Monday, November 3, 2008
CONTROLLING WEIGHT THE RIGHT WAY
CONTROLLING WEIGHT THE RIGHT WAY OBESITY is the accumulation of excess fat in the body mainly in the subcutaneous tissues, caused by eating more food than is necessary to produce the required energy for each day''''s activity. The effects of obesity are serious being associated with certain illnesses like 1) Cardio - vascular disease 2) Diabetes 3) Gall Bladder compaints 4) And many more Being obese is not the same as being overweight. The term obesity is when a person has too much body fat and atleast 20% heavier than he or she should be for his or her height nad build. CAUSES : 1) Eating too much so that more than the required calories are going into the body than are being used up by energy. 2) Obese people''''s energy requirements may be less, because of a slower than average metabolic rate. 3) a tendency to obesity can be inherited. 4) Hormonal disorder. How does one look like: 1) A vastly increased amount of actual body fat as well as an increase in weight. 2) Regular exercise helps us to a point. The best way to lose weight, however is totally to rethink you eating habits. 3) A sensible balanced diet should help at the outset, but the weight will only stay off, if you continue to eat properly. 4) In our day to day life the hectic schedules and the increasing work pressures are an alarming threat. 5) Our health has become the last on our priority list. 6) Nutrition is the key to feeling and looking good. Obesity as we know is excess of fat. Normally all of us to look slim and trim. So any one who has decided that "yes now I have to slim down" will have to ask these questions. 1) WHATY DO I EAT 2) DO I HAVE TO GO ON A CRASH DIET 3) DO I HAVE TO EXERCISE RIGOROUSLY 4) DO I HAVE TO USE ANY SLIMMING AIDS Food is one of the body''''s basic needs. When the body doesn''''t get what it has been eating for so many number of years, the body reacts &nb
THE VALUE OF DRY FRUITS
THE VALUE OF DRY FRUITS
Raisins, cashew nuts, figs are wholesome and check acidity
in an empty stomach.They also recharge the body with minerals
like iron, calcium and potassium.
Raisins, Dates, fig, cashew nut, Almond, Apricot and prune
which are a healthy alternative to fresh fruits.
Bacteria fail to develop when the water in the fruit is below
25%. The common drying agents are sun and hot air devices.
Many of the nutrients like dietary fibres, protiens and other
phyto chemicals are concentrated during drying process.
Drying of fruits does not change the calorie value,fibre content
and mineral composition. Easy to carry along with, a handful of
dried fruits can give instant energy boost.
As they contain natural sugars, mostly in easily digestable forms,
like glucose and fructose, it quicky enters the blood stream as an
immediate source of energy.
RAISINS :- are dried grapes, prepared from wine grapes with a high
sugar content and firm flesh. Raisins have high calorie value .
They are helpful in anaemia and to gain body weight.
Ayurveda recommends black raisins for the re-establishment of sexual
vigour.Raisins are also a good remedy for constipation and are given
to infants to help regular bowel action.
DRY DATES :- contains 84% edible matter consisting of carbohydrates,
dietary fibre, proteins and fats.They contain more natural sugars
(glucose and fructose) than any other fruit.Dates are also a rich
source of potassium, calcium, iron and magnesium.
Nicotine in dates is helpful for intestinal disturbances and is a
good laxative.
PRUNES ;- are plums with higher sugar content, and are cured by drying.
After rupturing the skin, they are dried, either under the sun or
artifically after which they are allowed to ''''sweat''''for a few weeks,
and are finally graded and marketed.
All dried fruits are good source of antioxidants, with prunes having
highest amount of antioxidants.
DRIED FIGS :- in addition to their nutritive value have protein
digesting enzymes and laxative properties, thus important in herbal
medicine. Dried fig is an effective remedy for bilious diseases.
ALMOND :- are rich in fat(59 per cent) with 10 percent carbohydrates
and with no starch at all. It is also a rich source of potassium,
calcium, and fairly good amount Vitamin B.
Almond is an excellent tonic for nervous system. Writer.............. JACOB VARGHESE Summary by ..........R.Krishnkumar
Email : routhu_krishna@yahoo.co.in
Raisins, cashew nuts, figs are wholesome and check acidity
in an empty stomach.They also recharge the body with minerals
like iron, calcium and potassium.
Raisins, Dates, fig, cashew nut, Almond, Apricot and prune
which are a healthy alternative to fresh fruits.
Bacteria fail to develop when the water in the fruit is below
25%. The common drying agents are sun and hot air devices.
Many of the nutrients like dietary fibres, protiens and other
phyto chemicals are concentrated during drying process.
Drying of fruits does not change the calorie value,fibre content
and mineral composition. Easy to carry along with, a handful of
dried fruits can give instant energy boost.
As they contain natural sugars, mostly in easily digestable forms,
like glucose and fructose, it quicky enters the blood stream as an
immediate source of energy.
RAISINS :- are dried grapes, prepared from wine grapes with a high
sugar content and firm flesh. Raisins have high calorie value .
They are helpful in anaemia and to gain body weight.
