Written by Dr.Md.Redwanul Huq (Masum)

Sunday, 17 March 2013 13:16

What is blood pressure:

Blood pressure is the lateral pressure exerted by the flowing blood against the blood

vessel walls.

What is high blood pressure (Hypertension):

High blood pressure (Hypertension) is defined as Blood Pressure (BP) 140/90 mm of Hg

or more in 2 or more occasions 1 to 2 weeks apart in a person having age more than

18 years or BP 140/90 mm of Hg or more in single occasion with the evidence of target

organ damage or BP 210/120 mm of Hg or more in a single occasion.

What is normal blood pressure:

Normal blood pressure means the BP is within the normal limit which is-

For Systolic blood pressure: 100-139 mm of Hg

For Diastolic blood pressure: 60-89 mm of Hg.

Causes of high blood pressure:

I. Primary hypertension-

Cause of high blood pressure is unknown.

II. Secondary hypertension-

i) Endocrine diseases-

Phaeochromocytoma

Conn’s syndrome

Cushing’s syndrome

Hyperparathyroidism

Primary hyperaldosteronism

Thyrotoxicosis

Primary hypothyroidism

Congenital adrenal hyperplasia

Acromegaly

ii) Renal diseases-

Renal vascular disease

Polycystic kidney disease

Parenchymal renal disease

iii) Coarctation of aorta

iv) Pregnancy

v) Drug induced-

Oral contraceptive pills

Anabolic steroids

Corticosteroids

Sympathomimetic agents

NSAIDs

vi) Family history of hypertension

vii) Obesity

viii) Diabetes

ix) Tension

x) Aging

xii) Smoking

xiii) Alcohol

xiv) Inactive lifestyle

xv) Dietary factors-

Excessive intake of salt

Inadequate intake of calcium, potassium and magnesium

Less intake of vitamin D.

Symptoms of high blood pressure:

Usually asymptomatic, but symptoms of high blood pressure may be as following:

Headache and heaviness in head

Blurred vision

Dizziness

Neck pain

Insomnia

Nausea and vomiting

Palpitation

Irritability and lack of concentration

Chest pain

Breathlessness.

Signs of high blood pressure:

Blood pressure- High, systolic and/or diastolic

Epistaxis

Fundoscopy- may reveal hypertensive retinopathy

Signs of cause- if present.

Investigations for hypertension:

A) General Investigations:

I) First Line Investigations (to be done in all patients)

Urine for R/M/E
Complete blood count
Blood suger (Fasting and 2 hrs after breakfast)
S. lipid profile.
S. Creatinine CXR – P/A view
E.C.G.

II) Subsequent Investigations (to be done according to clinical presentation)

S. electrolyte
Echocardiography
24 hrs UTP
Urine for micro albuminuria

B) Special Investigations (to be done when history and clinical examination suggest of specific cause)

1) In renal parenchymal disease:

a) IVU if blood urea and S. creatinine is normal.

b) Renogram and renal scan with split GFR.

2) In pheochromocytoma:

a) 24 hrs Urinary VMA.

b) CT scan of supra renal gland.

3) In renal arterial stenosis:

a) Captopril renogram.

b) Renal angiography.

4) In Conn’s syndrome:

a) Plasma rennin level.

b) Plasma Urinary aldosteron level.

5) In Cushing’s syndrome:

a) 24 hr Urinary free cortisol level.

b) Dexa methasone suppression test.

6) In coarctation of aorta: CT angiography.

7) In hyperparathyroidism:

a) S. Ca+, S. PO4.

b) S. alkaline phosphatase.

Treatment of high blood pressure

[HINTS: Contd-To be continued, M- Month, ±M- Before or After Meal, AM- After Meal, ½HBM- ½ Hour Before Meal,W- Week, D-Day.2HAM- 2 Hour After Meal,bid-Twice daily, tid-Three times daily,qid-Four times daily.]

‹ 55 yrs :

Step 1:

(A)Tab. Captopril (25/50 mg)

1 tab-Once or Twice daily(1HBM) —————————–contd.

