Hypertension: Symptoms, prevention, and treatment

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High blood pressure or Hypertension is the cause of many deaths in society. In this article, this disease is discussed in different aspects.

When the heartbeats, it pumps blood throughout the body to provide energy and oxygen to the body’s tissues. As the blood moves, pressure is applied to the walls of the blood vessels. The severity of this pressure is the same as blood pressure. Blood pressure is not the same at all times. Blood pressure rises when a person is exercising or getting excited. When a person is resting, their blood pressure is lower. Blood pressure can also change as you age, take certain medications, and change your lifestyle.

A brief look at the structure of the heart

The heart is made up of four chambers, two atria and two ventricles. Blood whose oxygen is taken up by the body’s tissues returns to the heart’s right side through the venous circulation. This blood is pumped into the right ventricle and then goes to the lungs, where carbon dioxide is released and re-oxygenated. The oxygenated blood then returns to the left side of the heart and enters the left atrium, from where it flows into the left ventricle; From where blood is sent into the aorta and arterial flow.

Blood pressure created in the arteries by left ventricular contraction is systolic blood pressure. After the left ventricle has fully contracted, it expands and fills again with blood from the left atrium. The pressure in the arteries drops when the left ventricle is filling, which is diastolic blood pressure. The atrioventricular wall completely separates the two parts of the heart. These two parts of the heart are never connected unless there is a wall problem. Blood flows only through the lungs from right to left. Although the cavities themselves work together simultaneously, the two atria contract together, and the two ventricles contract at the same time.

What is Hypertension?

If the blood pressure is too high, a lot of force is applied to the arteries and heart. Hypertension is also known as hypertension. If Hypertension is not treated and controlled, it can cause serious health problems. These problems include heart failure, vision loss, stroke, and kidney disease. (What Is Normal Blood Pressure? + Dietary Methods For Treatment)

How is blood pressure measured?

Usually, a special armband is used along with a medical earpiece to measure blood pressure. Blood pressure is recorded as two numbers: systolic blood pressure and diastolic blood pressure.

Systolic blood pressure: prime number; The pressure in the arteries when the heartbeats and the arteries fill with blood

  • The average systolic blood pressure is below 120.
  • Values ​​between 129-120 are considered elevated.
  • The 139-130 range is a sign of primary hypertension.
  • One hundred forty and above is a sign of secondary hypertension.
  • One hundred eighty and above indicate critical blood pressure.

Diastolic blood pressure: second number; Pressure in the arteries when the heart is resting between beats

  • Average diastolic blood pressure should be below 80 (although if this number is lower than 80, but the systolic blood pressure is between 129-120, it can still be a sign of high blood pressure).
  • Diastolic blood pressure 89-80 is a sign of primary hypertension.
  • Ninety or more is a sign of secondary hypertension.
  • One hundred twenty or more is a sign of critical blood pressure.

The American Heart Association’s new high blood pressure guidelines set a blood pressure of 130 over 80 millimeters of mercury as the threshold for hypertension (previously 140/90). Anyone who has had this condition for a while is said to have high blood pressure.

Causes of high blood pressure:

If a person has hypertension, his arteries’ walls are under more pressure. Causes of high blood pressure include the following:

Age: The older a person gets, the more likely they are to develop high blood pressure.

Family history: If a close relative has hypertension, they have a slightly higher chance of developing the condition. In a new study, researchers looked at the human genome to find genes that influence blood pressure. They compared 2.5 million genetic variants of 34,000 people and found eight genetic variants related to blood pressure. Genes identified in various ways are thought to affect blood pressure: for example, by producing chemicals called steroids or influencing how blood vessels regulate blood pressure. However, each of these genes alone is negligible; But their combined effect can significantly increase a person’s risk of stroke or heart attack.

Temperature: In one study, 8801 people over the age of 65 were studied, and it was found that systolic and diastolic blood pressure levels change significantly throughout the year based on temperature. When the weather was warmer, the blood pressure went down, and when the air got colder, the blood pressure went up in these people.

Ethnicity: People of African or South Asian descent are more likely to have a high blood pressure than Caucasian or Native American.

