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<blockquote data-quote="ollie989898" data-source="post: 9231638" data-attributes="member: 54866"><p>There are two kinds of hypertension (high blood pressure).</p><p></p><p><em>Primary </em>or<em> essential</em> hypertension generally happens as people age. This is the one that most people with hypertension will have. Certainly more than 95+% of all the people I have ever seen or will see with higher than normal blood pressure will have primary hypertension. The thing is; nobody really knows what the <em>actual</em> cause of this is. There are various theories about this but one day someone will win a Nobel prize for working out <em>exactly</em> why this happens. There might even be a 'cure' of sorts that addresses or even prevents it that will turn up one day and it will sell bigly.</p><p></p><p>Studies have been done on tribes of people living in the wild; Nomadic peoples on the African plains, tribes who live deep within the jungle or in costal communities- all of whom are never exposed to the levels of pollutants we are in the developed world and more importantly have never been exposed to any of the Western diet. Despite all these things, and their very active, sunshine rich and hunter/gatherer lifestyles, these people too, experience a degree of primary hypertension as they age.</p><p></p><p></p><p><em>Secondary</em> hypertension is a much rarer thing. But it's important to identify because it may be possible to cure it and more importantly it can drive your blood pressure <em>extremely</em> high.</p><p></p><p>This is a snip from a national early warning score chart, used in hospitals across the UK to monitor patients. You will note the wide range in potential readings before you enter the red (i.e. something is drastically wrong) range. You have just read that right- if you turn up in an emergency department with a blood pressure (systolic, as in the peak pressure generated when your heart <em>contracts</em>) you score a 0 whether your systolic is 125mmHg, 150mmHg or 200mmHg. Only when you get readings above 220mmHg do alarm bells ring. (<strong>note</strong>- this chart has no idea if you are male, female, young, old, on medicines, pregnant or any other factor of your health- it is thus only a piece of paper, it does not know what is normal or high blood pressure for you as an individual and so is not really used in clinical decision making, it is an early warning tool used to aid monitoring of patients by clinical staff- what they are actually looking for is <em>changes</em> to these numbers over time which may indicate a deterioration -or improvement- in a person).</p><p></p><p></p><p>[ATTACH=full]1171967[/ATTACH]</p><p></p><p>Does this mean having a blood pressure over 140mmHg or more but under 220mmHg is healthy? Not really- studies have shown that if someone has sustained high blood pressure over long periods of time they are at high risk of complications because of this.</p><p></p><p>Firstly, your heart is a muscle and like more muscles if you work it harder it increases in size and power so it is better adapted to do it's job. Sounds ideal, no? Bigger heart, surely a good thing? Unfortunately not. Because of the shape of the heart and the way it contracts (in a sort of twisting motion which shortens it lengthwise), having <em>thicker</em> walls of the ventricles actually <em>reduces</em> the volume of blood it moves with each beat. So your cardiac output decreases- if you had a bucket that held 10 litres and magically made it thicker and stronger walled to the point it only held 8 litres, you wouldn't really be commending the designer of it as your bucket now holds less.</p><p></p><p>[ATTACH=full]1171968[/ATTACH]</p><p></p><p>Next stop after the heart is your aorta. The aorta is a herculean blood vessel that is the anatomical equivalent of the M6 motorway. It is a lovely elastic and muscular artery that runs from your heart down the length of your body to your pelvis. It's the first structure that is going to be hit by that rising pressure of blood when the heart contracts ever more strongly. And it spent the first 20 or 30 years of your life doing about it's business quietly and happily. If you begin asking it to stick another 60 or 80mmHg onto it begins to test the design limits of this thing. It is strong and well built (diameter ranges around 2cm so not far off garden hose in size) but if you strain it enough, studies show that the risk of a dissection increases. Dissection is a strong word which to my mind means cut completely in half, but an aortic dissection really means blood manages to delaminate the vessel and form a pocket within the walls of the aorta as shown below. As you can imagine, repairing this sort of thing surgically isn't always the most straight forward thing to attempt.