High Blood pressure(hypertension)-Types,symptoms, investigations,prevention,complications and management

HYPERTENSION

DEFINITION

Is a chronic disorder when there is frequent elevation of Blood pressure above 140/90 mmHg. It can either be the systolic or diastolic.

TYPES

It is divided into;

PRIMARY /ESSENTIAL/ IDIOPATHIC HYPERTENSION:  is the chronic elevation of blood pressure from an unknown cause. However, It could be linked with the following;

  • Hereditary
  • Stress. Both Physical and emotional stress.
  • Obesity.
  • Unhealthy Lifestyle such as smoking, alcohol tobacco and caffeine intake.
  • Excessive ingestion of Salt or its salty canned condiments.

SECONDARY HYPERTENSION: Is also known as morbidity Hypertension. There is a disease or abnormality which gives rise to the elevation of the blood pressure. These diseases/abnormalities include;

  • Acute and Chronic glomerulonephritis
  • Phaeochromocytoma
  • Thyrotoxicosis
  • Tumour or any  other conditions that give rise to intracranial pressure.
  • Toxemia in pregnancy.
  • Coartation of aorta.
  • Use of Oral Pills.

SIGNS AND SYMPTOMS

Often hypertension causes no signs or symptoms other than elevated blood pressure readings. Because of this, hypertension is referred to as the “silent killer.” Patients with hypertension

are often first diagnosed when seeking health care for reasons unrelated to hypertension. In a small number of cases, a patient with hypertension may complain of ;

  • headache.
  • bloody nose or epistaxis.
  • blurred vision.
  • Light headedness.
  • Vertigo.
  • Tinnitus.
  • Syncope.
  • Fatigue.
  • Shortness of breath.
  • Insomnia.
  • Nervousness.
  • Angina Pectoris.

DIAGNOSIS

Diagnosis is based on  health history to assess a patient’s risk factors for hypertension, any previous diagnosis of hypertension, presence of any signs and symptoms, history of kidney or heart disease, and current use of medications. Although there are no diagnostic studies specifically for hypertension,

there are diagnostic tests that can be helpful in identifying related information, such as damage to organs or blood vessels. The types of diagnostic tests performed depend

on the stage of the hypertension  or other medical conditions that may be present at the time of evaluation.

Laboratory tests such as urinalysis, blood urea nitrogen, and creatinine may indicate kidney damage from high blood

other Investigations include:

Full blood count

Urinalysis and urine microscopy.

Uric acid.

Fasting blood sugar.

Lipid profile,

Electrocardiography ecg

Chest xray

Abdominal ultrasound

Renal angiograph.

COMPLICATIONS

  • Heart disease
  • Ischemic heart disease
  • Renal failure
  • Blindness
  • Death
  • Cerebrovascular accident (CVA)/ stroke
  • Aortic aneurysm

MANAGEMENT

THE Management of hypertension is focused on;

  • Health Education and counseling,
  • Lifestyle modifications,
  • Pharmacological Treatments ,
  • Treatment/Prevention of complications.

HEALTH EDUCATION AND COUNSELLING: This involves a multi-disciplinary approach by which the patient is counseled as soon as the diagnosis is made and confirmed. The clinical Psychologist take the patient on a counsel as regards to  his or her new status after which he hand over to the nurse. The Nurse further counsels him and introduces him to patients with the similar status who have been able to cope through it. The Nurse educates the patient on the disease condition and the need for the patient to modify his/her lifestyle.

                The Nurse hands the patient over to the physician who Further counsels, health educate, then prescribe the medication and hand over to the nurse who assist the patient secure the drugs from the pharmacy and educate him/her on the medication and the need for total adherent to drug schedule, the adverse effects of the drugs and when to seek for medical advice.

LIFESTYLE MODIFICATIONS: This can be remembered using an acronym “LIFESTYLE”

L—Limit salt and alcohol.

I—Include daily potassium, calcium, and magnesium.

F—Fight fat and cholesterol.

E—Exercise regularly.

S—Stress management.

T—Try to quit smoking.

Y—your medications are to be taken daily.

L—Lose weight.

E—End-stage complications will be avoided!

PHARMACOLOGICAL TREATMENT: This involves managing the patient with medications. This can be used as a adjunct  to synergize the other.

  • Beta-blockers/adrenergic- receptor blockers e.g Propranolol(inderal), atenolol.
  • Centrally anti-hypertensive drugs e.g, methyldopa(aldomet), hydralazine hydrochloride(apresoline)
  • Calcium channel blockers eg, amlodipine(norvasc), Nifedipine.
  • Angiotensin Converting Enzyme Inhibitors eg, enalapril,lisinopril,captopril.
  • Angiotensin ii Receptor antagonist e.g, Valsartan(diovan),Losartan Pottassium(cozaar).
  • Anti coagulant e.g, clopidogrel,aspirin.
  • Diuretics such as thiazide diuretic (hydrochlorothiazides), Loop diuretics (frusemide), potassium sparing (amiloride) other diuretics (moduretic).

TREATMENT/PREVENTION OF COMPLICATIONS: Complication can be prevent by total adherence to both the treatment schedule and doctors appointment where routine screening would be done for possible complications. Should in case  any complications was detected, it is to be treated immediately.

PREVENTION

  • Due to some non-modifiable risk factors such as Age (old Age), Race (African-American), Socio-economic and familiar tendencies which are inevitable, modifiable factors such as smoking, Obesity sedentary life style should be reduced to the barest minimum.
  • Exercise should be done regularly every 30 minutes for 5 days of the week.
  • Inculcate adhere  to the lifestyle modification acronym above.
  • Sleep and rest well.  

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