International Data

What Say You?

How can we serve you better?

More content please... - 33.7%
A bit more pictures would be better - 19.4%
More up to date content - 12.3%
Nothing! your site is superb! - 34.6%

Hypertension

Introduction

What should I know about Hypertension?

When your doctor says you have high blood pressure, the medical name for your condition is "hypertension." Blood pressure is created when the heart beats, propelling blood throughout the body. Blood pressure occurs in two distinct phases, corresponding to the contraction and relaxation of the heart muscle. When the heart contracts, it ejects a certain volume of blood out from its right side into the body’s largest artery, the aorta. This initial thrust causes "systolic" blood pressure, which is the upper number of your blood pressure reading. As the heart relaxes, the blood presses against the walls of the arteries as it circulates, causing "diastolic" blood pressure, which is the lower number in your reading. Systolic blood pressure is a measure of the heart’s blood output, while diastolic is determined by the resistance of arteries in the extremities to the flow of blood. If your blood pressure reading is "120 over 80," this means your systolic pressure is 120 and your diastolic is 80.

Blood pressure tends to be lower in women than men, and higher in blacks than whites. It rises with age. Blood pressure generally stays within a fairly narrow range. But it does not stay the same at all times. Blood pressure fluctuates, rising during physical and emotional stress and falling when we are relaxed or asleep. Just because your blood pressure goes up temporarily when you are stressed, this does not mean you have hypertension.

Hypertension is a type of cardiovascular disease characterized by elevation of blood pressure above the level considered normal for people of similar racial and environmental backgrounds. (1) Because it affects the entire circulatory system, hypertension can be detrimental to all the major organs, including the heart, brain, and kidneys. It may contribute to death from heart failure, heart attacks, stroke, and even kidney failure. (2)

Hypertension has many possible causes. Hypertension that results from another disease is called "secondary hypertension." Fewer than 5 percent of people who suffer from hypertension have secondary hypertension, and in the majority of those, kidney disease in the cause. Other disorders known elevate blood pressure include thyroid disorders and Cushing’s disease, which is a disorder of the adrenal glands. Certain medications— nervous system stimulants, synthetic estrogen, and NSAIDs (nonsteroidal anti-inflammatory drugs), to name a few— sometimes contribute to hypertension.

Most people with chronic high blood pressure have hypertension have "primary" hypertension. Another name for this is "essential" hypertension. The exact cause of primary hypertension remains a mystery, although medical scientists are searching hard for answers. Research studies on hypertension have revealed detailed information about alterations in physiology that may lead to chronically elevated blood pressure. Researchers have zeroed in on the kidneys and their role in maintaining the right amount of sodium in the blood. By controlling retention of sodium and water, the kidneys play a major role in maintaining normal blood pressure.

Statistic

World health Organization, 2007.

  • World wide, high blood pressure is estimated to cause 7.1 million deaths, about 13% of the total and about 4.4% of the total disease burden. 
  • There are, by a conservative estimate, at least 600 million hypertension sufferers worldwide.

Malaysia Ministry of Health, 2002.

  • Prevalence of hypertension among adults aged 30 years and above was 29.9% equivalent to 2.19 million Malaysians in 1996.
  • By the year 2010, it is projected that 2.99 million Malaysians will have hypertension.

American Heart Association, 2002.

    High blood pressure (hypertension) killed 44,619 Americans in 2000 and contributed to the deaths of about 118,000. As many as 50 million Americans age 6 and older have high blood pressure. One in five Americans (and one in four adults) has high blood pressure. Of those people with high blood pressure, 31.6 percent don't know they have it. Of all people with high blood pressure, 14.8 percent aren't on therapy (special diet or drugs), 26.2 percent are on inadequate therapy, and 27.4 percent are on adequate therapy. The cause of 90–95 percent of the cases of high blood pressure isn't known; however, high blood pressure is easily detected and usually controllable. High blood pressure affects more than one out of every three African Americans.