Or,

Tab. Perindopril (2/4/8 mg)

1 tab-once daily (½HBM) —————————contd.

Or,

Tab.Losartan Potassium (25 /50 mg)

1 tab -once daily (±M) —————————–contd.

_OR

(B)Tab. Atenolol (50 /100 mg)

1 tab -once daily (±M) —————————–contd.

Or,

Tab. Metoprolol Tartarate (50 /100 mg)

1 tab -once daily (±M) —————————–contd.

Step 2:

Step 1+

(C)Tab. Amlodipine (5 /10 mg)

1 tab-once daily ( +M) ———————–contd

(D)Tab. Indapamide (1.5 mg)

1 tab-once daily (AM) ————————-contd.

Or,Tab.Hydrochlorothiazide(25/50 mg)

1 tab-once daily(AM) —————————contd.

Step 3:

Step 1+(C)+(D)

Step 4:

Step 3 + Tab.Prazosin (1 / 2 mg)

½ tab-bid (±M) ———————–7 D

then, 1 tab- bid (±M) ——————–Contd.

55 yrs Or More :

Step1 :

(C) OR (D).

Step 2 :

(A) OR (B) + (C) OR (D).

Step 3 :

(A) OR (B) + (C) + (D)

Step 4 :

Step 3 +Tab.Prazosin (1 / 2 mg)

½ tab-bid (±M) ———————–7 D

then, 1 tab- bid (±M) ——————–Contd.

* HTN ( with IHD) : (B) + (C) ±Tab.Captopril (25/50mg)

* HTN ( withDM) : (A) + (C)

* Isolated Syst. HTN : (C) + (D)

* Isolated Diast. HTN : (B)±(A)

* Treatment of high blood pressure (with pregnancy):
Tab.Methyldopa (250 mg)-2-3 times daily.

Lifestyle modification:

• Exercise regularly — at least 30 minutes a day
• If you smoke, find a program to stop smoking
• Avoid alcohol completely
• If you have diabetes, keep your blood sugar under control with the help of your doctor.
• Reduce stress & try to avoid things that cause stress for you
• Try meditation or yoga
• Lose weight if you are overweight.

Diet in High Blood Pressure:

• Decrease the amount of dietary sodium(salt) (less than 1,500 mg per day) And therefore-
a)Do not use salt at the table (for salads or others)
b)Give light salt in cooking
c)Don’t take salt preserved foods such as salted or smoked meat (ham, bacon,
sausages etc), salted or smoked fish
d) Avoid highly salted foods such as potato chips, crackers, salted nuts,salted popcorns,
salted snacks
e) Try to avoid foods with sodium as preservative like tomato ketchup, soya sauce,
chilli sauce, garlic sauce, pickles, chutneys etc.
• Have a heart-healthy diet in high blood pressure, including potassium(Highly present in milk, fruits and vegetables), calcium(more in milk and leafy vegetables) and fiber
• Drink plenty of water
• Eat a diet rich in fruits, vegetables, and low-fat dairy products
• Reduce total and saturated fat intake
• Avoid excess amount of proteins
• Take fats of plant origin like sunflower oil, soya oil,groundnut oil, and corn oil
•Reduce intake of fats of animal origin such as ghee, butter etc.

Sample diet plan in high blood pressure:

(Prepared by Mrs. Sharmin Sultana , M.S. in Food & Nutrition )

Meal	Menu
Early Morning	Tea
Breakfast	1% low fat milk / tea / coffeeVegetable pan cake / stuffed chapattiApple / pear / papaya / water melon / banana
Lunch	2-3 cup rice / 2 chapattiAny dal preferably whole dalChicken 1-2 piece(s) Curd / vegetable raita
Evening	Tea / coffee /fruit juiceBiscuits(salt free)
Dinner	Rice 1 / 2 cup(s)/ 1 chapattiFish 1 pieceMixed vegetables Vegetable salad Fruit custard