Sometimes cases are noticed, where drug treatment is started straight in the first visit of a newly diagnosed patient of hypertension. I, somehow could not digest this. If it is too high when first noticed drug treatment may be started but with mild to moderate rise in pressure, some other things should be tried first. Researchers also agree to it. It may have a cause to be designated as secondary hypertension. When a cause is not found it is termed as idiopathic or primary hypertension. However many theories are advanced to explain it.
- Atherosclerosis is the main contributing factor. Here fat plaques form on the inner layer of the blood vessels, thereby narrowing the lumen. That gives resistance to flow of blood and the pumping force of heart has to increase to maintain adequate flow. So, the result is increased pressure.
- Stress and strain induces a variety of endocrine hormones such as corticosteroids and adrenaline play a major role in sustaing it.
- Rennin, angiotensin and aldosterone axis also plays a major role.
- Obesity is a major cause of it. It is measured by what is called body mass index (BMI), which is arrived at by the formula body weight in kgs/body surface in square meter. If it is more than 30 the person is obese. And around 25 is normal
Blood pressure has two components namely systolic and diastolic. Systolic is the pressure when the heart pumps blood and diastolic is the pressure when the heart receives blood from vein and getting filled. Normally systolic blood pressure ranges from 90 mm. to 130 mm. of mercury and diastolic pressure ranges from 60 mm. to 90 mm. of mercury. When its value exceeds 130/90 mm. it is termed as hypertension. However, the patient should not be stamped as hypertensive right in the first visit, because simple tension of being examined may raise the blood pressure of a person. We usually take three recordings in three different occasions to confirm the disease.
Relevant investigations for diabetes mellitus, lipid profile, ECG, ultrasonogram, kidney profile and urine examination are to be done to exclude any other cause for it or to find out associated diseases. If no specific cause is found it is termed as idiopathic and presumed to be due to atherosclerosis.
The hierarchy of treatment should be as follows.
- Life style modification. Patients leading a sedentary life should be encouraged to go for physical exercise. That will give relaxation, reduce weight, mobilize fat and keep the arteries clean from the deposits of atheromatous plaques. That will streamline blood flow and reduce hypertension.
- Restriction of salt intake will go a long way in reducing the hypertension influencing the rennin-angiotensin-aldosterone axis.
- Meditation will give relaxation and reduce stress which in turn will reduce the steroid hormone level to facilitate reduction of blood pressure.
- Taking a few petals of garlic is said to have positive health benefits,as well as Yogic practices.
- Thereafter, comes the role of drugs and first being a diuretic. And there is a long list of drugs which are to be prescribed by the expert physician.
Therefore, hypertension should be treated in a planned way. If pre-drug treatment practices are followed a number of patients may not require medications at all.
Reeling of head is a distressing condition.In medical terminology it is called Vertigo.Here there is sensation of reeling of head or the surrounding.There are so many causes for it.It may be physiological or pathological. Mainly three systems are involved in it.The ear and related nervous system,the eyes and related nervous system or the peripheral sensory system.
The Course Of Vertebral Artery.
Physiologically this is seen while suddenly getting up from a sitting or standing position called a positional vertigo.Amongst the pathological conditions atherosclerotic hypertension is most common .Other diseases of the three system described above can give rise to vertigo.Common causes are an infection or disease of the middle ear,visual disturbances like ill fitting glasses , sensory disturbance of lower limbs and more generalized diseases like diabetes are important.
Atherosclerosis causes impairment of blood flow to the brain and it’s subsections causing vertigo.Any body presenting with vertigo should be examined for atherosclerosis first.Hypertension easy to diagnose should be treated.Investigations like blood lipid profile is contributory.
Ill fitting glasses easily be corrected and an ear disease is easy to diagnose and treat.
The next important disease to cause vertigo is Cervical Spondylosis.Here the seven neck vertebral bones get affected commonly due to aging process.Other diseases of neck bone like Ankylosing Spondylosis also
Blood Supply
important.Here the vertebrae are deformed ,loose the flexibility and loose the natural C curve.The deformity may pose an obstruction to the blood flow in the vertebral arteries which travels through the bony processes of of neck bones.The vertebral arteries in tern could not deliver required amount of blood to the brain system and cause relative ischaemia and the consequent symptom of vertigo.This disease can also be diagnosed easily from a host of available investigations i.e. from a good quality digital X-Rays to MRI .
Adequately treated spondylosis can go a long way in relieving the symptoms.
But before jumping to diagnosis of Cervical Spondylosis as cause of vertigo the more common and dangerous cause atherosclerotic hypertension should be excluded.
MRI Image.
Many come to the hospital with a story that one of their apparently healthy looking relation fell down on ground suddenly.Actually it is possible that a hidden unhealthy process might be going on under ground.The causes are numerous and may range from much innocent ones to dangers ones.
Most common are (a) Simple vasovagal attack (b) Hypertension (c)Heat Stroke (d) Brain Stroke (e) Heart Stroke (f)Absent Attack of Epilepsy and more diverse (G) Fracture of head of thigh bone called Femur.
The vasovagal attack being more simple may occur after listening to very shocking news , seeing a dreaded scene or sudden rising from a sitting posture .Simple measure like elevating the legs will normalize blood flow to the brain and patient gains consciousness.Other injuries are to be looked after.
Hypertensives especially undiagnosed ones and those dincontinued drugs against a medical advice or due to complication called hypertensive encephalopathey may suddenly fall down.They usually complain of reeling of head before the episode.Obviously the root cause is to be treated.Associated injuries in form if a traumatic haematoma of scalp has to be evaluated in the light of possible injury to brain.
Heat stroke is a tell tale diagnosis and has to be treated promptly.Main stray of treatment being rehydration by intravenous fluid administration and cooling.
Juvenile epileptics especially experience absent attacks sustaining multiple injuries ,has to be treated accordingly.And they must be warned and guided not to go to dangers places like fire and water body.
A fracture of head of thigh bone ,femur mainly due to old age osteoporosis usually seen in menopausal lady and person falls on ground.Also pathological fractures due to other causes importantly a metastatic cancer may cause it.A simple X-Rays will clinch diagnosis and guide the treatment.Post menopausal ladies should always get calcium supplement to prevent osteoporosis.
Heart stroke and brain strokes are more dangerous usually associated with hypertension and/or diabetes.So the primary disease if known should be kept under control always and patient should not discontinue drugs without consulting treating doctor.If undiagnosed and these diseases suspected one tablet of aspirin 150 mg. ,if available should be started at home and swiftly shifted to the nearest health centre even if small one.Because first-aid can be started which is similar everywhere.
BESIDES THERE ARE SO MANY OTHER CAUSES OF BLACK OUT AND FALL ON GROUD, ARE OF ACEDEMIC INTEREST AND BY FAR ABOVE ONES TO BE KEPT IN MIND.
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