Friday 28 November 2014
PATHOPHYSIOLOGY OF HYPERTENSION
In the development of hypertension, there is increase in peripheral resistance which usually involve the constriction of arterioles due to constriction of smooth muscles upon stimulation by sympathetic nerves
(constriction of arterioles is also affected by oxygen concentration,metabolic production,hormones and drugs).
The increase peripheral resistance causes increase in heart beat in an attempt to overcome the resistance subsequent there is increased cardiac output.
The consistent resistance place a greater demand on the heart resulting in myocardial hypertrophy and
cardiomegally.The increased cardiac output (increase blood volume)flows through the vessels and against
the resistance.The result is increased pressure within the vessels.This is related to hydraulic principle which states that the flow through a tube is proportional to the pressure inside the tube and is inversely proportional
to the resistance in the tube.
The arteries are subjected to arteriosclerotic changes which in addition to constricted arterioles results in reduced blood supply to many organs in the body such as the brain,the lungs,the heart,the kidney and
muscles.
The tiny vessels are prone to rupture due to the arteriosclerotic changes and increased pressure within them.Where this occurs,it accounts for the haemorrhage which usually accompanies HTN as epistaxis.
Bleeding to the retina may occur resulting in blurred vision and blindness.Apoplexy (stroke) is usually
due to this facts.
HYPERTENSION IN MILDLIFE
An analysis of cerebrospinal fluid samples of adults without cognitive impairment revealed that participants with a high value of blood pressure were more likely to have biomarkers of Alzheimer's disease (AD).
The study included 177 adults, 55-100 years without cognitive impairment , previous stroke or EA . All of them took the pulse pressure and underwent a lumbar puncture to determine the levels of β -amyloid 1-42 ( Aβ1 -42 ) and phosphorylated tau (p- tau ) in cerebrospinal fluid .
In a multivariate analysis , increased blood pressure was significantly associated with an increased level of p- tau ( p = 0.002 ), a reduction of Aβ1 -42 (p = 0.01) and a higher ratio p- tau/Aβ1-42 ( p <0.001). After controlling for important covariates , blood pressure remained associated with the level of p- tau ( p = 0.0196 ) and p-tau/Aβ1-42 (p < 0.001 ) relationship, but not Aβ1 -42 (p = 0.35).
These results suggest that high blood pressure would be associated with the appearance of signs of AD keys that cause the loss of brain cells. Scientists noted that the increase in blood pressure was associated with all biomarkers evaluated in adults 55-70 years , but not in 70-100 years.
The study included 177 adults, 55-100 years without cognitive impairment , previous stroke or EA . All of them took the pulse pressure and underwent a lumbar puncture to determine the levels of β -amyloid 1-42 ( Aβ1 -42 ) and phosphorylated tau (p- tau ) in cerebrospinal fluid .
In a multivariate analysis , increased blood pressure was significantly associated with an increased level of p- tau ( p = 0.002 ), a reduction of Aβ1 -42 (p = 0.01) and a higher ratio p- tau/Aβ1-42 ( p <0.001). After controlling for important covariates , blood pressure remained associated with the level of p- tau ( p = 0.0196 ) and p-tau/Aβ1-42 (p < 0.001 ) relationship, but not Aβ1 -42 (p = 0.35).
These results suggest that high blood pressure would be associated with the appearance of signs of AD keys that cause the loss of brain cells. Scientists noted that the increase in blood pressure was associated with all biomarkers evaluated in adults 55-70 years , but not in 70-100 years.
HYPERTENSION IN MILDLIFE
Hypertension in midlife anticipate cognitive disorders
An analysis of cerebrospinal fluid samples of adults without cognitive impairment revealed that participants with a high value of blood pressure were more likely to have biomarkers of Alzheimer's disease (AD).
The study included 177 adults, 55-100 years without cognitive impairment , previous stroke or EA . All of them took the pulse pressure and underwent a lumbar puncture to determine the levels of β -amyloid 1-42 ( Aβ1 -42 ) and phosphorylated tau (p- tau ) in cerebrospinal fluid .