Signs and Symptoms

The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.

Patients with uncomplicated, primary hypertension usually have no symptoms, at least initially. Often, it is not until damage to certain organs occurs that symptoms of high blood pressure begin to appear. The brain, heart, circulatory system, and kidneys are among the parts of the body first affected by high blood pressure. Often, patients with essential hypertension may only have elevated blood pressure, with all other portions of the physical examination appearing normal.

It should be emphasized that a single reading of high blood pressure does not indicate hypertension. If blood pressure readings taken on two or more subsequent days is 140/90 mm Hg or higher, then a diagnosis of hypertension can be confirmed. Some basic laboratory tests (addressed elsewhere in this monograph) should be performed before any medication is started.

Some of the target organs where changes are seen include the brain, heart, kidney, and eye. Hypertension, more than any other reason, causes individuals to develop the most common variety of stroke. The relationship between hypertension and atherosclerosis, coronary artery disease and congestive heart failure (CHF) has been clearly established in medical studies. CHF and myocardial infarction (heart attack) account for the majority of deaths caused by hypertension. Atherosclerosis and reduced kidney function occur to some degree in adults as a normal part of the aging process, but occur more rapidly in adults with mild to moderate hypertension. Hypertension can cause disturbances in vision due to a variety of retinopathies that develop from damage to the delicate blood vessels in the eye.

Uncomplicated, primary hypertension

  • Usually there are no symptoms initially
  • May present with only high blood pressure, with all other parts of a physical examination appearing normal
  • A blood pressure taken on two or more subsequent days is 140/90 mm Hg or higher
  • Hypertension can increase individuals to developing a stroke
  • Hypertension may accelerate certain diseases such as atherosclerosis, coronary artery disease, congestive heart failure and /or heart attack
  • May cause kidney diseases
  • May cause serious eye problems which may need immediate medical attention

Treatment Options

Conventional

Before prescribing a treatment plan, your doctor may ask if you are bothered by any of the following symptoms that could point to underlying cardiovascular disease: chest pain, palpitations, dizziness, dyspnea, slurred speech, orthopnea, and loss of balance.

An important part of the treatment plan is for you to check your blood pressure yourself. It is not difficult, anyone can be easily taught to take a blood pressure reading, and the equipment is not expensive.

Blood pressure lowering medications, called "antihypertensives" are divided into the following eight classes of drugs:

    Diuretics Beta blockers ACE inhibitors Calcium channel blockers Central alpha 2-agonists Adrenergic inhibitors Vasodilators Sympathetic inhibitors

Your health professional may also recommend diet and lifestyle changes to help bring your blood pressure under control.

Nutritional Suplementation


Coenzyme Q10 (CO-Q10)

CoQ10 is a vitamin-like nutrient found in virtually all plant and animal cells. All cells need energy to function, and they contain internal power plants to generate this energy. CoQ10 is required for these cellular generators to work. The heart, as the body’s hardest working muscle, is especially dependent on CoQ10, and the most vulnerable to CoQ10 deficiency. CoQ10’s supportive role in maintaining heart health has been tested in clinical trials showing that CoQ10 benefits people with heart failure. Blood pressure reductions have been seen in CoQ10 studies, allowing patients to cut down or even eliminate antihypertensive medications. (3) In one double-blind trial, people taking blood pressure-lowering drugs took CoQ10 daily for six weeks. Systolic and diastolic readings came down, along with increases in HDL cholesterol, vitamins A, C, E, and beta-carotene. (4)


Magnesium

Magnesium is an essential mineral that performs many important functions in the body. Working as a natural counterpart to calcium, magnesium plays a role in the cellular processes that allow smooth muscle tissue to contract and relax properly. Since all blood vessels walls contain smooth muscle, magnesium should in theory help maintain normal blood pressure. Double-blind studies bear this out, showing that magnesium lowers both systolic and diastolic blood pressure in patients with mild to moderate primary hypertension. (5) , (6) There are hints that magnesium might be used to enhance the effectiveness of existing antihypertensive medications. (7) Doses in the range of 300-600mg/day are frequently used.


