HIGH BLOOD PRESSURE OR HYPERTENSION

HYPERTENTION OR HIGH BLOOD PRESSURE

 

Hypertension or high blood pressure is no doubt one of the major causes for cardiac diseases,stroke,and kidney damage.But there are contraversies regarding to the measurement of blood pressure as whether they are truely representing your body health at the right time at which it is measured at the Doctor's room.Because the movement when you entered inside the hospital, your already elevated B.P by the travel movement either by walk or vehicle from your home to hospital,would elevate further and the B.P would reach its peak level when you are called by the doctor to get in.
The Blood Pressure is always said to be the basic and funtamental information with regarding to the physiology of our body.An ordinary mild fever may be some times undetected by a thermometer but a proper measurement of a spygmomanometer would reveal that.Hence measurement of blood pressure should be made by giving sufficient time to the patient to relax by the time when he arrived at the hospital.
There are BP home measurement kits are available in the market.There are many brands in various price ranges.There are electronic and nonelectronic(Aneroid) BP kits.

An aneroid BP apparatus is the one which has a rectangular bladder on one side of the cuff embedded with a calibrated dial known as the aneroid gauge with a movable pointer,a stethoscope embedded in the cuff bladder,and a bulb pump to inflate the air.The figure is shown above.This is very simple and give more accurate measurement very close to the Doctor's mercury manometer but need experience of detecting the various pulse sounds.

Measuring BP with Aneroid BP Kit

Insert all the detachable parts like the bulb,the gauge dial,and the stethoscope armed earpieces into the respective tubes.Relax by sitting in a convenient chair for five minutes.

Place the bladder on your right or left arm by putting the stethoscopic dial exactly on the brachial artery which is right around the elbowwhere the fold is formed when you bent the arm.Wrap the cuff around the arm not too tight and not too loose such that after the wrap a pointer finger can be inserted.Place the ear pieces of the steth,into your ears.Put your wrapped arm on the table with a height exactly in a line with your heart.Relax.Inflat the bulb a little high above 150 mm/Hg and slowly deflate it.watch the pulse sound carefully.

PHASES OF PULSE SOUNDS WHEN MEASURING WITH ANEROID KITS

Phase-1 After inflate the cuff more sufficiently just 5 mm/Hg above your preveously measured or assumed BP slowly deflate by releasing the bulb valve and carefully hear the faint clear murmuring and tapping sound,the point at which this sound start is the systolic pressure

Phase-2 On continue deflation at the end of the Phase-1,a murmur nd swishing sound follows.This sound is longer than the phase-1 sound. This is the Phase-2 sound and continue deflating

Phase-3 At the end of the Phase-2,the sounds are more crisp,loud and increase in intensity
Phase-4 At the end of the phase-3 the sounds become less distinct,muffled and faint like blowing.This is phase-4.
Phase-5 At the end of the phase -4 watch the disappearence of the last sound that indicate the exact beginning of the Phase-5 which should be noted down as your diastolic pressure.Then deflate the gauge commpletely.
The procedure should be repeated two or more times daily until you become familiar with the pulse sounds.Aneroid methods are as accurate as Mercury meters,less expensive,and more convenient.

MEASUREMENT WITH ELECTRONIC METERS

 

Electronic meters are available in variety of models some are manual, semi automatic (auto deflation only),some are fully automatic (Both inflate and deflate automatically) and some with printers.All are automatically measuring the pulse and pressure and will display the values digitally at the end of the measurements in an electronically calibrated dial.Most of them are working in both battery and direct current operation.

 There are various different types such as arm model to measure by arm which are fuzzy logic,wrist watch model to measure in the wrist and finger model to measure by the finger.But measuring the BP by the arm is the reliable method.Procedures are discribed in the manufacturers instruction manual comes along with the products.The testers for Consumer Reports gave brands such as Omron and Marshalls top rating for reliability and ease of use.
Blood Pressure can be defined as the product between stroke volume and heart rate multiplied by systamic vascular resistance and can be conveniently read by the following equation:-
(stroke volume x heart rate) x systamic vascular resistance

  Altering any of the above factors would result in a change in the blood pressure.

