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A Proper Diet For Hypertension

2010-12-15T03:19:00.001-08:00

Hypertension is usually controlled with a combination of drugs and some special diets; this is because drugs alone do not really help the patient achieve all the needed relief. Since the condition is incurable, the patient is placed on a carefully planned nutrition devoid of the ingredients that aggravate the disease.

When the right type of food is given to the sufferer, he/she would least experience some of the complications; and the rate of relapse is minimized. Diet is of importance in the management of hypertension because if the right drugs are prescribed and the right type of exercise is adhered to, and the patient does not eat the right type of foods, he/she is likely to get little or no relief from the condition.

The proper diet for the hypertensive patient should therefore have less sodium. Sodium is known to retain fluid; it should be reduced but not completely eliminated from the diet since it still has some roles to play in electrolytes balance. It should rather be reduced to about 4gm per day.

The food should also be natural and not artificial because of the fact that artificial foods have a lot of chemical addictives that make the individual’s health condition worse. Canned foods should not be eaten due to their high sodium content as well.

A proper hypertensive diet should also contain little or no spices which act as stimulants due to the fact that stimulating the patient would lead to extra adrenaline discharge and further elevation of his/her blood pressure.

Foods containing caffeine should also be eliminated from his food regimen. Coffee and strong tea must not make the list. Alcoholic beverages must not be taken as part of the meal or after the meal.

Saturated fats should not be included in the food as they increase the cholesterol level of the blood and worsen the already existing atherosclerosis or arteriosclerosis as the case may be. Red meats and fatty meats like pork should generally not be included in the meal.

While planning the meal therefore, you should remember that foods with a stimulating effect; foods with the ability to retain fluids and foods with artificial addictives do not actually help the patient; rather they worsen his condition. Once you have this at the back of your mind, you will be able to come out with a natural diet best suited for him/her.

The diet for hypertension should contain protein, carbohydrate, vitamins, minerals, water and fats in their right proportion. In other words, he/she should eat balanced diets so long as they do not contain those forbidden items

High Diastolic Blood Pressure - What Is It, and Should You Be Trying to Lower It?

2010-10-31T12:17:00.001-07:00

Diastolic blood pressure is the lower reading that you get when you take somebody’s BP. It is usually measured in ranges, depending on the individual’s age, sex, position and sometimes health condition.

It is the rhythmic expansion of the chambers of the heart at each heartbeat, during which they fill with blood. Ideally, the Diastolic pressure for a young adult should be around 60 – 85 mmHg, with 90 mmHg considered as borderline.

The reading could get a little higher as the individual’s age increases. This means that the diastolic blood pressure of a man of 60 years and above should be higher than that of a 40 year old, though the variation should not be too much.

High diastolic blood pressure occurs when the reading goes above 90mmHg and remains sustained on repeated checks. When the reading for a man of 40 years goes up to 95 or 100 and above, we can say that the reading is high.

In other word, with the elevated BP we can say that the individual has diastolic hypertension. The difference between this and primary hypertension is that there is a noticeable change in the walls and inside of the arteries in diastolic hypertension.

When the reading is high, and with the changes in the walls of the vessels, the individual is at risk. With such a high reading, the individual could be at the risk of developing a stroke or he could suffer from heart attack. Everything has to be done to prevent a further rise; and also to reduce the already elevated pressure to an acceptable level.

The individual should see the doctor who would in turn prescribe drugs that would help lower the elevated blood pressure. The prescribed drug regimen must be strictly followed if one hopes to get a positive result.

Other ways to lower it also include using a planned programme of exercise and controlled diet to improve the heart and the condition of the blood vessels. Some of the drugs would help to dilate the vessels, while others help to relax the vessels and reduce the frequency of the heart beats.

Certain diets are withdrawn to reduce the rate with which fats are deposited on the walls of the arteries and veins. With the combined therapy, it is easier to lower the elevated blood pressure and the individual could lead a normal life again.

How To Check Someone's Blood Pressure To Check For Hypertension

2010-09-29T04:04:00.001-07:00

How To Check Someone’s Blood Pressure To Check For Hypertension
Blood pressure should be taken in such a way as to ensure that you do not come up with the wrong result, especially when you are suspecting that the individual may be having hypertension. When the right procedure is followed you are sure to avoid errors that could prove expensive in the long run.

What should you do before taken the blood pressure?
1. Ensure the individual is not over excited. If he/she is excited the secretion of adrenaline increases and this would give you a wrong result.
2. Be sure the individual has not just finished a rigorous exercise. This would increase the heart rate and alter the result as well.
3. Ensure the person has also not just finished eating a heavy meal. This would increase the work load of the heart as it attempts to digest the heavy meal.
4. Make sure he/she rests for at least 2-5 minutes after arriving in your clinic before taking the blood pressure.

To find out if someone has hypertension, you need to check his/her blood pressure for the first time and record the result. The individual should then be advised to repeat the check daily (at the same time) or on alternate days for at least one further week to be sure there is a sustained elevation before you could come up with a diagnosis.

How should you check the blood pressure?
1. Make the person sit up in a chair or lie down on a bed.
2. Squeeze the cuff to expel air if you are using the analog sphygmomanometer.
3. Wrap the arm cuff around his/her upper arm, at least half an inch above the elbow joint, with the air tube over the brachial artery.
4. Press the ‘start’ button (if you are using the digital sphygmomanometer); and the cuff is inflated automatically. Allow it to deflate on its own and when the measurement value is displayed, you have to take down the reading. Press the ‘stop’ button and return the equipment to a safe place.
5. If you are using the analog sphygmomanometer, you have to place the diaphragm of your stethoscope over the brachial artery (after procedure number 3 above) and place the ear tubes over your ears; tighten the knob of the sphygmomanometer and then pump with the inflator.
6. Listen to the heart beat as you pump. Take note of the point at which you stopped hearing the sound. Pump a little further before releasing the knob to deflate the cuff.
7. Take note of the first heart sound (systolic) as you deflate the cuff; and also the point at which the heart’s sound finally disappears (the diastolic).
8. Remove equipment and record your findings.

The upper sound is referred to as the ‘systolic’ while the lower sound is referred to as the ‘diastolic’ sound. If the reading for an average adult is in the range of 140-159 over 90-99 (140/90 – 159/99), ‘stage 1 hypertension’ is said to exist. But if the reading is above 160/100, ‘stage 2 hypertension’ is said to exist.

