Friday, January 30, 2015

Hypertension - Remaining Part

High Blood Pressure and Calcium Channel Blockers

Calcium channel blockers are drugs used to lower blood pressure. They work by slowing the movement of calcium into the cells of the heart and blood vessel walls, which makes it easier for the heart to pump and widens blood vessels. As a result, the heart doesn't have to work as hard, and blood pressure lowers.

Examples of calcium channel blockers include:
·         Norvasc (amlodipine)
·         Plendil (felodipine)
·         DynaCirc (isradipine)
·         Cardene (nicardipine)
·         Procardia XL, Adalat (nifedipine)
·         Cardizem, Dilacor, Tiazac, Diltia XL (diltiazem)
·         Sular (Nisoldipine)
·         Isoptin, Calan, Verelan, Covera-HS (verapamil)

 

Side Effects of Calcium Channel Blockers
Potential side effects from taking a calcium channel blocker include:
·         Dizziness or lightheadedness
·         Low blood pressure
·         Heart rhythm problems
·         Dry mouth
·         Edema (swelling of ankles, feet, or lower legs)
·         Headache
·         Nausea
·         Fatigue
·         Skin rash
·         Constipation or diarrhea
·         Gastroesophageal reflux disease (GERD)

High Blood Pressure and ACE Inhibitors
Angiotensin converting enzyme (ACE) inhibitors are high blood pressure drugs that widen or dilate the blood vessels to improve the amount of blood the heart pumps and to lower blood pressure. ACE inhibitors also increase blood flow, which helps to decrease the amount of work your heart has to do and can help protect your kidneys from the effects of hypertension and diabetes.

ACE inhibitors are used to treat a number of heart-related conditions, including high blood pressure, heart failure, heart attack, and preventing kidney damage associated with high blood pressure and diabetes.

Examples of ACE inhibitors include:
·         Capoten (captopril)
·         Vasotec (enalapril)
·         Prinivil, Zestril (lisinopril)
·         Lotensin (benazepril)
·         Monopril (fosinopril)
·         Altace (ramipril)
·         Accupril (quinapril)
·         Aceon (perindopril)
·         Mavik (trandolapril)
·         Univasc (moexipril)

What Are the Side Effects of ACE Inhibitors?
Like any drug, an ACE inhibitor is likely to have some side effects. They may include:
·         Cough. If this symptom persists or is severe, contact your doctor. Ask your doctor what type of cough medicine you should use to control the cough.
·         Red, itchy skin. Contact your doctor; do not treat the rash yourself.
·         Dizziness, light headedness or faintness upon rising. This side effect may be strongest after the first dose, especially if you have been taking a diuretic (water pill). Get up more slowly. Contact your doctor if these symptoms persist or are severe.
·         Salty or metallic taste or a decreased ability to taste. This effect usually goes away as you continue taking the medication.
·         Physical symptoms. Sore, fever, mouth sores, unusual bruising, fast or irregular heartbeat, chest pain, and swelling of feet, ankles and lower legs. Contact your doctor if you have any of these symptoms.
·         Swelling of your neck, face, and tongue. See a doctor right away if you have any of these symptoms. These represent a serious emergency.
·         Potassium levels. This is a potentially life-threatening complication. Therefore, people on ACE inhibitors should regularly have blood tests to measure potassium levels. Signs of too much potassium in the body include confusion, irregular heartbeat, nervousness, numbness or tingling in hands, feet or lips, shortness of breath or difficulty breathing, and weakness or heaviness in legs. Contact your doctor right away if you have any of these symptoms.
·         Kidney failure. Although ACE inhibitors help to protect the kidneys, it can also cause kidney failure in some people.
·         Severe vomiting or diarrhea. If you have severe vomiting or diarrhea you may become dehydrated, which can lead to low blood pressure. Contact your doctor right away.

High Blood Pressure and Angiotensin II Receptor Blockers (ARBs)

Angiotensin II receptor blockers (ARBs) have the same effects as ACE inhibitors, another type of blood pressure drug, but work by a different mechanism. These drugs block the effect of angiotensin II, a chemical that narrows blood vessels. By doing so, they help widen blood vessels to allow blood to flow more easily, which lowers blood pressure. ARBs are generally prescribed for people who cannot tolerate ACE inhibitors.