In a multivariate analysis , increased blood pressure was significantly associated with an increased level of p- tau ( p = 0.002 ), a reduction of Aβ1 -42 (p = 0.01) and a higher ratio p- tau/Aβ1-42 ( p <0.001). After controlling for important covariates , blood pressure remained associated with the level of p- tau ( p = 0.0196 ) and p-tau/Aβ1-42 (p < 0.001 ) relationship, but not Aβ1 -42 (p = 0.35).
These results suggest that high blood pressure would be associated with the appearance of signs of AD keys that cause the loss of brain cells. Scientists noted that the increase in blood pressure was associated with all biomarkers evaluated in adults 55-70 years , but not in 70-100 years.
An analysis of cerebrospinal fluid samples of adults without cognitive impairment revealed that participants with a high value of blood pressure were more likely to have biomarkers of Alzheimer's disease (AD).
The study included 177 adults, 55-100 years without cognitive impairment , previous stroke or EA . All of them took the pulse pressure and underwent a lumbar puncture to determine the levels of β -amyloid 1-42 ( Aβ1 -42 ) and phosphorylated tau (p- tau ) in cerebrospinal fluid .
In a multivariate analysis , increased blood pressure was significantly associated with an increased level of p- tau ( p = 0.002 ), a reduction of Aβ1 -42 (p = 0.01) and a higher ratio p- tau/Aβ1-42 ( p <0.001). After controlling for important covariates , blood pressure remained associated with the level of p- tau ( p = 0.0196 ) and p-tau/Aβ1-42 (p < 0.001 ) relationship, but not Aβ1 -42 (p = 0.35).
These results suggest that high blood pressure would be associated with the appearance of signs of AD keys that cause the loss of brain cells. Scientists noted that the increase in blood pressure was associated with all biomarkers evaluated in adults 55-70 years , but not in 70-100 years.
EXERCISE HELP CONQUER HYPERTENSION
New studies continue to provide evidence about the importance of regular physical activity. In this case, the results confirm that the exercise undertaken during leisure time helps control hypertension. Already hypertensive ( a) or have any risk factors for this condition? Then you should continue reading .
If you have high blood pressure or tension you will have certainly indicated to control your intake of salt or sodium, but this is not the only thing you can do to maintain healthy levels. There is another thing you can do to protect hypertension : regular exercises.
A new study by scientists at Shandong University in Jinan , China, provides more evidence that physical activity is done during leisure time helps to control blood pressure, the more intense movement that you can do during working hours.
To arrive at these figures, which were published in the journal Hypertension , researchers analyzed the findings of 13 studies that examined the effects of physical activity on blood pressure . In total , the studies evaluated included nearly 137,000 people from America , Europe and East Asia , which initially had a healthy blood pressure. The data shows that , during follow-up periods ranging from 2 to 45, more than 15,600 participants developed hypertension.
By analyzing the information obtained, the specialists found that people who exercised one to three hours per week were 11 percent less likely to suffer from hypertension , compared with those who exercised for less than an hour a week in his spare time . Moreover, they did recreational exercise for more than 4 hours a week decreased.
If you have high blood pressure or tension you will have certainly indicated to control your intake of salt or sodium, but this is not the only thing you can do to maintain healthy levels. There is another thing you can do to protect hypertension : regular exercises.
A new study by scientists at Shandong University in Jinan , China, provides more evidence that physical activity is done during leisure time helps to control blood pressure, the more intense movement that you can do during working hours.
To arrive at these figures, which were published in the journal Hypertension , researchers analyzed the findings of 13 studies that examined the effects of physical activity on blood pressure . In total , the studies evaluated included nearly 137,000 people from America , Europe and East Asia , which initially had a healthy blood pressure. The data shows that , during follow-up periods ranging from 2 to 45, more than 15,600 participants developed hypertension.
By analyzing the information obtained, the specialists found that people who exercised one to three hours per week were 11 percent less likely to suffer from hypertension , compared with those who exercised for less than an hour a week in his spare time . Moreover, they did recreational exercise for more than 4 hours a week decreased.
THE TREATMENT
TREATMENT
What Are The Treatment Options For Addiction?
The first step for the addicted person is to acknowledge that there is a substance dependency problem (addiction problem). The next step is to get help. In most of the world there are several support groups and professional services available.