Note: Nobody should be termed hypertensive except after the readings have been taken for a period of one or more weeks and they are consistently elevated. You should also cross check using both arms.

Hypertension: Why You Must Not Neglect Your Drugs

2010-07-16T03:33:00.001-07:00

There is this false belief or erroneous impression that hypertension can be cured like other disease conditions; thereby making some patients not to want to continue taking their drugs the moment their condition improves. The moment they check their blood pressure and get a reading of 120/80mmHg or less, they conclude they no longer need to comply with their regimen.

However, the painful truth about hypertension is that it is an incurable condition that requires the sufferer taking his drugs for the rest of his life, except God performs a miracle on him.

We once had a patient who was on a regular medical check up in our company clinic: he was also on doctor’s prescriptions which were supposed to be adhered to, and only be changed after the doctor’s review. He adhered religiously to his drugs regimen for sometime. Suddenly, he disappeared and never showed up for review for over 6 months.

Then one evening as workers were closing for the day, we received a call that there was an emergency situation that required the doctor’s urgent attention. The young man suddenly started to experience bleeding from the nose (epistaxis). The ambulance rushed him into the clinic where attempts were made by our doctor to stop the bleeding.

After series of methods were tried and there was no success, he invited two other doctors from the other nearby company clinics. The young man kept bleeding profusely from the nose for upward of about 4 hours. Ice packs, adrenaline packs, digital pressure, etc. were applied, yet no positive result. Then they resolved to apply an in-dwelling catheter, which was inserted into the nostril and inflated. The ball eventually acted as a plug over the bleeding vessel and the haemorrhage stopped. He had to breathe with his mouth for the whole night.

He was very lucky the rupture had only occurred in the nostril and not in the brain; if it had occurred in the brain he would have suffered from stroke, and perhaps he would have died from the complications. Imagine the number of hours he bled from the nose and the failed attempts to arrest the bleeding. If it had been in the brain, there would have been unrestricted bleeding and his life would have been in serious danger.

There is a need to adhere to medical advice and never to assume you know more than the professional doctor. Don’t ever think hypertension would go away by itself or by merely taking your drugs for a few months. Always check with your doctor before adjusting the dosage of your drugs, and before going off the prescription for sometime if you ever need to do so.

You should not allow anyone to deceive you by claiming to cure your condition with whatever remedy. Be sure your doctor places you on close monitoring for a specific period of time, and that he’s satisfied with the result and claims (if you ever take alternative medicine) before you shout ‘eureka’.

Blood Pressure: What Does It Mean?

2010-05-20T21:28:00.001-07:00

Blood pressure is the pressure or force exerted on the arteries by the blood as it flows or travels through them. It is usually measured in millimeters of mercury (mmHg) with the aid of a sphygmomanometer.
Two readings are important and should be noted while taking blood pressure measurement: they are the systolic and the diastolic pressure. Systolic is the pressure produced when the heart contracts, while diastolic is the pressure produced when the heart is at rest, and as the ventricles dilate and are refilled with blood. Systolic is therefore the upper reading while diastolic is the lower reading.
The normal range of blood pressure readings for a young adult is 100-120/70-80mmHg, though this may vary with age. Sometimes the formula 100±20/70±10 could be used to determine the normal pressure for a young adult.

How is it measured?
Usually the individual is made to sit down for at least 2-3 minutes before readings are taken. The cuff of the sphygmomanometer (Analogue or digital) is wrapped around his upper arm (whichever arm you choose) with the bottom of the cuff about ½” above your elbow. Place the earpiece of your stethoscope on your ears and place the diaphragm over the brachial artery (at the inside of the elbow) and inflate, Listening as you inflate (if using the analogue sphygmomanometer). Take the upper reading where you start to hear the heart beat and then the lower reading where the beating stops and record them. If the upper reading is heard at 120 and the lower at 70, the blood pressure is then 120/70mmHg. If you are using the digital sphygmomanometer, follow same procedure but without using the stethoscope. Press the button and the cuff is inflated automatically. The readings are displayed on the monitor, including the pulse rate.

Note that some factors affect the blood pressure. Some of the factors include Age, Drugs, Exercise, Position, body surface etc. For instance blood pressure slightly increases with age and in a person with a larger body surface.

Some terminologies you should know:

1. Normotension: this refers to normal blood pressure. It is the ideal for an individual, depending on his or her age.
2. High blood pressure: this is when the blood pressure is elevated above normal. Normally it is elevated above 140/90mmHg.
3. Hypertension: this is the persistent elevation of blood pressure above 140/90mmHg.
4. Hypotension: It is an abnormally low arterial blood pressure. This could be a reading of below 80/60mmHg.

An abnormally high blood pressure is dangerous just as an abnormally low one is. There should therefore be a balance. The best desired blood pressures should then be the normotensive pressure.

Am I Experiencing Hypertension?

2010-04-23T09:13:00.001-07:00

I woke one morning feeling very terrible; my head banged as though there were people dancing masquerade inside my cranium. I tried to take my mind off the pain but just couldn’t: the more I tried to relax the worse the pain became. Several things began to race across my mind. Have I become hypertensive? I asked, talking to no one in particular. I finally decided to see my doctor and after series of tests I was told what I had was just malaria.

The doctor took time to explain to me what I should ask myself if I thought I was experiencing hypertension. So what are those questions to ask yourself?
1. Am I having a terrible headache? One thing that could be a warning signal that you may be experiencing hypertension is if you have severe occipital headache (at the back of your head) especially in the mornings.
2. Am I losing sleep? Losing your sleep or suffering from a medical condition known as insomnia could be a warning that you may be having hypertension especially if you have no other way of explaining the cause of your sleeplessness.
3. Do I have any difficulty breathing? One other way you could know if you may be experiencing hypertension is if you suddenly begin to suffer shortness of breath. This should serve as a signal that you may be having a mild form of complication already setting in.
4. Am I dizzy? This is a feeling of unsteadiness or haziness and is usually accompanied by anxiety. If you are sure that that describes the symptom you have you need to see the doctor to find out if you are having hypertension.
5. Any palpitation? Do you have any rapid and forceful contraction in your heart? Then there is need to ask if you are becoming hypertensive. It could just be a warning sign or it could also be another condition. You need to see a doctor to be sure what it is.
6. Chest pain? Is there any chest pain or any heaviness on your chest? They are a warning that should not be overlooked. Find out what exactly might be responsible for such pain or heaviness.
7. Am I urinating frequently? That you urinate frequently could be a sign that your kidneys are experiencing some kind of distress as a result of hypertension which may have affected the vessels of your kidneys
8. Do I see clearly? If you are no longer seeing clearly or you feel there is reduction in your visual acuity this might well be a warning to you too. Don’t play with it; inquire further by visiting your doctor.
9. Sexual difficulty? Are still enjoying sex with your spouse the way you use to some years back? A sudden or gradual decline in your sexual capacity or libido may just tell you that hypertension is already with you. Don’t conclude you have it, you need to see the doctor for proper investigation.
10. Buzzing in your ears? Has there been buzzing, ringing or roaring sound in your ears of recent? If there has then there is the possibility that you may be experiencing hypertension. You need to be concerned even if the ringing or roaring is mild
11. A feeling of rotation? One more question you need to ask yourself is if you have a feeling of rotation inside you or in your surroundings. This could mean that there is serious problem somewhere in your system.

