Blood pressure depends on cardiac output, blood volume and peripheral resistance. BP is regulated by many mechanisms, which include the nervous system which is involved with a body system that controls the degree of constriction of blood vessels. If constriction increases too much this increases peripheral resistance. Capillary fluid can move in and out of arteries however this process can take a multiple hours to adjust and therefore may not be suited to the current blood pressure at any one time. Kidney excretion controls the amount of urine the body produces. If a lot of urine is produced the blood pressure can fall however if the kidney retains water and the patient does not go to the toilet as often, the blood pressure can rise. Hormonal changes can control the amount of sodium release. If a lot of sodium is released then water will follow it due to osmosis, decreasing blood pressure.
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Causes may include
Aortic aneurysm
- Increase in systolic
- Not diastolic
Atherosclerosis
- Increase in systolic
- Not diastolic
Cushings syndrome
- More common in females
- Caused by CCS use
Hypertension
Essential hypertension may be asymptomatic with an increase in BP of decades
Increased intracranial pressure
- Increased systolic pressure
- Increased respiratory rate initially
Myocardial infarction
Pheochromocytoma
Polycystic kidney disease
Preeclampsia or eclampsia
Renovascular stenosis
Elevated systolic and diastolic
Thyrotoxicosis
Drugs
- CNS stimulants
- Sympathomimetics - CCS - MAOI’s - Cocaine
Herbs
- Ephedra
- Ginseng
- Licorice
- St John’s Wort
Treatments
- Kidney dialysis
- Transplantation
Whatever the cause of hypertension is, the important thing is make positive changes to lifestyle or therapy to decrease blood pressure and increase control. This would lower your health risks and increase your quality of life.
Paediatrics
Generally children have lower blood pressure than adults. Therefore if elevated levels are seen, other causes should be considered.
- Lead poisoning
- Mercury poisoning
- Renovascular stenosis
- Pyelonephritis
- Adrenogenital syndrome
- Neuroblastoma
Kowalak, J and Hughes, A (2002) Handbook of Signs and Symptoms 2nd Ed. (Page 77-82) Library of Congress Lippincott and Williams and Wilkins
Hypertensive Crisis
Causes - Abnormal Renal fn - Hypertensive encephalopathy - Intracerebral haemorrhage - HF - Abrupt withdrawl of hypertensive drugs - MAOI interactions - Eclampsia - Myocardial ischemia - Phenochromocytoma Which leads to Prolonged hypertension Inflammation and necrotic arterioles Narrowed blood vessels Restricted blood flow to organs Damage of organs 1. Renal 2. Cardiac 3. Cerebral
Considerations
What to do to help lower high blood pressure
Encourage dietary change
Consume less sodium foods (Link) Foods that are high in sodium include: These foods should be consumed minimally as there is a recognised relationship between the amount of salt intake and hypertension
Change lifestyle
- less stress
- more exercise
- An exercise regime should be developed that is realistic. Light exercise should be tackled to begin with.
- Aiming to achieve a BMI of between 18.5 – 24.9 kg/m2
Compliance
It is important to take medications as directed, even if you are feeling fighting fit. Hypertension often has no symptoms
Smokers
Smokers are encouraged to quit smoking. This decreases the risk of having a stroke even when hypertension remains. Smoking leads to many health risks and is therefore quitting smoking is recommended for everyone, not only if you have hypertension.
Drinking
Drinkers should be encouraged to decrease their alcohol consumptions to decrease the pressure on the arteries. No more than 2 standard alcoholic drinks per day is recommended
Public awareness education programs
Family history
If a close family member has experienced high blood pressure then you have a greater chance of also suffering from high blood pressure. Ensure you arrange regular check ups with your health professional.