What is the meaning of Hypertension? | Definition Of Hypertension
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart disease stroke and other vascular complication.
It is one of the major risk factors of cardiovascular mortality, which accounts for 20 to 50% of all deaths.
There is also a direct relationship between cardiovascular risk and blood pressure: the higher the blood pressure, the higher the risk of both stroke and coronary events.
Organ Damage
Although the extent of organ damage often correlates with the level of blood pressure. It is not always the case, in addition, the rate of progression of organ damage varies from one individual to another depending on many influences, most of which are incompletely understood.
Blood pressure measurement
Despite more than 75 years of experience which the measurement of blood pressure discussion continuous about its reliability and wide variability in individual subjects.
Accurate measurements are essential under standardized conditions for value comparison between a person or group over time.
Three sources of errors have been identified in the recording of blood pressure:-
1. Observer errors:- e.g. Hearing Acuity, interpretation of Korotkow sounds.
2. Instrumental errors:- e.g. leaking Valve, cuffs that do not encircle the arm. If the cuff is too small and fails to encircle the arm properly then a too-high reading will be obtained.
3. Subject Error:- e.g. the circumstances of examination. These include the physical environment, the position of the subject, external stimuli such as fear, anxiety and so on.
Classification of Hypertension | Types Of Hypertension
Hypertension is divided into Primary and Secondary.
Hypertension is classified as essential when the cores are generally unknown.
Essential hypertension is the most prevalent form of hypertension accounting for 90% of all cases of hypertension.
Hypertension is classified as secondary when some other disease process or abnormality is involved in its causation.
Prominent among these is a disease of the kidney, tumours of the adrenal glands, congenital narrowing of the aorta and toxaemias of pregnancy. Altogether these are estimated to account for about 10% or less of the cases of hypertension.
Risk factors of hypertension
Hypertension is not only one of the major risk factor for most form of cardiovascular disease but it is a condition with its oven risk factors.
1. Non-modifiable risk factors
(a) Age:- blood pressure rises which are in both sexes and the rise is greater in those with higher initial blood pressure. Age probably represents in accumulation of environmental influences and the effects of genetically programmed senescence in body systems.
(b) SEX:- early in life there is little evidence of a difference in blood pressure between the sexes.
Postmenopausal changes in women may be the contributory factor for this change studies are in progress to evaluate whether oestrogen supplementation protest against the late relative rise of blood pressure in women.
(c) Genetic Factors:- There is considerable evidence thet the blood pressure levels are determined in part by genetic factors, and that the inheritance is polygenic. The evidence is based on twin and family studies. Twin studies have confirmed the importance of genetic factors in hypertension the blood pressure values of monozygotic twins are usually more strongly correlated than those of zygotic twins.
(d) Ethnicity:- population studies have consistently revealed higher blood pressure levels in black communities than other ethnic groups.
Average blood pressure between the two groups varies from slightly less than 5 mm HG during the second decade of life to nearly 20 mm HG during the Sixth.
Black Americans of African origin have been demonstrated to have higher blood pressure levels than whites.
2. Modifiable Risk Factors
(a) Obesity:- Epidemiological observations have identified obesity as a risk factor for hypertension.
The greater the weight gain, the greater the risk of high blood pressure.
Data also indicate that when people with high blood pressure lose weight, their blood pressure generally decreases, "Central obesity" indicated by an increased waist to hip ratio has been correlated with high blood pressure in several populations.
(b) Salt Intake:- There is an increasing body of evidence to the effect that high salt intake increases blood pressure proportionately.
Low sodium intake has been found to lower blood pressure.
(c) Saturated Fat:- the evidence suggested saturated fat raises blood pressure as well as serum cholesterol.
(d) Dietary Fibre:- several studies indicated the risk of coronary heart disease (CHD) and hypertension is inversely related to the consumption of dietary fibre.
(e) Alcohol:- High alcohol intake is associated with an increased risk of high blood pressure. It appears that alcohol consumption raises systolic pressure more than diastolic.
But the finding that blood pressure returns to normal with abstinence suggests alcohol-induced elevations may not be fixed and do not necessarily lead to sustained blood pressure elevation.
(f) Heart Rate:- when groups of normotensive and untreated hypertensive subjects for age and sex compared the heart rate of the hypertensive group is invariably higher.
(g) Physical Activity:- physical activity by reducing body weight may have an indirect effect on blood pressure.
