Sign up for our newsletter

Hypertension

Hypertension (HTN) or High blood pressure is a potentially serious medical condition. It is when the blood pressure becomes elevated for a period of time, usually a chronic condition that doesn’t improve with sitting or improvement of stress.

In some cases, your blood pressure can become elevated for a short period of time. This may be caused by Stress, Pain, Drugs, Withdrawals, and other causes.

Normal blood pressure is typically 120/80 and below. There are different classifications of blood pressure that seem to change from professional to professional or by National committees.

Different Classifications of blood pressure:

1.)  Normal Blood pressure = 120/80
2.)  Low Blood pressure = 70-99/40-64
3.)  Low Normal Blood pressure = 100-119/65-79
4.)  Borderline blood pressure = 121-139/81-89
5.)  Elevated blood pressure = 140-159/90-99
6.)  Very Elevated blood pressure = 160+/100+

***Too low of a blood pressure is often not a great thing either. Some patients with low body weight, malnutrition, dehydration, and other conditions can have low blood pressure.  Low blood pressure is called Hypotension.

Hypertension is more often seen in adults –  but increasing cases of children and even infants with elevated blood pressure are being seen.

Blood pressure is the pressure of blood itself against the arteries:

–  Similar to the amount of pressure it takes to blow up a balloon.
–  The difference is that blood is always moving and the air inside a balloon is contained

Two numbers measure blood pressure:

1.  Systolic Pressure – measures cardiac output
2.  Diastolic Pressure – measures arterial resistance

Two Main Categories

1.)  Primary

–  When the cause is unknown it also referred to as essential hypertension
–  95% of the cases

2.)  Secondary

–  Occurs when the cause is known
–  5% of cases

Symptoms

–  Many have no symptoms at all
–  Headache
–  Dizziness
–  Nausea
–  Heart racing
–  Vision changes
– Chest Pain
– Heartburn
– Indigestion
– Anxiety
– Difficulty catching breath
– Shortness of breath

Symptoms in infants

–  Failure to thrive
–  Irritability
–  Seizures
–  Lethargy
–  Respiratory distress

*** – if hypertension is a secondary cause from another disease then symptoms of that disease are often present as well

Factors that play a key role include:

–  Age
–  Race
–  Obesity
–  Stress
–  Smoking
–  Genetics or heredity

*** Pregnancy-induced Hypertension can be seen and can lead to Pre-eclampsia or Eclampsia.

PreHypertension

–  The is when a person’s blood pressure is elevated above the normal level
–  However, this level is not yet at the level to be considered hypertension.
–  Systolic is between 120 and 139 mm Hg
–  Diastolic is between 80 and 89 mm Hg
–  When over 140/90 mm Hg – is considered hypertension

Over 50 million Americans have High Blood Pressure

–  A large portion of those with this condition (65-70%) know they have increased blood pressure
–  Around 30% are not aware of their condition.
–  However, only 50% who are aware of their condition are taking medication
–  And only half who take medications are under 140/90

Causes:

Essential Hypertension

–  This is a very complex disorder
–  By definition has no identifiable cause
–  Affects 90-95% of individuals with hypertension

Risk factors:

1.)  Increase in Age
2.)  Increase Weight  (Obesity)
3.)  Sedentary lifestyle
4.)  Increase Alcohol intake
5.)  Increase Salt intake
6.)  Genetic changes

Secondary Hypertension

–  Seen in only 5% of those with hypertension

1.)  Endocrine diseases

–  Cushings Syndrome
–  Pheochromocytoma
–  Hyperaldosteronism (Conn’s syndrome)
–  Hyperthyroidism
–  Hypothyroidism
–  Acromegaly
–  Hyperparathyroidism
–  Others

2.)  Kidney diseases

–  Chronic renal failure
–  Kidney disease

3.)  Cancers

4.)  Medication

–  Alcohol
–  Stimulants
–  Hormonal contraception
–  Nasal decongestants
–  Meth, Heroin, Withdrawal, etc
–  others

5.)  Pregnancy

6.)  Obstructive Sleep Apnea

7.)  Neurological disorders

8.)  others

Some Major Complications of Hypertension are:

1.  Stroke
2.  Coronary Heart Disease
3.  End-stage Renal Failure
4.  Heart Failure
5.  Arterial Aneurysms

Resistant Hypertension

This is a difficult portion of this disease and it is seen when someone with hypertension is still uncontrolled even though 3 or more medications are being used.

Only a small amount of those with hypertension will develop this “resistance”

Exercise Hypertension

Elevated blood pressure only during exercise. The spike is often seen in the Systolic pressure which can exceed 250 mm Hg

Diagnosis often occurs when systolic goes above 200 mm Hg and medication is required when above 220 mm Hg.

