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Lối sống lành mạnh : Glossary
Hypertention(High blood pressure)
[2007-09-18 09:42] (1,291)

Outline

There is no set value and the blood pressure level differs depending on the age and sex of the person. You should measure your blood pressure at lest three times a day. High blood pressure is defined as a blood pressure exceeding 95/100 of the blood pressures in the same sex and age group, with the same contracting and dilating levels. If your blood pressure is higher than normal and you need to observe your health more closely. High blood pressure is caused by kidney failures (chronic pyelonephritis, glomerulonephritis, obstructive diseases in principal locations), vascular diseases (coarctation of the aorta), disease of the endocrine glands, (Cushing syndrome, hyperthyroidism, congenital adrenal hyperplasia), diseases of the central nerve system (tumor, hemorrhage), and essential high blood pressure (for obesity).

It can be diagnosed by measuring the blood pressure using a sphygmomanometer. Other useful tests in managing high blood pressure include blood tests, chest X-ray, serum electrolyte test, uric acid test, urine test, and lipid profile tests. Special tests include vascular filming exams, isotype filming of the kidneys, and hormone exams. Severe high blood pressure with headaches, eye changes, and symptoms of nervous system disease are treated with anti-high blood pressure medications. However, a sudden fall of blood pressure is detrimental to the central nervous system, so it is recommended to lower the blood pressure gradually. The first goal is not to reduce the blood pressure levels to normal levels, but to remove the risk factors that may cause cerebral and cardiac complications.

 

Definition

 

In at least three separate occasions, the blood pressure should be measured by contracting and dilating equipment and should be compared to the blood pressures of other people from the same age and sex. If the blood pressure was below 90 percent, it is a normal blood pressure, if it is between 90 and 95, it is called a high normal blood pressure, and if the measurements are above 95 percent, they are defined as high blood pressure.

 

Cause, conditions and physiological

 

The cause can be divided largely into primary and secondary. The primary condition is when the patient has no previous diseases, and the secondary condition is when the blood pressure levels are increased due to an existing disease. The primary condition is more common in adolescence rather than childhood, and is related to genetics. Usually, several physiologic conditions or factors are involved. The first factor is genetics. There are no known genetic mutations that cause primary high blood pressure. However, researches on twins and family members show that 30-60 % of high blood pressure cases are due to genetic factors. The clinical importance of this genetic factor is to prevent complications caused by the blood pressure by regularly measuring the blood pressure and restraining yourself from environmental factors that increase blood pressure. The second factor is the influence of the increase in peripheral artery resistance caused by the narrowing of the arteries. The third factor is the increase in insulin, especially in obesity. Peripheral insulin resistance occurs, which raises the vessels and increases the insulin production to fix this. Fourthly, too much intake of salt increases the salt concentration and the capacity of the blood vessels. This causes a rise in calcium concentration, which in turn tenses the blood vessels causing high blood pressure. Fifthly, the hematological changes in the renin angiotensin system, the rise of catecholamine levels due to stress, and the acceleration of the mutual nervous system are all included. Secondary high blood pressure comprises only 5% of the total high blood pressure patients, but mostly occurs in infants. Firstly, there are many diseases which include chronic pyelonephritis, glomerulus, obstructive kidney disease, diseases of principle organs, new tumors, new damages, and hereditary diseases. Secondly, vascular diseases which include the coarction of the aorta, new thrombus in the arteries, and a new thrombus in the veins. Thirdly, the internal secreting disease which includes the Cushing syndrome, primary hyperaldosteronism, loss of thyroid gland functions, loss of parathyroid function, chronic congenital adrenal hyperplasia, nerve cell malfunctions, etc. Fourthly, the central nervous diseases which include tumors and hemorrhages.

Diagnosis

 

Diagnosed evaluation

  1. Determine the blood pressure level. If the patient has high blood pressure (10~20 mmHg higher than the blood pressure of 95%), the patient should start receiving treatments.
  2. Determine if the condition is acute or chronic. (Look at medical history, eye exams, and cardiac ultrasonic exams to evaluate)
  3. Determine whether the condition is primary or secondary. The younger the patient and the higher the blood pressure, the higher the chances of a secondary condition.
  4. Family history. The patient may have a family medical history of high blood pressure
  5. Examine whether the patient has had previous headaches, convulsions, or medications.
  6. Depending on the age group, consider other factors that caused the high blood pressure.