Blood Pressure composed of two parts like the pressure at which the left ventricle empties a large chunk of blood into the aorta against the systamic resistance in the aotra during the contraction of the left portion of the heart(the sound is specific as Lub) the pressure raises in the arteries is known as SystolicPressure.

When the left side relax,by the cotraction of the right side of the heart the (sound is specific as Dup) left ventricle relax,and receive a chunk of blood from the right venricle,and the pressure in the aorta lowers and is known as Diastolic Pressure.

The mean calculation of these two parts of the B.P is measured by the various spygmomanometers as we have seen above.
If the systolic raises above 120 mm/Hg and the diastolic above 80mm/Hg we should be careful about we may have the preliminary conditions of hypertension. 

Table

No  ----        category        ----                             sytolic/diastolic       

  1.   ---         High normal -----                             130/85 to 139/89

  2..   ---        Mild               ----                              140/90 to 149/99

  3.   ----       Moderate       ---                              160/100 to 179/109

  4.   ---        Severe            ---                            180/110  to  209/119

  5.  ----        Very severe   -----                          >210/120 
In the olden days the physicians did not start to worry unless the pressure reached 150/95.At present the medical field is more aggressive in assessing the patient's model condition to be normal or above the normal with a base of 120/80mm/Hg.Because blood pressure is any way is varying environementally flexuating here and there according to the emotinal feelings,situation and sorroundings of our daily routine life.A patient is said to be having high pressure only if his repeated readings show an high persistant value.First the medical field considered only the high persisting diastolic pressure as a base.But now they consider both systolic and diastolic  if above 130/90 .
But if you are above forty it is normal and not to be panic if the pressure readings are systolic 130-140 and diastolic is 90 to 100.
There are some conditions in whic care should be taken in altering the pressure by treatments.For example some studies shows that lowering the diastolic below 90mm/Hg may produce adverse effects in patients with coronary insufficiency. 

Non-Drug Therapies For Hypertension

1.Weight Reduction:-It is of no doubt that obesity plays an important role in hypertension and cardiac overload.Food control especially fat restricted and fiber rich foods are recommended and reduced intake of food with minimum excercise may certainely have an benificial impact on overweight.

Use of tobacco,and alcohol may put on overweight by depositting fats.Avoid to take more saturated fatty meals such as redmeats like mutton beaf and like meats,adulterated cooking oils,daldas etc.

Drink a tablespoon of pure honey mixed with a cup of lukewarm water in the morning wakeup on empty stomach daily is assumed to be good extra fat remover.Similary daily morning have a drink of smooth light dicoction of fresh tea is said to have beneficiary effect.

2.Helping Minerals Foods with extra calcium,megnesium,and potassium also helping to reduce blood pressure.Apricots,avocados,bananas,cocoa,dates,figs,fish,molasses,dried peaches,peanuts,peacans,potatos,raisins,sunflower seeds,wheatgerm and brewer's yeast are potassium rich.
3.Excercise Non aggressive aerobic excercises such as morning and evening walkings,cyclings,swimmings are of benificial to help blood pressure. 

Drugs Therapy

Many people are thinking that helping blood pressure to ease down  simply by taking proper medications and enjoy the freedom from diet restriction and excercises are good thing.But a trial known as Multiple Riskfactor Intervension Trial (MRFIT), was conducted for 10 years at a cost of $100 million with 12000 recruits.The results are unexpected and it explained that those who are taking medicines are dying faster than those who are not taking medicines.

