Hypertension

What is it?
Blood circulates within the blood vessels under pressure. This pressure normally is about 110 to 135 mm of Mercury (Hg) when the heart contracts, and this is called Systolic Blood Pressure. When the heart relaxes this pressure is about 80 to 85 mm of Hg and this is called Diastolic Blood Pressure. These values are for adults. In children these values are much less.

When these normal limits of pressure are exceeded then the condition is called Hypertension (High Blood Pressure). The higher the pressure the severe the Hypertension. According to the severity of the Hypertension, it is categorized into various stages as follows:

BLOOD PRESSURE	SYSTOLIC	DIASTOLIC
OPTIMUM	<120	<80
NORMAL	<130	<85
HIGH-NORMAL	130 TO 135	<85


CATEGORY OF HYPERTENSION	SYSTOLIC PRESSURE	DIASTOLIC PRESSURE
Stage I	140 to 159	90 to 99
Stage II	160 to 179	100 to 109
Stage III	180 to 209	110 to 119
Stage IV	>210	>120

Malignant Hypertension: This is the most dangerous kind of hypertension and is a medical emergency. It often requires the patient to be in Intensive Care for appropriate treatment. This happens when the blood pressure is high enough to break down the natural mechanism to protect various organs (esp., Brain) from being supplied with blood under very high pressure.

In about 90% (or more) of the individuals with Hypertension there is no other disease in them that could be causing their Hypertension. In them the Hypertension itself is the primary disease. Such a condition is called Primary Hypertension and is also known as Essential Hypertension.

In the rest of 10% (or less) of the patients usually there is another specific diagnosable disease that is causing their Hypertension. Such a Hypertension is called Secondary Hypertension. Most of the diseases that could cause the Secondary Hypertension are limited to Kidneys and Various (Endocrine) Glands in the body.

* 4% of people under the age of 30 65% of people at the age of 80 and above More than 50 million Americans 2 million new* patients added every year
*More than 20% of American population
More common in: African Americans Who take birth control pills Who take diet pills	Who consume alcohol (>two drinks a day) Who are obese *Who have strong family history of HT

THE FOLLOWING ARE THE RECOMMENDED MEASURES ADOPTED FROM JOINT NATIONAL COMMITTEE ON PREVENTION, DETECTION, EVALUATION, AND TREATMENT OF HIGH BLOOD PRESSURE VI (JNC VI - 1998)

BLOOD PRESSURE	RISK BASED GROUPS
BLOOD PRESSURE	GROUP A WITH NO OTHER RISK FACTOR	GROUP B WITH ONE RISK FACTOR, NOT INCLUDING DIABETES MELLITUS; AND WITH NO CLINICAL HEART DISEASE OR TARGET ORGAN DISEASE	GROUP C WITH TARGET ORGAN DAMAGE, CLINICAL HEART DISEASE AND/OR DIABETES, WITH OR WITHOUT OTHER RISK FACTORS
High Normal	Life-style modification	Life-style modification	Drug therapy
Stage I	Life-style modification for up to 12 months and then start Drug therapy if needed	Life-style modification for up to 6 months and then start Drug therapy if needed	Drug therapy
Stage II, III and IV	Drug therapy	Drug therapy	Drug therapy
NOTE: All patients on drug therapy will benefit from continued life-style modification. Target Organ: Primarily Kidney, Heart and blood vessels inside the eyes If drug therapy is needed appropriate drug(s) need to be selected based on other medical, as well as, non-medical condition(s) that may exist concomitantly

        First step in the treatment of Hypertension starts with measures other than taking medications
        and they are collectively called "Life style modification." The following are
        some of the modifications that will be needed:
            a. Moderate salt restriction
            b. Loosing excess weight
            c. Increasing physical activity (exercise)
            d. Re-examining current lifestyle in general
            e. Refraining from excessive consumption of alcohol as well as caffeine
            f.   Stop smoking
            g. Reduce fat (especially saturated fat) in the diet
            h. If there are no other medical conditions exist, increase Calcium,
                 Magnesium and Potassium intake.
                 Otherwise high Calcium, Magnesium and Potassium diet
                 may not be safe ! Therefore, discuss with MD regarding their
                 usefulness to you.)

        Once such measures are taken it will take many weeks prior to seeing their effect on lowering the blood pressure. During that time, depending on the intensity of Hypertension, addition of medications to control the Hypertension may be necessary.

DRUG THERAPY:

        There are several groups of medications available. Depending upon various factors - including age, race and other coexisting medical conditions - a medication from one or the other group will be better suited as the initial drug of choice. The initial drug of choice ( as well as the subsequent additions of other medications) should be undertaken only in consultation with your physician. Not doing so could be detrimental to your health.

        The following is the general approach taken by many physicians in selecting the initial drug of choice - and is not intended as a recommendation:

BEST SUITED FOR	VARIOUS GROUPS OF MEDICATIONS
BEST SUITED FOR	DIURETIC	BETA-BLOCKER	ALPHA-AGENTS#	CALCIUM CHANNEL BLOCKER	ACE-INHIBITOR	AT₁ RECEPTOR BLOCKER (ARB)
BLACK RACE	*	*	*	*	*	*
OLDER AGE	*	*	*	*	*	*
CONGESTIVE HEART FAILURE	*	*	*	*	*	*
CORONARY ARETERY DISEASE	*	*	*	*	*	*
DIABETES MELLITUS	*	*	*	*	*	*
KIDNEY FAILURE	*	*	*	*	**	**
KIDNEY TRANSPLANT	*	*	*	*	*	*
STROKE	*	*	*	*	*	*
EMPHYSEMA / BRONCHIAL ASTHMA	*	*	*	*	**	*
POOR CIRCULATION TO ARMS AND LEGS	*	*	*	*	*	*
PROSTATE ENLARGEMENT	*	*	*	*	*	*
MORE THAN ONE OF THE ABOVE	Best decided by appropriate risk-benefit evaluation
THE LUCKY ONE WHO DOES NOT BELONG TO ANY OF THE ABOVE GROUP !	*	*	*	*	*	*
* PREFERRED * ACCEPTABLE * LESS PREFERRED * GENERALLY NOT PREFERRED / BUT COULD BE USED WITH CAUTION AND CLOSE MONITORING FOR SIDE EFFECTS GENERALLY PREFERRED BUT NEED TO BE USED WITH CAUTION AND CLOSE MONITORING FOR SIDE EFFECTS # Alpha agents are generally a poor choice as the initial medication to control blood pressure**

                1. Poorly controlled Diabetes Mellitus
                2. Sleeping Disorder ( Sleep Apnea)
                3. High Blood calcium levels
                4. Unrecognized high salt consumption
                5.    Undiagnosed kidney diseases like Nephritis,
                        Polycystic Kidney disease etc.
                6.    Other unrecognized causes of Secondary Hypertension
                7.   Undiagnosed / co-existing overactive Thyroid or Para-Thyroid glands

* 4% of people under the age of 30 65% of people at the age of 80 and above More than 50 million Americans 2 million new* patients added every year
*More than 20% of American population
More common in: African Americans Who take birth control pills Who take diet pills	Who consume alcohol (>two drinks a day) Who are obese *Who have strong family history of HT