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LIFE WITH HYPERTENSION

29/01/11

The untreated person with persistent hypertension faces complications involving his heart, brain, and kidneys. The time necessary for hypertension to produce these complications is variable. Some may have hypertension for years without any serious complications, while others may develop an accelerated phase of the hypertension and have serious problems within a matter of months. Actually, any untreated hypertensive is susceptible to a sudden acceleration in the severity of his disease. This accelerated phase is called malignant hypertension. There is no relationship to cancer; the term malignant merely signifies that the process is virulent and getting worse.

The cardiac response to hypertension is usually an enlargement of the heart, especially the left ventricle, the main pumping chamber. There is usually an accelerated development of atherosclerosis of the coronary arteries, and a heart attack or angina pectoris may occur. Eventually the heart may weaken, and the person will then develop heart failure, with shortness of breath and swelling of the body.

In a person with hypertension, the blood vessels that supply the brain may intermittently narrow (vasospasm) with the resultant lack of adequate blood flow to parts of the brain. This may produce periods of confusion, actual unconsciousness, or intermittent periods of paralysis of one side of the body. The arteries usually also develop increased degrees of atherosclerosis, and this process may lead to the permanent occlusion of one of the vessels or to its rupture with bleeding into the brain. These events produce strokes, with paralysis or death.

The small blood vessels that lie inside the kidneys can be affected by prolonged or severe hypertension. The response in these blood vessels is to deposit a coating on the inside of the vessel, which results in the vessels becoming narrower than normal. The kidneys then suffer from a lack of blood flow. This eventually produces gradual death of parts of the kidney, with ensuing kidney failure or uremia. As uremia develops in the hypertensive person, we frequently see that they lose weight and their appetite. They often become anemic, and edema or swelling of the lower parts of the body develops.

With proper treatment, a hypertensive patient may have a near normal life span. This is particularly true if his problem is detected before any complications occur.

Prior to 1950 there were very few effective techniques for treating hypertension. Sedatives were used to help lower the pressure in mild cases, but those people with malignant hypertension had an inauspicious future. The death rate in malignant hypertension took 80 percent of those so affected in the first year. Severe salt restriction helped some people. This was the era of the rice diet, or low salt diet.

Then the Rauwolfia serpentina, or Indian snake root, entered the scene. Derivatives of this plant are still some of the principal agents used today to control blood pressure. A short time later the first of the modern diuretic drugs appeared. A variety of different diuretic drugs is now available. They act primarily by removing excess salt from the body. As a result, salt restriction is usually not necessary in the hypertensive patient. Additional drugs have been developed that block the blood pressure mechanism at different levels in the body. Agents may work primarily on the brain, the sympathetic nervous system, the small arteries of the body, or the kidneys. The stronger agents have side effects that may hinder their use in certain persons, but such a wide range of effective drugs are in existence today that the vast majority of hypertensive patients can now be adequately managed by one or more drugs.

*60/309/5*

LIFE WITH HYPERTENSIONThe untreated person with persistent hypertension faces complications involving his heart, brain, and kidneys. The time necessary for hypertension to produce these complications is variable. Some may have hypertension for years without any serious complications, while others may develop an accelerated phase of the hypertension and have serious problems within a matter of months. Actually, any untreated hypertensive is susceptible to a sudden acceleration in the severity of his disease. This accelerated phase is called malignant hypertension. There is no relationship to cancer; the term malignant merely signifies that the process is virulent and getting worse.The cardiac response to hypertension is usually an enlargement of the heart, especially the left ventricle, the main pumping chamber. There is usually an accelerated development of atherosclerosis of the coronary arteries, and a heart attack or angina pectoris may occur. Eventually the heart may weaken, and the person will then develop heart failure, with shortness of breath and swelling of the body.In a person with hypertension, the blood vessels that supply the brain may intermittently narrow (vasospasm) with the resultant lack of adequate blood flow to parts of the brain. This may produce periods of confusion, actual unconsciousness, or intermittent periods of paralysis of one side of the body. The arteries usually also develop increased degrees of atherosclerosis, and this process may lead to the permanent occlusion of one of the vessels or to its rupture with bleeding into the brain. These events produce strokes, with paralysis or death.The small blood vessels that lie inside the kidneys can be affected by prolonged or severe hypertension. The response in these blood vessels is to deposit a coating on the inside of the vessel, which results in the vessels becoming narrower than normal. The kidneys then suffer from a lack of blood flow. This eventually produces gradual death of parts of the kidney, with ensuing kidney failure or uremia. As uremia develops in the hypertensive person, we frequently see that they lose weight and their appetite. They often become anemic, and edema or swelling of the lower parts of the body develops.With proper treatment, a hypertensive patient may have a near normal life span. This is particularly true if his problem is detected before any complications occur.Prior to 1950 there were very few effective techniques for treating hypertension. Sedatives were used to help lower the pressure in mild cases, but those people with malignant hypertension had an inauspicious future. The death rate in malignant hypertension took 80 percent of those so affected in the first year. Severe salt restriction helped some people. This was the era of the rice diet, or low salt diet.Then the Rauwolfia serpentina, or Indian snake root, entered the scene. Derivatives of this plant are still some of the principal agents used today to control blood pressure. A short time later the first of the modern diuretic drugs appeared. A variety of different diuretic drugs is now available. They act primarily by removing excess salt from the body. As a result, salt restriction is usually not necessary in the hypertensive patient. Additional drugs have been developed that block the blood pressure mechanism at different levels in the body. Agents may work primarily on the brain, the sympathetic nervous system, the small arteries of the body, or the kidneys. The stronger agents have side effects that may hinder their use in certain persons, but such a wide range of effective drugs are in existence today that the vast majority of hypertensive patients can now be adequately managed by one or more drugs.*60/309/5*

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LIFE WITH HYPERTENSION

29/01/11

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