Hypertension

Dr. Hassan Chamsi Pasha Dr. Fawaz Akhras

High blood pressure (hypertension) is a common condition. It affects approximately 10-20% of population. This chapter tries to answer some of the questions patients might have when they are diagnosed to have hypertension .

What is blood pressure?

Your circulation is similar to two closed systems of pipes within which the blood is driven by a pump , the heart. Your pressure is the force that drives the blood through the larger system taking the blood round the body, and through the smaller system taking the blood between the heart and the lungs, but under much lower pressure. A certain level of pressure is necessary to drive the blood around the body.

Where are the components of blood pressure come from?

The blood pressure has two components. Each time the heart beats and the blood surges through, the arteries and arterioles expand a little. This is the blood pressure at its highest point and , since it coincides with the systolic sequence of the heart (i.e. when it beats), it is called systolic pressure. During diastole, when the heart chambers and the arteries are relaxing, blood pressure is at its lowest point and is called diastolic pressure.

Systolic blood pressure is always higher than diastolic blood pressure, and the blood pressure rises and falls between the two with each beat.

How is the blood pressure measured?

Blood pressure is usually measured with a mercury sphygnomanometer and the measurements are therefore expressed in millimeters of mercury (mmHg).

What is the normal blood pressure?

The normal blood pressure varies with age (the pressure becoming higher as one gets older). The blood pressure is customarily regarded as normal if the systolic pressure is at or below 140 mmHg and the diastolic at or below 90 mmHg. Blood pressure is usually written as a ratio of the two pressure so that, for example, 130/80 simply means that the systolic pressures is 130 and the diastolic pressure is 80 mmHg. In children, blood pressure is slightly lower, usually around 90/60 mmHg

Does my blood pressure vary?

In the same way as the heart can speed up or slow down according to the demands of the day, the blood pressure can also vary. Normally, your blood pressure remains steady through quite a narrow range. However, during exercise or when under stress, it goes up, but when you lie back and relax it should fall again. These fluctuations in the level of blood pressure are quite normal .

What is hypertension? (High blood pressure)

Only when blood pressure remains well above normal without the stimulus of exercise or stress is a person considered to have high blood pressure or "hypertension". Blood pressure is regarded high if the systolic is above 140 mmHg and the diastolic above 90 mmHg (140/90). However, a visit to the doctor can cause anxiety and temporarily increase the pressure. Therefore, no one should be regarded as having a high blood pressure unless it remains high on several occasions.

What is mild and what is severe hypertension?

In high blood pressure, both pressures are usually raised, although only the systolic pressure may be raised in the elderly. On the whole, a rise in the diastolic pressure is more serious than systolic pressure. Hypertension, is classified as "mild' if the diastolic pressure is between 90 and 99 mmHg , "moderate" if it is between 100-109 mmHg, and "severe" if it is 110-119 mmHg and very severe if it is more than 120 mmHg . Fortunately, the vast majority of patients with hypertension are in the mild category.

Are there any obvious symptoms for hypertension?

The majority of patients with hypertension have no specific symptoms that could be attributed to their blood pressure elevation and will be identified only in the course of physical examination.

Many people are under the impression that headaches, particularly early morning ones, dizziness, nose-bleeds, and noises in the ears are all symptoms of high blood pressure. These symptoms can, however, be present in people with normal blood pressure and quite high blood pressure may be present without them. The only way you can be sure is to have your blood pressure measured.

Everyone should have his blood pressure checked at least every five years and if is on the higher side of normal, it should be measured more frequently.

If hypertension is well advanced or has been present for many years, it may cause severe headaches, shortness of breath, giddiness and visual disturbances.

What can high blood pressure do?

High blood pressure puts considerable strain on the heart and blood vessels. If untreated, the blood vessels become thickened and more rigid. In these narrowed thickened arteries, the blood flow becomes sluggish and the blood itself becomes stickier. This increases the risk of having a stroke or developing a heart attack. High blood pressure can also lead to heart failure and may eventually cause kidney damage and retinopathy (damage to the retina at the back of the eye). All these risks are related to the severity of hypertension.

What causes hypertension?

The cause of elevated blood pressure can not be identified in about 90-95% of cases. These individuals are said to have "essential hypertension" . Apart from the age and male gender, factors associated with an increased risk of essential hypertension include: tobacco smoking, obesity, alcohol intake, a family history of hypertension, a sedentary life style and high degree of social and occupational stress.

In the other 5-10% of patients with hypertension a definite cause is found. It is called "secondary hypertention" . Specific causes include various disorders of the kidneys, certain disorders of the adrenal glands, coarctation of the aorta (a congenital heart defect) and use of certain drugs. Taking the combined ( estrogen-containing ) contraceptive pill appears to increase the risk of hypertension.

Do I need any tests doctor?

Yes. Your doctor will ask for certain blood tests, and a urine test. A chest x-ray and ECG are also essential. Other tests may be requested if a certain cause of hypertension is suspected.

I feel well doctor. Why should I be treated?

The goal of treatment of hypertension is to reduce overall cardiovascular risk and the complications of hypertension which are mentioned earlier. There is no doubt that the treatment gives many people extra years of life to enjoy.

Do I need to change my life-style?

Yes. With a mild to moderate hypertension, if no underlying cause (such as a kidney disorder)is found, the first line of things to do is to alter your life-style. Smokers should stop smoking and alcohol drinkers should avoid alcohol. Any overweight person with hypertension should reduce his weight through restriction of food intake and gradually increased exercise. A regular exercise produces a modest reduction in blood pressure. The dietary intake of animal fat (contained in milk, cream, cheese, fatty meats and eggs) should be reduced. A restricted intake of salt is also recommended. All these measures may also help to prevent hypertension from developing in the first place. These measures may obviate the need for drug treatment or reduce the doses of the drugs.

When do I need to take a drug for hypertension?

If self-help measures have no effect or in the case of more severe hypertension, anti-hypertensive drugs may be prescribed. A large number of different types of anti-hypertensive drugs are available.

These includes:

1. Diuretics: Such as the thiazides

2. Betablockers: Which reduce the force of the heart beat . e.g.: Atenolol, Metoprolol, Propranolol

3. Calcium channel blockers: Such as: Nifidipine, Amlodipine, Isradipine

4. ACE Inhibitors: Such as, Captopril, Fosinopril, Enalapril, Quinapril, Perindopril

Do I need to take more than one drug?

Patients with high blood pressure may require one or a combination of drugs to control their blood pressure.

How often do I need to see my doctor?

Usually the doctor will wish to monitor the effects of treatment through measurements of blood pressure every two to four weeks, in the first instance, so that adjustment to the drug dosages or regimen can be made, if necessary..

Are there any side effects of the drugs?

Any drug may cause some side effects.. If any side effects develop, the doctor should be told, as a more suitable alternative therapy may be available.

How long do I need to take these medications for?

For many cases, drug treatment has to continue for several years or even for the rest of the patient's life. However, this is a small price to pay for the many extra years of life expectancy added through the control of hypertension.

From the Book : “ Patient Guidelines to Heart Disease : Questions and Answers “

By Dr. Hassan Chamsi Pasha & Dr. Fawaz Akhras

Dar Almanara – Jeddah in 1999

Tel : 6603652