HYPERTENSION GROUP 5

Group - Hypertension - Page HYPERTENSION (High blood pressure) A.INTRODUCTION: I DEFINITION: Blood pressure is the force of blood pushing against blood vessel walls High blood pressure means the pressure in your arteries is higher than it should be Another name for high blood pressure is hypertension (American Heart Association) II STAGES OF HYPERTENSION: • Systolic blood pressure (during heart contraction): the highest arterial blood pressure of a cardiac cycle occurring immediately after systole of the left ventricle of the heart • Diastolic blood pressure ( during heart relaxation): the lowest arterial blood pressure of a cardiac cycle occurring during diastole of the heart Blood pressure category Systolic mmHg (upper) Diastolic mmHg (lower) Normal Less than 120 and Less than 80 Prehypertension 120-139 or 80-89 High Blood Pressure (Hypertension) Stage 140-159 or 90-99 High Blood Pressure (Hypertension) Stage 160 or higher or 100 or higher Hypertensive Crisis Higher than 180 or Higher than 110 (Emergency care needed) This table reflects blood pressure categories defined by the American Heart Association III STATISTICS: In the world: Hypertension is the leading cause of mortality and morbidity Global disease (12.7%), higher than other causes such as smoking (8.7%) or hyperglycemia (5.8%) – The frequency of hypertension around the world is generally about 41% in developed countries and 32% in developing countries • In Vietnam: • – Group - Hypertension - Page Hypertension in Vietnam is increasingly becoming a serious threat to the community while nearly 48% of adults get it (approximately 44,8 million people), including the proportion of infected men higher than in women (28.3% versus 23.1%) B.CAUSES • • • • • • • • There are two types of high blood pressure  Primary (essential) hypertension (About 90–95% of cases are primary) Hypertension results from a complex interaction of genes and environmental factors For most adults, there's no identifiable cause of high blood pressure, but lifestyle factors that increase the risk include excess salt, excess body weight, smoking, and alcohol  Secondary hypertension (The remaining 5–10% of cases are categorized as secondary high blood pressure) Defined as high blood pressure due to an identifiable cause Some people have high blood pressure caused by an underlying condition 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: Kidney problems: Diabetes complications, Polycystic kidney disease, Glomerular disease, Renovascular hypertension, Aldosteronism Thyroid problems: When the thyroid gland doesn't produce enough thyroid hormone (hypothyroidism) or produces too much thyroid hormone (hyperthyroidism), high blood pressure can result Hyperparathyroidism: The parathyroid glands regulate levels of calcium and phosphorus in your body If the glands secrete too much parathyroid hormone, the amount of calcium in your blood rises — which triggers a rise in blood pressure Coarctation of the aorta: With this defect you're born with, the body's main artery (aorta) is narrowed (coarctation) This forces the heart to pump harder to get blood through the aorta and to the rest of your body This, in turn, raises blood pressure — particularly in your arms Sleep apnea: In this condition, often marked by severe snoring, breathing repeatedly stops and starts during sleep, causing you to not get enough oxygen.Not getting enough oxygen may damage the lining of the blood vessel walls, which may make your blood vessels less effective in regulating your blood pressure In addition, sleep apnea causes part of the nervous system to be overactive and release certain chemicals that increase blood pressure Obesity: As you gain weight, the amount of blood circulating through your body increases This puts added pressure on your artery walls, increasing your blood pressure.Excess weight often is associated with an increase in heart rate and a reduction in the capacity of your blood vessels to transport blood In addition, fat deposits can release chemicals that raise blood pressure All of these factors can cause hypertension Pregnancy: Pregnancy can make existing high blood pressure worse, or may cause high blood pressure to develop (pregnancy-induced hypertension or preeclampsia) Medications and supplements: Various prescription medications — such as pain relievers, birth control pills, antidepressants and drugs used after organ transplants — can cause or aggravate high blood pressure in some people Group - Hypertension - Page C SYMPTOMS AND SIGNS OF HYPERTENSION Most people with high blood pressure will not experience any symptoms and signs until levels reach about 180/110 mmHg : In this cases, the common symptoms and signs can occur: • Severe Headache and restlessness • Fatigue and dizziness • Nausea or vomiting • Pale skin colour • Shortness of breath • Blurred vision • Blood in the urine Children: • Nosebleeds • Bell's palsy - inability to control facial muscles on one side of the face • Failure to thrive • Irritability • Respiratory distress D COMPLICATIONS OF HYPERTENSION When blood pressure stays high over