Friday, March 11, 2016

Essential Hypertension

Blood Pressure (PB) reading consists of 2 numbers in a top/bottom assembly.The top number is the systolic pressure which measures BP when the heart is contracted, and the Aorta and carotid arteries (that carry the output of blood) are stretched out to expand, while the bottom number is the diastolic pressure which measures the BP when the heart, aorta and carotid arteries are negative at work.The difference between the 2 numbers measures the resistance exerted by the blood vessels and is called the pulse pressure. It is a rough index of vascular rigidity, and we should consult a specialist if it is higher than 70mmHG.

In 10% of hypertension cases the cause may be a congenitally inherited disease , chronic disease in the kidney or its supplying arteries (e.g. renal failure), alcohol abuse or hormonal imbalance, it is called "Secondary hypertension".
In 90% of hypertension cases, the cause is unknown and is regularly seen at older age. It is called " Essential hypertension".

A normal BP is 120/80 or lower, higher BP is 140/90 or higher. If it is in between the case is called a pre-hypertensive case. As hypertension is the "silent killer" if not treated in time to guard against its prognosis, one should be aware of his BP at any age. After the age of 21, it should be measured every 2 years.

Hypertension damage the blood vessels, raising the risk of stroke, kidney failure, heart disease and heart attack. Nicotine in cigarettes and other Tobacco products causes BP to rise as a result of both constricting blood vessels and accelerating heart beats. Sodium (in table salt) can increase BP in some people but not every one.

FACTORS FACILITATING HYPERTENSION:
Large arteries are designed so as to stretch out expanding when they receive blood pumped by the heart, then when this blood flows out of these arteries into smaller ones, they recoil back to their original size before the heart beat.
To perform this job, the middle layer of the arteries is made up of smooth muscle cells surrounded by a network of collagen and elastic fibers. Collagen and Elastin are proteins which together form the nest or the matrix where-in the smooth muscle cells reside. It is this middle layer that is responsible for elasticity of arteries.

A young person arteries are similar to soft latex birthday balloon. But for many persons, the arteries have become more like rubber tires.This is due to stiffening of arteries which is determined by the changes in the smooth muscle cells and the matrix proteins(collagen and elastin) in their walls. This stiffening of arteries is called "Athersclerosis".

Atherosclerosis is initiated by direct damage of blood vessels through glycation.With aging the amount of vascular collagen increases, causing an imbalance of collagen and elastin to occur, and abnormal cross-links from between the collagen strands as a result. These cross-liks are the result of advanced-glycation-end-products(AGEs).

GLYCATION:
It is the result of a sugar molecule, such as Glucose, Fructose or Galactose bonding to a protein or lipid molecule without enzymatic control.
Dietary-Preformed Glycation products and Advanced Glycation End Products(AGEs):
As an organic reaction AGEs can be and they are typically formed when sugars are heated(cooked) with proteins or fats. High temperature greatly accelerates the reactions, but lower temperature with larger cooking times also promote their formation.
These compounds are absorbed by the body during digestion with about 30% efficiency .
Sugars are added to products such as french fries and baked goods to enhance browning. Browning reactions are evidence of pre-formed Glycations.
Many foods contain AGEs, like those with significant browning, or with directly added AGEs ( as flavors or colorants). Just to mention a few of foods with very high exogenous AGEs:
Donuts - Barbecued meats -Cake - Dark colored Soda pop.

In-Vivo formation of AGEs( Inside the body) :
In the blood, Glucose, Fructose and Galactose, through a complex series of very slow reactions ( inside the body) like Amadori's, Schiff's base formation and Millard reactions, leading finally to AGEs formation. Some AGEs are more reactive than the sugars they are derived from and are implicated in many age-related disease.

MANAGEMENT:
1- Reduce weight.
2- Exercise as your health allows.
3- Reduce intake of foods known to contain AGEs.
4- Untill very recently, not a single study has shown improved health outcomes on reduced Sodium diets.
5- Stop smoking.
6- Keep visiting your Dr periodically.

TREATMENT:
It should be through a specialist who can describe one or more of these drug groups:
Diuretics - B-Blockers - Methyl-Dopa - ACE inhibitors - Calcium channel blockers - Angiotensin2 antagonists, according to how he evaluates the patient condition.

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