Examples of ARBs include:
·         Atacand (candesartan)
·         Avapro (irbesartan)
·         Benicar (olmesartan)
·         Cozaar (losartan)
·         Diovan (valsartan)
·         Micardis (telmisartan)
·         Teveten (eprosartan)

What Are Some of the Side Effects?
Some of the side effects of taking ARBs include:
·         Dizziness, lightheadedness, or faintness upon rising, This side effect may be strongest after the first dose, especially if you have been taking a diuretic (water pill). Contact your doctor if these symptoms are persistent or severe.
·         Physical problems. Diarrhea, muscle cramps or weakness, back or leg pain, insomnia (difficulty sleeping), irregular heartbeat, or fast or slow heartbeat, sinusitis or upper respiratory infection. Contact your doctor if these symptoms are persistent or severe.
·         Confusion. Contact your doctor right away.
·         Severe vomiting or diarrhea. If you become sick with severe vomiting or diarrhea you may become dehydrated, which can lead to low blood pressure. Contact your doctor.
·         Abnormalities in blood chemistry laboratory tests.
·         Cough, though less commonly than with ACE inhibitors.

High Blood Pressure and Beta-Blockers

Beta-blockers are drugs used to treat high blood pressure. They block the effects of the sympathetic nervous system on the heart. This reduces the work of the heart so that it requires less blood and oxygen. As a result, the heart doesn't have to work as hard, which in turn lowers blood pressure. Beta-blockers help control heart rate and are also used in the treatment of abnormal heart rhythms that may too fast or irregular.

There are several beta-blockers available, including:
·         Sectral (acebutolol)
·         Tenormin (atenolol)
·         Kerlone (betaxolol)
·         Zebeta, Ziac (bisoprolol)
·         Coreg (carvedilol)
·         Normodyne, Trandate (labetalol)
·         Lopressor, Toprol-XL (metoprolol)
·         Corgard (nadolol)
·         Nebivolol (bystolic)
·         Levatol (penbutolol)
·         Visken (pindolol)
·         Inderal, Inderal LA (propanolol)
·         Blocadren (timolol)

 

Side Effects of Beta-Blockers
Potential side effects of beta-blockers include:
·         Dizziness or lightheadedness
·         Problems with sexual performance and ability
·         Sleeping problems and drowsiness
·         Fatigue
·         Cold hands and feet
·         Slow heartbeat
·         Edema (swelling in ankles, feet, or legs)
·         Trouble breathing, especially asthma symptoms
·         Depression

Omega-3 Fish Oil Supplements for High Blood Pressure
In the past 10 years, many Americans have turned to omega-3 fish oil supplements. Dietary fish and fish oil supplements have benefits for healthy people and also those with heart disease.
Omega-3 fish oil contains both docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Omega-3 fatty acids are very important in preventing and managing heart disease.

Findings show omega-3 fish oil may help to:
·         Lower blood pressure
·         Reduce triglycerides
·         Slow the development of plaque in the arteries
·         Reduce the chance of abnormal heart rhythm
·         Reduce the likelihood of heart attack and stroke
·         Lessen the chance of sudden cardiac death in people with heart disease

 How much omega-3 fish oil is safe?
The AHA says taking up to 3 grams of fish oil supplements daily is considered safe. Don't take more than that unless you discuss it with your doctor first. 

Are there side effects with omega-3 fish oil?

Side effects from omega-3 fish oil may include:
·         a fishy taste in your mouth
·         fishy breath
·         stomach upset
·         loose stools
·         nausea

Taking more than 3 grams of fish oil daily may increase the risk of bleeding. 


Hypertension

Hypertension Overview
High blood pressure or hypertension increases the risk of heart disease and stroke. Hypertension risk factors include obesity, drinking too much alcohol, smoking, and family history. Beta-blockers are a common treatment for hypertension.

Overview & Facts
High blood pressure, also known as hypertension, affects millions -- even children and teens.

