TAKE CARE—– DEAR HEART

Blood pressure is a measurement of the force exerted against the walls of your arteries as your heart pumps blood to your body. Normal blood pressure is when your blood pressure is lower than 120/80 mm Hg most of the time.
Hypertension: High blood pressure, defined as a repeatedly elevated blood pressure exceeding 140 over 90 mmHg — a systolic pressure above 140 or a diastolic pressure above 90.
Chronic hypertension is a “silent” condition. Stealthy as a cat, it can cause blood vessel changes in the back of the eye (retina), abnormal thickening of the heart muscle, kidney failure, and brain damage.
For diagnosis, there is no substitute for measurement of blood pressure. Not having your blood pressure checked (or checking it yourself) is an invitation to hypertension.
No specific cause for hypertension is found in 95% of cases.
Hypertension is treated with regular aerobic exercise, weight reduction (if overweight), salt restriction, and medications..

Causes
Many factors can affect blood pressure, including:
• The amount of water and salt in body
• The condition of kidneys, nervous system, or blood vessels
• Hormone levels
The blood pressure increases with age advancement ,this is because the blood vessels become stiffer as the age advances. High blood pressure increases the chance of having a stroke, heart attack, heart failure, kidney disease, or early death.
Risk factors
• African Americans
• Obese patients
• Stress or anxiety
• Alcoholics (more than 1 drink per day for women and more than 2 drinks per day for men)
• Excess salt intake
• Family history of high blood pressure
• Diabetes
• Smoking
Most of the time, no cause of high blood pressure is found. This is called essential hypertension.
High blood pressure that is caused by another medical condition or medications called secondary hypertension. Secondary hypertension may be due to:
• Chronic kidney disease
• Disorders of the adrenal gland (such as pheochromocytoma or Cushing syndrome)
• Hyperparathyroidism
• Pregnancy or preeclampsia
• Medicines such as birth control pills, diet pills, some cold medicines, and migraine medicines
• Narrowed artery that supplies blood to the kidney (renal artery stenosis)

Symptoms
Most of the time, there are no symptoms. For most people, high blood pressure is found when they visit their health care provider or have it checked elsewhere.
Because there are no symptoms, people can develop heart disease and kidney problems without knowing they have high blood pressure.
Malignant hypertension is a dangerous form of very high blood pressure. Symptoms may include:
• Severe headache
• Nausea and vomiting
• Confusion
• Vision changes
• Nosebleeds
Exams and Tests
Diagnosing high blood pressure early can help prevent heart disease, stroke, eye problems, and chronic kidney disease.
Adults aged 18 to 39 years should have their blood pressure checked:
• Every 3 to 5 years, if their blood pressure was less than 120/80 mm Hg at their most recent reading.
• Every year if you have high blood pressure, diabetes, heart disease, kidney problems, or certain other conditions, have your blood pressure checked more often.

Adults aged 40 and over should have their blood pressure checked at least once every year.
Blood pressure readings taken at home may be a better measure of your current blood pressure than those taken at your provider’s office.
• A good quality, well-fitting home blood pressure monitor should be used. It should have the proper sized cuff and a digital readout.
• Patient should be relaxed and seated for several minutes prior to taking a reading.

Tests may also be done to look for:
• High cholesterol level
• Heart disease, using tests such as an echocardiogram or electrocardiogram
• Kidney disease, using tests such as a basic metabolic panel and urinalysis or ultrasound of the kidneys
Treatment
The goal of treatment is to reduce your blood pressure to lower the risk of complications. It includes:
LIFESTYLE CHANGES
• Healthy diet, including potassium and fiber.
• Drink plenty of water.
• Exercise regularly for at least 30 minutes of aerobic exercise a day.
• Quit smoking
• Limit alcohol intake
• Limit the amount of sodium (salt) ,i.e. , aim for less than 1,500 mg per day.
• Reduce stress. Try to avoid things that cause you stress, and try meditation or yoga to de-stress.
• Stay at a healthy body weight. Patient may consult dietician.
MEDICINES FOR HYPERTENSION
Most of the time, physician aims at lifestyle changes first and check BP 2 or more times. Medicines will likely be started if individual’s BP readings remain at or above these levels:
• Top number (systolic pressure) of 140 or more in people younger than 60 years
• Top number of 150 or more in people 60 years and older
• Bottom number (diastolic pressure) of 90 or more
If individual have diabetes, heart problems, or a history of a stroke, medicines may be started at lower blood pressure reading. The most commonly used blood pressure targets for people with these medical problems are below 130 to 140/80 mm Hg.
Outlook (Prognosis)
Most of the time, high blood pressure can be controlled with medicine and lifestyle changes.
When blood pressure is not well-controlled, patients are at risk for:
• Bleeding from the aorta, the large blood vessel that supplies blood to the abdomen, pelvis, and legs
• Chronic kidney disease
• Heart attack and heart failure
• Poor blood supply to the legs
• Problems with vision
• Stroke