Ayurveda recommends black raisins for the re-establishment of sexual
vigour.Raisins are also a good remedy for constipation and are given
to infants to help regular bowel action.
DRY DATES :- contains 84% edible matter consisting of carbohydrates,
dietary fibre, proteins and fats.They contain more natural sugars
(glucose and fructose) than any other fruit.Dates are also a rich
source of potassium, calcium, iron and magnesium.
Nicotine in dates is helpful for intestinal disturbances and is a
good laxative.
PRUNES ;- are plums with higher sugar content, and are cured by drying.
After rupturing the skin, they are dried, either under the sun or
artifically after which they are allowed to ''''sweat''''for a few weeks,
and are finally graded and marketed.
All dried fruits are good source of antioxidants, with prunes having
highest amount of antioxidants.
DRIED FIGS :- in addition to their nutritive value have protein
digesting enzymes and laxative properties, thus important in herbal
medicine. Dried fig is an effective remedy for bilious diseases.
ALMOND :- are rich in fat(59 per cent) with 10 percent carbohydrates
and with no starch at all. It is also a rich source of potassium,
calcium, and fairly good amount Vitamin B.
Almond is an excellent tonic for nervous system. Writer.............. JACOB VARGHESE Summary by ..........R.Krishnkumar
Email : routhu_krishna@yahoo.co.in
Non - Drug Therapy for Hypertension
NON - DRUG THERAPY FOR HYPERTENSION
1) Weight reduction :- " Excess weight at any age is associated with
more hypertension, apart fom the risk of coronary heart disease".
a) Obesity may also be associated with diabetes.
b) There is an association between diabetes and high blood pressure.
c) Calorie restriction results in a fall in high blood pressure.
d) Whether it is diet restriction plus modified fasting, it should work
without endangering the health of the person.
e) The weight reduction must be slow and steady.
f) In medical term over weight is called obesity.
g) Over weight or obesity occurs in people where food intake
exceeds the energy requirements of the body for physical
activity and growth. As a result, there is accumulation of fat
which is stored in a dispose tissue (fat cells). This storage
may be localised in certain parts of the body.
h) It is proved that harmones from pituitary, thyroid and adernal
glands along with insulin and sex harmones have an important
role in regulating the fat metabolism.
i) In the adults, an increase in body weight may reflect an increase
in fat in a dispose tissue, an accumulation of fluid or both.
j) Weight gain excess of 1kg per day almost invariably implies
excess fluid retentation
k) Caution:- Every one should appreciate that any programme
which results in weight loss more than 0.3 kg per day undoubtedly
represents large amounts fluid loss rather than fat.
The weight reduction must be slow and steady.
A person is considered over weight if he exceeds the upper range of
ideal weight for his body frame. He is considered as obese if his weight
exceeds by 9 to 10 kgs his ideal weight.
m) Caution : - Obesity (Over weight) is the commonest predisposing cause
for the following problems
1) Diabetes Mellitus ( Excessive blood sugar )
2) Hypercholesterolaemia ( High blood cholesterol ).
3) Hypertension ( High blood pressure )
4 ) Ischaemic heart disease ( heart attacks ).
5) Osteoarthritis of weight bearing joints ( Hips, knees and ankles ).
6) Lumbar and Cervical Spondylosis.
7) Varicose veins ( Dilated, tortuous veins in legs).
8) Hernias, particularly incisional hernia, after operations.
9) Galler blader stones.
Diet and exercises are the only methods to attain ideal weight.
2) Avoid Rich food : - Chocolates, softies, ice creams, oily spice foods,
tinned & stored foods( animal fat foods).
Take more fibre and less saturated fat : - Increase in use of unsaturated
fats ( sun flower oil, corn oil) can induce lower blood pressures. Take
high - fibre foods like vegetables, fruits, bran, cereals etc.
3) Restriction of salt (sodium) intake to 1g per day. Avoid permanently
mangoe pickles and other pickles.
4) Stop Smoking permanently : - smoking immediately accelerates heart
rate and shoots up blood pressure which imposes extra burden on the
heart. Heavy smoking The Nicotin in tobacco increases the tendency
of the blood to clot in arteries.
5) Reduction in Alcohol intake : - Ethanol ( ethyl alcohol) in small amounts
( 10 - 20 ml maximum per day) may not be harmful.
6) Regular exercise keeps healthy : - Regular , rhythmic physical activities
in the form of brisk walking, or slow jogging, performed daily , will reduce
High blood pressure by dilating blood vessels and loss of salt and water
from the body through perspiration. But if the BP is very high in the
beginning, the exercises are deffered till BP is brought under control
and doctor should be consulted before starting exercises.
7) Meditation and Yoga : - In patients with High blood pressure some
chemical substances in the body produced in excess causing High
blood pressure. Their production will be reduced by meditation, thus
lowering the BP.
Writer................ Dr. A. Jayarajan MD.
Summary by .... R.Krishnakumar.
