INTRODUCTION higher will be blood pressure.[4] The pressure that

INTRODUCTION

1.1 Hypertension

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Throughout
most of the world till this day, “hypertension” is defined as long-lastingrise
in Blood Pressure equal to or greater than 140/90 mmHg. For diabetes and
chronic kidney disease, blood pressure should be maintained at levels
160/100 mm Hg not
uncommon)

·        
Cardiovascular events
may have already occurred

·        
Aging and persistence
of other identifiable risk factors continue to exacerbate the risk of morbidity
and mortality

Classification 

Systolic BP (mm Hg) 

 

Diastolic BP (mm Hg) 

Normal 

1500mg/day)  or too little potassium
Lack
of physical activity
Drinking
too much alcohol
Stress
Smoking
and Tobacco use

 

1.4.6
Family History

A
family history of high blood pressure increases the risk of developing pre-hypertension
or hypertension. People having hypertension in their family are at risk of
getting it as compared to others who don`t have a family history. Some people
have a high sensitivity to sodium and salt, which may increase their risk for
high blood pressure and may run in families.

1.4.7 Diabetes

Diabetes,
a disorder of the endocrine system in which body is either unable to produce
Insulin or it cannot utilize insulin despite production. Insulin is a hormone
secreted by Pancreas that regulates sugar levels in the blood under different
circumstances according to needs of the body. Diabetes also increases the risk
of cardiovascular diseases, in which hypertension is one of them. Diabetes
increases levels of sugar in the blood to rise abnormally.About 60% of diabetic
patients have hypertension. 26

1.5 Causes of High Blood Pressure

Changes,
either from genes or the environment, in the body’s normal functions
may cause high blood pressure. Some known causes are discussed below:

1.5.1
Biology and High Blood Pressure

It
is being studied through ongoing researches that how internal changes in normal
body functions cause high blood pressure. The significant factors which are
considered to be affected in high blood pressure include:

Kidney
Fluid and Salt Balances

The
kidneys usuallycontrol the levels of salt in the body by retaining sodium and
water and expelling unwanted amount ofpotassium. Imbalance in this function of
the kidney can expand circulating blood volumes, which can lead to rise in blood
pressure.27

Renin-Angiotensin-Aldosterone
System

This
system of the body makes two different hormones, angiotensin and aldosterone.
Angiotensin constricts blood vessels, which develops the pressure of blood in
these vessels. Aldosterone is responsible for regulation of fluid and salt
levels by the kidneys. Increased levels or action of aldosterone may affect
this function of kidney, leading to increased blood volumes and ultimately high
blood pressure.

Sympathetic
Nervous System Activity

The
sympathetic nervous system has a central role in blood pressure regulation,
including heart rate, blood pressure, and breathing rate. It is under studies
to observe the relation of SNS with increase in blood pressure. Although
uncertain, but the case is strong that in hypertension, we are now on the edge
of successful “mechanisms to management” shift, with the use of catheter-based
renal sympathetic nerve ablation for treating drug-resistant hypertension. 28

Blood
Vessel Structure and Function

Changes
in the internal structure and endothelial function of small and large arteries
may contribute to high blood pressure. In up to date researches, it has become
clear that structural changes inside arteries, referred to as remodelling, can
be the reason for losing flexibility found in arterial walls which can
contribute in the development of hypertension. 29,
30

1.5.2
Genetic Causes of High Blood Pressure

Most
of the understandings that body internal functions are involved in the increase
of blood pressure have come from genetic studies. Hypertension is more common
in patients having a family history of it. Large numbers of studies have identified
many genes and mutations in them associated with hypertension, some of them
exist in the renal salt regulatory and renin-angiotensin-aldosterone pathways. 31
However, these known genetic factors only responsible for 2-3% of all
cases. Recent studies suggest involvement ofcertain changes in DNA during
embryological stages inside motherbody also may cause the development of hypertension
later in life.

 

1.5.3
Other Medical Causes of High Blood Pressure

Certain
other known medical conditions which can cause hypertensionare chronic kidney
disease, sleep apnea, thyroid problems, or certain tumours. This happens
because these conditions change the activity of body for example, sodium and
water regulation, hormones levels in the blood, which also contribute in
causing secondary hypertension.

1.6 Signs and Symptoms

Myth:
People with hypertension will pass through symptoms, such as nervousness,
sweating, and trouble in sleeping or cheek redness.

Truth:
Hypertension is symptomless, in most of the cases best termed as a “silent
killer.” If persistent high blood pressure values are neglected and the appearance
of symptoms is waited then it becomes a life threatening condition.

1.7 Investigations32

Hypertension: Investigation of all patients

Urinalysis for blood, protein and glucose
Blood urea, electrolytes and creatinine
N.B. Hypokalaemic
alkalosis may indicate primary
hyperaldosteronism but is
usually due to diuretic therapy
Blood glucose
Serum total and HDL cholesterol
Thyroid function tests
12-lead ECG (left ventricular hypertrophy,
coronary artery disease)

 

1.8 Treatment32

Optimal target blood pressures 1                                          

Age    

Clinic BP

Ambulatory/ home BP 2