastolic blood pressure (<90 mmHg), it is called
"isolated systolic hypertension" and may present a health concern.
 Symptoms of hypertension

• Most people with high blood pressure have no signs or symptoms,

even if blood pressure readings reach dangerously high levels.

• A few people with high blood pressure may have headaches, shortness
of breath or nosebleeds, but these signs and symptoms aren't specific
and usually don't occur until high blood pressure has reached a severe
or life-threatening stage
 Causes of HTN
• There are two types of high blood pressure.

• Primary (essential) hypertension

• For most adults, there's no identifiable cause of high blood pressure.

• This type of high blood pressure, called primary (essential) hypertension, tends to develop
gradually over many years.

• Secondary hypertension

• Some people have high blood pressure caused by an underlying condition.

• This type of high blood pressure, called secondary hypertension, tends to appear suddenly
and cause higher blood pressure than does primary hypertension.
• Various conditions and medications can lead to secondary hypertension,
including:

• Obstructive sleep apnea

• Kidney problems

• Adrenal gland tumors

• Thyroid problems

• Certain defects you're born with (congenital) in blood vessels

• Illegal drugs, such as cocaine and amphetamines

 Risk Factors Of Hypertension

• Age. The risk of high blood pressure increases as you age. Until about age 64, high blood
pressure is more common in men. Women are more likely to develop high blood pressure
after age 65.

• Race. High blood pressure is particularly common among people of African heritage, often
developing at an earlier age than it does in whites. Serious complications, such as stroke,
heart attack and kidney failure, also are more common in people of African heritage.

• 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,

• 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.

• Secondhand smoke also can increase your heart disease risk.

• Too much salt (sodium) in your diet. Too much sodium in your diet can
cause your body to retain fluid, which increases blood pressure.
• Drinking too much alcohol. Over time, heavy drinking can damage
your heart. Having more than one drink a day for women and more
than two drinks a day for men may affect your blood pressure.

• If you drink alcohol, do so in self-control. For healthy adults,

Stress. High levels of stress can lead to a temporary 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.
 Complications of Hypertension

• Uncontrolled high blood pressure can lead to complications including:

• Heart attack or stroke. High blood pressure can cause hardening and thickening of the
arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.

• Heart failure. To pump blood against the higher pressure in your vessels, the heart has
to work harder.

• Eventually, the thickened muscle may have a hard time pumping enough blood to meet
your body's needs, which can lead to heart failure.
 Treatment of Hypertension
• Changing your lifestyle can go a long way toward controlling high blood pressure. Your
doctor may recommend you make lifestyle changes including:

• Eating a heart-healthy diet with less salt

• Getting regular physical activity

• Maintaining a healthy weight or losing weight if you're overweight or obese

• But sometimes lifestyle changes aren't enough. In addition to diet and exercise, your doctor
may recommend medication to lower your blood pressure.

• Your blood pressure treatment goal depends on how healthy you are.
• Thiazide diuretics. Diuretics, sometimes called water pills, are medications
that act on your kidneys to help your body eliminate sodium and water,
reducing blood volume.

• Thiazide diuretics are often the first, but not the only, choice in high blood
pressure medications. Thiazide diuretics include chlorthalidone,
hydrochlorothiazide (Microzide) and others.

• If you're not taking a diuretic and your blood pressure remains high, talk to
your doctor about adding one or replacing a drug you currently take with a
diuretic.
• Angiotensin-converting enzyme (ACE) inhibitors. These medications —
such as lisinopril ,benazepril ,captopril and others — help relax blood vessels
by blocking the formation of a natural chemical that narrows blood vessels.

• People with chronic kidney disease may benefit from having an ACE
inhibitor as one of their medications.

• Calcium channel blockers. These medications — including amlodipine

(Norvasc), diltiazem (Cardizem, Tiazac, others) and others — help relax the
muscles of your blood vessels. Some slow your heart rate. Calcium channel
blockers may work better for older people.
 2) Low blood pressure
• Blood pressure that is too low is known as hypotension. This is a medical concern if it causes signs or

symptoms, such as dizziness, fainting, or in extreme cases, circulatory shock.

• Causes of low arterial pressure include:

• Sepsis

• Hypovolemic shock

• Hemorrhage – blood loss

• Cardiogenic shock

• Hormonal abnormalities

• Eating disorders, particularly anorexia nervosa and bulimia

 Pulse rate
• Heart rate, also known as pulse, is the number of beats, or contractions, your heart makes per

minute or is the number of times a person's heart beats per minute.

• Normal heart rate varies from person to person, but a normal range for adults is 60 to 100 beats

per minute.

• However, a normal heart rate depends on the individual, age, body size, heart conditions, whether

the person is sitting or moving, medication use and even air temperature.

• Emotions can affect heart rate; for example, getting excited or scared can increase the heart rate.
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