Written by: Chandrika KC, ESC Intern
Blood pressure is the force exerted by the circulating blood against the wall of the arteries. It’s a measurement which is measured in mm of Hg. The blood pressure has two numbers.
1.Systolic pressure
Pressure exerted by blood on the arteries when the heart beats.
2. Diastolic pressure
Pressure exerted by blood on the arteries when the heart rests between the beats.
The normal range of blood pressure is 120/80 mm of Hg.
There are two types of conditions when the blood pressure fluctuates.
1. Hypertension
If the blood pressure is high that condition is called hypertension.
2. Hypotension
If the blood pressure is low that condition is called hypotension.
Range of Blood Pressure according to American Heart Association (ADA)
| S.N. | Categories | Systolic pressure (mm of Hg) | Diastolic pressure (mm of Hg) |
|---|---|---|---|
| 1. | Normal | Less than 120 | Less than 80 |
| 2. | Elevated | 120 – 129 | Less than 80 |
| 3. | Stage 1 | 130 – 139 | 80 – 90 |
| 4. | Stage 2 | 140 or higher | 90 or higher |
| 5. | Hypertensive crisis | Higher than 180 | Higher than 120 |
Regulation of Blood Pressure
- At first the renin secreted by Kidney is converted to angiotensin I with the help of angiotensinogen enzyme secreted by the liver.
- Then angiotensin I is converted to angiotensin II with the help of angiotensin converting enzyme (ACE) which is secreted by Lungs.
- On one hand angiotensin II stimulate vasoconstriction and causes rise in BP.
- On another hand angiotensin II stimulate the adrenal gland to secrete aldosterone which stimulate water reabsorption and cause ankle swelling, edema, etc.
Hypertension
If the systolic blood pressure is higher than 140 mm Hg and the diastolic blood pressure is higher than 90 mm Hg then that condition is called Hypertension.
Symptoms of hypertension
They do not often show the symptoms therefore, known as “silent killer”. Some of the symptoms seen in the patient with hypertension are Headaches, dizziness, blurred or double vision, chest pain, etc.
Causes of Hypertension
Modifiable causes of Hypertension
- Diet (the high intake of sodium and less intake of potassium cause hypertension)
- Physical activity (Lack of physical activity can result in hypertension)
- Alcohol consumption (excessive intake of alcohol results in hypertension)
- Stimulative substances (Smoking, nicotine, cocaine, methamphetamine can cause hypertension because of their stimulative properties)
- Stress (high stress can spike the pressure for certain period of time)
- Weight (obesity is main risk factor)
Non modifiable causes
- Age (increasing age can result in hypertension)
- Family history (if the parents or grandparents have hypertension there is high chance of hypertension)
Medical conditions that can be the causes of hypertension
- Diabetes, sleep apnea, chronic kidney disease, etc. can cause hypertension.
- If the tumor is present in adrenal glands that can lead to hypertension.
- Hyperlipidemia can cause build up in the blood vessels, narrowing them and causing hypertension.
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Consequences of Hypertension
- Eyes
- Retinopathy
- Kidney
- Renal failure
- Heart
- Myocardial infraction, Cardiac heart failure, Angina pectoris
- Brain
- Stroke
- Arteries
- Atherosclerosis
Routine test recommended by JNC (Joint National committee) for the initial evaluation of Hypertension
- Serum chemistry
- Creatinine, Glucose, Potassium
- Electrolyte
- Uric acid
- Chest radiography
- Urinalysis
- Electrocardiogram
Treatment of Hypertension
Lifestyle modification
- Eating healthy diet with less salt
- Physical exercise regularly
- Losing weight and maintaining healthy weight
- Limit alcohol
- No smoking
- Getting enough sleep
Antihypertensive agents
Mnemonics: ABCD
- ACE inhibitors: Captopril, enalapril, lisinopril, ramipril
- ARB: Losartan, valsartan, irbesartan, candesartan
- Alpha blocker: Prazosin, Terazosin, Phentolamine, phenoxybenzamine
- Alpha beta blocker: Labetalol, Carvedilol
- Beta blocker: Metoprolol, Propranolol, atenolol
- Calcium channel blocker: Verapamil, Diltiazem, nifedipine
- Diuretics: Spironolactone, thiazide, furosemide
- Direct renin inhibitor: Alis Kiren
- Central sympatholytic: methyldopa, clonidine
- Vasodilators: Hydralazine, Minoxidil
Hypotension
The condition in which the blood pressure measure is below 90 (systolic) to 60 (diastolic) mm hg is called Hypotension. It simply means low blood pressure i.e. the force exerted by blood on the wall of artery is very less. Normally, the hypotension does not cause any serious problem in many people but for some it can be life threatening. Hypotension symptoms are not generally noticed except dizziness, fainting and tremor.
Symptoms of hypotension
- Dizziness, fainting, tremor, upset stomach, trouble concentrating, fatigue, blurred vision, etc.
Conditions that can cause the low blood pressure
- Dehydration
- Pregnancy
- Heart attack, health failure, heart valve disease
- Hormone related disease: Addison’s Disease
- Blood loss
- Severe infection that causes septic shock
- Anaphylaxis
- Lack of nutrients in diet
- Certain medications: medicine to treat hypertension, Parkinson disease, etc.
Treatment of hypotension
- Use more salt in the diet
- Drink a lot of water
- Eat small but frequent meals
- Increase fluid intake
- Get up slowly to avoid dizziness
- Medications: Vasopressor, fludrocortisone, midodrine, droxidopa, pyridostigmine, etc.
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