Treatment options for addiction depend on several factors, including what type of substance it is and how it affects the patients. Typically, treatment includes a combination of inpatient and outpatient programs, counseling (psychotherapy), self-help groups, pairing with individual sponsors, and medication.
Treatment programs - these typically focus on getting sober and preventing relapses. Individual, group and/or family sessions may form part of the program. Depending on the level of addiction, patient behaviors, and type of substance this may be in outpatient or residential settings.
Psychotherapy - there may be one-to-one (one-on-one) or family sessions with a specialist.
Help with coping with cravings, avoiding the substance, and dealing with possible relapses are key to effective addiction programs. If the patient’s family can become involved there is a better probability of positive outcomes.
Self-help groups - these may help the patient meet other people with the same problem, which often boosts motivation. Self-help groups can be a useful source of education and information too. Examples include Alcoholics Anonymous and Narcotics Anonymous. For those dependent on nicotine, ask your doctor or nurse for information on local self-help groups.
Help with withdrawal symptoms – the main aim is usually to get the addictive substance out of the patient’s body as quickly as possible. Sometimes the addict is given gradually reduced dosages (tapering). In some cases a substitute substance is given. Depending on what the person is addicted to, as well as some other factors, the doctor may recommend treatment either as an outpatient or inpatient.
The doctor or addiction expert may recommend either an outpatient or inpatient residential treatment center. Withdrawal treatment options vary and depend mainly on what substance the individual is addicted to:
Addiction to depressants - these may include dependence on barbiturates or benzodiazepines. During withdrawal the patient may experience anxiety, insomnia, sweating and restlessness. In rare cases there may be whole-body tremors, seizures, hallucinations, hypertension (high blood pressure), accelerated heart rate and fever. In severe cases there may be delirium, which according to the Mayo Clinic, USA, could be life-threatening.
Addiction to stimulants - these may include cocaine and other amphetamines. During withdrawal the patient may experience tiredness, depression, anxiety, moodiness, low enthusiasm, sleep disturbances, and low concentration. Treatment focuses on providing support, unless the depression is severe, in which case a medication may be prescribed.
Addiciton to opioids – Opioids are a class of drugs that are commonly prescribed for their analgesic, or pain-killing, properties. They include substances such as morphine, codeine, oxycodone, and methadone. Opioids may be more easily recognized by drug names such as Kadian, Avinza, OxyContin, Percodan, Darvon, Demerol, Vicodin, Percocet, and Lomotil. During withdrawal there may be sweating, anxiety and stuffy nose – symptoms tend to be mild. In rare cases there may be serious sleeping problems, tachycardia, hypertension and diarrhea. The doctor may prescribe methadone, or buprenorphine for cravings (alternative substances).
What Are The Treatment Options For Addiction?
The first step for the addicted person is to acknowledge that there is a substance dependency problem (addiction problem). The next step is to get help. In most of the world there are several support groups and professional services available.
Treatment options for addiction depend on several factors, including what type of substance it is and how it affects the patients. Typically, treatment includes a combination of inpatient and outpatient programs, counseling (psychotherapy), self-help groups, pairing with individual sponsors, and medication.
Treatment programs - these typically focus on getting sober and preventing relapses. Individual, group and/or family sessions may form part of the program. Depending on the level of addiction, patient behaviors, and type of substance this may be in outpatient or residential settings.
Psychotherapy - there may be one-to-one (one-on-one) or family sessions with a specialist.
Help with coping with cravings, avoiding the substance, and dealing with possible relapses are key to effective addiction programs. If the patient’s family can become involved there is a better probability of positive outcomes.
Self-help groups - these may help the patient meet other people with the same problem, which often boosts motivation. Self-help groups can be a useful source of education and information too. Examples include Alcoholics Anonymous and Narcotics Anonymous. For those dependent on nicotine, ask your doctor or nurse for information on local self-help groups.
Help with withdrawal symptoms – the main aim is usually to get the addictive substance out of the patient’s body as quickly as possible. Sometimes the addict is given gradually reduced dosages (tapering). In some cases a substitute substance is given. Depending on what the person is addicted to, as well as some other factors, the doctor may recommend treatment either as an outpatient or inpatient.
