High blood pressure, or hypertension, is often referred to as "the silent disease" because it has no symptoms until it reaches an advanced state. Very often, it is detected during a routine doctor's visit or high blood pressure screening program. Even then, several measurements may be needed to make a definite diagnosis of hypertension, which is defined as blood pressure that is persistently elevated over what is considered normal.
Blood pressure is the force that is exerted by the blood against the vessel walls. It is measured by using a simple instrument called a sphygmomanometer, which consists of an inflatable cuff that goes around the upper arm and a column of mercury or a pressure dial. When the cuff is inflated, it tightens around the arm and momentarily blocks the flow of blood through the main artery of the arm. As the cuff is slowly released, the person taking the blood pressure uses a stethoscope to listen to the returning blood flow. One sound signals the maximum force that occurs with the heartbeat. This is the systolic pressure, the higher of the two numbers in a blood pressure reading. The second or lower number, referred to as the diastolic pressure, reflects the lowest amount of pressure, which occurs between heartbeats.
Everyone's blood pressure varies during the course of a day. As would be expected, it is usually lower when resting or engaged in quiet activities, and it may spurt up during a sudden burst of activity, such as running to catch a bus or exercising. Age also affects blood pressure; it is geerally lower in children and gradually rises as we grow older. Although there is some disagreement over how high is to high, the average normal blood pressure for healthy children is about 90/60, while the normal adult average ranges from 100/85 to 135/90. A diastolic pressure over 95 in an otherwise healthy adult is regarded as suspiciously high and a reading of 140/100 usually would be diagnosed as hypertension that should be treated. Many experts feel that any diastolic pressure that is consistently over 95 should be treated.
Causes of Hypertension
It is estimated that more than 35 million Americans have hypertension. In the large majority of cases, the cause of the high pressure is unknown. Doctors refer to this most common form of the disease as primary or essential hypertension. There are some unusual instances, however, in which the high blood pressure may be caused by kidney disease, tumor or some other identifiable cause. This is known as secondary hypertension, and treating the underlying cause usually will cure the high blood pressure.
While the cause of primary hypertension is unknown, a number of factors appear to increase the risk of developing it. These include a family history of high blood pressure or strokes at an early age, cigarette smoking, obesity and excessive salt intake. Altering or avoiding these risk factors will not necessarily prevent hypertension, but all are thought to play some role. Cutting salt intake, stopping smoking or losing weight may be sufficient to prevent borderline high blood pressure from developing into frank hypertension. This is particularly true for adolescents or young adults whose blood pressures may be in the higher end of the normal range.
Treatment of Hypertension
Over the last few years, dozens of highly effective antihypertensive drugs have been developed that have truly revolutionized the treatment of this disease. At one time, the only treatments available for high blood pressure were surgery, which was not very effective, or an extreme restriction of salt intake, which in some cases meant living on a diet of mostly fruit and rice. Now most cases of high blood pressure can be brought under control with drugs, which may be prescribed singly or in combination.
There are three major categories of antihypertensive drugs:
In addition, anew class of drugs, known as reninaxis blockers, has recently become available that interferes with the formation of a powerful vessel-constricting substance in the body and also with the action of the hormone aldosterone, which causes the body to retain salt and water.
Since there are many antihypertensive drugs and combinations, an effective treatment that lowers blood pressure with a minimum of unpleasant side effects almost always can be found. There, if you experience a side effect such as unusual tiredness, dizziness or faintness upon standing, depression or any other untoward symptom that you think may be related to your antihypertensive drugs, report it to your doctor. It may be only temporary, or it may be something that can be remedied by altering the regimen. In any case, remember that the treatment is usually for life. The drugs will keep the high blood pressure under control, but they do not cure the disease. If you stop taking the drugs, the blood pressure will return to its previous level or go even higher. Therefore, it is particularly important that you follow your doctor's instructions and that you return for periodic checks.
Summing Up
High blood pressure is the most common serious disease in the United States. Once diagnosed, however, most cases can be brought under control through the use of antihypertensive drugs, and where appropriate, through life-style changes such as stopping smoking or losing excess weight. Treatment is usually for life, but if high blood pressure is brought down to normal and kept there, the patient can expect to live a normal life with no major interference with day-to-day activities.
Hospitalization - Admission Procedures
The procedures you follow on admission to a hospital vary from one hospital to another, but basically the process is the same in most institutions in the United States.
Care of the Dying - Role of Friends
The friend can show appreciation of the work being done by the family and offer to stay with the patient if the family needs a little time away from home.
Care of the Dying - Death of an Older Child or an Adolescent
From the age of three years onward, a child begins to understand the concept of death and dying. The dying child feels protective toward his or her parents. Although the child desperately needs to talk about what is going to happen, he or she may never get close to the subject. The child may attach himself or herself to a nurse or physician while still relying on the parents. By doing this, the child is sharing the emotional responsibility. The parents may find this difficult to accept, but must realize that someone else can perhaps give more help by listening dispassionately to the child's fears and anxieties.