However, you should not conclude that you are experiencing hypertension because you have one or more of the afore-mentioned symptoms. You need to see a doctor for investigations to be carried out before you make your conclusions.

Why You Should Take Hypertension Seriously

2010-04-23T09:08:00.001-07:00

Hypertension is such a dangerous health problem that should not be taken for granted or toiled with; it should be handled with the seriousness it deserves and everything should be done to prevent the nasty experiences that come with it. Anyone who wants to live long and enjoy life to the fullest must take his health serious and show concern when it comes to incurable conditions especially.
You should take Hypertension seriously because of the following reasons:

1. It is crippling: Some of the complications of hypertension are crippling e.g. Stroke or cardiovascular accident. This deadly complication can render a man who has been very active and agile completely helpless to himself, his family and the society at large. Inability to move a particular part of the body makes one dependent on others for hygiene, feeding, mobility, and sometimes speech. In order not to experience this state of complete dependence you must take this health monster serious and do all you can to lead an independent life.
2. Blindness: the worst thing that could happen to a man is for him to be blind; then he is unable to admire the beauty of his surrounding environment, the beauty of his wife, his new clothes, the faces of his new born children, the beautifully coloured flowers in his compound, his beautiful bed spread, just name them. Blindness is one of those things hypertension could cause and so in order not to live in perpetual darkness for the rest of your life you need to take it serious and if you are hypertensive you do your best to prevent this ugly complication from setting in by having your eyes examined from time to time.
3. Kidney damage: Have you ever thought of the possibility of living on a dialysis machine for life? Have you also thought of getting someone who is compatible to donate a kidney for you? Does the possibility of tissue rejection strike any fear inside you? Then think of taking your health serious. Visit your doctor and seek his help to prevent you from losing your priceless kidneys to hypertension.
4. Heart failure: Just like stroke, heart failure could make you live like vegetable if it ever happens to you (especially the serious type). What happens then? You feel tired all the time, you are no longer able to do those physically challenging things you could do before – no more football, boxing, cycling, sex, marathon, etc. Life would no longer make any meaning to you if you just exist but are not imparting your environment. Take your hypertension serious because it could really harm you and make you debilitated for the rest of your life.
5. Myocardial infarction: How about having an excruciating pain on your heart that could make you feel terrible all times, and living on drugs to kill the pain? A dead portion of your heart ensures that your heart is not able to carry out its normal duty of pumping blood to the rest of your body.

Hypertension must be taken seriously for the afore-mentioned reasons, especially because of the fact that once these complications set in they are very difficult or almost completely impossible to reverse.

Hypertension And Pregnancy

2010-03-24T12:01:00.001-07:00

Pregnancy is a wonderful and joyous time in a woman’s life, but if you suffer with chronic hypertension, it can also be a scary time. And even if you’ve never suffered from high blood pressure while not with child, you still may experience hypertension during pregnancy. Let’s break it all down and examine the risks.

Chronic Hypertension – Chronic hypertension is when the mother has had an ongoing problem with high blood pressure, even before becoming pregnant. In normal pregnancies, a woman’s blood pressure tends to go down during the first 20 weeks of gestation, so if the patient is getting high readings at their regular prenatal check-ups, it is a good bet that they have chronic hypertension that has gone untreated, rather than gestational hypertension.

Treatment: The patient should consult with her health care practitioner to decide which treatment is best. If the patient is already on an anti-hypertensive medication, the caregiver will determine if the medication should be continued, substituted or stopped altogether. The patient must make certain she follows all of her doctor’s guidelines and does not try to self-treat with counterfeit medications or herbal supplements that have not been approved by her healthcare team.

Gestational Hypertension – This is the type of hypertension that occurs after 20 weeks gestation. If a patient shows readings significantly higher than during the early weeks of pregnancy, she may be exhibiting symptoms of gestational hypertension. Anything greater than 160/110 is considered dangerous and must be carefully observed.

Treatment: Mandatory rest periods, suspension of work and even hospitalization may be required to bring down a patient’s blood pressure. Otherwise, close observation of the mother and fetus will continue. The doctor may order fetal non-stress tests to be given twice weekly and/or ultrasounds to check in on the baby.

Preeclampsia/Eclampsia – The most severe form of pregnancy-induced hypertension is preeclampsia and eclampsia. This is when a patient’s high blood pressure is paired with bodily swelling that can’t be relieved and protein in the patient’s urine. If preeclampsia is not dealt with quickly, it can have dire effects on both the mother and the fetus. Furthermore, eclampsia can also result, which consists of the symptoms listed above plus maternal seizures and/or coma.

Treatment: If a patient gets to this point, the most effective treatment is delivery of the baby. If the fetus is not mature enough to live outside the womb, a medication called magnesium sulfate will likely be given intravenously to stop the progression of preeclampsia into eclampsia.

As always, a healthy diet and a moderate exercise plan even before getting pregnant are keys to keeping blood pressure normalized. Once you become pregnant, regular monitoring of your blood pressure at prenatal visits is essential, and swift action against impending problems is the safest bet.

Be well, take care of yourself, and enjoy your pregnancy.

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Liberty Kontranowski is a freelance writer and blogger with hundreds of articles published online and in print, covering everything from sexual health to parenting to beauty, fashion, entertainment and more. Liberty is the newest member of the Secure Medical team providing the highest quality articles to AccessRx.com.