The doctor or addiction expert may recommend either an outpatient or inpatient residential treatment center. Withdrawal treatment options vary and depend mainly on what substance the individual is addicted to:
Addiction to depressants - these may include dependence on barbiturates or benzodiazepines. During withdrawal the patient may experience anxiety, insomnia, sweating and restlessness. In rare cases there may be whole-body tremors, seizures, hallucinations, hypertension (high blood pressure), accelerated heart rate and fever. In severe cases there may be delirium, which according to the Mayo Clinic, USA, could be life-threatening.
Addiction to stimulants - these may include cocaine and other amphetamines. During withdrawal the patient may experience tiredness, depression, anxiety, moodiness, low enthusiasm, sleep disturbances, and low concentration. Treatment focuses on providing support, unless the depression is severe, in which case a medication may be prescribed.
Addiciton to opioids – Opioids are a class of drugs that are commonly prescribed for their analgesic, or pain-killing, properties. They include substances such as morphine, codeine, oxycodone, and methadone. Opioids may be more easily recognized by drug names such as Kadian, Avinza, OxyContin, Percodan, Darvon, Demerol, Vicodin, Percocet, and Lomotil. During withdrawal there may be sweating, anxiety and stuffy nose – symptoms tend to be mild. In rare cases there may be serious sleeping problems, tachycardia, hypertension and diarrhea. The doctor may prescribe methadone, or buprenorphine for cravings (alternative substances).
Saturday 15 March 2014
THE TREATMENT OF HYPERTENSION
HYPERTENSION TREATMENTS
STEP 1
LIFESTYLE MODIFICATION
*Weight reduction
*Reduction of sodium intake
*Moderation of alcohol intake
*Smoking cessation
*Physical activity increase (this has shown to decreas blood pressure and improve cardiovascular
tone
and reserve).
STEP 2
INADEQUATE RESPONSE
*Continue lifestyle modifications
*Initial drug selection
-Diuretic or B-blocker (this tend to decrease serum sodium levels and blood volume)
-ACE inhibitor,calcium channel blocker,alpha blocker,alpha and beta blocker (ACE inhibitor blocks
the conversion of angiotensin 1 to 11 thereby blocking the effects of angiotensin 11 on the blood
vessel.
Calcium blocker relaxes muscle contraction.Beta blocker decreases heart rate and streght of
contraction as well as vasodilation
STEP 1
LIFESTYLE MODIFICATION
*Weight reduction
*Reduction of sodium intake
*Moderation of alcohol intake
*Smoking cessation
*Physical activity increase (this has shown to decreas blood pressure and improve cardiovascular
tone
and reserve).
STEP 2
INADEQUATE RESPONSE
*Continue lifestyle modifications
*Initial drug selection
-Diuretic or B-blocker (this tend to decrease serum sodium levels and blood volume)
-ACE inhibitor,calcium channel blocker,alpha blocker,alpha and beta blocker (ACE inhibitor blocks
the conversion of angiotensin 1 to 11 thereby blocking the effects of angiotensin 11 on the blood
vessel.
Calcium blocker relaxes muscle contraction.Beta blocker decreases heart rate and streght of
contraction as well as vasodilation
THE COMPLICATIONS AND HOW TO MANAGE HYPERTENSION
COMPLICATIONS
-Cardiac failure
-Cerebrovascular accident
-Retinoparthy
-Renal failure
-Hypertensive encephalopathy
MEDICAL MANAGEMENT
The goal of treatment is to prevent death and complications by achieving and maintain the arterial
blood
pressure at 140/90 mmHg or lower.
To promote compliance,clinicians,try to prescribe the simplest treatment schedule possible,ideally
one pill once each day.
-Cardiac failure
-Cerebrovascular accident
-Retinoparthy
-Renal failure
-Hypertensive encephalopathy
MEDICAL MANAGEMENT
The goal of treatment is to prevent death and complications by achieving and maintain the arterial
blood
pressure at 140/90 mmHg or lower.
To promote compliance,clinicians,try to prescribe the simplest treatment schedule possible,ideally
one pill once each day.
