HYPERTENSION

Hypertension (high blood pressure) is defined as having a blood pressure higher than 140 over 90 mmHg, with a consensus across medical guidelines.

This means the systolic reading (the pressure as the heart pumps blood around the body) is over 140 mmHg (millimeters of mercury) and/or the diastolic reading (as the heart relaxes and refills with blood) is over 90 mmHg.This threshold has been set to define hypertension for clinical convenience as patients experience benefits once they bring their blood pressure below this level.

However, medical experts consider high blood pressure as having a continuous relationship to cardiovascular health. They believe that, to a point, the lower the blood pressure the better (down to levels of 115-110 mmHg systolic, and 75-70 mmHg diastolic)

This view has led the American Heart Association (AHA), for example, to define the following ranges of blood pressure (in mmHg):

• Normal blood pressure is below 120systolic and below 80 diastolic
• Prehypertension is 120-139systolic or 80-89 diastolic
• Stage 1 high blood pressure (hypertension) is 140-159systolic or90-99 diastolic
• Stage 2 high blood pressure (hypertension) is 160or higher systolic or 100 or higher diastolic
• Hypertensive crisis (a medical emergency) is when blood pressure is above 180systolic or above 110

About 33% urban and 25% rural Indians are hypertensive. Of these, 25% rural and 42% urban Indians are aware of their hypertensive status. Only 25% rural and 38% of urban Indians are being treated for hypertension. One-tenth of rural and one-fifth of urban Indian hypertensive population have their BP under control.

The number of people living with hypertension (high blood pressure) is predicted to be 1.56 billion worldwide by the year 2025.

The increasing prevalence of the condition is blamed on lifestyle and dietary factors, such as physical inactivity, alcohol and tobacco use, and a diet high in sodium (usually from processed and fatty foods).

Fast facts on hypertension

Here are some key points about hypertension. More detail and supporting information is in the body of this article.

• Hypertension is defined as blood pressure higher than 140 over 90 mmHg (millimeters of mercury).
• A diagnosis of hypertension may be made when one or both readings are high: systolic (the pressure as the heart pumps blood around the body), given first; or diastolic (pressure as the heart relaxes and refills with blood), given second.
• Modern lifestyle factors are responsible for a growing burden of hypertension: physical inactivity, salt-rich diets with processed and fatty foods, and alcohol and tobacco use.
• High blood pressure can also be secondary to other conditions – kidney disease, for example – and can be associated with some medications.
• Hypertension itself does not cause symptoms but in the long-term leads to complications caused by narrowing of blood vessels.
• Doctors diagnose high blood pressure over a number of visits using a sphygmomanometer, which involves applying an inflatable cuff to the upper arm.
• Lifestyle measures are used first to treat high blood pressure, including salt restriction and other dietary changes, moderation of alcohol, and stress reduction.

Causes of hypertension:

As acute stress, intense exercise and other factors can briefly elevate blood pressure even in people whose blood pressure is normal, a diagnosis of hypertension requires several readings showing high blood pressure over time.

Having high blood pressure for a short amount of time is a normal physiological response to many situations. However, a systolic reading of 180 mmHg or higher OR a diastolic reading of 110 mmHg or higher could be a sign of a hypertensive crisis that warrants immediate medical attention.

Anyone who gets such a reading when testing their own blood pressure should wait a couple of minutes and repeat the test. If the reading remains at that level or increases, seek emergency medical treatment (call an ambulance or have someone drive you to the hospital immediately.

Blood pressure does vary throughout the day, lowering during sleep and rising on awakening. It also rises in response to excitement, anxiety and physical activity.

Blood pressure also increases steadily with age as arteries become stiffer and narrower due to plaque build-up. Vascular and heart disease also contribute to rising blood pressure in older adults, and a high systolic reading is a major risk factor for cardiovascular disease in adults over 50 years old.

The disease burden of high blood pressure is a growing problem worldwide, in part because of a rapidly aging population. Other key contributors include lifestyle factors, such as:

• Physical inactivity
• A salt-rich diet associated with processed and fatty foods
• Alcohol and tobacco use.

