Doctorshealthsystems

The treatment of blood pressure almost needs a book on its own, because there are so many methods, and so many ways in which the doctor, patient and complementary therapist can join forces to help.

In a few cases, high blood pressure has a basic cause, and in these cases removing the underlying problem may bring the blood pressure down to normal. Underlying problems like this include obstruction of the arteries to the kidney; certain rare types of kidney disease; and various tumours (some benign, a few malignant) that secrete excess hormones which raise the blood pressure.

One of these hormone-producing tumours is called a phaechromocytoma and it’s a non-malignant growth of a type of tissue that normally forms part of the adrenal glands. It produces excess, uncontrolled quantities of adrenalin-like substances which can raise the blood pressure to very high levels. Finding and cutting out offending cells brings the blood pressure back to normal.

Other hormonal causes for raised blood pressure include tumours of the pituitary gland (a gland at the base of the brain) which secrete too much growth hormone and diabetes is associated with higher blood pressure. However, with the exception of diabetes, all these conditions are rare: most doctors are unlikely to meet even a single case in their whole lifetime.

Once we’ve eliminated these conditions, we’re left with what is called ‘essential’ hypertension, and this forms the majority of cases of high blood pressure. Many cases of essential hypertension are probably genetic, and at the moment there is very little that we can do to cure it. Just keep taking the tablets! On the other hand, there are many things that can make blood pressure worse, chief of which is being too fat. For every extra pound of fat you put on, your blood has to go through an extra mile of capillaries; the fatter you are the harder the heart has to work. Mild to moderate blood pressure frequently rises in those who are overweight, and often returns to normal if the patient goes on a diet and returns to normal size.

Exercise also helps, making the body more efficient in how it uses biochemical raw materials, and regular exercise reduces blood pressure in the long run.

Stress, too, is associated with blood pressure, though the relationship is far from precise. Undoubtedly, extra levels of stress put up the blood pressure over a short period of time; for example, frantically rushing to get to work on time puts up the blood, pressure transiently. Some people seem to get high blood pressure when stress is maintained for a long time, yet others don’t get a raised blood pressure in these situations.

There are many things that the orthodox practitioner can do to treat high blood pressure. These fall into four main sections: dealing with obesity; encouraging exercise; reducing stress; and, prescribing medicines.. However, we shouldn’t look at these four groups independently; they all interact one with the other. A little less stress, a few extra pounds off, a little more exercise and a mild diuretic may together bring the blood pressure down to normal levels, but it might require a far higher dose of medicines if the first three procedures aren’t undertaken.

Let’s look at each of these in turn:

Obesity. Without doubt, being fat causes your blood pressure to rise, and shedding those extra few pounds may make all the difference to your overall health and wellbeing.

Exercise. Firstly, exercise uses up the excess adrenalin that swills round the system when we are in a state of alertness as a result of a fright or stress. Secondly, the fit person who exercises is less likely to become obese. Thirdly, the body systems of fit people work in a slightly different way to those who are unfit.

Exercise promotes a greater sense of well-being, a sense of relaxation, and causes some significant but subtle changes to occur in the body, particularly in the way in which the cells of the body handle sugar.

•    Stress. Our bodies are good at responding to external stress; they do so by putting up the blood pressure transiently, which is useful if we need to run away quickly in the face of danger. However, if stress is applied for days and weeks on end, or if we don’t get any opportunity to relieve the stress, then our bodies become constantly over-stimulated, with adrenalin swimming around the system; no wonder the blood pressure goes up!

Anti-stress measures can be simple, but very effective in reducing the levels of stress within the body; and by reducing stress we may reduce blood pressure fairly quickly.

However, stress on its own is unlikely to be the entire cause of high blood pressure; it probably has an effect mainly on those with an underlying predisposition to high blood pressure.

•    Medication. There are five main groups of drugs to treat high blood pressure. 1. The thiazide diuretics. These are drugs which are often used to produce extra

urine and dry out the body.

Beta-blockers are drugs which block the effects of adrenalin and nor-adrenalin, and so reduce the contraction of the arteriolar muscles, reducing blood pressure. They also stop the heart over-exerting itself, in much the same way that putting a wooden block under the car’s accelerator pedal prevents you over-revving the engine.

