Role of High Blood Pressure In Heart attack:

What makes high blood pressure important is that initially it may cause no symptoms but can still cause serious long-term complications.

• Many people have high blood pressure and don't even know it.
  
  
• The key complications of high blood pressure include heart disease, heart attack, congestive heart failure, stroke, kidney failure, peripheral artery disease, and aortic aneurysms (outpouchings of the aorta).
  
  
• Public awareness of these dangers has increased. High blood pressure has become the second most common reason for medical office visits in the United States.

Blood pressure is measured with a blood pressure cuff and recorded as two numbers, such as 120/80 mm Hg (millimeters of mercury).

• The top, larger number is called the systolic pressure. This is the pressure generated when the heart contracts (pumps). It reflects the pressure of the blood against arterial walls.
  
  
• The bottom, smaller number is called the diastolic pressure. This reflects the pressure in the arteries while the heart is filling and resting between heartbeats.

Scientists have determined a normal range for both systolic and diastolic blood pressure after examining the blood pressure of many people.

• Those whose blood pressure is consistently higher than this norm are said to have high blood pressure or hypertension.
• High blood pressure in adults is defined as a consistently elevated blood pressure of 140 mm Hg systolic and 90 mm Hg diastolic or higher.
• Uncontrolled high blood pressure is indirectly responsible for many deaths and disability resulting from heart attack, stroke, and kidney failure.
• According to research studies, the risk of dying of a heart attack is directly linked to blood pressure, especially systolic hypertension. The higher your blood pressure, the higher your risk, even with blood pressure in the normal range.
• However, the progress of heart disease caused by high blood pressure can be slowed down.

High Blood Pressure Causes

In about 10% of people, high blood pressure is caused by another disease (this is called secondary hypertension). In such cases, when the root cause is treated, blood pressure usually returns to normal. These causes of secondary hypertension include the following conditions:

• Chronic kidney disease
  
  
• Tumors or other diseases of the adrenal gland
  
  
• Coarctation of the aorta - A narrowing of the aorta that you are born with that can cause high blood pressure in your arms
  
  
• Pregnancy
  
  
• Use of birth control pills
  
  
• Alcohol addiction
  
  
• Thyroid dysfunction

In the other 90% of cases, the cause of high blood pressure is not known (referred to as primary hypertension). Although the specific cause is unknown, certain factors are recognized as contributing to high blood pressure.

Factors that can't be changed

• Age: The older you get, the greater the likelihood that you will develop high blood pressure, especially systolic, as your arteries get stiffer. This is largely due to arteriosclerosis, or "hardening of the arteries."
  
  
• Socioeconomic status: High blood pressure is also more common among the less educated and lower socioeconomic groups.
  
• Family history (heredity): The tendency to have high blood pressure appears to run in families.
  
  
• Gender: Generally men have a greater likelihood of developing high blood pressure than women. This likelihood varies according to age and among various ethnic groups.

Factors that can be changed

• Overweight (obesity): Obesity is defined as having a body mass index (BMI) greater than 30 kg/m2. It is very closely related to high blood pressure. Medical professionals strongly recommend that all obese people with high blood pressure lose weight until they are within 15% of their healthy body weight. Your health care provider can help you calculate your BMI and healthy range of body weight.
  
  
• Sodium (salt) sensitivity: Some people have high sensitivity to sodium (salt), and their blood pressure goes up if they use salt. Reducing sodium intake tends to lower their blood pressure. Fast foods and processed foods contain particularly high amounts of sodium. Many over-the-counter medicines, such as painkillers, also contain large amounts of sodium. Read labels to find out how much sodium is contained in food items. Avoid those with high sodium levels.
  
  
• Alcohol use: Drinking more than one to two drinks of alcohol per day tends to raise blood pressure in those who are sensitive to alcohol.
  
  
• Birth control pills (oral contraceptive use): Some women who take birth control pills develop high blood pressure.
  
  
• Lack of exercise (physical inactivity): A sedentary lifestyle contributes to the development of obesity and high blood pressure.
  
  
• Drugs: Certain drugs, such as amphetamines (stimulants), diet pills, and some pills used for cold and allergy symptoms, tend to raise blood pressure.

As body weight increases, the blood pressure rises.

• Obese people are two to six times more likely to develop high blood pressure than people whose weight is within a healthy range.
  
  
• Not only the degree of obesity is important, but also the manner in which the body accumulates extra fat. Some people gain weight around their belly (central obesity or "apple-shaped" people), while others store fat around their hips and thighs ("pear-shaped" people). "Apple-shaped" people tend to have greater health risks than "pear-shaped" people.

High Blood Pressure Symptoms

High blood pressure usually causes no symptoms.

