Hypertension Health Dictionary

High blood pressure. The World Health Organisation defines high blood pressure (arterial hypertension) as that with a persistent sphygomanometer reading of 160/90, and over. Average blood pressure is 120/80 for men but lower in women. The diastolic pressure (lower figure) represents pressure to which the arterial walls are subject and is the more important figure.

Main causes of a raised pressure include increase in blood thickness, kidney disorder or loss of elasticity in the arteries by hardening or calcification.

Well defined physical problems account for 10 per cent of high blood pressure cases. By the age of 60, a third of the peoples of the West are hypertensive. Other causes: genetic pre-disposition, endocrine disorders such as hyperactive thyroid and adrenal glands, lead and other chemical poisoning, brain tumour, heart disorder, anxiety, stress and emotional instability.

Other causes may be food allergies. By taking one’s pulse after eating a certain food one can see if the food raises the pulse. If so, that food should be avoided. Most cases of high blood pressure are related to lifestyle – how people think, act and care for themselves. When a person is under constant stress blood pressure goes up. It temporarily increases on drinking the stimulants: alcohol, strong tea, coffee, cola and caffeine drinks generally.

Symptoms. Morning headache (back of the head), possible palpitation, visual disturbances, dizziness, angina-like pains, inability to concentrate, nose-bleeds, ringing in the ears, fatigue, breathlessness (left ventricular failure).

Dr Wm Castelli, Director of the Framlingham Heart Study in Massachusetts, U.S.A., records: “The greatest risk is for coronary heart disease (CHD). Hypertensives have more than double the risk of people with normal blood pressure and seven times the risk of strokes.”

In countries where salt intake is restricted, a rise in blood pressure with age is not seen.

Simple hypotensive herbs may achieve effective control without the side-effects of sleep disturbance, adverse metabolic effects, lethargy and impaired peripheral circulation.

Essential hypertension is where high blood pressure is not associated with any disease elsewhere; it accounts for 90 per cent cases. Most of the remainder have kidney disease except for a few other abnormalities.

Alternatives. Balm, Black Haw, Black Cohosh (blood pressure of the menopause), Cactus, Cramp bark, Chamomile (German). Garlic, Buckwheat, Lily of the Valley, Balm, Mistletoe, Motherwort. Passion flower, Nettles, Lime flowers, Wood Betony, Yarrow, Rosemary, Hawthorn flowers, Olive leaves, Dandelion. Where there is nerve excitability: Valerian.

Tea No 1. Equal parts: Hawthorn leaves and flowers, Mistletoe, Lime flowers. Mix. 2 teaspoons to each cup boiling water; infuse 5-10 minutes. 1 cup 2-3 times daily. Alternative:–

Tea No 2. Equal parts: Nettles, Lime flowers, Yarrow, Passion flower. Mix. 2 teaspoons to each cup boiling water; infuse 5-10 minutes. 1 cup 2-3 times daily.

Nettles. Nettle tea is capable of removing cholesterol deposits (“fur”) from artery walls, increasing their elasticity. Like so many herbs they are rich in chlorophyll. The tea may be made as strong as desired. Mistletoe. 2-3 teaspoons cut herb (fresh or dried) to cup cold water. Allow to infuse overnight (at least 8 hours). 1 cup morning and evening.

Garlic. Juice from one Garlic corm expressed through a juicer taken morning and evening. Garlic dilates blood vessels. Alternative: 2-3 Garlic capsules at night.

Blood pressure of pregnancy: See – PREGNANCY.

Tablets/capsules: Cramp bark, Mistletoe, Motherwort, Rutin, Garlic.

Powders. Formula. Buckwheat (rutin) 1; Motherwort 1; Mistletoe half; Valerian quarter. Dose: 500mg (two 00 capsules or one-third teaspoon) thrice daily.

Liquid extracts, tinctures. Formula. Equal parts: Cactus, Mistletoe, Valerian. Dose: liquid extracts, one 5ml teaspoon; tinctures, two 5ml teaspoons; thrice daily.

Practitioner Formula. Tinctures: equal parts: Lily of the Valley, Mistletoe, Valerian. Dose: 30-60 drops thrice daily.

Where high blood pressure is due to faulty kidney function diuretics such as Dandelion or Bearberry will be added according to individual requirements. Dandelion root is one of the most widely-used potassium-conserving agents for increasing flow of urine, as well as being a mild beta-blocker to reduce myocardial infarction. Broom (Sarothamnus scoparius) (diuretic) is not used in cases of high blood pressure. It is good practice to assess kidney function in all new cases of hypertension for renal artery stenosis.

Evidence from two major studies confirms that diuretics rather than beta-blockers should be the treatment of choice for most elderly hypertensives. The addition of a diuretic (Yarrow, etc) to prescriptions for the elderly is commended.

Prevention. Chances of developing high blood pressure are said to be reduced by a daily dose of Cod

Liver oil. Results from studies at the University of Munich, Germany, show that when an ounce of Cod Liver oil was added to the typical Western diet, better pressure readings and lower cholesterol levels followed. When the flavour renders it objectionable to the palate, taste may be masked by stirring briskly into fruit juice.