Certain diseases and medications (as described below) can cause high blood pressure, and there are a number of general risk factors for hypertension, including:

• Age – everyone is at greater risk of high blood pressure as they get older. Prevalence of hypertension is higher in people over 60 years of age
• Race – African-American adults are at higher risk than white or Hispanic American adults
• Size – being overweight or obese is a key risk factor for hypertension
• Sex – males and females have different risk profiles. While lifetime risk is the same for everybody, men are more prone to hypertension at a younger age and women have a higher rate of hypertension at older ages
• Lifestyle – greater intake of dietary salt, excessive alcohol, low dietary potassium, and physical inactivity all contribute to an increased risk of hypertension.

Other risk factors include a family history of the disease, and chronic, poorly managed stress.

Specific causes of hypertension:

High blood pressure that is not caused by another condition or disease is termed primary hypertension (or essential hypertension). This is more common than secondary hypertension, which has an identified cause such as chronic kidney disease.

Primary hypertension is unlikely to have a specific cause but is instead usually a result of multiple factors, including blood plasma volume and activity of the renin-angiotensin system, the hormonal regulator of blood volume and pressure. Primary hypertension is also influenced by environmental factors, including lifestyle-related issues as outlined above.

Secondary hypertension has specific causes – that is, it is secondary to another problem. One example, now thought to be one of the most common causes of treatment-resistant hypertension, is primary aldosterone, a hormone disorder causing an imbalance between potassium and sodium levels, thus leading to high blood pressure.

Primary aldosterone may account for some 5-15% of cases of hypertension. It is important that physicians determine if the condition is caused by hyperplasia of the adrenal gland(s) or an adrenal gland tumor as treatments differ between the two.

Common reversible causes are excessive intake of alcohol and use of oral contraceptives, which can cause a slight rise in blood pressure; hormone therapy for menopause is also a culprit.

Secondary hypertension can also result from:

• Diabetes(both due to kidney problems and nerve damage)
• Kidney disease
• Pheochromocytoma (a cancer)
• Cushing syndrome (which can be caused by use of corticosteroid drugs)
• Congenital adrenal hyperplasia (disorder of the adrenal glands, which secrete the hormone cortisol)
• Hyperthyroidism(overactive thyroid gland).
• Hyperparathyroidism (which affects calciumand phosphorous levels)
• Pregnancy
• Sleep apnea
• Obesity.

Symptoms of hypertension:

High blood pressure itself is usually asymptomatic, meaning that patients do not experience any direct symptoms of the condition. This is why hypertension is often referred to as “the silent killer,” as it can quietly cause damage to the cardiovascular system.

Hypertension can also lead to problems in the organs affected by high blood pressure. Long-term hypertension can cause complications through arteriosclerosis, where the formation of plaques results in narrowing of blood vessels.

The complications associated with hypertension-related arteriosclerosis can include:

• An enlarged or weakened heart, to a point where it may fail to pump enough blood (heart failure)
• Aneurysm– an abnormal bulge in the wall of an artery (which can burst, causing severe bleeding and, in some cases, death)
• Blood vessel narrowing – in the kidneys this can lead to possible kidney failure; in the heart, brain and legs, this can lead to heart attack, stroke or the need for amputation, respectively
• Blood vessels in the eyes may rupture or bleed, leading to vision problems or blindness.

The reliability of blood pressure readings may be improved by having a patient or someone else take a series of measurements outside the doctor’s office using standardized devices.

We have more detailed information about measuring blood pressure.

In addition to measuring blood pressure using sphygmomanometer, a doctor will take a history (ask questions, such as about cardiovascular problems) and do a physical examination before diagnosing hypertension.

These questions and additional tests can help to identify the cause of high blood pressure and determine whether there have been any complications. Such tests may include urine tests, kidney ultrasound imaging, blood tests, an electrocardiogram (ECG) and/or an echocardiograph.

Measures to reduce blood Pressure:

Lifestyle changes are important for both treatment and prevention of high blood pressure, and they can be as effective as a drug treatment. These lifestyle changes can also have wider benefits for heart health and overall health.

