Hypertension

What is Blood Pressure? 
 Blood pressure (BP) is the pressure exerted by circulating blood upon the walls of blood vessels, and is one of the principal vital signs.
Two pressures are measured for a blood pressure reading:     
a)Systolic blood pressure is a measure of blood pressure while the heart is beating.
b)Diastolic pressure is a measure of blood pressure while the heart is relaxed.

What is high blood pressure?                                 
High blood pressure, also known as HBP or hypertension, is a widely misunderstood medical condition. Some people think that those with hypertension are tense, nervous or hyperactive, but hypertension has nothing to do with personality traits. The truth is, you can be a calm, relaxed person and still have HBP. Let's look at the facts about blood pressure so you can better understand how your body works and why it is smart to start protecting yourself now, no matter what your blood pressure numbers are.
By keeping your blood pressure in the healthy range, you are:
a)Reducing your risk of your vascular walls becoming overstretched and injured
b)Reducing your risk of your heart having to pump harder to compensate for blockages

c)Protecting your entire body so that your tissue receives regular supplies of blood that is rich in the oxygen it needs

 These categories were defined by the American Heart Association. This chart applies to adults age 20 and older..

What Are the Signs and Symptoms of High Blood Pressure?
         High blood pressure (HBP) itself usually has no signs or symptoms. Rarely, headaches may occur.
         You can have HBP for years without knowing it. During this time, the condition can damage your heart, blood vessels, kidneys, and other parts of your body.
         Some people only learn that they have HBP after the damage has caused problems, such as coronary heart disease, stroke, or kidney failure.
         Knowing your blood pressure numbers is important, even when you're feeling fine. If your blood pressure is normal, you can work with your health care team to keep it that way. If your blood pressure is too high, you can take steps to lower it. Lowering your blood pressure will help reduce your risk for related health problems.

Complications of High Blood Pressure
       When blood pressure stays high over time, it can damage the body. HBP can cause:
a) The heart to get larger or weaker, which may lead to heart failure. Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs.
b) Aneurysms (AN-u-risms) to form in blood vessels. An aneurysm is an abnormal bulge in the wall of an artery. Common spots for aneurysms are the main artery that carries blood from the heart to the body; the arteries in the brain, legs, and intestines; and the artery leading to the spleen.
c) Blood vessels in the kidneys to narrow. This may cause kidney failure.
d) Arteries throughout the body to narrow in some places, which limits blood flow (especially to the heart, brain, kidneys, and legs). This can cause a heart attack, stroke, kidney failure, or amputation of part of the leg.
e) Blood vessels in the eyes to burst or bleed. This may lead to vision changes or blindness.  

What Causes High Blood Pressure?
      Blood pressure tends to rise with age, unless you take steps to prevent or control it.
      Some medical problems—such as chronic kidney disease, thyroid disease, and sleep apnea—may cause blood pressure to rise. Some medicines also may raise your blood pressure. Examples include asthma medicines (for example, corticosteroids) and cold-relief products.
      Other medicines also can cause high blood pressure (HBP). If you have HBP, let your doctor know about all of the medicines you take, including over-the-counter products.
      In some women, birth control pills, pregnancy, or hormone therapy (HT) may cause blood pressure to rise.
      Women taking birth control pills usually have a small rise in both systolic and diastolic blood pressures. If you already have HBP and want to use birth control pills, make sure your doctor knows about your HBP. Talk with him or her about how often you should have your blood pressure checked and how to control it while taking the pill.
       Taking HT to reduce the symptoms of menopause can cause a small rise in systolic blood pressure. If you already have HBP and want to start using HT, talk with your doctor about the risks and benefits. If you decide to take hormones, find out how to control your blood pressure and how often you should have it checked.
        Children younger than 10 years old who have HBP often have another condition that's causing it (such as kidney disease). Treating the underlying condition may resolve the HBP.
        The older a child is when HBP is diagnosed, the more likely he or she is to have essential hypertension. This means that doctors don't know what's causing the HBP.

