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Things You Must Know About Hypertension

What is Blood pressure? Blood Pressure is the force of your blood when pushing against the walls of your arteries. Every time your heart beats, it pumps blood to the arteries. Your blood pressure is higher when your heart beats, pumping blood. This is called systolic pressure. When your heart is at rest, between beats, your blood pressure drops. This is called diastolic pressure. How is high blood pressure diagnosed? Your blood pressure reading uses these two numbers. Usually, the systolic number is placed before or above the diastolic number. For example, 120/80 means a systolic pressure of 120 and a diastolic pressure of 80. Blood pressure is a measure of the force exerted against the walls of the arteries as the heart pumps blood to your body. Hypertension is the term used to describe high blood pressure. If left untreated, blood pressure can lead to many medical conditions. These include heart disease, stroke, kidney failure, eye problems and other health problems. Blood pressure readings are usually given as two numbers. The top number is called systolic blood pressure. The lower number is called diastolic blood pressure. For example, 120 over 80 (written as 120/80 mm Hg). What are the different types of high blood pressure? One or both numbers may be too high. (Note: these amounts apply to people who are not taking blood pressure medications and for those who are not sick). Why do I have to worry about high blood pressure? A normal blood pressure is when the blood pressure is less than 120/80 mm Hg most of the time. A high blood pressure (hypertension) is when one or both blood pressure numbers are greater than 130/80 mm Hg most of the time. If the value of the higher number of your blood pressure is between 120 and 130 mm Hg and the value of the lower number is less than 80 mm Hg, it is called high blood pressure. If you have heart or kidney problems, or if you had a stroke, your doctor may recommend that your blood pressure be even lower than that of people who do not have these conditions. Diagnosis To measure your blood pressure, the doctor or a specialist will usually place an inflatable bracelet around the arm and measure your blood pressure using a pressure gauge. The blood pressure measurement, which is given in millimeters of mercury (mm Hg), consists of two numbers. The first, or greater, measures the pressure in the arteries when the heart beats (systolic pressure). The second, or less, measures the pressure in the arteries between the heartbeat (diastolic pressure). Blood pressure measurements fall into four general categories: Normal blood pressure You have normal blood pressure if the number is below 120/80 mm Hg. High blood pressure. High blood pressure is a systolic pressure between 120 and 129 mm Hg and a diastolic pressure below 80 mm Hg. High blood pressure tends to get worse over time unless steps are taken to control it. Stage 1 hypertension. Stage 1 hypertension is a systolic pressure between 130 and 139 mm Hg or a diastolic pressure of 80 to 89 mm Hg. Stage 2 hypertension. Stage 2 hypertension, a more severe hypertension, is a systolic pressure of 140 mm Hg or greater, or a diastolic pressure of 90 mm Hg or greater. Both numbers in a blood pressure measurement are important. But after 50 years of age, systolic measurement is even more significant. Isolated systolic hypertension is a disorder in which diastolic pressure is normal (less than 80 mm Hg), but systolic pressure is high (greater than or equal to 130 mm Hg). It is a type of high blood pressure common among people over 65 years. The doctor will probably take two or three blood pressure measurements in each of the three or more consultations before diagnosing high blood pressure. This is because blood pressure normally varies throughout the day, and may be higher during visits to the doctor (white coat hypertension). Blood pressure in general should be measured in both arms to determine if there is any difference. It is important to wear an appropriate size bracelet. Your doctor may ask you to record your blood pressure at home for additional information and confirm that you have high blood pressure. The doctor may recommend a 24-hour blood pressure monitoring test, called ambulatory blood pressure monitoring, to confirm that you have high blood pressure. The device used for this test measures your blood pressure at regular intervals over a 24-hour period and provides a more accurate picture of changes in blood pressure over the course of an average day and night. However, these devices are not available at all medical centers, and are rarely reimbursed. If you have any type of high blood pressure, the doctor will review your medical history and perform a physical exam. The doctor may also recommend routine tests, such as a urinalysis (urinalysis), blood tests, a cholesterol test, and an electrocardiogram, which is a test that measures the electrical activity of the heart. It may also recommend additional tests, such as an echocardiogram, to check for more signs of heart disease. Home blood pressure control Control of blood pressure at home is an important way to check if blood pressure treatment works, confirm the presence of high blood pressure or diagnose worsening high blood pressure. Home blood pressure monitors are easy to get, low priced and no prescription is needed to buy them. Home blood pressure control does not replace doctor visits, and home blood pressure meters may have limitations. Make sure you use a validated device and that the handle has a good fit. Once a year, take the meter with you to the doctor's office to verify its accuracy. Ask the doctor how to start monitoring your blood pressure at home. The American Heart Association does not recommend devices that measure blood pressure in the wrist or finger. Diagnosis and treatment Changing the lifestyle is very important in the control of high blood pressure. The doctor may recommend the following lifestyle changes: Eat a diet with less heart-healthy salt Perform regular physical activity Maintain a healthy weight or lose weight if you are overweight or obese Limit the amount of alcohol you consume However, sometimes changes in lifestyle are not enough. In addition to diet and exercise, the doctor may recommend medications to lower blood pressure. The objective value of treatment for blood pressure depends on the state of health you have. The target value of treatment for blood pressure should be less than 130/80 mm Hg if you have the following: You are a healthy adult 65 years and older You are a healthy adult under 65 with a 10 percent or more risk of developing cardiovascular disease in the next 10 years You have chronic kidney disease, diabetes or coronary artery disease Although 120/80 mm Hg or less is the ideal target value for blood pressure, doctors don't know for sure if you need a treatment (medication) to reach that level. If you are 65 years of age and older, and the consumption of medications produces a lower systolic blood pressure (less than 130 mm Hg), the medications should not be changed unless they cause negative effects on health or quality of life. The category of medication prescribed