Further detailed studies by The New England Journal of Medicines  based on the MRFIT findings revealed that treatments of coronary artery disease with aggressive thiazide dosing may increase the major cause of sudden deaths by heart attack.The main reason is diuretics generally causes dipletion of the major important minerals potassium and magnesium which leads to cardiac arrhythmias and cardiac arrest.
Reserpine and guanethidine(Ismelin),as they are indirectly working by blocking the secretion of the main adrenergic transmitter norepinephring from the adrenergic nerve endings they often produce unpleasant side effects such as Orthostatic hypotension and sexual dysfunction as in the case of guanethidine,CNS depression and bradycardia as in the case of reserpine.Hence these medicines are now minimised by the doctors.
Then came the betablockers.They are non selective like propranolol(Inderal),selective such as metaprolol(Lopressor),atenolol(Tenormin,Aten),betablockers with little alpha blocking capacity such as carvedilol(Coreg)and labetalol,betablockers selective at beta-1 receptor with an partial sympathetic agonism such as acebutol(Secral).These medicines are especially the beta one selective blockers are advantageous more to youngsters with minimal side effects.But people sometimes complains fatigue.cold hands,sexual difficulties,and problem controlling sugar and cholesterol.
Then came the calcium channel blockers such as Nifedypine(Adalat),Diltiazem(Dilzem) are introduced with further minimal side effects. 
Conclusively different people responded to different medicines and should be thoroughly subjected to proper evaluation. 
For a full reference ANENCYCLOPAEDIA OF HYPERTENSION

 

 

BODY FITNESS AND BLOOD CHOLESTEROL MANAGEMENT

Healthy Lifestyle And Cholesterol

Everybody in the world wants to enjoy a longer but healthy life.To lead a healthy life our over all body fitness our healthy mind,our food and family atmosphere all plays important roles.Hence Body Fitness is one important factor to have a healthy prolonged enjoyable life.In our body to keep it fit over all Cholesterol plays an imporant role.

Cholesterol Sructure

 

 Cholesterol is chemically a steroid as it is having the typical four ringed portion which is known as cyclo pentano perhydro phenantherenn  ring or steroidal ring  indicated by two arrows and carved by a circle in the picture above.Typically any compound which if it has this four membered ring in its chemical sructure is known as a steroid.But the word steroid was derived by a different methodology as follows.In greek stero means stone like solid.These compounds are mostly oily in nature oil soluble and easily solidyfy into stones in nature.The name cholesterol is derived from the Greek word Chole means bile and stero means solid and ol means an alcohol as first first cholesterol was identified from the extracted gall stones.But later on amazingly they find out that our entire body which is made out of numerous cell units which are all made out of cholesterol.
Humen and any animal cells in general cells of any vertebrates (The bony Living Things)  are differing from the plant and bacterial cells by devoid of a cell wall and instead of cell wall they contains cholesterol which covers the entire cell and protect the inner cell content.That is why humen and animal cells are more flexible and movable than the plant and bacterial cells which are more rigid.
 Cholesterol is available in our body in various forms as alcohol which is soluble in water and is esterified with our body fatty acids to form water insoluble fats.Cholesterol in our body available in high concentration in Liver,Spinal Cord and Brain.

Fats are storable substances which are oily in nature and are water insoluble are mostly stored in Adipose (Fatty) tissues for later consumption in emergency  in energy starving situation and in end stage ketonic Type-1 Juvanile Diabetes Mellitus.

Our body is getting fats mainly in two ways.First is the synthesis of Triglycerides,which are the esters formed by the esterification reaction between our body glycerol with three molecules of fatty acids.This synthesis is mostly performed in liver catalysed by insulin.Secondly the esterification of Cholestryl Alcohol or Cholesterol with a molecule of a fatty acid.This synthesis is performed in the entire body tissues especially Adipose Tissues,the tissues which is more vulnerable to become fatty

Interestingly most of our body steroids such as Adrenocorticosteroids and sex hormones are all prepared from Cholesterol as a base.Vitamin D3(Chole-calciferol) the important and more tolerable type than D2(Ergo-calciferol) in humen body is prepared from our body cholesterol when our body skin is exposed to the evening sun light

CHOLESTEROL IN THE BLOOD

As we have seen our body contains cholesterol in the form of soluble alcohol and fatty esters especially in the Adipose tissues,in he Liver,in the Brain in the Spinal chord and in the entire nervous systems.But on contrary in our cardio vascular system or simply in our blood cholosterol is circulating in a packed particles known as Lipoproteins.Esterified cholesterol and glycerol are naturally having a molecular structure similar to minute powdered small pieces of glass and they have sharp edges and hence they may damage the inner wall of the blood vessels if they circulate as they are without packed in as lipoproteins.See below the structure of a Low Density Lipoprotein (LDL) cholesterol 

 and note the arrows pointing the fat particles looking like broken glass pieces with sharp edges nicely packed inside with apolipoproteins,phopholipids and unesterified cholesterol.