Who Is at Risk for High Blood Pressure?
       High blood pressure (HBP) is a common condition. In the United States, about 1 in 3 adults has HBP.
       Certain traits, conditions, and habits can raise your risk for HBP. The major risk factors for HBP are described below.
Older Age
     Blood pressure tends to rise with age. About 65 percent of Americans aged 60 or older have HBP.
     Isolated systolic hypertension (ISH) is the most common form of HBP in older adults. ISH occurs when only systolic blood pressure (the top number) is high. About 2 out of 3 people over age 60 with HBP have ISH.
     HBP doesn't have to be a routine part of aging. You can take steps to keep your blood pressure at a normal level.
Race/Ethnicity
     HBP can affect anyone. However, it's more common in African American adults than in Caucasian or Hispanic American adults. In relation to these groups, African Americans:
 a)Tend to get HBP earlier in life
 b)Often have more severe HBP
 c)Are more likely to be aware that they have HBP and to get treatment
 d)Are less likely than Caucasians to achieve target control levels with HBP treatment
 e)Have higher rates than Caucasians of early death from HBP-related problems, such as coronary heart disease, stroke, and kidney failure
     HBP risks vary among different groups of Hispanic American adults. For instance, Puerto Rican American adults have higher rates of HBP-related death than all other Hispanic groups and Caucasians. However, Cuban Americans have lower rates of HBP-related death than Caucasians.
Overweight or Obesity
    You're more likely to develop prehypertension or HBP if you're overweight or obese. The terms "overweight" and "obesity" refer to body weight that's greater than what is considered healthy for a certain height.
Gender
      Men and women are equally likely to develop HBP during their lifetimes. However, before age 45, men are more likely to have HBP than women. After age 65, the condition is more likely to affect women than men.
      Also, men younger than 55 are more likely to have uncontrolled HBP than women. However, after age 65, women are more likely to have uncontrolled HBP.
Unhealthy Lifestyle Habits
     Many unhealthy lifestyle habits can raise your risk for HBP, including:
a) Eating too much sodium (salt)
b) Drinking too much alcohol
c) Not getting enough potassium in your diet
d) Lack of physical activity
e) Smoking
Other Risk Factors
       A family history of HBP raises your risk for the condition. Long-lasting stress also can put you at risk for HBP.
       You're also more likely to develop HBP if you have prehypertension. Prehypertension means that your blood pressure is in the 120–139/80–89 mmHg range.
Risk Factors for Children and Teens
      Prehypertension and HBP are becoming more common in children and teens. This is due in part to a rise in overweight and obesity among children and teens.
      African American and Mexican American youth are more likely to have HBP and prehypertension than Caucasian youth. Also, boys are at higher risk for HBP than girls.
      Like adults, children and teens need to have routine blood pressure checks, especially if they're overweight.
 
How Is High Blood Pressure Diagnosed?
    
       High blood pressure (HBP) is diagnosed using a blood pressure test. This test will be done several times to make sure the results are correct. If your numbers are high, your doctor may have you return for repeat tests to check your blood pressure over time.
       If your blood pressure is 140/90 mmHg or higher over time, your doctor will likely diagnose you with HBP. If you have diabetes or chronic kidney disease, a blood pressure of 130/80 mmHg or higher is considered HBP.

How Is Blood Pressure Tested?
       A blood pressure test is easy and painless. This test is done at a doctor's office or clinic or at home.
To prepare for the test:
? Don't drink coffee or smoke cigarettes for 30 minutes prior to the test. These actions may cause a short-term rise in your blood pressure.
? Go to the bathroom before the test. Having a full bladder can change your blood pressure reading.
? Sit for 5 minutes before the test. Movement can cause short-term rises in blood pressure.
      To measure your blood pressure, your doctor or nurse will use some type of a gauge, a stethoscope (or electronic sensor), and a blood pressure cuff.
      Most often, you will sit or lie down with the cuff around your arm as your doctor or nurse checks your blood pressure.

What Does a Diagnosis of High Blood Pressure Mean?
      If you're diagnosed with HBP, your doctor will prescribe treatment. Your blood pressure will be tested again to see how the treatment affects it.
       Once your blood pressure is under control, you'll still need treatment. "Under control" means that your blood pressure numbers are in the normal range. Your doctor will likely recommend routine blood pressure tests. He or she can tell you how often you should be tested.
       The sooner you find out about HBP and treat it, the better. Early treatment may help you avoid problems such as heart attack, stroke, and kidney failure.

