September 22, 2021

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High blood pressure (hypertension)

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Diagnosis: Your doctor will ask questions about your medical history and do a physical examination. The doctor, nurse or other medical assistant will place an inflatable arm cuff around your arm and measure your blood pressure using a pressure-measuring gauge. Your blood pressure generally should be measured in both arms to determine if there is a difference. It’s important to use an appropriate-sized arm cuff. Blood pressure measurements fall into several categories:

Normal blood pressure. Your blood pressure is normal if it’s below 120/80 mm Hg.     Elevated blood pressure. Elevated blood pressure is a systolic pressure ranging from 120 to 129 mm Hg and a diastolic pressure below (not above) 80 mm Hg. Elevated blood pressure tends to get worse over time unless steps are taken to control blood pressure. Elevated blood pressure may also be called prehypertension.

Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 130 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. Stage 2 hypertension. More-severe hypertension, stage 2 hypertension is a systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher.    Hypertensive crisis. A blood pressure measurement higher than 180/120 mm Hg is an emergency situation that requires urgent medical care. If you get this result when you take your blood pressure at home, wait five minutes and retest. If your blood pressure is still this high, contact your doctor immediately. If you also have chest pain, vision problems, numbness or weakness, breathing difficulty, or any other signs and symptoms of a stroke or heart attack, call 911 or your local emergency medical number.Both numbers in a blood pressure reading are important. But after age 50, the systolic reading is even more important. Isolated systolic hypertension is a condition in which the diastolic pressure is normal (less than 80 mm Hg) but systolic pressure is high (greater than or equal to 130 mm Hg). This is a common type of high blood pressure among people older than 65.

Because blood pressure normally varies during the day and may increase during a doctor visit (white coat hypertension), your doctor will likely take several blood pressure readings at three or more separate appointments before diagnosing you with high blood pressure.

Taking your blood pressure at home. Your doctor may ask you to record your blood pressure at home to provide additional information and confirm if you have high blood pressure. Home monitoring is an important way to confirm if you have high blood pressure, to check if your blood pressure treatment is working or to diagnose worsening high blood pressure. Home blood pressure monitors are widely available and inexpensive, and you don’t need a prescription to buy one. Home blood pressure monitoring isn’t a substitute for visits to your doctor, and home blood pressure monitors may have some limitations. Make sure to use a validated device, and check that the cuff fits. Bring the monitor with you to your doctor’s office to check its accuracy once a year. Talk to your doctor about how to start checking your blood pressure at home.

Devices that measure your blood pressure at your wrist or finger aren’t recommended by the American Heart Association because they can provide less reliable results.

Tests. If you have high blood pressure, your doctor may recommend tests to confirm the diagnosis and check for underlying conditions that can cause hypertension. Ambulatory monitoring. This 24-hour blood pressure monitoring test is used to confirm if you have high blood pressure. The device used for this test measures your blood pressure at regular intervals over a 24-hour period and provides a more accurate picture of blood pressure changes over an average day and night. However, these devices aren’t available in all medical centers, and they may not be reimbursed.

Lab tests. Your doctor may recommend a urine test (urinalysis) and blood tests, including a cholesterol test. Electrocardiogram (ECG or EKG). This quick and painless test measures your heart’s electrical activity. Echocardiogram. Depending on your signs and symptoms and test results, your doctor may order an echocardiogram to check for more signs of heart disease. An echocardiogram uses sound waves to produce images of the heart.

Blood pressure chart. Blood pressure test. Treatment. Changing your lifestyle can help control and manage high blood pressure. Your doctor may recommend that you make lifestyle changes including:  Eating a heart-healthy diet with less salt

Getting regular physical activity. Maintaining a healthy weight or losing weight if you’re overweight or obese. Limiting the amount of alcohol you drink. But sometimes lifestyle changes aren’t enough. If diet and exercise don’t help, your doctor may recommend medication to lower your blood pressure.

Medications. The type of medication your doctor prescribes for high blood pressure depends on your blood pressure measurements and overall health. Two or more blood pressure drugs often work better than one. Sometimes finding the most effective medication or combination of drugs is a matter of trial and error.

You should aim for a blood pressure treatment goal of less than 130/80 mm Hg if:

You’re a healthy adult age 65 or older, You’re a healthy adult younger than age 65 with a 10% or higher risk of developing cardiovascular disease in the next 10 years.  You have chronic kidney disease, diabetes or coronary artery disease. Ask your doctor what your blood pressure treatment goal should be. Also, the ideal blood pressure treatment goal can vary with age and health conditions, particularly if you’re older than age 65.

Medications used to treat high blood pressure include: Diuretics. Diuretics, sometimes called water pills, are medications that help your kidneys eliminate sodium and water from the body. These drugs are often the first medications tried to treat high blood pressure. There are different classes of diuretics, including thiazide, loop and potassium sparing. Which one your doctor recommends depends on your blood pressure measurements and other health conditions, such a kidney disease or heart failure. Diuretics commonly used to treat blood pressure include chlorthalidone, hydrochlorothiazide (Microzide) and others. A common side effect of diuretics is increased urination, which could reduce potassium levels. If you have a low potassium level, your doctor may add a potassium-sparing diuretic — such as triamterene (Dyazide, Maxide) or spironolactone (Aldactone) — to your treatment.

Angiotensin-converting enzyme (ACE) inhibitors. These medications — such as lisinopril (Prinivil, Zestril), benazepril (Lotensin), captopril and others — help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels.

Angiotensin II receptor blockers (ARBs). These medications relax blood vessels by blocking the action, not the formation, of a natural chemical that narrows blood vessels. ARBs include candesartan (Atacand), losartan (Cozaar) and others.  Calcium channel blockers. These medications — including amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others) and others — help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for older people and people of African heritage than do ACE inhibitors alone. Don’t eat or drink grapefruit products when taking calcium channel blockers. Grapefruit increases blood levels of certain calcium channel blockers, which can be dangerous. Talk to your doctor or pharmacist if you’re concerned about interactions.

Source. Mayo Clinic.

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