Liver is one of the important organ which is synthesizing and releasing fatty esters in various form into the blood as LDL,HDL,VLDL,etc.The above figure is giving an outline diagrammatically.When we take fatty food especially dietary foods the fat in the food is first saponified by the alkaline inestinal juice and absorbed along with the food as large chylomicrons  and enter first into the lymphatic circulation and hen into the blood stream.These chylomicrons are large but very very  thin packets of fatty lipids mostly triglycerides covered by thin layers of lipoproteins,phospholipids and unesterified cholesterol. and carry them into tissues.Tissues hydrolyze the triglycerides into glycerol and fatty acids by the action of he enzyme Lipoproteinlipase.The free fatty acids are absorbed by the tissues and the remaining chylomicron remnents are taken by the liver.Thus liver gets milk fats.Thus chylomicrons carry exogenous fat in the blood for metabolism.

Cholesterol is produced in the liver as by the following map:-

In the liver the Acetyl Coenzyme-A is converted to mavalonic acid by HMG Co-A reductase and the mavalonic acid after underwent into various step is converted to cholesterol.Thus the increased cholestrol would supress the mavalonate pathways.Then again the cholesterol gets esterified to form various lipo proteins.Thus a reduction in cholesterol gears up the pathways on one side and the increase in LDL would induce more and more LDL receptors in the liver on he otherside and the cycle repeats.

DYSLIPIDAEMIA AND THE CORONORY HEART DESEASE 

                                          (CHD)

As we have seen previously our body contains cholesterol through out all the entire tissue cell units as the cell-wall,the entire nervous system including the brain and spinal chord  the liver, the adipose tissues, and the blood.Out of our total body cholesterol 90% produced by the liver endogenously and the remaining 10% only coming from food intake.Total cholesterol of our body should be at the range of 160mg to 200mg. see the chart.

                                                       

  Always remember that only total cholesterol may not be a correct indicator for you that you have CHD.Because some people have total cholesterol little out of range such as >260 but <400 may not have the risk of CHD.
On the otherhand CHD or Coronary Heart Desease is a fatal condition in which the coronory artery which supplies blood and energy to the heart may have some blocks due to athrosclerosis which is mainely due to the elevation of LDL cholesterol or bad cholesterol.Hence in your lipid profile you must watch the LDL and Triglyceride levels.Remember Triglycerides are not cholesterol but they are fatty esters formed by the esterification reactions between glycerol with three molecules of fatty acids
The normal levels of the Lipid Profiles are as follows:-
Total cholesterol                    > 190   and  < 210
LDL-C                                 > 90    and < 110
Triglycerides                         > 100   and < 150 
HDL-C                               > 40      and < 65 
If LDL-C elevated above the level then the symptoms are Pancreatitis tiredness fatigue and symptoms of CHD 
Here are formulas for finding out LDL-C cotents:-
LDL- Cholesterol     = Total Cholesterol-(HDL-C+VLDL-C)     VLDL=means very low density choles-                                                                                                   - terol whic is produced by live endogen-                                                                                                      -ously
LDL-Cholesterol     = Total Cholesterol - (HDL-C+ TG)              TG=means Triglycerides
If the Triglyceride levels are >400 then the above formula should be calculated with non  HDL-C as follows:-
LDL-Cholesterol    = Total Cholesterol - (HDL-C+ nonHDL-C)
non HDL-C           = Total cholesterol  - HDL-C

SYMPTOMS OF CHD OR  IHD (ISCHEMIC HEART DISEASE)

Ischemia is the condition in which blood flow to a particular area of the heart is blocked so that the area becomes dimmed or blackish  in colour because of there is lesser oxygen supply than the demand by the tissues of that area and the area is known as Ischemic

Reversible Angina is a condition in which there is a temporary insufficiency or blockade of blood and oxygen supply due to restlessness,stress,anxiety.The condition would releive after taking sufficient rest.

