High Blood Pressure - 2

High Blood Pressure Symptoms

High blood pressure usually causes no symptoms and high blood pressure often is labeled "the silent killer." People who have high blood pressure typically don't know it until their blood pressure is measured.

Sometimes people with markedly elevated blood pressure may develop:

• headache,
• dizziness,
• blurred vision,
• nausea and vomiting and
• chest pain and shortness of breath.

People often do not seek medical care until they have symptoms arising from the organ damage caused by chronic (ongoing, long-term) high blood pressure. The following types of organ damage are commonly seen in chronic high blood pressure:

• Heart attack
• Heart failure
• Stroke or transient ischemic attack (TIA)
• Kidney failure
• Eye damage with progressive vision loss
• Peripheral arterial disease causing leg pain with walking (claudication)
• Outpouchings of the aorta, called aneurysms

About 1% of people with high blood pressure do not seek medical care until the high blood pressure is very severe, a condition known as malignant hypertension.

• In malignant hypertension, the diastolic blood pressure (the lower number) often exceeds 140 mm Hg.
• Malignant hypertension may be associated with headache, lightheadedness, nausea, vomiting, and stroke like symptoms
• Malignant hypertension requires emergency intervention and lowering of blood pressure to prevent brain hemorrhage or stroke.

It is of utmost importance to realize that high blood pressure can be unrecognized for years, causing no symptoms but causing progressive damage to the heart, other organs, and blood vessels.

When to Seek Medical Care

Many symptoms present gradually after years of poorly blood pressure control. Many times, the first knowledge of hypertension occurs when a patient complains of chest pain or has stroke-like symptoms. Should these occur, it is appropriate to co activate emergency medical services and seek care.

You may be directed to seek medical care if blood pressure readings are elevated if done as part of a community health screening. Isolated elevated blood pressure readings do not necessarily make the diagnosis of hypertension. Blood pressure readings vary throughout the day, and your primary care provider may record a different reading than the one that was measured in a screening that sent you in for care.

There are non-specific symptoms associated with hypertension that may cause a person to seek care, including lightheadedness, dizziness, headache with or without nausea, change in vision, or lethargy and fatigue. There are many other reasons to develop these symptoms other than high blood pressure.

High Blood Pressure Diagnosis

Blood pressure is measured with a blood pressure cuff (sphygmomanometer). This may be done using a stethoscope and a cuff and gauge or by an automatic machine. It is a routine part of the physical examination and one of the vital signs often recorded for a patient visit. Other vital signs include pulse rate, respiratory rate (breathing rate), temperature, and weight.

When discussing blood pressure issues, the health care practitioner may ask questions about past medical history, family history, and medication use, including prescriptions, over-the-counter medications, herbal remedies, and food additives. Other questions may include lifestyle habits, including activity levels, smoking, alcohol consumption, and illegal drug use.

Physical examination may include listening to the heart and lungs, feeling for pulse in the wrist and ankles, and feeling and listening to the abdomen looking for signs of an enlarged aorta. Eye examination with an ophthalmoscope may be helpful by looking at the small blood vessels on the retina in the back of the eyeball.

• Normal Blood Pressure
  • Systolic less than 120 mm Hg; diastolic less than 80 mm Hg
  
  
• Prehypertension
  • Systolic 120-139 or diastolic 80-89 mm Hg
  
  
• High Blood Pressure
  • Stage 1: Systolic 140-159; diastolic 90-99 mm Hg 
  • Stage 2: Systolic more than 160; diastolic more than 100 mm Hg

Blood tests may be considered to assess risk factors for heart disease and stroke as well as looking for complications of hypertension. These include complete blood count (CBC), electrolytes, BUN (blood urea nitrogen), and creatinine and GFR (glomerular filtration rate) to measure kidney function. A fasting lipid profile will measure cholesterol and triglyceride levels in the blood. If appropriate, blood tests may be considered to look for an underlying cause of high blood pressure including abnormal thyroid or adrenal gland function.

Ultrasound of the kidneys, C T Scan of the abdomen, or both may be done to assess damage or enlargement of the kidneys and adrenal glands.

Other studies may be considered depending upon the individual patient's needs

• Electrocardiogram (ECG) may help evaluate heart rate and rhythm. It is a screening test to help assess heart muscle thickness. If hypertension is long-standing, the heart muscle has to hypertrophy, or get larger, to push blood against the increased pressure within the arteries of the body.
• Echocardiogram is an ultrasound examination of the heart It is used to evaluate the anatomy and the function of the heart. A cardiologist is required to interpret this test and can evaluate the heart muscle and determine how thick it is, whether it moves appropriately, and how efficiently it can push blood out to the rest of the body. The echocardiogram can also assess heart valves, looking for narrowing (stenosis) and leaking (insufficiency or regurgitation). A chest X-ray may be used as a screening test to look for heart size, the shape of the aorta, and to assess the lungs.
• Doppler ultrasound is used to check blood flow through arteries at pulse points in your arms, legs, hands, and feet. This is an accurate way to detect peripheral vascular disease, which can be associated with high blood pressure. It also can measure blood flow in the arteries to both kidneys and sometimes depicts narrowings that can lead to high blood pressure in a minority of patients.

High Blood Pressure Treatment

Blood pressure control is a lifelong challenge. Hypertension can progress through the years, and treatments that worked earlier in life may need to be adjusted over time. Blood pressure control may involve a stepwise approach beginning with diet,weight loss, and lifestyle changes and eventually adding medications as required. In some situations, medications may be recommended immediately. As with many diseases, the health care practitioner and patient work together as a team to find the treatment plan that will work for that specific individual.

(To be continued)