HOW CAN EXERCISE LOWER BLOOD PRESSURE?
Regular physical activity makes the heart stronger and blood vessels more flexible. A strong heart can pump more blood with less effort. If heart can work less hard to pump blood throughout the body, the force on the arteries decreases, thereby lowering blood pressure.
Becoming more active can lower your systolic blood pressure — the top number in a blood pressure reading — by an average of 4 to 9 millimeters of mercury (mm Hg). That improvement is as good as some blood pressure medications.
For many people, getting some exercise is enough to reduce the need for blood pressure medication altogether. If blood pressure is at a desirable level — 120/80 mm Hg or lower — exercise can help keep it from rising with advancement of age.
Regular exercise also helps to maintain a healthy weight, another important way to control blood pressure. It takes about one to three months of regular exercise to have an impact on blood pressure.
Healthy Tips
• Go for a walk every day. Start with short distances and build up gradually. Try to walk at a pace that makes you mildly out of breath. Walking with a friend can make it more enjoyable and help you to keep up the routine
• Get advice from your physiotherapist or GP before you start doing more energetic and structured exercise
• Stop smoking – see your GP if you need help with this
• Lose weight if you need to
• Eat a balanced diet with plenty of fresh fruit and vegetables and oily fish
• Reduce the amount of alcohol, salt and animal fat in your diet
• Take your medication as prescribed.

Cardiovascular, or aerobic, exercise can help lower your blood pressure and make your heart stronger. Examples include walking, jogging, jumping rope, bicycling(stationary or outdoor), cross-country skiing, skating, rowing, high- or low-impact aerobics, swimming, and water aerobics.

Effect of atmosphere variation on blood pressure
– Falling temperatures in winter may cause an unhealthy rise in high blood pressure in elderly people, according to a new study linking cooler temperatures with higher blood pressure.
Seasonal variations in blood pressure have been noted for years, but few studies have looked at these temperature-related effects in one of the most at-risk populations: the elderly.
Now a large study from France has shown that blood pressure in elderly people varies significantly with the seasons, with rates of high blood pressure readings rising from 23.8% in summer to 33.4% in winter. Blood pressure increases were seen in both the systolic (top) and diastolic (bottom) numbers.
“Elderly persons may be particularly susceptible to temperature-related variations in blood pressure,” researcher Annick Alperovitch, MD, of the Institut National de la Sante et de la Recherche Medicale, in Paris, and colleagues write in the Archives of Internal Medicine. “Mechanisms that could explain the association between blood pressure and temperature remain undetermined.”
Researchers say possible explanations of the cold weather effect include activation of the sympathetic nervous system (which helps control how the body responds to stress) and release of the hormone catecholamine, which may increase blood pressure by speeding the heart rate and decreasing the responsiveness of blood vessels.
Seasonal Variation in High Blood Pressure
In the study, researchers analyzed seasonal variation in blood pressure among 8,801 adults over the age of 65 in France over two years.
The results showed both systolic and diastolic blood pressures varied with the weather.
Overall, the average systolic blood pressure was 5 points higher in winter than in summer. But researchers say the temperature-related effects onhigh blood pressure were greatest among those 80 and older.
“Although our study does not demonstrate a causal link between blood pressure and external temperature, the observed relationship nevertheless has potentially important consequences for blood pressure management in the elderly,” the authors write.
Researchers say the findings may help may explain the well known seasonal variations in illness and death from stroke, blood vessel rupture, or aneurysm.
“Because the risk of stroke or aneurysmal rupture is highest in the elderly, improved protection against these diseases by close monitoring of blood pressure and antihypertensive medication when outdoor temperature is very low could be considered,” they write.
“During cold weather, the body restricts blood flow in an effort to maintain temperature and retain heat,” said vascular surgeon David Stone, MD of Dartmouth-Hitchcock Medical Center in New Hampshire. “In return, the survival mechanism restricts blood movement and causes blood pressure to rise.”
Dr. Stone suggests the following winter weather tips:

•Minimize outdoor activity.
•Dress in several layers of loose-fitting wool, silk, or polypropylene clothing.
•Always wear a hat.
•Wear mittens instead of gloves.
•Eat well-balanced meals.
•Avoid alcohol and caffeine because they cause the body to lose heat more rapidly

By -ASSISTANT PROFESSOR – Dr. Aslam
Department -Physiotharapy
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