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High Blood Pressure (Hypertension)

High blood pressure is very common and is generally considered to be present when the blood pressure is more than 140/90 (except in the elderly), although at this level treatment is not always necessary. It is a disease mainly of middle and old age, rarely occurring before the age of twenty. If it does occur in the young age group, it is usually caused by kidney disease. Over the age of twenty, hypertension is very common, especially in the western world. As much as twenty-five per cent of the population may be hypertensive in some countries, and the incidence rises with age.

High blood pressure puts a strain on the heart and may cause heart disease. People with high blood pressure are also more likely to suffer a stroke. For these reasons it is important that hypertension is treated, even though there are often no obvious symptoms.

There are two types of hypertension. In essential hypertension, the most common type, the blood pressure is raised for no obvious reason. Secondary hypertension occurs as a side-effect of some other diseases such as an hormonal disorder or kidney disease. The contraceptive pill and some other drugs can also cause hypertension. Treatment of the underlying condition is needed to relieve the hypertension in these cases.

Essential hypertension often runs in families; a child of a hypertension parent has a considerably greater chance of developing hypertension than children with no such family history. It is also more common in overweight people and in diabetics.

Symptoms

Hypenension usually develops slowly without symptoms over several years. Very rarely, it develops rapidly and can be dangerous unless promptly treated. This is sometimes known as 'malignant' hypertension although it has nothing to do with cancer.

In hypertension the diastolic blood pressure is more significant than the systolic pressure. A person with a diastolic pressure of more than 90mm Hg might be considered mildly hypertensive; a pressure of between 100 and 110 is moderately hypertensive; above this, hypertension is generally considered severe and potentially dangerous.

Hypertension eventually results in the small arteries throughout the body becoming constricted, and the walls may become thickened. This decreases the amount of blood they can carry, so that organs requiring a very large volume of blood in order to function properly also become diseased.

As the blood vessels narrow, the heart has to pump harder to push the blood round the circulatory system, and it soon increases in size to cope with this extra work-load. Eventually, however, the strain may be too much for the heart, which becomes less and less efficient at pumping the blood through the arteries, leading to heart failure. Hypertensive heart disease is frequently associated with atherosclerosis of the arteries supplying blood to the heart, and hypertension also hastens the progress of atherosclerosis. With this combination, there may be a chest pain brought on by physical exertion, and the affected person runs a greater risk of a heart attack.

Hypertension can also damage the kidneys, and this may first show itself by blood in the urine, and later by kidney failure and uraemia, the accumulation of waste products in the blood. Since this dangerous condition often goes undeteCted, it is important for people with high blood pressure to have regular medical check-ups.

Treatment

Although in many people hypertension does not show any obvious symptoms, because of the severity of possible complications arising directly from high blood pressure it is essential that it is treated. Sometimes this means taking a life-long course of drugs.

There are several self-help measures that can be taken to reduce blood pressure without drugs. The most important is to stop smoking, since this is a major cause of athero­sclerosis and leads to high blood pressure. If you are over­weight, go on a diet; in any case reduce the amount of fat in your diet. Salt has been found to be linked to high blood pressure, so reduce your salt intake as much as possible, by nor adding salt to food at the table and giving up highly salted foods such as pickles. In addition, relaxation exercises and yoga-type techniques help reduce stress and anxiety and so lower blood pressure.

Whether drugs are given or not depends on the degree of hypertension. If you have mild or moderate hypertension you may simply be monitored regularly by your doctor, without drug treatment. Hypertension is usually treated if the diastolic pressure is above 105mm Hg.

Several different types of antihypertensive drugs might be prescribed, including beta-blockers which lower blood pressure by acting directly on the heart, slowing the heart rate. These are sometimes combined with diuretic drugs that increase the amount of water excreted from the body in the urine, preventing the build-up of fluid caused by the slowing of the heart rate. Other drugs widely used to treat high blood pressure include those that block the flow of calcium through blood-vessel walls, calcium ion antagonists. New drugs are being developed to treat hypertension, without the side-effects produced by the drugs now commonly used.

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