Calcium channel blockers such as nifedipine (Adalat, Verapamil, Diltiazem, etc) block the movement of calcium ions across the outer membrane of muscle cells and, in doing so, reduce the force with which the involuntary muscles can act. As all the muscles controlling blood pressure are involuntary, these medicines are excellent for reducing blood pressure.

Drugs which act to block the transmission of nerve impulses, e.g. Alpha-methyldopa. After being absorbed in the body this is changed into an imitation transmitter chemical – one that doesn’t stimulate the nerves – so, effectively, the nerve starts firing blanks! As a result the nervous system can’t force the muscles to contract as strongly, so the blood pressure drops.

The group of blood pressure reducers called ACE-inhibitors (which stands for Angiotension Converting Enzyme Inhibitor). These block the effects of a hormone called angiotensin which when converted into its active form normally acts to constrict the muscle cells in the arterioles. Blocking the conversion reduces the stimulus on the muscle cells.

    In controlling your blood pressure your doctor may use one drug on its own, or several of them together. Often the control of blood pressure is easier using two different drugs that work in different ways. Diuretics and beta-blockers are often used together; but, in fact, most anti-hypertensive drugs can be combined usefully with one another. Some combinations of drug even come together in one capsule, for convenience and ease of administration.

Once your blood pressure is under control you’ll probably only need to see the doctor once every six months for a routine blood-pressure check.

Once drug treatment has started, it is usually for life. While it is often possible to bring down minor degrees of raised blood pressure by curbing obesity, instituting relaxation therapy, etc., if hypertension remains despite these measures, then permanent drug treatment is likely to be needed. High blood pressure like this doesn’t often come down of its own accord, and although the drugs currently used reduce the blood pressure directly, they don’t affect what causes the alteration in blood-pressure control. So, in effect, they are just ameliorating the effects of high blood pressure, rather than curing it so that it goes away.

Just occasionally the blood pressure does come down again, but this is either after some years have passed, or else after a major event such as a heart attack or a stroke. In these circumstances it may be possible to reduce the medication.

A problem with taking drugs is that occasionally they can give side-effects -dizziness, weakness, coughs, difficulty with erections, etc. As they are being given for a condition which is largely symptomless it’s often difficult to persuade the patient to continue taking the medication, because as far as he is concerned, he feels fine when he’s off the medication, and worse when he’s on it. It is vital to keep taking your blood pressure pills; if you don’t you run tin’ risk of an earlier stroke, which may reduce your life expectancy by several years, or paralyse you.

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The headache starts very suddenly, without any warning at all, and feels as if you’ve been hit hard on the back of the head or neck or, alternatively, that there’s been an explosion inside the head. The pain is extreme.

What else could it be?

Four conditions can mimic or be mimicked by a sub-arachnoid haemorrhage:

Meningitis gives the same type of stiff neck, in which the patient is unable to bend his chin to his chest (remember that a true stiff neck is one that cannot be bent forwards). Like a sub-arachnoid haemorrhage, meningitis can also come on quite quickly (but in a matter of hours, not minutes) and soon produces altered consciousness, irritability and drowsiness. Hut patients with meningitis almost always have a temperature, even if it’s only a small one,.

In practice, for the lay person the difference is unimportant. In both cases you need a doctor and you need one now. Don’t wait for the morning; don’t wait even five minutes – it could be the difference between life and death.

A stroke can cause sudden headache, collapse and unconsciousness, within a few minutes. However, paralysis is usually one-sided, with one arm or leg obviously more floppy and paralysed than on the other side.

Headaches coming on during intercourse can mimic a sub-arachnoid haemorrhage, because they come on very quickly, and sometimes almost explosively; and, of course, a sub-arachnoid haemorrhage can be precipitated by the excitement and stress of intercourse. In fact, if a headache of this type and magnitude occurs during intercourse, it may be wise to do a full medical investigation, just to be sure. Once a sub-arachnoid haemorrhage has been eliminated, then it is fair to assume that any further headaches during intercourse are not likely to be sub-arachnoid bleeds.

