Hypertension: The silent killer
What is hypertension? Hypertension is high blood pressure. Blood pressure is the pressure of blood against the walls of the arteries. The higher the blood pressure, the harder it is for the heart to pump blood against such pressure. This fatigues the heart and causes it to become larger and more muscular in order to accommodate the increased work load and eventually fail over time. In addition, the arteries can become damaged from the increased pressure, rupture, and cause debilitating and often fatal strokes. Lastly, hypertension can cause organs in your body to become deprived of blood and lead to irrevocable damage to that organ and sometimes death. Hypertension is known as the silent killer because most people who have hypertension feel fine and have no symptoms at all. Yes, you could have severe hypertension for years and not even know it. This is why it is critical to contact your physician and schedule at least two blood pressure readings to find out if you have hypertension and receive the appropriate treatment. Despite the fact that symptoms are not often present, there are a few symptoms to watch out for:
- Shortness of breath
What is your blood pressure? Here are examples of ideal and pathological blood pressures:
Normal blood pressure: systolic <120 mmHg and diastolic <80 mmHg
•Prehypertension: systolic 120 to 139 mmHg or diastolic 80 to 89 mmHg
•Stage 1 hypertension: systolic 140 to 159 mmHg or diastolic 90 to 99 mmHg
•Stage 2 hypertension: systolic ≥160 or diastolic ≥100 mmHg
•Isolated systolic hypertension: blood pressure of ≥140/<90 mmHg
•Isolated diastolic hypertension: blood pressure <140/≥90 mmHg
•Malignant hypertension: severe hypertension with retinal hemorrhages, exudates, or papilledema, with or without hypertensive encephalopathy
•Hypertensive urgency: severe hypertension (diastolic pressure >120 mmHg) in asymptomatic patients
•Definitions based upon ambulatory or home blood pressure measurements are somewhat different
Lowering Blood Pressure:
Medication may be necessary to help control your hypertension. I will discuss medical treatments later in this blog. However, here are a few things you can do to lower your blood pressure.
- Lower your salt intake. Salt increases blood pressure. Here is why: Salt is made of one sodium molecule and one chloride molecule. These molecules act as a magnet due to their different charges. Water has both a positive and a negative pole and has an attraction for the sodium in salt. Therefore, where sodium goes, water follows it like a magnet. When you eat salt, your body holds on to extra water and it enters the blood. This process increases your blood volume and more blood equals more blood pressure against the walls of your arteries.
- Exercise regularly. Of course it is important that you consult your physician before engaging in an exercise program to determine if you are healthy enough and do not already have dangerously high hypertension. Exercise increases blood pressure and can be a fatal cocktail with exercise. In addition, lifting weights and other static exercises can increase blood pressure. Your physician will advise you on the best strategy to lower your blood pressure. The American Heart Association recommends the following if your doctor deems fit:
- For most healthy people, get the equivalent of at least 150 minutes (2 hours and 30 minutes) per week of moderate-intensity physical activity, such as brisk walking.
- If you need to lower your blood pressure or cholesterol, aim for 40 minutes of moderate to vigorous physical activity 3 to 4 times per week.
- You can incorporate your weekly physical activity with 30 minutes a day on at least 5 days a week.
- Physical activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the week.
- Include flexibility and stretching exercises.
- Include muscle strengthening activity at least 2 days each week.
- Lose fat weight. There is muscle and lean body weight and there is fat weight. Obesity increases blood pressure by a proposed set of complicated hormonal pathways. Losing weight has been proven to lower blood pressure. Eating less total calories per day and exercising will help to lose fat.
- Reduce alcohol consumption
- Avoid caffeine
What are some other causes of hypertension?