General. Stop smoking. Watch weight. Moderate exercise. Avoidance of stress by relaxation, yoga, music, etc. These relieve constriction of peripheral blood vessels. Curb temper

Diet. Avoid processed and fast foods high in fat and salt, and empty calories. Cheese and meat sparingly. Eat plenty of natural foods. Positively reject coffee, strong tea and alcohol. “There is a significant drop in plasma Cortisol with a fall in blood pressure after stopping alcohol.” (Dr J.F. Potter, University of Birmingham, England) It is well-documented that a vegetarian diet is associated with a lower blood pressure.

Salt. The association of salt with blood pressure is larger than generally appreciated and increases with age and initial blood pressure. Even a small reduction in salt (3g) may reduce a systolic and diastolic pressure by 5mmHg and 2.5mmHg respectively. All processed foods containing salt should be avoided. Supplementation. Inositol, zinc, Vitamin C, Vitamin B6. (Dr C. Pfeiffer) Vitamin E to improve circulation. Check with practitioner pressure level before starting 200iu increasing to 400iu daily. Magnesium: 300mg daily. Choline.

See: BLOOD PRESSURE. 

Persistently raised blood pressure exceeding about 140 mmHg

(systolic) and 90 mmHg (diastolic) at rest. Hypertension is very common, particularly in men, and its incidence is highest in middle-aged and elderly people.

Hypertension is usually symptomless but may cause headaches and visual disturbances when severe. It increases the risk of stroke, coronary artery disease, and heart failure, and may eventually lead to kidney damage and retinopathy.

In many cases, there is no obvious cause. Factors associated with hypertension include high alcohol intake, a high-salt diet, obesity, a family history of the condition, a sedentary lifestyle, a high degree of stress, and smoking.

Specific causes include various kidney disorders, certain disordes of the adrenal glands, pre-eclampsia, coarctation of the aorta, and use of certain drugs. Taking the combined contraceptive pill can increase the risk.

With mild to moderate hypertension, if no underlying cause is found, lifestyle changes are recommended, for example, introducing regular exercise and

stopping smoking. Biofeedback training and relaxation techniques can help reduce blood pressure. If self-help measures have no effect, or hypertension is severe, 1 or a combination of antihypertensive drugs may be given.

High arterial blood pressure

Means high BLOOD PRESSURE (raised pressure of the circulating blood), but since there is a wide range of ‘normal’ blood pressure in the population, a precise level of pressure above which an individual is deemed hypertensive is arbitrary. (A healthy young adult would be expected to have a systolic pressure of around 120 mm Hg and a diastolic of 80 mm Hg, recorded as 120/80.) Hypertension is not a disease as such but a quantitative deviation from the norm. A person with a pressure higher than the average for his or her age group is usually symptomless – although sometimes such people may develop headaches. The identi?cation of people with hypertension is important because it is a signal that they will be more likely to have a STROKE or myocardial infarct (coronary thrombosis or heart attack) than someone whose pressure is in the ‘normal’ range. Preventive steps can then be taken to lessen the likelihood of their developing these potentially life-threatening conditions.

Blood pressure is measured using two values. The systolic pressure – the greater of the two – represents the pressure when blood is pumped from the left VENTRICLE of the heart into the AORTA. The diastolic pressure is the measurement when both ventricles relax between beats. The pressures are measured in millimetres (mm) of mercury (Hg). Despite the grey area between normal and raised blood pressure, the World Health Organisation (WHO) has de?ned hypertension as a blood pressure consistently greater than 160 mm Hg (systolic) and 95 mm Hg (diastolic). Young children have readings well below these, but blood pressure rises with age and a healthy person may well live symptom free with a systolic pressure above the WHO ?gure. A useful working de?nition of hypertension is the ?gure at which the bene?ts of treating the condition outweigh the risks and costs of the treatment.

Between 10 and 20 per cent of the adult population in the UK has hypertension, with more men than women affected. Incidence is highest in the middle-aged and elderly. Because most people with hypertension are symptomless, the condition is often ?rst identi?ed during a routine medical examination, otherwise a diagnosis is usually made when complications occur. Many people’s blood pressure rises when they are anxious or after exercise, so if someone’s pressure is above normal at the ?rst testing, it should be taken again after, say, 10 minutes’ rest, by which time the reading should have settled to the person’s regular level. BP measurements should then be taken on two subsequent occasions. If the pressure is still high, the cause needs to be determined: this is done using a combination of personal and family histories (hypertension can run in families), a physical examination and investigations, including an ECG and blood tests for renal disease.

Over 90 per cent of hypertensive people have no immediately identi?able cause for their condition. They are described as having essential hypertension. In those patients with an identi?able cause, the hypertension is described as secondary. Among the causes of secondary hypertension are:

Lifestyle factors such as smoking, alcohol, stress, excessive dietary salt and obesity.

Diseases of the KIDNEYS.

