amudu: July 2020

Tuesday, July 28, 2020

High blood pressure (Hypertension)

High blood pressure, or hypertension, occurs when your blood pressure increases to unhealthy levels. Your blood pressure measurement takes into account how much blood is passing through your blood vessels and the amount of resistance the blood meets while the heart is pumping.

Source: CDC

Narrow arteries increase resistance. The narrower your arteries are, the higher your blood pressure will be. Over the long term, the increased pressure can cause health issues, including heart disease.

Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.

You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.

High blood pressure generally develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.

Symptoms

Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.

A few people with high blood pressure may have headaches, shortness of breath or nosebleeds, but these signs and symptoms aren't specific and usually don't occur until high blood pressure has reached a severe or life-threatening stage.

How is blood pressure measured?

Blood pressure is measured by a blood pressure cuff (sphygmomanometer).

The blood pressure cuff consists of an air pump, a pressure gauge, and a rubber cuff. The instrument measures the blood pressure in units called millimeters of mercury (mm Hg).

The cuff is placed around the upper arm and inflated with an air pump to a pressure that blocks the flow of blood in the main artery that travels through the arm. The arm is held at the side of the body at the level of the heart, and the pressure of the cuff is gradually released. As the pressure decreases, a health practitioner listens with a stethoscope over the artery at the front of the elbow or an electronic machine senses the pulsation. The pressure at which the practitioner (or machine) first hears a pulsation from the artery is the systolic pressure (the top number). As the cuff pressure decreases further, the pressure at which the pulsation finally stops is the diastolic pressure (the bottom number).

When to see a doctor

You'll likely have your blood pressure taken as part of a routine doctor's appointment.

Ask your doctor for a blood pressure reading at least every two years starting at age 18. If you're age 40 or older, or you're 18 to 39 with a high risk of high blood pressure, ask your doctor for a blood pressure reading every year.

Blood pressure generally should be checked in both arms to determine if there's a difference. It's important to use an appropriate-sized arm cuff.

Your doctor will likely recommend more frequent readings if you've already been diagnosed with high blood pressure or have other risk factors for cardiovascular disease. Children age 3 and older will usually have blood pressure measured as a part of their yearly checkups.

If you don't regularly see your doctor, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. You can also find machines in some stores that will measure your blood pressure for free.

Public blood pressure machines, such as those found in pharmacies, may provide helpful information about your blood pressure, but they may have some limitations. The accuracy of these machines depends on several factors, such as a correct cuff size and proper use of the machines. Ask your doctor for advice on using public blood pressure machines.

Causes

There are two types of high blood pressure.

Primary (essential) hypertension

For most adults, there's no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years.

Secondary hypertension

Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:

Obstructive sleep apnea
Kidney problems
Adrenal gland tumors
Thyroid problems
Certain defects you're born with (congenital) in blood vessels
Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
Illegal drugs, such as cocaine and amphetamines

It's not always clear what causes high blood pressure, but certain things can increase your risk.

You're at an increased risk of high blood pressure if you:

are over the age of 65
are overweight
are of African or Caribbean descent
have a relative with high blood pressure
eat too much salt and do not eat enough fruit and vegetables
do not do enough exercise
drink too much alcohol or coffee (or other caffeine-based drinks)
smoke
do not get much sleep or have disturbed sleep

Making healthy lifestyle changes can help reduce your chances of getting high blood pressure and help lower your blood pressure if it's already high.

Complications

The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.

Uncontrolled high blood pressure can lead to complications including:

Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
Heart failure. To pump blood against the higher pressure in your vessels, the heart has to work harder. This causes the walls of the heart's pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body's needs, which can lead to heart failure.
Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
Metabolic syndrome. This syndrome is a cluster of disorders of your body's metabolism, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL) cholesterol, the "good" cholesterol; high blood pressure and high insulin levels. These conditions make you more likely to develop diabetes, heart disease and stroke.
The trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. The trouble with memory or understanding concepts is more common in people with high blood pressure.
Dementia. Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular dementia.

