Malignant Hypertension Symptoms Treatment

Malignant Hypertension and accelerated high blood pressure are two emergency conditions which should be treated promptly. Both conditions have same outcome and therapy. However Malignant hypertension is a complication of high blood pressure characterized by very elevated high blood pressure, and organ damage in the eyes, brain, lung and/or kidneys. It differs from other complications of hypertension in that it is accompanied by papilledema. (Edema of optic disc of eye) Systolic and diastolic blood pressures are usually greater than 240 and 120, respectively. While Accelerated high blood pressure is condition with high blood pressure, target organ damage, on fundoscopy we have flame shaped hemorrhages, or soft exudates, but without papilledema.

There are two things. Hypertensive Urgency and Hypertensive emergency. In hypertensive urgency we don?t see any target organ damage while in emergency we see target organ damage along with high blood pressure greater than systolic >220. Now depending upon target organ damage you will decide whether you have hypertensive emergency or urgency. It is essential to bring down high blood pressure in hypertensive emergency immediately, while in urgency, bring down blood pressure very rapidly is not required.

Pathogenesis of malignant hypertension is fibrinoid necrosis of arterioles and small arteries. Red blood cells are damaged as they flow through vessels obstructed by fibrin deposition, resulting in microangiopathic hemolytic anemia. Another pathologic process is the dilatation of cerebral arteries resulting in increased blood flow to brain which leads to clinical manifestations of hypertensive encephalopathy. Common age is above 40 years and it is more frequent in man rather than women. Black people are at higher risk of developing hypertensive emergencies than the general population.

Target organs are mainly Kidney, CNS and Heart. So symptoms of Malignant hypertension are oligurea, Headache, vomiting, nausea, chest pain, breathlessness, paralysis, blurred vision. Most commonly heart and CNS are involved in malignant hypertension. The pathogenesis is not fully understood. Up to 1% of patients with essential hypertension develop malignant hypertension, and the reason some patients develop malignant hypertension while others do not is unknown. Other causes include any form of secondary hypertension; use of cocaine, MAOIs, or oral contraceptives; , beta-blockers, or alpha-stimulants. Renal artery stenosis, withdrawal of alcohol, pheochromocytoma {most pheochromocytomas can be localized using CT scan of the adrenals}, aortic coarctation, complications of pregnancy and hyperaldosteronism are secondary causes of hypertension. Main Investigations to access target organ damage are complete renal profile, BSR, Chest Xray, ECG, Echocardiography, CBC, Thyroid function tests.

Management:
Patient is admitted in Intensive Care Unit. An intravenous line is taken for fluids and medications. The initial goal of therapy is to reduce the mean arterial pressure by approximately 25% over the first 24-48 hours. However Hypertensive urgencies do not mandate admission to a hospital. The goal of therapy is to reduce blood pressure within 24 hours, which can be achieved as an outpatient department. Initially, patients treated for malignant hypertension are instructed to fast untill stable. Once stable, all patients with malignant hypertension should take low salt diet, and should focus on weight lowering diet. Activity is limited to bed rest until the patient is stable. Patients should be able to resume normal activity as outpatients once their blood pressure has been controlled.

Hospitalization is essential until the severe high blood pressure is under control. Medications delivered through an IV line, such as nitroglycerin, nitroprusside, or others, may reduce your blood pressure. An alternative for patients with renal insufficiency is IV fenoldopam. Beta-blockade can be accomplished intravenously with esmolol or metoprolol. Labetalol is another common alternative, providing easy transition from IV to oral (PO) dosing. Also available parenterally are enalapril, diltiazem, verapamil, Hydralazine is reserved for use in pregnant patients as it also increases uterine profusion, while phentolamine is the drug of choice for a pheochromocytoma crisis. After the severe high blood pressure is brought under control, regular anti-hypertensive medications taken by mouth can control your blood pressure. The medication may need to be adjusted occasionally.

Remember, It is very necessary to control malignant hypertension, otherwise it can lead to life threatening conditions like Heart Failure, Infarction, Kidney failure and even blindness.

Dr Armughan, Author of this article. Read More about Malignant Hypertension

The Obesity-Hypertension Connection: Is Your Weight Putting You At

Copyright 2006 Frank Mangano

Did your daily weigh-in cause your blood pressure to spike? If it did, you are not alone. More than 50 percent of Americans are overweight or obese and the numbers just keep on rising. These shocking statistics have doctors from the World Health Organization, Center for Disease Control, and American Heart Institute wondering how to stop the epidemic. That sudden shock of seeing the numbers on the scale inch up is not what?s giving rise to your blood pressure. It is the ongoing, day-to-day strain that obesity puts on the entire cardiovascular system that causes blood pressure to reach dangerous heights.

Being extremely overweight and having high blood pressure is so closely related that it has even been given its own name: obesity hypertension. Of all the cases of hypertension in the U.S., 75% can be directly attributed to obesity. Deaths directly from hypertension or that had high blood pressure as a primary contributor totaled 310,707 deaths in the U.S. in 2002. It?s a chain reaction (obesity=hypertension= heart disease=death) that all begins with how fat a person is.

Obesity is also a condition that is an equal opportunity disease. It doesn?t matter if you are male, female, old, young, or the origins of your ancestry. If you are overweight, you increase your chances for hypertension and if you lose weight, your risk goes down. But stay overweight and your risk of developing hypertension is 5 to 6 times greater than someone who is at his or her ideal weight.

How Heavy is Obese?

The first question to ask in removing the obesity risk factor for hypertension is ?Am I overweight?? Obesity is determined by Body Mass Index (BMI), which takes into account the relationship between height and weight. A BMI above 30.0 is considered obese. A score between 25.0 and 29.9 is considered ?overweight.? Ideally, BMI should be between 18.5 and 24.9.

To measure your own BMI you take your current weight and divide it by the number you get when you multiply your height in inches by your height in inches again. Then multiply that number by 703 for your BMI. For example, if you are 5?6? and weight 165 pounds, you would multiply 66? times 66? for a total of 4356. Then divide 165 by 4356 for a total of 0.0378. Next multiply that by 703 for a BMI equal to 26.6, which is considered overweight.

How Does Being Overweight Impact Blood Pressure?

When you are obese, your body needs more blood in order to supply oxygen to and nourish the extra tissue. When you put more blood into the same passageway of veins and arteries, there will be extra pressure on those blood vessels.

Weight gain is also usually in the form of fat. According to Mayo Clinic research, fat cells even produce more chemicals, which in turn add to the strain on the heart and pressure on the blood vessels. In addition, there is an increase in insulin from weight gain. This makes the body retain sodium and water, which also increases heart rate and decreases the ability of the blood vessels to move blood throughout the body, thereby increasing blood pressure.

It?s not just how much you are overweight, but also where you carry your extra weight that can have a great impact on blood pressure. Risk factors are increased when added weight is in the abdominal area. This is because people with a so-called spare tire also have increases in blood sugar, which causes the fat to be deposited there, and then starts the sodium and water retention cycle.

Reducing Weight to Lower Blood Pressure

Because there is a direct correlation between obesity and hypertension, it makes perfect sense that by losing weight you can lower blood pressure. The proof is in the numbers. Blood pressure is measured in mm/hg. A reading of blood pressure both as the heart beats and as it relaxes, creates the dual number of X over Y giving you your final blood pressure reading. For every 2.2 pounds of weight lost, blood pressure falls 1 mm/hg. Realistically, an overweight person like in our example above could lose just 10 percent of their body weight ? in this case 16.5 pounds and lower their blood pressure by 7 or 8 points.

Small Steps for Big Results

If you can conquer obesity, then you can take dramatic steps in lowering blood pressure. One of the best ways to combat weight is with walking. Walking increases metabolism and is more effective in the long run than more strenuous cardiovascular workouts. Those who are overweight should talk to their doctor before starting an exercise program of any kind, but all physicians will agree that walking is one of the safest, most effective forms of exercise. Good shoes that provide support to the arches will protect feet and knees from stress injuries. Also, walking on softer surfaces such as a grassy field or dirt road will give a better workout because more balance and coordination is needed.

Some other ways to lose weight safely and lower blood pressure include:

1. Reduce sodium intake

2. Don?t eat within 3 hours of going to bed at night

3. Drink at least 8 glasses of water each day

4. Replace saturated animal fats with non-saturated, healthy fats from vegetable sources

5. Limit consumption of alcoholic beverages that are packed with calories

There are some risk factors associated with hypertension that you cannot control, such as genetics, race, and age. How much you weigh and what you do to make sure you are a good weight is within your control. Take action to keep obesity in check and reduce your risk of developing high blood pressure.

