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Hypertension - Medical Malpractice
Hypertension is also called high blood pressure. It is an elevated pressure in the arteries of the blood stream. The arteries carry the blood from the heart to the capillaries in the end organs. Normal blood pressure is about 120/80 and high blood pressure is considered to be 140/90 or greater. Anything between those two levels could be pre-hypertension. The top number is the systolic heart pressure or the amount of pressure in the heart and vessels during the pumping of the heart. The bottom number is the diastolic pressure or the pressure in the heart and vessels when the heart is at rest.
High blood pressure can contribute to heart disease, kidney or renal disease, arteriosclerosis, damage to the eye or stroke. This is why doctors are so diligent about checking the blood pressure every time a person goes to the doctor's office. It used to be that diastolic high blood pressure was considered to be worse than just having systolic high blood pressure. It is now known that both types of high blood pressure are risky to have. About one out of three people in the US have some form of high blood pressure in their lives and it actually can affect children and adolescents. High blood pressure is clearly an under-diagnosed disease.
The blood pressure is measured using a sphygmomanometer, which is a cuff that is placed around the upper arm. A stethoscope is used to find the systolic blood pressure, which is when a pulse is heard in the brachial artery when lowering the pressure in the cuff. The diastolic blood pressure is measured when the beat is no longer heard. This is why there are two numbers to a blood pressure.
When your blood pressure is measured, you need to avoid eating, smoking, caffeine intake and strenuous exercise before having the blood pressure checked. Stress, too, can increase the blood pressure. A blood pressure of 130/80 in diseases like diabetes is considered too high and can cause end organ damage even though the blood pressure is technically normal. Those with kidney disease also should have a blood pressure of lower than 130/80. African Americans are prone to hypertension so they should be kept below 135/80. Blood pressure is measured in mm Hg or millimetres mercury. The risk of problems due to high blood pressure doubles with every 20/10 increase beyond 115/75.
There are two forms of hypertension: essential hypertension and secondary hypertension. Essential hypertension accounts for 95 percent of all cases of high blood pressure and has a multifactorial cause. Secondary high blood pressure accounts for 5 percent of all cases of hypertension. It is caused by diseases such as pheochromocytoma and kidney disease.
Essential hypertension affects about 72 million Americans and it is not always known why a person gets it. It may be due to high salt intake, heredity, obesity, being African American or having kidney failure. The genes representing high blood pressure are not completely identified yet but it is known to run in families. If you have a parent with high blood pressure, you are much more likely to have high blood pressure yourself. About a third of all cases of essential hypertension are related to genetics. Certain genetic factors play a role in who gets essential hypertension and who does not.
In essential hypertension, there appears to be an abnormality of the arteries with increased stiffness of the blood vessels, particularly the small arteries distant from the heart. These are called arterioles and no one knows exactly why they become so stiff.
Secondary hypertension is caused by kidney disease-a condition called renal hypertension. The renal artery can be narrowed, resulting in a secondary effect of having high blood pressure. The treatment of this form of hypertension is to open up the renal artery with a balloon angioplasty. A permanent stent is placed in the artery to keep it open.
A pheochromocytoma can be a cause of hypertension. This is a tumour in the adrenal gland that secretes epinephrine (adrenaline) or norepinephrine. These can increase the blood pressure to staggering proportions. The treatment is to remove the tumour so that the norepinephrine and adrenaline levels return to normal.LEGAL HELPLINE: ☎ 855 804 7125
The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here