Acute Heart Attack(AMI) is a condition if Reversible Angina is allowed to persist for prolonged time without taking rest or medications like Nitroglycerin then the ischemia damages that part of the heart in which  it occured may presipitate Irreversible ischemia Or Acute Reversible Myocardial Infarction

Sudden Death is a condion in which if the acute reversible myocardial infarction is allowed to persists for prolonged time without proper hospitalization the result will be Irreversible Heart Attack or Sudden Death due to the fatal ventricular fibrillation   

  The first symptems of the CHD is chest pain or angina which will elevate from the chest and radiate to the left arm and further radiate to neck jaws and back  followed by sweating, unconciousness and heart attack which indicates that there is a complete blockade of the coronary blood circulation

A partial blockade will leads to a minor angina which will be similar to the symptoms of hyper acidity.
A mild or moderate angina is common in stressfull,and hard work,or sleeplessness condition but will be relieved by taking rest.But a severe angina as a result of complete blockade of arteries will eventually leads to Heart Attack or Myocardial Infarction which will damage the heart muscle permanently if not treated immediately may cause death.The severe anginal pain which means a heart attack will not be releived by taking rest or nitro glycerin.
There are other symptoms also common in heart attack such as 1.nausea 2.sweating 3.restlessness 4.loss of conciousness 5.breathlessness,
A severe chestpain lasting for more than 15 minutes indicates it is a heart attack.Usually a mild angina will relive if you take a rest or a nitroglycerin tablet.But heart attack would not get relieved by these.The heart attack can happen at any time even at rest.Some times without any painor symptom a heart attack may occur this is known as Silent Heart Attack .This is common in patients with Diabetes Mellitus 

Treatment Options For Dyslipidemia And CHD

The treatment according to the National Cholesterol Education Program Guidelines (NCEPG) should be based on the LDL-C level in the blood.Accordingly the base level line they fixed is = or > 190mg/dl.If a patient is having LDL-Cholesterol equals to or above the base level if he has no CHD or one or two strokes of CHD.

Usually hyperlipidemias are classified as per the causes of occurrence.

Primary Hyperlipidemias are caused by either genetic factors or environmental factors   e.g.Hyperchylomicronemia;Hypercholesteremia;Hyperlipidemia and Hyperglyceridemia

Secondary Hyperlipidemias are caused by other metabolic disorders such as Diabetes,Hypothyroidism ,

Renal Desease,and Alcoholism.  

Treatments  

1.First intervention is food control and exercises.Relaxed Walkings,and very light Aerobic Exercises
2.Bile acid binding resins such as Cholestyramine and Colestipol
   Bile acids are acting by forming insoluble complexes with bile acids which are the cholesterol raw materials and the insoluble complexes lateron would be excreted in stools.
3.HMG CoA Reductase Inhibitors (HMGCAR) such as various statins.To study further about STATINS clic here.
4.Fibric Acid Derivative such as Clofibrate,Gemfibrozil.For Mechanisms of actions and Side effects please click on the hyperlinks
5.Niacin