1) Weight reduction :- " Excess weight at any age is associated with
more hypertension, apart fom the risk of coronary heart disease".
a) Obesity may also be associated with diabetes.
b) There is an association between diabetes and high blood pressure.
c) Calorie restriction results in a fall in high blood pressure.
d) Whether it is diet restriction plus modified fasting, it should work
without endangering the health of the person.
e) The weight reduction must be slow and steady.
f) In medical term over weight is called obesity.
g) Over weight or obesity occurs in people where food intake
exceeds the energy requirements of the body for physical
activity and growth. As a result, there is accumulation of fat
which is stored in a dispose tissue (fat cells). This storage
may be localised in certain parts of the body.
h) It is proved that harmones from pituitary, thyroid and adernal
glands along with insulin and sex harmones have an important
role in regulating the fat metabolism.
i) In the adults, an increase in body weight may reflect an increase
in fat in a dispose tissue, an accumulation of fluid or both.
j) Weight gain excess of 1kg per day almost invariably implies
excess fluid retentation
k) Caution:- Every one should appreciate that any programme
which results in weight loss more than 0.3 kg per day undoubtedly
represents large amounts fluid loss rather than fat.
The weight reduction must be slow and steady.
A person is considered over weight if he exceeds the upper range of
ideal weight for his body frame. He is considered as obese if his weight
exceeds by 9 to 10 kgs his ideal weight.
m) Caution : - Obesity (Over weight) is the commonest predisposing cause
for the following problems
1) Diabetes Mellitus ( Excessive blood sugar )
2) Hypercholesterolaemia ( High blood cholesterol ).
3) Hypertension ( High blood pressure )
4 ) Ischaemic heart disease ( heart attacks ).
5) Osteoarthritis of weight bearing joints ( Hips, knees and ankles ).
6) Lumbar and Cervical Spondylosis.
7) Varicose veins ( Dilated, tortuous veins in legs).
8) Hernias, particularly incisional hernia, after operations.
9) Galler blader stones.
Diet and exercises are the only methods to attain ideal weight.
2) Avoid Rich food : - Chocolates, softies, ice creams, oily spice foods,
tinned & stored foods( animal fat foods).
Take more fibre and less saturated fat : - Increase in use of unsaturated
fats ( sun flower oil, corn oil) can induce lower blood pressures. Take
high - fibre foods like vegetables, fruits, bran, cereals etc.
3) Restriction of salt (sodium) intake to 1g per day. Avoid permanently
mangoe pickles and other pickles.
4) Stop Smoking permanently : - smoking immediately accelerates heart
rate and shoots up blood pressure which imposes extra burden on the
heart. Heavy smoking The Nicotin in tobacco increases the tendency
of the blood to clot in arteries.
5) Reduction in Alcohol intake : - Ethanol ( ethyl alcohol) in small amounts
( 10 - 20 ml maximum per day) may not be harmful.
6) Regular exercise keeps healthy : - Regular , rhythmic physical activities
in the form of brisk walking, or slow jogging, performed daily , will reduce
High blood pressure by dilating blood vessels and loss of salt and water
from the body through perspiration. But if the BP is very high in the
beginning, the exercises are deffered till BP is brought under control
and doctor should be consulted before starting exercises.
7) Meditation and Yoga : - In patients with High blood pressure some
chemical substances in the body produced in excess causing High
blood pressure. Their production will be reduced by meditation, thus
lowering the BP.
Writer................ Dr. A. Jayarajan MD.
Summary by .... R.Krishnakumar.
Saturday, November 1, 2008
' Know " the SILENT Killer " ! '
' Know the " SILENT KILLER " ! '
HYPERTENSION / HIGH BLOOD PRESSURE is the 'Silent Killer.
The pressure exerted by blood in the aorta and its branches persistently
exceeds the upper limits of normal and high systemic arterial pressure
causes hypertensive heart disease. It can affect organs such as the
brain, kidney and the heart directly by a) complete obstruction of the
blood supplying vessel. b) diminishing blood supply to the organs.
c) sustained involuntary muscular contraction which can diminish or cut
the blood supply temporarily.
A highl systolic pressure and / or diastolic pressure is a serious development
The extra pressure which results from various causes exerts as strain on the
left ventricle. Which at first generally hypertrophies and manages to maintain
effective circulation against the increased resistance.
However, the muscle eventually weakens, then dilation of the ventricle occurs
and the heart begins to fail. It can lead to either.
Angina pectoris : - Where in there is a sensation ( pain or uncomfortable) in
the breast or the chest, palpitation, shortness of breath and hiccups. or
Cardiac Asthma in which the blood supply to the left ventricle is substantially
choaked off or reduced. or
Congestive failure meaning the failure of the left ventricle because of its
enlargement and thickening. It is usually followed by failure of the right ventricle or
Mycocardial infarction : - a most serious condition resulting from untreated or
prolonged high blood pressure which is generally reffered to as ' heart attack'.
Hypertension can also affect the brain and kidneys which can lead to a stroke
and a possible partial or complete death of brain or renal failure which seriously
affects kidney function.
What causes Hypertension or High blood pressure?
1) Heridity 2) Environmental and aquired stress and tension 3) Smoking
4) A high intake of salt 5) Regular intake of alcohol 6) Obesity
7) A high - cholesterol diet.
