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PHARMACY: HYPERTENSION EDITED BY DENISE GERSON ABSTRACT DEFINITION: HYPERTENSION (HT) is a term used to describe a high blood pressure. It is a condition that affects millions of people worldwide and can put you at a greater risk for health problems. WHAT IS HYPERTENSION? BLOOD PRESSURE (BP) is the force applied by CAUSES AND SYMPTOMS: blood against artery (type of blood vessels that BP depends on the blood vessel’s width, how carry blood from the heart to the rest of the forcefully the heart contracts during pumping body) walls. Two types of BP are measured. and the volume of blood present in the circulation. In most cases, the reason for SYSTOLIC BP Measures the pressure in your arteries during systole, while the heart contracts and pumps blood (the heartbeat). increased BP is not known. This is called Essential HT. However, certain factors are associated with HT. These include: DIASTOLIC BP Measures the pressure in your arteries during the diastole, while the heart relaxes and is filled with blood (between heartbeats). The normal value of BP is, usually, less than 120/80 mmHg - 120 refers to the systolic BP and 80 refers to the diastolic BP. The 'mmHg' (millimetres of mercury) are the units used to measure the pressure. In HT, systolic BP is usually greater than 140 mmHg and/or the diastolic BP is greater than 90 mmHg. Often, this condition is like a, because although you do not feel sick the disease and its risks are still present. Overweight/obesity, not physically active, diabetes, high cholesterol Older age, male gender Stress Diet with too much salt and fat Smoking African-Americans and West Indians Family history HT PHARMACY: HYPERTENSION EDITED BY DENISE GERSON When the cause of increased BP is known, it is STROKE called Secondary HT it may be due to: Arteries supplying the brain may become Atherosclerosis (narrowing of the arteries) of the brain and its malfunction. Endocrine disorders (hormonal problems) Kidney disease narrowed and blocked, causing death of a part Alcohol abuse and use KIDNEY FAILURE of some Occurs due to blockage of blood vessels, medications Heart disease making them wider and weaker, thus Kidney disease increasing the risk of rupture and bleeding. Heart disease SYMPTOMS ANEURYSMS Usually, there are no symptoms; however the High Blood Pressure can damage blood vessels, disease and its risks are present even in the making absence of symptoms and signs (“Silent increasing the risk of rupture and bleeding. them wider and weaker, thus Killer”). When BP is severely elevated, some symptoms may occur: VISUAL LOSS Headache Tiredness Awareness of heartbeat (palpations) Confusion, nosebleed, changes in vision These symptoms complication as Due to blockage of blood vessels in the eyes. can be alert of Hypertension some causes COMPLICATIONS: 1. Stroke 2. Visual loss; 3. Aneurysms; progressive damage over time (it can also be 4. Heart failure; present with symptoms): 5. Heart Attack; 6. Kidney failure. HYPERTENSIVE HEART DISEASE The heart must be stronger to pump blood out against an elevated Blood Pressure, there is an enlargement of the heart muscle. MYOCARDIAL INFRACTION (HEART ATTACK) Coronary arteries may become narrowed and blocked, causing death of a part of the heart tissue and its subsequent malfunction. CONGESTIVE HEART FAILURE The heart cannot pump sufficient enough amount of blood to meet the body’s needs. PHARMACY: HYPERTENSION EDITED BY DENISE GERSON DIAGNOSIS4,5 usually, around the arm; then the doctor Blood pressure levels experience some normal pumps it with one hand on a bulb and with the variations during the day, as it is low during other hand places the diaphragm of the sleep and increases on wakening. Physical stethoscope on your arm, to listen to the activity, an emotional episode or drinking arterial sound, while watching the BP values; caffeine levels an automated system may be used instead. episodically, but it will return to normal levels Both the systolic and diastolic BP can be soon after. Because of these variations, blood measured using this method. can pressure raise levels blood must pressure be measured repeatedly over time to confirm a diagnosis The pre-hypertensive stage means that the of HT. As HT can be present without any individual is at a higher risk of developing HT symptoms, BP must be checked regularly. and its complications. Additional tests, such as blood and urine tests or an electrocardiogram, may be required to look for signs of complications. BLOOD PRESSURE: CLASSIFICATION