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HYPERTENSION

BLOOD PRESSURE

We need a blood pressure to send blood around our bodies.It is needed to overcome the resistence of the smaller blood vessels. The arteries in the body have muscles in their walls to give them the tone.If this muscle is supple the arteries can relax,their size or width increases and blood flows more easily.Think of artery as a garden hose pipe,if you turn the tap on water flows more easily_ now clamp the pipe to reduce its size by half and water will need more pressure to to get through to give the same flow.In a similar way heart pumps the blood through the arteries but, if your arteries get smaller the pressure will need to raise in order to force the blood through.The blood pressure reading should not be more than 140/90.nmjm.As a natural part of growing old,your arteries tends to loose their elastic properties to some degree.Also the walls of your arteries tends to thicken after middle age,consequently the internal diameter of the vessel is slightly reduced.All that changes require a very slight increase in blood pressure,which is perfectly normal as you grow older.

MECHANISMS

Your level of BP depends on how hard your heart pumps blood in your arteries,on the volume of the blood in your circulation,and how tight and stiff your arteries are.The smaller arteries are sheathed by a strand of muscles which spirals around them,if the muscle tightens and shortens,it narrows the artery.In this way smaller arteries can be varied in diameter according to varying needs of different organs in different activities.In people with high BP something goes wrong with this mechaniasm,so that all the arteries are too tight.The heart thus has to beat harder to push the blood through them.This tightening up may be caused by signals sent by brain through nervous system or by chemical signals released by other organs in the body such as kidneys or by the thickening of the walls of the arteries.

WHAT CAUSES HIGH BLOOD PRESSURE

iN VAST MAJORITY OF PEOPLE THERE IS NO SINGLE CAUSE,JUST AS THERE IS NO SINGLE CAUSE FOR PEOPLE TALL OR SHORT.The medical term is essential or primary hypertension.Tests may be done to check the kidneys,adrenal gland and heart .Some peoples biood pressure is raised as a side effect of their medications.

RISK FACTORS FOR ESSENTIAL HYPERTENSION

Age

Gender

Family history

Stress (psychological,social,occupational)

Social class

Excess alcohal

Smoking

Diet

Excess salt or too little potassium

Fat

Sugar

Obesity

Sedentary lifestyle

Lack of sleep

.HOW A TEMPORARY RISE BECOMES PERMANANT

Whatever the causative factors blood pressure usually rises gradually.In the begining it is sometimes up and sometimes down,but it gradually remains higher and higher.The level is usually lower while you are sleep.

Frequent risees in blood pressure means that the barorecptors in the artery walla are reset at a higher level so they no longer recognize the higher pressure as high.Once they are reset they try to maintain the blood pressure within the new higher range.

Frequently rise in blood pressure also cause structural changes in medium sized muscular arteries.All muscles develop with use; high blood pressure causes the artery walls to become thicker and more muscular so they can resist high pressure in the system.The result is that whenever these vessels constrict-for e-g in response to stress-the narrowing of the blood vessels is therefore that much greater and the rise in your blood pressure corrorpondingly higher.

Eventually these structural changes not only help to maintain higher pressure,but alson perpertuate it.Thus it is possible that higher blood pressure once established could be maintained by a different set of factors from those that initiated it.

CHILDREN AND HIGH BLOOD PRESSURE

Children also get high blood pressure but very rarly.Most family doctors spent a life-time without seeing a single case.However when high blood pressure do occour in childhood, it may cause a very serious damage to the brain,eyes,kidneys if it is not recognized and treated.Because high blood pressure is so rare in childhood,the possibility is often forgotten,so the diagnosis may be made late
Primary high BP can be said to occour in childhood; that is there is a distribution of BP in children just as there is in adults, with a high end and a low end.As in adults children are at the high end of this distribution can be labelled as having high blood pressure, the question is what purpose does such labelling serves.Adults with primary high BP are considered at increased risk for coronary heart disease,stroke and other kinds of organ damage, but children are not except at extremes.There is not yet convincing evidence that children with high BP derive any benefit from BP lowering medications.
 Since 1977 the US task force on childhood hypertension that children in the top 5% of the distribution for BP be investigated fully and followed up, and some US experts in the field recommended that some of these children should be started on long-term medication,even in the absence of any evidence of organ damage.
 For all practical purposes,when children have high blood pressure_ their high BP is a result of some other disorder.In fact 95% of all children with a sustained diastolic pressure of over 120mmHg have an identifiable cause for theit high BP,that is nearly always a kidney disorder,occasioanally coarctation of the aorta or another rare condition.They need accurate diagnosis and urgent treatment for these rare conditions.

