HYPERTENSION

Definition:
Hypertension is a serious disease that has a profound influence on cardio-metabolic health; it has been estimated that 66% of strokes and 50% of ischaemic heart disease cases are attributable to hypertension. Other common effects of hypertension include:
Impaired renal health:
Over time hypertension can narrow and thicken the blood vessels of the kidneys causing reduced filtration and a build-up of metabolic wastes in the blood. Renal failure may also occur.
Impaired vision:
High blood pressure can cause blood vessels in the eyes to burst or bleed causing blurred or impaired vision and/or blindness.

The World Health Organisation suggests optimal systolic BP is <115mmHg, withn62% of strokes and 76% of myocardial infarctions attributable to systolic BP above this. However, overt hypertension is defined as an average or sustained systolic blood pressure (SBP) over 140 mmHg and/or a diastolic blood pressure (DBP) over 90 mmHg. Persons with hypertension are four times more likely than normotensive individuals to experience a major cardiovascular event (e.g., myocardial infarction, cerebrovascular accident, congestive heart failure)

Categories of hypertension are:
                       Category                                               Systolic                                 Diastolic
           Optimal blood pressure                         105-119 mmHg                     60-80 mmHg
           Pre-Hypertension                                    120-139 mmHg                     80-89 mmHg

           Hypertension Stage 1 (mild)                 140-159 mmHg                     90-99 mmHg
           Hypertension Stage 2 (moderate)       160-179 mmHg                 100-109 mmHg
           Hypertension Stage 3 (severe)             ≥180 mmHg                       ≥110 mmHg
           Isolated systolic hypertension              ≥140 mmHg                       <90 mmHg

Accuracy of blood pressure measurements may be affected by caffeine, stress, talking whilst taking the BP, wrong size cuff for the patient or holding the arm lower than level with the heart.

It is important to take blood pressure on both arms , as a difference in blood pressure between the two arms can also indicate a cardiovascular complication. It has been established that a difference of systolic 10-14mmHg is associated with atherosclerotic plaques, and a difference over 15mmHg is associated with an increased risk of cardiovascular death.


A more systemic assessment of atherosclerotic plaque formation is using the ankle-brachial pressure index (ABPI), which measures the ratio of the blood pressure in the lower legs to the blood pressure in the arms, used to assess patients for peripheral arterial disease. The ABPI is calculated by dividing the systolic blood pressure at the ankle by the systolic blood
pressure in the arm.

Risk factors:
Major causative factors and risk factors that can contribute to the incidence of hypertension include the following:
• Family history of hypertension
• Existing cardiovascular disease (e.g., atherosclerosis, hypercholesterolaemia)
• Insulin resistance
• Obesity
• Low birth weight
• Renal disease
• Certain endocrine conditions (e.g., Diabetes, Cushing’s Syndrome)
• Obstructive sleep apnoea
• Stress
• Chronic heavy alcohol use
• Long term use of NSAIDs
• Use of oral contraceptives
• Taking medications that contain pseudoephedrine
• Hormone replacement therapy
• Heavy coffee drinking (5 cups or more per day)
• Use of cocaine
• Smoking
• Prolonged use of Glycyrrhiza glabra (licorice)
• High sodium intake
• High carbohydrate intake
• Cadmium and/or lead toxicity
• Food sensitivities
• Toxic chemical exposure
• Low fibre intake
• Male gender
• Age over 55
• Sedentary lifestyle
• Mood disorders, particularly depression, anxiety and repressed anger

Signs and Symptoms:
Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels. Although a few people with high blood pressure may experience:
Headaches                            Dizziness                          Nosebleeds
Tinnitus                                  Confusion                         Papilloedema
Tiredness                              Anxiety                                Increased perspiration
Florid skin complexion