</p><p></p><p></p><p>[ATTACH=full]1171969[/ATTACH]</p><p></p><p>Next up on our trip around the circulatory system is the kidney. The kidney is actually one of the geezers that regulates your blood pressure in the medium and long term through a variety of mechanisms. To do this is relies on being given information from sensing blood pressure and counteracts changes in this by secreting hormones to change things. Too much pressure- lets lose a bit of blood volume and pass more urine. Not enough pressure, lets retain more sodium and water will be reabsorbed. It's poetry. Even if you completely cut the nerve supply to a kidney, it will still carry on trying to regulate things all by itself. Magic. But it too was designed with a range of pressures in mind. In the same way it can't cope with extremely low blood pressure (you need to pass blood to the thing for it to be able to work) it has very fine filtration systems that can't really withstand high pressures. Press it too hard and these filtration systems don't work so well and you begin getting materials in the urine that shouldn't be there- protein or blood.</p><p></p><p>Next stop on this whistle stop tour is the brain. Now the brain is a privileged place to be at the best of times and it insists on a good steady blood supply. Brain tissue is quite spongy, too and it is filled with tiny arteries which supply all the respective regions. If your blood pressure is too low, you collapse and pass out. If your blood pressure is too high, you risk the pressure overwhelming some of those tiny arteries in your brain and you get a squirt of leaking blood which damages the soft tissue it enters- haemorrhagic stroke. Studies have shown that the stroke risk increases with high blood pressure.</p><p></p><p>Lastly, and worth a special mention are the eyes. At the back of the eye is a disc where the arteries that supply the retina enter and spread out. The eye is quite unique because it's the only place where you can actually visualise the arteries in the body with little more than the naked eye. Just look at the design of this thing, it's marvellous.. Look at those beautiful little arteries. Only if you have high blood pressure for long periods of time, these arteries also, are at risk of leaking which can have a knock on effect on sight.</p><p></p><p>[ATTACH=full]1171970[/ATTACH]</p><p></p><p></p><p>These are just some of the reasons why there are medicines used to treat hypertension and why GPs have such an array of tricks up their sleeves to deal with it. Lots of evidence has been collected over many years by people who literally live and breathe the research of this stuff and put into risk estimates. Whilst no model can really tell if a particular individual will ever have any consequences from hypertension, they are a tool used to try and reduce the health burden of hypertension as best we can.</p></blockquote><p></p>
[QUOTE="ollie989898, post: 9231638, member: 54866"] There are two kinds of hypertension (high blood pressure). [I]Primary [/I]or[I] essential[/I] hypertension generally happens as people age. This is the one that most people with hypertension will have. Certainly more than 95+% of all the people I have ever seen or will see with higher than normal blood pressure will have primary hypertension. The thing is; nobody really knows what the [I]actual[/I] cause of this is. There are various theories about this but one day someone will win a Nobel prize for working out [I]exactly[/I] why this happens. There might even be a 'cure' of sorts that addresses or even prevents it that will turn up one day and it will sell bigly. Studies have been done on tribes of people living in the wild; Nomadic peoples on the African plains, tribes who live deep within the jungle or in costal communities- all of whom are never exposed to the levels of pollutants we are in the developed world and more importantly have never been exposed to any of the Western diet. Despite all these things, and their very active, sunshine rich and hunter/gatherer lifestyles, these people too, experience a degree of primary hypertension as they age. [I]Secondary[/I] hypertension is a much rarer thing. But it's important to identify because it may be possible to cure it and more importantly it can drive your blood pressure [I]extremely[/I] high. This is a snip from a national early warning score chart, used in hospitals across the UK to monitor patients. You will note the wide range in potential readings before you enter the red (i.e. something is drastically wrong) range. You have just read that right- if you turn up in an emergency department with a blood pressure (systolic, as in the peak pressure generated when your heart [I]contracts[/I]) you score a 0 whether your systolic is 125mmHg, 150mmHg or 200mmHg. Only when you get readings above 220mmHg do alarm bells ring. ([B]note[/B]- this chart has no idea if you are male, female, young, old, on medicines, pregnant or any other factor of your health- it is thus only a piece of paper, it does not know what is normal or high blood pressure for you as an individual and so is not really used in clinical decision making, it is an early warning tool used to aid monitoring of patients by clinical staff- what they are actually looking for is [I]changes[/I] to these numbers over time