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Wednesday, November 23, 2011

High blood pressure (hypertension)

PhotoDisc - high blood pressure The heart is a pump designed to force blood through our body. Blood is pumped from the heart through the arteries out to our muscles and organs.
Pumps work by generating pressure. Put simply, too much pressure puts a strain on the arteries and on the heart itself. This can cause an artery to rupture or the heart to fail under the strain – in the worst case stopping altogether.
Blood pressure depends on a combination of two factors:
  • how forcefully the heart pumps blood around the body
  • how narrowed or relaxed your arteriesare.
Hypertension occurs when blood is forced through the arteries at an increased pressure.
Around 10 million people in the UK have high blood pressure – that's one in five of us.

What is normal blood pressure?

Blood pressure is measured using two numbers. An example of this could be 'the blood pressure is 120 over 80', which is written as '120/80mmHg'.
  • The first figure is the systolic blood pressure – the maximum pressure in the arteries when the heart contracts (beats) and pushes blood out into the body.
  • The second figure is the diastolic blood pressure. This is the minimum pressure in the arteries between beats when the heart relaxes to fill with blood.
Because the height of a mercury column is used in blood pressure gauges, standard blood pressure readings are always written as so many ‘millimetres of mercury’, which is abbreviated to ‘mmHg’.
The systolic pressure is always listed first, then the diastolic pressure. A typical normal blood pressure reading would be 120/80 mmHg.

What's classed as high?

There is a natural tendency for blood pressure to rise with age due to the reduced elasticity of the arterial system. Age is therefore one of the factors that needs to be taken into account in deciding whether a person's blood pressure is too high.
In general terms, people with a systolic blood pressure consistently above 140mmHg and/or a diastolic pressure over 85mmHg need treatment to lower their blood pressure.
People with slightly lower blood pressures (130 to140mmHg systolic or 80 to 85mmHg diastolic) may also need treatment if they have a high risk of developing cardiovascular disease, eg stroke or angina (chest pains).

What are the symptoms?

One of the big problems with high blood pressure is that it hardly ever causes symptoms.
This means it may go unnoticed until it causes one of its later complications, such as a stroke or heart attack.
Despite the popularity of such ideas, nosebleeds and ruddy complexions are hardly ever caused by high blood pressure.
Severe hypertension can cause symptoms such as:

What complications are caused by high blood pressure?

  • Atherosclerosis: narrowing of the arteries.
  • Stroke: haemorrhage or blood clot in the brain.
  • Aneurysm: dangerous expansion of the main artery either in the chest or the abdomen, which becomes weakened and may rupture.
  • Heart attack.
  • Heart failure: reduced pumping ability.
  • Kidney failure.
  • Eye damage.

What causes hypertension?

For more than 95 per cent of people with high blood pressure, the cause is unknown. This is called 'primary' or 'essential hypertension'.
In the remaining 5 per cent or so, there is an underlying cause. This is called 'secondary hypertension'.
Some of the main causes for secondary hypertension are:
  • chronic kidney diseases
  • diseases in the arteries supplying the kidneys
  • chronic alcohol abuse
  • hormonal disturbances
  • endocrine tumours.

What factors increase the risk of hypertension?

Anyone can suffer from high blood pressure, but certain factors can seriously aggravate hypertension and increase the risk of complications:

What can I do?

Every adult near or past middle age should ‘know their numbers’ – ie your height, weight, blood pressure and cholesterol levels.
You should also have regular blood pressure tests if there is a family tendency for hypertension. This way, treatment can be started before any complications arise.
Change your lifestyle:
  • stop smoking
  • lose weight
  • exercise regularly – as a minimum, 20 minute sessions, three times a week, sufficiently intense to induce some breathlessness
  • cut down on alcohol – aiming for less than 21 units a week for men, 14 units a week for women
  • eat a varied diet
  • avoid all salt in food
  • reduce stress by trying different relaxation techniques or by avoiding stressful situations.
These changes will lower blood pressure – to reduce your risk of developing the condition in the first place or to treat hypertension.
If your blood pressure requires medical treatment, you will probably have to take medicine on a regular basis.
If so, never stop taking it without consulting your GP, even if you feel fine. Hypertension can lead to serious complications if left untreated.

