Evidence-Based Research: Hypertension

Description and Diagnostic issues of Hypertension

Hypertension is the medical condition of neurotic character associated with considerable increase in the arterial blood pressure. Nowadays, the increased blood pressure is typical for every third resident of the Earth and can have life-threatening consequences. It remains one of the main reasons for a heart stroke or cerebrovascular accident, cardiovascular diseases, myocardial infarction and chronic kidney disease.

Unawareness of hypertension symptoms and the ways of treatment prevents from detecting and predicting the disorder in time or from paying attention to worrisome signs. While writing the essay and visiting different specialized sites, such key words as high blood pressure, hypertension, and follow-up treatment for hypertension and antihypertensive agents were used. The purpose of the essay is to fill the gap in medical knowledge and discuss the facts that help recognize such an ailment as hypertension. It will focus on clinical aspects of hypertension, its diagnostic issues, various ways of treatment and their efficiency.

Hypertension remains to be an important health concern due to its close association with high level of morbidity and mortality. According to the report issued in 2013 by the Centers of Disease Control and Prevention, approximately one-third of the American grown-ups, that is about 70 million people, have high arterial pressure (Rettner, 2015). High blood pressure or, in other words, hypertension is a medical condition. It happens when “the long-term force of the blood against one’s artery walls” can drastically damage the vessel walls and cause severe complications, and even jeopardize one’s life (“High Blood Pressure,” 2016).

Arteria is the main transportation means that is responsible for blood delivery to all tissues of the body. Spasm and, consequently, thickening of the vessel walls brings to almost permanent vessel constriction and makes it harder for the heart muscle to ensure proper blood circulation along the vessels. Continuing vessel constriction provokes noticeable increase in arterial blood pressure and complicates blood circulation. Blood pressure can be systolic or upper, and diastolic or lower. Systolic pressure is the blood pressure on the vessels during the heart muscle contraction. Diastolic pressure is the pressure with which the bloodstream presses down on the vessels’ walls when the heart relaxes between its beats. The normal arterial blood pressure is 120/80 mm/Hg (Rettner, 2015). The measurements beyond the indicated figure are the evidence of high blood pressure.

Hypertension is diagnosed with the help of sphygmomanometer that shows up the upper and the bottom pressure in the vessels (MacGill, 2016). It is an ordinary and widely used practice for controlling the blood pressure even in case of absence of any complaints or symptoms. Before going through the blood pressure test, one should not drink any coffee, strong tea or alcohol and avoid smoking due to high probability of the blood pressure increase, which will affect the test result. The clinicians usually practice multiple blood pressure tests with time intervals for receiving an actual picture and dynamics of the highlighted disorder. Checking-up blood pressure on both hands allows determining a degree of variability in the measurements that can indicate the risk of suffering from a heart attack or stroke at a later stage. Regular blood pressure measurements help to control the overall cardiovascular health. All hypertensive patients have to go through the blood and urine tests, tests that determine level of hemoglobin, potassium, glucose and cholesterine, chest X-ray, abdominal ultrasound, eye ground check-up and ECG tracing. The patients can be asked to take additional tests to clarify symptomatic nature of the high blood pressure condition for further proper treatment prescription.