Obesity and overweight: People with overweight are more likely to develop high blood pressure than people with average weight.

Some aspects related to gender: In general, high blood pressure is higher in adult men than in adult women, although after the age of 60, men and women are equally sensitive.

Inactivity: Lack of exercise and a sedentary lifestyle increase the risk of developing high blood pressure.

Smoking: Smoking causes blood vessels to narrow and blood pressure to rise. Smoking also lowers blood oxygen, so the heart pumps blood faster to compensate, raising blood pressure.

Alcohol consumption: People who consume alcohol have a higher cytolytic blood pressure than other people. Systolic blood pressure levels in these people are about 7 mm Hg higher than people who do not consume alcohol.

High salt intake: The prevalence of high blood pressure in communities where people do not consume much salt is lower than in communities that consume large amounts of salt.

High-fat diets: Many health experts say that a high-fat diet increases Hypertension’s risk, although most dietitians emphasize that the problem is not the amount of fat but the type of fat. Plant-based fats such as avocados, nuts, olive oil, and omega-1 oils are good for your health. Saturated fats, which are common in animal foods and trans fats, are harmful to health.

Psychological stress: Stress, especially in the long run, can severely affect blood pressure.

Diabetes: People with diabetes are at risk for high blood pressure. Among people with type 1 diabetes, high blood sugar is a risk factor for high blood pressure. Reasonable and stable control of blood sugar using insulin reduces the long-term risk of developing high blood pressure in these people. People with type 2 diabetes are also at risk for high blood pressure due to high blood sugar and other factors such as for overweight, certain medications, and some cardiovascular diseases.

Psoriasis: Psoriasis is associated with a higher risk of high blood pressure and diabetes. Psoriasis is an autoimmune disease that appears as red sores on the skin.

Pregnancy: Pregnant women are more at risk for Hypertension than women who are the same age but not pregnant. High blood pressure occurs in 2 to 3% of all pregnancies. Choosing unhealthy lifestyles can lead to Hypertension during pregnancy. Being overweight or inactive are important risk factors in this regard. Women who are in their first pregnancy are more likely to develop high blood pressure. Blood pressure is less likely in subsequent pregnancies. More than one fetus in their body is more likely to develop high blood pressure because their bodies are under extra stress. Maternal age is also an influential factor; Pregnant women over the age of 40 are at greater risk. According to the American Society of Reproductive Medicine, assisted reproductive technologies such as IVF can increase Hypertension’s risk in pregnant women. Before pregnancy, women who had high blood pressure were more likely to have problems during pregnancy than women who had normal blood pressure.

Changes in blood pressure during pregnancy

As the pregnancy progresses, the person’s blood pressure may change or return to pre-pregnancy levels. The reasons for this are:

  • Increased blood levels of pregnant women: According to the Journal of Circulation, a woman’s blood volume increases by 45% during pregnancy. This is the amount of extra blood that the heart must pump throughout the body.
  • The left ventricle becomes thicker and more extensive. This temporary effect allows the heart to work harder in a situation where there is more blood.
  • The kidneys release large amounts of vasopressin; A hormone that increases water retention in the body.

In most cases, this increased blood pressure during pregnancy will disappear after delivery. In cases where your blood pressure remains high, your doctor will prescribe medication to bring your blood pressure back to normal.

Signs and symptoms of high blood pressure:

Most people with hypertension show no symptoms, so high blood pressure is also called the silent killer. Of course, when blood pressure reaches about 180/110 mm Hg, a medical emergency called critical blood pressure occurs.

Symptoms of critical Hypertension include:

  • Headache
  • nausea
  • Vomit
  • Vertigo
  • Blurred vision or diplopia
  • Heart palpitations or strong, irregular heartbeats
  • Shortness of breath

Symptoms of high blood pressure in children:

  • Headache
  • Fatigue
  • Blurred vision
  • nose bleeding
  • Bell’s palsy or inability to control the muscles on one side of the face

Symptoms of high blood pressure in infants and very young children:

  • Staying out of growth
  • Convulsions
  • Irritability
  • numb
  • Respiratory disorders

People diagnosed with high blood pressure should have their blood pressure monitored regularly.