time, it can damage the body and cause complications Some common complications include: I DAMAGE TO YOUR ARTERIES Healthy arteries are flexible, strong and elastic Their inner lining is smooth so that blood flows freely, supplying vital organs and tissues with adequate nutrients and oxygen If you have high blood pressure, the increased pressure of blood flowing through your arteries gradually can cause a variety of problems:  Aneurysms: When an abnormal bulge forms in the wall of an artery Aneurysms develop and grow for years without causing signs or symptoms until they rupture, grow large enough to press on nearby body parts, or block blood flow The signs and symptoms that develop depend on the location of the aneurysm  Peripheral Artery Disease: A disease in which plaque builds up in leg arteries and affects blood flow in the legs When people have symptoms, the most common are pain, cramping, numbness, aching, or heaviness in the legs, feet, and buttocks after walking or climbing stairs Group - Hypertension - Page II DAMAGE TO YOUR HEART Your heart pumps blood to your entire body Uncontrolled high blood pressure can damage your heart in a number of ways, such as: • Coronary artery disease Coronary artery disease affects the arteries that supply blood to your heart muscle Arteries narrowed by coronary artery disease don't allow blood to flow freely through your arteries When blood can't flow freely to your heart, you can experience chest pain, a heart attack or irregular heart rhythms (arrhythmias) • • Enlarged left heart High blood pressure forces your heart to work harder than necessary in order to pump blood to the rest of your body This causes the left ventricle to thicken or stiffen (left ventricular hypertrophy) These changes limit the ventricle's ability to pump blood to your body This condition increases your risk of heart attack, heart failure and sudden cardiac death Heart failure Over time, the strain on your heart caused by high blood pressure can cause your heart muscle to weaken and work less efficiently Eventually, your overwhelmed heart simply begins to wear out and fail Damage from heart attacks adds to this problem III DAMAGE TO YOUR BRAIN Just like your heart, your brain depends on a nourishing blood supply to work properly and survive But high blood pressure can cause several problems, including: • Stroke A stroke occurs when part of your brain is deprived of oxygen and nutrients, causing brain cells to die Uncontrolled high blood pressure can lead to stroke by damaging and weakening your brain's blood vessels, causing them to narrow, rupture or leak High blood pressure can also cause blood clots to form in the arteries leading to your brain, blocking blood flow and potentially causing a stroke • Dementia Dementia is a brain disease resulting in problems with thinking, speaking, reasoning, memory, vision and movement There are a number of causes of dementia One cause, vascular dementia, can result from narrowing and blockage of the arteries that supply blood to the brain It can also result from strokes caused by an interruption of blood flow to the brain In either case, high blood pressure may be the culprit IV DAMAGE TO YOUR KIDNEYS Your kidneys filter excess fluid and waste from your blood — a process that depends on healthy blood vessels High blood pressure can injure both the blood vessels in and leading to your kidneys, causing several types of kidney disease (nephropathy) Having diabetes in addition to high blood pressure can worsen the damage Group - Hypertension - Page • • Kidney failure High blood pressure is one of the most common causes of kidney failure That's because it can damage both the large arteries leading to your kidneys and the tiny blood vessels (glomeruli) within the kidneys Damage to either makes it so your kidneys can't effectively filter waste from your blood As a result, dangerous levels of fluid and waste can accumulate You might ultimately require dialysis or kidney transplantation Kidney artery aneurysm An aneurysm is a bulge in the wall of a blood vessel When it occurs in an artery leading to the kidney, it's known as a kidney (renal) artery aneurysm One potential cause is atherosclerosis, which weakens and damages the artery wall Over time, high blood pressure in a weakened artery can cause a section to enlarge and form a bulge — the aneurysm Aneurysms can rupture and cause life-threatening internal bleeding V DAMAGE TO YOUR EYES Tiny, delicate blood vessels supply blood to your eyes Like other vessels, they, too, can be damaged by high blood pressure: • Eye blood vessel damage (retinopathy) High blood pressure can damage the vessels supplying blood to your retina, causing retinopathy This condition can lead to bleeding in the eye, blurred vision and complete loss of vision If you also have both diabetes and high blood pressure, you're at an even greater risk • Fluid buildup under the retina (choroidopathy) In this condition, fluid builds up under your retina because of a leaky blood vessel in a layer of blood vessels located under the retina Choroidopathy (kor-oid-OP-uh-thee) can result