HYPERTENSION

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INTRODUCTION-

High blood pressure is a common condition in which the long-term force of the blood against your artery walls is high enough 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.

You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.

High blood pressure generally develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.

Blood pressure is the force that a person’s blood exerts against the walls of their blood vessels. This pressure depends on the resistance of the blood vessels and how hard the heart has to work.

Almost half of all adults in the United States have high blood pressure, but many are not aware of this fact.

Hypertension is a primary risk factor for cardiovascular disease, including stroke, heart attack, heart failure, and aneurysm. Keeping blood pressure under control is vital for preserving health and reducing the risk of these dangerous conditions.

In this article, we explain why blood pressure can increase, how to monitor it, and ways to keep it within a normal range.

CAUSES-

There are two types of high blood pressure.

Primary (essential) hypertension

For most adults, 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

Some people have 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:

• Obstructive sleep apnea
• Kidney problems
• Adrenal gland tumors
• Thyroid problems
• Certain defects you’re born with (congenital) in blood vessels
• Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
• Illegal drugs, such as cocaine and amphetamines

The cause of hypertension is often not known. In many cases, it is the result of an underlying condition.

Doctors call high blood pressure that is not due to another condition or disease primary or essential hypertension.

If an underlying condition is the cause of increasing blood pressure, doctors call this secondary hypertension.

Primary hypertension can result from multiple factors, including:

• blood plasma volume
• hormone activity in people who manage blood volume and pressure using medication
• environmental factors, such as stress and lack of exercise

Secondary hypertension has specific causes and is a complication of another health problem.

Chronic kidney disease (CKD) is a common cause of high blood pressure, as the kidneys no longer filter out fluid. This excess fluid leads to hypertension.

Conditions that can lead to hypertension include:

• diabetes, due to kidney problems and nerve damage
• kidney disease
• pheochromocytoma, a rare cancer of an adrenal gland
• Cushing syndrome that corticosteroid drugs can cause
• congenital adrenal hyperplasia, a disorder of the cortisol-secreting adrenal glands
• hyperthyroidism, or an overactive thyroid gland
• hyperparathyroidism, which affects calcium and phosphorous levels
• pregnancy
• sleep apnea
• obesity

SYMPTOM

A person with hypertension may not notice any symptoms, and so people often call it the “silent killer.” Without detection, hypertension can damage the heart, blood vessels, and other organs, such as the kidneys.

It is vital to check blood pressure regularly.

In rare and severe cases, high blood pressure causes sweating, anxiety, sleeping problems, and blushing. However, most people with hypertension will experience no symptoms at all.

If high blood pressure becomes a hypertensive crisis, a person may experience headaches and nosebleeds.

When to see a doctor

You’ll likely have your blood pressure taken as part of a routine doctor’s appointment.

Ask your doctor for a blood pressure reading at least every two years starting at age 18. If you’re age 40 or older, or you’re 18 to 39 with a high risk of high blood pressure, ask your doctor for a blood pressure reading every year.

Blood pressure generally should be checked in both arms to determine if there’s a difference. It’s important to use an appropriate-sized arm cuff.

Your doctor will likely recommend more frequent readings if you’ve already been diagnosed with high blood pressure or have other risk factors for cardiovascular disease. Children age 3 and older will usually have blood pressure measured as a part of their yearly checkups.

If you don’t regularly see your doctor, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. You can also find machines in some stores that will measure your blood pressure for free.

Public blood pressure machines, such as those found in pharmacies, may provide helpful information about your blood pressure, but they may have some limitations. The accuracy of these machines depends on several factors, such as a correct cuff size and proper use of the machines. Ask your doctor for advice on using public blood pressure machines.

Risk factors

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High blood pressure has many risk factors, including:

• Age. The risk of high blood pressure increases as you age. Until about age 64, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65.
• Race. High blood pressure is particularly common among people of African heritage, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack and kidney failure, also are more common in people of African heritage.
• Family history. High blood pressure tends to run in families.
• Being overweight or obese. The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
• Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
• Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart disease. Secondhand smoke also can increase your heart disease risk.
• Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
• Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you don’t get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.
• Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure. If you drink alcohol, do so in moderation .For healthy adults, that means up to one drink a day for women and two drinks a day for men. One drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof liquor.
• Stress. High levels of stress can lead to a temporary increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure.
• Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease, diabetes and sleep apnea.

Sometimes pregnancy contributes to high blood pressure, as well.

Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits, such as an unhealthy diet, obesity and lack of exercise, contribute to high blood pressure.

Complications

The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.

Uncontrolled high blood pressure can lead to complications including:

• Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
• Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
• Heart failure. To pump blood against the higher pressure in your vessels, the heart has to work harder. This causes the walls of the heart’s pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body’s needs, which can lead to heart failure.
• Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
• Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
• Metabolic syndrome. This syndrome is a cluster of disorders of your body’s metabolism, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL) cholesterol, the “good” cholesterol; high blood pressure and high insulin levels. These conditions make you more likely to develop diabetes, heart disease and stroke.
• Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure.
• Dementia. Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular dementia.

TREATMENT-

Regular physical exercise-

Current guidelines recommend that all people, including those with hypertension, engage in at least 150 minutes of moderate intensity, aerobic exercise every week, or 75 minutes a week of high intensity exercise.

