Hypertension is considered as the biggest single risk factor for deaths worldwide.
According to the World Health Organization (WHO), hypertension causes 7 million deaths every year while 1.5 billion people suffer due to its complications.
Here in the Philippines, Hypertension remains to be the leading cause of illness and a primary contributor to premature death, projecting around 200,000 deaths yearly in the country attributed directly or indirectly to
high blood pressure.
Did you know that 1 out of 4 Filipinos are unaware that they are at risk of Hypertension.
Based on national surveys, the total number of hypertensive Filipinos is now more than 12 million, with more than half of them are unaware of their condition.
High blood pressure is a common condition in which the long-term force of the blood against your artery walls is high enough and it can lead to severe complications and increases the risk of heart disease, stroke, and death.
Blood pressure is the force exerted by the blood against the walls of the blood vessels. It is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries.
The pressure depends on the work being done by the heart and the resistance of the blood vessels. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.
Increase in Blood Flow = Increase in Heart work load/ pumping =
Increase in Blood Pressure
Increase in Blood vessels resistance/ Blood vessel constriction = Increase in Blood Pressure
You can have high blood pressure (hypertension) for years without any symptoms .
Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.
High blood pressure generally develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.
SIGNS AND SYMPTOMS
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, dizziness, 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.
ETIOLOGIES (CAUSE) OF HYPERTENSION
There are 2 types of 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.
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, see the image below:
DRUG AND FOOD INDUCED
Sympathomimetic amines include amphetamines, pseudoephedrine, phenylpropanolamine, and ephedrine. Historically, these compounds were contained in some OTC cough and cold preparations.
Nonsteroidal anti-inflammatory drugs (NSAIDs) have potentially adverse effects on blood pressure. Drug-induced hypertension associated with NSAIDs is due to the renal effects of these drugs. Specifically, NSAIDs cause dose-related increases in sodium and water retention.
All corticosteroid drugs, including prednisone, can cause sodium retention, resulting in dose-related fluid retention.
*Fludrocortisone causes significant blood pressure increases and, thus, is useful in treating patients with postural hypotension.
Chronic use of oral contraceptives may slightly raise blood pressure in certain women and may have other adverse effects on cardiovascular risk.
Ginseng is generally recognized as safe and has been associated with few serious side effects. Because it can have a mild stimulant effect, use with other stimulants in patients with cardiovascular disease should be cautioned. A type of ginseng abuse syndrome, characterized by diarrhea, hypertension, nervousness, dermatologic eruptions, and insomnia, has been described.This syndrome may be exhibited after single high doses or prolonged periods of use. Other supplements that may increase arterial pressure include natural licorice and yohimbine.
Ex. Venlafaxine and Sibutramine
Ex. Cyclosporine and Tacrolimus
Hypertension in Pregnancy
– may occur pre-Pregnancy or before 20 weeks of pregnancy.
– no presence of kidney disease
– Hypertension during pregnancy.
– no presence of kidney disease.
– Hypertension before or during Pregnancy.
– there could be a presence of kidney disease
– there’s a possibility of having an edema
– asymptomatic / no symptoms
*Blurring of vision
*Acute heart failure
*Acute renal failure
DETERMINANTS OF BLOOD PRESSURE
BP = CO + SVR
BP (Blood Pressure)
CO (Cardiac Output)
SVR (Systemic Vascular Resistance)
1. CARDIAC OUTPUT
volume of blood pumped out by the heart in 1 minute.
CO = SVR + HR
2. STROKE VOLUME
volume of blood pumped out by the heart with every contraction.
DETERMINANTS OF STROKE VOLUME
Inotropism = Increase Stroke Volume
Inotropism = Decrease Stroke Volume,
Decrease Cardiac Output = Decrease Blood Pressure
Blood vessels Constricted (Venoconstriction =
Blood vessels Dilated (Venodilation) =
Decrease Preload = Decrease Stroke Volume = Decrease cardiac Output = Decrease Blood pressure
Decrease Fluid (Water + Sodium) = Decrease Blood Pressure
3. SYSTEMIC VASCULAR RESISTANCE (SVR)
resistance encountered by the heart as it pumps out it’s blood contents
Arteriolar Constriction = Increase SVR =
Increase Blood pressure
Arteriolar Dilation = Decrease SVR = Decrease Blood pressure
What do the numbers mean?
SYSTOLIC PRESSURE. refers to the amount of pressure in your arteries during the contraction of your heart muscle. This is the top number.
DIASTOLIC PRESSURE. refers to your blood pressure when your heart muscle is between beats. This is the bottom number.
Both numbers are important in determining the state of your heart health.
Numbers greater than the ideal range indicate that your heart is working too hard to pump blood to the rest of your body.
What’s a normal reading?
For a normal reading, your blood pressure needs to show a top number (systolic pressure) that’s between 90 and less than 120 and a bottom number (diastolic pressure) that’s between 60 and less than 80. The American Heart Association (AHA) considers blood pressure to be within the normal range when both your systolic and diastolic numbers are in these ranges.