in distorted vision or in some cases scarring that impairs vision VI SEXUAL DYSFUNCTION Although the inability to have and maintain an erection (erectile dysfunction) becomes increasingly common in men as they reach age 50, it's even more likely to occur if they have high blood pressure, too Over time, high blood pressure damages the lining of your blood vessels and causes your arteries to harden and narrow (atherosclerosis), limiting blood flow This means less blood is able to flow to your penis For some men, the decreased blood flow makes it difficult to achieve and maintain erections — often referred to as erectile dysfunction The problem is fairly common, especially among men who are not treating their high blood pressure Women may have sexual dysfunction as a side effect of high blood pressure, as well High blood pressure can reduce blood flow to your vagina For some women, this leads to a decrease in sexual desire or arousal, vaginal dryness, or difficulty achieving orgasm Improving arousal and lubrication can help Like men, women can experience anxiety and relationship issues due to sexual dysfunction VII HIGH BLOOD PRESSURE EMERGENCIES Group - Hypertension - Page High blood pressure is typically a chronic condition that gradually causes damage over the years In some cases, though, blood pressure rises so quickly and severely that it becomes a medical emergency requiring immediate treatment, often with hospitalization In these situations, high blood pressure can cause: • Problems with your brain, marked by memory loss, personality changes, trouble concentrating, irritability or progressive loss of consciousness (encephalopathy) • Stroke • Severe damage to your body's main artery (aortic dissection) • Seizures in pregnant women (preeclampsia or eclampsia) • Unstable chest pain (angina) • Heart attack • Sudden impaired pumping of the heart, leading to fluid backup in the lungs resulting in shortness of breath (pulmonary edema) E DIAGNOSIS AND TEST - High blood pressure is diagnosed using a blood pressure test This test will be done several times to make sure the results are correct If your numbers are high, your doctor may have you return for repeat tests to check your blood pressure over time - Blood pressure is most often measured with a device known as a sphygmomanometer, which consists of a stethoscope, arm cuff, dial, pump, and valve - A blood pressure test is easy and painless This test is done at a doctor's office or clinic - To prepare for the test: Don't drink coffee or smoke cigarettes for 30 minutes prior to the test These actions may cause a short-term rise in your blood pressure • Go to the bathroom before the test Having a full bladder can change your blood pressure reading • Sit for minutes before the test Movement can cause short-term rises in blood pressure In addition to measuring your blood pressure, your doctor will ask about your medical history (whether you've had heart problems before), assess your risk factors (whether you smoke, have high cholesterol, diabetes, etc.), and talk about your family history (whether any members of your family have had high blood pressure or heart disease) • Your doctor will also conduct a physical exam As a part of this exam, he or she may use a stethoscope to listen to your heart for any abnormal sounds and your arteries for a whooshing or swishing sound that may indicate that the artery may be partially blocked Your doctor may also check the pulses in your arm and ankle to determine if they are weak or even absent Group - Hypertension - Page  If you're diagnosed with high blood pressure, your doctor may recommend other tests, such as: • Electrocardiogram (EKG or ECG): A test that measures the electrical activity, rate, and rhythm of your heartbeat via electrodes attached to your arms, legs, and chest The results are recorded on graph paper • Echocardiogram: This is a test that uses ultrasound waves to provide pictures of the heart's valves and chambers so the pumping action of the heart can be studied and measurement of the chambers and wall thickness of the heart can be made • Urine sample analysis • Ultrasound tests of kidneys • Exercise stress test  Home testing Blood pressure tests can also be carried out at home using your own digital blood pressure monitor Like 24-hour or ambulatory monitoring, this can give a better reflection of your blood pressure It can also allow you to monitor your condition more easily in the long term You can buy a variety of low-cost monitors so you can test your blood pressure at home or while you're out and about It's important to make sure you use equipment that has been properly tested The British Hypertension Society (BHS) has information about validated blood pressure monitors that are available to buy F TREATMENT Defending on the severity levels of hypertension, we have different treatment This table shows levels of hypertension and their treatment: Kinds of hypertensio n Treatment Slightly elevated blood pressure (stage 1) Lifestyle changes Moderately high blood pressure (stage 2) Hypertensive Crisis Medication with lifestyle changes Do not