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Saturday, June 17, 2017

Cardiovascular Disorders: What You Should Know!


Cardiovascular risk factors
Types of Hypertension


One of the largest killers in western urbanised societies is acute myocardial infarction. Its diagnosis is usually made on the clinical presentation and electrocardiographic findings, and confirmed by the characteristic changes in plasma enzyme activities.
 Cardiovascular disease, including coronary heart disease and myocardial infarction is responsible for the major burden of mortality in urbanized societies and is commoner in males, the elderly and those with a positive family history of premature coronary heart disease (for example below 60 years of age).
          In addition, certain ethnic groups are more at risk of coronary heart disease than others e.g. South Asian groups.


There are over 200 cardiovascular risk factors amongst which include:
Abnormal lipids (high plasma cholesterol, and triglycerides and low high density lipoprotein (HDL) cholesterol)
Diabetes mellitus
Family history of cardiovascular disease
Sex (men and menopausal women)
Age (greater than 60 years)


  This can be defined as sustained systolic blood pressure of more than 140mmHg and/or diastolic blood pressure more than 90mmHg. It is the major risk factor for coronary heart disease and stroke. Hypertension increases with age and is more common in blacks than in whites. 
Cardiovascular morbidity and mortality increase as both systolic and diastolic blood pressures rise. In individuals over age 50, the systolic blood pressure and the pulse pressure are better predictors of complications than diastolic blood pressure.

Types of Hypertension

 Hypertension can be:
Primary (essential) or
Primary/essential hypertension is hypertension in which there is no known cause. This occurs in 10-15% of white adults and 20-30% of black adults in the USA.

     Although hypertensive emergencies have become less frequent in recent years, it still requires prompt recognition and aggressive but careful management. The initial goal in hypertensive emergencies is to reduce the pressure by about 25% within minutes to 1-2 hours. Care must be taken to avoid excessive reduction in pressure as this can lead to coronary or renal ischemia. 

Secondary hypertension is hypertension due to a known cause. It is common in patients who develop hypertension at an early age without a positive family history, those who exhibit hypertension when over 50 years of age.

       Some causes of secondary hypertension are:

1. Use of estrogens: increase in blood pressure occurs in women taking oral contraceptives.
 Contraceptive – related hypertension is more common in women over 35 years of age, or in obese women, or in women who have taken contraceptives for over 5 years. In most, hypertension is reversible by discontinuing the contraceptive.

2. Renal disease: this is the most common cause of secondary hypertension, and is as a result of glomerular disease and other diseases of the kidneys.

3. Exacerbating factors: to exacerbate is to make an already bad or problematic situation worse. A number of conditions elevate blood pressure especially in predisposed individuals. These conditions include:
Obesity: this refers to being unhealthily fat or overweight or having a body weight more than 20% greater than recommended for the relevant height.

       Obesity is associated with an increase in intravascular volume and an elevated cardiac output. Weight reduction lowers blood pressure modestly and hence reduces the risk of cardiovascular failure.

The relationship between sodium intake and hypertension remains controversial, and some –not all –hypertensives respond to high salt intake with substantial increase in blood pressure. Hypertensives should consume no more than 6g of NaCl daily.

Alcohol: excessive use of alcohol raises blood pressure, by increasing plasma catecholamines (substances that act as neurotransmitter). Hypertension may be difficult to control in alcoholics.
Cigarette smoking raises blood pressure although the relationship between the long term effect of smoking and hypertension is not clear. 

The relationship between stress and hypertension is not established. Polycythemia, whether primary or due to decreased plasma volume, increases blood viscosity and may raise blood pressure.

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