About Hypertension

I have questioned about Hypertension form one of my friends, she asked especially  rationality of 6 drugs  that she accepted from  her physician.  It’s was amazing combination, of drugs (I said it’s  amazing, because she accept 4 drugs for antihypertension, remaining the patient is under 55 years and didn’t have other complain, good for lab result,  except she felt dizzy and having a shoulder pain) , and she felt her hearth beat faster than usual after she take  all the drug, with insomnia.

So.. I try to make all this information, starting from definition, what can be caused hypertension, how to prevent from hypertension, drug infromation, and others.

Starting to write in English (even the grammar is not god enough), but this is the start for  me to continously learning english languange. I keep my information to my friends in this blog, in case if there some one need the same info.

This is my info as a lecturer and pharmacist, not as physician.. So , if there is some information is not appropriated , please write in the comment., I’ll make it right .

Definition high blood pressure

High blood pressure (hypertension) means that the pressure of the blood in  arteries (blood vessels) is too high. Blood pressure is recorded as two figures. For example, 150/90 mm Hg. This is said as ‘150 over 90’. Blood pressure is measured in millimetres of mercury (mm Hg).

What do the numbers mean?

  • The top (first) number is the systolic pressure. This is the pressure at the height of the contraction of each heartbeat.
  • The bottom (second) number is the diastolic pressure. This is the pressure in the arteries when the heart rests between each heartbeat.

The machine that measures blood pressure is called a sphygmomanometer. The cuff is placed around your arm and pumped up. The pressure in the cuff around your arm is then gradually reduced. A doctor or nurse listens with a stethoscope over an artery in the arm as the pressure in the cuff is lowered. They can hear typical noises when the pressure in the cuff equals your systolic and diastolic pressures. Modern electronic devices can also measure blood pressure.


Classification of Blood Pressure (BP)*

Table 1. Classification of Blood Pressure Levels (JNC VII )

Category Systolic (mm Hg) Diastolic (mm Hg)
Normal < 120 < 80
Prehypertension 120-139 80-89
Stage 1 140-159 90-99
Stage 2 >160 >100

Normal and high blood pressure values

  • Normal blood pressure is less than 140/90 mm Hg. (However, if you have diabetes, a level of 130/85 or below is best.)
  • Mildly high blood pressure is 140/90 or above, but below 160/100 mm Hg. Treatment with tablets may be advised if it remains at this level, depending on whether you have other health risk factors.
  • Definitely high blood pressure is 160/100 mm Hg or above. Treatment with tablets is usually advised if it remains at this level.

Common of  high blood pressure

I make a sample case from UK. Because the data from Indonesia, was very rare. In the UK, about half of people over 65, and about 1 in 4 middle aged adults, have high blood pressure. It is less common in younger adults. It is more common in people from African-Caribbean origin, and from the Indian sub-continent. Most cases are mildly high (between 140/90 and 160/100 mm Hg). But, at least 1 in 20 adults have blood pressure above 160/100 mm Hg.

Caused high blood pressure

The cause is not known in most cases.  It is then called ‘essential hypertension’. The pressure in the blood vessels depends on how hard the heart pumps, and how much resistance there is in the arteries. Slight narrowing of the arteries increases the resistance to blood flow, which increases the blood pressure. The cause of the slight narrowing of the arteries is not clear. A variety of factors probably contribute.

(It is a bit like water in a hosepipe. The water pressure is increased if you open the tap more, but also if you make the hosepipe narrower by partially blocking the outflow with your thumb.)

Rarely, high blood pressure is caused by other conditions
For example; certain kidney or hormone problems can cause high blood pressure.

Diagnosed  high blood pressure

A ‘one-off’ high reading does not mean that you have ongoing high blood pressure. Your blood pressure varies throughout the day. It may be high for a short time if you are anxious, stressed, or have just been exercising. If you have ‘high blood pressure’ it means that your blood pressure remains high when you are relaxed. A diagnosis of high blood pressure is usually only made if you have several high readings which are taken on different occasions, and when you are relaxed.

Observation period

Therefore, if one reading is found to be high, it is usual for your doctor or nurse to advise a time of observation. This means several blood pressure checks at intervals over time. The length of the observation period varies depending on the initial reading, and if you have other health risk factors.

For example, say a first reading was mildly high at 150/96. If you are otherwise well, then a period of several months ‘observation’ may be advised. A blood pressure reading may be taken every couple of weeks or so. The observation period is also a good time to address any lifestyle factors (see below). However, if you have diabetes, or have had a recent heart attack, you may be advised to have repeat readings fairly often over the next week or so, and treatment with medication may be considered ‘sooner rather than later’ if the reading remains at this level.