(h) Environmental Stress:- the term hypertension itself implies a disorder initiated by tension or stress. since stress is nowhere defined, the hypothesis is untestable.
However, it is an accepted fact that psychosocial factors operate through mental process consciously or unconsciously to produce hypertension.
(i) Socio-economic Status:- In countries that are in post transitional stage of economic and epidemiological change consistently higher level of blood pressure have been noted in lower socioeconomic groups.
This inverse relation has been noted with levels of education, income and occupation.
(j) Other Factors:- the commonest present cause of secondary hypertension is oral contraception because of the oestrogen component in combined preparations.
Other factors such as noise vibration temperature and humidity required for the investigation.
Prevention Of Hypertension | Hypertension treatment
The low prevention of hypertension in some communities indicates theatre hypertension is potentially preventable.
The W h O has recommended the following approaches in the prevention of hypertension:-
1. Primary Prevention
(a) population strategy
(b) High risk strategy
2. Secondary Prevention
1. Primary Prevention
Primary prevention has been defined as "all measures to reduce the incidence of disease in a population by reducing the risk of onset".
(a) population strategy
The population approach is directed at the whole population irrespective of individual risk levels the concept of population approach is based on the fact that even a small reduction in the average blood pressure of a population would produce a large reduction in the incidence of cardiovascular complications such a stroke and coronary heart disease (CHD).
I - Nutrition:- dietary changes are of paramount importance comprises (i) reduction of salt in the text to an average of not more than 5 gram per day (ii) moderate fat intect (iii) the avoidance of alcohol intake and (iv) restriction of energy intake appropriate to body needs.
II - Weight Reduction:- the prevention and correction of overweight obesity is a prudent way of reducing the risk of hypertension and indirectly coronary heart disease (CHD) it goes with dietary changes.
III - EXERCISE PROMOTION:- the evidence that regular physical activity leads to a fall in bodyweight blood lipids and blood pressure goes to suggest that regular physical activity should be encouraged as part of the strategy for risk factor control.
IV - BEHAVIOUR CHANGES:- reduction of stress and smoking modification of personal lifestyle yoga and transcendental meditation could be profitable.
V - HEALTH EDUCATION:- the general public require preventive advice on risk factors and related health behaviour.
The whole community must be mobilized and made aware of the possibility of primary prevention.
VI - SELF-CARE:- an important element in community-based health programs is patient participation the patient is taught self-care, i.g., to take his own blood pressure and keep a logbook of his readings.
(b) High risk strategy
This is also part of primary prevention. The aim of this approach is "to prevent the attainment of the level of blood pressure at which the institution of treatment would be considered".
This approach is appropriate if the risk factor occurs with very low prevalence in the community.
Detection of high-risk subjects should be encouraged by the optimum use of clinical methods since hypertension sends to cluster in families the family history of hypertension and tracking of blood pressure from childhood may be used to identify individual at risk.
2. Secondary Prevention
The goal of secondary prevention is to detect and control high blood pressure in affected individuals.
I - EARLY CASE DETECTION:- Early detection is a major problem. This is because high blood pressure really cause is symptoms until organ damage has already occurred and our aim should be to control it before this happens. the only effective method of diagnosis of hypertension is to screen the population but screening that is not linked to follow-up and sustained care is a fruitless exercise.
II - TREATMENT:- innocent shall hypertension in diabetes we cannot treat the cause because we do not know what it is.
Instead, we try to scale down the high blood pressure to an acceptable level the aim of treatment should be to open a blood pressure below 140/90, and ideally a blood pressure of 120/80.
Control of hypertension has been shown to reduce the incidence of stroke and other complete captions.
This is a major reason for identifying and treating asymptomatic hypertension.
Care of hypertensive should also involve attention to other risk factors such as smoking and elevated blood cholesterol levels.
III - PATIENT COMPLIANCE:- the treatment of high blood pressure must normally be life long and this presents problems of patient compliance which is defined as the extent to which patient behaviour.
The compliance rates can be improved through education directed to patients families and the community.
Intensive research carried out during the past decade aiming at the control of hypertension at the community level has already provided valuable results.
The studies have show one that control of hypertension in a population is feasible, that it can be carried out through the the existing system of health services in different countries and that the control of blood pressure leads to A reduction of implications of high blood pressure, stroke, heart failure and renal failure.
In some of the projects, the incidence of myocardial infarction was also reduced.
As a result of this finding, some countries have launched nationwide control programs in the field of hypertension.
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