Side effects of high blood pressure

If hypertension is not treated and controlled, the extra pressure that enters the arteries’ walls can lead to damage to blood vessels (cardiovascular disease) and vital organs. The injury’s extent depends on two factors: the severity of the blood pressure and how long it remains untreated.

Some of the possible side effects of high blood pressure are:

  • Stroke
  • Heart attack and heart failure
  • Creating blood clots
  • Aneurysm (enlargement of the artery wall)
  • kidney disease
  • Thickening, narrowing, or rupture of blood vessels in the eye
  • Metabolic syndrome
  • Brain and memory problems
  • Blood pressure and heart attacks

If left untreated, high blood pressure can increase the risk of a heart attack. The deposition of fat, cholesterol, and other substances inside the arteries is called plaque. Over time, the plaques harden and narrow the arteries. Narrowing of the arteries means that more pressure is needed to pump blood through the blood vessels’ network. When plaque forms in the wall of the artery, it separates from the wall, a blood clot forms around the plaque. Because plaques or blood clots cause the heart’s blood supply to be disrupted or the heart ducts to become blocked, they can cause a heart attack.

Diagnosis of high blood pressure

Using a blood pressure monitor: Most people have seen this device. This device consists of an armband that closes around the arm and can be inflated. When the armband is full of wind, it blocks blood flow. A manometer (barometer) measures mercury or mechanical blood pressure. A standard blood pressure monitor is usually used with a medical earphone. If a digital device is used for this purpose, all measurements will be made using electrical sensors. A blood pressure measurement is not enough to diagnose a patient with high blood pressure. People’s blood pressure may change throughout the day. Even a doctor’s visit can cause high blood pressure due to stress and anxiety in the patient. Because hypertension is defined as the frequent increase in blood pressure, it is necessary to measure blood pressure several times. It is essential to correctly read your blood pressure because your blood pressure may be asymptomatic until it is dangerously high.

In some cases, the patient may be advised to measure their blood pressure at home. One of the reasons a doctor may ask a patient to measure their blood pressure at home is to know if the patient’s blood pressure rises after taking certain medications or certain times of the day. If the blood pressure measured at home was higher than usual, another measurement should be taken every 5 minutes to ensure an accurate reading.

Automatic blood pressure monitors: The easiest and most accurate way to measure blood pressure at home is to use a blood pressure monitor with a blood pressure monitor. The instructions for using each device may be slightly different and should be read carefully. If the instructions are difficult to understand, you can ask a doctor or pharmacist for help. Using a quality device is very important because inaccurate measurements can lead to unnecessary and harmful changes in medications or treatments. There are various devices on the market for this purpose, and one should consult with your doctor about choosing the type and brand. Studying a handbook for measuring blood pressure can be helpful in this regard.

Tests for the diagnosis of hypertension

Blood and Urine Tests: Behind-the-scenes causes of hypertension may be related to cholesterol, high potassium levels, blood sugar, infection, kidney problems, and more. Protein or blood in the urine can indicate kidney damage. High blood glucose can also be a sign of diabetes.

Exercise test: This is mostly used for people with borderline high blood pressure. This test usually involves cycling on a stationary bike or walking on a treadmill. An exercise test sometimes reveals problems that are not detectable at rest. Imaging of the heart’s blood supply may also be performed at the same time.

Electrocardiogram (EGG) or ECG: This test looks at the heart’s electrical activity. This test is mostly used for patients who are at high risk for heart problems such as high blood pressure and high cholesterol levels. The primary electrocardiogram is called the baseline or isoelectric line. By comparing subsequent electrocardiograms with baseline, changes that may be due to coronary artery disease (CAD) or thickening of the heart wall can be identified.

Holter monitoring: The patient carries a portable electrocardiograph that attaches to the electrodes on his chest for about 24 hours, during which time the electrical activity of his heart is recorded.

Echocardiograph: This device uses ultrasound to examine the beating heart. Your doctor will diagnose problems such as thickening of the heart wall, heart valve defects, blood clots, and excess fluid around the heart.