High Blood Pressure Basics
Hypertension, or high blood pressure, is a common condition that will catch up with most people who live into older age.

What Is High Blood Pressure?
High blood pressure, also known as hypertension, is the most common cardiovascular disease.
Blood pressure refers to the force of blood pushing against artery walls as it courses through the body. Like air in a tire or water in a hose, blood fills arteries to a certain capacity. Just as too much air pressure can damage a tire or too much water pushing through a garden hose can damage the hose, high blood pressure can threaten healthy arteries and lead to life-threatening conditions such as heart disease and stroke.






Hypertension is the leading cause of stroke and a major cause of heart attack.
How Is Blood Pressure Measured?
A blood pressure reading appears as two numbers. The first and higher of the two is a measure of systolic pressure, or the pressure in the arteries when the heart beats and fills them with blood. The second number measures diastolic pressure, or the pressure in the arteries when the heart rests between beats.

Who Gets Hypertension?
High blood pressure is more likely in people who:
  • ·         Have a family history of high blood pressure, heart disease, or diabetes
  • ·         Are over age 55
  • ·         Are overweight
  • ·         Are not physically active
  • ·         Drink excessively
  • ·         Smoke
  • ·         Eat foods high in salt
  • ·         Use certain medications such as NSAIDs (ibuprofen, aspirin, e.g.), decongestants, and illicit drugs such as cocaine


What Causes High Blood Pressure?
What Does the Systolic Blood Pressure Number Mean?
When your heart beats, it contracts and pushes blood through the arteries to the rest of the body. This force creates pressure on the arteries. This is called systolic blood pressure.
·         A normal systolic blood pressure is below 120.
·         A systolic blood pressure of 120 to 139 means you have prehypertension, or borderline high blood pressure. Even people with prehypertension are at a higher risk of developing heart disease.
·         A systolic blood pressure number of 140 or higher is considered to be hypertension, or high blood pressure.

What Does the Diastolic Blood Pressure Number Mean?
The diastolic blood pressure number or the bottom number indicates the pressure in the arteries when the heart rests between beats.
·         A normal diastolic blood pressure number is less than 80.
·         A diastolic blood pressure between 80 and 89 indicates prehypertension.
·         A diastolic blood pressure number of 90 or higher is considered to be hypertension or high blood pressure.


Diagnosis & Tests
Diagnosis
Hypertension, or high blood pressure, is often called a "silent disease" because you usually don't know that you have it. There may be no symptoms or signs. Nonetheless, it damages the body and eventually may cause problems like heart disease.
Therefore, it's important to regularly monitor your blood pressure, especially if it has ever been high or above the "normal" range, or if you have a family history of hypertension. Because hypertension can cause heart disease, you may also need to be tested for heart disease.

Measuring Blood Pressure
You can get your blood pressure measured by a health care provider, at a pharmacy, or you can purchase a blood pressure monitor for your home.
Blood pressure is most often measured with a device known as a sphygmomanometer, which consists of a stethoscope, arm cuff, dial, pump, and valve.
Blood pressure is measured in two ways: systolic and diastolic.
  • ·         Systolic blood pressure is the maximum pressure during a heartbeat.
  • ·         Diastolic blood pressure is the lowest pressure between heartbeats.


Your doctor will also conduct a physical exam.
If you're diagnosed with high blood pressure, your doctor may recommend other tests, such as:
  • ·         Electrocardiogram (EKG or ECG): A test that measures the electrical activity, rate, and rhythm of your heartbeat via electrodes attached to your arms, legs, and chest. The results are recorded on graph paper.
  • ·         Echocardiogram: This is a test that uses ultrasound waves to provide pictures of the heart's valves and chambers so the pumping action of the heart can be studied and measurement of the chambers and wall thickness of the heart can be made.