wait to see if your blood pressure comes down on its own Seek emergency medical assistance immediately Group - Hypertension - Page I LIFESTYLE CHANGES (More information in Part G: Prevention) • • • • Enjoy regular physical activity Reducing alcohol consumption Eating healthily Lowering salt (sodium) intake • • • Losing weight Relaxation techniques Sleep II MEDICATIONS Angiotensin-converting enzyme (ACE) inhibitors Mechanism of action Block the actions of Angiotensin-converting enzyme (ACE), so Angiotensin I cannot be converted to Angiotensin II Contraindications - History of heart disease - Pregnant women - Individuals with conditions that affect the blood supply to the kidneys Adverse effects - Fatigue - Weakness - Headaches - Persistent dry cough (increase in Bradykinin level due to ACE inhibition, this effect can continue ) Note Some patients may find the side effects too unpleasant or long-lasting, then doctors will switch to an Angiotensin-2 receptor antagonist Side effects are less common, but may include dizziness, headache and/or hyperkalemia Renin inhibitors Mechanism of action Reduces renin production, blocks the production of Angiotensin I so that levels of both Angiotensin I and Angiotensin II fall Contraindications - Pregnancy - Breastfeeding – – – – – Adverse effects Diarrhea Dizziness Flu-like symptoms Fatigue Cough Note Calcium channel blockers (CCBs) Mechanism of action Decrease the calcium in blood vessels, resulting in vasodilation If the arteries are wider blood pressure will drop Contraindications - History of heart disease, liver disease - Problems with circulation Adverse effects - Flushing - redness of the skin - Headaches - Dizziness - Fatigue - Skin rash Note Patients taking CCBs should avoid grapefruit, because it can reduce the medical absorption Thiazide diuretics Mechanism of action Contraindications Adverse effects Note Thiazide diuretics act on the kidneys to help the body eliminate sodium and water, resulting in less blood volume - less blood volume results in lower blood pressure - Hypotension - Allergy to sulphur-containing medications - Gout - Renal failure - Lithium therapy - Hypokalemia - Hypokalemia - low blood potassium (affect kidney and heart functions) - Impaired glucose tolerance - raising risk of diabetes - Impotence (erectile dysfunction) Patients aged 80 or over may be given indapamide (Lozol), a special type of thiazide diuretic which helps reduce death from stroke, heart failure and some other cardiovascular diseases Beta-blockers Mechanism of action Beta blockers slow the heart rate down, as well as reducing the force of the heart, resulting in a drop in blood pressure Contraindications - Asthma - History of cocaine use or in cocaineinduced tachycardia Adverse effects Note - Fatigue - Cold hands and feet - Slow heartbeat - Nausea - Diarrhea - Disturbed sleep, nightmares,erectile dysfuction (rare) G.PREVENTION Reducing alcohol consumption Alcohol consumption is a double-edged sword In very small amounts it may lower blood pressure But if you drink too much, even moderate amounts regularly in some cases, blood pressure levels may go up Eating healthily Eating plenty of fruits and vegetables, good quality unrefined carbohydrates, vegetable oils, and omega oils If you eat animal products make sure all the fat is trimmed and avoid processed meats Lowering salt (sodium) intake This is the most important way to lower your blood pressure Studies have shown that even a moderate reduction in sodium intake can lower blood pressure levels by to mmHg Here are some tips to help you maintain that sodium-free diet: • Read the Nutrition Facts label • Prepare your own meals (and limit the salt in recipes and “instant” products) • Buy fresh meats, fruits, and vegetables • Add spices to your food Instead of salt, try coriander, black pepper, garlic or onion powder Losing weight Moderate weight loss - just ten pounds - can have a significant impact in lowering elevated blood pressure If you are overweight, the nearer you get to your ideal weight the more your blood pressure is likely to fall Reducing your waistline will have the greatest effect Any high blood pressure medications you are taking will become more effective when you lose weight Achieving your ideal body weight involves a combination of exercise, good diet, and at least hours good quality sleep each night 5 Relaxation techniques Adding the relaxation response, a stress-management approach, to other lifestyle modifications may significantly improve treatment of the type of hypertension most common in the elderly Sleep Not getting enough sleep can increase a person's risk of developing high blood pressure In 2008 the American Academy of Sleep Medicine published a study suggesting that people with sleep duration above or below the recommended 7-to-8 hours per night face an increased risk of hypertension Enjoy regular physical activity Exercising for 30 to 60 minutes five days a week will usually lower a person's blood pressure by to mmHg It is important to make sure you check with your doctor before embarking on any physical activity program The secret