Symptoms of Hypertension

Hypertension belongs to a dangerous disease due to its hidden, asymptomatic nature meaning that a person can have a permanent high or increased blood pressure without knowing it. That is why the described condition is often referred to as “the silent killer” as it can quietly cause damage to the cardiovascular system” (MacGill, 2016). It is crucial to know the symptoms of hypertension to avoid leaving them unnoticed. Depending on blood pressure measurements, one may distinguish three stages of high pressure condition. The initial stage is characterized by headaches, emotional instability, and salutatory blood pressure. The repeated headaches, dizziness, head noises, performance degradation and defective memory indicate the initial changes of the cerebral blood flow. Later, it is complicated with diplopia, seeing spots, fatigue, difficulties during speaking. There are many cases when “people with high blood pressure usually have no symptoms, and so patients can have the condition for years without knowing it” (Rettner, 2015). The second stage involves frequent headaches, further considerable increase in the arterial pressure, and heart pain due to the left ventricle hypertrophy. Furthermore, any physical exercise provokes respiratory malfunction and changes in the kidneys and eye ground. The third level of hypertension demonstrates the critical measures of arterial blood pressure accompanied with splitting headaches and atherosclerosis. Substantial, life-threatening increase in blood pressure can cause a definite organ-lesion and develop one of three syndromes: either cardiac, brain or nephritic one. Domination of the cardiac syndrome provokes vessel constriction, oxygen deficit for proper heart functioning, and local asphyxia. Nephritic syndrome manifests in renal scarring and gradual deprivation of their functions. If the brain syndrome prevails, then a sick person suffers from periodical mental abstraction and eventually has a micro stroke or cerebral accident. Ignorance of the above-indicated symptoms can result in deterioration of health. Increased blood pressure can severely damage the blood vessels and organs inside the body. It can lead to heart attack or stroke, heart failure, aneurism, metabolic syndrome, cause problems connected with kidneys and eyes (“High Blood Pressure,” 2016).

Causes of Hypertension

Blood pressure can vary throughout the day as it is a normal reaction of the body to certain life situations: stress, physical activity, anxiety. However, there are definite risk factors that predestinate the ailment progression. Blood pressure can increase gradually with age considering that the arteries become narrow and stiff because of plaque formation (Rettner, 2015). With age, human vessels’ walls become harder and more rigid and, consequently, the muscle resistance to the blood stream increases making the blood pressure go up.

The elderly patients are more prone to hypertension due to the weakened immune system, chronic diseases, and inherited predisposition. Cardiovascular diseases also increase the risk of developing the ailment under discussion. Males are more susceptible to hypertension than females (MacGill, 2015). Hypertension more frequently develops among African adults when compared to white or Hispanic ones. Furthermore, one should not exclude the hereditary factor in hypertension development. Besides, chronic diseases, diabetes, liver and renal diseases, excessive alcohol and tobacco use, diet with the great amount of salt, obesity, permanent stress, sleep deficit, and physical inactivity can contribute to acquiring the high blood pressure condition, although they can be minimized and controlled (“High Blood Pressure,” 2016).

The Genomic Issues of Hypertension

Considering the fact of inherited predisposition to the highlighted sickness, the genomic issues of hypertension are crucial for effective treatment and prevention of the mentioned disorder. That is the reason why the researchers try to reveal the genetic codes. This knowledge can warn the potential sufferers against the risks of developing the discussed condition. For example, the scientists from the Sahlgrenska Academy at The University of Gothenburg “analysed the genetic data from more than 200,000 Europeans and discovered 16 genetic regions with interesting genes that regulate the body’s blood pressure” (The University of Gothenburg, 2011). On the ground of the received data, the scientists formulated genetic risk groups that can help in preventing hearts strokes or attacks. High blood pressure is considered to be the result of interaction of the inherited genetic factors with the environmental ones. The scientists define such type of hypertension as monogenic with substantial increase of extracellular fluid and decrease of rennin and potassium amount in the blood. It can relate to high mineralocorticoid activity followed by mutation of dehydrogenases gene that inactivates hydrocortisone in the kidneys. Till nowadays, the researchers keep on scrutinizing the role of candidate genes, paying special attention to the factors of the rennin-angiotensin system as the role of the candidate genes in hypertension development remains unknown. Therefore, detection of genes that are capable of controlling the pathogenesis of hypertension allows implementing screening programs to identify people with predisposition to cardiovascular diseases and warn against the probability of developing hypertension, although all combinations of hypertension-related genes are not verified and confirmed.

