Hypertension: A Case Study

Introduction

Hypertension is a haemodynamic disorder, characterized by an increase in peripheral vascular resistance that results in complicated diseases i.e. myocardial infarction, renal failure, strokes and even death if not diagnosed early and treated properly [1]. Generally, known as high blood pressure and defined as BP ≥140/90 millimeters of mercury (mmHg). Approximately 970 million people worldwide have high BP. It is estimated that 1.56 billion adults will be living with hypertension by 2025 [2, 3, 4, 5, 6, 7]. The overall occurrence of hypertension is similar between both males and females, but differs with age [2].

In majority of patients, cause of hypertension is unknown. This is called as primary or essential hypertension. While on the other hand, some patients have a specific cause of their high blood pressure that is classified as secondary hypertension [2, 3, 4, 5]. Above, 90% of hypertensive patients have primary hypertension [2]. Primary hypertension cannot be completely cured but can be controlled by appropriate therapy including lifestyle modifications and medications. This type of hypertension develops gradually in many years [2, 3, 5].

Less than 10% of hypertensive patients have secondary hypertension [2]. It is caused by some underlying medical condition or medication. This can be resolved by treating the underlying medical condition or removing the medication. The most common cause of secondary hypertension is kidney impairement i.e CKD. This type of hypertension tends to occur suddenly causing more high blood pressure as compare to primary hypertension [2, 3, 5]. Multiple factors that control the blood pressure contribute in the development of primary hypertension. The two primary factors are problems in either hormonal [natriuretic hormone, rennin angiotensin- aldosterone system (RAAS)] mechanisms or electrolytes (sodium, chloride, potassium) disturbances [2, 5].

hypertension is measurement of blood pressure by some physician or other health care professional [3, 4].

Various factors increase the person’s risk for developing hypertension includes health conditions, lifestyle, and family history. Some risk factors cannot be controlled such as age, race and family history. While others such as physical activity, diet and stress can be controlled to decrease the risk of developing hypertension in patient [2, 3, 4].

Treatment for hypertensive patients includes both pharmacological (medication) and non-Pharmacological (lifestyle modifications) therapy [2, 3].

Moreover, lifestyle modifications should be suggested to lower blood pressure [2, 3, 8]. American Heart Association (AHA) recommends DASH diet to help lowering blood pressure. The DASH diet suggest a food plan rich in fruits, vegetables, whole grains, fish, and poultary while limit the intake of sweets, beverages, and red meat. Moreover, the DASH diet recommends that men restrict alcohol intake to two or fewer drinks a day and women to one or less. In addition to dietary modifications, exercise is also recommended.

If non pharmacological therapy is insufficient in the management of high blood pressure, Pharmacological therapy is started [2, 3, 8, 9]. The JNC-8 guidelines on hypertension recommend that initial pharmacologic therapy should include a thiazide-type diuretic, calcium channel blocker, angiotensin- converting enzyme inhibitor, or angiotensin receptor blocker. The objectives of initiating drug therapy are to achieve and maintain the goal of blood pressure. If patients’ blood pressure goal is not attained after one month of therapy, the dose of initial drug can be increased or second drug can be added [8]. Other medications used for the treatment of hypertension include beta-blockers, , alpha-blockers, aldosterone antagonists and direct renin inhibitors [8, 9].

Discussion

Approximately one in three adults have high blood pressure thus hypertension is one of the most prevalent disease in world [2, 3]. Patient suffering from hypertension may be due to stress, lack of activity, obesity, and family history etc [2, 3, 4]. All these risk factors if not properly controlled and the condition if not properly treated may increase the risk of developing several serious health conditions such as heart attack, stroke, chronic heart failure and kidney disease [2, 3]. So, hypertensive patient should properly manage her blood pressure by using recommended antihypertensive medication and also by adopting life style modifications such as DASH [Dietary Approaches to Stop Hypertension] diet plan [2, 3, 10]. DASH diet plan suggest the food rich in fruits, vegetables and fish and limiting the use of salt, sweet, malcohol and red meat. It recommends that sodium intake should be less than 1500 mg/day (1.5g) and alcohol intake should be up to two or fewer drinks for males and one or less for females. Moreover, exercise is also recommended [10].

As, patient was also suffering from diabetes mellitus type 2.This may be due to many reasons such as less production of insulin from beta cells of pancreas or development of body resistance against insulin [11].Diabetes and hypertension often occur together because of similarity in physiological traits. So, a patient with comorbidity of hypertension and diabetes must have a proper control of both. In the setting of diabetes, there should be a target blood pressure of ˂130/80 [11]. To achieve this target both pharmacological and non pharmacological therapy is needed. The best drugs to recommend in diabetic patients with high blood pressure are ACE inhibitors, diuretics, calcium channel blockers, angiotensin receptor blockers, beta blockers and rennin inhibitors. While non-drug therapy includes dietary changes, salt restriction, alcohol limitation and exercise to lose weight [11]. This all is also recommended in DASH (Dietary approach to stop hypertension) diet plan. So, to prevent complications all these necessary guidelines should be followed.