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Health: Disease: Hypertension


Hypertension is a silent disease, usually discovered through a physical examination. Blood pressure readings are taken to identify the symptoms of hypertension. When the top number of millimeters of mercury is higher than 140 mm Hg (systolic reading) and the bottom number is higher than 90 mm Hg (diastolic reading), there is cause for concern.

NIH: Seventh Report: Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7):
"The National High Blood Pressure Education Program presents the complete Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Like its predecessors, the purpose is to provide an evidence-based approach to the prevention and management of hypertension. The key messages of this report are these: in those older than age 50, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease (CVD) risk factor than diastolic BP; beginning at 115/75 mm Hg, CVD risk doubles for each increment of 20/10 mm Hg; those who are normotensive at 55 years of age will have a 90% lifetime risk of developing hypertension; prehypertensive individuals (systolic BP 120-139 mm Hg or diastolic BP 80-89 mm Hg) require health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and CVD; for uncomplicated hypertension, thiazide diuretic should be used in drug treatment for most, either alone or combined with drugs from other classes; this report delineates specific high-risk conditions that are compelling indications for the use of other antihypertensive drug classes (angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers); two or more antihypertensive medications will be required to achieve goal BP (<140/90 mm Hg, or <130/80 mm Hg) for patients with diabetes and chronic kidney disease; for patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using two agents, one of which usually will be a thiazide diuretic, should be considered; regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan. Positive experiences, trust in the clinician, and empathy improve patient motivation and satisfaction. This report serves as a guide, and the committee continues to recognize that the responsible physician's judgment remains paramount."

This special version of the updated clinical practice guidelines for hypertension is written for the busy Primary Care Clinician.(pdf)
Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)(pdf)

My Blood Pressure Wallet Card(pdf)
Your Guide to Lowering Blood Pressure(pdf)
DASH Eating Plan(pdf)

Physician Reference Card(pdf)

Approaches

Heart and Stroke Foundation: Your Blood Pressure: Action Plan:
" There are many things you can do to treat and prevent high blood pressure. Find out what you can do to live a healthier life.
Based in Canada


Dietitians of Canada:
"Tools that assess food choices and nutrition knowledge, FAQs and factsheets on current healthy eating topics, and tasty recipes.
Based in Canada


Solving Hypertension Without Drugs:
" The good news is that prehypertension should not be treated with medication. The role of the health professional should be to stress maintaining a healthy weight, increasing physical activity, reducing stress and anxiety, and eating a healthy diet. The ideal dietary plan adopts many principles of the DASH (Dietary Approaches to Stop Hypertension) plan with other important additions."
Based in Chicago, IL 60610


Angiotensin Converting Enzyme (ACE) Inhibitors:
" Angiotensin II is a very potent chemical that causes the muscles surrounding blood vessels to contract and thereby narrows the blood vessels. The narrowing of the vessels increases the pressure within the vessels and can cause high blood pressure (hypertension). Angiotensin II is formed from angiotensin I in the blood by the enzyme, angiotensin converting enzyme (ACE). ACE inhibitors are medications that slow (inhibit) the activity of the enzyme, which decreases the production of angiotensin II. As a result, the blood vessels enlarge or dilate, and the blood pressure is reduced"


Angiotensin II Receptor Blockers:
"The final active messenger of the renin-angiotensin pathway is angiotensin II. Angiotensin II binds to AT1 receptors to cause vasoconstriction and fluid retention, both of which lead to an increase in blood pressure. The angiotensin II receptor blockers lower blood pressure by blocking the AT1 receptors. Therefore they have similar effects to angiotensin converting enzyme (ACE) inhibitors, which inhibit the synthesis of angiotensin II by ACE (see illustration). However, non-ACE pathways can produce some angiotensin II. ACE inhibitors also decrease bradykinin breakdown and this action could be involved in some of the beneficial and adverse effects of that class of drugs. Therefore, a potential for differential clinical effects exists for these two classes of drugs."


Cardiovascular Physiology Concepts: Histamine and Bradykinin:
"Histamine, released by mast cells in response to injury, inflammation and allergic responses, causes arteriolar vasodilation, venous constriction in some vascular beds, and increased capillary permeability (by causing endothelial cell contraction). Both H1 and H2 receptors may be involved in the vascular effects of histamine. The actions of bradykinin are similar to histamine. Bradykinin is a potent stimulator of nitric oxide formation by vascular endothelium. It also stimulates prostacyclin formation."


Taking Blood Pressure:
How to take blood pressure with a blood pressure cuff and a Stethoscope.


Mayo Clinic: Hypertension and High Cholesterol(Video Real Player):
"Doctors at Mayo Clinic published a study that shows high blood pressure found during an exam not only puts you at increased risk for heart disease and stroke, but it also may be a sign that you're cholesterol is too high. And that high cholesterol can lead to blocked arteries. Here's what you should know about cutting your risk of heart attack."


Vitamine D

OSU: Linus Pauling Institute: Vitamine D:
"The renin-angiotensin system plays an important role in the regulation of blood pressure (13). Renin is an enzyme that catalyzes the cleavage (splitting) of a small peptide (Angiotensin I) from a larger protein (angiotensinogen) produced in the liver. Angiotensin converting enzyme (ACE) catalyzes the cleavage of angiotensin I to form angiotensin II, a peptide that can increase blood pressure by inducing the constriction of small arteries and increasing sodium and water retention. The rate of angiotensin II synthesis is dependent on renin (14). Recent research in mice lacking the gene encoding the VDR, indicates that 1,25(OH)2D decreases the expression of the gene encoding renin through its interaction with the VDR (15). Since inappropriate activation of the renin-angiotensin system is thought to play a role in some forms of human hypertension, adequate vitamin D levels may be important for decreasing the risk of high blood pressure."