Other primary causes : - a) sometimes caused by disease of the kidney.
b) Pregnancy c) Narrowing of the aorta (congenital) overactivity of the
pictuitary glands.
How to prevent and control Hypertension ?
1) Reduction weight : - Medical /Clinical findings have found that weight
reductiony dieting seems to reduce the blood pressure.
2) Reduction of salt intake : - Excessive salt or sodium which comprises
40% of pure salt has been associated with high blood pressure..
Salt is responsible for rention of water in the body. And so the volume
of the blood and the pressure is maintained in the body.
3) Reduction in cholesterol intake : High cholesterol diet results in
hardening of the arteries which is responsible for high blood pressure.
Cut down cholesterol rich and animal -fat foods like eggs, all dairy
products, fatty meats; instead take high fibre foods like vegetables,
fruits, bran, cereals etc.
4) Reduction of emotional stress and environmental tension :- Learn
to relax. ---------- slow down the pace of your life.
.........Convince yourselves you can do more if you are in better health.
.........Consciously check yourselves again and again.
5) Giving up smoking : - smoking immediately accelerates heart rate and
shoots up blood pressure which imposes extra burden on the heart.
Heavy smoking elevates blood cholesterol. The Nicotin in tobacco
increases the tendency of the blood to clot in arteries. 56% Heart
attacks are due to smoking.
6) Reduction in Alcohol intake : - Heavy drinking may cause or aggravate
high blood pressure. Alcohol has a high calori content which usually
leads to obesity.
7) Regular early Morning walking, physical exercises and Yoga asanas, pranayam
( breathing exercises) and meditation keeps healthy.
writers........ Dr. BK Mehra
Dr.BK Lashkan
Summary by R.Krishnakumar.
HYPERTENSION / HIGH BLOOD PRESSURE is the 'Silent Killer.
The pressure exerted by blood in the aorta and its branches persistently
exceeds the upper limits of normal and high systemic arterial pressure
causes hypertensive heart disease. It can affect organs such as the
brain, kidney and the heart directly by a) complete obstruction of the
blood supplying vessel. b) diminishing blood supply to the organs.
c) sustained involuntary muscular contraction which can diminish or cut
the blood supply temporarily.
A highl systolic pressure and / or diastolic pressure is a serious development
The extra pressure which results from various causes exerts as strain on the
left ventricle. Which at first generally hypertrophies and manages to maintain
effective circulation against the increased resistance.
However, the muscle eventually weakens, then dilation of the ventricle occurs
and the heart begins to fail. It can lead to either.
Angina pectoris : - Where in there is a sensation ( pain or uncomfortable) in
the breast or the chest, palpitation, shortness of breath and hiccups. or
Cardiac Asthma in which the blood supply to the left ventricle is substantially
choaked off or reduced. or
Congestive failure meaning the failure of the left ventricle because of its
enlargement and thickening. It is usually followed by failure of the right ventricle or
Mycocardial infarction : - a most serious condition resulting from untreated or
prolonged high blood pressure which is generally reffered to as ' heart attack'.
Hypertension can also affect the brain and kidneys which can lead to a stroke
and a possible partial or complete death of brain or renal failure which seriously
affects kidney function.
What causes Hypertension or High blood pressure?
1) Heridity 2) Environmental and aquired stress and tension 3) Smoking
4) A high intake of salt 5) Regular intake of alcohol 6) Obesity
7) A high - cholesterol diet.
Other primary causes : - a) sometimes caused by disease of the kidney.
b) Pregnancy c) Narrowing of the aorta (congenital) overactivity of the
pictuitary glands.
How to prevent and control Hypertension ?
1) Reduction weight : - Medical /Clinical findings have found that weight
reductiony dieting seems to reduce the blood pressure.
2) Reduction of salt intake : - Excessive salt or sodium which comprises
40% of pure salt has been associated with high blood pressure..
Salt is responsible for rention of water in the body. And so the volume
of the blood and the pressure is maintained in the body.
3) Reduction in cholesterol intake : High cholesterol diet results in
hardening of the arteries which is responsible for high blood pressure.
Cut down cholesterol rich and animal -fat foods like eggs, all dairy
products, fatty meats; instead take high fibre foods like vegetables,
fruits, bran, cereals etc.
4) Reduction of emotional stress and environmental tension :- Learn
to relax. ---------- slow down the pace of your life.
.........Convince yourselves you can do more if you are in better health.
.........Consciously check yourselves again and again.
5) Giving up smoking : - smoking immediately accelerates heart rate and
shoots up blood pressure which imposes extra burden on the heart.
Heavy smoking elevates blood cholesterol. The Nicotin in tobacco
increases the tendency of the blood to clot in arteries. 56% Heart
attacks are due to smoking.
6) Reduction in Alcohol intake : - Heavy drinking may cause or aggravate
high blood pressure. Alcohol has a high calori content which usually
leads to obesity.
