What is blood pressure?

Blood pressure is the measurement of the force exerted by the smooth muscle cells in the walls of your arteries. Arteries are the blood vessels that carry blood from the heart to the rest of the body. The pressure is greatest at the moment blood is pumped by the left ventricle.Blood pressure is expressed as Systolic pressure/diastolic pressure

• • When the heart is contracting, it is called the systolic reading.
  • When the heart is relaxing, it is called the diastolic reading.
  • Optimal blood pressure is 120/80

What is high blood pressure?

High blood pressure or hypertension is a condition in which the blood pressure is consistently higher than normal. The condition may be mild, moderate or severe. If untreated, hypertension can lead to cardiovascular disease, heart attack, stroke or a kidney problem. A blood pressure of 120/80 or below is considered optimal. Hypertension is present when the blood pressure is consistently 140/90 or above.

	Systolic	Diastolic
Optimal	<120	<80
Normal	<130	<85
High Normal	130-139	85-89
Hypertension Stage -1	140-159	90-99
Hypertension Stage -2	>160	>100

From the Seventh report of the Report of the Joint National Committee (JNC) on Hypertension – USA

What is the cause of high blood pressure?

The specific cause of hypertension is unknown. In 90% of patient this condition is called essential or primary hypertension. A variety of factors can put a person at risk for high blood pressure. Some of these factors cannot be modified. For example.

• • The risk of hypertension increases with age.
  • Hypertension is more common in men than in women until theage of 55
  • Family history of hypertension.

Modifiable factors are obesity, lack of regular exercise, high caffeine intake, diet high in fats and oils and high cholesterol levels, stress and anxiety. It is more common in Type A personality. This can be overcome with stress control measures like meditation, yoga etc.

What are the symptoms of hypertension?

Most people with hypertension do not have any symptoms so they don’t know they have this serious health problem. Hypertension is often called “the silent killer” because often the first manifestation of undetected and untreated high blood pressure may be a heart attack, stroke or kidney problem.

Other symptoms of hypertension include

• • Fatigue/tiredness
  • Excessive sweating
  • Paleness or redness of skin
  • Bleeding from the nose
  • Anxiety or nervousness
  • Ringing or in the ears
  • Palpitations
  • Nausea
  • Headache
  • Giddiness
  • Impotence

Are there any guidelines for measuring blood pressure?

A single check is inadequate for a conclusive diagnosis because blood pressure normally changes throughout the day. Vigorous activity, stress, anxiety, drinking caffeinated beverages, smoking, having a full bladder or eating immediately before having blood pressure checked may cause an inaccurate reading. Multiple checks should be made over a period of one or two months. The average blood pressure is needed for a conclusive diagnosis. Some guidelines are

• • Blood pressure is to be measured 5 minutes after sitting
  • Two readings, at least five minutes apart are desirable
  • If the person has taken coffee or tea, blood pressure should be taken after one hour
  • The cuff should be at the level of the heart.

What are the different types of blood pressure monitors?

The one normally used by most doctors is the sphygmomanometer. It has been inuse since the last 110 years. Since it uses mercury and mercury is a toxic substance if it is accidently release into the environment, the World Health Organization has issued guidelines for countries to substitute mercury based devise with electronic ones.

Newer electronic or digital monitors are available, which are fully automatic. It inflates, deflates and the reading appears on the monitor. These require only tying the cuff and pressing a button. There are ones which measures the blood pressure at the upper arm and those at the wrist. Upper arm blood pressure monitors usually give the most accurate and consistent results. Many of them also show the pulse rate.

What are the other tests done in a person with hypertension?

The following tests are done to find out if hypertension has affected other systems.

• • Urine analysis and Kidney function tests – to rule out kidney disease.
  • Electrocardiogram- to check for heart related problems that could occur along with high blood pressure like enlargement of any chamber of the heart.
  • Echocardiogram – is also used for checking heart related problems
  • Chest X-ray- to rule out enlarged heart.

What are the complications of hypertension?

Hypertension is a major risk factor for all forms of stroke. Hypertension causes the heart to work harder to pump blood. The heart, brain and kidneys are most susceptible to damage from hypertension. If hypertension is not treated the heart must work harder and harder to pump enough blood and oxygen throughout the body. This extra work may cause the heart to become enlarged making it more difficult to meet the body’s demands

Specific effects of Hypertension

Congestive Heart Failure

The heart is enlarged which compromises its ability to pump blood efficiently.

Atherosclerosis

The arteries are scarred, less elastic and narrowed with plaque, making it difficult for them to carry blood throughout the body.

Thrombus

Clots lodge in narrowed arteries, blocking the flow of blood andpotentially causing a heart attack, stroke or Transient Ischemic Attack (TIA)

Nephropathy

High BP can damage kidneys. This is called Hypertensive renal disease. It can cause proteinuria ( proteinin the urine) or haematuria (blood in the urine) If left untreated it may lead to failure of the kidneys