GOOD OR BAD SPORTS FOR HYPERTENSION

Scuba diving may be dangerous for anyone either with an uncontrolled high bloodpressure or on BP lowering drugs.They have to be satisfied with snorkelling,diving to not more than 2 or 3 meters.

Squash and other similar extremely active and exhausting sports are unwise, and so all kinds oh static exercise such as weightlifting,press-ups and body building.Boxing is unwise.Otherwise there is virtually nothing that people treated with high blood pressure cannot do,providing they get themselves sensibly into training and do not rush into verydemanding activities for the first time in middle age.People who exercise regularly tend to have lower blood pressure than couch potatoes.Swimming is a very good form of exercise,as it remains possible even for elderly people with joint and back pain.Cycling is a good alternative for people without back pain.

SPORTS NOT ALLOWED

There may be some.Most BP lowering drugsinterfear with your bodys natural responses to extreme changes in atmospheric pressure or accelration.Because of this,it is reasonable for the governing bodies of these sports which involve you in such games to be concerned about your high blood pressure.They may perhaps tell you not to do them or should have a medical check up before taking part.Examples which spring to mind are motor racing,parachuting and recreational flying, but we doubt this list is exhaustive.If you want to take part in a sport of this type, we suggest that you contact its governing body to see if they impose any restrictions and, if so, what they are.

SEX

The vast majority(90% or more) of people with high blood pressure,both male and female are able to lead full and normal sex lives.What about the other 10%?There is no evidence to suggest that high BP itself cause problems of diminished desire,but in any large group of men,about 10% of them will have such problems(the average figure for general population is about 5%)The difference is caused by other health changes often associated with high BP(such as circulation problems,diabetes), or by BP lowering medication or simply by the worry or loss of confidence which can be associated with the diagnosis of high BP.

Sex starts in mind. If mind is disturbed or preoccupied withn other worries, the secquence of first emotional changes and then physical changes which must occour before successful love making can take place may not even begin,or having begun it may at any point be interrupted.Depending upon where this interruption occours,the consequences may be loss of desire,failure to obtain or maintain erection,premature ejaculation or failure of orgasm.

BP LOWERING DRUGS AND IMPOTENCE
All BP-lowering drugs can occasionally cause partial or complete failure of erection in men.About 5% of all men are affected by worries about their potency.This figure is double for men who are on BP lowering tablets.Impotance caused by BP lowering tablets is always reversible: in other words it is a side effect that disappears soon after stoping the drug.If it does not then the drud is unlikely to be the cause.The worst offenders are thiazide diuretics, mainly when prescribed in unnecessarily large doses.Runners -up are the drugs that mainly act on brainstream and the beta-blockers.If you are taking any of these drugs then it is worthy to go back to doctor and ask for change of medicine.

TREATMENT OF IMPOTENCE FOR HYPERTENSIVE PEOPLE 

Depending on the actual causes of your impotence,there are various effective forms of treatments.These include vaccume therapy,with a device which look rather like a rigid condom_this is harmless and helped many people.Injections of papaverine penis and penis implants.

Sildenafil(viagra) is also effective in men with high BP and erection failure.But it is not recommended in those people requiring 3 or 4 tablets to control BP. It must never be used if youn require nitrates(for example Anginine) for the treatment of angina.

                 DOES SEX RAISE BP

Yes,but only briefly.As in any other vigrous physical activity,BP rises moderately in anticipation, steeps during performance and falls quickly afterwords.

                               THE FUTURE

The mostlikely- and perhaps the most important- change will come as primary high blood pressure is recognized as being not a single category,but to consist of separate subgroups for which different causes are known and therefore different treatments are most appropriate. To some extent this has already happened.Many young men with both high blood pressure and either weight or alcohol problems can attain normal pressures if they loose weight,stop drinding and a vigorous exercise program.

In FUTURE NEW BIOLOGY INCLUDING GENOMICS and other new services will have an impact on treatment of high blood pressure.

As matter stands now it seems unlikely that it makes any difference to people with high blood pressure how their blood pressure is lowered.What matters is how much is lowered_in general,the more the better.We simply choose the drug whichever seems to work and is well tolerated.Sooner or later this position will change.As we find more distinct causes,we shall use more distinct solutions.Treatment and management will thus become more complex.

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