Is Hypertension A Syndrome???

Hypertension is one of the most common worldwide diseases afflicting humans. Why can’t it be called a syndrome(association of several clinically recognizable features, signs, symptoms that occur often)??? It is the most important modifiable risk factor coronary heart disease, stroke, peripheral vascular disease, end stage renal failure. According to what I have seen in clinics, out of every 100 patients visiting a doctor 70 of them are hypertensive.


Hypertension

Actually what is hypertension??? Before knowing it you have to know what blood pressure is, it is the pressure exerted by blood flowing in the blood vessels on the walls of the blood vessels. It is determined by certain factors like peripheral vascular resistance, kidney function, sympathetic nervous system activity and endocrinal activity. Any alteration in the normal physiology of these factors leading to elevation in the blood pressure above 140/90 mm of Hg(according to BHS classification) is termed as hypertension and people with blood pressure of 130/85 mm of Hg (high normal blood pressure) are at higher risks of developing hypertension.


Classifications & Causes

Depending on the cause of hypertension it can be classified as essential (the most common type of hypertension with around 95% of hypertensive cases to its credit) with no identifiable cause (idiopathic) and secondary hypertension (with about 5% of hypertensive patients) with an underlying pathology leading to hypertension

Sometimes in pregnant women hypertension develops which can be either pre-eclampsia or eclampsia.

The causes for secondary hypertension may be underlying
•Renal pathology: Renal Vascular disease, Polycystic kidney disease, Renin producing tumor(some segment of people have low rennin hypertension), Glomerulo nephritis
•Endocrinal derangements: Phaeochromocytoma, Cushing syndrome, Conn’s syndrome, Congenital Adrenal Hyperplasia, Acromegaly, Hyperthyroidism, Liddle’s syndrome, diabetes mellitus
•Cardiovascular causes: Corctation of aorta, Polyarteritis nodosa
•Neurogenic causes: psychogenic, increased intra-cranial pressure, acute stress
•Drugs: monoamine oxidase inhibitors, tyramine containing food, oral contraceptive pills, NSAID’s(non steroidal anti inflammatory drugs)




Risk Factors

Risk factors for hypertension are male sex, persistent diastolic blood pressure of >115mm of Hg, smoking, diabetes mellitus, hypercholesterolemia, obesity, alcohol abuse and evidence of end organ damage


Signs and Symptoms

Mostly a hypertensive person is asymptomatic or may present with features ranging from headache, breathlessness, angina, palpitations, sweating to features of end organ damage

After recording the blood pressure with a sphygmomanometer (in a very relaxed state of the patient the blood pressure is recorded as the patient blood pressure may go up in a stressful state after seeing a doctor which is called white collar hypertension) and diagnosing as hypertensive the doctor will be conducting a series of examinations (fundoscopy, ECG, urine stir test for blood and glucose, levels of glucose and lipids in blood, serum creatinine , urea ,electrolytes etc.,) to rule out various causes of secondary hypertension.



Treatment

Treatment strategies depends on the intensity of hypertension (presentation)

But treatment actually starts with non-pharmacological modalities i.e, diet modification, exercise, smoking and alcohol restriction and avoiding stressful conditions etc.

The pharmacological treatment is indicated if the person has following
•If person has blood pressure greater than or equal to 160/100 mm of Hg
•In case of diabetic person it should be started if blood pressure is greater than or equal to 140/90 mm of Hg

The regimen for pharmacological treatment varies with age of the person and health status. The drugs used in the treatment of hypertension are Angiotensin antagonists or ACE inhibitors (A), beta blockers (B), Calcium channel blockers(C), Diuretics (D).

The treatment regimen goes this way: link (press the link to see the regimen)


Complications

The complications of hypertension are end organ damage which can become fatal.
Hypertension can cause damage to various organs

Central Nervous System
Stroke is the common complication of hypertension caused by either cerebral hemorrhage or cerebral infarction. Subarachnoid hemorrhage is also quite common
Retina
Retinal ischemia associated with “cotton wool” exudates, central retinal vein thrombosis
Heart
Hypertension leads to increase in the after load which causes the left ventricular hypertrophy leading to the dilatation of the left atrium and atrial fibrillation (inappropriate contraction of the heart wall).the most common complication of hypertension in heart is coronary artery disease (CAD)
Kidney
Long standing hypertension can lead to renal vasculature damage leading to renal failure
Blood vessels
With hypertension the integrity of the vessel is lost and becomes weak and prone to aneurysms. There also a chance for developing coronary or cerebro vascular disease if hypertension is further added up with factors like smoking, alcohol abuse and hyperlipidemia

Leaving these aside there also are conditions like malignant hypertension (diastolic blood pressure>130mm of Hg + papilloedema + retinal hemorrhage) is medical as well as hypertensive emergencies and accelerated hypertension (diastolic blood pressure>130 mm of Hg without any evidence of papilloedema) which is a hypertensive emergencies

So hypertension is always associated with one or the other conditions listed above so in our opinion we can call hypertension a syndrome

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What is Breast Cancer?

