Hypertension, otherwise known as high blood pressure, is a fairly coarse continuing disease in the community. In Singapore, about 1 in 5 adults is hypertensive, and this figure is set to rise as our citizen ages. It is often called a "silent killer" because most citizen do not feel any symptoms even when their blood pressure is high. Many explore that they have hypertension only when complications develop, such as after a stroke or heart attack.
The blood pressure measured is the pressure within the blood vessels, as blood is pumped by the heart nearby the body. This pressure is highest ("systolic" pressure) when the heart contracts to push blood out into the arteries. It is bottom ("diastolic" pressure) when the heart relaxes to fill up with blood again from the venous system.
Causes
Essential Hypertension
Up to 90-95% of hypertension is classified as Primary, or critical Hypertension, in which there is no identifiable cause. Whilst there is no direct cause for the raised blood pressure, there are many risk factors such as a sure family history of hypertension, sedentary lifestyle and obesity.
Secondary Hypertension
In the remaining 5-10%, an identifiable cause is present. This type of hypertension is known as Secondary Hypertension, and it is leading to have it differentiated from the former form, as the fundamental cause will need to be treated.
Conditions which can result in hypertension include,
1. Endocrinological conditions:
- Primary aldosteronism (Conn's syndrome)
- Cushing's syndrome
- Phaeochromocytoma
- Oral contraceptives
2. Kidney diseases:
- glomerulonephritis
- renal artery stenosis
- reflux nephropathy
3. Coarctation of the aorta 4. Immune disease eg. Polyarteritis nodosa 5. Drugs eg. Nsaids (non-steroidal anti-inflammatory drugs) and steroids. 6. Reproduction 7. Obstructive Sleep Apnoea
Signs & Symptoms
Generally none. Occasionally, if your pressures are unusually high, you may feel headaches or giddiness.
Diagnosis
A person's blood pressure can be affected by many factors, such as acute illness, stress, rehearsal and smoking. Blood pressure levels also vary continuously throughout the day. Hence, care should be taken to ensure that the pressure readings obtained are that of your usual pressure.
Before you have your blood pressure measured at the doctor's office, try to ensure that:
- You have rested for at least 5 min before a reading is measured,
- You have not consumed caffeine for 4-6 hours
- You have not smoked for at least 2 hours
- You have not eaten or exercised for at least half an hour
The diagnosis of hypertension is not made on the basis of a singular measurement. So, you would expect you physician to ask you to come back for repeat measurements.
Normal pressure: (adapted from Joint National Committee Jnc-7)
There is a role of home blood pressure monitoring, as it can supply measurements of a person's blood pressure at different times throughout the day, and in a more relax environment face a doctor's office. As many as 25% of citizen suffer from what is known as "White Coat Hypertension", in which their blood pressures are high only when in the doctor's office, and general at other times.
If your physician suspects that you may have secondary hypertension, he may achieve some laboratory tests to confirm or rule them out. Baseline tests are also performed, to look for potential complications as well as contributory risk factors for coronary artery disease (in particular, diabetes and hypercholesterolemia).
Complications
Over time, high pressures lead to hardening and narrowing of the arteries, known as atherosclerosis. When this happens in various organ of the body, the following can result:
- Coronary Heart Disease - ischaemic heart disease and heart attacks
- Heart Failure - from over-taxing of the heart, having to pump constantly against high pressures
- Stroke
- Kidney Failure
- Peripheral Artery Disease - causing ischaemic pain on walking
It is therefore leading to diagnose and treat hypertension, with the view of normalizing pressures, in order to prevent these end-organ complications.
Management
The first step to administration is to make changes to your lifestyle, regardless of either or not you require medication to operate your hypertension. You should also work with your physician to form rehabilitation goals.
Lifestyle Changes
- Weight allowance and quarterly aerobic exercise
- Reduced salt intake in diet
- Reduce and ideally stop smoking and alcohol consumption
- Reduce and manage stress
Medication
Your physician may prescription you medication to lower your blood pressure to a target level, based on your risk profile. These are the main types of blood pressure medication:
- Diuretics - help your body get rid of extra sodium and fluid
- Beta blockers - block the effects of adrenaline
- Alpha blockers - help your blood vessels stay open
- Ace inhibitors - block the yield of angiotensin Ii, a chemical that constricts blood vessels
- Calcium channel blockers - prevent your blood vessels from constricting by blocking calcium from entering the cells
- Angiotensin receptor blockers - similar to Ace inhibitors, except that they impede the performance of angiotensin-Ii instead of stopping its production
Treatment Goals
In general, more stringent blood pressure operate is required in diabetics and those with end-organ damage.
The Singapore Ministry of health Clinical institution Guidelines has recommended that optimal Bp rehabilitation target levels are
