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HYPERTENSION

March 27, 2017 - nerve and brain
HYPERTENSION

DEFINITION

hypertentionHigh blood pressure (hypertension) is an increase in blood pressure in the arteries.

In general, hypertension is a condition without symptoms, in which abnormally high pressure in the arteries causes an increased risk for stroke, aneurysm, heart failure, heart attack and kidney damage.

On examination of blood pressure will get two numbers. Higher numbers obtained when the heart contracts (systolic), a lower number obtained when the heart relaxes (diastolic). Blood pressure is written as systolic pressure diastolic pressure slash, eg 120/80 mmHg, read one hundred and twenty over eighty. It said if the high blood pressure while sitting systolic blood pressure to 140 mmHg or more, or a diastolic blood pressure was 90 mmHg or more, or both. In high blood pressure, usually an increase in systolic and diastolic pressures.

In isolated systolic hypertension, systolic blood pressure to 140 mmHg or more, but the diastolic pressure less than 90 mmHg and diastolic pressure is still within normal range. Hypertension is often found in the elderly. Along with age, almost everyone has experienced an increase in blood pressure; systolic pressure continues to increase up to 80 years and diastolic pressures continue to increase until the age of 55-60 years, then decrease slowly or even declined drastically.

Malignant hypertension is a very severe hypertension, which, if untreated, will lead to death within 3-6 months.
Hypertension is rare, only 1 out of every 200 people with hypertension.

Blood pressure in a person’s life varies naturally. Infants and children normally have a blood pressure that is much lower than adults. Blood pressure is also affected by physical activity, which will be higher at the time of the activity and lower when resting. Blood pressure is also different in one day; the highest in the morning and lowest at night while sleeping.

Classification of Blood Pressure In Adults

Category Systolic Blood Pressure Diastolic Blood Pressure

BLOOD PRESSURE CONTROL

Increased blood pressure in the arteries can occur in several ways:

1. The heart pumps more powerful that drain more fluid on every second

2. The large arteries lose elasticity and become rigid, so they can not inflate when the heart pumps blood through the artery. Because the blood in each heartbeat is forced to pass through narrow vessels than normal and cause a rise in pressure. This is what happened in the elderly, where the walls of arteries thickened and stiff due to arteriosclerosis.

In the same way, the blood pressure also rose during vasoconstriction occurs, ie if the small arteries (arterioles) to temporarily shrink due to stimulation of nerves or hormones in the blood.

3. Increased fluid in the circulation can cause increased blood pressure. This occurs if there are abnormalities in kidney function that can not afford to throw some salt and water from the body. The blood volume in the body increases, so that the blood pressure also increases.

Conversely, if:
– Reduced heart pumping activity
– Arteries are widening
– A lot of fluid out of circulation
then the blood pressure will decrease.

Adjustments to these factors implemented by changes in renal function and autonomic nervous system (part of the nervous system that regulates many body functions automatically).

1. Changes in kidney function
Kidneys control blood pressure in several ways:
– If your blood pressure rises, the kidneys will increase spending on salt and water, which will cause a reduction in blood volume and return to normal blood pressures.
– If the blood pressure falls, the kidneys will reduce the discharge of salt and water, so that the increased blood volume and blood pressure returned to normal.
– Kidneys can also increase blood pressure by producing an enzyme called renin, which triggers the formation of the hormone angiotensin, which in turn will trigger the release of the hormone aldosterone.

Kidney is an important organ in controlling blood pressure; Therefore a variety of diseases and disorders of the kidney pda can cause high blood pressure.
Eg narrowing of the arteries leading to one of the kidneys (renal artery stenosis) can cause hypertension.
Inflammation and injury to one or both kidneys can also cause a rise in blood pressure.

2. The sympathetic nervous system is part of the autonomic nervous system, which for the time being:
– Increased blood pressure responses during the fight-or-flight (the body’s physical reaction to the threat from the outside)
– Improving the speed and strength of the heartbeat; also narrowed mostly arterioles, but the widening of the arterioles in certain areas (for example skeletal muscle, which requires more blood supply)
– Minimizing the loss of water and salt by the kidneys, thereby increasing the volume of blood in the body
– Releases the hormone epinephrine (adrenaline) and norepinephrine (noradrenaline), which stimulates the heart and blood vessels.