A very severe tension headache can actually be quite difficult to distinguish from a sub-arachnoid haemorrhage, particularly if it has a sudden onset – such as a sudden tensing of the muscles as a result of a fright; or in a minor injury to the head which reflexively results in all the neck muscles going into spasm (for example, bringing your head up underneath a cupboard, hitting it hard and finding that the resultant reflex pulling of the head downwards by the neck muscles has sent all of them into spasm).

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Typically, the pain is in the front of the face, around one or both eyes, though as there are four different sets of sinuses, the site of pain coming from each is slightly different. Pressure ewer the affected sinus causes an instant increase in pain; and the pain also worsens when the head is bent down towards the knees (because the pressure of the blood pooling in the veins adds to the pressure inside the sinuses). Anything that increases the pressure or the amount of fluid in the sinuses will increase the pain, so often sinus pain is worse on lying down. You may wake with a headache, which will go after being upright for a time as the blood-vessel congestion reduces slightly. However, pain from the frontal sinus can sometimes start an hour or two after getting up, and then get better in the afternoon.

What else could it be?

Pain centred around an eye could be migraine (but in migraine there are usually changes in the vision, together with vomiting). The pain of glaucoma settles round one eye, but the eye is usually inflamed and the vision will be blurred; pain radiating from the back of the neck in a tension headache or in cervical spondylosis can be sensed in one eye, but there won’t be a raised temperature, and the pain won’t increase much if you bend or lie down.

Toothache and sinus pain can often be very difficult to tell apart, particularly as some of the upper front teeth, especially the upper canines (the ‘eye teeth’, slightly pointed ones just to the side of the front of the mouth) have their roots embedded in the bottom wall of the bone that forms one of the sinuses. A root abscess in a tooth here (that’s an abscess at the very end of the root of the tooth) can be excruciatingly painful and, just like sinusitis, can also give more pain if you put your head down. However, the offending tooth is often very tender when touched or banged, and the pain doesn’t normally increase when pressure is put on the hone overlying the sinuses (though pressure on the bone under the gum certainly Increases the pain).

In addition, a nasal-sounding voice, a history of nasal allergies, or pus dripping down the nose are usually pretty obvious indicators that the pain is sinus rather than dental. However, in difficult cases you may need to see both doctor and dentist – sinus and dental X-rays may be necessary before the diagnosis can be made with certainty.

Just occasionally sinus pain which doesn’t go away with treatment can indicate a 11 nicer of the sinuses, so if your pain doesn’t get better, be sure to check with your doctor – though in most cases, it will be simply because the bacteria responsible for the infection are resistant to the antibiotics that are being used.

finally, high blood pressure can give the same pattern of headaches – worse on rising – but there won’t be facial tenderness, and, obviously, your blood pressure will be high.

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Migraine in childhood behaves slightly differently from migraine in adults. As we have already seen it can sometimes occur as stomach pain – abdominal migraine.

However, many children get common or classical head migraines, sometimes alternating between the abdominal and head pain; and others get abdominal pain at the time that the aura would occur in an adult.

Even in children with normal migraine, there are differences between childhood and adult attacks. In children, attacks tend to be frequent and severe, though normally slightly shorter than in adults, and there can be long periods in between the bouts. Incomplete attacks are common. There may be many more generalised symptoms – nausea, vomiting, sweating, passing water frequently, or water retention.

In children there is an association between migraine and travel sickness and with dizziness. It is possible also that repeated attacks of unexplained vomiting (the so-called ‘periodic’ syndrome) actually are a form of migraine. It may develop into full migraine in later life.

Before puberty, migraine occurs more often in males, which is the reverse of the over-all picture, but after puberty the oestrogen levels of young girls rise. It is oestrogen which is the factor responsible for the preponderance of migraine in women. Basilar migraine is most common in adolescent girls, and ophthalmoplegic migraine in young boys.

The relationship between childhood and adult migraine isn’t certain; some lose their attacks only to get them back later. However, of those who have migraine in childhood, approximately half will have slopped having attacks by the age of thirty.

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