Treatment of Hypertension

The treatment objective is normalization of the increased blood pressure. Basically, there are two variants of treatment: pharmacological and non-pharmacological therapy depending on severity and the body reaction to the taken actions. Non-pharmacological treatment is usually used at the primary stage of the disorder progress. Certain restrictions in eating and specially developed physical exercise can have medicinal and preventive effect. Limited salt intake and low-fat diet, control over strong drinks’ consumption, diet rich in vegetables and fruits are the first recommendations from the health care providers (MacGill, 2016). Such point as reduction of salt and sodium intake can prevent many fatal cases provoked by hypertension. The University of Utah states that excessive consumption of sodium caused more than a million cardiovascular deaths worldwide in 2010 (The University of Utah, 2016). Weight reduction, regular physical training can be helpful in bringing the blood pressure to the normal state. Stress avoidance or its minimization helps to keep blood pressure under control. Besides, the hypertension patients are strongly recommended to give up smoking and “reduce intake of dietary saturated with fat and cholesterol for overall cardiovascular health” (Madhur & Maron, 2016). Traditional treatment considerably relies upon the radical changes in lifestyle and medication. Despite that, the clinicians prescribe some herbal, prebiotic supplements’ intake that can significantly decrease both systolic and diastolic blood pressure. Unfortunately, this alternative is frequently missing in the doctors’ prescriptions due to insufficient clinical trial of the indicated cure. Furthermore, such alternative as natural and herbal remedies as garlic, fish oil, Omega-3 fatty acids, hibiscus, chocolate and others may be helpful in decreasing high blood pressure, but not when the condition becomes severe (Wong, 2016). One more option ‒ DASH diet ‒ is not usually practiced. Dietary approaches to stop hypertension (DASH) is “specially formulated, flexible and balanced eating plan based on research studies” that should help people to bring the blood pressure back to the controllable level, improve level of blood lipids and reduce the risk of developing cardiovascular diseases (MacGill, 2016). It is not often specified in the peer-reviewed sources. Thus, the drug-free treatment is used only for the essential or prehypertension conditions and in case of compelling indications absence.

The health care providers prescribe medications to avoid or cure life-threatening conditions if non-pharmacological therapy is insufficient or low effective. Allan Schwartz, a professor of medicine, in his article “Complexity, controversies and disagreements in hypertension treatment goals” specifies that for high blood treatment, combinations of antihypertensive agents are chosen individually and cannot be universal, considering that none of the patients is similar in their age, race, presence of chronic and coronary artery disease and other compelling conditions (Schwartz, 2016).

Drug treatment is strongly recommended to the patients that suffer from diabetes, are at risk of acquiring high coronary disease and such compelling conditions as ischemic heart disease, heart failure, chronic disease, and recurrent stroke (Madhur & Manor, 2014). The doctors prescribe mono or combined medical therapy. Combined drug treatment means intake of one or combined dozes of antihypertensive agents. Their quantity and combinations may vary and depend on the health status of a patient and severity of the condition. National Institutes of Health practitioners, the professor Allan Schwartz and others acknowledge the presence of many various tested types of medications available for the hypertensive sufferers to lower the blood pressure. The drug treatment involves prescription of diuretics, beta-blockers, calcium-channel blockers, and angiotensin-converting enzyme inhibitors (MacGill, 2016). Diuretics help to decrease fluid quantity in the blood vessels by removing salt from the organism. “The urinary salt and water excretion returns to normal after a few days, but the blood pressure remains at the reduced level” (“Blood pressure and hypertension,” 2016). The reason why the blood pressure is at the controllable level when the level of the urinary salt and water excretion goes up is unknown. The diuretics are considered as the first-line medication for treatment of hypertension. However, some guidelines, in particular, the guidelines by the Joint National Commission (JNC8 guidelines) “recommend both calcium-channel clockers and angiotensin-converting enzyme inhibitors as the first-line drugs in addition to diuretics” (Jarari et al., 2016). Beta-blockers prescription is meant for deceleration of the heartbeat frequency and its force reduction. Many β-blockers have a selective effect but all their compounds have similar effect of reducing of cardiac contraction and therefore reduces the pressure. Their prescription is recommended if one suffers from bradycardia and respiratory diseases. Angiotensin-converting enzyme (ACE) inhibitors prevent from “the formation of a hormone that narrows blood vessels, allowing vessels to open up” (Rettner, 2015). Calcium-channel blocking agents (CCB) stop calcium penetration into the heart muscles and blood vessels that results in the vessels’ relaxation. Rettner additionally highlights angiotensin II receptor blockers (ARBs) that are new amidst the antihypertensive agents but have similar to ACE inhibitors effect. They assist in widening the blood vessels. National Heart, Lung, and Blood Institute additionally specifies such groups of medication as alpha blockers, alpha-beta blockers, central-acting agents, and vasodilators. The aim of alpha-blockers and alpha-beta blockers prescription is reduction of the nerve impulses that tighten the blood vessels. These medications help blood to flow freely. Administration of central-acting agents allows “decreasing nerve signals that narrow blood vessels,” while “vasodilators assist in relaxing the muscles in blood vessel walls” (National Heart, Lung, and Blood Institute, 2015). Each compelling indication may involve using combinations of various agents to achieve the goal of decreasing the blood pressure. Some of the compelling conditions include intake of diuretics, ACE inhibitors, beta-blockers, aldosterone antagonists. The others, such as high coronary disease risk and diabetes, include calcium-channel blocker intake. The multiple trials proved that “angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers, calcium-channel blockers, and diuretics have all reduced cardiovascular events” (Aronow, 2012). Therefore, the highlighted non-pharmacological and pharmacological therapies both are targeted at the reduction of the blood pressure and minimization of risks to avoid the complications due to increased blood pressure. All articles and other resources stress the necessity of the complex approach to hypertension treatment.