Hypertension: Nursing Management

2010-03-07T11:51:00.000-08:00

Some patients may be admitted for the treatment of hypertensive crisis, control of complication or for the establishment of a treatment regimen. When on admission, here are some of the immediate cares that the nursing team could give to the patient to aid his speedy recovery:

1.Observation: Vital signs should be checked 2 hourly with emphasis on Blood pressure and pulse rate.
Monitor patient’s weight daily and keep proper record. This is to help detect oedema or weight loss. Check for side effects of drugs e.g. orthostatic hypotension.

2.Rest: Patient should be advised to avoid stress and tension. He should therefore have physical and mental rest in order to conserve energy.
Encourage moderate exercise e.g. walking if there is no dyspnoea. Mild tranquilizers may be given to enable patient sleep. Should there be dizziness patient should be protected from falls and injury.

3.Diet: Restrict sodium intake to about 4grams daily. Give light, easily digestible diet. Fatty food and excessive carbohydrate that can increase weight and cholesterol should be avoided. Coffee, tea, kola nuts, alcohol should be avoided or minimized.

4.Physical care: Assist patient with physical care if patient is very weak. Where there is blurred vision patient may require the use of medicated eye glasses. If there is bleeding from the nose (epistaxis) apply ice pack to the bridge of the nose and back of the neck. When the ice pack cannot control bleeding the nose may be packed. The pack should however be removed within few days. Make sure patient does not lie on one side of his body for several days in bed. If he is to be admitted for days, his position should be changed every 2-4 hours to prevent pressure sore from developing.

5.Elimination: Constipation should be avoided because it makes the patient strain at defecation thereby further elevating the blood pressure. Food rich in fibre should be given to prevent constipation.

Hypertension And Stroke: Any Hope?

2010-02-07T02:53:00.001-08:00

The words ‘Stroke, apoplexy and cerebro-vascular accident’ all mean the same thing. The hypertensive patient may become prone to this condition as a result of the narrowing of the blood vessels (this time in the brain) coupled with the increasing pressure with which blood is forced through them.

Usually the vessels in the brain are not as prominent as those in the limbs or trunk hence they are liable to rupture so easily. The hypertensive patient may suffer from this condition if he/she does not recognize the warning signs and act fast or if the stroke develops spontaneously without initial warning. Some of the warning signs of impending stroke are sudden severe headache or an increase in the quality or intensity of an already existing headache and a feeling of numbness in the extremities. These signs must be reported to the doctor immediately. Some of the factors that can precipitate this condition include non-adherence to drug regimen, excessive stress, sudden bereavement, loss of job, drug resistance, etc.

Some of the signs that the patient may have had stroke include loss of sensation on one part of the body, inability to move especially the affected side, slurred speech, drooping of one side of the mouth, drooling at the mouth, unequal pupils of the eyes, etc. When you see any of these signs stroke should be suspected and the doctor or the Emergency medical service called immediately. Do not attempt to move the patient to the hospital by yourself as this could end up complicating the situation.

The patient is usually admitted into the hospital for expert medical management; an attempt is made to gradually lower the blood pressure and control the condition from deteriorating rapidly. Some of the things that would be done for the patient include helping him to regain the use of the affected part of the body, regaining his speech, prevention of complication that would set in as a result of long period of confinement in bed and the control of the cause of the apoplexy, which could primarily be haemorrhage or other causes. If urgent and immediate steps are taken in the right direction and treatment commenced as soon as possible the level of damage would be greatly minimized, but if treatment is delayed for more than eight hours after the onset of the stroke extensive damage would have been done.

Hypertension And Nosebleed: What You Should Do

2010-01-30T02:36:00.000-08:00

Nosebleed is one of those nasty experiences that a hypertension patient could have occasionally. This could either be mild or severe depending on the contributory factors. It must be understood that this condition could start spontaneously without any injury in the patient.

Sometimes nosebleed is a product of long neglect of the medical treatment needed to put hypertension under control. It is due to a rupture of one or more capillary blood vessels in the nose following the elevated blood pressure within the vessel. We once had a patient with the severe type of bleeding which lasted for about 4 hours. The reason he actually suffered this serious problem was because he assumed his condition was already stabilized and he didn’t need to continue on his drugs any more. Unfortunately, the nosebleed came without a warning 6 months after he stopped taking his drugs. All efforts to stop the haemorrhage proved abortive until an indwelling catheter was inserted into his nostril and inflated. He was lucky he had that as the last resort otherwise he would have perhaps died from the uncontrollable bleeding.

It is therefore advisable not to suddenly stop your drug or adjust the dosage without your doctor’s supervision. However, if you notice that someone close to you starts to bleed from the nose as a result of his/her hypertension, here are some things you could do to help:
1.Sit the patient up in order to prevent discomfort as a result of standing. This also lessens fatigue or the possibility of fainting.
2.Patient should tilt his head slightly forward to prevent ingesting the blood (can cause vomiting) or inhaling the blood (which can cause choking).
3.Have patient pinch the soft part of the nose firmly between the thumb and forefinger (index finger).
4.He should be instructed not to blow the nose as this may dislodge blood clot that would help arrest the bleeding.
5.He should also be instructed to breathe through the mouth
6.Apply cold compress to the bridge of the nose, lips and back of the neck
7.Reassure the patient that bleeding would soon stop.
8.Protect his clothing from being soiled with blood.
9.Keep the patient as calm as possible
10.Keep on-lookers away to enable patient get adequate ventilation
11.If bleeding is severe call the doctor or arrange to take patient to the hospital.

Hypertension and Sex: Things You Need To Know

2010-01-27T06:11:00.000-08:00

Are you hypertensive and recently started to notice that you can no longer achieve or maintain erection as you use to? You need to know that there are reasons why you are having such problems; the first being that your condition has brought some structural changes to your system including your sexual organs.
For you to be able to acquire and maintain a strong and perfect erection there ought to be adequate blood flow to your sexual organs through the arteries supplying those organs. Unfortunately with hypertension blood flow to the penile vessels is considerably reduced and as such the pressure needed to produce erection is poor. Don’t forget that hypertension either on its own brings about organic dysfunction of some of your body organs or it is in itself a product of other disease conditions like diabetes mellitus which has arteriosclerosis as one of its major complications. When hypertension accompanies diabetes, it is almost certain that erectile dysfunction would soon follow.
The second reason you are unable to enjoy sex anymore is as a result of some of the drugs employed in the treatment of your condition. Some of those drugs produce that nasty effect as a side effect. What this means therefore is that you may be having a double assault (one from the disease and the other from your drugs) on your system. When you discover there is a problem like that you may become anxious and desperate to get out of the tight corner you are held. In an attempt to get out of the problem you may actually compound it if you do not employ the right solutions. Sexual dysfunction is such a sensitive issue that must be handled with care; so you must consult a real professional lest you destroy your sex life completely or even worsen the hypertension by the kind of therapy you adopt.
You must never attempt to remedy this problem on your own by self-medicating because some of the performance enhancing drugs have the ability to elevate your blood pressure further. Most of the drugs used to increase erection actually contain androgen or testosterone which can elevate blood pressure. You need to seek the advice and prescription of a medical doctor who should recommend for you the kind of therapy to apply. Don’t use aphrodisiacs that you do not know their contents; you may not even need them. It is possible that what would take care of your problem could be just physical exercise and dietary modification. So watch out for any slightest change in your sex life and see the doctor immediately.