Blood pressure readings are expressed in millimeters of mercury. This unit is abbreviated as mm Hg. A normal reading would be any blood pressure below 120/80 mm Hg and above 90/60 mm Hg in an adult.
If you’re in the normal range, no medical intervention is needed. However, you should maintain a healthy lifestyle and healthy weight to help prevent hypertension from developing. Regular exercise and healthy eating can also help. You may need to be even more mindful of your lifestyle if hypertension runs in your family.
Elevated blood pressure
Numbers higher than 120/80 mm Hg are a red flag that you need to take on heart-healthy habits.
When your systolic pressure is between 120 and 129 mm Hg and your diastolic pressure is less than 80 mm Hg, it means you have elevated blood pressure.
Although these numbers aren’t technically considered high blood pressure, you’ve moved out of the normal range. Elevated blood pressure has a good chance of turning into actual high blood pressure, which puts you at an increased risk of heart disease and stroke.
No medications are necessary for elevated blood pressure. But this is when you should adopt healthier lifestyle choices. A balanced diet and regular exercise can help lower your blood pressure to a healthy range and help prevent elevated blood pressure from developing into full-fledged hypertension.
Hypertension: Stage 1
You’ll generally be diagnosed with high blood pressure if your systolic blood pressure reaches between 130 and 139 mm Hg, or if your diastolic blood pressure reaches between 80 and 89 mm Hg. This is considered stage 1 hypertension.
However, the AHA notes that if you get only one reading this high, you may not truly have high blood pressure. What determines the diagnosis of hypertension at any stage is the average of your numbers over a period of time.
Your doctor can help you measure and track your blood pressure to confirm whether it’s too high. You may need to start taking medications if your blood pressure doesn’t improve after one month of following a healthy lifestyle, especially if you’re already at high risk for heart disease. If you’re at lower risk, your doctor may want to follow up in three to six months after you’ve adopted more healthy habits.
If you’re 65 years or older and otherwise healthy, your doctor will likely recommend treatment and lifestyle changes once your systolic blood pressure is greater than 130 mm Hg. The treatment for adults 65 and older who have significant health problems should be made on a case-by-case basis.
Treating high blood pressure in older adults appears to decrease memory problems and dementia.
Hypertension: Stage 2
Stage 2 high blood pressure indicates an even more serious condition. If your blood pressure reading shows a top number of 140 or more, or a bottom number of 90 or more, it’s considered stage 2 hypertension.
At this stage, your doctor will recommend one or more medications for keeping your blood pressure under control. But you shouldn’t rely solely on medications to treat hypertension. Lifestyle habits are just as important in stage 2 as they are in the other stages.
Some medications that can complement a healthy lifestyle include:
A blood pressure reading above 180/120 mm Hg indicates a serious health problem. The AHA refers to these high measurements as a “hypertensive crisis.” Blood pressure in this range requires urgent treatment even if there are no accompanying symptoms.
You should seek emergency treatment if you have blood pressure in this range, which may accompany symptoms such as:
However, sometimes a high reading can occur temporarily and then your numbers will return to normal. If your blood pressure measures at this level, your doctor will likely take a second reading after a few minutes have passed. A second high reading indicates that you’ll need treatment either as soon as possible or immediately depending on whether or not you have any of the symptoms described above.
Low blood pressure is known as hypotension. In adults, a blood pressure reading of 90/60 mm Hg or below is often considered hypotension. This can be dangerous because blood pressure that is too low doesn’t supply your body and heart with enough oxygenated blood.Some potential causes of hypotension can include:
Hypotension is usually accompanied by lightheadedness or dizziness. Talk to your doctor to find out the cause of your low blood pressure and what you can do to raise it.
To measure your blood pressure, your doctor or a specialist will usually place an inflatable arm cuff around your arm and measure your blood pressure using a pressure-measuring gauge.
A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure).
Your doctor will likely take two to three blood pressure readings each at three or more separate appointments before diagnosing you with high blood pressure. This is because blood pressure normally varies throughout the day, and it may be elevated during visits to the doctor (white coat hypertension).
Your blood pressure generally should be measured in both arms to determine if there is a difference. It’s important to use an appropriate-sized arm cuff.
Your doctor may ask you to record your blood pressure at home to provide additional information and confirm if you have high blood pressure.
Your doctor may recommend a 24-hour blood pressure monitoring test called ambulatory blood pressure monitoring to confirm if you have high blood pressure. The device used for this test measures your blood pressure at regular intervals over a 24-hour period and provides a more accurate picture of blood pressure changes over an average day and night. However, these devices aren’t available in all medical centers, and they may not be reimbursed.
If you have any type of high blood pressure, your doctor will review your medical history and conduct a physical examination.
Your doctor may also recommend routine tests, such as a urine test (urinalysis), blood tests, a cholesterol test and an electrocardiogram — a test that measures your heart’s electrical activity. Your doctor may also recommend additional tests, such as an echocardiogram, to check for more signs of heart disease.
