Question

1- What are risk factors for Hypertension, describe systolic and diastolic blood pressure?

2- What is considered normal blood pressure and what conditions predisposes the patient to hypertension?

3- What teaching is recommended to prevent the development of the condition and its progression?

4- What are treatment options?

5- What are the two types of hypertension?

6- Describe signs and symptoms and the difference between Arteriosclerosis and Atherosclerosis.

Answer 1

1. Blood pressure: is the pressure of the circuculating blood exerted on the walls of the blood vessels due to the pumping action of heart.Systole and Diastole are two phases of the cardiac cycle. Systole is the period when the heart contracts to pump blood into the systemic circulation and diastole is the period when the heart relaxes after each contraction. Hypertension is the term used to refer a condition in which the pressure exerted by blood within the arteries is persistently elevated.

Systolic blood pressure is the pressure exerted by blood on vessel walls when it is pumped into the arteries,that is during the systole. Diastolic blood pressure is pressure exerted by blood within the arteries between the heart beats, that is during the diastolic phase.

2. Normal systolic blood presure is 120mmhg for a healthy adult.Normal diastolic blood pressure is 80mmhg.So normal BP for a healthy adult is 120/80mmhg. In hypertension the SBP will be more than or equal to 140mmhg and DBP will be more than or equal to 90mmhg. So a BP more than or equal to 140/90mmhg is considered as hypertension in a normal adult.

Predisposing factors of hypertension: age above 50 years,smoking,alcoholism,family history of hypertension,obesity,inactive life style(sedentary),high intake of sodium in food , h/o diabetese mellitus and stress.

3. Health teaching to prevent onset or progression of hypertension

• Maintain an active lyfestyle with regular exercise schedule
• Life style modification and weight reduction
• Reduction or avoidance of sodium intake
• Practicing stress management techniques like yoga,meditation,spending time with family,engaging in sports or activities of interest.
• Quit smoking and alcoholism
• Eating a healthy diet,teach about DASH diet(Dietary Approach to Stop Hypertension) that instructs an intake of low fat dietary products,heart healthy fish(rich in omega 3 fatty acid), low fat diet,fruits,vegetables and whole grains.

4. Treatment options of hypertension in brief is as follows

• Life style modification
• DASH diet
• Pharmacological management including diuretics (eg:furosemide) that inhibits renal sodium reabsorption,Beta blockers(eg:atenelol) reduces cardiac workload,Vasodialators(eg:NTG,Sodium nitroprusside) acts on the narrowed vessels walls making them to dialate and reducing the blood pressure, ACE inhibitors(eg:Captopril) prevents vasoconstriction and calcium channel blockers(eg:Amlodipin,Verapamil) blocks the movement of calcium ions into the cells and cause vasodialation and decreased heart rate.
• Relaxation techniques and diversion therapies to manage stress

5.Two types of hypertension: Essential hypertension and Secondary hypertension.Essential hypertension is elevated blood pressure that may develop due to environmental or genetic factors,sometimes due to unidentifiable etiology.Secondary hypertension is the elevated blood pressure that develops secondary to other illnesses like renal disease,endocrine disorder,sleep apnoea,cirrhosis of liver, certain medications like contraceptive pills or NSAIDs

6. Arteriosclerosis and Atherosclerosis

Terms	Arteriosclerosis	Atherosclerosis
Definition	Thickening and hardening of the walls of the arteries,common with advancing age	Building up of fats, cholesterol and other substances in and on the walls of the artery causing the arteries to narrow. Atherosclerosis is a kind of arteriosclerosis
Afefcted areas	Affects small arteries and arterioles	Affects the vessel walls causing obstruction to blood flow and the plaque sometimes rupture causing blood clots
Cause	Associated with hypertension and DM	high BP, high cholesterol,smoking(irritant nicotine),DM
Effect of the disease	Thickening of the vessel walls with luminal narrowing may lead to ischemic injury.	Causes chronic inflammatory response in the arterial walls and endothelial injury
Extent of disease	Usually the calcification do not encroach a vessel lumen	May encroach and block the vessel lumen
Clinical features may be almost similar for both the conditions	Same signs and symtoms as atherosclerosis	Develops and progress gradually,asymptomatic until an artery is blocked or narrowed affecting perfusion of organs. Blood clots may completely obstruct blood flow or fragments and lead to stroke or heart attack. Symptoms:if plague is in arteries in heart: chest pain and angina,in Brain: numbness,weakness,difficulty speaking,drooping of facial muscles, in arms or legs:pain while walking or using the extremity.