MGH: BrainTalk: Vitamine D:
"Here's how it works: According to a study published in 2002 in the Journal of Clinical Investigation, one of your genes (a tiny part of your DNA) leads to the formation of a molecule called renin. Renin breaks down another molecule, called angiotensinogen, into angiotension I. Angiotensin I is converted into angiotensin II by ACE. Vitamin D persuades the renin-controlling gene to become less active, and the whole process slows down.5 The end result is less angiotensin II and lower blood pressure."


Sleep

National Sleep Foundation: Myths And Facts About Sleep:
"Studies have found a relationship between the quantity and quality of one's sleep and many health problems. For example, insufficient sleep affects growth hormone secretion that is linked to obesity; as the amount of hormone secretion decreases, the chance for weight gain increases. Blood pressure usually falls during the sleep cycle, however, interrupted sleep can adversely affect this normal decline, leading to hypertension and cardiovascular problems. Research has also shown that insufficient sleep impairs the bodyÕs ability to use insulin, which can lead to the onset of diabetes. More and more scientific studies are showing correlations between poor and insufficient sleep and disease."

Didgeridoo Playing as alternative treatment for obstructive sleep apnoea syndrome: randomized controlled trial:
Conclusion: "Regular didgeridoo playing is an effective treatment alternative well accepted by patients with moderate obstructive sleep apnoea syndrome."

CPAP Machines & Information:
A US based vendor that provides lots of good information.

Sleepreview: Hypertension and OSA:
"Sleep-disordered breathing (SDB) plays a causal or contributing role in the development of comorbidities such as hypertension and cardiovascular events. Snoring, SDB, and obstructive sleep apnea (OSA) have been reported to be associated with hypertension since the early 1980s.1 There is substantial epidemiological and pathophysiological evidence to suggest that SDB causes hypertension. Moreover, an association between sleep apnea and hypertension that is independent of age, sex, and body weight has been reported."

MGH: Hypertension and Obstructive Sleep Apnea:
Current Hypertension Reports 2003, 5:380 "Obstructive sleep apnea is a common disorder that is often unrecognized and underappreciated. Emerging evidence suggests that there is a causal link between obstructive sleep apnea and hypertension."


Water

Medically supervised water-only fasting in the treatment of hypertension (Clinical Trial):
"Almost 90% of the subjects achieved blood pressure less than 140/90 mm Hg by the end of the treatment program. The average reduction in blood pressure was 37/13 mm Hg, with the greatest decrease being observed for subjects with the most severe hypertension. Patients with stage 3 hypertension (those with systolic blood pressure greater than 180 mg Hg, diastolic blood pressure greater than 110 mg Hg, or both) had an average reduction of 60/17 mm Hg at the conclusion of treatment. All of the subjects who were taking antihypertensive medication at entry (6.3% of the total sample) successfully discontinued the use of medication. CONCLUSION: Medically supervised water-only fasting appears to be a safe and effective means of normalizing blood pressure and may assist in motivating health-promoting diet and lifestyle changes. "


Water As Medicine (Pani Prayog):
"Drink 1.25 liters of water (4 glasses), which has been kept overnight, early morning before sunrise & before brushing the teeth. DonÕt eat & drink for 45 min. of course you wash & brush, after drinking. Do not exercise for 30 min. While following this treatment one can drink water only 2 hrs after meals. Even a healthy person can do this therapy to prevent illness in future. Beginners can start with 2 glasses of water & then increase it to 4 glasses."


High Blood Pressure.:
"Hypertension is a state of adaptation of the body to a generalized drought, when there is not enough water to fill all the blood vessels that diffuse water into vital cells. As part of the mechanism of reverse osmosis, when water from the blood serum is filtered and injected into important cells through minute holes in their membranes, extra pressure is needed for the "injection process." Just as we inject I.V. "water" in hospitals, so the body injects water into tens of trillions of cells all at the same time. Water and some salt intake will bring blood pressure back to normal! Tragedy: Not recognizing hypertension as one of the major indicators of dehydration in the human body, and treating it with diuretics that further dehydrate the body will, in time, cause blockage by cholesterol of the heart arteries and the arteries that go to the brain. It will cause heart attacks and small or massive strokes that paralyze. It will eventually cause kidney disease. It will cause brain damage and neurological disorders, such as Alzheimer's disease."


"Bad Cholesterol": A Myth and a Fraud!:
" We in the medical profession, totally oblivious of the vital roles of cholesterol in the body, have been duped into thinking that it is this substance that causes arterial disease of the heart and the brain. The pharmaceutical industry has capitalized on the slogan of "bad cholesterol" and has produced toxic-to-the-body chemicals that minimally lower the level of cholesterol in the body and in the process cause liver damage to thousands of people, some who die as a result of using the medication. "


Water - The Stuff of Life:
"The human body is a bio-electrical water machine that requires a quart a day for every 50 lbs of body weight. The blood alone is made up of a large percentage of watery serum. The lymph fluids which transport waste and nutrients, comprising four times the volume of blood in the body, are made from the water we consume. Every cell that makes us who we are literally owes its life to an adequate supply of fresh, clean water. When the body does not receive a constant, reliable supply of water, it has to ration what is available and cut back on certain functions to make the supply go round. Essential systems like the brain are prioritised, others are impaired or cut back until the brain has decided a reliable source of water has been garnered."


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Updated: Thursday, January 12, 2006 - V0N 1V1
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