Taking your blood pressure at home
An important way to check if your blood pressure treatment is working, to confirm if you have high blood pressure, or to diagnose worsening high blood pressure, is to monitor your blood pressure at home.
Home blood pressure monitors are widely available and inexpensive, and you don’t need a prescription to buy one. Home blood pressure monitoring isn’t a substitute for visits to your doctor, and home blood pressure monitors may have some limitations.
Make sure to use a validated device, and check that the cuff fits. Bring the monitor with you to your doctor’s office to check its accuracy once a year. Talk to your doctor about how to get started with checking your blood pressure at home.
Devices that measure your blood pressure at your wrist or finger aren’t recommended by the American Heart Association.
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
-Limiting the amount of alcohol you drink
But sometimes lifestyle changes aren’t enough. In addition to diet and exercise, your doctor may recommend medication to lower your blood pressure.
BLOOD PRESSURE GOALS
Your blood pressure treatment goal depends on how healthy you are.
Your blood pressure treatment goal should be less than 130/80 mm Hg if:
You’re a healthy adult age 65 or older
You’re a healthy adult younger than age 65 with a 10 percent or higher risk of developing cardiovascular disease in the next 10 years
You have chronic kidney disease, diabetes or coronary artery disease
Although 120/80 mm Hg or lower is the ideal blood pressure goal, doctors are unsure if you need treatment (medications) to reach that level.
If you’re age 65 or older, and use of medications produces lower systolic blood pressure (such as less than 130 mm Hg), your medications won’t need to be changed unless they cause negative effects to your health or quality of life.
The category of medication your doctor prescribes depends on your blood pressure measurements and your other medical problems. It’s helpful if you work together with a team of medical professionals experienced in providing treatment for high blood pressure to develop an individualized treatment plan.
RISK FACTORS OF HYPERTENSION
High blood pressure has many risk factors, it can be either Risk factors that can be controlled and cannot be controlled:
CANNOT BE CONTROLLED:
CAN BE CONTROLLED
Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
Smoking/ 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. This can cause your arteries to narrow and increase your risk of heart disease. Secondhand smoke also can increase your heart disease risk.
Excessive/ Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you don’t get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.
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 moderation. For healthy adults, that means up to one drink a day for women and two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
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.
Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease, diabetes and sleep apnea.
Pregnancy. Sometimes pregnancy contributes to high blood pressure, as well.
Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise, contribute to high blood pressure.
The excessive pressure on your artery walls caused by hIgh blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.
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.
Aneurysm. Increased bLood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
Heart failure. To pump bloOd against the higher pressure in your vessels, the heart has to work harder. This causes the walls of the heart’s pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may haVe a hard time pumping enough blood to meet your body’s needs, which can lead to heart failure.
Kidney Disease/ Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally. Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
Metabolic syndrome. This syndromE is a cluster of disorders of your body’s metabolism, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL) cholesterol, the “good” cholesterol; high blood pressure and high insulin levels. These conditions make you more likely to develop diabetes, heart disease and stroke.
Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding conceptS is more common in people with high blood pressure.
Dementia. NarroWed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular dementia.
Vision Loss/ Hypertensive Retinopathy. HypertensIon can cause damage to the blood vessels in the retina, the area at the back of the eye where images focus. This eye disease is known as hyPertensive retinopathy. The damage can be serious if hypertension is not treated.
Sexual Dysfunction. A link between high blood prEssure and sexual problems is proved in men. For women who have decreased sexual satisfaction, it’s not yet proved that high blood pressure is to blame.
Over time, high blood pRessure damages the lining of blood vessels and causes arteries to harden and narrow (atherosclerosis), limiting blood flow. This means less blood is able to flow to the penis.
For some men, the decreased blood flow makes i
High blood pressure’s effect on sexual problems in women isn’t well-understood. But it’s possible that high blood pressure could aft difficult to achieve and maintain erections — often referred to as erectile dysfunction. The problem is fairly common.
High blood pressure can also interfere with ejaculation and reduce seXual desire. Sometimes the medications used to treat high blood pressure have similar effects.
High blood pressure’s effect on sexual problems in women isn’t well-understood. But it’s possible that high blood pressure could affect a woman’s sex life.
High blood pressure can reduce blood flow to the vagina. For some women, this leads to a decrease in sexual desire or arousal, vaginal dryness, or difficulty achieving orgasm. Improving arousal and lubrication can help.
Like men, women can experience anxiety and relationship issues due to sexual dysfunction. Women should talk to their doctor if they experience these difficulties.
Lifestyle changes can help you control and prevent high blood pressure, even if you’re taking blood pressure medication. Here’s what you can do:
If you’re having trouble reaching your blood pressure goal with combinations of the above medications, your doctor may prescribe:
To reduce the number of daily medication doses you need, your doctor may prescribe a combination of low-dose medications rather than larger doses of one single drug. In fact, two or more blood pressure drugs often are more effective than one. Sometimes finding the most effective medication or combination of drugs is a matter of trial and error.