People should exercise on at least 5 days of the week.

Examples of suitable activities are walking, jogging, cycling, or swimming.

Stress reduction

Avoiding or learning to manage stress can help a person control blood pressure.

Meditation, warm baths, yoga, and simply going on long walks are relaxation techniques that can help relieve stress.

People should avoid consuming alcohol, recreational drugs, tobacco, and junk food to cope with stress, as these can contribute to elevated blood pressure and the complications of hypertension.

Smoking can increase blood pressure. Avoiding or quitting smoke

educes the risk of hypertension, serious heart conditions, and other health issues.

Medication

People can use specific medications to treat hypertension. Doctors will often recommend a low dose at first. Antihypertensive medications will usually only have minor side effects.

Eventually, people with hypertension will need to combine two or more drugs to manage their blood pressure.

Medications for hypertension include:

• 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 medication depends on the individual and any underlying medical conditions they may experience.

Anyone on antihypertensive medications should carefully read the labels of any over-the-counter (OTC) drugs they may also take, such as decongestants. These OTC drugs may interact with the medications they are taking to lower their blood pressure.

Diet

People can prevent high blood pressure by following a heart-healthy diet.

Reducing salt intake

People’s average salt intake is between 9 grams (g) and 12 g per day in most countries around the world.

The World Health Organization (WHO) recommend reducing intake to under 5 g a day to help decrease the risk of hypertension and related health problems.

Lowering salt intake can benefit people both with and without hypertension.

Moderating alcohol consumption

Moderate to excessive alcohol consumption can increase blood pressure.

The American Heart Association (AHA) recommend a maximum of two alcoholic drinks a day for men, and one for women.

The following would count as one drink:

• a 12-ounce (oz) bottle of beer
• 4 oz of wine
• 1.5 oz of 80-proof spirits
• 1 oz of 100-proof spirits

A healthcare provider can help people reduce consumption if they find it difficult to moderate their alcohol intake.

Eating more fruit and vegetables and less fat

People who have high blood pressure or people at high risk of developing high blood pressure should eat as little saturated and total fat as possible.

Instead, experts recommend:

• whole grain, high fiber foods
• a variety of fruit and vegetables
• beans, pulses, and nuts
• fish rich in omega-3 twice a week
• nontropical vegetable oils, for example, olive oil
• skinless poultry and fish
• low fat dairy products

It is important to avoid trans fats, hydrogenated vegetable oils, and animal fats, as well as large portion sizes.

Some fats, such as those in oily fish and olive oil, have protective effects on the heart. However, these are still fats. While they are typically healthful, people with a risk of hypertension should still include them in their total fat intake.

Managing body weight

Excess body weight can contribute to hypertension. A fall in blood pressure usually follows weight loss, as the heart does not have to work so hard to pump blood around the body.

A balanced diet with a calorie intake that matches the individual’s size, sex, and activity level will help.

The DASH diet

The U.S. National Heart, Lung, and Blood Institute (NHLBI) recommend the DASH diet for people with high blood pressure. DASH stands for “Dietary Approaches to Stop Hypertension.”

DASH is a flexible and balanced eating plan with a firm grounding in research by the NHLBI who advise that the diet:

• lowers high blood pressure
• improves levels of fats in the bloodstream
• reduces the risk of cardiovascular disease

The NHLBI produce a cookbook called Keep the Beat Recipes that provides meal ideas to help reduce blood pressure.

Research from 2014 suggests that using probiotic supplements for 8 weeks or more may benefit people with hypertension.

PHYSICAL THERAPY MANAGEMENT

According to the American Physical Therapy Association, “Physical therapist patient/client management integrates an understanding of a patient’s/client’s prescription and nonprescription medication regimen with consideration of its impact upon health, impairments, functional limitations, and disabilities. The administration and storage of medications used for PT interventions is also a component of patient/client management and thus within the scope of PT practice”. Considering the prevalence of hypertension, therapists will undoubtedly work with many patients taking antihypertensive medications and should factor the effects of antihypertensives in their plan of care. A few important considerations for the physical therapist when treating hypertensive patients include: ensuring efficient scheduling in correspondence with therapy schedule, monitoring side effects, ensuring patient adherence to medications, and also selecting appropriate therapeutic exercises for each individual patient.

In regards to monitoring side effects, orthostatic hypotension is of the utmost concern for patients currently taking antihypertensives. Clinicians should be cautious when their patient changes posture suddenly or engages in activities that may lower blood pressure. In addition, patients need to be educated on the significant impact that uncontrolled high blood pressure can have on their health. When hypertension is left uncontrolled it has the ability to become a “silent killer” which serves reason as to why adherence should be continuously reinforced. Exercise is an imperative component of evidence-based treatment for many conditions treated in PT settings, however, it is an essential aspect of improving health in those diagnosed with hypertension. Regular exercise has been shown to drastically decrease blood pressure and can potentially eliminate the need for antihypertensive medications when it is accepted as a lifestyle. Exercise may present health risks to patients with hypertension, making it crucial for physical therapists to identify which exercise interventions are appropriate and safe for individual patients.

A randomized controlled pilot study suggests positive outcomes with neuromuscular electrical stimulation (NMES) for patients with pulmonary arterial hypertension (PAH)

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