Treatment for high blood pressure

Doctors can help you keep your blood pressure to a safe level using:

lifestyle changes
medicines

What works best is different for each person.

Talk to your doctor to help you decide about treatment.

Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise, contribute to high blood pressure.

Dozens of different medications can help treat high blood pressure. These drugs are called antihypertensives. They’re divided into many different categories, each of which works differently and causes different side effects.

With so many options available, finding the best one for you may take some time and patience. Your doctor will work with you to find the best treatment plan for you, which may include one or more medications.

Diuretics

Diuretics are some of the most commonly used drugs for treating high blood pressure. They help the kidneys get rid of excess water and sodium, or salt. This reduces the volume of blood that needs to pass through your blood vessels, which lowers your blood pressure.

There are three major types of diuretics: thiazide, potassium-sparing, and loop diuretics. Thiazide diuretics generally have fewer side effects than the others. This is especially true when they’re prescribed in the low doses that are generally used in treating early high blood pressure.

Examples of thiazide diuretics include:

chlorthalidone (Hygroton)

chlorothiazide (Diuril)

hydrochlorothiazide (Hydrodiuril, Microzide)

indapamide (Lozol)

metolazone (Zaroxolyn)

Examples of potassium-sparing diuretics include:

amiloride (Midamor)

spironolactone (Aldactone)

triamterene (Dyrenium)

Examples of loop diuretics include:

bumetanide (Bumex)

furosemide (Lasix)

torsemide (Demadex)

Examples of combination diuretics include:

amiloride hydrochloride/hydrochlorothiazide (Moduretic)

spironolactone/hydrochlorothiazide (Aldactazide)

triamterene/hydrochlorothiazide (Dyazide, Maxzide)

Beta-blockers

Beta-blockers work by blocking the actions of chemicals in your body that stimulate your heart. This allows your heart to beat with less speed and force. Your heart pumps less blood through the blood vessels with each beat, so blood pressure decreases.

Examples of these drugs include:

acebutolol (Sectral)

atenolol (Tenormin)

betaxolol (Kerlone)

bisoprolol (Zebeta)

bisoprolol/hydrochlorothiazide (Ziac)

metoprolol tartrate (Lopressor)

metoprolol succinate (Toprol-XL)

nadolol (Corgard)

pindolol (Visken)

propranolol (Inderal)

solotol (Betapace)

timolol (Blocadren)

Angiotensin converting enzyme (ACE) inhibitors

ACE inhibitors keep the body from making a hormone called angiotensin II, which causes blood vessels to narrow. These medications lower blood pressure by helping constricted blood vessels expand to let more blood through.

Examples of ACE inhibitors include:

benazepril (Lotensin)

captopril (Capoten)

enalapril (Vasotec)

fosinopril (Monopril)

lisinopril (Prinivil, Zestril)

moexipril (Univasc)

perindopril (Aceon)

quinapril (Accupril)

ramipril (Altace)

trandolapril (Mavik)

Angiotensin II receptor blockers (ARBs)

This class of drugs also protects the blood vessels from angiotensin II. In order to tighten blood vessels, angiotensin II must bind with a receptor site. ARBs prevent that from happening. As a result, blood pressure is lowered.

Examples of ARBs include:

candesartan (Atacand)

eprosartan (Teveten)

irbesartan (Avapro)

losartan (Cozaar)

telmisartan (Micardis)

valsartan (Diovan)

Calcium channel blockers

To move, all muscles need calcium to flow in and out of the muscle cells. Calcium channel blockers help block calcium from entering the smooth muscle cells of the heart and blood vessels.

This makes the heartbeat with less force and helps blood vessels relax. As a result, blood pressure decreases.

Examples of these drugs include:

amlodipine (Norvasc, Lotrel)

diltiazem (Cardizem CD, Cardizem SR, Dilacor XR, Tiazac)

felodipine (Plendil)

isradipine (DynaCirc, DynaCirc CR)

nicardipine (Cardene SR)

nifedipine (Adalat CC, Procardia XL)

nisoldipine (Sular)

verapamil (Calan SR, Covera HS, Isoptin SR, Verelan)

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Alpha-blockers

In certain situations, your body makes hormones called catecholamines. These hormones can bind to parts of cells called alpha-receptors. When this occurs, your blood vessels narrow and your heart beats faster and with more force. These actions cause your blood pressure to rise.