Making a choice between the drug-free treatment and medication, the doctors prefer prescription of antihypertensive agents along with required modifications in lifestyle. One may recommend lifestyle changes only in case of essential hypertension. Most hypertension-oriented associations, such as “the American Diabetes Associate (ADA), the American Heart Association/American Stroke Association (AHA/ASA) recommend lifestyle modifications at the first step in managing hypertension” (Madhur & Maron, 2016). Dietary improvement and physical exercising belong to the crucial modifications in the lifestyle of hypertensive sufferers. National Heart, Lung and Blood Institute in its overview of hypertension condition first emphasizes the healthy lifestyle changes and then, drug administration, if required. The pharmacological treatment will not be effective if the patient has acquired bad habits and leads unhealthy lifestyle. Lifestyle improvement should “retard development of hypertension and as adjunctive therapy in those with hypertension” (Aronow, 2014). Consideration of all accessible and available curing means and methods for handling hypertension is the most efficient way of blood pressure normalization. It can simultaneously minimize the risks of acquiring and developing severer medical conditions. Further, antihypertensive therapy is “generally used for effective long-term management and to treat comorbid conditions” (Jarari et al., 2016).

The hypertensives have to follow up the prescribed medication and recommendations to keep the blood pressure within the safe range and control it. The hypertensive sufferers have to attend their health care providers on a permanent and regular basis for control checks. Periodically, they have to go through additional physical examinations and tests. The ones “should be screened for damage to the heart, eyes, brain, kidney, and peripheral arteries that may be related to high blood pressure” (“Follow-up Care for High Blood Pressure,” 2015). One’s medication is to be reviewed in case of its insufficiency or ineffectiveness. Clinical guidance from the American Family Physician Association recommends pharmacological treatment for the young and elderly population. People suffering from chronic kidney disease should receive “initial antihypertensive treatment that includes an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker to improve kidney outcomes” (“Hypertension,” 2014). Diabetics that additionally suffer from hypertension should take a calcium-channel blocker, a thiazide-type diuretic, ACEI or ARB. Treatment reconsideration is required if the previous medication stops improving the blood pressure or demonstrates side effects. Many health care providers “practice their own prescribing pattern in treating hypertensive patients according to their clinical experience” (Jarari et al., 2016). Simultaneously, people who experience high blood pressure should reconsider their dietary, eating habits, level of physical load and abide to the modified, healthy lifestyle rules.

In conclusion, hypertension belongs to the group of dangerous disorders that may result in severe complications and have life-threatening consequences. Various negative external and internal factors may be the triggers of the highlighted condition. Hypertension can have obvious symptoms as well as be symptoms-free, which is the most dangerous point of the condition. Treatment of hypertension involves drug administration including antihypertensive agents and non-pharmacological one that includes lifestyle modifications. Both curing ways of managing hypertension can be beneficial and demonstrate positive therapeutic effects. Lack of treatment and failure to follow further medical recommendations may lead to the development of complications that affect other organs and even reduce life expectancy.