SYSTOLIC BP DIASTOLIC BP Normal Below 120 and Below 80 Prehypertension 120 - 139 or 80 - 89 Stage 1 140 - 159 or 90 - 99 160+ or 100+ hypertension Stage 2 hypertension HYPERTENSION TERMS EXPLAINED ANEURYSM: An aneurysm occurs when part of a blood This should also be done when there are vessel (artery) or cardiac chamber swells, - symptoms present. Your doctor will refer to either the blood vessel is damaged, or there is medical history, asking about your general a weakness in the wall of the blood vessel. As health condition both in the present and in the blood pressure builds up it balloons out at its past, as well as any symptoms or factors related to HT. He/she will also perform a physical examination to check for any possible symptoms. weakest point. The swelling can be quite small or very large - when large it tends to extend along the blood vessel. As the aneurysm grows there is a greater risk of rupture - this can lead to Blood Pressure is sphygmomanometer: measured a cuff using is a placed, severe haemorrhage, and complications, including sudden death. other PHARMACY: HYPERTENSION EDITED BY DENISE GERSON ARTERY: A vessel that carries blood away from the heart MYOCARDIAL INFARCTION: to the cells, tissues and body organs. Death or damage of part of the heart muscle (myocardium), typically causing a severe pain the chest, which often radiates to the shoulder ATHEROSCLEROSIS: A degenerative disease of the arteries arm or jaw. characterised by the thickening and loss of elasticity of arterial walls. SYSTOLE: Period of contraction of the heart, especially of BLOOD CLOTS: the ventricles. Coagulated blood (formed into a solid mass) TREATMENT: CHOLESTEROL: Hypertension cannot be cured, but it can be An animal sterol that is normally synthesised by controlled the liver. High levels of cholesterol in the blood treatment is to lower the blood pressure. and prevented. The goal of have been implicated in the development of atherosclerosis. The first option for treatment includes some healthy-living recommendations: CONGESTIVE: An abnormal accumulation of fluid in an organ or body area. Low-salt (less than 1500,g/day) and low-fat diet; CORONARY: Maintain a healthy weight; Of or relating to the heart or its vessels. Exercise for at least 30 minutes a day; Do not smoke and limit alcohol intake; Reduce stress. DIABETES: Any of various disorders characterised by the inability to process sugar in the diet. When healthy-living recommendations are not enough for lowering blood pressure several are DIASTOLE: prescribed to reduce HT and its complications; Phase of the cardiac cycle with relaxation and these act by modifying the blood vessel width, dilation of the heart chambers, especially the the heart's pumping function, the blood volume ventricles during which the heart is filled with or even by preventing blood clots. blood. Medications are often taken in combination and HORMONE: for life, with the dosages being gradually Chemical substance, produced in the body, reduced as BP is controlled and returns to having a specific regulatory effect on the normal. activity of a certain organ of organs. PHARMACY: HYPERTENSION EDITED BY DENISE GERSON REFERENCES: Bibliography: l. Kimball JW Anatomy of the human circulatory system Internet 2011 Jan 10 [cited 2011 Jul7] Available from: http://users.rcn.com/jkimball.ma.ultranet/Bio ogyPages/C/Circulation.html.2.American Medical Association. Atlas of human body: general circulation [lnternet]. 1995 [cited 2011 Jul 7] One is advised to continue treatment even when feeling normal, as this condition usually has no symptoms. – A BP record table must be maintained at home using a self-testing kit or through a medical appointment. Available from: http://www.ama-assn.org/ama/pub/physicianresources/patient-education-materials/atlasof-human-body/circulation-general.page?#.3. North of England Hypertension Guideline Development Group Evidence based clinical practice guideline essential hypertension managing adult patients in primary care Newcastle (UK): Centre for Health Services Research; 2004.261 p. Report No. 111.4 Moser, M. High blood pressure: lower it and live longer Scarsdale(NY)r Hypertension Education Foundationi200T 5 National Institutes of Health National Heart, Lung, and Blood Institute National High Blood Pressure Education Program The seventh report of the joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure Bethesda (MD):National Institutes of Health (US);2004Aug. 87 p. NIH Publication No. 045230,6,Bullt by Doctors Ltd. Letter of authorisation Wilmington DE,2013 Oct.