7) Regular early Morning walking, physical exercises and Yoga asanas, pranayam
( breathing exercises) and meditation keeps healthy.
writers........ Dr. BK Mehra
Dr.BK Lashkan
Summary by R.Krishnakumar.
Investigations of Hypertension
INVESTIGATIONS OF HYPERTENSION / HIGH BLOOD PRESSURE
Blood pressure is the product of Cardiac out put & peripheral vascular
resistance. change in either one of them or both results in change in
blood pressure.During daily life activity blood pressure varies, because
of constant change in the cardiac output & peripherial resistance.
Blood pressure could rise during mental stress or anxiety but these
transient elevations of blood pressure are not considered diagnostic.
A constant rise of blood pressure throughout the day is a diagnostic
feature of hypertension (high blood pressure).
After the diagnosis, the following information is necessary for the
investigations of high blood pressure / Hypertension.
1) Family History of high blood pressure.2) physical Examination.
3) Laboratory investigations. 4) Radiological Examination
5) ECG 6) Special investigations.
When investigating these patients, it is important to assess.
a) The degree of hypertension (mild, moderate or severe).
b) Involment of target organs like heart, brain, kidneys, eyes and
peripheral arteries.
c) Evidence of target organ damage such as ischaemic heart disease,
heart failure, stroke, kidney failure and eye changes.
d) Is this increase in blood pressure Curable?
Systemic symptoms in Hypertension
------------------------------------------------------
Heart .... Chest pain, Breathlessness, palpitation & swelling of the legs
Kidney...... Dysuria, Nocturia, Frequency of Micturition.
Central Nervous
system ...... Headache, Dizziness, Hemiplegia, Hemianopia.
Fundus ............ Blurring of vision.
Blood pressure
------------------------
Normal blood pressure is 120/80 but can vary from 90/70 to 140/90.
as age advances blood pressure steadily.
Note : - Blood pressure of 140/90 in a 20 years old patient is abnormal
and needs investigations.
I ) Cardiovascular Examination : - on ausculation of the heart, aortic
heart sound is loud; fourth heart sound may be heard, due to decrease
distensibility of the left ventricle from thickened left ventricular muscle.
Left ventricular hypertrophy occurs; this will be followed by left ventricular
failure. Congestion in the lungs can be detected by auscultation.. It is a
sign of left ventricular.
II ) Examination of the fundus of the eye : - On fundal examination
arteriolar narrowing, irregularity and arteriovenous nipping (for nickling)
In advanced stages of hypertension, haemorrhages and exudates are
seen in the retina. Papilloedema with blurring of the disc margins is the
end stage.
III ) Central Nervous System : - In early stages no abnormality could be
detected. When brain damage occurs from severe hypertension,
evidence of hemiplegia may be detected. On examination, plantars
may be up going with weakness of the paralysed side.
I V ) Kidneys : - Urinary symptoms may occur from renal disease.
Long standing hypertension causes shrinkage of the kidney size
and scarring of the glomeruli affecting the function.
Kidneys are enlarged and palpable in polycystic disease.
V ) Laboratory Investigations: - are done to establish the cause and
evidence of involment of the target organs from long standing
hypertension.
a ) Urine : - Urine analysis gives lot of information about the renal
pathology. Proteinuria occurs in renal disease.
Specific gravity around 1010 ( fixed specific gravity) suggest chronic
renel failure. Granular casts & pus cells appear in the urine.
Bacterial culture examination done. Positive culture is found in
urinary tract infection. or chronic pyelonephritis..
b ) Blood tests : - In kidney disease, blood urea nitrogen and
serum creatinine are elevated.
c) Serum potassium level is low in primary aldosteronism.
In patients with long standing blood pressure with kidney
damage, serum level is high.
VI ) Radiological Examination : - a) Chest X- ray:
sometimes heart size may be normal ,
as the muscle mass of the left ventricle may have increased
Concentrically. Usually left ventricular enlargement is seen on the
border of the heart.
b) Intravenous pyelogram : - This test may give evidence of renal
parenchymal disorder or renal artery stenosis as a cause of
hypertension.
V I I ) ECG : - most useful investigation in confirming the left ventricular
hypertrophy. I t is a reliable investigation even though chest x - ray
may not show any evidence of the left ventricular enlargement.
ECG shows evidence of hypertrophy and not dilatation.
TESTS AND THEIR PURPOSE
---------------------------------------------------
TEST PURPOSE OF INVESTIGATION
URINE -------------> Evidence of kidney disease.
BUN
a) Serium Creatinine ------> To assess kidney function.
b) potassium -------> Low in primary hyperaldosteronism
High in Chronic renal failure.
HAEMOGLOBIN --------> Low in chronic renal disease.
CHEST X - RAY ---------->Evidence of left ventricular Enlargement
or / and failure.
ECG ---> To assess left ventricular hypertrophy.
I. V. P ---> To assess renal pathology and function.
Writer......... Dr HC Sathya MRCP.
Summary by R.Krishnakumar.
Blood pressure is the product of Cardiac out put & peripheral vascular
resistance. change in either one of them or both results in change in
blood pressure.During daily life activity blood pressure varies, because
of constant change in the cardiac output & peripherial resistance.