Potassium

A large and growing body of scientific research, both from animal and human studies, strongly suggests that reducing salt and increasing potassium in the diet can help improve blood pressure and cardiovascular health. (8) Studies report that people consuming diets containing foods that are high in potassium have a lower incidence of hypertension. (9) Evidence suggests that people with primary hypertension can lower blood pressure and decrease their use of antihypertensive drugs. Potassium’s effect is considered moderate, and the people most likely to benefit are those whose diets are low in potassium. (10)


Vitamin C

A number of studies done through the 1980's and 90's have found a relationship between blood pressure and the amount of vitamin C in the blood. Low vitamin C intake and low vitamin C blood levels appear to favor increased blood pressure. (11) A double-blind study reported that giving vitamin C lowers blood pressure in patients with hypertension. (12) The recommended dose ranges from 500 to 1,000mg of vitamin C, 1 to 2 times daily.


Calcium

Calcium may have a mild blood pressure lowering effect, but not all the studies agree on this. On study found that 1000 mg of calcium a day lowered systolic and diastolic readings by 6 and 3, respectively--a modest, although not insignificant result. (13)


Omega-3 Fatty Acids

Omega-3 fatty acids are beneficial fats found in fish oils known to support cardiovascular health. The two major omega-3 fatty acids found in the diet, "EPA" and "DHA," have a mild blood pressure lowering effect. Researchers think these fatty acids help control formation of substances in cells that favor blood vessel contraction. (14) Several studies have reported that relatively large doses of omega-3 polyunsaturated fatty acids effectively lower blood pressure in people with mild hypertension. Maximum results generally take about two months. (15)

Herbal Suplementation


Coleus

Coleus is a relatively new medicinal herb in the United States, although it has been extensively researched in India over the last twenty years. Coleus contains an active ingredient called "forskolin" that stimulates production of "cyclic AMP" in cells. One of the body’s most important chemical messengers, cyclic AMP regulates many vital functions. To name just two of its jobs, cyclic AMP keeps the heart strong and regulates blood pressure. A number of studies show that forskolin has blood pressure-lowering and muscle relaxing properties. (16) , (17) Most of this research has been done using pure forskolin, but some evidence suggests the whole plant is actually more effective. Coleus extract standardized for forskolin is available as a dietary supplement.


Hawthorn

Hawthorn berries are an old favorite among herbalists as a heart tonic. Modern research has found that hawthorn stimulates circulation and relaxes blood vessels. (18) , (19) Doctors in Europe have used hawthorn extract for years to treat various cardiovascular and circulatory conditions. As a heart tonic, hawthorn seems to work especially well for elderly people with the beginnings of heart failure. Studies report that hawthorn lowers blood pressure in people with atherosclerosis (plaque buildup in the arteries) and chronic kidney trouble. (20) , (21) Hawthorn is also helpful for people with poor circulation in the extremities. Hawthorn contains bioflavonoids and other plant ingredients called "PCOs" that dilate blood vessels and help the heart beat with more force. Hawthorn also has a slight diuretic effect, which may help lower high blood pressure.


Garlic

Now widely popular for its cardiovascular benefits, garlic has been extensively researched in recent years. Studies show garlic lowers both blood cholesterol and triglycerides. (22) , (23) , (24) Garlic also inhibits platelet aggregation which translates to possible stroke prevention. (25) , (26) , (27) , (28) , (29) , (30) , (31) , (32) Aged garlic also has an antioxidant, free radical scavenging effect that has been found beneficial for preventing strokes and hardening of the arteries. (33)

To get these benefits, it is important to use a garlic product as unprocessed as possible. Heating and processing cane render garlic virtually ineffective. Garlic oil has little value. (34) The quality of garlic supplements varies greatly in the marketplace. The key benchmark of a garlic supplement is its ability to form "allicin" in the body. Allicin is a key compound in garlic that is formed when garlic cloves are crushed. A high "allicin potential" is considered indicative of a quality garlic product.

