Hypertension
Hypertension, commonly referred to as high blood pressure, is a medical condition where the blood pressure in the arteries is persistently elevated. Blood pressure is the force exerted by the blood against the walls of the blood vessels as it flows through them.
Hypertension is classified based on the level of blood pressure as follows:
- Normal blood pressure: Less than 120/80 mmHg
- Elevated blood pressure: 120-129/less than 80 mmHg
- Stage 1 hypertension: 130-139/80-89 mmHg
- Stage 2 hypertension: 140/90 mmHg or higher
Causes of Hypertension
Genetics:
Some people are predisposed to hypertension due to their genetic makeup. Research has shown that certain genes can contribute to the development of hypertension, including those involved in regulating blood pressure, blood vessel function, and sodium balance in the body.
Age:
As people age, their blood vessels become less flexible, leading to an increase in blood pressure. This is because the walls of the arteries become stiffer and less able to expand and contract with changes in blood flow.
Obesity:
Being overweight or obese can increase the risk of hypertension. This is because excess weight puts extra pressure on the heart, leading to an increase in blood pressure. In addition, obesity can also cause insulin resistance and inflammation, which can further contribute to the development of hypertension.
Lack of physical activity:
Physical activity is important in maintaining healthy blood pressure levels. A sedentary lifestyle can lead to an increase in blood pressure as the heart has to work harder to pump blood throughout the body.
Poor diet:
A diet high in salt, saturated fats, and processed foods can contribute to the development of hypertension. Sodium is known to increase blood pressure by causing the body to retain water. In addition, a diet lacking in fruits, vegetables, and other healthy foods can also contribute to hypertension.
Smoking:
Smoking can cause the blood vessels to narrow, leading to an increase in blood pressure. In addition, smoking also damages the lining of the blood vessels, making them more prone to plaque buildup and narrowing, which can further contribute to hypertension.
Stress:
Chronic stress can contribute to hypertension by causing the body to release stress hormones such as cortisol and adrenaline, which can increase blood pressure.
Medical conditions:
Certain medical conditions can also contribute to the development of hypertension, including kidney disease, sleep apnea, and thyroid disorders.
Clinical Feature of Hypertension
Hypertension, also known as high blood pressure, often has no symptoms or warning signs. However, as blood pressure levels rise, the condition can cause several clinical features or signs that may indicate the need for further evaluation and treatment. Here are some of the common clinical features of hypertension:
Headaches:
Hypertension can cause headaches, especially in the morning. These headaches can be dull or throbbing and may be accompanied by dizziness or lightheadedness.
Blurred vision:
Elevated blood pressure can cause changes in the blood vessels of the eyes, leading to blurred vision or even vision loss in severe cases.
Chest pain:
Hypertension can cause chest pain, especially during physical activity or emotional stress. This is due to the increased workload on the heart and can be a sign of an underlying heart condition.
Shortness of breath:
Hypertension can lead to shortness of breath, especially during physical activity. This is due to the increased demand for oxygen by the body and can be a sign of an underlying heart or lung condition.
Nosebleeds:
Elevated blood pressure can cause the blood vessels in the nose to rupture, leading to nosebleeds.
Fatigue:
Hypertension can cause fatigue or a feeling of tiredness, especially during physical activity or after exertion.
Flushing:
Hypertension can cause flushing or redness in the face or neck, especially during emotional stress or physical activity.
Nausea or vomiting:
Hypertension can cause nausea or vomiting, especially in severe cases.
It's important to note that these clinical features are not specific to hypertension and can be caused by other medical conditions. Therefore, it's essential to seek medical evaluation if you experience any of these signs or symptoms.
Treatment of Hypertension
The treatment of hypertension, also known as high blood pressure, depends on the severity of the condition and the presence of other medical conditions. In general, the goal of treatment is to lower blood pressure levels and reduce the risk of complications such as heart disease, stroke, and kidney failure.
Here are some of the common approaches to treating hypertension:
Lifestyle modifications:
Lifestyle modifications are the first-line treatment for hypertension. These include dietary changes such as reducing sodium intake, increasing potassium intake, and following a heart-healthy diet such as the DASH (Dietary Approaches to Stop Hypertension) diet. Regular physical activity, weight loss, and stress reduction techniques such as meditation, yoga, or deep breathing can also help lower blood pressure.
Monitoring and follow-up:
Patients with hypertension require regular monitoring to ensure that their blood pressure is under control. The frequency of follow-up visits may vary depending on the severity of hypertension and the presence of other medical conditions.
Treatment of underlying medical conditions:
If hypertension is caused by an underlying medical condition such as kidney disease, thyroid disease, or sleep apnea, treating the underlying condition may help lower blood pressure.
Medications:
If lifestyle modifications are not enough to lower blood pressure, medications may be prescribed. There are several types of medications that can be used to treat hypertension, including diuretics, beta-blockers, calcium channel blockers, ACE inhibitors, and ARBs. The choice of medication depends on the patient's age, medical history, and other medications they are taking.
If not controlled with lifestyle modifications start with drug,
• Tab. Atenolol 25 mg (Beta blocker) or Tab. Telmisartan 20 mg (Angiotensin receptor blocker) once a day.
Moderate Hypertension (140 - 160 / 90-100 mm Hg)
• Tab. Atenolol 50 mg (Beta blocker) 1-2 daily
Or
• Tab. Metoprolol 50 to 100 mg once a day
Or
• Tab. Losartan 25 to 50 mg once a day (Angiotensin receptor blocker)
Or
• Tab. Telmisartan 20 - 40 mg once a day (Drug of choice)
Or
• Tab. Enapril Maleate 2.5 to 10 mg once a day (ACE inhibitors)
Or
• Tab. Nifedipine 10 mg Once a day to thrice a day (Calcium channel blocker)
Or
• Tab. Prazosin Hydrochloride 2.5 to 5 mg Once a day (Alpha blocker)
If not controlled,
* Add diuretics like Hydrochlorothiazide 12.5 mg
* Combine two drugs like Beta blocker + Calcium channel blocker or ACE inhibitor + Calcium channel blocker or ACE inhibitor + Calcium channel blocker or ACE inhibitor + alpha blocker.
Severe Hypertension (160-180 / 100-120 mm Hg)
Start with combination of 2 drugs
• Tab. Amlodipine + Lisinopril 1 once a day Or twice a day
Or
• Tab. Amlodipine + Metoprolol 1 once a day Or twice a day
Or
• Tab. Telmisartan + Ramipril 1 once a day Or twice a day
Plus
• Tab. Torsemide 10 mg once a day
• Tab. Restyl 0.25 mg once at bed time
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