Blood pressure could rise during mental stress or anxiety but these
transient elevations of blood pressure are not considered diagnostic.
A constant rise of blood pressure throughout the day is a diagnostic
feature of hypertension (high blood pressure).
After the diagnosis, the following information is necessary for the
investigations of high blood pressure / Hypertension.
1) Family History of high blood pressure.2) physical Examination.
3) Laboratory investigations. 4) Radiological Examination
5) ECG 6) Special investigations.
When investigating these patients, it is important to assess.
a) The degree of hypertension (mild, moderate or severe).
b) Involment of target organs like heart, brain, kidneys, eyes and
peripheral arteries.
c) Evidence of target organ damage such as ischaemic heart disease,
heart failure, stroke, kidney failure and eye changes.
d) Is this increase in blood pressure Curable?
Systemic symptoms in Hypertension
------------------------------------------------------
Heart .... Chest pain, Breathlessness, palpitation & swelling of the legs
Kidney...... Dysuria, Nocturia, Frequency of Micturition.
Central Nervous
system ...... Headache, Dizziness, Hemiplegia, Hemianopia.
Fundus ............ Blurring of vision.
Blood pressure
------------------------
Normal blood pressure is 120/80 but can vary from 90/70 to 140/90.
as age advances blood pressure steadily.
Note : - Blood pressure of 140/90 in a 20 years old patient is abnormal
and needs investigations.
I ) Cardiovascular Examination : - on ausculation of the heart, aortic
heart sound is loud; fourth heart sound may be heard, due to decrease
distensibility of the left ventricle from thickened left ventricular muscle.
Left ventricular hypertrophy occurs; this will be followed by left ventricular
failure. Congestion in the lungs can be detected by auscultation.. It is a
sign of left ventricular.
II ) Examination of the fundus of the eye : - On fundal examination
arteriolar narrowing, irregularity and arteriovenous nipping (for nickling)
In advanced stages of hypertension, haemorrhages and exudates are
seen in the retina. Papilloedema with blurring of the disc margins is the
end stage.
III ) Central Nervous System : - In early stages no abnormality could be
detected. When brain damage occurs from severe hypertension,
evidence of hemiplegia may be detected. On examination, plantars
may be up going with weakness of the paralysed side.
I V ) Kidneys : - Urinary symptoms may occur from renal disease.
Long standing hypertension causes shrinkage of the kidney size
and scarring of the glomeruli affecting the function.
Kidneys are enlarged and palpable in polycystic disease.
V ) Laboratory Investigations: - are done to establish the cause and
evidence of involment of the target organs from long standing
hypertension.
a ) Urine : - Urine analysis gives lot of information about the renal
pathology. Proteinuria occurs in renal disease.
Specific gravity around 1010 ( fixed specific gravity) suggest chronic
renel failure. Granular casts & pus cells appear in the urine.
Bacterial culture examination done. Positive culture is found in
urinary tract infection. or chronic pyelonephritis..
b ) Blood tests : - In kidney disease, blood urea nitrogen and
serum creatinine are elevated.
c) Serum potassium level is low in primary aldosteronism.
In patients with long standing blood pressure with kidney
damage, serum level is high.
VI ) Radiological Examination : - a) Chest X- ray:
sometimes heart size may be normal ,
as the muscle mass of the left ventricle may have increased
Concentrically. Usually left ventricular enlargement is seen on the
border of the heart.
b) Intravenous pyelogram : - This test may give evidence of renal
parenchymal disorder or renal artery stenosis as a cause of
hypertension.
V I I ) ECG : - most useful investigation in confirming the left ventricular
hypertrophy. I t is a reliable investigation even though chest x - ray
may not show any evidence of the left ventricular enlargement.
ECG shows evidence of hypertrophy and not dilatation.
TESTS AND THEIR PURPOSE
---------------------------------------------------
TEST PURPOSE OF INVESTIGATION
URINE -------------> Evidence of kidney disease.
BUN
a) Serium Creatinine ------> To assess kidney function.
b) potassium -------> Low in primary hyperaldosteronism
High in Chronic renal failure.
HAEMOGLOBIN --------> Low in chronic renal disease.
CHEST X - RAY ---------->Evidence of left ventricular Enlargement
or / and failure.
ECG ---> To assess left ventricular hypertrophy.
I. V. P ---> To assess renal pathology and function.
Writer......... Dr HC Sathya MRCP.
Summary by R.Krishnakumar.
Hypertension --- an Overview
HYPERTENSION ---AN OVERVIEW
High Blood pressure (HBP) also called Hypertension, is a common
cause for heart attack, stroke and renal failure. culminating in premature
disability and untimely death.
SPHYGMOMONOMETER is a device to measure blood pressure.
What is High blood pressure ?
The heart during rest normally contracts and relaxes 60 - 90 times per minute.
with each contraction the heart expels blood into the aorta.
The flowing blood exerts pressure on the side wall of blood vessel and is called
ontraction or systolic pressure.
After this, heart relaxes or dilates to receive blood and the pressure during
this phase is called diastolic B.P.
Thus B.P has two components, systolic and diastolic.
The systolic is written above the line and diastolic below.
As the level of B.P is related to the age, the B.P of 120/80 in adults upto age
30 and of 140/90 in middle age is considered as normal.
Classification and nomenclature as a practical guide.
1) Border line High blood pressure .-----> B.P more than 140/90mm Hg,
but reurning to normal at other times.
2) Mild HBP ------> 140/95 ------160/105
3) Moderate HBP -----> 160/105 -----------180/115
4) Severe HBP -------> more than 180/115
5) Malignant ---------> 240/140 and above.
The majority of them have non specific symptoms like headache (23%)
impatience (35%), depression (7%), dizziness (30%) and nose bleed.
" In patients with High blood pressure complications like heart attack
are 3 times, stroke 7 times and congestive Cardiac failure 4 times greater
compared to people with normal B.P.
Health Jokes
------------------------------
1) Some people are no good at counting calories and they have the figures
to prove it.
2) A good many people commit suicide with a knife and fork.
3) Doctor to a patient : "Congratulations The high price of meat, butter and
eggs has cleared up your cholesterol ".
4) Taste Makes Waist
Pertly precise
---------------------------
1) Appetizers : Those little bits you eat until you lose your appetite.
2) Gossip : Letting the chat out of the bag.
3) ZOO : A place devised for animals to study the habits of human beings.
4) Ignorance : A Voluntary Condition of Bliss.
5) Philosophy : Unintelligible answer to insoluble problems.
6) Experience : Yesterday's answer to todays problem.
7) Sculpture : mud pies that endure.
8) Prescription : -Hiieroglyphics written by a physician, to be translated
by a pharmacist to rupee signs.
Beware of desperate steps; the darkest day, lived till tomorrow,
will have passed away!.
Not in the dictationary
-----------------------
1) Archives : Where Noah kept his bees.
2) Athletics : The excuse for institutions of higher learning.
3) Bacteria : Back of cafeteria.
4) Compliments : False hoods infull dress.
5) Darwin : The man who made money out of Adam.
Writer................Dr.BV Dugani MRCP
Summary by R.Krishnakumar.
Ads by Google
High Blood pressure (HBP) also called Hypertension, is a common
cause for heart attack, stroke and renal failure. culminating in premature
disability and untimely death.
SPHYGMOMONOMETER is a device to measure blood pressure.
What is High blood pressure ?
The heart during rest normally contracts and relaxes 60 - 90 times per minute.
with each contraction the heart expels blood into the aorta.
The flowing blood exerts pressure on the side wall of blood vessel and is called
ontraction or systolic pressure.
After this, heart relaxes or dilates to receive blood and the pressure during
this phase is called diastolic B.P.
Thus B.P has two components, systolic and diastolic.
The systolic is written above the line and diastolic below.
As the level of B.P is related to the age, the B.P of 120/80 in adults upto age
30 and of 140/90 in middle age is considered as normal.
Classification and nomenclature as a practical guide.
1) Border line High blood pressure .-----> B.P more than 140/90mm Hg,
but reurning to normal at other times.
2) Mild HBP ------> 140/95 ------160/105
3) Moderate HBP -----> 160/105 -----------180/115
4) Severe HBP -------> more than 180/115
5) Malignant ---------> 240/140 and above.
The majority of them have non specific symptoms like headache (23%)
impatience (35%), depression (7%), dizziness (30%) and nose bleed.
" In patients with High blood pressure complications like heart attack
are 3 times, stroke 7 times and congestive Cardiac failure 4 times greater
compared to people with normal B.P.
Health Jokes
------------------------------
1) Some people are no good at counting calories and they have the figures
to prove it.
2) A good many people commit suicide with a knife and fork.
3) Doctor to a patient : "Congratulations The high price of meat, butter and
eggs has cleared up your cholesterol ".
4) Taste Makes Waist
Pertly precise
---------------------------
1) Appetizers : Those little bits you eat until you lose your appetite.
2) Gossip : Letting the chat out of the bag.
3) ZOO : A place devised for animals to study the habits of human beings.
4) Ignorance : A Voluntary Condition of Bliss.
5) Philosophy : Unintelligible answer to insoluble problems.
6) Experience : Yesterday's answer to todays problem.
7) Sculpture : mud pies that endure.
8) Prescription : -Hiieroglyphics written by a physician, to be translated
by a pharmacist to rupee signs.
Beware of desperate steps; the darkest day, lived till tomorrow,
will have passed away!.
Not in the dictationary
-----------------------
1) Archives : Where Noah kept his bees.
2) Athletics : The excuse for institutions of higher learning.
3) Bacteria : Back of cafeteria.
4) Compliments : False hoods infull dress.
5) Darwin : The man who made money out of Adam.
Writer................Dr.BV Dugani MRCP
Summary by R.Krishnakumar.
Ads by Google
Secondary Hypertension
SECONDARY HYPERTENSION
Hypertension or High blood pressure one of the most important
contributers to cardiovascular sickness & death.