Hypertension and Your Kidneys: any Relationship?

2010-01-19T02:13:00.000-08:00

The relationship between hypertension and kidney disease is such that it is difficult to determine which of them precedes the other. It is a known fact that hypertension can cause kidney problems, especially the chronic types such as chronic pyelonephritis, nephrosclerosis, etc and it is also known that kidney diseases such as acute or chronic glomerulonephritis can cause hypertension.
When there is a renal (kidney) problem e.g. glomerulonephritis which is primarily caused by streptococcal or other infections, there is an inflammation of the glomeruli of the kidneys. This inflammatory process brings about reduced blood supply to the renal vessels as a result of the swelling that accompanies the inflammation. Reduced blood supply ensures that Renin (an enzyme) is released into the blood stream. The released rennin now leads to the breakdown of Angiotensinogen (plasma protein) into angiotensin I. Angiotensin I is further acted upon by Angiotensin-converting-enzyme (ACE) which is found in the lungs, converting it into angiotensin II. This angiotensin II leads to the secretion of Aldosterone (which stimulates salt and water re-absorption by the kidneys), and constriction of arterioles thereby leading to an elevation in both systolic and diastolic blood pressures.
The elevated blood pressure on the other hand brings about renal ischaemia (reduced blood supply to the kidneys), thereby leading to a further release of renin into the blood stream. The release of rennin leads to a further rise in the blood pressure by ensuring that more angiotensinogen is converted into angiotensin I to continue the cycle. But the use of drugs known as ACE inhibitors can help to disrupt this process or minimize the rate at which angiotensin I is converted to angiotensin II thereby bringing the hypertension under control.
However, high blood pressure reduces blood supply to the kidneys (a condition referred to as renal ischaemia); and if the kidneys remain deprived of blood and oxygen supply for a long period of time physiological changes and complications begin to occur in them and they become susceptible to infections: there could be recurrent renal infections. This is where pyelonephritis and nephrosclerosis come in. With nephosclerosis there is further constriction of the arterioles of the kidneys and as such more release of rennin, and by extension another increase in blood pressure. Recurrent renal infection could lead to chronic pyelonephritis and eventually to kidney failure if not managed on time. Therefore, renal problems should be promptly managed to prevent hypertension, and hypertension should as well be controlled to reduce the possibility of renal disease.

Hypertension: How is it Classified?

2009-12-31T02:13:00.000-08:00

Hypertension is classified into Primary and Secondary; systolic or diastolic, and true systemic.

1. Systolic hypertension: This is common among the elderly especially where there are other disease conditions. The systolic blood pressure is persistently raised above 160mmHg.

2. Diastolic hypertension:In this case the diastolic blood pressure is elevated and sustained, and is severe in most cases. The difference between this and primary hypertension is that there is a noticeable change in the walls and inside of the arteries in diastolic hypertension whereas primary hypertension does not show any such change.

3. True systemic hypertension: In this particular condition both the systolic and diastolic blood pressures are equally elevated and sustained. Note that for one to be said to be hypertensive, his/her blood pressure must be taken repeatedly for at least one to two weeks.

4. Primary hypertension: This accounts for about 85% of known cases. There are no known underlying causes for this to develop. There is a persistent elevation of the diastolic blood pressure above 95mmHg. In most cases it is common within the family hence the general consensus that it is hereditary. Other factors that have been implicated in the development of primary hypertension include obesity, emotional stress, personality variables, etc.

5. Secondary hypertension: This is caused by a disease condition in the system. The pathological changes in the body lead to the surfacing of this condition. Some of the conditions that can lead to secondary hypertension include: Renal (kidney) disease, thyrotoxicosis, Toxaemia of pregnancy, Phaeochromocytoma (tumour of the adrenal gland), Arteriosclerosis, Coarctation of the aorta, Cushing syndrome, Renal artery stenosis and Oral contraceptives.

Joseph Ezie Efoghor is a professional nurse with years of practical experience. He writes on variety of topics which you may find beneficial to you. For more on his write-ups visit http://bloodpressureandmore.blogspot.com

Curing Hypertension through Surgical Operation

2009-12-31T02:09:00.000-08:00

The hope of curing hypertension through surgical operation is increasing as the first attempt to reduce and permanently cure a persistently elevated blood pressure was made in Britain recently. All attempts before now seemed to only offer a palliative rather than curative hope for the hypertensive patient. Recently however, a renal surgery was carried out for the first time in Britain which already is yielding a positive result.
The one-hour surgical operation was carried out on one Mr. Anthony Henry and its objective is to attempt to disrupt the signals from the brain that have persistently kept the blood pressure high. Disrupting these signals is hoped to permanently cure the hypertension. The operation which is otherwise known as ‘Renal sympathetic-nerve ablation’ involves inserting a wire into a blood vessel close to the kidneys to burn through the nerves that stimulate high blood pressure.
The patient’s blood pressure is reportedly down only two weeks after the successful surgical operation. The 68 year old retired chef from Stratford already has started to enjoy the benefit this surgical procedure hopes to offer all sufferers of hypertension, and also enjoys the privilege of being the first Briton to undergo this operation.
The benefits of this operation could become apparent within 3 months, and there is the hope that the patient would stop taking anti-hypertensive drugs for life. It is also hoped that this procedure would reduce the blood pressure significantly as well as reduce the stroke mortality by as much as 50%.
In a world where there are millions of people suffering from hypertension this scientific innovation could just be the scientific achievement of the century. We do hope that it truly gives a permanently cure to hypertension and stop the untold hardship patients are suffering in the hands of this seemingly incurable health monster.