Fish Oils

Fish oils especially from Cod and Salmon fish livers are major sources for unsaturated fatty acids such linolenic acid and omega 3 fatty acids such as eicosapentanoicacid(EPA) and docosohexanoicacid(DHA).These linonenic acid also acids  on consuming is converted into eicsapentanoicacid(EPA) and docosahexanoic acid (DHA).
Fish oils because of their omega 3 poly unsaturated fatty acids contents are believed to reduce the synthesis of VLDL-C and LDL-C but enhance the metabolism of VLDL-C to LDL-C and thereby increase the LDL-C paradoxically The effect on HDL-C is uncertain.
Fish oil treatments are of little value unless the patient has to consume twice or thrice diets contains fish in a weak.
But the fish oils are reducing the risk of CHD because of their anti arrhithmic effect and less because of their lipid lowering effect.
The EHA and DHA competes with arachidonic acid for cyclo oxigenase enzyme to form the more potent platlet anti aggregator thromboxane A3 by which the blood becomes more thinner to fecilitate the circulation and thereby reduce the risk of CHD

Fat Management Programmes

For a complete pharmacology of Fat management to down load into your computer please click here

See the following video

 

ConclutionTotal cholesterol along with LDL-C and Triglycerides should be controlled within the limits as they are major causes for the Coronary Heart Disease (CHD).

Smoking,Alcohol,Obesity,And Diabetes Mellitus should be avoided.CHD may lead to fatal Myocardial Infarction if left untreated. 

Do regular excercises especially a morning and evening walks.

Thank you. 

TOP 10 FRUITS FOR LOWERING BAD CHOLESTEROL

 1.Avocados a large berry type fruit with a central stone like seed is rich in Mono Unsaturated and Poly Unsaturated Fatty Acids very similar to olive fruits.Scientists beleive that 75% of the unsaturated fatty acids are responsible for reducing LDL cholesterol

AVOCADO

2.Apples are really wonderful and miraculous fruits to lower LDL bad cholesterol.The researchers from the Florida State University in 2011 explained this in The Experimental Biology Meeting in Washington DC.

3.Strawberrys are beleived to have good anti oxidant properties and a recent researches by some Italian scientists also proved that strawberries are powerfully reducing bad LDL cholesterol and triglycerides as they enriched with mono unsaturated and poly unsaturated fatty acids.

  4.Oranges are though not having cholesterol but they have good fiber contents which is responsible for lowering cholesterol.Eventhough oranges are not placed in the top ten fruits to lower the cholesterol it is of having high beneficial effects to reduce cardio vascular insufficency,coronery heart disease because of its antioxidant properties.Oranges are rich in vit-C,flavenoids and enormous fibers.

5.Pineapples are found to be good for reducing bad cholesterol.Pineapple is rich in vitamins,minerals and fibers.Its main cotent Bromelin is said to be good for digesting,assimilating and metabolising proteins and fats.It also prevent excess fats hovering into the blood.

6.Grapes are tasty sweet juicy fruit available as black and green grapes.Grapes contains a chemica known as Pterostilbene this can reduce bad cholesterol and triglycerides in the blood just as a priscription medicine known as Ciprofibrate according to Dr.Agnes Rimendo,Ph.D of Department Agricultures National Products Utilization Research centre in Oxford,Mississippi.

7.Pomegranate not only reduce bad cholestrol it also protects HDL from damage.This is very important to those who are under metabolic woes such as overweight,obesity,devolopimg DM in which there are unprotected good cholesterol like HDL.Paraoxonase an enzyme which is helping HDL to absorb LDL before it gets broken and thus protecting the arteriolar wall.Pomegranate as well as Grapes are acting through this enzyme.

8.Lemon contains pectin an enzyme which is good for reducing bad cholestero along with Vitamin-C a powerful anti oxident and fibers which makes Lemon is a perfect fruit in the fight for bad cholesterol.

9.Grape fruit is one kind of a citrus fruit,Like other citrus fruits such as orange ,and lemon grape fruit also contains pectin,Vit-C,and fibers to lower the bad Cholesterol

 

10.Blueberry is the fruit very similar in appearance and taste to grapes and hence they too have the wonderful cholesterol reducing enzyme Pterostilbene which work very similar to the commercially available cholesterol lowering drug Ciprofibrate said by Dr.Agnes Rimendo,Ph.D of Department Agricultures National Products Utilization Research centre in Oxford,Mississippi.Also the blueberrys are rich in Vit-C and fiber contents which are also help to reduce bad cholesterol in the blood.
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