Hypertension

 

Hypertension or High Blood Pressure sometimes called Arterial is a chronic medical conditions in which the blood pressure in arteries is elevated, blood pressure is summarized by two measurements, Systolic and Diastolic which depends on whether the Heart muscle is contracting (systole) or relax between beats (Diastole) this equal to a maximum and minimum pressure respectively.

Normal blood pressure at rest is within the range of 100 to 140mmHg systolic (Top reading) and 60 to 90mmHg Diastolic (Bottom reading).

High Blood Pressure is when its above 140/90mmHg at separate interval on two or more independent measurements.

Hypertension is classified as either primary (essential) hypertension or secondary hypertension. About 90 to 95% of cases are categorized as primary hypertension which has no obvious underlying medical cause. Secondary hypertension is cause by condition that affect the Kidneys, Arteries, Heart or Endocrine systems.


Classification of Hypertension

According to the JNC 7 classification Hypertension can be classified as follows

Classification (JNC7)

Systolic pressure

Diastolic pressure

mmHg

kPa

mmHg

kPa

Normal

90–119

12–15.9

60–79

8.0–10.5

High normal or prehypertension

120–139

16.0–18.5

80–89

10.7–11.9

Stage 1 hypertension

140–159

18.7–21.2

90–99

12.0–13.2

Stage 2 hypertension

≥160

≥21.3

≥100

≥13.3

Isolated systolic hypertension

≥140

≥18.7

<90

<12.0

 

Signs and Symptoms

Hypertension usually doesn’t have symptoms and commonly identified through blood pressure checks for an unrelated problem. Some people with hypertension have headaches usually at the back of the head in the morning as well as light headedness, vertigo, tinnitus, altered vision of fainting episodes. On clinical evaluation, hypertension may be suspected by examining the optic fundus using an opthalmoscope which may show hypertensive retinopathy.

Hypertensive Crisis

This is elevated blood pressure (equal or greater than a systolic of 180 or diastolic of 110. People with blood pressure of this range may have no symptoms but are more likely to report headache and dizziness than the general population. A hypertensive emergency is diagnosed when there is evidence or direct damage to one more organs as a result of severely elevated blood pressure greater than 120 diastolic

 

Hypertension in Pregnancy

Hypertension occur in 8 – 10% of pregnancy and is usually when blood pressure is elevated above 140/90mmHg 6 hours apart on 2 separate measurement. Most women with hypertension in pregnancy have preexisting primary hypertension, but high blood pressure in pregnancy may be the first sign of pre-eclampsia.

Diagnosis

HYPERTENSION is diagnosed on the basis of persistent High BP. The American Heart Association recommends at least three measurements on at least two separate health care visits. Once Hypertension has been diagnose, a good history is taken with general physical examination. Blood sample should be taken to assess Kidney function through Urea electrolyte and creatinine, a lipid profile to assess blood cholesterol level, a chest x-ray echocardiogram to assess for the presence of heart enlargement (Left ventricular hypertrophy). Additional tests include electrocardiogram ECG to check if the heart is under strain and urine sample for Protein as an indicator of Kidney disease.

The tests usually done to monitor and prevent hypertension are as follows

Typical tests performed

System

Tests

Renal

Microalbumin,Microscopic urinalysis for proteinuria, Urea and creatinine

Endocrine

sodium, potassium, calcium, TSH

Metabolic

Fasting plasma glucose, HDL, LDL, and total cholesterol, triglycerides

Others

Hematocrit, electrocardiogram, and chest radiograph

Sources: Harrison's principles of internal medicine

 

Prevention

The 2004 British Hypertension Society guidelines proposed the following lifestyle changes consistent with those outline by the US National High BP Education programme in 2002 for the prevention of primary hypertension:

·        Maintain normal body weight for adult for example: body mass index 20- 25kg/m2

·        Reduce dietary sodium intake to less than 100mmol/day (< 6g of sodium chloride or less than 2.4g of sodium/day).

·        Engage in regular aerobic physical activity such as brisk walking (> 30 minutes/ day for most days of the week)

·        Limit Alcohol consumption to no more than three units/ day in men and no more than two units/ day in women. 

·         Consume a diet reach in fruits and vegetables

·        Keeping your Doctor’s appointment is of extreme importance

 

Management

Lifestyle modification: this includes but not limited to dietary changes or physical exercise and weight loss as highlighted above.

Medication: anti-hypertensive drugs are used to treat hypertension