High blood pressure must monitored

High blood pressure usually causes no symptoms. (This is why all adults should have their blood pressure checked every 3-5 years.) However, over the years, high blood pressure may do some damage to the arteries and put a strain on your heart. In general, the higher your blood pressure above normal, the greater your health risk.

So, high blood pressure is a ‘risk factor’ for developing heart disease (angina, heart attacks, and heart failure), strokes, peripheral vascular disease, and kidney damage sometime in the future.

Other risk factors which also increase the risk of developing these conditions are:

  • smoking
  • lack of exercise
  • a poor diet
  • excess alcohol
  • obesity
  • high cholesterol level
  • a strong family history of heart disease or a stroke.
  • being male
  • ethnic group (for example, British Asians have an increased risk)
  • diabetes

Note: some risk factors are more ‘risky’ than others. For example, smoking or high blood pressure causes a greater risk to health than obesity. Also, risk factors interact. So, if you have two or more risk factors, your health risk is much more increased than if you just had one. For example, a male smoker who takes no exercise and has high blood pressure has quite a high risk of developing heart disease before the age of 60.

So, the benefits of lowering a high blood pressure are a reduced risk of serious illness. For example, it is estimated that reducing a high diastolic blood pressure by 6 mm Hg reduces your risk of stroke by nearly 40% and reduces your risk of heart disease by about 15%. Larger reductions in blood pressure provide greater benefits.

Way to lowering Blodd pressure

Lose weight if you are overweight

Losing some weight can make a big difference. On average, blood pressure falls by about 2.5/1.5 mm Hg for each excess kilogram which is lost. Losing weight has many other health benefits apart from lowering blood pressure.

If you need to lose weight, even a small weight loss will help to lower your risks of developing high blood pressure and other serious health conditions. At the very least, you should not gain weight

Exercise regularly

You should aim to do some exercise on 5 or more days of the week, for at least 30 minutes. For example, brisk walking, swimming, cycling, dancing, gardening, etc. Regular exercise can lower blood pressure in addition to giving other health benefits and can make our perifer become more easy to dilated, just in case if suddenly  we have high blood pressure, the perifer will be easy to dilatation , so will decrease the heart attack risks.

Eat a healthy diet, which means

  • MORE cereals, wholegrain bread, poultry, rice, grilled food, lean meat, pasta, etc.
  • AT LEAST five portions of fruit and vegetables per day.
  • LESS fatty foods such as fatty meats, cheeses, full-cream milk, fried food, butter, etc.
  • Include two portions of fish per week, one of which should be ‘oily’ (herring, mackerel, sardines, kippers, pilchards, salmon, trout, anchovies, etc).
  • If you do fry, choose a vegetable oil such as sunflower or rapeseed.
  • Use low fat, mono-, or poly-unsaturated spreads.
  • Add less salt to food, and avoid foods which are salty. Some tips:

● Choose low- or reduced-sodium, or no-salt-added versions of foods and condiments when available.

● Choose fresh, frozen, or canned (low-sodium or no-salt-added) vegetables.

● Use fresh poultry, fish, and lean meat, rather than canned, smoked, or processed types.

● Choose ready-to-eat breakfast cereals that are lower in sodium.

● Limit cured foods (such as bacon and ham); foods packed in brine (such as pickles, pickled vegetables, olives, and sauerkraut); and condiments (such as mustard, horseradish, ketchup, and barbecue sauce). Limit even lower sodium versions of soy sauce and teriyaki sauce. Treat these condiments sparingly as you do table salt.

● Cook rice, pasta, and hot cereals without salt. Cut back on instant or flavored rice, pasta, and cereal mixes, which usually have added salt.

● Choose “convenience” foods that are lower in sodium. Cut back on frozen dinners, mixed dishes such as pizza, packaged mixes, canned soups or broths, and salad dressings—these often have a lot of sodium.

● Rinse canned foods, such as tuna and canned beans, to remove some of the sodium.

● Use spices instead of salt.In cooking and at the table, flavor foods with herbs, spices, lemon, lime, vinegar, or salt-free seasoning blends. Start by cutting salt in half.

A healthy diet provides health benefits in different ways. For example, it can lower cholesterol, help control your weight, and has plenty of vitamins, fiber, and other

Nutrients which help to prevent certain diseases. Some aspects of a healthy diet also directly affect blood pressure. For example:

  • Increasing the number of portions of fruit and vegetables from 2 to 7 per day will, on average, reduce blood pressure by 7/3 mm Hg.
  • If this is combined with a low-fat diet, the effect on lowering blood pressure is greater.
  • If you also keep to a low-salt diet, then the blood pressure may become even lower.

