In todays life very often we hear that the so and so person is suffering from High Blood Pressure or Hypertension. In social parties or gatherings it is a usual scene that some body or the other is refusing to take certain food items or dishes and found saying No! I can't take this because of Salt or Fat restriction on my diet by the Doctor as I have Blood Pressure. Now this creates a lot of interest to know more about this malady called Hypertension and also known as one of The Silent Killers of todays society ,others being the Diabetes and I.H.D. or Ischaemic Heart Diseases.
What exactly is Hypertension?
     Before this we must understand What exactly is Blood Pressure .To explain To have proper perfusion to occur in all the tissues of the body , Heart has to pump blood with sufficient pressure. This is called the Arterial pressure or Blood Pressure. Or it is defined as a Lateral pressure exerted by blood column on the arterial wall.It is simply the pressure exerted by the blood on the vessel walls,measured in millimeters of mercury(Hg) by Sphigmomanometer. it is of two types Systolic Pressure(when the heart muscle is at the maximum contraction) is recorded first followed by the Diastolic Pressure (when the left ventricle is in a state of relaxation). In normal circumstances it is around 120/80mm of Hg.I put it as ideal B.P. but as the ideal circumstances are not preavailing anywhere with any body so slight variation is also considered as normal which is plus minus 10mm of Hg in both systolic and diastolic pressure. But a reading of 140/90 mm of Hg, on two out of three random checks, at different times of the day is to be taken as Abnormal Arterial pressure or Hypertension and needs further follow -up and/or evaluation.
     Hypertension ,hyperpiesia, high blood pressure , essential hypertension, the silent killer , problem of modern civilisation are the epithets used to describe but a feature of cardiovascular physiology. Interestingly without blood pressure, life would be impossible. In more than 60% of patients with "high blood pressure", the symptoms made their appearance after they were told that they are hypertensives. It is Amazing, but rightly, a check up clinic should be defined as, a place wherein a person walks in and wherefrom a patient totters out. In most cases, which fall into the category of Mild and Moderate Hypertension , patient have NO symptoms. In about 40 -50% of cases it is detected on a routine check,LIC or Pre employment check or as a complication like Stroke, Infarct, Loss of vision or Renal Failure. Hence it becomes very important for a treating physician to keep a close watch. Another reason for its significance is the attitude of the patient. They always have a ready explanation for an abnormally high pressure reading like "I didn't sleep well" or" I have so much of tension". Also they all feel that they can MAKE OUT what their Blood Pressure is by way of getting angry etc.,and since they FEEL thay have normal pressure, they neither go for regular checks nor take regular treatment, once again putting the onus on doctor.
Case Study
     Mr.H.P. 41 yrs.old Exporter consulted me for known Hypertension for the last 4 -5 years. He was on various Antihypertensive drugs time to time.His BP was 190/120 mm of Hg.Main complaints were Feeling of Weakness,Tendency for Loose Stools, Occasional Burning Micturation with Excessive Sweating all over the body and Disturbed Sleep. Has two daughters, Son died soon after birth. Sensitive++, Brooding+++, Supresses his Anger and emotions ++, Worried nature++ with Fear of Future. X- Ray Chest NAD, Hb- 15.7 gm%, ESR-6mm , TLC-9900,P74,L25,E1 Serum Cholestrol - 260 ng/dl, Triglycerides - 800 ng/ , S.Uric acid - 7.8, BUN -16. and Urine Exam. revealed Cal. Oxalate Crystals +++, ECG - WNL Patient was given Nat.Mur 200 C / 3 doses at the interval of 15 minutes followed by Kali Phos 6x tds for 2 weeks. Patient reported feeling better in next visit the BP was 140/90 mm of Hg.Sleep better, No episode of acute headache.Pain in the legs. Further he told me that in the past he had been passing small tiny stones off and on. He was prescribed Lyco 200 /1 dose followed by S/L for another 2 weeks. Patient reported feeling much better BP was 136/88 mm of Hg. NO more sleep disturbance, No more headaches. Occasional pain in the Knee joints. Nothing significant reported in subsequent visits and the Bp recorded 132/84 to 130/80 mm of Hg. S.cholestrol 218 ng/dl, Triglycerides 327 ng/dl and Uric Acid 7.3 mg/dl.
Factors
Aetiological Factors for Essential Hypertension are:
1. Heriditary factor : Commonly seen in the children of hypertensive patients, twins. This is due to abnormality in trans-cellular sodium transport which is one of the genetic defect.
2. Mental Stress : Stress in everyday life is one of the most common aetiological factors found in now a days life style.
3. Dietry factor : Excessive intake of Salt and Fats in rich diet throgh pickles, papads,fast foods etc. and over use of salt in daily diet.
4. Low Potassium diet :
5. Alcohol : Alcoholics often suffer from hypertension. Although alcohol does not have any direct effect on hypertension, yet it effects indirectly and is seen during the withdrawl stage which is mediated by sympathetic nervous system.
6. Obesity : Caused due to more salt,fat and crbohydrate intake and sedentary habits.
7. Smoking.
Aetiological factors for Secondary Hypertension can be:
1.RENAL :- Hydronephrosis, Renal Artery Stenosis, Glomerulo-Nephritis Polycystic renal disease, Diabetes.
2.ENDOCRINAL:- Cushing's syndrome, Adrenal Carcinoma, Hyperparathyroidism, Hypothyroidism, Pheochromocytoma.
3.CARDIO - VASCULAR : - Raised Systolic pressure in Aortic Regurgitation or in Complete Heart Block, Coarctation of Aorta.
4.CEREBRAL :- Cerebral Trauma, Encephalitis, Increased Intracranial Pressure due to any causes, Bulbar Poliomyelitis.
5. TOXIC :- Toxaemia of Pregnancy, Intake of Oral Contraceptives Steroids or Lead toxicity, Estrogen therapy.
6. POLYCYTHEMIA VERA :
7. DRUGS INDUCED :
     Out of all these mentioned types, essential hypertension is commonly seen. Most of the times such causes are ignored and patient comes with the complications. Thus, knowledge about the type and its management becomes must for all of us.
     Most symptoms of hypertension generally start after a patient knows that he/she has HT.Usually it is asymptomatic.In early stages the hypertension is fluctuant. It rises to abnormal levels under the influence of emotional changes etc. and later on it becomes permanently elevated even at rest. Occasionally patient may complain of vague complaints like Headache, Headache is usually occipital which starts on waking and improves with the day.Heaviness of head,Giddiness, Palpitation,Paroxysmal Nocturnal Dyspnoea. The comonest presentation is patient says that nowadays I feel very angry or the accompning person tells that he/she feels very angry and agitated on trival matters,so please check my or his/her BP. Symptoms generally are of dangerous complications due to effects on Target Organs namely Brain, Heart, Kidneys and Eyes. Sudden rise in BP can cause an artery to burst in the brain causing a Stroke. Heart has to pump harder leading to either Ischemia(IHD) or Pump failure(LVF) . Renal failure can occur by reduction of blood flow to the kidneys. Tiny haemorrhages occur in the Retinal vessels leading to diminution of the Vision and finally may be to total Blindness