CAUSE

In about 90% of hypertensive patients, the cause is unknown and this situation is known as essential hypertension or primary hypertension. Essential hypertension is likely to have many causes; some changes on the heart and blood vessels possibilities together cause increased blood pressure.

If the cause is unknown, it is called secondary hypertension. In about 5-10% of patients with hypertension, the cause is kidney disease. In about 1-2%, the cause is hormonal abnormalities or use of certain medications (eg, birth control pills).

Other rare causes of hypertension is pheochromocytoma, which is a tumor in the adrenal gland that produces the hormone epinephrine (adrenaline) or norepinephrine (noradrenaline).

Overweight (obesity), an inactive lifestyle (lazy exercise), stress, alcohol or salt in food; can trigger hypertension in people have inherited sensitivity. Stress tends to cause a rise in blood pressure for a while, if the stress has passed, the blood pressure usually returns to normal.

Some causes of secondary hypertension:

1. Kidney Disease
– Renal artery stenosis
– pyelonephritis
– glomerulonephritis
– Kidney Tumors
– Kidney disease polikista (usually inherited)
– Trauma to the kidney (renal involvement wounds)
– Radiation therapy is the kidney

2. Hormonal Disorders
– Hyperaldosteronism
– Cushing’s syndrome
– Pheochromocytoma

3. Drugs
– Family planning pills
– Corticosteroids
– Cyclosporine
– Erythropoietin
– Cocaine
– Alcohol abuse
– Cinnamon (in very large numbers)

4. Other Causes
– Koartasio aorta
– Preeclampsia in pregnancy
– Acute intermittent porphyria
– Lead poisoning is acute.

SYMPTOMS

In most patients, hypertension produces no symptoms; although inadvertently some of the symptoms occur simultaneously and reliably associated with high blood pressure (when in fact it is not). Symptoms in question is a headache, bleeding from the nose, dizziness, flushed face and fatigue; which could have occurred both in patients with hypertension, as well as a person with normal blood pressure.

If hypertension is severe or chronic and untreated, can result in the following symptoms:
– headache
– fatigue
– nausea
– gag
– out of breath
– restless
– Sight becomes blurred
that occur because of damage to the brain, eyes, heart and kidneys.

Some patients with severe hypertension experienced a loss of consciousness and even coma due to swelling of the brain. This condition is called hypertensive encephalopathy, which require immediate action.

That untreated hypertension

DIAGNOSIS

Blood pressure is measured after a person sitting or lying down for 5 minutes. Figures 140/90 mmHg or more can be defined as hypertension, but the diagnosis can not be enforced only by one measurement.

If the first measurement to provide high yields, and blood pressure were measured again and then measured as much as 2 times in the next 2 days to convince their hypertension. The measurement results not only determine the presence of high blood pressure, tetepi also used to classify the severity of hypertension.

Once the diagnosis is made, the examination of the major organs, especially the blood vessels, heart, brain and kidneys.

The retina (the light sensitive membrane on the inner surface of the back of the eye) is the only body part that can directly show the effect of hypertension on arterioles (small blood vessels). Assuming that the changes that occur in the retina are similar to the changes that occur in other blood vessels in the body, such as the kidneys. To check the retina, used an ophthalmoscope. By determining the degree of retina damage (retinopathy), then it can be determined the severity of hypertension.

Changes in the heart, especially the enlargement of the heart, can be found on electrocardiography (ECG) and chest x-rays. In the early stages, these changes can be found through echocardiography (examination with ultrasonic waves to describe the state of the heart).

Abnormal heart sounds (called the fourth heart sound), can be heard through a stethoscope and a heart earliest changes that occur due to high blood pressure.

The first indication of kidney damage can be known mainly through the examination of the urine. The presence of blood cells and albumin (a protein) in the urine may indicate kidney damage.

Tests to determine the cause of hypertension is mainly performed on young patients. These checks can include x-rays and radioisotopes kidney, chest X-rays and blood tests and urine for certain hormones.