The lifestyle measures shown to reduce blood pressure and recommended by experts include:

• Salt restriction– typical salt intake is between 9 and 12 g day and modest blood pressure reductions can be achieved even in people with normal levels by lowering salt to around 5 g a day – the greatest effects are seen in people with hypertension.
• Moderation of alcohol consumption– expert guidelines say moving from moderate to excessive drinking is “associated both with raised blood pressure and with an increased risk of stroke”
• High consumption of vegetables and fruits and low-fat– people with, or at risk of, high blood pressure are advised to minimize intake of saturated fat and total fat and to eat whole-grain, high-fiber foods, at least 300 g of fruit and vegetables a day, beans, pulses, and nuts, and omega-3-rich fish twice a week.
• Reducing weight and maintaining it– hypertension is closely correlated with excess body weight, and weight reduction is followed by a fall in blood pressure.
• Regular physical exercise– guidelines say “hypertensive patients should participate in at least 30 min of moderate-intensity dynamic aerobic exercise (walking, jogging, cycling or swimming) on 5 to 7 days a week”.
• Stress reduction– avoiding sources of stress, where possible, and developing healthy coping strategies for managing unavoidable stress can help with blood pressure control, especially as many people turn to alcohol, drugs, smoking and unhealthy foods or overeating to cope with stress.

Smoking can also raise blood pressure, and because of its wider effects on heart health and the rest of the body, giving up smoking is highly recommended for people with high blood pressure.

Dietary recommendations for Hypertension:

10 fruits and vegetables those are good for people with hypertension:

Naturally available fresh fruits and vegetables are the best bet to prevent and control your high blood pressure levels.

Here is a list of easily available fruits and veggies that will help you out in lowering your raised blood pressure with no side effects.

Five tasty fruits to beat hypertension

Bananas – Bananas are the most common and easily available fruits that are loaded with potassium, a mineral whose shortage is found to trigger hypertension. Also, potassium is found to flush out the harmful effects caused by excess of sodium by acting as a powerful diuretic agent thereby preventing as well as lowering blood pressure.

Citrus fruits – Citrus fruits such as oranges, grapefruit, etc. are full of phytonutrients and bioflavonoids along with possessing high levels of potassium, vitamin and dietary fiber. These fruits not only exert anti-inflammatory effect but also help in lowering cholesterol levels as well as high blood pressure levels.

Papaya – This fruit not only contains good quantities of potassium and magnesium but is also rich in flavonoids, which quantitatively result in decreasing your hypertension.

Berries – Blueberries, raspberries and strawberries are packed with potassium and anthocyanin (flavonoid compound) that not only cut the risk of hypertension but also lowers high blood pressure levels in the body.

Avocado – Avocados contain potassium that regulates sodium-potassium balance in addition to a fatty alcohol called avocadoes that is found to be effective in decreasing your high blood pressure levels.

Five healthy Veggies for hypertensive:

Potatoes – Potatoes as well as sweet potatoes are low in sodium content and high in potassium making them a perfect food for reducing the raised blood pressure levels. Also, magnesium present in good quantities helps in promoting proper blood flow and maintenance of proper mineral balance in the body.

Leafy veggies – Many dark green and leafy veggies like spinach, lettuce and spring greens are found to be high in magnesium, dietary fiber and potassium; which act collectively in maintaining blood pressure levels to normal.

Beetroot – It is been reported that a glass of beet juice has the power to reduce your blood pressure levels in a span of few hours after consumption. This is because, it is rich in nitrate and potassium that are the key factors responsible for control of hypertension.

Peas and beans – While soybeans are excellent source of the two important blood pressure lowering minerals namely potassium and magnesium, proteins present in peas are found to exert blood pressure lowering effect in the body.

Radish – Antihypertensive properties of radish are found to be in its leaves in the form of ethyl acetate. Studies have also reported the constant use of its leaves is found to be very effective in controlling your blood pressure.

The DASH diet

The US National Heart Lung and Blood Institute recommend the DASH diet for people with high blood pressure.

Standing for Dietary Approaches to Stop Hypertension, DASH has been specially formulated to help people lower blood pressure. It is a flexible and balanced eating plan based on research studies sponsored by the institute, which says the diet:

• Lowers high blood pressure
• Improves levels of blood lipids (fats in the bloodstream)
• Reduces the risk of developing cardiovascular disease.

There is a National Institute cookbook called Keep the Beat Recipes with cooking ideas to help achieve these results.