Treatment:

1.)  Diuretics

Diuretics for those with:

1.)  Heart Failure
2.)  Coronary Heart Disease
3.)  Diabetes Mellitus
4.)  Stroke risk

Thiazide

.    Hydrochlorothiazide
.    Metolazone
.    Chlorthilidone
.    Block sodium resorption in the cortical diluting segment – at the terminal point of the loop of Henle.
.    Become ineffective when GFR goes below 30-40 mL/min

Loop Diuretics

.    Furosemide
.    Bumetanide
.    Torsemide
.    Inhibits chloride reabsorption in ascending limb of the loop of Henle

Potassium-Sparing agents

.    Spironolactone
.    Triamterene
.    Eplerenone
.    Amiloride
.    Can be used in combo with Loop diuretics and Thiazides
.    Triameterene and Amiloride work in distual tubule to limitpotassium secretion
.    Spironolactone inhibits aldosterone – which is often elevated in Congestive Heart Failure (CHF)
.    Eplerenone is used for post MI cases  (heart attacks)

2.) Beta Blockers

Beta-Blockers are intended for those with:

1.)  Heart Failure
2.)  Past history of Myocardial Infarction
3.)  Coronary Heart Disease
4.)  Diabetes Mellitus

Beta Blockers

.    Acebutolol (Sectral)
.    Atenolol (Tenormin)
.    Betaxolol (Kerlone)
.    Bisoprolol & HCTZ (Ziac)
.    Carteolol (Cartrol)
.    Carvedilol (Coreg)
.    Labetalol (Normodyne, Trandate)
.    Metoprolol (Lopressor, Toprol XL)
.    Nadolol (Corgard)
.    Penbutolol (Levatol)
.    Pindolol (Visken)
.    Propranolol (Inderal)
.    Timolol (Blocadren)

3.) ACE Inhibitors

ACE Inhibitors are intended for those with:

1.)  Heart Failure
2.)  Past history of Myocardial Infarction
3.)  Coronary Heart Disease
4.)  Diabetes Mellitus
5.)  Chronic Kidney Disease
6.)  Stroke risk

ACE Inhibitors

.    Benazepril (Lotension)
.    Captopril (Capoten)
.    Enalapril (Vasotec)
.    Fosinopril (Monopril)
.    Lisinopril (Prinivil, Zestril)
.    Moexipril (Univasc)
.    Perindopril (Aceon)
.    Quinapril (Accupril)
.    Ramipril (Altace)
.    Trandolapril (Mavik)
.    Block the rennin-angiotension-aldosterone system
.    Reduce deaths by 20% with those who have symptoms of Heart failure

4.) Angiotension II Receptor Blockers  (ARBs)

ARBs are intended for those with:

1.)  Heart Failure
2.)  Diabetes Mellitus
3.)  Chronic Kidney Disease

Angiotension II Receptor Blockers

.    Candesartan (Atacand)
.    Eposartan (Teveten)
.    Irbesartan (Avapro)
.    Losartan (Cozaar)
.    Olmesartan (Benicar)
.    Telmisartan (Micardis)
.    Valsartan (Diovan)

Combinations

.    Eposartan + HCTZ (Teveten HCTZ)
.    Irbesartan + HCTZ (Avalide)
.    Losartan + HCTZ (Hyzaar)
.    Olmesartan + HCTZ (Benicar HCT)
.    Telmisartan + HCTZ (Micardis HCT)
.    Valsartan + HCTZ (Diovan HCT)

5.) Calcium Channel Blockers (CCB)

CCBs are intended for those with:

1.)  Diabetes Mellitus
2.)  Chronic Kidney Disease

Calcium Channel Blocker

Nondihydropyridine Agents

.    Diltiazem (Cardizem, Dilacor, Tiazac)
.    Verapamil (Calan, Ssoptin, Verelan, Covera)

Dihydropyridines

.    Amlodipine (Norvasc)
.    Felodipine (Plendil)
.    Isadipine (DynaCirc)
.    Nicardipine (Cardene)
.    Nifedipine (Adalat, Procardia)
.    Nisoldipine (Sular)

6.) Alpha-Adrenoceptor Blockers

Alpha-Adrenoceptor Blockers

.    Prazosin (Minipress)
.    Terazosin (Hytrin)
.    Doxazosin (Cardura)

7.) Central Sympatholytics

Central Sympatholytics

.    Cloidine (Catapres, Wytensin, Tenex, Aldomet)
.    Guanfacine (Tenex)
.    Guanabenz (Wytensin)
.    Methyldopa (Aldomet)

8.) Peripheral Neuronal Antagonists

Peripheral Neuronal Antagonists

.    Reserpine (Serpasil)

9.) Aldosterone Antagonists

Aldosterone Antagonists for those with:

1.)  Heart Failure
2.)  Past history of Myocardial Infarction

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report in JAMA 2003; 289:2560

Diet

–  The Dietary Guidelines for Americans report that for adults should not consume more than 2,400 milligrams of sodium daily.
–  It is believed that foods high in Omega and/or Fatty acids can help hypertension
–  Calcium and Magnesium may be helpful
–  Increase Fruits and Vegetables
–  Increase low-fat dairy products

Drugs for Hypertensive Emergencies

.    Nitroprusside [Nipride]
.    Nitroglycerin
.    Labetalol [Normodyne, Trandate]
.    Esmolol [Brevibloc]
.    Nicardipine [Cardene]
.    Nifedipine [ Adalat, Procardia]
.    Clonidine [Catapres]
.    Captopril [Capoten]
.    And others