Tuesday, August 10, 2010

Attention to Treatment of Hypertension

A person should not say if it is only done once hypertension checks only. For this situation needs to be done several times, inspection or measurement, unless the diastolic blood pressure above or equal to 120 mm Hg or systolic pressure above or equal to 210 mm Hg. The first measurement should be in confirmation at least two visits more within one to several weeks (depending on high blood pressure). conditions people will be checked also affect the results of the examination. Therefore, a person suspected of hypertension should be relaxed when it will run the checks. they should not be smoking or drinking coffee within 30 minutes before the examination. Measurements made with mercury sfigmomanometer with cuff long enough to cover at least 80 percent of those who arm circumference will be checked. They should sit with arms that are not covered with clothes and propped up as high as the heart. Cuff is pumped up to 20-30 mm Hg above the systolic blood pressure and then pressure lowered by 2-3 mm Hg per second speed.
When someone has been declared as hypertensive medication it must be done with a purpose to prevent morbidity and mortality from these high blood pressure. this means that the blood pressure should be reduced as low as possible which does not interfere with the function of kidneys, brain, heart and quality of life, in addition to control cardiovascular risk factors other. has been proved that the lower the diastolic and systolic blood pressure the better the prognosis. In general, the blood pressure in young people the ideal is less than 140/90 mm Hg (up to 130/85 mm Hg), whereas in people with old age until the age of 80 years is less than 160/90 mm Hg (up to 145 mm Hg for systolic / can be tolerated).
Lowering blood pressure with anti hypertensive (AH) has been shown to decrease cardiovascular morbidity and mortality, is stroke, cardiac ischemia, congestive heart failure, and exacerbation of hypertension.

Lifestyle Modification Patterns
Lifestyle modification therapy can be referred also to hypertension in addition to the use of drugs (non-pharmacological). Through this way is very useful for lowering blood pressure in hypertensive patients, increase the anti hypertensive effect, prevent the increase in blood pressure in those with high normal blood pressure and / or reduce the overall risk of cardiovascular disease. How this is done by:
1). Lose weight if obese,
2). Physical exercise such as aerobics regularly,
3). Reduce your intake of salt to less 2.3 grams of sodium or less than 6 grams of Na Cl (sodium chloride) in one day,
4). Eating foods that have vitamin potassium (K), Calcium (Ca) and magnesium (Mg), which is enough from the diet,
5). Should limit alcohol (a maximum of 20-30 milliliters of ethanol a day),
6). Stop smoking and reduce the foods containing cholesterol and saturated fats for overall cardiovascular health.
From the result, combined application of 1,2,3 and 5 by way of people suffering from mild hypertension for an average of 4.4 years it can lower blood pressure around 9 / 9 mm Hg.

Doing Therapy with Drug
In principle, the treatment of hypertension in stages.
1. Mild Hypertension
The initial phase is a lifestyle modification as the basis for therapy of hypertension with anti hypertensive drug therapy as an addition. As the first stage of anti hypertensive drugs recommended by JNC-V (1992) as well as from WHO/ISH (1993) is mono therapy with one of the following five drug classes, is diuretics, β-blockers, ACE inhibitors, calcium antagonists, and α- blockers (including α, β-blockers). Of the five anti-hypertensive group was selected as the first anti-hypertensive stage because not many side effects that may disturb and will not cause long-term tolerance to the award, so it can be used as mono therapy. Other anti hypertensive direct vasodilators, central adrenolitik (α2 agonist) and adrenergic nerve inhibitors, not used for monotherapy first stage but is an additional anti hypertensive. This is more due to the effects caused tolerance of these drugs occurs due to fluid retention (in a direct vasodilator, also occurs sympathetic reflex that stimulates the cardiovascular system), and cause side effects that interfere in most patients.

2. Weight Hypertension
Mono therapy rarely give effect to severe hypertension. Anti hypertensive 2nd or 3rd often need to be added with a shorter interval when blood pressure has not been controlled. In addition, the maximum dose of some drugs can be improved. People who develop hypertension, level 4 or diastole blood pressure above or equal to 120 mm Hg should be treated promptly, and if there is Target Organ Disease (TOD) was significant, may require hospitalization. except in hypertensive urgency and hypertensive emergency, blood pressure reduction is better done slowly within weeks with oral drug administration.
3. Systolic Hypertension
Is hypertension with normal diastolic blood pressure (less than 90 mm Hg) and diastolic blood pressure is high (above or equal to 140 mm Hg). This often occurs in elderly patients. When occur in adolescents or older adults, often showing circulation hiperdinamik and will someday be an increase in blood pressure diastole. The first step is the implementation of lifestyle modifications to lower systolic blood pressure increased this. but if the systolic blood pressure above or equal to the settled 160 mm Hg then began given anti-hypertensive.

Anti Hypertensive Drugs
1. Diuretics
Diuretics have a mechanism of anti-hypertensive. Anti hypertensive efficacy diuretics originated from the effect to increase excresi sodium, chloride, and water, thus reducing plasma volume and extracellular fluid. Blood pressure decreased as a result of the lack of cardiac output, whereas peripheral resistance remained unchanged at the beginning of therapy. On chronic administration, plasma volume returned but is still roughly 5 percent below the value before treatment. Cardiac output back toward normal. Keep blood pressure down, now that the peripheral resistance decreased. Peripheral vasodilatation that occurs then this seems to open a direct effect tiazid but because of the adjustment of the blood vessels peripheral to the reduction in plasma volume constant. Another possibility is the lack of reduction in fluid volume resulting interstitial blood vessel wall stiffness and increased power supple (compliance) vascular.

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