There is some evidence that probiotic supplements may be beneficial for people with hypertension. A review of studies found that people taking a multistrain probiotic formula containing at least 10 billion colony-forming units every day for at least 8 weeks had significant decreases in systolic and diastolic blood pressure, with the greatest effects seen in people with hypertension at the beginning of the study.

No significant effects were seen when people took probiotics for less than 8 weeks, however.

Once diagnosed with high blood pressure, your doctor may recommend the DASH (Dietary Approaches to Stop Hypertension) eating plan, which focuses on heart-healthy foods that are low in fat, cholesterol, and sodium, and rich in nutrients, protein, and fiber.

Foods may include the following:

• Fruits
• Vegetables
• Whole grains
• Low-fat dairy products
• Fish
• Poultry
• Nuts

DASH limits the following:

• Red meats (including lean red meats)
• Sweets
• Added sugars
• Sugar-containing drinks

Foods to be avoided in Hypertension:

Salt:
Generally we consume more salt in our diet than what is required. Even a small reduction in the amount of salt can reduce the blood pressure to a considerable extent. Consumption of excess salt in food increases the chances of damage to the heart by increasing the hypertension.

Ideally, the daily sodium intake should not be more than 2400mg/day limiting the salt intake to 6g/day. This includes all salt and sodium consumed, including that used in cooking and at the table. Always check the food label on any food product to find the total sodium present in the food. Use fewer sauces, mixes and instant foods which include flavored rice, pasta and noodles that has sufficient amount of salt added in it.

Avoid adding salt on top of any food like fruits or salads, while kneading the chapatti dough, cooking rice, etc. The use of table salt should be completely restricted. You can use other flavoring ingredients in the food like lemon, tamarind, spices, herbs, etc.

Pickles and papad:
Too much of salt goes in while preparing pickles or papads. Salt preserves the pickle and increases its shelf life, on the contrary, decreases ours! Soda added to the papads proves to be the hidden source of sodium.

Canned fruits and vegetables:
In order to avoid rise of blood pressure, try restricting the consumption of canned foods. Brine is used to preserve the vegetable. Make sure you rinse them thoroughly before consumption to get rid of extra salt. Also boiling of salted or brined vegetables for at least 10 mints before consumption would help to reduce the sodium intake considerably. Even fruits are canned along with acid regulators which are sodium salts of different compounds. These foods prove to be the hidden sources of sodium.

Processed foods:
In recent times, due to changing lifestyles we are very much dependent on processed and ready-to-eat foods. It is important to avoid processed or packed foods as they are high in salt, preservatives (hidden source of sodium,) fats and are deficient in one or more essential nutrients. E.g.: Ready-to-make soups.

Bakery products:
Packed with salted saturated fats, sodium rich leavening agents (baking powder, soda bicarb). This can lead to increase in blood pressure and also obesity which aggravates the problem further.

Sugar:
Sugar and other sweets from sugar like sweets, candies, pastries, cakes, etc. should be avoided as they all in excess lead to obesity. Many researches have proven that obese individuals are more prone to develop hypertension.

Fats:
Excess consumption of fats leads to obesity which in turn leads to high blood pressure. The consumption of saturated and Trans fats in the diet should be avoided. All fried food stuffs, butter, margarine, coconut oil, etc. should be consumed in minimal amounts.

Alcohol:
Alcohol damages the artery walls giving rise to hardening and narrowing of the arteries, which is called arteriosclerosis. This leads to blood flowing in the arteries with much high pressure, giving rise to hypertension.

Caffeine:
Reduce the intake of caffeine products like cocoa, coffee or some soft drinks as these being stimulants give rise to instant spike in blood pressure. Caffeine acts as a vasoconstrictor, i.e. it narrows the arteries increasing the pressure of blood flow. Limit the intake of coffee to 2 cups a day only.

References:

http://www.medicalnewstoday.com/articles/150109.php
http://www.everydayhealth.com/high-blood-pressure/guide/diet/
http://www.thehealthsite.com/diseases-conditions/food-for-hypertension-high-bp/
http://timesofindia.indiatimes.com/life-style/health-fitness/diet/Foods-to-avoid-in-hypertension/articleshow/19797814.cms