Tests
Tests for High Blood Pressure
The only way to tell whether you have high blood pressure is to have it measured with a blood pressure cuff (sphygmomanometer).
  • This device consists of a gauge and a rubber cuff that is placed around your arm and inflated.
  • Having your blood pressure measured is painless and takes just a few minutes.
  • Blood pressure (BP) is classified as follows by the American Heart Association:
Normal BP:
  • Under age 60: Systolic less than 140 mm Hg; diastolic less than 90
  • Age 60 years and older:  Systolic less than 150 mm Hg; diastolic less than 90 mm Hg
High BP:
  • Under age 60: Systolic greater than 140 mm Hg; diastolic greater than 90 mm Hg
  • Age 60 years and older: Systolic greater than 150 mm Hg; diastolic greater than 90 mm Hg
Tests may be ordered by your health care provider to check for causes of high blood pressure and to assess any organ damage from high blood pressure or its treatment. These tests may include the following:
  • Blood tests, including measurement of electrolytes, blood urea nitrogen, and creatinine levels (to assess kidney involvement)
  • Lipid profile for levels of various kinds of cholesterol
  • Special tests for hormones of the adrenal gland or thyroid gland
  • Urine tests for electrolytes and hormones
  • A noninvasive, painless eye examination with an ophthalmoscope will look for ocular damage.
  • Ultrasound of the kidneys, CT scan of the abdomen, or both may be done to assess damage or enlargement of the kidneys and adrenal glands
Treatment & Care
Treating high blood pressure can take a multi-pronged approach including diet changes, medication, and exercise. Learn about hypertension treatment options here.

Treatment

Drugs to Treat High Blood Pressure

There are several types of drugs used to treat high blood pressure, including:
·         Angiotensin-converting enzyme (ACE) inhibitors
·         Angiotensin II receptor blockers (ARBs)
·         Diuretics
·         Beta-blockers
·         Calcium channel blockers
·         Alpha-blockers
·         Alpha-agonists
·         Renin inhibitors
·         Combination medications

High Blood Pressure and Smoking
Smoking makes you more likely to get high blood pressure and heart disease. Put quitting at the top of your to-do list to help lower your blood pressure. It could save your life.

The nicotine in cigarette smoke is a big part of the problem. It raises your blood pressure and heart rate, makes your arteries more narrow and hardens their walls, and also makes your blood more likely to clot. It stresses your heart and sets you up for a heart attack or stroke.

If you don't smoke but you spend time with people who do, you're still at risk. Their secondhand smoke makes you more likely to get the same life-threatening health problems that smokers get, including high blood pressure, heart disease, and many types of cancer.

How to Quit Smoking
There's no single method that works for everyone. You need to prepare and get support. Here's how to start:
1.      Pick a date to stop smoking and tell your doctor about it.
2.      Write down your reasons for quitting. Read the list every day, before and after you quit.

Here are some other tips:
·         Before you quit, write down when you smoke, why you smoke, and what you are doing when you smoke. You will learn what triggers you to smoke.
·         Stop smoking in certain situations first (such as during your work break or after dinner).
·         Make a list of things you can do instead of smoking. Be ready to do something else when you want to smoke.
·         Join a quit-smoking group or program.
·         Don't carry a lighter, matches, or cigarettes. Keep all of these smoking reminders out of sight.
·         If you live with someone who smokes, ask that person not to smoke around you.
·         Keep your hands busy. Doodle, play with a pencil or straw, or work on a computer.
·         Take a walk or read a book instead of taking a cigarette break.
·         Eat low-calorie, healthful foods (such as carrot or celery sticks, sugar-free hard candies) or chew sugar-free gum when you crave cigarettes.
·         Drink plenty of fluids, but limit alcoholic and caffeinated beverages. They can trigger urges to smoke.
·         Exercise. It will help you relax. Consider starting a fitness program before you quit.

Heart Disease and Stress: What's the Link?
Having too much stress, for too long, is bad for your heart. 
If you're often stressed, and you don't have good ways to manage it, you are more likely to have heart disease, high blood pressure, chest pain, or irregular heartbeats.

The stress itself can be a problem. It raises your blood pressure, and it's not good for your body to constantly be exposed to stress hormones. Studies also link stress to changes in the way blood clots, which makes a heart attack more likely.

You may also want to:
·         Change what you can to lower your stress.
·         Accept that there are some things you cannot control.
·         Before you agree to do something, consider whether you can really do it. It's OK to say "no" to requests that will add more stress to your life.
·         Stay connected with people you love.


Continued