by the doctor depends on your blood pressure measurements and your other medical problems. If you work with a team of medical professionals trained in offering a treatment for high blood pressure, it is helpful to develop a personalized treatment plan. Medications to treat high blood pressure Thiazide diuretics Diuretics are medications that act on the kidneys to help the body eliminate sodium and water and thus reduce the volume of blood. Often, thiazide diuretics are the first, but not the only, choice of medications used to treat high blood pressure. Thiazide diuretics include chlorthalidone, hydrochlorothiazide (Microzide) and others. If you are not taking diuretics and still have high blood pressure, talk to your doctor about adding or replacing a medication you are currently taking with a diuretic. Diuretics or calcium channel blockers may work better in people with African ancestors and in older adults than angiotensin-converting enzyme inhibitors alone. A common side effect of diuretics is increased urination. Angiotensin converting enzyme inhibitors. These medications, such as lisinopril (Zestril), benazepril (Lotensin), captopril (Capoten) and others, help relax blood vessels by blocking the formation of a natural chemical that narrows them. People with chronic kidney disease can benefit from using an angiotensin-converting enzyme inhibitor as a medicine. Angiotensin II receptor blockers. These medications help relax the blood vessels by blocking the action, and not the formation, of a natural chemical that narrows them. Angiotensin II receptor blockers include candesartan (Atacand), losartan (Cozaar) and others. People with a chronic kidney disease may benefit from using an angiotensin II receptor blocker as a medicine. Calcium channel blockers. These medications, which include amlodipine (Norvasc), diltiazem (Cardizem, Tiazac or others) and others, help the muscles in the blood vessels relax. Some may decrease heart rate. Calcium channel blockers may work better than angiotensin-converting enzyme inhibitors alone for people with African ancestors and older ones. Grapefruit juice interacts with some calcium channel blockers by increasing the levels of the drug in the blood and causing an increased risk of side effects. Talk to your doctor or pharmacist if you are concerned about interactions. Other medications that are usually given to treat high blood pressure If you have trouble reaching your blood pressure goals with the combinations of the medications mentioned, your doctor may indicate the following: Alpha blockers These medications reduce nerve impulses to blood vessels, which reduces the effects of natural chemicals that narrow the blood vessels. Alpha blockers include doxazosin (Cardura), prazosin (Minipress) and others. Alphabetablockers. In addition to reducing nerve impulses to blood vessels, alpha blockers decrease the beat to reduce the amount of blood that is pumped through the blood vessels. Alphabetablockers include carvedilol (Coreg) and labetalol (Trandate). Beta blockers These medications reduce the burden on the heart and open the blood vessels so that the heart beats less frequently and without much effort. Beta blockers include acebutolol (Sectral), atenolol (Tenormin) and others. In general, beta blockers are not recommended as a single medication but may be effective in combination with other blood pressure medications. Aldosterone antagonists. Some examples of these are spironolactone (Aldactone) and eplerenone (Inspra). These medications block the effect of a natural chemical that can cause salt and fluid retention, which contributes to the appearance of high blood pressure. Renin inhibitors The drug aliskiren (Tekturna) decreases the production of renin, an enzyme produced by the kidneys and that begins a chain of chemical stages that increase blood pressure. Aliskiren acts by reducing the ability of the renin to begin this process. Because there is a risk of serious complications, including stroke, aliskiren should not be consumed with angiotensin converting enzyme inhibitors or angiotensin II receptor blockers. Vasodilators These medications, which include hydralazine and minoxidil, act directly on the muscles of the arterial walls, and prevent such muscles from straining and narrowing the arteries. Central action agents. These medications prevent the brain from sending signals to the nervous system to increase the heart rate and narrow the blood vessels. Some examples are clonidine (Catapres, Kapvay), guanfacine (Intuniv, Tenex) and methyldopa. In order to reduce the amount of daily doses of medication you need, your doctor may prescribe a combination of low-dose medications instead of large doses of a single medication. In fact, two or more blood pressure medications are usually more effective than just one. Sometimes finding the medication or the most effective combination is a matter of trial and error. Resistant hypertension: When blood pressure is difficult to control If your blood pressure is still excessively high despite having taken at least three different types of medications for high blood pressure, of which one should generally be a diuretic, you may have resistant hypertension. If a person has controlled high blood pressure, but takes four different types of medications at the same time to achieve that control, they are also considered to have resistant hypertension. Generally, the possibility of a secondary cause of high blood pressure should be reconsidered. Having resistant hypertension does not mean that blood pressure will never drop. In fact, if you and your doctor can identify the cause of persistent high blood pressure, there are many possibilities that you can reach your goal with the help of a more effective treatment. Your doctor or hypertension specialist can: Evaluate the potential causes of your disease and determine if they can be treated. Review the medications you take for other diseases and recommend not taking any that worsen your blood pressure. Recommend that you check your blood pressure at home to see if you have a higher blood pressure in the doctor's office (white coat hypertension). Suggest healthy lifestyle changes, such as eating a healthy diet that includes less salt, maintaining a healthy weight and limiting alcohol consumption. Make changes to your medications for high blood pressure to get the most effective combination and doses. Consider adding an aldosterone antagonist such as spironolactone (Aldactone), which may favor the control of resistant hypertension. Some experimental treatments are being studied, such as catheter-based radiofrequency ablation of renal sympathetic nerves (renal denervation) and electrical stimulation of carotid sinus baroreceptors. If you do not take your medications for high blood pressure exactly as directed, your blood pressure may suffer. If you skip doses because you cannot afford the medications, because you have side effects or simply because you forget to take your medications, talk to your doctor about the solutions. Do not modify your treatment without the doctor's advice.



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Things You Must Know About Hypertension

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