There is increased incidence of coronary, cerebrovascular and
renal arteriolar disease ( kidneys).
Most of the patients have primary or essential hypertension/
High blood pressure; they do not have an identifiable specific
cause for the rise in blood pressure.
About 5 percent of the persons with high blood pressure have
a specific cause which can be identified and most of them can
be treated successfully.
Identifying the patient with secondary hypertension/ High blood
pressure is important.
we must think of secondary hypertension/ High blood pressure,
when
a) The age is less than 30 years and onset is sudden.
b) Hypertension /High blood pressure is severe.
c) Systolic and diastolic murmurs can be heard in the abdomen.
d) There is history of passing blood in the urine.
e) The kidney can be palpated.
f ) Peripheral arterial pulses are absent or delayed
h ) There are indications of hormonal disorders.
What causes of secondary hypertension / High Blood pressure ?
There are many, one group is due to involvement of the kidney.
There can be reduced blood supply to the kidney ( narrowing of the
artery by stenosis or renal arterial disease). Other kidney disease
can also cause hypertension.
Glomerulonephritis is suggested by puffiness of face, scanty urine,
blood in urine and oedema.
Repeated episodes of fever with dysuria suggests pyelonephritis.
Both can lead to High blood pressure.
Another cause of hypertension is aldosteronism. Aldosterone is a
hormone produced by the adrenal gland. Excess of it leads to
high blood pressure.
Phaeochromocytoma, a tumour of the adrenal medulla, can be
another cause. It can cause dramatic episodes of high blood pressure.
The prevalence of hypertension is higher in diabetic patients.
steroids ( excess production in the body or given as treatment) can
cause high blood pressure. Skin ointments, eye drops and nasal sprays
contain steroids. They can lead to hypertension.
A case study : - Shyam, a 10 - year old boy with eczema ( a type of
skin disease), was treated for six years with an ointment containing
prednisolone. His arterial blood pressure was high. The average was
about 230/160mm Hg.
Hypertension was considered as essential and he was treated with
many anti - hypertensive drugs. after 6 years, a re- assement was
made after taking an accurate medical history. The correct diagnosis
was made and the steroids stopped. The blood pressure came down.
Many other drugs like phenylbutazone can cause hypertension, when
given large in large quantities.
Cigarette smoking can raise blood pressure.
The greater the quantity of alcohol ( more than 60 ml per day taken) the
higher the prevalence of hypertension.
Writer ................ Dr. G. Kuppuswamy FRCP FAMS
Summary by .. R.Krishna kumar
Hypertension or High blood pressure one of the most important
contributers to cardiovascular sickness & death.
There is increased incidence of coronary, cerebrovascular and
renal arteriolar disease ( kidneys).
Most of the patients have primary or essential hypertension/
High blood pressure; they do not have an identifiable specific
cause for the rise in blood pressure.
About 5 percent of the persons with high blood pressure have
a specific cause which can be identified and most of them can
be treated successfully.
Identifying the patient with secondary hypertension/ High blood
pressure is important.
we must think of secondary hypertension/ High blood pressure,
when
a) The age is less than 30 years and onset is sudden.
b) Hypertension /High blood pressure is severe.
c) Systolic and diastolic murmurs can be heard in the abdomen.
d) There is history of passing blood in the urine.
e) The kidney can be palpated.
f ) Peripheral arterial pulses are absent or delayed
h ) There are indications of hormonal disorders.
What causes of secondary hypertension / High Blood pressure ?
There are many, one group is due to involvement of the kidney.
There can be reduced blood supply to the kidney ( narrowing of the
artery by stenosis or renal arterial disease). Other kidney disease
can also cause hypertension.
Glomerulonephritis is suggested by puffiness of face, scanty urine,
blood in urine and oedema.
Repeated episodes of fever with dysuria suggests pyelonephritis.
Both can lead to High blood pressure.
Another cause of hypertension is aldosteronism. Aldosterone is a
hormone produced by the adrenal gland. Excess of it leads to
high blood pressure.
Phaeochromocytoma, a tumour of the adrenal medulla, can be
another cause. It can cause dramatic episodes of high blood pressure.
The prevalence of hypertension is higher in diabetic patients.
steroids ( excess production in the body or given as treatment) can
cause high blood pressure. Skin ointments, eye drops and nasal sprays
contain steroids. They can lead to hypertension.
A case study : - Shyam, a 10 - year old boy with eczema ( a type of
skin disease), was treated for six years with an ointment containing
prednisolone. His arterial blood pressure was high. The average was
about 230/160mm Hg.
Hypertension was considered as essential and he was treated with
many anti - hypertensive drugs. after 6 years, a re- assement was
made after taking an accurate medical history. The correct diagnosis
was made and the steroids stopped. The blood pressure came down.
Many other drugs like phenylbutazone can cause hypertension, when
given large in large quantities.
Cigarette smoking can raise blood pressure.
The greater the quantity of alcohol ( more than 60 ml per day taken) the
higher the prevalence of hypertension.
Writer ................ Dr. G. Kuppuswamy FRCP FAMS
Summary by .. R.Krishna kumar
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