Using Blood Pressure Measurement Apps: Some wristbands and apps claim to measure blood pressure, but these results are often inaccurate and not reliable enough to monitor a person’s health. Of course, applications that record a patient’s blood pressure results can help people who need regular blood pressure tests. Recording a set of blood pressure measurements in these applications can help your doctor understand your patient’s blood pressure and recommend treatment.

Treatment of hypertension

Slightly elevated blood pressure: If the patient has only slightly elevated blood pressure and a low risk of cardiovascular disease, only lifestyle changes may be enough advice.

Moderately high blood pressure: If blood pressure is moderately high, the risk of cardiovascular disease over the next ten years will be about 20 percent. Your doctor will probably prescribe medication and make recommendations for lifestyle changes.

High blood pressure: If your blood pressure levels are 180/110 or higher, your doctor will refer you to a specialist.

 Lifestyle changes that can help lower blood pressure

Here are some lifestyle changes that can help lower your blood pressure. Note that you should consult a doctor before making significant lifestyle changes.

Regular exercise: Exercising for 30 to 60 minutes, five days a week, usually lowers a person’s blood pressure by 4 to 9 millimeters of mercury. Regular physical activity strengthens the heart. A healthier heart can pump more blood with less energy. If the heart can pump blood with less work, the arteries’ force will be reduced, and the blood pressure will be reduced. Of course, you should consult your doctor before starting any physical activity program (if you have hypertension). Exercise should be tailored to the needs and health status of the person with high blood pressure. The key to a successful sports program is to be regular.

Weight loss: Even moderate weight loss can have a significant effect on lowering blood pressure. The closer an overweight person gets to their ideal weight, the lower their blood pressure will be. When a person loses weight, the effect of blood pressure medications on him increases. Reducing the waist is most effective. Achieving a healthy weight requires considering diet and having at least 7 hours of quality sleep each night.

Relaxation techniques: One study found that tai chi exercise significantly boosted exercise capacity, lowered blood pressure, and improved cholesterol, triglycerides, insulin, and C-reactive protein levels in people at risk for heart disease. Reactive protein C is a cyclic protein found in the blood plasma and its level increases in response to inflammation.

Sleep: Lack of adequate sleep can increase the risk of high blood pressure. It is recommended that adults should not be less than 7 hours and more than 8 hours. In 2008, a study was published that showed that people who slept outside the range of 7-8 hours experienced high blood pressure.

Diet: Diet management can be an effective way to prevent and treat hypertension. The National Institutes of Health (NIH) has introduced a diet called Dash (DASH) to control blood pressure. This diet is also recommended by the American Heart Association (AHA). This diet is based on fruits, vegetables, nuts, seeds, beans, and low-fat dairy products.

Reduce salt intake: Even a moderate reduction in salt intake can reduce blood pressure by 2 to 8 millimeters of mercury. Most people diagnosed with hypertension still consume more salt than recommended levels.

Medications for high blood pressure:

There are currently several antihypertensive drugs on the market. Controlling the disease in some people may require a combination of several medications. Some people may also need regular medication to control their blood pressure. Your doctor may confirm that you stop taking medicine if you can control your blood pressure over a satisfactory period and are not at risk for stroke or cardiovascular disease.

Medications are used to treat and control high blood pressure.

Angiotensin-converting enzyme inhibitors: Angiotensin-converting enzyme inhibitors block the action of some hormones, such as angiotensin II. The enzyme angiotensin II narrows the arteries and increases blood volume, eventually increasing blood pressure. People with a history of heart disease, pregnant women, or people with the condition that affects the kidneys’ blood supply should not take this medicine. Doctors may order a blood test to determine if the patient has a kidney problem. Angiotensin II inhibitors can reduce blood flow to the kidneys, so regular blood tests should be done.

Side effects of angiotensin-converting enzyme inhibitors:

  • Vertigo
  • Fatigue
  • Weakness
  • Headache
  • Dry cough

Some patients may have very unpleasant or prolonged side effects. In such cases, doctors will prescribe a drug from the group of angiotensin II receptor antagonists. In this case, the side effects are not very common but may include dizziness, headache, and high blood potassium levels.

