High Blood Pressure (BP)

BLOOD PRESSURE and its MEASUREMENT

Pressure in the blood (BP) refers to the force that blood flow in our arteries exerts on our vessel wall. The blood vessels in the arteries transport oxygen-rich blood from our heart to other areas of our body.

The pressure is at its highest ( systolic BP) when the heart contracts during the heartbeat, and then expels blood into the arterial (aorta). The pressure is the lowest ( diastolic BP) during intervals between heartbeats. Thus, blood pressure is measured in units of millimeters of mercury (Hg) as a percentage of diastolic on systolic BP (for example 120/80 mmHg).

The measurement of blood pressure should be conducted using a BP machine that has the right cuff dimension and calibrator.

To take a BP test, you must be in a relaxed state for a minimum of 5 minutes (with no smoking, exercising, or drinking coffee for 30 minutes before). Be sure to flush your urine before taking you to take a BP test.

BP is measured when you are relaxed and comfortable on a chair that has a backrest. Your feet are placed flat on the floor. The BP instrument and your armrest are on the same table at the same level as your heart. BP when measured lying down, should be measured using the BP machine at a level with your body. Sitting BP is generally 5-10 mm higher than lying (supine) BP while standing BP is the smallest. If you’re prone to feeling dizzy, the difference between standing and sitting BP is something to be measured.

STAGING HIGH-BP (HYPERTENSION)

Hypertension classification Based upon BP measure has been established in the 2020 International Society of Hypertension as follows.

BP classification

It is important to remember that only a single BP reading is not diagnostic and should not use to make a decision. If on the first visit the BP reading is elevated, it should be checked once more (after 2 weeks in the case of BP between 160/100 and 2 weeks in the case of BP between 130/80 and 159/99). Minimum 3 consecutive BP readings during 3 different visits should show elevated readings that indicate anyone is being hypertensive.

If your BP readings are 180/110 and more at any time it will be treated as an emergency that needs to be treated immediately medically.

The cut-offs listed previously are for clinical BP measurement. Sometimes self-BP measurement at your home (to prevent a rise in BP and heart rate due to anxiousness/nervousness) or a continuous BP measurement over 24 hours (ambulatory BP monitoring) may be advised. In these cases, it is possible that your BP thresholds to be used for hypertension could be reduced.

Risk Factors

The risk factors mentioned raise the chance of developing hypertension, cardiovascular disease, and its consequences. The advancing years of age and the male gender are risk factors that naturally occur (an older man has a higher chance to develop hypertension than an adult female in her early 20s). People of South Asian and African races are also at a higher chance to develop high BP when compared to white people.

Other danger factors include :

  • Being overweight or obese (high BMI)
  • Dyslipidemia(increased cholesterol and/or triglycerides in blood)
  • Psychosocial stress
  • Too excessive amounts of sodium (sodium) or not enough potassium intake in your daily diet
  • A lifestyle that is sedentary or insufficient physical exercise
  • Smoking
  • Excessive alcohol consumption
  • Psychosocial stress or suppressed anger
  • Diabetic
  • Kidney diseases
  • Sleep Apnea
  • Long-term use of drugs: painkillers (of the Ibuprofen group) Some decongestant medications for colds, antipsychotics or antidepressants oral contraceptives and corticosteroids, and certain anti-cancer medicines.
  • Family background from high BP
  • Women who are post-menopausal, or who had diabetes or hypertension in one or more of their pregnancy.

CONSEQUENCES AND COMPLICATIONS OF HYPERTENSION

High blood pressure that is not well or properly managed can cause complications.

The term “cardiovascular disorder” (CVD) refers to a set of ailments that result from the blockage of blood vessels, specifically arteries, and the consequences on the heart as well as other organs.

A blood flow that is higher in pressure is more likely to create micro-injuries to the wall of an artery. This leads to the creation of plaques and clots, which can result in a narrowing or obstruction of blood vessels, which leads to CVD. It can lead to a decrease (partial obstruction) or complete loss (complete blockage) of blood flow essential organs. The risk factors above mentioned for hypertension can also be potential risk factors for the development of CVD. Higher blood pressure can increase the chance of CVD and vice versa. each CVD and hypertension can occur simultaneously.

Angina can be a result of CVD and heart attack (myocardial infarction) as well as stroke or peripheral arterial diseases (PAD). Myocardial Infarction and angina (MI) is by partial and total blood flow obstructions to the heart. It results in heart pain because of heart muscle oxygen deprivation. Because the heart must pump blood in the face of more pressure and pressure it is forced to contract more which eventually leads to its diminished effectiveness and the inability to handle and cause heart failure.

Obstruction/reduction in blood flow to the brain leads to stroke, (also called cerebrovascular accident CVA). A high BP can also impact blood flow to the legs ( peripheral arterial disease) which may cause severe pain when walking.

Hypertension can cause permanent damage to kidneys and eventually kidney failure.