which may indicate a deterioration -or improvement- in a person). [ATTACH type="full" width="682px"]1171967[/ATTACH] Does this mean having a blood pressure over 140mmHg or more but under 220mmHg is healthy? Not really- studies have shown that if someone has sustained high blood pressure over long periods of time they are at high risk of complications because of this. Firstly, your heart is a muscle and like more muscles if you work it harder it increases in size and power so it is better adapted to do it's job. Sounds ideal, no? Bigger heart, surely a good thing? Unfortunately not. Because of the shape of the heart and the way it contracts (in a sort of twisting motion which shortens it lengthwise), having [I]thicker[/I] walls of the ventricles actually [I]reduces[/I] the volume of blood it moves with each beat. So your cardiac output decreases- if you had a bucket that held 10 litres and magically made it thicker and stronger walled to the point it only held 8 litres, you wouldn't really be commending the designer of it as your bucket now holds less. [ATTACH type="full" width="379px"]1171968[/ATTACH] Next stop after the heart is your aorta. The aorta is a herculean blood vessel that is the anatomical equivalent of the M6 motorway. It is a lovely elastic and muscular artery that runs from your heart down the length of your body to your pelvis. It's the first structure that is going to be hit by that rising pressure of blood when the heart contracts ever more strongly. And it spent the first 20 or 30 years of your life doing about it's business quietly and happily. If you begin asking it to stick another 60 or 80mmHg onto it begins to test the design limits of this thing. It is strong and well built (diameter ranges around 2cm so not far off garden hose in size) but if you strain it enough, studies show that the risk of a dissection increases. Dissection is a strong word which to my mind means cut completely in half, but an aortic dissection really means blood manages to delaminate the vessel and form a pocket within the walls of the aorta as shown below. As you can imagine, repairing this sort of thing surgically isn't always the most straight forward thing to attempt. [ATTACH type="full" width="316px"]1171969[/ATTACH] Next up on our trip around the circulatory system is the kidney. The kidney is actually one of the geezers that regulates your blood pressure in the medium and long term through a variety of mechanisms. To do this is relies on being given information from sensing blood pressure and counteracts changes in this by secreting hormones to change things. Too much pressure- lets lose a bit of blood volume and pass more urine. Not enough pressure, lets retain more sodium and water will be reabsorbed. It's poetry. Even if you completely cut the nerve supply to a kidney, it will still carry on trying to regulate things all by itself. Magic. But it too was designed with a range of pressures in mind. In the same way it can't cope with extremely low blood pressure (you need to pass blood to the thing for it to be able to work) it has very fine filtration systems that can't really withstand high pressures. Press it too hard and these filtration systems don't work so well and you begin getting materials in the urine that shouldn't be there- protein or blood. Next stop on this whistle stop tour is the brain. Now the brain is a privileged place to be at the best of times and it insists on a good steady blood supply. Brain tissue is quite spongy, too and it is filled with tiny arteries which supply all the respective regions. If your blood pressure is too low, you collapse and pass out. If your blood pressure is too high, you risk the pressure overwhelming some of those tiny arteries in your brain and you get a squirt of leaking blood which damages the soft tissue it enters- haemorrhagic stroke. Studies have shown that the stroke risk increases with high blood pressure. Lastly, and worth a special mention are the eyes. At the back of the eye is a disc where the arteries that supply the retina enter and spread out. The eye is quite unique because it's the only place where you can actually visualise the arteries in the body with little more than the naked eye. Just look at the design of this thing, it's marvellous.. Look at those beautiful little arteries. Only if you have high blood pressure for long periods of time, these arteries also, are at risk of leaking which can have a knock on effect on sight. [ATTACH type="full"]1171970[/ATTACH] These are just some of the reasons why there are medicines used to treat hypertension and why GPs have such an array of tricks up their sleeves to deal with it. Lots of evidence has been collected over many years by people who literally live and breathe the research of this stuff and put into risk estimates. Whilst no model can really tell if a particular individual will ever have any consequences from hypertension, they are a tool used to try and reduce the health burden of hypertension as best we can. [/QUOTE]
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