High Blood Pressure

High Blood Pressure is the general term for a medical condition called Hypertension or HTN. A  more complete article can be found at Hypertension.

This is a serious medical condition of substantially elevated blood pressure over the normal number of 120/80. Typically, long term high blood pressure over 140/90 requires medications. Somewhere between 20-50% of all those with hypertension don’t know that they have it. It is called the silent killer because there are often no symptoms.

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.

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.

Two numbers that 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

Potential 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.

Risk factors:

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

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

Potential Causes:

1.)  Genetics
2.)  Obesity
3.)  Poor Health
4.)  Smoking
5.)  Excessive Drinking
6.)  Sedentary Lifestyle
7.)  Other Medical Problems
8.)  Endocrine diseases
9.)  Kidney diseases
10.)  Some Cancers
11.)  Medication
12.)  Pregnancy
13.)  Obstructive Sleep Apnea
14.)  Neurological disorders
15.)  others

Some Major Complications of Hypertension are:

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

Dietary Changes

–  The Dietary Guidelines for Americans report that 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

Treatment:

1.)  Diuretics

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 distal tubule to limit potassium 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

.    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

.    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)

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)

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

 

Drugs for Hypertensive Emergencies

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

 

References:

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