Pregnancy (ECLAMPSIA).

Various ENDOCRINE disorders – for example, PHAEOCHROMOCYTOMA, CUSHING’S DISEASE, ACROMEGALY, thyrotoxicosis (see under THYROID GLAND, DISEASES OF).

COARCTATION OF THE AORTA.

Drugs – for example, oestrogen-containing oral contraceptives (see under CONTRACEPTION), ANABOLIC STEROIDS, CORTICOSTEROIDS, NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS).

Treatment People with severe hypertension may need prompt admission to hospital for urgent investigation and treatment. Those with a mild to moderate rise in blood pressure for which no cause is identi?able should be advised to change their lifestyle: smokers should stop the habit, and those with high alcohol consumption should greatly reduce or stop their drinking. Obese people should reduce their food consumption, especially of animal fats, and take more exercise. Everyone with hypertension should follow a low-salt diet and take regular exercise. Patients should also be taught how to relax, which helps to reduce blood pressure and, if they have a stressful life, working patterns should be modi?ed if possible. If these lifestyle changes do not reduce a person’s blood pressure su?ciently, drugs to achieve this will be needed. A wide range of anti-hypertensive drugs are available on prescription.

A ?rst-line treatment is one of the THIAZIDES, e?ective at a low dosage and especially useful in the elderly. Beta blockers (see BETAADRENOCEPTOR-BLOCKING DRUGS), such as oxprenolol, acebutol or atenolol, are also ?rst-line treatments. ACE inhibitors (see ANGIOTENSIN-CONVERTING ENZYME (ACE) INHIBITORS) and CALCIUM-CHANNEL BLOCKERS can be used if the ?rst-line choices are not e?ective. The drug treatment of hypertension is complex, and sometimes various drugs or combinations of drugs have to be tried to ?nd what regimen is e?ective and suits the patient. Mild to moderate hypertension can usually be treated in general practice, but patients who do not respond or have complications will normally require specialist advice. Patients on anti-hypertensive treatments require regular monitoring, and, as treatment may be necessary for several years, particular attention should be paid to identifying sideeffects. Nevertheless, e?ective treatment of hypertension does enable affected individuals to live longer and more comfortable lives than would otherwise be the case. Older people with moderately raised blood pressure are often able to live with the condition, and treatment with anti-hypertensive drugs may produce symptoms of HYPOTENSION.

In summary, hypertension is a complex disorder, with di?erent patients responding di?erently to treatment. So the condition sometimes requires careful assessment before the most e?ective therapy for a particular individual is identi?ed, and continued monitoring of patients with the disorder is advisable.

Complications Untreated hypertension may eventually result in serious complications. People with high blood pressure have blood vessels with thickened, less ?exible walls, a narrowed LUMEN and convoluted shape. Sometimes arteries become rigid. ANEURYSM may develop and widespread ATHEROMA (fat deposits) is apparent in the arterial linings. Such changes adversely affect the blood supply to body tissues and organs and so damage their functioning. Patients suffer STROKE (haemorrhage from or thrombosis in the arteries of the BRAIN) and heart attacks (coronary thrombosis

– see HEART, DISEASES OF). Those with hypertension may suffer damage to the retina of the EYE and to the OPTIC DISC. Indeed, the diagnosis of hypertension is sometimes made during a routine eye test, when the doctor or optician notices changes in the retinal arteries or optic disc. Kidney function is often affected, with patients excreting protein and excessive salt in their urine. Occasionally someone with persistent hypertension may suffer an acceleration of damage to the blood vessels – a condition described as ‘malignant’ hypertension, and one requiring urgent hospital treatment.

Hypertension is a potentially dangerous disease because it develops into a cycle of self-perpetuating damage. Faulty blood vessels lead to high blood pressure which in turn aggravates the damage in the vessels and thus in the tissues and organs they supply with blood; this further raises the affected individual’s blood pressure and the pathological cycle continues.

High blood pressure - usually above 150/95mm Hg.

n. high *blood pressure, i.e. elevation of the arterial blood pressure above the normal range expected in a particular age group. Hypertension may be of unknown cause (essential hypertension or hyperpiesia). It may also result from kidney disease, including narrowing (stenosis) of the renal artery (*renovascular hypertension), endocrine diseases (such as Cushing’s disease or phaeochromocytoma) or disease of the arteries (such as coarctation of the aorta), when it is known as secondary or symptomatic hypertension.

Complications that may arise from hypertension include atherosclerosis, heart failure, cerebral haemorrhage, and kidney failure, but treatment may prevent their development. Hypertension is symptomless until the symptoms of its complications develop. Some cases of hypertension may be cured by eradicating the cause. Most cases, however, depend upon long-term drug therapy to lower the blood pressure and maintain it within the normal range. The drugs used include thiazide *diuretics, *ACE inhibitors, *calcium-channel blockers, *beta blockers, and *alpha blockers. Combinations of drugs may be needed to obtain optimum control. See also portal hypertension; pulmonary hypertension.

raised blood pressure.