To find their kidney abnormalities, were asked about their previous history of renal disease. A stethoscope affixed over the abdomen to listen to their bruit (noise occurs because the blood flowing through the arteries leading to the kidneys, which is narrowing). Do urine analysis and x-ray or ultrasound of the kidney.

If the cause is a pheochromocytoma, then in the urine can reveal any material decomposition of hormones epinephrine and norepinephrine. Usually, these hormones also cause symptoms of headache, anxiety, palpitations (heart palpitations), excessive sweating, tremor (shaking) and pale.

Other causes can be found through a routine examination. For example, measuring the levels of potassium in the blood can help people find their hyperaldosteronism and measure blood pressure in both arms and legs can help people find their koartasio aorta.

TREATMENT

Essential hypertension can not be cured but can be given treatment to prevent complications.

The initial step is usually to change the lifestyle of the patient:

1. Patients with hypertension who are overweight it is recommended to lose weight until the ideal limit.
2. Changing the diet in diabetes, obesity or high blood cholesterol levels.
Reducing the use of salt to less than 2.3 grams of sodium or 6 grams of sodium chloride per day (accompanied by the intake of calcium, magnesium and potassium are sufficient) and cutting back on alcohol.
3. Aerobic exercise is not too heavy.
People with essential hypertension do not need to restrict his activities during his blood pressure under control.
4. Stop smoking.

PROVISION OF MEDICINES

1. thiazide diuretics are usually the first drug given to treat hypertension.
Diuretics help the kidneys remove salt and water, which will reduce the volume of fluid in the body that lowers blood pressure.
Diuretics also causes dilation of blood vessels.
Diuretics cause loss of potassium through the urine, so it is sometimes given extra potassium or potassium relievers.
Diuretics are very effective in:
– Blacks
– Elderly
– obesity
– Patients with heart failure or chronic kidney disease

2. adrenergic inhibitors are a group of drugs consisting of alpha-blockers, beta-blockers and alpha-beta-blocker labetalol, which inhibit the effects of the sympathetic nervous system.
The sympathetic nervous system is the nervous system which will immediately respond to stress by increasing blood pressure.
The most commonly used is a beta-blocker, which effectively granted to:
– Young patients
– Patients who have had heart attacks
– Patients with rapid heartbeat
– Angina pectoris (chest pain)
– Migraine headaches.

3. Angiotensin converting enzyme inhibitors (ACE-inhibitors) causes a decrease in blood pressure by widening the artery.
This drug is effective is given to:
– Whites
– young age
– Patients with heart failure
– Patients with protein in the urine caused by chronic kidney disease or diabetic kidney disease
– Men who suffer from impotence as a side effect of other drugs.

4. Angiotensin-II-blockers cause a decrease in blood pressure by a mechanism similar to ACE-inhibitor.

5. Calcium antagonists cause widening blood vessels with a mechanism that is completely different.
Very effective awarded to:
– Blacks
– Elderly
– Patients with angina pectoris (chest pain)
– Rapid heartbeat
– Migraine headaches.

6. Vasodilators directly cause the widening blood vessels.
Drugs of this class is almost always used in addition to other anti-hypertensive drugs.

7. Emergency hypertension (eg malignant hypertension) need a drug that lowers high blood pressure immediately.
Some medications can lower blood pressure quickly and mostly given intravenously (through a vein):
– diazoxide
– nitroprusside
– nitroglycerin
– Labetalol.
Nifedipine is a calcium antagonist to work very quickly and can be given by mouth (swallowed), but these drugs can cause hypotension, so that the gift must be closely monitored.

MANAGEMENT OF SECONDARY HYPERTENSION

Treatment depends on the cause of secondary hypertension. Coping with kidney disease often can restore blood pressure to normal or at least not lower blood pressure.

Narrowing of the arteries can be treated by inserting a hose which in the end is attached balloons and develop the bubble. Or it could be removed surgically to create a shortcut (bypass surgery).

Tumors that cause hypertension (eg, pheochromocytoma) is usually removed surgically.

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