Thursday, August 12, 2010

At What Level is Blood Pressure Too High?

At What Level is Blood Pressure Too High?



Blood pressure is measured with a blood pressure cuff (sphygmomanometer). This may be done using a stethoscope and a cuff and gauge or by an automatic machine. It is a routine part of the physical examination and one of the vital signs often recorded for a patient visit. Other vital signs include pulse rate, respiratory rate (breathing rate), temperature, and weight.

When discussing blood pressure issues, the health care practitioner may ask questions about past medical history, family history, and medication use, including prescriptions, over-the-counter medications, herbal remedies, and food additives. Other questions may include lifestyle habits, including activity levels, smoking, alcohol consumption, and illegal drug use.

Physical examination may include listening to the heart and lungs, feeling for pulse in the wrist and ankles, and feeling and listening to the abdomen looking for signs of an enlarged aorta. Eye examination with an ophthalmoscope may be helpful by looking at the small blood vessels on the retina in the back of the eyeball.

    * Normal Blood Pressure
          o Systolic less than 120 mm Hg; diastolic less than 80 mm Hg
    * Prehypertension
          o Systolic 120-139 or diastolic 80-89 mm Hg
    * High Blood Pressure
          o Stage 1: Systolic 140-159; diastolic 90-99 mm Hg
          o Stage 2: Systolic more than 160; diastolic more than 100 mm Hg

Blood tests may be considered to assess risk factors for heart disease and stroke as well as looking for complications of hypertension. These include complete blood count (CBC), electrolytes, BUN (blood urea nitrogen), and creatinine and GFR (glomerular filtration rate) to measure kidney function.

A fasting lipid profile will measure cholesterol and triglyceride levels in the blood. If appropriate, blood tests may be considered to look for an underlying cause of high blood pressure including abnormal thyroid or adrenal gland function.

Ultrasound of the kidneys, CT scan of the abdomen, or both may be done to assess damage or enlargement of the kidneys and adrenal glands.

Other studies may be considered depending upon the individual patient’s needs

    * Electrocardiogram (ECG) may help evaluate heart rate and rhythm. It is a screening test to help assess heart muscle thickness. If hypertension is long-standing, the heart muscle has to hypertrophy, or get larger, to push blood against the increased pressure within the arteries of the body.

    * Echocardiogram is an ultrasound examination of the heart It is used to evaluate the anatomy and the function of the heart. A cardiologist is required to interpret this test and can evaluate the heart muscle and determine how thick it is, whether it moves appropriately, and how efficiently it can push blood out to the rest of the body. The echocardiogram can also assess heart valves, looking for narrowing (stenosis) and leaking (insufficiency or regurgitation). A chest X-ray may be used as a screening test to look for heart size, the shape of the aorta, and to assess the lungs.

    * Doppler ultrasound is used to check blood flow through arteries at pulse points in your arms, legs, hands, and feet. This is an accurate way to detect peripheral vascular disease, which can be associated with high blood pressure. It also can measure blood flow in the arteries to both kidneys and sometimes depicts narrowings that can lead to high blood pressure in a minority of patients.

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High Blood Pressure Medication Information

High Blood Pressure Medication Information

 It may take trial and error to find the proper medication or combination of medications that will help control hypertension in each case. It is important to take the medications as prescribed and only discontinue them on the advice of your health care practitioner.

Water Pills (diuretics)

    * Diuretics are used very widely to control mildly high blood pressure, and are often used in combination with other medications.

    * They increase sodium excretion and urine output and decrease blood volume. The sensitivity to the effect of other hormones in your body is decreased.

    * One example of a diuretic is hydrochlorothiazide (HydroDIURIL)
    * The most commonly used diuretics to treat hypertension include:
          o hydrochlorothiazide (HydroDIURIL),
          o the loop diuretics furosemide (Lasix) and torsemide (Demadex),
          o the combination of triamterene and hydrochlorothiazide (Dyazide), and
          o metolazone (Zaroxolyn).

Beta-Blockers

    * Beta-blockers reduce heart rate and decrease the force of heart contraction by blocking the action of adrenaline receptors. Beta blockers are widely prescribed and effective but can cause increased fatigue and decreased exercise tolerance because they prevent an increased heart rate as a normal response to physical activity.

    * They are also prescribed for people who have associated heart disease, angina, or history of a heart attack.

    * Examples of beta blockers include, carvedilol (Coreg), metoprolol (Lopressor), atenolol (Tenormin)

Calcium Channel Blockers (CCBs)

    * Calcium channel blocking agents work by relaxing the muscle in artery walls and by therefore reducing the force of contraction of heart muscle.

    * Example of calcium channel blockers include, nifedipine (Procardia), diltiazem (Cardizem), verapamil (Isoptin, Calan), nicardipine (Cardene), amlodipine (Norvasc), and felodipine (Plendil)

Angiotensin-Converting Enzyme (ACE) Inhibitors

    * ACE inhibitors stop the production in the body of a chemical called angiotensin II, which causes blood vessels to contract. Narrower blood vessels are associated with increased blood pressure. Relaxing artery walls leads to lower blood pressure.

    * Examples of ACE inhibitors include Captopril (Capoten), enalapril (Vasotec), lisinopril (Zestril, Prinivil), quinapril (Accupril), and fosinopril (Monopril)

Angiotensin Receptor Blockers (ARBs)

    * ARBs work block angiotensin II receptors and prevent vasoconstriction, or narrowing of blood vessels.

    * Examples of ARBs include losartan (Cozaar), valsartan (Diovan), candesartan (Atacand), and irbesartan (Avapro)

Blockers of Central Sympathetic (autonomic nervous) System

    * These agents block messages from the brain’s autonomic nervous system that contract blood vessels. The autonomic nervous system is the part of the unconscious nervous system of the body that controls heart rate, breathing rate, and other basic functions.

    * These medications relax blood vessels, thus lowering blood pressure.

    * An example is clonidine (Catapres)

Direct Vasodilators

    * Direct vasodilators relax (dilate) the blood vessels to allow blood to flow under lower pressure.

    * These medications are most often used in times of hypertensive crisis and are injected intravenously to quickly lower blood pressure readings.

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