How Can High Blood Pressure Be Prevented?
If You Have Normal Blood Pressure
      If you don't have high blood pressure (HBP), you can take steps to prevent it. Healthy lifestyle habits can help you maintain normal blood pressure.
Follow a healthy diet. Limit the amount of sodium (salt) and alcohol that you consume. The National Heart, Lung, and Blood Institute's DASH (Dietary Approaches to Stop Hypertension) eating plan promotes healthy eating.
Be physically active. Routine physical activity can lower HBP and reduce your risk for other health problems.
? Maintain a healthy weight. Staying at a healthy weight can help you control HBP and reduce your risk for other health problems.
 Quit smoking. Smoking can damage your blood vessels and raise your risk for HBP. Smoking also can worsen health problems related to HBP.
Learn to manage and cope with stress. Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health.
       Many people who adopt these healthy lifestyle habits are able to prevent or delay HBP. The more lifestyle changes you make, the more likely you are to lower your blood pressure and avoid related health problems.
If You Have High Blood Pressure
        If you have HBP, you can still take steps to prevent the long-term problems it can cause. Healthy lifestyle habits (listed above) and medicines can help you live a longer, more active life.
        Follow the treatment plan your doctor prescribes to control your blood pressure. Treatment can help you prevent or delay coronary heart disease, stroke, kidney disease, and other health problems.
 
Advantages of measuring your blood pressure at home

       Blood pressure changes from moment to moment. Some of the things that can affect blood pressure are body position, emotional state, physical activity and sleep. If you have high blood pressure, altering your lifestyle may be all that is required to lower it.
        In other cases, you may also need to take one or more medicines. Measuring your blood pressure at home and/or at work, with your own equipment, gives your doctor a guide to what your blood pressure is outside the clinic during your usual activities. It will also help your doctor to know whether any prescribed treatment is working. 
        Taking your blood pressure at home will give you a better understanding of your condition and will help you to be more actively involved in your own management.
        Measuring your blood pressure at home can accomplish several of the advantages of ambulatory BP monitoring, such as a greater number of readings, an avoidance of the white-coat syndrome and, when automated devices are used, an absence of observer bias. Furthermore, self-measurement of BP may also increase compliance with antihypertensive therapy and reduce the number of visits required for the diagnosis and treatment of hypertension. It is also a less expensive method of monitoring blood pressure.
 
Advantages and Disadvantages of Mercury and Automatic sphygmomanometer.
    
          If your doctor or other healthcare provider has told you to monitor your blood pressure at home, you'll need a sphygmomanometer. It's made up of a cuff, pressure registering system and stethoscope. Some devices contain all of these in one unit. There are mercury and automatic sphygmomanometer. Automatic devices usually work with batteries and have a digital readout. They may remember and even print out your readings. Each of the sphygmomanometer has advantages and disadvantages:
Mercury sphygmomanometer: It's the standard for blood pressure measurement. It's durable, easy to read and doesn't require readjustment. The mercury sphygmomanometer is a simple mechanism that works by gravity to give consistent and accurate readings. It has a long, tubular gauge made of glass or plastic. For safety, glass tubes should be wrapped in Mylar to prevent breakage. It's not often recommended for home use due to the hazards of mercury. However, those made for home use are lightweight and relatively safe by design, and can be used with a D-ring cuff and attached stethoscope for convenient self-measurement. It will easily last a lifetime with minimal maintenance.
Disadvantages: May be bulky to carry. A mercury spill could be hazardous. Must be kept upright on a flat surface during measurement; the gauge must be read at eye level for accuracy. May not work well for the hearing or visually impaired or for those unable to perform the hand movement needed to squeeze the bulb and inflate the cuff.
Automatic equipment is contained in one unit, so less manual dexterity is required than for systems with separate gauge and stethoscope. It's easy to use, minimizes human error and is good for people with hearing or vision loss. Most units are very portable and have a D-ring cuff for one-handed application. The cuff may fit around the wrist or arm. More expensive models have automatic inflation and deflation systems; large, easy-to-read digital display and error indicator; reading printouts; and built-in pulse (heart rate) measurement.
Disadvantages: Mechanism is complex, fragile and sensitive. Device accuracy must be checked first by comparing to a mercury device, then during measurement on the user. The most accurate devices don't give accurate readings on certain individuals. Body movements may influence accuracy. It can be expensive; requires batteries and an AC adapter for large arm cuffs; may require factory repair and readjustment when faulty. Requires careful cuff placement and arm positioning for accurate operation, especially the wrist cuff model. Some models are designed for use on only the right or left arm. Large cuffs may be relatively expensive or difficult to obtain.
 
Body posture during measurement
         Relax, place the elbow on the desk with palm facing up; cuff should be at the heart level (show as the following Fig). The reading accuracy may be affected if the cuff is not fitted properly. The arm should be at the same level of your heart. If your arm is too low, your reading will be too high. If your arm is too high, your reading will be too low.