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What is hypertension: All the science and how to lower it naturally


In India, hypertension is the leading health risk factor. It is responsible for an estimated 1.6 million deaths each year as a result of ischemic heart disease and stroke. Hypertension is responsible for 57% of all stroke deaths and 24% of all coronary heart disease deaths. According to recent estimates, hypertension is one of the most common noncommunicable diseases in India with an overall prevalence of nearly 30 per cent and a higher prevalence in urban areas (34 per cent vs 28 per cent, p=0.05).



What is High blood pressure?

Blood pressure is defined as the force exerted by circulating blood against the walls of the body’s arteries by the major blood vessels in the body. Hypertension is when blood pressure is too high. Blood pressure is expressed in two figures. When the heart contracts or beats, the first number (systolic) shows the pressure in blood vessels. The second number (diastolic) indicates the pressure in the arteries while the heart is at rest between beats. Hypertension is diagnosed by measuring it on two different days, the systolic blood pressure readings on both days is ≥130 mmHg and/or the diastolic blood pressure readings on both days is ≥80 mmHg.


Hypertension is a leading cause of cardiovascular disease, which includes stroke, heart attack, heart failure, and aneurysms. High blood pressure can be present for several years without causing any symptoms. Headaches, shortness of breath, and nosebleeds are common signs and symptoms of high blood pressure, but they aren't specific and usually don't appear until the condition has progressed to a severe or life-threatening stage. Uncontrolled high blood pressure can also raise your risk for significant health problems such as heart attack and stroke. Fortunately, high blood pressure is easily detectable. You can consult your doctor to control your blood pressure after you discover you have it.

Blood pressure measurements are categorized as follows:

  • Normal: systolic less than 120 mm Hg and diastolic less than 80 mm Hg.

  • Elevated: systolic between 120-129 mm Hg and diastolic less than 80 mm Hg.

  • Stage 1: systolic between 130-139 mm Hg or diastolic between 80-89 mm Hg.

  • Stage 2: systolic at least 140 mm Hg or diastolic at least 90 mm Hg.

There are two types of hypertension:

  • Primary Hypertension: High blood pressure that is not related to another medical condition is called primary hypertension. After a doctor detects that your blood pressure is high on three or more visits and has visible causes, then this form of hypertension is diagnosed. Primary hypertension usually has no symptoms, but it can cause recurrent headaches, fatigue, dizziness and nosebleeds. Although the exact origin of primary hypertension is unknown, reports by experts show that obesity, smoking, alcohol, nutrition and inheritance play a significant role.

  • Secondary Hypertension: Another medical condition that causes high blood pressure, usually affecting the kidneys, arteries, heart or endocrine system is secondary hypertension. An irregularity in the arteries delivering blood to the kidneys is the most common cause of secondary hypertension. Airway blockage during sleep, illnesses and tumours of the adrenal glands, hormone imbalances, thyroid disorders and a diet that is high in salt or alcohol are some of the other causes. Over-the-counter drugs including ibuprofen and pseudoephedrine can also cause secondary hypertension. Some examples include: Sleep problems like sleep apnea, blocked renal arteries in the kidneys and unusual levels of hormones controlling blood pressure.


Additional Hypertension types:


  • Malignant Hypertension: This type of hypertension happens to around 1% of individuals. It is more common among young adults, African-American men and pregnant ladies with pre-eclampsia. Harmful hypertension happens when your circulatory strain rises very rapidly. Assuming your diastolic strain goes north of 130, you might have harmful hypertension. This is a health-related crisis and ought to be treated in a clinic. Several side effects of the same include deadness of the arms and legs, obscured vision, disarray, chest torment and migraine.

  • Resistant Hypertension: Assuming your PCP has endorsed three distinct kinds of anti-hypertensive prescriptions and your circulatory strain is still excessively high, you might have safe hypertension. Safe hypertension might happen in 20 to 30 per cent of hypertension cases. Safe hypertension might have a hereditary cause and is more typical in individuals who are stout, female, African American or have a hidden sickness, like diabetes or kidney infection.




Major risk factors for hypertension include:

  1. Age: Though maturing doesn't constantly prompt hypertension, it turns out to be more common in later years. Diastolic tension increases continuously over the course of the years by around 10 mm Hg until age 55 in men and 60 in ladies, then it starts to decline. Between ages 30 and 65, systolic strain expands to a normal of 20 mm Hg, and it keeps on moving after 70. This age-related increment to a great extent makes sense of disconnected systolic hypertension.