“Breast cancer” what is this? I know most of you know the answer for that, but why is this month of October declared as the month of breast cancer awareness? Is this that significant?

According to statistics breast cancer is the 2nd most common cancer next to lung cancer.

One might think breast cancer affects only the females but ironically it also occurs in males due to the fact that breast is composed of similar tissues in both females and males.Even though the prevalence of breast cancer in men is lower but the survival rate in males is to that of females  

Right now the cause for breast cancer is unclear but there are some studies going on in this field according to which the most significant factors are the advanced age and family history of breast cancer. Researchers have isolated 2 genes BRCA1 and BRCA2 which in some instances are the cause for the expression of breast cancer. The other factor is exposure to hormone estrogen which increases cell division in turn leads to dysplastic changes and then cancer. Alcohol consumption and radiation exposure also increase the risk of developing breast cancer. A protein HER2(human epidermal growth factor receptor 2) which accelerates tumor formation is found to be over-expressed in 20-30% breast cancers

While in men the important risk factors include Klinefelter syndrome along with the factors that pose risk in women

Symptoms:
The most common symptom a woman observes is a lump or mass in her breasts. Generally women are encouraged to perform breast self examination in order to find any lumps in their breast. The other important symptoms are changes in the size and shape of the breast, inversion of the nipple, dimpling of the skin and discharge from a single nipple. Hotness around nipple is cited in conditions like inflammatory breast cancer (IBC). Paget’s disease of breast in which approximately 50% of the diagnosed women have a lump in their breast with the features of tingling , itching , mild flaking of nipple , increased sensitivity , burning and redness. Breast cancer can metastasize to bone, liver, lung, brain etc, presenting with bone or joint pains, jaundice and neurological symptoms with all these the common symptom is unexplained weight loss

The symptoms in men also follow the same pattern.

Diagnosis:
Diagnosis is based on mammogram studies and microscopic analysis of the tissue samples collected from breast using certain modalities like fine-needle aspiration, nipple aspirates, ductal lavage, core needle biopsy, and local surgical excision. These diagnostic steps, when coupled with radiographic imaging techniques like X-ray, CT scan and MRI better results. 


CT scan, chest X-ray and MRI are useful in determining any metastasis of the cancer beyond the breasts.

Treatment:
Treatment of breast cancer is based on staging of the cancer (TNM staging). The mainstay of breast cancer treatment is surgery when the tumor is localized. The other modalities for treatment are chemotherapy, radiotherapy and a recent innovation laser interstitial thermal therapy (LITT). 

Surgery for breast cancer may depend on the extent of involvement i.e., mastectomy (complete removal of all of the breast tissue), lumpectomy (breast-conserving surgery, is the removal of only the tumor and a small amount of surrounding tissue.). Sometimes surgery can be prophylactic like prophylactic oophorectomy and prophylactic mastectomy which reduces the risk of cancer in high risk individuals. After surgery women are put on an adjuvant chemotherapy or radiotherapy to destroy the lingering cancer cells 

Hormonal therapy is a modality of treatment for estrogen and progesterone receptor sensitive breast cancer. Tamoxifen which is selective estrogen receptor modulator (SERM) is the most used drug against estrogen receptor positive breast cancer.

Prognosis:
Prognosis in a woman depends on several factors like staging , age , degree of differentiation of cancerous cells, size of tumor , location and whether tumor has metastasized or not

Younger women tend to have a poorer prognosis than post-menopausal women.

Prognosis is poorer for women with greater staging at the time of diagnosis 

Women with well differentiated cancerous cells in the sample tissue from the breast have good prognosis when compared with women who have poor degree of differentiation of cancerous cells.

Preventive Measures:
Modifying the life style (abstinence to alcohol) and taking diet containing less fat and diary products, breast feeding, lower age at first child birth and having more children are proven to reduce the risk

Hope this info we provided would be useful to you. Please send in your valuable feedback to us at medicoconsult@yahoo.com or post your comment below

                                                                 Thank you,
                                                                 From the team of Medico Consult

HAZARDOUS SMOKING

Smoking listening to this word the first thing you remember is suffocation. I think there is no need for me to tell what people use for smoking. It’s addiction to nicotine. It’s the leading cause for preventive deaths. According to WHO statistics 100 million people were dead in 20th century and also warned that around 1 billion people are going to be killed in 21st century and all the credit goes to smoking

               