Diet & Lifestyle

The risk factors for hypertension are well known, and any treatment plan should begin with lifestyle changes. The risk factors we can control include obesity, cigarette smoking, alcohol consumption, and excessive salt intake.

Another useful lifestyle modification is a program of moderate exercise. Studies indicate that aerobic exercise such as walking, jogging, swimming, and bicycling can reduce blood pressure, even in the absence of weight loss. Patients should consult a physician before starting any exercise program.

Weight reduction: Several large studies have shown a direct connection between blood pressure and body mass. Weight gain in adult life especially seems to be an important hypertension risk factor. Weight loss is recommended for the obese hypertensive patient and has been shown to be the most effective non-drug treatment approach. A modest weight loss can normalize blood pressure levels even if the ideal weigh is not reached. Losing weight can help reduce the need for antihypertensive medications.

Reduce salt intake.

Identify and avoid allergy-causing foods.

References

  1. May DB, Young LY, Wiser TH. Essential Hypertension In: Koda-Kimble et al eds Applied Therapeutics: The Clinical use of Drugs, 4th ed. Vancouver, WA: Applied therapeutics; 1992:7-32.
  2. Hawkins DW, Bussey HI, Prisant LM. Hypertension In: DiPiro, et al, eds. Pharmacotherapy, A Pathophysiologic Approach, 4th ed. Stamford, CT: Appleton & Lange; 1999:131-151.
  3. View Abstract: Langsjoen P, et al. Treatment of essential hypertension with coenzyme Q10. Mil Aspects Med. 1994;15 Suppl:S265-72.
  4. View Abstract: Singh RB, et al. Effect of hydrosoluble coenzyme Q10 on blood pressures and insulin resistance in hypertensive patients with coronary artery disease. J Hum Hypertens. Mar1999;13(3):203-8.
  5. View Abstract: Widman L, et al. The dose-dependent reduction in blood pressure through administration of magnesium. A double blind placebo controlled cross-over study. Am J Hypertens. Jan1993;6(1):41-5.
  6. View Abstract: Geleijnse JM, et al. Reduction of blood pressure with oral magnesium supplementation in women with mild to moderate hypertension. Am J Clin Nutr. Jul1994;60(1):129-35.
  7. View Abstract: Wirell MP, et al. Nutritional dose of magnesium in hypertensive patients on beta blockers lowers systolic blood pressure: a double-blind, cross-over study. J Intern Med. Aug1994;236(2):189-95.
  8. View Abstract: Cutler JA. The effects of reducing sodium and increasing potassium intake for control of hypertension and improving health. Clin Exp Hypertens. Jul1999;21(5-6):769-83.
  9. View Abstract: Langford HG. Dietary potassium and hypertension: Epidemiologic data. Am Intern Med. 1983;98(2):770-772.
  10. View Abstract: Kawano Y, et al. Effects of potassium supplementation on office, home, and 24-h blood pressure in patients with essential hypertension. Am J Hypertens. Oct1998;11(10):1141-6.
  11. View Abstract: Ness AR, et al. Vitamin C and blood pressure--an overview. J Hum Hypertens. Jun1997;11(6):343-50.
  12. View Abstract: Duffy SJ, et al. Treatment of hypertension with ascorbic acid. Lancet. Dec1999;354(9195):2048-9.
  13. View Abstract: Olivan Martinez J, et al. Effect of an oral calcium supplement in the treatment of slight-to- moderate essential arterial hypertension. An Med Interna. Apr1989;6(4):192-6.