• Even if high blood pressure does cause symptoms, the symptoms are usually mild and nonspecific (vague, or suggesting many different disorders).
  
  
• Thus, 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 high blood pressure have the following symptoms:

• Headache
• Dizziness
• Blurred vision
• Nausea

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 "mini stroke" (transient ischemic attack, TIA)
• Kidney failure
• Eye damage with loss of vision
• Peripheral arterial disease
• 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, light-headedness, or nausea.
  
  
• This degree of high blood pressure requires emergency hospitalization 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.

Self-Care at Home

The management and control of high blood pressure involves two major options, lifestyle modification (detailed here) and medications (detailed in Treatment).

• Lifestyle options include changing what you eat and your activity level.
• Quitting smoking and moderating alcohol consumption will also help keep your blood pressure in the healthy range.

Maintain a healthy weight.

• If you are overweight or obese, lose weight. Aim for a healthy weight range for your height and body type. Your health care provider can help you calculate a target weight.
• Even a small amount of weight loss can make a major difference in lowering or preventing high blood pressure.
• To lose weight, you must burn more calories than you take in.
• Crash or fad diets are not helpful and may be dangerous.
• Some weight loss medications also carry major risks and may even elevate blood pressure, and great caution is advised in using these drugs.
• The healthiest and longest-lasting weight loss requires slow loss, such as losing one-half to one pound each week. Eating 500 calories less than you burn every day may help achieve this goal. In a week, you will eat 3500 calories less than you burn, which is enough to lose one pound.
• Increasing your physical activity will help you burn more calories.

Lose weight and keep it off.

• Choose foods low in calories and fat. Fat is a concentrated source of calories. You should cut down on butter, margarine, regular salad dressing, fatty or red meats, the skin of poultry, whole milk, cheese, fried foods, ice cream, many cookies, cakes, pastries, and snacks.
• Choose foods high in starch and fiber: These foods are low in fat and also good sources of vitamins and minerals. Try fruits, vegetables, whole-grain cereals, whole wheat pasta, rice, and dry peas and beans.
• Limit serving sizes: You should especially try to take smaller helpings of high-calorie foods such as meats and cheeses. Try to avoid the temptation of going back for seconds.
• Write down what you eat and when: It may be helpful to track your habits. You should note where you are and what you are doing when you snack on high-calorie foods. For instance, many people snack while watching television. Or do you skip breakfast and then eat a large lunch? Identifying your eating patterns can help you overcome the situations in which you overeat.
• Replace high-calorie, high-fat snacks with fresh fruits, air-popped popcorn (without salt or butter), or unsalted pretzels. If there is no time for breakfast, take a low-fat muffin, a bagel (without cream cheese), or whole-grain cereal along to eat at work. This will reduce the craving for a large lunch.

Exercise or increase physical activity.

• Physical activity burns calories, helps you lose weight, and reduces stress.
  
  
• Physical activity reduces total cholesterol and bad cholesterol (LDL) and raises the good cholesterol (HDL).
  
  
• At least 30 minutes of exercise every other day for cardiovascular fitness. The Surgeon General recommends 30 minutes of physical activity on most days of the week.
  
  
• Physical activity doesn't have to mean running a marathon. House cleaning or playing golf or baseball can burn as many as 300 calories per hour; brisk walking (at 3.5 mph), cycling (at 5.5 mph), gardening, dancing, or playing basketball burns as many as 450 calories per hour; jogging (9 min/mile), playing football, or swimming can burn as many as 730 calories per hour; and running (7 min/mile), racquetball, or skiing can burn as many as 920 calories per hour.
  
  
• You can fit physical exercise into your daily routine.
  
  
  • Use the stairs instead of the elevator.
    
    
  • Get off the bus one or two stops early and walk the rest of the way.
    
    
  • Park farther away from the store or office.
    
    
  • Ride a bike.
    
    
  • Work in the yard or garden.
    
    
  • Clean house.
    
    
  • Wash the car the old-fashioned way.
    
    
  • Go dancing.

General tips for controlling blood pressure include the following:

• Reduce sodium (salt) intake.
  
  
• Limit alcohol (If possible avoid it).
  
  
• Quit smoking.
  
  
• Take medicines as directed.

Medication is an important part of blood pressure control for almost everybody with high blood pressure. Many people cannot keep their blood pressure in the healthy range by lifestyle changes alone.

• Only 21% of people with high blood pressure are on blood pressure medicines and have their pressure adequately controlled.
  
  
• At least 16% of people with high blood pressure are not on any medication.
  
  
• Approximately 28% are taking medicines incorrectly, and their blood pressure is uncontrolled.
  
  
• Therefore, the biggest challenge in the treatment of high blood pressure is taking the medication correctly.

To be cont.....