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Getting Hypertension Under Control by Daniel Williams
According to the Centers for Disease Control and Prevention the total cost of treating hypertension in 2006 is estimated to be 63.5 billion dollars. Hypertension was the primary cause of death or at least a contributing cause in 277,000 deaths in the United States for 2002.
About 90% of the cases of hypertension occur gradually and are called essential or primary. No definite cause for these cases is apparent. The remaining cases are secondary and frequently are manifested abruptly. Examples of these are:
1) Renal artery stenosis or narrowing of the artery leading to the kidney can be due atherosclerotic plaque which significantly narrows the lumen of the artery or due to proliferations of cells in the arterial wall of the renal artery. The former is frequently seen in in middle-aged men and the latter in young women.
2) Acute and chronic inflammatory diseases of the kidneys, obstruction to urinary outflow from the kidney and polycystic kidney disease can cause hypertension.
3) Narrowing of the aorta which is the main artery coming from the heart is called coarctation of the aorta and can cause an elevated blood pressure.
4) Hyperaldosteronism due to increased secretion of the hormone aldosterone from the adrenal gland located at the upper pole of the kidney results in elevated blood sodium levels and retention of water with loss of potassium.
5) Cushing's syndrome with elevated blood cortisol levels from the adrenal can cause hypertension. Excess cortisol can raise blood glucose levels, increase appetite, breakdown protein from skeletal muscle, suppress immunity and inflammation making infection more common and lead to bone fractures because of decreased bone mass. Acute or chronic stress can also elevate cortisol levels.
6) A pheochromocytoma is a tumor of the adrenal gland that produces increased plasma levels of norepineprine and epinephrine. These patients can present with paroxysmal hypertension, headaches, palpitations and sweating.
7) Either low production of thyroid hormone (hypothyroidism) or high production (hyperthyroidism) from the thyroid gland can cause hypertension. An isolated systolic hypertension in which only the systolic value is high and the heart rate is increased can be seen with hyperthyroidism.
8) Hyperparathyroidism occurs with an excess production of parathyroid hormone from the parathyroid glands and can cause a rise in calcium levels resulting in hypertension.
9) Some drugs in the following categories may cause hypertension: thyroid pills, oral contraceptives, steroids, appetite suppressants, antidepressants and some over the counter medications.
10) Hypertension associated with pregnancy or pre-eclampsia can appear after the 20th week of gestation and is more common during the first pregnancy.
Hypertension can be defined as a blood pressure of 140/90 mm of mercury with a mercury sphygmomanometer. However, some have found that the correlation of this reference method of obtaining blood pressure measurements with those obtained with automated devices is less than satisfactory. The difference between the two methods may be 9 mm of mercury each for the systolic and for the diastolic measurements. Furthermore, about 20% of the cases of true positives for hypertension were missed and about 20% were classified as false positives when the patient's hypertensive readings could not be verified with the reference method.
Besides the inadequate standardization of blood pressure measuring devices, one has to take into account variation in blood pressure recordings based on different people taking the recordings. Also, the devices may have a technical defect that may give a constant error or may have sporadic errors for the readings.
There are other factors that have to be taken into consideration in making the diagnosis of hypertension. About 30% of readings taken in a medical setting may be elevated simply due to temporary anxiety of the patient. Also, typically there is variation of blood pressure values throughout the day.
Once a diagnosis of hypertension has been definitely established, there are ancillary factors that may interfere with the successful treatment of the patient. Examples of what may account for less than adequate patient compliance include patient costs for drugs, no or inadequate prescription coverage, poor health, poverty, and problems with the doctor patient relationship. Of course, patients may not adhere to the prescribed antihypertensive drug protocol if an unpleasant side effect such as dizziness may occur occasionally.
Because there is a substantial cost to taking an antihypertensive prescription drug, making the correct diagnosis is important. About 15 billion dollars or approximately 10% of all the money spent on prescription drugs in the United States is for the estimated 23 million patients who take antihypertensive drugs.
On the other hand, the cost in missing the diagnosis or failing to treat it effectively can also be high. About 30% of hypertensives do not even know they have the disease. About 40% of hypertensives are not being treated. Almost 70% who are being treated are not being controlled adequately.
A systolic blood pressure that is greater that 179 mm of mercury or a diastolic blood pressure that is greater than 109 mm of mercury can be called severe hypertension. Keeping the blood pressure under control is vital to avert a visit to the emergency room with hypertensive crisis. This condition that is associated with multiple organ damage such as hemorrhages in the retina, compromise of cardiac function and renal impairment can be expected to occur in 1% of hypertensives during their lifetime. Only about half of the patients who present with this emergency had actually taken their antihypertensive medicine in the preceding week. Aortic dissection or the separation of the wall of the main artery that comes from the heart may be the cause of hypertensive crisis. This dissection occurs in about 2000 patients annually.
In addition to drug therapy, changes in lifestyle may be helpful in reducing blood pressure. Some hypertensive patients 55 years of age or older have been shown to benefit from stress reduction therapy such as Transcendental Meditation when mortality was evaluated. The mortality rates from all causes, from cardiac causes and from cancer causes were all reduced significantly when Transcendental Meditation was practiced.
Even the environment may play a role in affecting the health of hypertensives. Inhaling pollutants or airborne particulate matter can cause oxidative injury leading to inflammation that adversely changes blood coagulation and that contributes to atherosclerotic plaque formation. Those elderly patients with obesity, diabetes and hypertension seem to be clearly more susceptible to increased cardiac risk after inhaling such pollutants.
Hypertensive disease is a common disease that is relatively easy to diagnose. There are adequate drug treatments to control the blood pressure of patients who are willing to adhere to drug protocols. Lifestyle changes such as diet and stress reduction can assist in managing the disease. Environmental factors such as air pollutants seem to create oxidative damage to the vascular system and subsequent exacerbation to already compromised elderly patients.
About the Author Author: Daniel Williams has been an online entrepreneur since 1998. He is webmaster of SarasotaFreeAds.com and lives in Sarasota, Florida 34237. You are permitted to reprint this article provided it is done so in its entirety including this signature box and remains unchanged except for formatting.
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