Hypertension is high pressure of the blood in the arteries. While Greek and Egyptian physicians first hypothesized that blood circulated through the body more than 2,000 years ago, it took a while to prove that blood was driven by pressure. Scientific theories that blood pressure varied from person to person first appeared in the 17th century and were proven and measured with measuring methods in the late 19th century. Most of the time, high blood pressure is “silent”—which means you may feel no symptoms. That’s why people can have high blood pressure and not even know it. In fact, 1 in 3 Americans has high blood pressure. It's a common health problem. And it’s important to know that uncontrolled high blood pressure can lead to other serious health problems.
Blood pressure is the force with which blood drives against the artery walls as it moves through the body. Blood pressure is measured by two systems—systolic pressure and diastolic pressure. Systolic pressure measures cardiac output and known as the pressure in the arterial system at its highest. Diastolic pressure measures peripheral resistance and known as arterial pressure at its lowest. Blood pressure is normally measured at the brachial artery with a sphygmomanometer (pressure cuff) in millimeters of mercury (mm Hg) and read as systolic over diastolic pressure. (Pharma Tips, 2011) A blood pressure reading appears as two methods. The upper number is the systolic pressure, which is the peak force of blood as the heart pumps it. The lower number the diastolic pressure, which is the pressure when the heart is filling or relaxing before the next beat. Normal blood pressure for an adult is 120/80 (on average), but normal for an individual varies with the height, weight, fitness level, age, and health of a person. (Pharma Tips, 2011). Hypertension, or high blood pressure, is known a reading of 140/90 on three repeated measurements at least six hours separately. The definition differs for pregnant women, where hypertension is known as 140/90 on two repeated measurements six hours apart. High blood pressure causes the heart to work harder than it should and can harm the coronary arteries, the brain, the kidneys, and the eyes. Hypertension is a main cause of stroke. Classification of hypertension is normal <120 and <80, normal <130 and <85, high normal 130-139 and 85-89, Stage 1 (mild) 140–159 and 90–99 Stag 2 (moderate) 160–179 and 100–109, Stage 3 (severe) 180 or 110, Isolated systolic hypertension 140 and <90, Subgroup: borderline 140–149 and <90 (Pharma Tips, 2011). There are two major types of hypertension. Primary or essential hypertension, has no recognized cause, is identified in the majority of publics. Secondary hypertension is frequently caused by reversible factors, and is sometimes curable. This may cause by Kidney damage, Tumours , Thyroid dysfunction, Contraction of the aorta, Pregnancy-related conditions, Sleep Apnea Syndrome, Medication, recreational drugs, drinks & foods. ( Pharma Tips, 2011) White coat hypertension called anxiety-induced hypertension, it means blood pressure is only abnormal high when tested by a health professional. In resistant hypertension If blood pressure cannot come down to below 140/90 mmHg, despite a triple-drug regime, resistant hypertension is measured. (Pharma Malignant Hypertension is the most severe form of hypertension, is severe and progressive. It leads to organ damage. Except properly treated, it is deadly within five years for the majority of patients. In Isolated Systolic Hypertension the systolic blood pressure, is above 160 mm Hg, and the diastolic below 90 mm Hg. This can occur in elder people, and results from the age-related hardening of the arteries. The Western daily life and diet. (Pharma Tips, 2011). History:
Based on the segmentation of ancient Egyptian mummies, high blood pressure (hypertension) has been found a health problem since the early Egyptian empires. The blood pressure cuff invented in 1896, but it wasn't until the 1950s that the public became aware of the importance of high blood pressure as a herald of the problems commonly credited to "old age". Recent investigators has publicized a critical relationship between high blood pressure and strokes, heart attacks, congestive heart failure, and vascular disease, which together include the leading cause of death in the United States for men and women (McCann, 2001). Epidemiology:
One in three adults worldwide, according to the report, has elevated blood pressure – a condition that causes around half of all deaths from stroke and heart disease. One in 10 adults has diabetes.“This report is further indication of the dramatic rise in the conditions that cause heart disease and other chronic illnesses, particularly in low- and middle-income countries,” says Dr Margaret Chan, Director-General of WHO. (Media Centre, 2012). For the first time, the World Health Organization’s annual statistics report contains evidence from 194 countries on the percentage of men and women with elevated blood pressure and blood glucose levels ((Media Centre, 2012). In developed countries, widespread diagnosis and treatment with low-cost medication have significantly decreased mean blood pressure across populations – and this has added to a decrease in deaths from heart disease. In Africa, however, more than 40% (and up to 50%) of adults in many countries are estimated to have high blood pressure. Most of these people stay undiagnosed, although many of these cases could be treated with low-cost medications, which would significantly decrease the risk of death and disability from heart disease and stroke (Media Centre, 2012). Pathogenesis:
In over 90% of cases, the cause of hypertension is unknown but some factors can increase the risk of developing the condition. Causes that can increase the risk of increasing primary high blood pressure include: age, the risk of developing high blood pressure increases as the person get older. A family history of high blood pressure, a high intake of salt, a lack of exercise, overweight, smoking ,drinking large amounts of alcohol and stress (NHS, 2012). About 10% of high blood pressure cases are the outcome of an underlying condition or cause. These cases are mentioned to as secondary high blood pressure. Common causes of secondary high blood pressure include: kidney disease, diabetes, narrowing of the arteries, hormonal conditions, such as Cushing's syndrome (a condition where the body creates an excess of steroid hormones), situations that affect the body’s tissue, such as lupus, oral contraceptive pills, pain killers like ibuprofen, recreational drugs, like cocaine, amphetamines and crystal methamphetamine and herbal medicines, such as herbal supplements (NHS, 2012). Diagnosis:
Hypertension is diagnosed using a blood pressure test. This exam will be done several times to find out the results are correct. If the readings are high, the doctor may have the patient to return for repeat tests to check for blood pressure over time If BP is 140/90 mmHg or higher over time, THE doctor will likely diagnose the person with HBP. In case of diabetes or chronic kidney disease, a blood pressure of 130/80 mmHg or higher is measured HBP (NIH, 2012) A blood pressure test is simple and painless. This test is usually done at a doctor's office or clinic. Before the test the doctor will instruct the patient that doesn’t drink coffee or smoke cigarettes for 30 minutes prior to the test. These actions may cause a short-term rise in blood pressure. Go to the bathroom before the test. Full bladder can changer blood pressure reading. Sit for 5 minutes before the test. Movement can cause short-term rises in blood pressure. To measure a blood pressure, the doctor or nurse will use a gauge, a stethoscope and a blood pressure cuff. Patient will sit or lie down with the cuff around arm as doctor or nurse checks blood pressure (NIH, 2012). If someone diagnosed with HBP, the doctor will recommend treatment. The blood pressure will be tested again to see how the treatment affects it. Once blood pressure is under control, the patient 'll still need treatment. "Under control" means that blood pressure readings are in the normal range. The doctor will usually recommend routine blood pressure tests, can tell you how often the person should be tested. The sooner the patient finds out about HBP and treats it, the better. Early treatment may help someone avoid problems like heart attack and kidney failure (NIH, 2012). Genetics:
The University of Leicester's Department of Cardiovascular Sciences made a pioneering discovery into the causes of hypertension during their study of genetic material in human kidneys in exploration of genes that might contribute to hypertension that could cover the way for future studies (Rattue, 2011). Researchers discovered genes in the kidneys, the messenger RNAs and micro RNAs, which may add to human hypertension. Also, they uncovered two microRNAs, a hormone long believed to be involved in monitoring blood pressure, which contribute to the regulation of renin ( Rattue, 2011). Regardless of scientists being long aware that kidneys are involved in regulating blood pressure, it is the first time that researchers have recognized key genes that play a role in the process and also recognized miRNAs that handle the expression of the hormone rennin. The results were made during a large, comprehensive gene expression study of human kidneys, using several techniques to study the genes mRNAs and miRNAs that are present in the medulla, the inner part of the kidney and the cortex, the kidney's outer part. The researchers examined kidney tissue samples from 15 male hypertensive patients and 7 male patients with normal blood pressure and compared both groups' messenger RNA (mRNA) and micro RNA ( miRNA) Messenger RNA (mRNA) is a single-stranded molecule that supports in the creation of protein from DNA, whereby genetic information is copied from DNA to mRNA strands, providing a pattern that allows the cell to produce new proteins. The process of changing mRNA into proteins is regulated in part by a very small molecule called MicroRNA ( Rattue, 2011). The human kidneys samples were gained from the Silesian Renal Tissue Bank (SRTB) that supplies human kidney samples for use in genetic investigation into cardiovascular diseases. All samples were from Polish male persons of white European ancestry. Investigators selected samples from 15 patients with hypertension, together with samples of 7 patients with normal blood pressure who they used as the control group (Rattue, 2011). Clinical manifestations:
Simple high blood pressure generally occurs without any symptoms (silently) and so hypertension has been considered "the silent killer." It is called this because the disease can advance to finally develop any one or more of the several potentially fatal problems such as heart attacks or strokes. Simple hypertension may be present and continue unnoticed for many years, or even decades. This happens because there are no signs, and those affected fail to undergo periodic blood pressure screening (Cunha and reviewed by Marks, 2012). Some people with simple hypertension, may experience symptoms such as headache, dizziness, shortness of breath, and blurred vision generally with blood pressure that is very high. The presence of symptoms can be a good thing in that they can ready people to consult a doctor for management and make them more compliant in taking their medications. Often, however, a person's first interaction with a physician may be after significant harm to the body has occurred. In many cases, a person visits or is taken to the doctor or an emergency department with a heart attack, stroke, kidney failure, or reduced vision (due to damage to the back part of the retina). Greater public awareness and frequent blood pressure screening may help to identify patients with undiagnosed high blood pressure before significant problems have developed (Cunha and reviewed by Marks, 2012). About one out of every 100 (1%) people with hypertension is diagnosed with severe high blood pressure at their first appointment to the doctor. In these patients, the diastolic blood pressure exceeds 140 mm Hg suffered persons often experience severe headache, nausea, visual symptoms, dizziness, and sometimes kidney failure. Malignant hypertension (high blood pressure that comes suddenly) is a medical emergency and requires urgent treatment to prevent a stroke (Cunha and reviewed by Marks, 2012). Treatment:
Blood pressure can be lower by lifestyle changes and by taking medications. The treatment will depend on blood pressure level and risk of developing a cardiovascular disease, such as a heart attack or stroke. If blood pressure is a little above 130/80mmHg but risk of cardiovascular disease is low, the blood pressure could go low by making some changes to the lifestyle. If the blood pressure is moderately high (140/90mmHg or above) then its risk of cardiovascular disease in the next 10 years, treatment will include medication and lifestyle changes. If the blood pressure is very high (180/110mmHg or above) the need of treatment soon, with further tests, depending on health (NHS, 2012). Lifestyle changes to reduce high blood pressure will lower blood pressure in a matter of weeks and others may take longer. In diet cut salt intake to less than 6g a day. Eat a healthy, low-fat, balanced diet, containing plenty of fresh fruit and vegetables. Be active: being physically active is one of the most vital things to prevent and control high blood pressure. Cut down on alcohol of daily life will help to manage the blood pressure. Stop smoking. Smoking is a cause of heart and lung diseases. Lose weight. Drink less caffeinated-rich drinks such as cola, coffee and tea. Caffeine may affect blood pressure. Do relaxation therapies, such as yoga, meditation and stress management. Consequently, some people find that, sticking to a healthy lifestyle, helps to prevent them depending on medicines (NHS, 2012). There are a several blood-pressure-lowering medicines available. In some cases, it may need to take blood pressure-lowering medication for the rest of life. But if blood pressure levels stay under control for several years, the person might be able to stop treatment (NHS, 2012). The most widely used medications for treating high blood pressure are ACE (Angiotensin-converting enzyme) inhibitors reduce blood pressure by relaxing blood vessels. Calcium channel blockers stop calcium from entering the muscle cells of the heart and blood vessels. This widens the arteries and helps to reduces blood pressure. Diuretics known as water pills, diuretics flush excess water and salt from the body through elimination. Beta-blocker makes the heart beat more slowly and with less force, to lower blood pressure. Alpha-blockers are not generally optional as a first choice for lowering high blood pressure unless other treatments have not worked. Alpha-blockers help to relax blood vessels, to make easier for blood to flow through them (NHS, 2012). Prevention:
High blood pressure can be prevented by eating healthy diet. By cutting down on the amount of salt food and eat plenty of fruit and vegetables can help to lower blood pressure. Salt increases blood pressure, the more salt in diet, higher the blood pressure will be (NHS, 2012). Frequently drinking alcohol above the recommended amount will raise blood pressure over time. Sticking within the recommended levels is the best way to reduce the risk of developing high blood pressure. The NHS recommends: Men should not regularly drink more than three-to-four units per day and Women should not regularly drink more than two-to-three units per day (NHS, 2012). More than four cups of coffee per day may raise blood pressure. Drink enough fluids. Overweight can raise blood pressure also so try to maintain a healthy weight according to the height. Stay active and regular exercise help to lower blood pressure by keeping the heart and blood vessels in good form. Regular exercise can also help to lose weight, which will also help to lower blood pressure (NHS, 2012). Smoking doesn't directly raise high blood pressure but it puts someone at much higher risk of a heart attack and a stroke. Smoking causes arteries to narrow much more quickly and risk of a heart or lung disease in the future will increase (NHS, 2012). Conclusion:
Hypertension is one of the most common chronic diseases worldwide. But, many people have hypertension without consciousness and treatment of the disease, indicating it is essential to offer some basic knowledge and vital information of hypertension to the public, upper primary pupils at early stage of their lifes to make them ready for early in prevention or management of this disorder in their future life. Many risk factors are connected with hypertension. Avoiding the factors help to prevent hypertension, reduce symptoms and prolong lives. Problems of hypertension are major causes of mortality. Reducing blood pressure with medication or keeping it within normal range will stop, or reduce these worries.
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