Calcium channel blockers (CCBs): These drugs reduce the amount of calcium in the blood vessels. Calcium depletion relaxes the smooth muscles of blood vessels, resulting in less contraction and dilation of the arteries. If the arteries dilate, blood pressure will drop. Patients with a history of heart disease or circulatory problems should not take these medications.

Side effects of calcium channel blockers:
  • Redness of the skin (usually around the cheeks or neck)
  • Headache
  • Swelling in the legs and ankles and sometimes in the abdomen
  • Vertigo
  • Fatigue
  • Skin rash

Thiazide diuretics: Thiazide diuretics affect the kidneys by removing sodium and water from the body. The result is a reduction in blood volume and, ultimately, a decrease in blood pressure. These drugs are often the first drug of choice in the treatment of hypertension.

Side effects of thiazide diuretics:
  • Decreased blood potassium (which can affect kidney and heart function)
  • Impaired glucose tolerance
  • Erectile dysfunction

Patients taking thiazide diuretics should have regular blood and urine tests to monitor potassium and blood sugar levels. Patients 80 years of age and older may be given indapamide (Lozol), a particular type of thiazide diuretic that helps reduce death from stroke, heart failure, and some other cardiovascular diseases.

Beta-blockers: Beta-blockers were once widely used to treat high blood pressure but are now only prescribed when other drugs do not affect the patient because they have more side effects than other available drugs. These drugs lower the heart rate and lower blood pressure by lowering the pressure exerted by the heart.

Side effects of beta-blockers:
  • Fatigue
  • Cold hands and feet
  • Decreased heart rate
  • nausea
  • Diarrhea

The following side effects may occur, although they are less common:

  • Sleep disorder
  • Nightmare
  • Erectile dysfunction

Renin Enzyme Inhibitors: Aliskiren (other names: Tectona and Russell) reduces renin production. Renin is an enzyme made in the kidneys. Renin is involved in the production of angiotensin protein. Angiotensin I is converted to the hormone angiotensin II, which narrows blood vessels. Aliskiren inhibits the production of angiotensin I, thus lowering the levels of angiotensin I and angiotensin II. This dilates the blood vessels and eventually lowers blood pressure.

Side effects of aliskiren:
  • Diarrhea
  • Vertigo
  • Symptoms similar to the flu
  • Fatigue
  • Cough

Status and trend of high blood pressure in the world

Worldwide, deaths from hypertension are estimated at 5.7 million, accounting for 12.8% of all deaths. High blood pressure is a significant risk factor for coronary heart disease and ischemic heart disease, as well as hemorrhagic strokes. High blood pressure has been positively and consistently associated with the risk of stroke and coronary heart disease. In some age groups, the risk of cardiovascular disease doubles with each 10-20 mm increase in blood pressure. In addition to coronary heart disease and stroke, other problems with high blood pressure include insufficiency, peripheral vascular disease (PVD), kidney failure, retinal hemorrhage, and visual impairment. Treatment of systolic and diastolic blood pressure will reduce cardiovascular problems as long as they are less than 140/90.

The overall prevalence of hypertension worldwide in adults 25 years of age and older was about 40% in 2008. The proportion of people with high blood pressure or uncontrolled blood pressure decreased between 1980 and 2008. However, due to population growth and aging, the number of people with uncontrolled hypertension rose from 600 million in 1980 to 1 billion in 2008. Among areas under the World Health Organization control, the prevalence of high blood pressure in Africa is higher than in all regions, at about 46% for both sexes. The lowest prevalence of hypertension in these areas was in the United States, where the prevalence of the disease in both sexes in these areas was reported to be 35%.

Regarding income status, the prevalence of hypertension was higher (40%) in low-income countries and lower (35%) in high-income countries. According to the American Heart Association, about 85 million people in the United States have high blood pressure or about one-third of those over 20. The US National Institutes of Health estimates that about two-thirds of people over 65 have high blood pressure.

 

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