Hypertension

Hypertension

Hypertension is an elevated arterial blood pressure. The upper (systolic) and lower (diastolic) measurements are measured. Normal values are about 120/80 mmHg, high normal to 139/89 mmHg.Values of 140/90 mmHg and higher represent hypertension.

Mild hypertension is 140-159 / 90-99 mmHg, medium-sized 160-179 / 100-109 and severe over 180/110.

Values over 200 mmHg are considered malignant, which is self-evident how dangerous it is. Hypertension is in 90-95% of cases of unknown origin and is called primary (this family load has a share) and the rest is secondary when the cause is: sickness of the thyroid gland, kidney, adrenal gland, narrowing of the renal arteries, aortic coarctation, use of drugs such as corticosteroids, contraceptives, antireumatics. Then we treat hypertension by treating the underlying disease.

Hypertension is the most common disease of today, one-third of people in the world have high blood pressure. In elderly people, the upper pressure is higher than the lower, so that they have isolated systolic hypertension, whereas lower pressure is generally higher in younger people. Preferred values in people in the eighth decade of life are 140-150 for systolic pressure, which allows sufficient flow through the arteries of the neck and head, because if the lower, there may be dizziness and fainting.

It is a delusion that it is not necessary to treat hypertension of an easier degree because in time there are serious consequences of the disease as well as in those with high pressure. People do not control blood pressure regularly, in addition, the disease initially passes without or with very few symptoms so that it passes for many years until a diagnosis is made and treatment begins. Then, changes in vital organs are often detected without the person having any particular problems or she ignored them, so hypertension is called “silent killer” because her consequences are very serious.

The consequences of elevated pressure are diseases heart and blood vessels, brain, eyes and kidneys.The patient has problems depending on which organ is damaged by long-term pressure. Hypertension is a risk factor for the development of coronary disease that occurs earlier in relation to a healthy population, heart and brain infarction, and for a sore and renal weakness.

Symptoms that occur due to changes in the heart muscle include: pain, weight or chest pressure (angina pectoris), heart attack (infarction), heart weakness accompanied by choking, fatigue, exhaustion, difficult to bear effort, islet of legs. Sometimes there are heart rhythm disorders that a person feels like throbbing, skipping, accelerating or irregular heartbeat.

Changes in the blood vessels of the eyes cause visual impairment to loss of eyesight.

The consequences on the brain are: headache (especially sore throat), dizziness, walking instability, unconsciousness, buzzing in the ears, nausea, short term loss of sensitivity, stiffness of one half of the face or body, speech impaired or disabled, crises of consciousness and a serious consequence is a stroke.

It can cause plenty bleeding in an abrupt leap of pressure.

Hypertension causes damage to the renal function with the appearance of protein in the urine and the rise in nitrogen in the blood (urea and creatinine).

Blood vessels accelerate thickening of the walls due to fat deposits (atherosclerosis) and loss of elasticity, aneurysms or splitting of the walls of the arteries (dissection) can result, which is a very serious complication. Constriction the peripheral blood vessels of the leg causes pain in the legs and leaves, tingling in the feet and the person has to stop after walk to pass the pain or cramp. Changes in the blood vessels of the neck and head cause dizziness, fainting, and the creates thrombus at that place cause a brain infarction.

In order to set the diagnosis, an internistic examination is required, which involves: talking to a patient who reports the type of discomfort and their duration, then a detailed examination, listens to the heart and lungs, touching the abdominal organs and peripheral arteries, the pressure is measured on both hands, therapy is guided by those values that are higher, ECG is performed from which we see whether there is left ventricular hypertrophy, that is, ischemia of the heart muscle or rhythm disorders.

It is necessary to do these diagnostic procedures that indicate whether and how many vital organs are damaged at the time of examination:

  • laboratory analysis of blood and urine (blood count, cholesterol, triglycerides, Na, K, Cl, glycemic, urea, creatinine, liver enzymes, bilirubin)
  • cardiac ultrasound that shows changes in the heart in the form of thickening of left ventricular walls, mobility disorders, enlargement of the dimensions of the heart cavities, changes in the heart valve and aorta
  • X-ray of lungs and hearts
  • eye examination, changes in the blood vessels of the eye are seen
  • ultrasound of the stomach which shows whether there is a change in the kidneys and above kidney, the abdominal aorta
  • ultrasound examination of the blood vessels of the neck and leg when measuring fat deposits on the walls and the degree of their narrowing
  • 24 hour pressure measurement should be done in patients with: suddenly hypertension, increased pressure in the doctor presence in his office so called “hypertension of white coats
  • with limit values of pressure, with suspicion of night hypertension (masking hypertension) when values are normal during daytime but elevated at night – occur in young, obese, smokers, then in cases of oscillations with jumps or hypertension drops, in people with hypertension at the workplace, and normal value beyond work place(labor-dependent hypertension), in order to evaluate the effects of therapy and the risk of unwanted cardiovascular occurs.

In this way, we have an insight into the pressure value in normal life and work circumstances, and we can determine the type, amount and time of taking the drug. There are normal oscillations of pressure, during the night it is lower, and in the early morning hours it is somewhat larger.

It is also a normal increase in physical effort, walking, running, fear, stress, after salty meals.

Medical examinations are more common until satisfactory pressure regulation is achieved and usually after a few months, depending on the general condition and associated illnesses.

Each newly hypertension should be thoroughly examined.

Often people with diabetes have elevated fats in the blood.

Hypertension is a modern-day illness associated with often sitting, stress, obesity, poor nutrition, drugs, alcohol, smoking, snoring and breathing breaks during the night. It is therefore necessary to change the way of life and nutrition: turn off fat and salt foods, reduce weight, stop smoking and alcohol intake, introduce regular physical activity.

The medicine for treating blood pressure can be prescribed only by a doctor.

Therapy is determined for each individual, depending on whether a person has an elevated blood pressure also have elevated blood fats, whether it is a diabetes mellitus, age, whether it has angina pectoris, an earlier heart attack or a stroke, heart rhythm disorders, heart weakness, chronic bronchitis or asthma, renal weakness, peripheral arterial disease.

Today we have a large number of drugs on the disposal, some are a combination of two drugs in one tablet and are given once a day so that the regimen of the treatment is simplified. Hypertension requires lifelong control and sometimes change of therapy.

 

dr Vranić Sonja
specialist in internal medicine