  14. View Abstract: Beilin LJ. Dietary fats, fish, and blood pressure. Ann N Y Acad Sci. Jun1993;683:35-45.
  15. View Abstract: Prisco D, et al. Effect of medium-term supplementation with a moderate dose of n-3 polyunsaturated fatty acids on blood pressure in mild hypertensive patients. Thromb Res. Aug1998;91(3):105-12.
  16. View Abstract: Bhat SV, et al. The Antihypertensive and Positive Inotropic Diterpene Forskolin: Effects of Structural Modifications on Its Activity. J Med Chem. 1983;26:486-92.
  17. View Abstract: Baumann G, et al. Cardiovascular Effects of Forskolin (HL 362) in Patients with Idiopathic Congestive Cardiomyopathy- A Comparative Study with Dobutamine and Sodium Nitroprusside. Cardiovasc Pharmacol. 1990;16(1):93-100.
  18. View Abstract: Schüssler M. Myocardial effects of flavonoids from Crataegus species. Arzneimittelforschung. Aug1995;45(8):842-5.
  19. View Abstract: Weikl A. Crataegus Special Extract WS 1442. Assessment of objective effectiveness in patients with heart failure (NYHA II). Fortschr Med. Aug1996;114(24):291-6.
  20. Racz-Kotilla E, et al. Salidiuretic and Hypotensive Action of Ribes-Leaves. Planta Medica. 1980;29:110-14.
  21. View Abstract: Garjani A. Effects of extracts from flowering tops of Crataegus meyeri A. Pojark. on ischaemic arrhythmias in anaesthetized rats. Phytother Res. Sep2000;14(6):428-31.
  22. Ernst E. Cardioprotection and Garlic. Lancet. 1997;349(9045):131.
  23. View Abstract: Steiner M, et al. A Double-blind Crossover Study in Moderately Hypercholesterolemic Men that Compared the Effect of Aged Garlic Extract and Placebo Administration on Blood Lipids. Am J Clin Nutr. 1996;64(6):866-70.
  24. View Abstract: Agarwal KC. Therapeutic Actions of Garlic Constituents. Med Res Rev. 1996;16(1):111-24.
  25. Fogarty M. Garlic's Potential Role in Reducing Heart Disease. Br J Clin Pract. 1993;47(2):64-65.
  26. View Abstract: Orekhov AN, et al. Direct Anti-atherosclerosis-related Effects of Garlic. Ann Med. 1995;27(1):63-65.
  27. View Abstract: Kiesewetter H, et al. Effect of Garlic on Platelet Aggregation in Patients with Increased Risk of Juvenile Ischaemic Attack. Eur J Clin Pharmacol. 1993;45(4):333-36.
  28. View Abstract: Bordia A. Effect of Garlic on Blood Lipids in Patients with Coronary Heart Disease. Am J Clin Nutr. 1981;34(10):2100-03.
  29. Bordia A, et al. Protective Effect of Garlic Oil on the Changes Produced by 3 Weeks of Fatty Diet on Serum Cholesterol, Serum Triglycerides, Fibrinolytic Activity and Platelet Adhesiveness in Man. Indian Heart J. 1982;34(2):86-88.
  30. View Abstract: Kendler BS. Garlic (Allium sativum) and Onion (Allium cepa): A Review of Their Relationship to Cardiovascular Disease. Prev Med. 1987;16(5):670-85.
  31. View Abstract: Arora RC, et al. The Long-term Use of Garlic in Ischemic Heart Disease - An Appraisal. Atherosclerosis. 1981;40(2):175-79.
  32. View Abstract: Koscielny J, et al. The Antiatherosclerotic Effect of Allium sativum. Atherosclerosis. May1999;144(1):237-49.
  33. View Abstract: Ide N, et al. Aged Garlic Extract Attenuates Intracellular Oxidative Stress. Phytomedicine. May1999;6(2):125-31.
  34. Garlic Oil: No Impact on Lipids. Harv Heart Lett. Sep1998;9(1):6.