Tests taken for diagnosis

  1. Basic exams: blood tests, chest X-ray, serum electrolytes, serum uric acid value, urine test, lipid profile test (especially if your condition is primary)
  2. Optional exams: after examining the medical history, diagnosis, and the basic tests, the following optional exams can be carried out.
    • Radiation exam: vascular filming, Intravenous pyelogram, etc
    • Nuclear medicinal exam : new scan, 131-I-metaiodobenzylfuanidine(MIBG) scan if suspected of brown tumor
    • Hormone tests

Progress, Prognosis

 

In many patients, the primary high blood pressure of adolescence develops into adult high pressure conditions. Treatment with medications reportedly decreases the frequency of myocardial infarctions and cerebral strokes. Therefore, the patient has an optimistic prognosis if the symptom is found early and treated with proper medications. On the other hand, the prognosis of secondary high blood pressure depends entirely on the progress of the primary condition which caused the high blood pressure. Therefore, it depends on special treatments. Depending on the type of the disease, different medications and surgical procedures may be required.


Complications

 

Malignant high blood pressure, hemorrhagic stroke, congested heart failure, exfoliation of the main artery, ischemic heart disease, etc.

 

Treatment

  1. Emergency treatment: If the patient has headaches, eye changes, symptoms of nervous system disease, and malignant new diseases, an anti-high blood pressure medication is used. However, a rapid decrease in blood pressure is detrimental to the central nerve system, so you would need a gradual decrease in the blood pressure. The primary goal is not to drop the blood pressure to normal levels, but to reduce the risk of strokes and myocardial infarctions caused by high blood pressure. (Example : decrease the blood pressure by 1/3 during the first 6 hours, and lower the rest in 2~3 days) Consult a physician for appropriate use of blood pressure medications.
  2. Treatment of chronic high blood pressure

If the high blood pressure is caused by another disease or condition, the disease should be treated first. Attempt vascular angiography in cases of coarctation of the aorta

    • For primary high blood pressure, first attempt to control the weight, and advised the patient to exercise regularly and to limit salt intake.
    • If the blood pressure is abnormally high or if the patient shows other symptoms of high blood pressure, medication therapy is recommended. Start with one kind of medication, at a low dosage, and gradually increase the dosage until the patient responds. Previously, diuretics were frequently used, but now the diuretics are used mainly for patients with new diseases. Also, angiotensin-converting enzyme inhibitors (captopril, enalapril) are known to be effective against high blood pressure. However, you should check whether the patient has any new functional disorders.

Preventions

 

Preventing high blood pressure is important in preventing cardiovascular diseases. In particular, if you smoke at an early age, the rate of arteriosclerosis and blood viscosity increases causing blood pressure elevation. You should avoid smoking or stop smoking to control your blood pressure. Other than that, you need continuous exercise and limited salt consumption to prevent primary high blood pressure. Patients with high blood pressure may not display any symptoms, and because of this they tend to think it is unnecessary to get treatment. If the patient is diagnosed as needing treatment, they should get the treatment regardless of the severity of the symptom. The reason for this is because complications develop rapidly, proportional to the level of blood pressure and the length of the disease. For infants, secondary high blood pressure is prevalent, and treatment should include finding the cause of the disease.


Consult a doctor in the following cases:

 

High blood pressure shows no symptoms and is therefore difficult to diagnose. It is recommended that you measure your blood pressure at least once a year, from the age of 3. In particular, obese adolescents with a family history of primary high blood pressure should have repeated measurements. Also, if a patient experiences stomach discomfort, outward symptoms in the genital area, swollen face, and weight loss, his/her blood pressure should be measured and he/she should undergo tests to determine the cause of his/her symptoms. Blood pressure should also be measured when a person experiences headaches, nausea, vomiting, convulsions, and changes in eyesight. 

Sắc đẹp & Phong cáchUng thư và Phòng ngừaLối sống lành mạnhSức khỏe tinh thần và stressGiới tính Nam/NữChủ đề nóng bỏng
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