Alpha-blockers work by blocking catecholamines from binding to alpha-receptors. As a result, blood can flow through the blood vessels more freely, and your heart beats normally. This helps lower your blood pressure.

Examples of alpha-blockers include:

doxazosin (Cardura)

prazosin (Minipress)

terazosin (Hytrin)

Alpha-beta-blockers

Alpha-beta-blockers have a combined effect. They block the binding of catecholamine hormones to both alpha- and beta-receptors. Therefore, they can decrease the constriction of blood vessels like alpha-blockers do. They also slow down the rate and force of the heartbeat-like beta-blockers do.

Examples of alpha-beta-blockers include:

carvedilol (Coreg)

labetalol (Normodyne, Trandate)

Central agonists

These medications keep the brain from sending messages to the nervous system telling it to release catecholamines. As a result, the heart doesn’t pump as hard and blood flows more easily, lowering blood pressure.

Examples of central agonists include:

methyldopa (Aldomet)

clonidine (Catapres)

guanfacine (Tenex)

Vasodilators

Vasodilators relax the muscles in the walls of blood vessels, especially in small arteries called arterioles. This widens the blood vessels and allows blood to flow through them more easily. As a result, blood pressure falls.

Examples of vasodilators include:

hydralazine (Apresoline)

minoxidil (Loniten)

Aldosterone receptor antagonists

Aldosterone receptor antagonists work by blocking a chemical called aldosterone. This action reduces the amount of fluids your body retains, which helps lower your blood pressure.

Examples of aldosterone receptor antagonists include:

eplerenone (Inspra)

spironolactone (Aldactone)

Direct renin inhibitors

A newer type of blood pressure medication is called direct renin inhibitors (DRIs). These drugs block a chemical in your body called renin. This action helps widen your blood vessels, which lowers your blood pressure.

The only type of DRI that is currently available in The United States is:

aliskiren (Tekturna)

High blood pressure drug treatment plans

For most people, the first-choice medication for high blood pressure is a thiazide diuretic. For other people, a diuretic alone is not enough to control blood pressure. In these cases, a diuretic may be combined with a beta-blocker, ACE inhibitor, angiotensin II receptor blocker, or calcium channel blocker. Adding a second medication may lower your blood pressure more quickly than using a diuretic alone. Also, it allows you to take less of each medication, which may reduce side effects.

Combination drugs

If your doctor thinks you need more than one drug to manage your blood pressure, they may prescribe a combination medication. For instance, they may prescribe a beta-blocker with a diuretic, or an ARB with a calcium channel blocker.

Using these combination medications may be more convenient than taking several different drugs each day.

Many combination medications to treat high blood pressure are available. Examples include:

triamterene/hydrochlorothiazide (Dyazide) — triamterene and hydrochlorothiazide are both diuretics

valsartan/hydrochlorothiazide (Diovan HCT) — valsartan is an ARB and hydrochlorothiazide is a diuretic

Treating for multiple conditions

The type of blood pressure medication your doctor prescribes may depend on what other health problems you have. For example, if you have coronary artery disease (CAD) and high blood pressure, your doctor may prescribe a beta-blocker. If you have had a myocardial infarction due to CAD, a beta-blocker can lower your blood pressure and decrease your overall risk of death.

If you have diabetes, your doctor may choose an ACE inhibitor or an ARB. That’s because these drugs can help protect the kidneys from diabetic damage by lowering the blood pressure in your kidneys.

Talk with your doctor

High blood pressure is a serious condition that requires treatment to prevent more severe health problems.

Don’t worry if you’re confused by all of your medication options. Your doctor can tell you which drugs might work best for you. Together, you can put together a treatment plan to get your blood pressure under control.