  2. Being overweight or obese: The more you weigh the more blood flow you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure inside your arteries.

  3. Too much sodium in diet: Too much sodium in your diet can cause your body to retain fluid, and also cause the arteries in your body to constrict.

  4. Too little potassium in diet: Potassium helps balance the amount of sodium in your cells. Potassium causes the smooth muscle cells in your arteries to relax, which lowers blood pressure.

  5. Physical activity: Exercise increases blood circulation through all veins of the body, which prompts the arrival of regular chemicals and cytokines that loosen up veins, thus bringing down circulatory strain. The absence of an active workout likewise expands the chances of being overweight.

  6. Stress: Elevated degrees of stress can prompt a transitory, yet sensational expansion in pulse. Additionally, once you attempt to unwind by eating more, utilizing tobacco or drinking liquor, you might be compounding the risk for hypertension. Unwinding and reflection procedures successfully lower circulatory strain.

  7. Too much alcohol consumption: Having more than two drinks per day can cause hypertension by activating your adrenergic nervous system, causing constriction of blood vessels and a simultaneous increase in blood flow and heart rate.


Medications for Hypertension:



  1. Diuretics:

Diuretics also called water pills, are prescriptions that assist your kidneys with disposing of sodium and water from the body. These medications are usually the main medication attempt to treat hypertension. There are various categories of diuretics, including thiazide, circle and potassium saving. The one that your primary care physician suggests depends upon your circulatory strain estimations and another medical issue, such as kidney illness or cardiovascular breakdown. Diuretics is used to treat pulse incorporate chlorthalidone, hydrochlorothiazide (Microzide) and others. A typical result of diuretics is expanded pee, which could decrease potassium levels. When you have a low potassium level, your primary care physician might add a potassium-saving diuretic for example, triamterene (Dyazide, Maxide) or spironolactone (Aldactone) — to your treatment.


  1. Calcium channel blockers:

These prescriptions including amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and others assist with loosening up the muscles of your veins. Some sluggish your pulse. Calcium channel blockers might turn out better for more established endlessly individuals of African legacy than do ACE inhibitors alone.

  1. Angiotensin-converting enzyme (ACE) inhibitors:

These medications such as lisinopril (Prinivil, Zestril), benazepril (Lotensin), captopril and others help relax the blood vessels by blocking the formation of a natural chemical that narrows blood vessels.

  1. Angiotensin II receptor blockers (ARBs):

These medications relax blood vessels by blocking the action instead of the formation of a natural chemical that narrows blood vessels. ARBs include candesartan (Atacand), losartan (Cozaar) etc.

  1. Vasodilators:

These medications include hydralazine and minoxidil. They work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.


Note: This content is provided for your general education only and is not intended to replace professional medical advice or treatment for specific medical conditions. If you have any questions about a medical condition, procedure or treatment, whether it is a prescription of any medication, over-the-counter drug, vitamins, supplements or herbal alternatives, always consult your doctor or another qualified healthcare provider.





Is it possible to prevent high blood pressure?

Hypertension can be prevented by reducing risk factors such as obesity, physical inactivity, high salt intake and moderate to high alcohol consumption.


To aid in the prevention of high blood pressure you need to do the following :

  • Engage in regular aerobic exercise.

  • Reduce your consumption of salt and alcoholic beverages.

  • Consume a diet that is high in fruits and vegetables and low in saturated fats.

  • Smoking should be avoided.

  • Maintain a healthy body weight

Hypertension increases your chances of having a heart attack or a stroke. As a result, it is critical to consider other risk factors, such as high LDL (bad) cholesterol. You may be able to cure your hypertension simply by changing your lifestyle


Lifestyle modification to lower hypertension

If you have high blood pressure but are not yet hypertensive, changing your lifestyle may be all that is required to lower it. This includes quitting smoking, losing weight, eating nutritious foods, limiting salt intake, exercising regularly, and reducing stress. Diligent efforts to improve your diet and fitness can add up and will almost certainly lower your blood pressure number possibly to the point where you won't need medication.


Quit smoking

Tobacco smoke raises blood pressure by constricting small blood vessels, requiring the heart to work harder to circulate blood. Some blood pressure medications most notably beta-blockers are also affected by nicotine. Smokers, like those with labile hypertension, may experience "part-time" hypertension, in which their blood pressure rises throughout the day. Your heart rate and blood pressure will fall within hours of quitting smoking. Your risk of heart disease is reduced by half within a year of quitting.



