Introduction:
Hypertension is defined as chronically elevated blood pressure levels. It It is the most common modifiable risk factor for cardiovascular diseases. Approximately one in every four adults is suffering from hypertension. Every year around 7.5 million deaths occur due to high blood pressure worldwide. Classically hypertension or elevated blood pressure is defined in terms of systolic and diastolic blood pressure. Individuals having systolic blood pressure < 120 mm/Hg and diastolic blood pressure < 80 mm/Hg are said to be normal. Individuals with systolic blood pressure >120 mm/Hg upto 139 mm/Hg and diastolic blood pressure >80 mm/Hg upto 89 mm/Hg are said to be prehypertensive. Individuals with systolic blood pressure ≥140 mm/Hg and diastolic blood pressure ≥90 mm/Hg are said to be hypertensive. Usually prehypertensive patients are at higher risk of developing hypertension.
Diagnostic values:
Blood pressure | Systolic mm/Hg | Diastolic mm/Hg |
Normal | <120 | <80 |
Prehypertensive | ≤139 | ≤89 |
Hypertensive | ≥ 140 | ≥ 90 |
Types of hypertension:
There are two types of hypertension
1. Essential hypertension
2. Secondary hypertension
Essential hypertension:
Chronically elevated blood pressure levels without any secondary cause or so called idiopathically elevated blood pressure levels is known as essential hypertension.
Secondary hypertension:
Hypertension due to some underlying medical condition e.g renal artery stenosis is known as secondary hypertension.
Causes of secondary hypertension:
Secondary hypertension is multifactorial disease and has following well known causes:
1. Renal artery stenosis or other renal problems
2. Adrenal gland abnormalities
3. Coarctation of aorta
4. Pregnancy
5. Thyroid and parathyroid abnormalities
Complications of hypertension:
Hypertension is primarily the disease of cardiovascular system and it affects arteries and almost every organ of the body. Usually it is asymptomatic and patients are diagnosed on clinical visits. Some of the complications of hypertension include;
1. Heart attack / Heart failure
2. Stroke
3. Haemorrhages
4. Aneurysms
5. Atherosclerosis
6. Kidney diseases ( Nephropathies )
7. Pulmonary oedema
8. Blindness ( Retinopathies )
9. Confusion
10. Headache and convulsions
Treatment of hypertension:
Treatment and management of hypertension include two broad management plans
1. Non pharmacological management
It involves patient education about lifestyle modifications and it involves all hypertensive patients regardless of comorbidities, age, gender and cardiovascular status. Lifestyle modifications include weight management, salt restriction, smoking management, adequate management of obstructive sleep apnea and exercise.
2. Pharmacological management:
It involves pharmacological preparations and patient status of disease, age and comorbidities are taken into consideration while prescribing the drug. It includes following medications:
3. Angiotensin converting enzyme inhibitors
4. Angiotensin receptor blockers
5. Diuretics
6. Calcium channel blockers
7. Beta blockers
Conclusion:
Hypertension is the most common cause of cardiovascular pathologies. Worldwide approximately 7.5 million death occur due to high blood pressure. All the individuals with systolic blood pressure ≥140 mm/Hg and diastolic blood pressure ≥90 mm/Hg are said to be hypertensives. Essential hypertension is primarily idiopathic however secondary hypertension has a well know secondary cause. Usually renal artery stenosis, coarctation of aorta and other secondary causes are the culprit for hypertension. Chronically elevated blood pressure levels give rise to cerebrovascular accidents and other comorbidities. Treatment of hypertension is classically non pharmacological interventions or pharmacological interventions. Non pharmacological management involves lifestyle modifications and pharmacological management involves beta blockers and other pharmaceutical preparations.