                Listening to these entire data one might get a doubt "what might be the reason that makes smoking so hazardous?" and the answer goes this way, smoking affects every organ in the body. The emissions of smoking contain polycyclic aromatic hydrocarbons , benzopyrenes , carbon monoxide and nitrosamines along with other toxic agents. The polycyclic aromatic hydrocarbons and benzopyrenes bind to the human DNA and cause mutations in the genes leading to cancers (Lung Cancer, Oral Cancer, Laryngeal Cancer, and Cervical Cancer)

                

                 Smoking also causes immunosuppression the mechanisms are complex but in brief smoking causes hypersensitivity  which uses up all the immunity and leaves the person susceptible to various infections like tuberculosis, pneumococcal pneumonia Legionnaires disease(a lobar pneumonia with fever, muscle and chest pain, headache, chills and dry cough),progression of AIDS, and risk of Human Papilloma Virus infection(HPV).

                 

                  Smoking causes the decrease of High Density Lipoprotein (HDL) which is good for health and increases the Low Density Lipoprotein (LDL) in blood which is harmful to health as a result the vessels are deposited with cholesterol and leads to a condition called atherosclerosis .smoking also increases the levels of fibrinogen and platelets (helpful in clotting) leading to clot formation in the vessels causing thrombosis. Due to these conditions the blood flow to the heart, brain are compromised resulting in myocardial infarction and stroke (chances of stroke are higher in smokers) respectively. The thrombosis in deep veins causes deep vein thrombosis which might be fatal with the formation of emboli, due to this mechanism there is increased chance of peripheral vascular disease (PVD)

                  

                    It also contain certain radioactive compounds (polonium formed by the disintegration of radium) and lung parenchymal irritants which cause conditions like chronic obstructive pulmonary disease (COPD), bronchitis, asthma

                   

                    Smoking reduces the vitamin A levels in the body which has a protective action in the skin and smoking increases the aging process of skin

                   

                    The carbon monoxide in the emissions from smoking has higher affinity towards hemoglobin than oxygen. This carbon monoxide reduces the oxygen carrying capacity of blood

                   

                     Nicotine increases the alertness at the beginning but on a long run the person gets addicted and leads to depression

                     

                      In pregnant mothers smoking leads to abortions, low birth weight babies.

 

                      In chinldren smoking can cause asthma,and in some cases can lead to sudden infant death syndrome(SIDS).

 

                      In males smoking can reduce the sperm count and can lead to fertility problems.                                         

Clinical Feature

 

When should a person visit a doctor for the following conditions?

          

                      Lung Cancer: a person with lung cancer would have persistent cough, blood in sputum, repeated respiratory infections, chest pain and unexplained weight loss.

                       

                      Myocardial Infarction: such a person would have shortness of breathe with mild exercise, palpitations (pounding heartbeat), chest pain radiating to left shoulder and arm, profuse sweating, nausea (sensation to vomit without vomiting)

 

                      Cataract: this is due to occlusion of artery and opaque cornea. This condition causes cloudy blurred vision, changes in color, poor night vision, double vision, and a characteristic white spot on the pupil.

                       

                       Berger's Disease (PVD): the person will have pain in legs and feet with clammy cool skin, decreased sensation, and discoloration of skin and swelling of legs 

             

                       Stroke: presents with head ache, sudden difficulty in walking and speech, paralysis, numbness and dizziness

            

                        Cervical Cancers: a woman with cervical cancers will have features of abnormal bleeding, bleeding after sexual intercourse, heavy menstruation, with pelvic pain, per-vaginal discharge and pain during urination. 

                          

                     Smoking also has some pros which are masked by the cons it has .let us talk a little about them, smoking interferes with the development of Kaposi’s sarcoma which is an AIDS defining illness but at the same time smoking increases the progression of AIDS due to immune suppression. Smoking also decreases the incidence of breast cancer in women and Alzheimer’s disease ulcerative colitis but smoking is notorious to cause ulcers in the GI system and Parkinson's disease is 2 times more common in non smokers than in smokers and at the same time with every cigarette a person smokes he looses 15 minutes of his precious life

           

Smoking cessation

 

                         People who want to quit smoking can get behavioral support from smoking cessation clinics

                         Nicotine replacement therapy (NRT) and bupraprion are effective aid for smoking cessation.

 

Immediate Benefits of Quitting Smoking 

 

When a person quits smoking:

                     

  1. Within 20 minutes his blood pressure, body temperature and pulse rate returns to normal

 

  2. Within 24 hours risk of myocardial infarction decreases

 

  3. Within 1 year excess risk CHD decreases to half that of a person who smokes

                            

  4. Within 5 years risk for stroke is equal to that of a person who has never smoked

                      

  5. Within 15 years risk of coronary heart disease is same as a person who never smoked .

 

                                   

                  With all this information we provided we hope someone out there might have thought of quitting the habit/addiction

 

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