Sleep apnea is a disease in which an individual does not breathe adequately at night. This leads to a state of hypoxia (not enough oxygen). When the body does not ventilate adequately, carbon dioxide builds up in the body which is acidic. The body tries to balance the ph by absorbing a basic compound called bicarbonate (HCO3-). This takes place in the kidneys but in order to absorb bicarbonate, water must be accompanied with it (that’s just how it is, we didn’t invent kidneys). Remember how if we have more water in our body, it enters the blood stream and increases blood volume? More blood volume equals more blood pressure. In addition, a hypercapnic (high levels of carbon dioxide) induce blood vessels to constrict. If the arteries have less area, then blood pressure increases. The same amount of blood has to travel through a smaller vessel (Pressure = Force/Area). Hypertension due to sleep apnea needs to be controlled with medication. Fixing sleep apnea with a CPAP does little to correct blood pressure.
Hyperaldostronism is a disease where the body secretes too much aldosterone. Aldosterone is a chemical that causes the reabsorption of sodium and water in the kidney. This increases blood volume, thus pressure. Hyperaldostronsim causes the body to lose potassium. Therefore, specific medication that prevents further loss of potassium while ridding the body of sodium is necessary to control this problem. In some instances, surgery may be needed to correct the problem.
Cushing’s Disease is a disease in which the body produces too much cortisol. There is a difference between Cushing’s disease and Cushing’s syndrome. However, that is beyond the scope of this blog. For now just remember that cortisol increases blood pressure and is treated surgically.
Renal Artery Stenosis:
Renal Artery Stenosis occurs when the arteries that supply the kidneys have an area of stenosis unilaterally or bilaterally. Since all blood flows through the kidneys to be filtered, when the arteries become stenosed, the flow of blood is hindered and increases the blood pressure against the walls of the capillaries. Renal artery stenosis is usually suspected after numerous medial trials have failed.
Medication as cause:
There are a vast number of medications that can induce hypertension in an individual. Your physician will work with you on finding the right medication schedule in order to minimize hypertension and discuss strategies.
A growing number of people are taking compounds like testosterone, Human Growth Hormone, Insulin-like Growth Factor (IGF-1), and pre-workout supplements. These substances are extremely dangerous. Testosterone cause increased blood pressure and arterial tone, human growth factor can cause the heart to become more muscular and less effective at pumping blood-this is lethal, and pre-workouts contain substances that activate the sympathetic nervous system and cause arteries to constrict (which increases blood pressure). In addition, pre-workouts cause the heart to work even harder against higher pressures. Eventually, the heart will fatigue and fail prematurely. Always be forthcoming with your physician about drugs and compounds that you are taking. Your physician has a confidentiality agreement with you and cannot disclose such activity. Your physician cares about you and just wants to be able to serve you better.
Medications that treat hypertension:
Thiazide diuretics- (water pills): Thiazide diuretics act on the kidney to excrete sodium. Remember, where sodium goes, water goes. These pills reduce water in the body thus, reduce blood volume and pressure.
Loop Diuretics- (furosemide, Lasix): Loop diuretics are powerful diuretics that block sodium, potassium, and chloride from entering the body in excess. Water is attracted to these molecules so blocking them also blocks water from entering the body and reduces blood volume and pressure.
Potassium sparing diuretics (spironolactone, triamterene): These diuretics block the aldosterone receptor and hold on to potassium. This drug is used in special cases such as hyperaldostronism and often sleep apnea.
ACE Inhibitors- (lisinopril, “prils”): These drugs block an enzyme that converts a series of compounds from causing an increase in water volume and constriction of the blood vessels. These medications are particularly useful in diabetics and have been shown to prevent diabetic damage to kidneys.
ARB’s (losartan, “sartans”): These drugs block a compound called angiotensin from binding to their receptors and causing vasoconstriction (constriction of the arteries).
Carbonic anyhydrase inhibitors: (acetazolamide): These drugs block carbonic anhydrase in the kidney and are used for mountain sickness but have a weak effect on total water loss so they are not commonly used.
Alpha 2 agonists (clonidine): Inhibits sympathetic outflow which causes vasodilation which widens the lumen of the artery thus decreasing pressure
Beta blockers (atenolol, “olol’s”): These drugs act in numerous ways which your physician can discuss. There are several varieties that work on different beta and also alpha receptors.
Calcium Channel blockers: These drugs have two subclasses and numerous effects. Please discuss these medications with your physician for more information.
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