Maintain a healthy weight

Overweight people are more likely to develop diabetes, arthritis, sleep apnea and different kinds of cancers. For every one to two pounds lost, systolic and diastolic blood pressure drops by 1 mm Hg. A person with high blood pressure who is more than 10% overweight may be able to lower their blood pressure solely through weight loss.


Increase your physical activity

At least 30 minutes of moderate physical activity can reduce systolic blood pressure by 4 to 8 mm Hg and is more effective than strenuous forms of exercise like running and jogging. Other advantages of regular physical activity include weight loss, an improved sense of well-being and a lower risk of cardiovascular disease.




Eat right

Even if you do not need to lose weight, eating the right foods can help you fight hypertension. Several diet plans, which are discussed below, have proven to be beneficial for a variety of reasons. They provide a high amount of nutrients but are low in calories and sodium.


Adopt a “DASH” diet

DASH is an abbreviation for Dietary Approaches to Stop Hypertension, a blood pressure-lowering diet developed by nutritionists. The DASH diet emphasises fruits, vegetables and whole grains; several servings of low-fat dairy products per day; and little red meat and sweets. For many people who adhere to it, the diet is sufficient to maintain normal blood pressure levels without the use of medication.


Mediterranean diet

Another similar eating style has been shown to lower blood pressure as well as promote weight loss and lower heart disease risk. It is a cuisine based on the traditional diets of people living in Greece, Italy and other Mediterranean countries. In general, a Mediterranean type diet is low in saturated fat and high in fibre. In this, fruits, vegetables, grains, beans, nuts, and seeds are eaten daily


Practise Yoga

A review and analysis of prior data published in Mayo Clinic Proceedings in 2019 found that people who practised yoga for an hour, five times a week for 13 weeks had lower blood pressure. Yoga, when combined with breathing methods and meditation leads to considerable and better results. If you have any concerns about specific poses, always consult your yoga instructor and doctor.




Let us see how certain unhealthy items, such as alcohol, caffeine, sugar, and certain minerals, may influence blood pressure


Alcohol

Moderate drinkers have lower rates of coronary artery disease than abstainers. Heavy drinking increases the likelihood of developing high blood pressure and heart disease. Heavy drinking can also make blood pressure medication ineffective and increase the risk of stroke and heart failure.


Caffeine

Caffeine has little effect on blood pressure unless you consume a lot of it. Caffeine should be limited to 300 milligrams (mg) per day, according to current blood pressure guidelines. However, regular users can drink up to three cups of coffee per day without significantly affecting blood pressure.


Sugar

Eliminating soda and other sugary drinks may aid in blood pressure reduction. According to one study, avoiding one sugary drink per day reduced blood pressure by about 1.8/1.1 mm Hg. Other studies have discovered a link between a high fructose intake and an increased risk of developing hypertension.


Potassium

People with potassium-rich diets have a lower blood pressure than those with potassium-deficient diets. Potassium lowers blood pressure by assisting the body in excreting excess sodium and relaxing blood vessels. Potassium is found in a variety of heart-healthy foods, including vegetables, legumes and fruits.


Calcium

Calcium is essential for maintaining healthy blood pressure because it allows blood vessels to tighten and relax. The DASH diet provides evidence for calcium's ability to lower blood pressure. Supplements have no effect on most people or reduce blood pressure only slightly (1 to 2 mm Hg on average).


Magnesium

People with certain medical conditions such as Crohn's disease, celiac disease or poorly controlled type 2 diabetes may have lower magnesium levels than others. Certain people with high blood pressure may benefit from magnesium supplements but this is far from proven. Do not take them without consulting your doctor. There are no known negative effects of consuming magnesium through food.



Even though medications are very effective in lowering blood pressure, they do have side effects. Evidence shows that even simple stress-reduction techniques can have a significant impact. Although the best programme for you may change your blood pressure levels over time, working closely with your doctor will help you stay in a healthy range.




References:


Essential Hypertension


Blood pressure basics


Standard treatment guidelines : Hypertension


Gasperin D et al. Effect of psychological stress on blood pressure increase: a meta-analysis of cohort studies. Cad Saude Publica. 2009;25(4):715–26.


Thenappan T, Ormiston M L, Ryan J J, Archer S L. hypertension: pathogenesis and clinical management BMJ 2018; 360 :j5492 doi:10.1136/bmj.j5492.


Food and Drug Administration and the Department of Health and Human Services. Notice. Guidance for Industry on Hypertension Indication: Drug Labeling for Cardiovascular Outcome Claims; Availability.15 March, 2011; 76 FR 14024:1–12


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