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What is Hypertension?

Hypertension is an abnormal elevation of the blood pressure.

What are the normal levels for blood pressure in an adult?

The blood pressure for normal defined as a systolic blood pressure which is between 120 to 135 and diastolic between 80 and 90 millimeters of mercury.

How common is hypertension?

Hypertension is very common in general population. The prevalence will differ based on the age of the population, the race, and the definition of hypertension. In general about 5% of the population will have blood pressure of over 140/90. This incidence increases to 35% by the age of 60.

What is essential hypertension?

Hypertension which is not attributable to any secondary cause such as underline endocrine, drug or related to vascular problems related to kidney is called as essential hypertension.

How is hypertension classified?

The Joint Nationality Committee (JNC) classification is generally used to classify the severity of the hyper tension. It can be classified for practical purposes by severity as border line as mild, moderate or severe.

What is white coat hypertension?

Blood pressure elevation which occurs due to apprehension of a doctor’s visit is called white coat hypertension. The pressure should be repeated at another time.

What precautions should be taken before a blood pressure reading is taken?

Four important points should be remembered while taking a patients blood pressure.
  1. The patients must be seated comfortably in a chair for at least 3 to 5 minutes.
  2. The cuff of an appropriate size should be used.
  3. Systolic and Diastolic blood pressures should be taken.
  4. Two or more readings about 5 minutes at intervals should be averaged.

Why is it important to treat Hypertension?

Hypertension if left untreated can affect the following:
  1. Heart: Resulting in heart attacks or heart failure.
  2. Brain: Stroke
  3. Kidney: Kidney failure.

What are the symptoms of hypertension?

  1. Patient may be asymptomatic.
  2. Headache
  3. Symptoms of angina or heart failure.

“If my parents have hypertension do I run the risk of having hypertension?”

The risk of hypertension is increased if one of the parents is Hypertensive and rises further if both are hypertensive. Although hereditary factors by itself are not enough to cause hypertension. Environmental factors are also important.

What other factors are important in causing hypertension?

  1. Obesity
  2. Sedentary lifestyle
  3. Alcohol consumption in excess of 3 or more drinks.
  4. Very high sodium intake.

“Reducing my salt intake has had no effect on my blood pressure?”

In many patients the blood pressure is not sensitive to sodium intake as opposed to those who are “salt sensitive”.

Are any additional investigations required for newly diagnosed patients with high blood pressure?

If the hypertension is mild and is the only problem then a limited investigation is all that is required. If the patient has severe hypertension then more extended evaluation is required. The limited investigation should at least include routine blood chemistry, a hemogram, an electrocardiogram and a chest X–ray.

What are the different drugs used in the management of hypertension?

They can broadly be classified as follows.
  1. Diuretics: e.g. Hydrochlorothiazide
  2. Beta blockers: e.g. Propranolol, Metoprolol, Atenolol
  3. Calcium channel blockers: e.g.: Diltazem, Nifedipine, Verapamil, Amlodipine, felodipine.
  4. ACE (Angiotensin Converting Enzyme Inhibitors) e.g. Lisinopril, Enalapril.
  5. Alpha blockers: Prazosin

What are the side effects of blood pressure medicines?

For all classes of blood pressure lowering medicines if the blood pressure is reduced too much the patients complain of dizziness and fainting. Side effects can be class specific.
Beta Blockers
Decreased heart rate, bronchospasm, depression, sexual dysfunction, peripheral vascular disease, lipid abnormalities.
Calcium Channel Blockers
Headache, flushing, palpitation, edema formation on the feet, constipation.
ACE Inhibitors
Cough, Hyperkalemia, skin rash, taste impairment.
Diuretics
Dehydration, High blood sugar level, increased lipids.

Which of the anti–hypertnsive medicines should be used first?

Many physicians will use medicines based upon the overall condition of the patient taking into account the cardiac status, the renal status etc. It should be remembered that beta blockers and diuretics are generally used as first line agents. The ACE inhibitors have also been used in many instances as first line drug therapy. The choice generally depends upon the physician who is treating the patient.

What is Malignant Hypertension?

Malignant Hypertension is a syndrome which results from very high elevated blood pressures, generally the diastolic is above 140mm of Hg. The patient has hemorrhage in the eyes swelling of the optic disk (papilledema), coma, fluid in the lungs. This is a medical l emergency and it needs to be treated in an intensive care unit. So the medicines generally are given intravenously to reduce blood pressure. These medicines usually include sodium nitroprusside, hydralazine, labetalol.