Hypertension: How The Body Controls Blood Pressure

Hypertension is the term doctors use for high blood pressure. It's often referred to as a Silent Killer since many people may have no noticeable symptoms. Over 50 million people suffer from high blood pressure, but nearly one third aren't even aware of it. Hypertension is a major risk factor for heart disease, the nations' number one killer.

Those who do experience the symptoms of high blood pressure feel dizzy, headaches and sometimes nosebleeds. Unfortunately, by the time symptoms are felt, blood pressure is dangerously high. But many people with uncontrolled high blood pressure never have any of these symptoms.

Blood pressure is the force of the blood through your arteries as your heart pumps blood through your circulatory system. Blood pressure is reported as a fraction, with one number over the other. The top number, called the systolic pressure, is the force when your heart contracts, the bottom number, called the diastolic pressure, is the pressure when you hear relaxes between beats.

To measure your blood pressure, an inflatable cuff is wrapped around your arm, and air is pumped in. The doctor or nurse, while watching the pressure gauge, listens with a stethoscope for your pulse to disappear. The pressure at which your pulse can no longer be heard corresponds to the systolic pressure. The cuff is released and the pressure at which your pulse can be heard again is the diastolic pressure.

Like the pressure in your car tires, pressure is measure in millimeters of mercury or mmHg. Typically, healthy people have a blood pressure at or below 120/80mmHg. Your risk of heart or CV disease has recently been found to begin increase at a much lower level, blood pressure of 115/75. Blood pressure above 120/80 is considered by the National Heart, Lung, and Blood Institute (NHLBI) to be pre-hypertenson. A BP of 140/90 mmHg is considered too high, and represents a significantly increased risk of heart disease.

Unfortunately, high blood pressure is more common in certain racial and ethnic minority groups, including blacks, Hispanics, and American Indians/Alaska Natives.

Factors Controlling Your Blood Pressure

High blood pressure can result from several factors. The heart itself can impact blood pressure. The heart muscles itself can enlarge, causing higher pressure of blood exiting the heart. Cardiomyopathy or enlargement of the heart muscle also increases blood pressure. Excess weight makes your heart work harder to pump blood through the body.

Extra fluid in your circulatory system as a result of lots of salt intake, kidney problems or other medical conditions also puts a higher demand on the heart. Increased blood volume also causes more constriction within the blood vessels, translating into higher blood pressure.

The blood vessels play an important role in your blood pressure. Usually, the arteries are elastic and can expand and contract in rhythm with the hearts pumping action. High cholesterol and the plaques that form cause the arteries to lose their elasticity. Each time the heart pumps, the vessel can no longer stretch, and a higher pressure is created. Just think about what happens if you step on a garden hose.

Smoking cigarettes constricts, or tightens your blood vessels, pushing the blood pressure even higher. Some medications you take such as steroids, non-steroidal anti-inflammatory drugs (NSAIDs), nasal decongestants and other cold remedies, diet pills, cyclosporine, erythropoetin, tricyclic antidepressants and a type of anti-depressant called monoamine oxidase inhibitors can also contribute to increased BP. Oral contraceptive, which are hormones, can raise blood pressure and should be used cautiously and carefully monitored in patients with HTN.

Treatment For Hypertension

If you are diagnosed with high blood pressure, your doctor will most likely order additional test to determine the cause of your elevated blood pressure. He or she will also recommend more frequent visits to monitor you. For moderate hypertension, lifestyle changes may be enough to normalize blood pressure.

One of the first things you can do is change your diet to avoid sodium or salt, and lower your fat intake. The National Institutes of Health's DASH diet (Dietary Approaches to Stop Hypertension) is rich in fruits, vegetables, and low-fat dairy foods, and low in total and saturated fat. The DASH diet also reduces red meat, sweets, and sugary drinks, and it's rich in potassium, calcium, magnesium, fiber, and protein.

Increasing physical activity can help to lower your blood pressure. By doing at least 30 minutes of exercise a day, your risk of complications can be reduced. If you are overweight, starting a weigh loss plan can also help bring your blood pressure into the normal range. If dietary and lifestyle changes alone don't normalize your blood pressure, the next step is medication. If your doctor recommend medication, it is vital that you take it exactly as directed. Because most people don't notice any symptoms of hypertension, even if you are feeling well, it is crucial to stick to your medication regimen. Never stop taking medication without discussing it with your healthcare team, even if you feel fine.

Ray Kelly is an Exercise Scientist with 15 years experience in the health and fitness industry. Sign up for his Free Exercise and Meal Planner at The Biggest Loser or http://www.free-online-health.com