In certain inpiduals, the muscles in the arterioles contract abnormally, reducing the blood flow from the arterial system into the capillaries and veins, and raising diastolic pressure to high levels. This, in turn, results in higher systolic blood pressure. A diastolic pressure higher than 95 in an inpidual is considered abnormal, and usually indicates resistance to the flow of blood out of the arterial system because of constriction of the arterioles. (Gareth, Gregory & O'Brien pp. 8-10) This medical condition is known as hypertension, which is also, in general, called “high blood pressure”.
Whether young or old, each of us experiences changes in blood pressure throughout the day. It is usually lower at night when we sleep and higher during waking hours. Psychological stress can temporarily increase the pressure, although even a relaxed person in a quiet room may experience increased or decreased pressure for no obvious reason. Blood pressure also varies considerably among different inpiduals, tending to vary more widely in younger than in older people. This may reflect older persons' greater experience in coping with the contingencies of day-to-day living. (Gareth, Gregory & O'Brien 36)
In addition to momentary fluctuations, the average blood pressure over a period of time also varies from one inpidual to another. It is this average pressure that physicians seek to determine and understand by measuring blood pressure several times during a single visit and again on successive visits, comparing readings to obtain an average. After the age of 40, systolic pressures of 140 or less are normal, pressures of 140 to 159 are considered borderline, and pressures exceeding 160 may signal an abnormality, especially if sustained over a period of time. At these ages, diastolic pressures under 90 are normal, pressures of 90 to 95 are the borderline, and pressures greater than 95 are considered abnormal, indicating a need for further evaluation. (Kaplan 82)
For the most part, psychological influences on blood pressure are transitory. Only rarely does psychological stress sustain an elevated pressure, the pressure usually dropping when the source of stress is removed. Excess salt, or sodium, is a more common cause of elevated pressure. Sodium apparently gets into arterioles, increases their contraction, and causes constriction. Although the association is poorly understood, overweight also significantly contributes to hypertension. However, it is clear that when weight increases the blood pressure, reducing the weight also lowers the pressure.
Genetics is the principal contributor to the hypertension, which affects almost 90 percent of all people with excessive diastolic pressure. For this reason, a family history of hypertension is noteworthy. This problem often first appears in middle life, but minor elevations in pressure during youth may give early clues. However, the mechanisms by which genes affect blood pressure are unknown.
Evaluation of hypertension usually includes a study of the kidneys because kidney disease is frequently associated with blood pressure problems. The essential type of hypertension can damage the kidneys. In some cases it is difficult to determine whether high pressure preceded kidney disease, or vice versa.
In rare instances, mostly in young people, tumors of the adrenal gland cause hypertension. The possibility must be considered, but is usually quickly ruled out.
Hypertension sometimes produces headaches, spots before the eyes, dizzy spells, or nose bleeds, but these symptoms are not major concerns. However, high blood pressure that persists over a period of years accelerates arteriosclerosis, which can be serious because it is a major predisposition to stroke, heart attack, kidney disease, poor circulation in the legs, and heart failure. In response to a long period of high pressure, the heart gradually increases in size as it attempts to do heavier-than-normal work. (Cowley & Roman 19) Eventually the workload becomes too great, pressure cannot be maintained, the heart fails, the lungs become congested, and breathing becomes difficult. Thus, the complications of hypertension are much more serious problems than the blood pressure itself. (Kaplan 193)
Treatment must always be preceded by a clear understanding of the causes of high blood pressure. This is achieved by careful evaluation of the patient's history, a thorough physical examination and appraisal of the status of the heart and circulatory system, laboratory tests, an electrocardiogram, and X rays of the heart and possibly the kidneys. The results are a guide to therapy.
Although help with psychological problems is often beneficial, it usually has little or no effect on the blood pressure. Occasionally, relief from an exceptionally stressful situation brings a temporary reduction in pressure, but only rarely is the improvement permanent. On the other hand, substantial weight reduction and maintenance of the lower weight over a period of time will often reduce borderline pressures to normal levels. This does not hold true for pressures above 160/95 which weight reduction is unlikely to lower to normal.
A substantial reduction in dietary salt, together with weight reduction, can sometimes significantly affect the blood pressure, especially if it is the borderline. This can often be achieved merely by omitting the use of salt during meals and avoiding salty foods such as ham, bacon, and soups. Physicians will usually recommend weight loss and reduction of salt intake as initial steps to lower borderline pressure, but are likely to begin drug treatment immediately for very high pressures.
Treatment of hypertension normally starts with the simplest and least disruptive measures as described above. Similarly, when drug therapy is appropriate, most physicians begin with a mild diuretic such as one of the thiazides. Taken in tablet form, these reduce blood pressure by increasing excretion of salt in the urine. They have minimal side effects and can be taken only once a day. Inconvenience is usually limited to the need to urinate more frequently for two or three hours after swallowing a tablet. (Schachter 26)The diuretic has the side effect of reducing potassium, a loss which must be compensated by eating fruit or drinking fruit juices. This undesirable effect makes it necessary to check blood potassium at three - to six-month intervals and to add potassium to the diet if needed. (Schachter 31)
If, after a month or two of thiazide therapy, blood pressure fails to return to normal, Aldomet or an equivalent antihypertensive drug may be added to the thiazide. Especially in the early weeks, Aldomet may cause tiredness, but the reaction is usually short-lived. As with any drug therapy, side effects should be promptly reported to the physician. If the combination of drugs proves ineffective in controlling blood pressure, guanethidine may be substituted for the antihypertensive while the diuretic is continued. The strength of guanethidine is a virtual guarantee of reducing pressure.
The physician's main concern is that the pressure should not drop too fast. A slow but steady decrease over a period of months is preferable. The body that has adjusted to high pressure requires time to readjust to lower pressure. (Black 85) Excessively low pressure will be most apparent during any sudden movement such as rising from a prone or sitting position, and causes slight dizziness, light headedness, or a feeling of faintness especially when getting out of bed in the morning. Such episodes should be reported to the physician, as they may indicate a need for a reduction of drug dosage.
Reserpine was among the first drugs used to treat hypertension. It is a very effective yet mild drug, but unfortunately tends to cause mental depression, an effect that can be more acute in older people because age increases the susceptibility to depression. This may lead to problems such as the inability to sleep well or sudden crying for no apparent reason. The reserpine user should also be alert for abdominal discomfort or indigestion, which may indicate a stomach ulcer.
Apresoline may sometimes be used in combination with other drugs, but only with due precaution as to its potential side effects. It tends to stimulate the heart and is therefore seldom considered appropriate to treat high blood pressure in older inpiduals.
Inderol is especially useful in the treatment of older patients whose high blood pressure is associated with chest pain caused by coronary artery disease. The drug reduces both blood pressure and chest pain. (Kaplan 57)
Clearly, the risks associated with high blood pressure make the trouble and expense of lifelong treatment acceptable to most hypertensive people. Actually, after the appropriate drug and dosage have been established, only minor adjustments over long periods are usually needed to maintain normal blood pressure. Success depends heavily on a willingness to learn the facts about the condition and the best ways to manage it effectively.
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