Hypertension

Blood Pressure is the pressure in the arterial system, which waxes and wanes as the heartbeat. It also varies from best to beat. The major determinants of blood pressure are cardiac output i.e. the amount of blood expelled by the left ventricle in one minute of pumping and peripheral resistance, which is determined by the tone of tension of the vascular musculature and the diameter of the vessels in the periphery.

Hypertension is one of the recognised risk factors which if it remains higher than the desired value poses a grave risk to the individual as regards his cardiac and cardiovascular health.

Hypertension has become one of the most prevalent and serious risk factors in the world. When hypertension and insulin resistance are concomitant, the risk of macrovascular complications rises further.

All diabetic and pre-diabetic patients should be screened for hypertension, patients with hypertension should receive aggressively antihypertensive therapy should be carefully evaluated; and those with IR or hypertension should be carefully screened for other cardiovascular disease risk factors. Hypertension is a widely prevalent condition. Proper identification and treatment of hypertension in patients with IR, both diabetic and pre-diabetic, particularly by primary care providers, is crucially important in achieving risk reduction in the primary care setting.

Classification of Hypertension

1) primary hypertension – Essential hypertension is the most prevalent and is present in more than 90℅of the high blood pressure cases.

2) Secondary hypertension – it is due to another disease or disorder. Prominent among these are kidney diseases like chronic glomerulonephritis and pyelonephritis, tumours of the Adrenal glands, congenital narrowing of the Aorta and Toxemias of pregnancy etc altogether this account for about 10% of the hypertension cases.

3) Malignant hypertension – it is a condition where the blood pressure rises sharply and rapidly too causing complications like internal haemorrhage in the brain or the eye or even causing cardiovascular complications. This condition is usually fatal if not detected and managed in time.

Steps of prevention

1) primary prevention

a) population strategy

b) high risk strategy

2) secondary prevention

1) primary prevention – it has been defined as all measures to reduce the incidence of disease in a population by reducing the risk of onset.

Detection of high-risk subjects is the key to this method. Family history and tracking of blood pressure right from childhood may be used to identify high-risk individuals.

2) secondary prevention

The goal of secondary prevention is to detect and control high blood pressure in the affected individuals. Modern antihypertensive drug therapy can adequately control high blood pressure and consequently the excess risk of morbidity and mortality from coronary and cerebrovascular and kidney disease.

Some useful tips for the prevention of blood pressure

1) nutrition

2) dietary changes as reduction of salt intake

3) moderate of low fat intake

4) avoidance of alcohol

5) avoidance of smoking

6) control and monitoring of sodium lipid levels

7) regular physical exercise

8) stress management, time management, self-motivation, yoga etc.

9) health education and modification of mindset towards a positive and responsive health behaviour

Treatment

In essential hypertension, we can not detect and treat the cause and therefore we try to scale down the blood pressure to acceptable levels. The aim of treatment should be to maintain a blood pressure of below 140/90 mmHg. According to the modern concept, patients having diastolic pressure of 90- 105 mmHg should also be treated. Recently it has been shown that these mild hypertension cases whose blood pressure is brought down from 100-105 diastolic levels to about 80-90 mmHg benefit a great deal and the incidence of stroke and CAD drops drastically in them. This is a major reason for identifying and treatment of these cases.

Patient compliance

1) patient compliance is the matching of the health behaviour of the patient to the prescription of the doctor.

2) the treatment of blood pressure when warranted is generally lifelong and this present problem of patient compliance.

3) the following has been the experience of so many years of operational research regarding hypertension.

4)control of hypertension in the population is feasible.

5) control of hypertension leads to the reduction of complications of high blood pressure.

So, I hope all of you will take care of your health.

Dr S.k.jha