FORMS OF HYPERTENSION Renovasular hypertension? Renovascular hypertension is one of the most common forms of secondary hypertension and is caused due to decreased blood flow to the kidneys. Usually, this blood flow gets restricted when the arteries to the kidneys becomes narrow (renal artery stenosis). Renal blood vessels narrow down due to one of the two following conditions – atherosclerosis or fibromuscular dysplasia. Atherosclerosis is a disease in which arteries become hardened and narrowed, as a result of plaque that had built up along the inside of the artery walls. Fibromuscular dysplasia is a condition in which cells from the artery walls overgrow, causing the arteries to narrow down. Isolated systolic hypertension? Isolated systolic hypertension (ISH) is when only systolic blood pressure (the larger number of a blood pressure reading) is elevated. ISH occurs mainly in older people because systolic pressure increases with age while diastolic pressure usually declines after the after the age of 55. ISH patients have a rise in systolic pressure (above 140) but diastolic but diastolic pressure remains normal. ISH is a common cause of stroke. Labile (transient) hypertension Labile, or transient, hypertension is a temporary rise in blood pressure during stressful situations. Blood pressure then returns to normal. Many young people who have labile hypertension for several years go on to develop primary hypertension, especially if there is a family history of hypertension. However, even labile hypertension may result in complications such as heart disease, kidney disease and stroke, if left untreated. It is often treated successfully with beta blockers or other medications and stress management. Resistant hypertension? Resistant hypertension is high blood pressure that does not respond to typical treatments and therapies. Because of this, it is difficult to control and often requires lifestyle changes and two or three different medications in order to properly treat this condition. People with resistant hypertension, are urged to work closely with the physician who manages their condition and to very careful follow all of the physician’s orders regarding diet, exercise and medications. Malignant (accelerated) hypertension? Malignant or accelerated hypertension occurs in less than one percent of hypertensive patients. It is defined as a sudden rise in diastolic blood pressure to over 125. This very high diastolic blood pressure can be associated with damage to the brain, heart, eyes and kidneys.
The condition is considered life threatening and immediate medical attention is extremely important. Treatment generally, requires intensive care hospitalization with potent medications delivered through an intravenous (I.V.) line to take effect as quickly as possible. Symptoms include loss of vision, nausea, drowsiness, confusion and headache. WHAT IS SECONDARY HYPERTENSION? Secondary hypertension is a condition in which the cause of the high blood pressure is known (e.g. sleep apnea or some form of kidney or endocrine diseases). The high blood pressure is secondary to another disease or disorder and the hypertension usually disappears once the underlying condition is controlled or cured. These underlying conditions include the following: • • • • • •
Sleep apnea Kidney or endocrine disease Cirrhosis of the liver Cushing disease (in which the body produces excess steroids) Pheochromocytoma (adrenaline producing tumor) Coarctation of the aorta (a condition in which the aorta is pinched, constricted or narrowed at some point along its length, often resulting in high blood pressure in the arms and low blood pressure in the legs).
BLOOD PRESSURE MEASUREMENT Blood Pressure is measured by wrapping an arm cuff (attached to a sphygmomanometer) snugly around the patient’s arm and then using a stethoscope to listen to the brachial artery located at the inside elbow on the same arm. The cuff is then pumped full of air until circulation is very briefly cut off. Then some air will be slowly let out of the device, loosening the cuff’s grip on the arm and releasing the blood to flow freely again. ELECTRONIC (DIGITAL MONITORS) Newer, electronic instruments work in a similar fashion, but they include a monitor that is fully automatic. It inflates and deflates the cuff, detects your systolic and diastolic pressure and then displays your measurement on a digital screen. These monitors generally require you to do just two things: Put the cuff on your arm and push a button after that. Everything is done automatically. Hope you liked this blog! This blog is written by Dr. Bimal Chhajer (India’s No. 1 heart specialist)