What is Hypertensive Crisis and How is it Managed?

2009-12-30T08:23:00.000-08:00

Hypertensive crisis is the sudden rise in the blood pressure of the hypertensive patient beyond 250/150mmHg. The onset is usually with little or no warning signs, and it is characterized by severe headache, nausea, vomiting, dizziness, visual disturbances and disorientation. In some cases these symptoms are accompanied by a cerebral spasm which brings about cerebral ischaemia, oedema, and thrombosis. Hypertensive crisis is such a dangerous medical condition that an immediate medical intervention would be needed to save the patient’s life. It is therefore medical emergency.
Hypertensive crisis is managed through the administration of administration of a vasodilator such as Hydralazine (Apresoline) intravenously to help dilate the blood vessel, and a diuretic e.g. Furosemide (Lasix) intravenously to help to help patient lose excess fluids and sodium.
The patient should be placed on strict bed rest and the vital signs –blood pressure, pulse and respiration monitored every 5-10 minutes. His neurological signs should also be monitored. Patient’s fluid intake and output should also be monitored to determine the level of progress made. The possibility of acute hypotensive reaction is quite high as a result the anti-hypertensive drugs hence patient should be strictly monitored and not allowed to get up suddenly from bed.
Everything medically possible should be done to see that the patient does not suffer any further stress as this is capable of making the patient suffer more complication such as stroke. Therefore, patient should be keep in a quiet environment with visitors restricted to allow for both physical and mental rest and aid speedy recovery. His physical care should be taken care of by the nurses.

Hypertension: How Dangerous are The Complications?

2009-12-30T08:17:00.000-08:00

The complications of hypertension are so dangerous that a lot has to be done to get them prevented. There are a few complications that gradually set in when one is hypertensive and with time they affect several organs of the body thereby posing a serious health threat to the sufferer.
Some of these known complications are:
1. Myocardial infarction: This is the necrosis or death of a part of the myocardium due to sustained inadequate blood supply to that portion. When the coronary arteries become narrowed as a result of changes in their walls and lumen it becomes increasingly difficult for blood to get to the myocardium of the heart. This subsequently leads to the death of the myocardium, a complication otherwise referred to as myocardial infarction.
2. Enlargement of the heart: This complication is brought about by an attempt made by the heart to overcome the peripheral resistance put up by the blood vessels. As the heart stresses itself to supply more blood to the organs the myocardium becomes enlarged (a condition known as myocardial hypertrophy), this eventually leads to overall enlargement of the heart (cardiomegaly) and its inability to pump out blood efficiently and effectively.
3. Heart failure: The inability of the heart to effectively and efficiently pump out blood to the rest parts of the body as a result of a weakness in the contractility of the myocardium leads to its failure. The failure of the heart brings about a further short supply in oxygen and nutrients supply to the organs.
4. Stroke: This is bleeding into the brain as a result of a rupture in the blood vessels of the brain. When stroke or cerebro-vascular accident occurs in a part of the cerebrum, the side of the body opposite the affected part becomes partially or totally paralyzed, leading to difficulty in movement, slurred and incoherent speech, etc.
5. Kidney problem: Poor blood supply to and changes within the blood vessels of the kidneys also bring about renal complication such as nephrosclerosis and chronic pyelonephritis.
6. Retinal damage: The retina of the eyes may also suffer one form of complication or the other. The chronic pathological changes in the tiny vessels of the eyes coupled with increasing blood pressure lead to a rupture and bleeding into the retina. This in the long run may lead to partial or total blindness or other form of retinopathy.

Hypertension: The Pathophysiology

2009-12-17T00:11:00.000-08:00

Arterioles and large blood vessels become hardened and constricted leading to an abnormal resistance to blood flow and subsequently an elevated blood pressure. The heart responds by trying to overcome the peripheral resistance. There is therefore an increased cardiac output as the heart tries to pump more blood to the different parts of the body. The continuous resistance puts a greater demand on the heart to increase its pressure thereby leading to an increase in the size of the tissue of the myocardium, a condition known in medical term as myocardial hypertrophy and then cardiomegaly (enlargement of the heart) and coronary insufficiency.
The abnormal resistance to blood flow leads to decrease in blood supply to vital organs such as the heart, brain, kidneys and the lower extremities. This brings about mental confusion, headache, oliguria (a deficiency in the secretion of urine), angina pectoris, dyspnoea, fatigue, etc. The changes in the blood vessels may lead to haemorrhage and intravascular coagulation bringing about occlusion of the blood vessels.
Coronary insufficiency results in myocardial infarction (MI) and subsequently the heart fails. Inability of the heart to pump out blood from the left ventricle into the aorta gradually leads to pulmonary congestion. The kidneys fail as a result of poor blood supply. Arteriosclerotic changes in the tiny vessels make them susceptible to rupture. Rupture occurs as the pressure continues to increase within the vessels. This brings about haemorrhage. Should the rupture occur in the brain there would be stroke (CVA). Epistaxis (nose bleed)occurs as a result of rupture of the tiny vessels of the nose. Bleeding into the retina brings about blurred vision and subsequently blindness. These effects on organs are referred to as “End-Organ damage”.

What Role Do Hormones Play in Hypertension?

2009-12-16T00:13:00.000-08:00

Hormones are chemical substances which are produced in an organ (usually a gland) and are transported by the blood to another target organ where they excite their activities. Some of the hormones are transported through a duct to their target organs while others pass directly into the blood stream.
Hormones are produced in order to help perform certain specific function for the body, but when certain things go wrong with their production or their discharge process there could be problems. Some hormonal activities therefore have been known to contribute to the development of hypertension. Some of the hormones cause hypertension through their direct effect on blood vessels while others cause hypertension indirectly.
1. Pituitary hormone: The pituitary gland otherwise known as the master gland regulates the activities of other glands by producing hormones which act on these glands. One of such hormones is the adrenocorticotrophic hormone (ACTH) which regulates the production of corticosteroids by the adrenal cortex. When there is a fault in the regulation process the corticosteroid could produce excess of its substances such as the mineralocorticocoids e.g. aldosterone which is known to retain sodium and subsequently fluid. Excessive retention of fluid by this hormone eventually leads to hypertension.
2. Thyroid hormone: The thyroid gland produces thyroxine which helps to regulate the body’s metabolic processes. Over stimulation of the thyroid gland by the thyroid stimulating hormone (TSH) which is produced by the anterior pituitary gland leads to excessive secretion of thyroxine. This eventually brings about hyperthyroidism; and one of the known effects of hyperthyroidism is hypertension.
3. Adrenal hormone: Adrenaline (epinephrine) is a major hormone secreted by the adrenal medulla. It exerts action similar to that of the sympathetic nervous system. It causes vasoconstriction of the peripheral blood vessels. When there is a problem with the kidneys the regulation of this hormone is altered thereby bringing about its excess production. This in the long run leads to hypertension.