Other complications, such as obstruction or rupture of delicate narrow vessels of the cornea of your eye ( hypertensive retinopathy) may affect the vision. Hypertension can result in a reduction in blood flow and cause damage to various other organs such as the reproductive organs, bones, and other organs, which can hinder the function of these organs.

Uncontrolled/highly elevated BP, as well as CVD, are the most likely causes of complications from COVID and other infections for patients who contract the disease and suffer from these complications.

Complications associated with high BP are described below.

Complications of high BP

HEALTH SOLUTIONS

In general, the more risk factors that are co-existing in an individual, the higher chance of developing complications due to high BP. Sometimes, the 10-year risk of CVD is determined. If it’s greater than 10 percent, BP lowering medicines are taken immediately in conjunction with lifestyle measures.

Setting Goal BP.

The goal of blood pressure for medication and lifestyle modifications for patients who are older than 65 years old and those who are 65 years old must be less than 140/80 or 130/80, respectively. There is evidence that suggests BP levels of 130-139/80-89 mm Hg for the general population as leading to a significant chance of suffering from cardiovascular disease (CVD) and early death. Lower blood pressure targets seek to raise awareness of diet and lifestyle and aid in early intervention to avoid complications and ensure the highest level of public health.

Therefore, 130/80 is thought of as the latest BP global goal from a cardiologist’s point of view. However, many general practitioners are still going with the 140/90 target BP which is sometimes relaxed to 150/90 for patients over 65 years old. age.

Plan Treatment

Patients with high BP are treated by modifying their lifestyle and eating habits. This can decrease the systolic BP by 4-10mmHg. Typically, it is within the range of 5mmHg in a couple of months.

People in stage 1 hypertension who have to coexist cardiovascular risk factors (or a 10-year CVD risk >10%), will require a BP-lowering medicine in addition to lifestyle-diet measures, as compared to people without additional/coexisting risk factors who can be initially managed with lifestyle-diet measures alone.

Anyone suffering from stage 2 hypertension must be treated using an array of drugs that lower BP as well as lifestyle changes.

The ideal BP of all patients suffering from stage 1 or 2 in hypertension should be 130/80. However, there could be a difference between physicians and cardiologists when it comes to setting the goal BP for various patients.

Lifestyle and Diet guidelines to lower BP as well as CVD risk

Lifestyle management for high BP

DASH– Dietary Approaches to End hypertension is designed to lower BP and lower the chance of developing cardiovascular sequelae and also aiding in weight loss and lowering BMI.

Other lifestyle-related diet measures for blood sugar and cholesterol (cholesterol as well as triglycerides) are also recommended if these risk factors are co-existing with hypertension.

An overview of BP Lowering Medicines

BP lower medications are available either in combination or as a single dose (separately or in one pill). In general, one medication will be added to every 10 millimeters of systolic BP over the target. Sometimes, two medications at lower doses can be preferential in preference to one medicine with a higher dose to increase the effectiveness and minimize adverse effects.

There are four classes of BP-lowering medications that are considered to be first-line. One or a combination of them is employed to lower and keep BP within the target range. Second-line medications are utilized in cases where the mix of three first-line drugs of different classes is unable to manage the high BP or in some specific situations or for patients with kidney, cardiac, or other medical conditions.

Important things to keep in mind

  • All medications should be used only with prescription and advice by a qualified medical professional with the dosage as well as the schedule and timing of the day prescribed, together with the recommendations for lifestyle and diet.
  • Separate medications may be required for co-existing risk factors (like high lipids and diabetes) in the event.
  • The inability to take these pills can result in uncontrolled BP.
  • There are situations in which certain classes of medications may not be appropriate or appropriate as some can produce side effects for certain patients. Therefore, one should not start or modify any medication without consulting a physician who is qualified.
  • The blood pressure and other risk factors in the event of an occurrence must be regularly monitored and measured with the help of the physician who is treating the patient.
  • The most frequent follow-up appointment is 3 months after beginning the lifestyle diet, and one month after beginning a BP-lowering medication.

Some terms from science

Essential (or Primary) hypertension is hypertension that doesn’t have a specific root.

Secondary Hypertension is high BP due to a medical condition, like a disease of the kidneys, the heart or arteries, or hormones

Resistant hypertension can be defined as the state used to describe situations where the blood pressure target of less than the cut-off cannot be reached even with actions to improve lifestyle and treatment with three BP lower medications (of one of the 1st class, with one of them being a diuretic of the thiazide family) following ensuring complete compliance and consistency of treatment.

‘ Uncontrolled Hypertension’ is a term used to describe hypertension that is resistant as well as those who are not completely regular with medications or the use of lifestyle modifications.

2. 2nd line medications are added to patients with hypertension resistance to reach the target BP. Sometimes, certain methods (called renal denervation, which is done using ultrasound or radiofrequency) are also used to treat resistant cases.

Drugs for high BP

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