A diet which is low-fat, low-salt, and high in fruit and vegetables can lower systolic blood pressure by up to 11 mm Hg.

And don’t forget these calorie-saving tips:

● Use fat-free or low-fat condiments.

● Use half as much vegetable oil, soft or liquid margarine, mayonnaise, or salad dressing, or choose available low-fat or fat-free versions.

● Eat smaller portions—cut back gradually.

● Choose fat-free or low-fat milk and milk products.

● Check the food labels to compare fat content in packaged foods items marked fat-free or low-fat are not always lower in calories than their regular versions.

● Limit foods with lots of added sugar, such as pies, flavored yogurts, candy bars, ice cream, sherbet, regular soft drinks, and fruit drinks.

● Eat fruits canned in their own juice or in water.

● Add fruit to plain fat-free or low-fat yogurt.

● Snack on fruit, vegetable sticks, unbuttered and unsalted popcorn, or rice cakes.

● Drink water or club soda—zest it up with a wedge of lemon or lime

Avoid Alcohol

A small amount of alcohol is good for the heart (1-2 units per day). But, too much can be harmful and can contribute to high blood pressure. One unit is about half a pint of beer, or one small glass of wine, or one pub measure of spirits.

  • Men should drink no more than 21 units of alcohol per week (and no more than 4 units in any one day).
  • Women should drink no more than 14 units of alcohol per week (and no more than 3 units in any one day).

Smoking and cholesterol

Smoking and a high cholesterol level do not directly affect blood pressure. But, they greatly add to your health risk if you already have high blood pressure. If you smoke, you should make every effort to stop. If your cholesterol level is high, then it can be treated.

High blood pressure can be controlled if you take these steps:

■ Maintain a healthy weight.

■ Be moderately physically active on most days of the week.

■ Follow a healthy eating plan, which includes foods lower in sodium.

■ If you drink alcoholic beverages, do so in moderation.

■ If you have high blood pressure and are prescribed medication, take it as directed.

All steps but the last also help to prevent high blood pressure.

When we have to started  for high blood pressure treatment  

If you have definite high blood pressure (160/100 or above)

Medication is usually advised if your blood pressure remains over 160/100 mm Hg (hipertension stage 2)  despite a period of observation and tackling any lifestyle factors.

If you have mildly high blood pressure (140/90 to 160/100)

The advice about treatment varies from person to person. If you are healthy and have an otherwise low health risk, medication is not usually advised. Your blood pressure should be monitored every now and then as advised by your doctor or nurse. Medication is likely to be advised if:

  • you have other risk factors which add to your increased health risk.
  • you already have heart disease, have had a stroke, or there are signs of early damage from the high blood pressure. This helps to prevent, or delay, further problems.

The treatment for high blood pressure

There are several medicines that can lower blood pressure. The choice may depend on such things as: whether you have other medical problems; whether you take other medication; side-effects; your age; etc. Some medicines work well in some people and not so well in others. Occasionally, one or two medicines are tried before one is found to suit.

If medication is started, the ‘target’ is to reduce blood pressure to below 140/85 mm Hg. The target blood pressure is lower if you have certain other conditions, such as diabetes. It is quite common to need two or more medicines to reduce high blood pressure to a target level.

Duration of Treatment

In most cases, treatment of high blood pressure is for life. However, in some people whose blood pressure has been well controlled for 3 years or more, treatment may be able to be stopped. Your doctor can advise. If you stop treatment, you need regular blood pressure checks. In some cases the blood pressure remains normal, but in others it starts to rise again. Treatment can then be started again.

It is danger or no, if we have hypertension?

I just can say, the dangerous of Hypertension is depend to patient. Depend on the other risks factor that involve with the disease and depend with patient strenght. Patient strength means the ability of artery dilated  if suddenly the blood pressure is increased. More easier to  dilatation, so more strenght the patient and having a low risk to gain hearth attacks, and others.

Clinical Highlights:

  • Confirmation of hypertension is based on the initial visit, plus one or more follow-up visits with at least two blood pressure measures at each visit.
  • Standardized blood pressure measurement techniques (including out-of-office or home blood pressure measurements) should be employed when confirming an initially elevated blood pressure and for all subsequent measures during follow-up and treatment for hypertension.
  • A thiazide-type diuretic should be considered as initial therapy in most patients with uncomplicated hypertension.
  • Physician reluctance to initiate and intensify treatment is a major obstacle to achieving treatment goals.
  • Systolic blood pressure level should be the major factor for the detection, evaluation and treatment of hypertension, especially in adults 50 years and older.
  • Fewer than 50% of patients with hypertension will be controlled with a single drug.

This is the pharmacotheraphy for Hypertension, i hope it can be useful for all of us.