High blood pressure (hypertension) is often called the silent killer because you can have it for years without knowing it.

Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. Your blood pressure normally varies during the day. It can even vary slightly with each beat of the heart. It increases during activity and decreases with rest.

Under new, stricter national blood pressure guidelines issued in May 2003, a resting blood pressure reading below 120/80 millimeters of mercury (mm Hg) is normal. If your resting blood pressure is consistently 140/90 mm Hg or higher, you have high blood pressure. A reading in between these levels places you in the prehypertensive category. Under the new guidelines, a reading of 115/75 is the level above which your risk of cardiovascular complications starts to increase.

Many people may not view a blood pressure above 115/75 as life-threatening because there are few, if any, symptoms. But uncontrolled high blood pressure can increase your risk of stroke, heart attack, heart failure and kidney failure. Fortunately, high blood pressure can be detected with a simple test — and once you know you have high blood pressure, you can work with your doctor to control it.

• Heart failure
• Kidney failure
• Stroke

The types of Hypertension are

• Primary or essential as there is no obvious precipitating cause. 

• Secondary Hypertension as some identifiable cause is present.

It affect the most

It usually affects adults and elderly both males as well as females.

Hypertension progress

The condition puts strain on the heart and arteries, damaging delicate tissues. If it is left untreated, it may eventually affect the eyes and kidneys.
Complications that occur are Heart attack, coronary artery disease, and stroke.

Causes of Hypertension

Genetic factors

• Hereditary

• Race - Essential hypertension is more common in blacks

Environmental factors

• Stress- Chronic psychological stress

• Excessive salt intake.

• Obesity-especially high cholesterol intake.

• Smoking

• Excessive alcohol intake.

• Lack of Physical exercise

Renal Disease

• Parenchymal renal disease.

• Stenosis or aberrant renal artery,

• Polycystic disease of kidney,

Endocrine

• Adrenocortical disease-  Adrenal carcinoma, Cushing's syndrome.

• Pheochromocytoma.

• Acromegaly

• Hyperparathyroidism

Cardiovascular

• Coarctation of aorta.

Toxic

• Pregnancy toxemia,

Symptoms of Hypertension

The symptoms are

• Headache-. Usually occipital and on waking

• Dizziness.

• Visual problems

• Sweating

• Tremours

• Breathlessness

• Numbness or weakness of limbs

Related signs

The related signs are

• Blood Pressure

Diastolic is very important and is grouped as

• mild- less than 100 

• moderate- 100-120 

• severe-120-140

• Gross-more than 140.

Peripheral arterial vessels

• Bounding Pulse, 

• Radial artery hard (whip cord).

• Locomotor brachials may be seen. 

Optic fundi

Retinal changes.

• Grade-I: Mild arteriolar narrowing.

• Grade-II: More marked narrowing and arteriovenous kinking or compression.

• Grade-III: Flame-shaped or circular hemorrhages and cotton wool exudates.

• Grade-IV: Any of the above plus edema of the disc.

Physical Examination

• Repeated B.P. examination 

• Examination of heart

• Pulse

• Abdomen, for presence of kidney lump

• Signs of Cushing's syndrome: Abdominal striae, truncal obesity, moon face.

• Fundus examination

Investigations

Routine Tests conducted are

• Urine for:

  • Proteinuria.

  • Microscopic haematuria

  • Leucocytes

  • Glycosuria

• X-Ray chest

• ECG

• Glucose tolerance test.

• Serum biochemistry

  • Serum Creatinine and BUN.

  • Serum potassium

  • Uric acid

  • Serum calcium

  • Serum lipids

• Liver function test

Special tests

1. Investigation of reno-vascular hypertension

• Plain X-ray of kidneys

• Imaging method
        Ultrasound, Intravenous urography (IVU)
        Micturiting cystourethrogram
        Intravenous Digital subtraction angiography- IV DSA 
        

•  CT Scan

2.  Investigation of endocrine hypertension

• Serum biochemistry 

• CT scan of adrenal gland 

Treatment measures

The treatment measures are

1.Correction of known risk factors

•  Smoking- should be stopped.

•  Obesity- calorie restricted diet.

•  Alcohol- intake should be moderate.

•  Salt- Moderate restriction (less than 5 gm/day).

•  Regular physical exercise.

2. Generally used drugs are

A. Initial (first line) drug therapy

• Diuretics- If renal function is normal 

• ACE inhibitors        

• Calcium Channel Blockers  

B. Second line drugs

• Beta-blockers

• Alpha adrenergic agonist

Hypertension prevention

Hypertension can be prevented by avoiding all the risk factors.

High blood pressure > 1 > 2 > 3 > 4