SIGNS AND SYMPTOMS
It is rarely accompanied by any symptom and the identification is usually through screening and
sometimes when seeking healthcare for an unrelated problem. But there are some signs that could
accompany hypertension examples:-
1) Persistent headache
2) Light headedness
3) Vertigo
4) Tinnitus
6) Fainting episodes
On physical examination,hypertension may be suspected on the basis of retinopathy. All those are
usually observed in primary hypertension which is mostly caused by stress. Additional signs and
symptoms may suggest secondary hypertension.
1) Kidney disease
2) Endocrine disease (cushings syndromme)
3) Acromegaly
4) Renal artery stenosis
5) Aortic coarctation
6) Phaeochromocytom
There are some extreme presentation of hypertension which is collectively called hypertensive
crisis.
Hypertensive crisis can be referred to as hypertensive urgency and emergency.
Hypertensive urgency
Hypertensive urgency is a situation where the blood pressure is severely elevated to180/110mmHg
persistently. But even at this reading there is no associated organ damage.
The symptoms frequently observed are:-
Severe headache
Shortness of breath
Nose bleeding
Anxiety
Hypertensive emergency
In hypertensive emergency, the blood pressure will exceed 180/110 and end organ damage will be
observed.
The consequences of hypertensive emergency are:-
Stroke
Memory loss
Loss of consciousness
Heart attack
Eye damage
Kidney damage
Aortic dissection
Angina
Pulmonary edema
Eclampsi
DIFFERENT TYPES OF HYPERTENSION
Types
-Primary (Essential)
-Secondary (Non Essential)
Primary or Essential Hypertension: Indicates that the reason for the elevation in blood pressure
cannot be identified.Approximately 90% of people with hypertension have primary type while the
remaining 10%
have secondary non essential hypertension.
There are two main types of hypertension and four types that are less common. Depending on the
type of hypertension, the cause could be known or unknown. Hypertension is suspected to be as a
result of combined factors related to genetics, diets and lifestyle.
The most common are:
Primary hypertension and Secondary hypertension.
The other less common include malignant hypertension, isolated systolic hypertension, white coat
hypertension and resistant hypertension.
Primary (Essential) Hypertension- indicates that the reason for the elevation in the blood pressure
cannot be identified. Approximately 90% of people with hypertension have primary type while the
remaining 10% have secondary (non essential) hypertension.
Secondary(Non-Essential)Hypertension-It is a term used to signify high blood pressure from an
identified cause. Such as drug induced or related causes, obesity, renal disorder, metabolic and
endocrine causes, pregnancy induced phaechromocytoma.
Malignant hypertension-This occurs suddenly and drastically, The person might experience
numbness
in the body as well as vision problems, extreme fatigue, confusion, anxiety and seizures. It is very
rare and affect both children and adults.Pregnant women are also at risk
THE REAL MEANING OF HYPERTENSION
Hypertension or high blood pressure sometimes called arterial hypertension is a chronic medical
condition in which the blood pressure in the artery is elevated.
Blood pressure is summarized by two measurement the systolic and diastolic which depend on
whether the heart muscle is contractor y. Normal blood pressure at rest is within the range of
100-140/60-90mmHg.
But if BP is persistently greater than or equal to 140/90 the person is said to be
hypertensive.
Hypertension is classified as either primary or secondary.
About 90-95% of hypertensive patient are categorize as primary hypertension which means high
blood pressure with no obvious underline medical cause. The remaining 5-10% of cases are
secondary and are caused by other conditions ranging from kidneys,arteries,heart or endocrine
condition in which the blood pressure in the artery is elevated.
Blood pressure is summarized by two measurement the systolic and diastolic which depend on
whether the heart muscle is contractor y. Normal blood pressure at rest is within the range of
100-140/60-90mmHg.
But if BP is persistently greater than or equal to 140/90 the person is said to be
hypertensive.
Hypertension is classified as either primary or secondary.
About 90-95% of hypertensive patient are categorize as primary hypertension which means high
blood pressure with no obvious underline medical cause. The remaining 5-10% of cases are
secondary and are caused by other conditions ranging from kidneys,arteries,heart or endocrine
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