What is Acute Hypotensive Reaction?

2009-12-14T02:52:00.000-08:00

Patients treated with anti-hypertensive drugs have the tendency to develop acute hypotensive reactions which are usually characterized by fainting, weakness, nausea and vomiting. This condition is equally dangerous and needs to handled properly so that the patient does suffer any harm
The patient should be taught how to prevent acute hypotensive reaction and what to do if they should occur.
i.In case of acute hypotensive reaction, patient should lie down immediately with his feet elevated above the head; flex the thigh and wriggle the toes to increase blood flow to the brain. This would help to increase blood and oxygen supply to brain cells
ii.Patient should get up slowly from lying position to a sitting position before standing. This is to allow the vascular system adjust to changes in position. Otherwise there could sudden drop in blood pressure which would make the to slump and get injured.
iii.Patient should avoid standing motionless, especially within the first 2 hrs of taking anti-hypertensive drugs. Standing motionless causes drainage of blood from the brain and other organs thereby leading to a fainting attack. It also makes the vessels of the legs to relax causing a pooling of blood in the lower extremities.
iv.Constipation should be avoided because it causes increased or irregular absorption of anti-hypertensive drugs. This can lead to critical hypotensive reactions.
v.Driving within 2 hours of taking anti-hypertensive drugs should be done carefully to avoid accidents.There could be pooling of blood from the brain and this eventually could make the patient experience dizziness or confusion and when this happen an accident may be inevitable. Accident is a major in acute hypotensive reaction.
vi.Avoid hot baths and excessive alcohol which can cause vasodilatation and fainting.A patient who is likely to experience acute hypotensive reaction or a patient who has actually experienced it before must try and avoid alcohol because the alcohol will produce a state of hypotension (lowered blood arterial pressure)and when its effect combines with the effect of the anti-hypertensive drugs acute hypotensive reaction would surely occur.

13 Possible Causes of Hypertension

2009-12-14T02:39:00.000-08:00

Hypertension is caused by one of several factors. Primary hypertension for example, develops when there are predisposing factors which is the hereditary link and for this to cause hypertension to come up other factors known as precipitating factors have to combine with them. The causes of hypertension therefore are discussed below:
1.Heredity: Primary hypertension is known to run in families. This can be directly passed on from parents to their offspring or from the grand parents to other generations even though there are no underlying diseases.
2.Obesity: Excessive weight gain can also trigger off primary hypertension. When an individual begins to add much weight extra work is added to the heart and the system is also stressed. This in the long run leads to primary hypertension.
3.Emotional stress: Emotional stress is known to release adrenaline which increases heartbeat, constrict surface blood vessels and lead to increase in blood pressure. Emotional stress, if not controlled can be a good source of primary hypertension.
4.Excessive salt intake: Excessive consumption of table salt (sodium chloride) by predisposed individuals makes the kidneys to retain more fluid and subsequently lead to hypertension.
5.Nervous activities: Over activity of the autonomic nervous system also leads to the over secretion adrenaline from the adrenal gland. This system is not under the control of the individual. If it keeps stimulating the adrenal glands to produce more adrenaline a state of hypertension would occur.
6.Certain drugs: Some tablets which are routinely taken by women to prevent pregnancy are known to lead to an increase in blood pressure. Other drugs which can lead to hypertension include anabolic steroids and corticosteroids.
7.Poor exercise: Poor physical exercise leads to poor muscle tone which make the muscles to over relax on peripheral blood vessels given little or no chance to expand.
8.Kidney disease: Some forms of kidney diseases which cause inflammation of the kidney nephrons lead to the release of certain enzymes into the blood stream which eventually brings about the constriction of the blood vessels. This is one of the major causes of secondary hypertension.
9.Tetanus infection: The organism that causes tetanus in man is also known to release a chemical that is capable of causing hypertension. When it infects man, this chemical or exotoxin affects the brain and the heart thereby causing hypertension.
10.Thyroid activity: The thyroid gland secrets hormones that regulate metabolic activities. But when it becomes over active it can bring about secondary hypertension.
11.Pregnancy: Some women develop hypertension during pregnancy. During their pregnancy there is raised level of protein in urine, swelling of the hands and feet, and also there is hypertension. This condition is usually referred to as toxaemia of pregnancy.
12.Tumour of Pituitary gland: The pituitary gland which is situated in the brain controls the activities of other glands in the body. When there is tumour of the pituitary gland it causes the adrenal gland to produce excess of its hormone and this eventually results in hypertension.
13.Phaeochromocytoma: This condition which is the tumour of the adrenal medulla leads to over production of adrenaline thereby bringing about constriction of the peripheral blood vessels as well increasing cardiac output. This in turn leads to secondary hypertension.