of getting success out of exercise is to it regularly No Smoking Cigarette smoking raises your blood pressure and puts you at higher risk for heart attack and stroke If you not smoke, not start If you smoke, quitting will lower your risk for heart disease Your doctor can suggest ways to help you quit Monitor your blood pressure Make sure that you have your blood pressure measured regularly, either at your doctor's office or at home High blood pressure often occurs with no symptoms, so only blood pressure readings will tell you if your blood pressure is on the rise If your doctor determines that you have prehypertension — blood pressure in the range of 120-139/80-89 millimeters of mercury (mmHg) that puts you at increased risk of developing hypertension — your doctor may recommend extra steps as a safeguard H FIRST AID MANAGEMENT(FOR H HYPERTENSIVE CRISIS) Reassure the patient and call for medical help Make him/her to lie on the bed and rest adequately Try to comfort and reduce anxiety, as anxiety alone can increase blood pressure Keep monitoring breathing, pulse rate, blood pressure, level of consciousness and for any other dangerous signs ( e.g paralysis of body in stroke, convulsions etc.) 5) Do not allow them to walk about, accompany the patient if it is really needed Watch out for falls 6) If the patient is vomiting or having seizures, turn to lateral side to prevent aspiration 7) If patient complains of difficulty in breathing, prop him/her up using pillows behind upper back 8) Do not give anything by mouth to eat/drink if there is suspicion of stroke 9) Specially avoid caffeine or alcohol containing beverages 10) Meanwhile look for possible cause for hypertensive crisis If the patient is a known hypertensive and missed medication, consult doctor over the phone and give a dose of medications if instructed 11) If breathing is unsatisfactory go for basic life support Mouth to mouth breathing and CPR (cardiopulmonary resuscitation) if needed 1) 2) 3) 4) I CONCLUSION Although the treatment for hypertension has been greatly improved, it is the most important preventable risk factor for premature death worldwide It increases the risk of many dangerous complications Prevention is always the most important Effective lifestyle modification may lower blood pressure as much as an individual antihypertensive drug If you have hypertension, you should go to the doctor to find the best treatment for your condition Remember that the more mistakes you take when treating hypertension, the more dangerous you get SOURCES https://en.wikipedia.org http://www.heart.org http://www.bloodpressureuk.org https://heartfoundation.org.au http://www.healthline.com http://www.medicalnewstoday.com NEW WORDS Vocabulary Pronunciation Aggravate /ˈaɡrəveɪt/ Aneurysm (also aneurism) /ˈanjʊrɪz(ə)m/ Angiotensin /ˌandʒɪə(ʊ)ˈtɛnsɪn/ Antidepressant /ˌantɪdɪˈprɛs(ə)nt/ Bulge /bʌldʒ/ Cardiovascular Culprit Diuretic /ˌkɑːdɪəʊˈvaskjʊlə/ /ˈkʌlprɪt/ /ˌdʌɪjʊ(ə)ˈrɛtɪk/ Dysfunction /dɪsˈfʌŋ(k)ʃ(ə)n/ Epidemiology /ˌɛpɪdiːmɪˈɒlədʒi/ Irritability /ˌɪrɪtəˈbɪlɪti/ Lethargy /ˈlɛθədʒi/ Mechanism /ˈmɛk(ə)nɪz(ə)m/ Meaning Make (a problem, injury, or offence) worse or more serious An excessive localized swelling of the wall of an artery A protein whose presence in the blood promotes aldosterone secretion and tends to raise blood pressure (chiefly of a drug) used to alleviate depression A rounded swelling which distorts an otherwise flat surface Relating to the heart and blood vessels The cause of a problem or defect (chiefly of drugs) causing increased passing of urine Abnormality or impairment in the operation of a specified bodily organ or system The branch of medicine which deals with the incidence, distribution, and possible control of diseases and other factors relating to health The quality or state of being irritable A pathological state of sleepiness or deep unresponsiveness and inactivity The doctrine that all natural phenomena, including life and thought, can be explained with reference to Obesity /ə(ʊ)ˈbiːsɪti/ Palpitation /palpɪˈteɪʃ(ə)n/ Peripheral /pəˈrɪf(ə)r(ə)l/ Pre-eclampsia /priːɪˈklam(p)sɪə/ Prevalence /ˈprɛvələns/ Respiratory /rɪˈspʌɪrət(ə)ri/ Seizure /ˈsiːʒə/ mechanical or chemical processes The state of being grossly fat or overweight A noticeably rapid, strong, or irregular heartbeat due to agitation, exertion, or illness Near the surface of the body, with special reference to the circulation and nervous system A condition in pregnancy characterized by high blood pressure, sometimes with fluid retention and proteinuria The fact or condition of being prevalent; commonness Relating to or affecting respiration or the organs of respiration A sudden attack of illness, especially a stroke or an epileptic fit  .. .Group - Hypertension - Page Hypertension in Vietnam is increasingly becoming a serious threat to the community... • • • There are two types of high blood pressure  Primary (essential) hypertension (About 90– 95% of cases are primary) Hypertension results from a complex interaction of genes and environmental... condition 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: