HYPERTENSION

Hypertension, also referred to as high blood pressure, is a condition in which the arteries have persistently elevated blood pressure that it may eventually cause health problems, such as heart disease. Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure. High blood pressure, is dangerous because it makes the heart work harder to pump blood out to the body and contributes to hardening of the arteries, or atherosclerosis, to stroke, kidney disease, and to heart failure.

A blood pressure reading is written like this: 120/80. It’s read as “120 over 80.” The top number is called the systolic, and bottom number is called the diastolic. Systolic—The top or larger number measures the pressure in the arteries while the heart muscle is contracting. Diastolic—The bottom or smaller number measures the pressure while the heart relaxes between beats. Blood pressure usually is measured in millimeters of mercury (mm Hg).

BLOOD PRESSURE CATEGORY	SYSTOLIC mm Hg (upper number)		DIASTOLIC mm Hg (lower number)
NORMAL	LES THAN 120	and	LESS THAN 80
ELEVATED	120-129	and	LESS THAN 80
HIGH BLOOD PRESSURE (HYPERTENSION) STAGE 1	130-139	or	80-89
HIGH BLOOD PRESSURE (HYPERTENSION) STAGE 2	140 OR HIGHER	or	90 OR HIGHER
HYPERTENSIVE CRISIS (consult your doctor immediately)	HIGHER THAN 180	and/or	HIGHER THAN 120

The five blood pressure ranges as recognized by the American Heart Association are:

Normal

Blood pressure numbers of less than 120/80 mm Hg are considered within the normal range. If your results fall into this category, stick with heart-healthy habits like following a balanced diet and getting regular exercise.

Elevated

Elevated blood pressure is when readings consistently range from 120-129 systolic and less than 80 mm Hg diastolic. People with elevated blood pressure are likely to develop high blood pressure unless steps are taken to control the condition.

Hypertension Stage 1

Hypertension Stage 1 is when blood pressure consistently ranges from 130-139 systolic or 80-89 mm Hg diastolic. At this stage of high blood pressure, doctors are likely to prescribe lifestyle changes and may consider adding blood pressure medication based on your risk of atherosclerotic cardiovascular disease (ASCVD), such as heart attack or stroke.

Hypertension Stage 2 is when blood pressure consistently ranges at 140/90 mm Hg or higher. At this stage of high blood pressure, doctors are likely to prescribe a combination of blood pressure medications and lifestyle changes.

Hypertensive crisis

This stage of high blood pressure requires medical attention. If your blood pressure readings suddenly exceed 180/120 mm Hg, wait five minutes and then test your blood pressure again. If your readings are still unusually high, contact your doctor immediately. You could be experiencing a hypertensive crisis.

If your blood pressure is higher than 180/120 mm Hg and you are experiencing signs of possible organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision or difficulty speaking, do not wait to see if your pressure comes down on its own. Call or visit a health facility immediately.

CAUSES OF HYPERTENSION

Based on the cause hypertension can be grouped into two types.

Primary (essential) hypertension

For most adult’s cases, there’s no identifiable cause of high blood pressure. This type of high blood pressure, called primary (essential) hypertension, tends to develop gradually over many years.

Secondary hypertension

This is high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including thyroid problems, Obstructive sleep apnoea, Kidney problems

Adrenal gland tumours, Certain defects you’re born with (congenital) in blood vessels and Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs and some Illegal drugs.

RISK FACTORS FOR HYPERTENSION

High blood pressure has many risk factors, including:

People with family members who have high blood pressure
Smokers
African-Americans
Pregnant women
Women who take birth control pills
People over the age of 35
People who are overweight or obese
People who are not active
People who drink alcohol excessively
People who eat too many fatty foods or foods with too much salt
People who have sleep apnea

Symptoms and Signs

A person with hypertension may not notice any symptoms, and it is often called the “silent killer.” While undetected, it can cause damage to the cardiovascular system and internal organs, such as the kidneys.

Regularly checking your blood pressure is vital, as there will usually be no symptoms to make you aware of the condition. It is maintained that high blood pressure causes sweating, anxiety, sleeping problems, and blushing. However, in most cases, there will be no symptoms at all. If blood pressure reaches the level of a hypertensive crisis, a person may experience headaches and nosebleeds. Severe hypertension (hypertensive crisis) can cause severe cardiovascular, neurologic, renal, and retinal symptoms (e.g. symptomatic coronary atherosclerosis, HF, hypertensive encephalopathy, renal failure). A 4th heart sound is one of the earliest signs of hypertensive heart disease. Retinal changes may include arteriolar narrowing, hemorrhages, exudates, and, in patients with encephalopathy, papilledema.

Blood pressure can be measured by a sphygmomanometer, or blood pressure monitor. Having high blood pressure for a short time can be a normal response to many situations. Acute stress and intense exercise, for example, can briefly elevate blood pressure in a healthy person. For this reason, a diagnosis of hypertension normally requires several readings that show high blood pressure over time.

The systolic reading of 140 mmHg refers to the pressure as the heart pumps blood around the body. The diastolic reading of 90 mmHg refers to the pressure as the heart relaxes and refills with blood.

Complications

Long-term hypertension can cause complications through atherosclerosis, where the formation of plaque results in the narrowing of blood vessels. This makes hypertension worse, as the heart must pump harder to deliver blood to the body.

High blood pressure raises the risk of a number of health problems, including a heart attack.

Hypertension-related atherosclerosis can lead to:

heart failure and heart attacks
an aneurysm, or an abnormal bulge in the wall of an artery that can burst, causing severe bleeding and, in some cases, death
kidney failure
stroke
amputation
hypertensive retinopathies in the eye, which can lead to blindness
Regular blood pressure testing can help people avoid the more severe complications.

Diagnosis

Hypertension is diagnosed and classified by sphygmomanometry. History, physical examination, and other tests help identify cause and determine whether target organs are damaged.

Treatment

Regular health checks are the best way to monitor your blood pressure. While blood pressure is best regulated through the diet before it reaches the stage of hypertension, there is a range of treatment options.

Lifestyle adjustments are the standard first-line treatment for hypertension.

Regular physical exercise

Doctors recommend that patients with hypertension engage in 30 minutes of moderate-intensity, dynamic, aerobic exercise. This can include walking, jogging, cycling, or swimming on 5 to 7 days of the week.

Stress reduction

Avoiding stress, or developing strategies for managing unavoidable stress, can help with blood pressure control.

Using alcohol, drugs, smoking, and unhealthy eating to cope with stress will add to hypertensive problems. These should be avoided.

Smoking can raise blood pressure. Giving up smoking reduces the risk of hypertension, heart conditions, and other health issues.

Medications

People with blood pressure higher than 140 over 90 may use medication to treat hypertension.

Drugs are usually started one at a time at a low dose. Side effects associated with antihypertensive drugs are usually considered minor.

Eventually, a combination of at least two antihypertensive drugs is usually required.

A range of drug types are available to help lower blood pressure, including:

diuretics, including thiazides, chlorthalidone, and indapamide.
beta-blockers and alpha-blockers
calcium-channel blockers
central agonists
peripheral adrenergic inhibitor
vasodilators
angiotensin-converting enzyme (ACE) inhibitors
angiotensin receptor blockers

The choice of drug depends on the individual and any other conditions they may have.

Anyone taking antihypertensive medications should be sure to carefully read labels, especially before taking any over-the-counter (OTC) medications, such as decongestants.

These may interact with medications used to lower blood pressure.

LIFESTYLE MODIFICATION

Ensuring the following is very helpful

Cessation of smoking
No alcohol intake
Weight reduction and exercise
Rest
Do not stress

DIET THERAPY

Ensuring the following is very helpful

Reduce salt intake
No fat intake
More fruits and vegetables

DRUGS- FOR LIFE!!

HERBAL MANAGEMENT OF Hypertension

Common herbal medicines commonly used in Ghana for the management of hypertension are:

Allium sativum- Garlic: Contains allicin which relaxes the muscles and as well thins the blood.
Tetrapleura tetraptera (Prek3se-Twi name): Contains tannic acid which causes vasodilation, reducing the peripheral resistance.
Diodia scandens: Acts as a diuretic by decreasing fluid volume in the system and helps to reduce the peripheral resistance.
Lippia multiflora ( Sareso nunum- Twi name): Causes vasodilation and reduce sympathetic hypertension

References

Causes of High Blood Pressure. WebMD. https://www.webmd.com/hypertension-high-blood-pressure/guide/blood-pressure-causes#1. Accessed May 9, 2019

High blood pressure (hypertension). Mayoclinic. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410. Accessed May 9, 2019

What is high blood pressure? American Heart Association. http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/GettheFactsAboutHighBloodPressure/What-is-High-Blood-Pressure_UCM_301759_Article.jsp#.WrqtReR1rcs. Accessed May 9, 2019.

Hypertensive crisis: When you should call 9-1-1 for high blood pressure. American Heart Association. https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings/hypertensive-crisis-when-you-should-call-911-for-high-blood-pressure#.WrqtoOR1rcs. Accessed May 9, 2019.