11 Steps to Diagnosing hypertension

2009-12-13T04:38:00.000-08:00

Hypertension can be properly diagnosed by carrying out detailed medical/laboratory investigations on the patient. The following the under-listed 12 steps can really be of great help in trying to establish whether or not an individual has hypertension:
1.Detailed health history of the patient should be obtained. Information such as the lifestyle, economic status and past medical history should be obtained so as to get a clue as to the probable type of hypertension, or any condition that is responsible for secondary hypertension.
2.Physical examination (palpation) to detect any signs of adrenal mass or cardiac enlargement. The radial and femoral pulses should also be palpated to determine the rate and quality. Blood pressure readings should be obtained from both arms and legs while the patient is in supine position.
Other forms of investigations to detect secondary hypertension include:
3.Urinalysis: To detect epithelial cell cast: this is indicative of chronic glomerular lesions. Presence of pus cells also suggests the presence of proteinuria (presence of protein in urine) or pyelonephritis.
4.Blood Urea Nitrogen (BUN) and creatinine clearance tests should be carried out to ascertain renal dysfunction. An elevation of BUN and creatinine is indicative of renal problem which may have secondarily elevated the blood pressure.
5.Serum electrolytes evaluation may be done to detect the presence of primary aldosteronism, hypercalcaemia, hyperkalaemia and chronic renal disease.
6.Intravenous Pyelogram: This is a procedure whereby an x-ray of the renal system is carried out following the intravenous injection of a radio-opaque dye, in order to check the status of the kidneys.This could help in arriving at a proper diagnoses of secondary hypertension since renal disease is known to be a contributory factor.
7.Renin assays: Helps to evaluate the level of renin in the blood stream. The enzyme is usually released into the blood stream when there is ischaemia of the kidneys. This enzyme causes vasoconstriction and eventually leads to hypertension in the long run or worsen an already existing hypertension.
8.Urinary steroid excretion: An increase in the urinary steroid excretion shows a link between the steroid production and secondary hypertension.
9.Serum thyroxine: This may give clue to the presence of hyperthyroidism which is also one of the causes of secondary hypertension.
10.Plasma cholesterol/triglycerides: This also helps to establish the link between plasma cholesterol level and artheriosclerosis which is contributory to the development of secondary hypertension
11.ECG (to detect left ventricular hypertrophy: This will help to determine whether or not there already an enlargement of the left ventricle of the heart, which one of the major complications of hypertension.

12 warning signs of hypertension

2009-12-11T06:38:00.001-08:00

Quite a number of persons walk the streets with hypertension but are never aware they have the problem. This is because sometimes the warning signs come up too lately. Sometimes too, people do not go to have their blood pressure checked in a health facility.
When an individual has hypertension, there are several signs and symptoms that would make him/her know or at least suspect that he/she may have become hypertensive. A combination of two or more of these signs should actually give the individual some concern and make him/her to want to see the doctor. Some of the signs include:
1. HEADACHE: The individual who has hypertension begins to feel unusual headache on the back of of the head especially on waking up in the morning. This kind of headache is very discomforting.
2. WEAKNESS: One of the signs of hypertension is weakness. So when you begin to feel unusually weak you should see the doctor.
3. NERVOUSNESS: Another sign of hypertension is nervousness. The individual experiences a state of mental and physical restlessness or unrest.
4. DIZZINESS: This is also one of the signs that accompany hypertension. It is a feeling of unsteadiness accompanied by tension or anxiety.
5. RINGING IN THE EARS: One other thing that would make you suspect you may have hypertension is when you begin to experience a ringing, buzzing or roaring sound in your ears.
6. LOSS OF SLEEP: Hypertension can interfere with your sleep. Because of the involvement of the brain you may be unable to sleep at night when you have hypertension. This condition is known as insomnia.
7. NOSE BLEED: Bleeding from the nose otherwise known as epistaxis also accompanies hypertension. When the small vessels in the nose rupture as a result of their raised pressure, the individual bleeds from the nose.
8. LIGHT-HEADED: A hypertensive also may feel lightness of the head.
9. SHORTNESS OF BREATH: The individual with hypertension may also experience some difficulty with breathing. The person feels as if his/her breathing is going to cease.
10. CHEST PAIN: Chest pain especially on the left chest wall or around the shoulder or neck may be present. The pain is usually provoked by physical exertion as the heart muscles are deprived of sufficient blood and oxygen supply.
11. FAINTING: The individual may also experience a fainting attack. In some cases there is a feeling of rotation of objects in the surrounding environment or within oneself.
12. CHANGES IN VISION: Hypertension is also accompanied by changes in vision. This includes poor vision, cloudy vision, or blindness. This occurs as a result of changes in the capillary blood vessels in the eyes.
NOTE: All these signs do not occur in just one person. However, one person may have several of these signs if adequate measure is not taken on time to detect and treat the condition.

10 sure ways to prevent hypertension

2009-12-10T04:44:00.000-08:00

Hypertension is a condition nobody desires to have because of the attendant complications or problems that come with it. Hypertension is really dangerous and could shorten one's life span by as much as 20 years if nothing concrete is done to control it.
There are a lot of things you can really do to help prevent this condition from developing in your life, or prevent the complications if you already have it. Certain factors known as 'Triggering factors' like the trigger of a pistol help to launch the condition if the predisposing factors (especially heredity) are already there in you. Here are some steps you can take to avoid developing hypertension:
1. REDUCE SALT INTAKE: Your dietary salt (sodium chloride) intake should be reduced to about 4grams per day. You must avoid the temptation to add more salt to your food or soup after it is prepared because salt retains fluid in your system and therefore would elevate your blood pressure.
2. AVOID STIMULANTS: Foods which stimulate the system should be avoided. Some of them include coffee, tea, alcohol, kola nuts and some drugs with caffeine. They increase heart rate and discharge adrenaline thereby raising further the blood pressure.
3. HAVE ENOUGH REST: You should have adequate rest; this includes both physical and mental rest. Avoid excess workload or watching movies late into the night. You should have time to sleep in the night and also take naps during the day. Excessive physical exertion should be avoided.
4. REDUCE WEIGHT: If you are obese or you are gaining more weight than is necessary you should try and reduce your weight because obesity increases the body surface area and increases the oxygen demand on the heart thereby making the heart work harder than necessary.
5. MEDICAL CHECK-UP: Always visit the clinic at least once in three months to have your blood pressure checked. But if you are hypertensive already you should check your blood pressure at least once every two weeks. Regular medical examination should be conducted to detect complications.
6. AVOID SATURATED FATS: Saturated fats are those fats or oils that become congealed at room temperature. They contain cholesterol which can become deposited on the walls of your arteries thereby elevating your blood pressure.
7. AVOID CONSTIPATION: Frequent constipation should be avoided by taking enough water and by adding fibres to your food because straining on defecation increases your blood pressure. You can also reduce constipation and hypertension by eating more fruits and vegetables.
8. REGULAR EXERCISES: You should exercise regularly for at least 30 minutes per day and several times a week. This improves blood circulation and proper functioning of the heart and blood vessels. The exercise should however be done moderately each time.
9. TREAT ILLNESSES: Diseases of the kidney and other organs should be treated promptly by visiting the hospital or clinic. Early treatment helps to prevent complications that would lead to hypertension in the long run.
10. FIND OUT THE CAUSE: If your blood pressure begins to rise rapidly in a short time find out the cause. If it is caused by oral contraceptive drugs, alcohol, stress, etc. they should be eliminated to prevent further worsening the condition.