TIBIN VARGHESE CREATED BY Hypertension Hypertension Hypertension is a disorder characterized by consistently high blood pressure Generally high blood pressure consists of systolic blood pressure the top number which represents the pressure generated when the heart beats higher than 140 or diastolic blood pressure the bottom number which represents the pressure in the vessels when the heart is at rest over 90 Effect on the Eyes High blood pressure can injure the eyes causing a condition called retinopathy Hypertensive retinopathy Damage to the retina from high blood pressure is called hypertensive retinopathy It occurs as the existing high blood pressure changes the microvasculature of the retina Some of the first findings in the disease are flame hemorrhages and cotton wool spots As hypertensive retinopathy progresses hard exudates can appear around the macula along with swelling of the macula and the optic nerve causing impairment of vision In severe cases permanent damage to the optic nerve or macula can occur Bone Loss Hypertension also increases the elimination of calcium in urine potentially leading to loss of bone mineral density a significant risk factor for fractures particularly in elderly women In one study women with the highest levels of blood pressure lost bone density at nearly twice the rate of those in the lowest range It is not clear whether this effect occurs in men or in non Caucasian women Sexual Dysfunction Sexual dysfunction is more common and more severe in men with hypertension and in smokers than it is in the general population Many of the drugs that treat hypertension are thought to cause impotence as a side effect In these cases it is reversible when the drugs are stopped More recent evidence suggests however that the disease process that causes hypertension is itself the major cause of erectile dysfunction in these men Newer anti hypertensive drugs including angiotensin converting enzyme ACE inhibitors and angiotensin receptor blockers ARBs are less associated with erectile dysfunction ARBs such as losartan Cozaar may be particularly effective in restoring erectile function in men with high blood pressure Sildenafil Viagra is successful in achieving erections in almost two thirds of patients with controlled high blood pressure Because sildenafil has a shorter half life and is eliminated more quickly from the body than newer erectile dysfunction drugs it may be a safer option for men with hypertension In a 2003 review of safety data sildenafil did not appear to pose a risk for men who had both high blood pressure and erectile dysfunction Pregnancy and Preeclampsia Severe sudden high blood pressure in pregnant women is one component of a condition called preeclampsia commonly called toxemia that can be very serious for both mother and child Preeclampsia occurs in up to 10 of all pregnancies usually in the third trimester of a first pregnancy and resolves immediately after delivery Other symptoms and signs of preeclampsia include protein in the urine severe headaches and swollen ankles This condition may be caused by a failure of the placenta to embed properly in the uterus which causes it to misconnect with the mother s blood vessels As a result the fetus does not receive a sufficient blood supply and the mother s own blood pressure increases to replace it The reduced supply of blood to the placenta can cause low birth weight and eye or brain damage in the fetus Severe cases of preeclampsia can cause kidney damage convulsion and coma in the mother and can be lethal to both mother and child Women at risk for preeclampsia particularly those with existing hypertension may benefit from having an ultrasound of uterine arteries at 20 to 24 weeks of pregnancy followed if abnormal by 24 hour blood pressure monitoring Uterine Fibroids High blood pressure may increase the risk of developing fibroids according to data from the Nurses Health Study Tracking women for 10 years the prospective epidemiologic study found that for every 10 mm Hg increase in diastolic blood pressure the risk for developing fibroids increased by 8 10 Outlook for Children with Hypertension Children with high blood pressure should first be treated with lifestyle changes including weight reduction increased physical activity and diet modification If blood pressure is not controlled with lifestyle changes drug treatment may be required Although there are few clinical trials conducted in children a 2005 study found that the angiotensin receptor blocker losartan was safe and effective in children Results of studies evaluating outcomes of children with hypertension suggest that early abnormalities including enlarged heart and abnor