What can your doctor do?

  • Pinpoint risk factors and help you change your lifestyle to reduce blood pressure.
  • Offer medication for the reduction of blood pressure and arrange regular monitoring. Sometimes blood pressure control is not straightforward. Many people require more than one drug on a regular basis to get their blood pressure under good control.
  • Your GP may wish to seek the advice of an expert in hypertension if your blood pressure seems particularly difficult to control.

What are the treatment targets?

Diabetes considerably increases the risk of cardiovascular disease if hypertension is also present, so the targets for blood pressure control in diabetes are tighter.
For people who don't have diabetes, the treatment goals for blood pressure for are:
  • systolic pressure of less than 140mmHg
  • diastolic pressure of less than 85mmHg.
For people with diabetes, the goals are:
  • systolic pressure of less than 130mmHg
  • diastolic pressure of less than 80mmHg.

Which medicines are used to treat hypertension?

  • ACE inhibitors stop the production of a hormone called angiotensin II that makes the blood vessels narrow. As a result, the vessels expand, improving blood flow. Tension in the circulation is also lowered by the kidneys filtering more fluid from the blood vessels into urine. This also helps reduce blood pressure. If your blood pressure is not easily controlled on simple medication, your doctor will probably use a medicine of this type.
  • Angiotensin-II receptor antagonists work in a similar way to ACE inhibitors. But instead of stopping the production of angiotensin II, they block its action. This allows the blood vessels to expand, improving blood flow and reducing blood pressure.
  • Beta-blockers block the effect of the hormone adrenaline and the sympathetic nervous system on the body. This relaxes the heart so that it beats more slowly, lowering the blood pressure.
  • Alpha-blockers cause the blood vessels to relax and widen. Combining them with beta-blockers has a greater effect on the resistance in the circulation.
  • Calcium-channel blockers reduce muscle tension in the arteries, expanding them and creating more room for the blood flow. In addition, they slightly relax the heart muscle so it beats more slowly, reducing blood pressure.
  • Diuretics help the body get rid of excess salt and fluids via the kidneys. In certain cases, they relax blood vessels, reducing the strain on your circulation.
The following medicines are used less frequently.
  • Indapamide (eg Natrilix) is a mildly diuretic preparation that also relaxes the peripheral arteries.
  • Hydralazine (eg Apresoline) relaxes the vascular walls in the peripheral arteries thereby reducing the blood pressure.
  • Methyldopa (eg Aldomet) stimulates the alpha receptors in the brain that relax the blood vessels, causing the blood pressure to drop.
  • Moxonidine (eg Physiotens) is another medicine that acts on receptors in the involuntary part of the brain, causing blood pressure to decrease.
  • Minoxidil (Loniten) relaxes the small arteries so that blood pressure drops. It must be used in combination with other hypertension medicines.

Cholesterol

An important factor in determining the danger of high blood pressure is your cholesterol – a high cholesterol increases the sensitivity of the arteries to high blood pressure and makes them more likely to be damaged.
This means that when treating blood pressure, it's crucial to know what the cholesterol is – and if it is raised, to bring it down.
While diet, exercise, ideal weight and regular exercise are all important in reducing cholesterol, most people with high blood pressure and normal or high cholesterol also need a cholesterol lowering drug, such as a statin.

In the long term

By treating hypertension well, complications can be avoided and average life expectancy will remain almost normal.
Without treatment, life expectancy may well be reduced due to the risk of developing complications such as heart failure or stroke.
http://www.netdoctor.co.uk/diseases/facts/hypertension.htm
            

Sunday, November 20, 2011

Diabetes overview

What is diabetes?

PhotoDisc
Diabetes affects 2.3 million people in the UK.
Diabetes is a condition where the blood sugar level is higher than normal.
There are two main types of diabetes.
  • Type 1 diabetes or insulin-dependent diabetes. It is usually seen in young people.
  • Type 2 diabetes - usually non insulin-dependent diabetes. It tends to affect adults over 40 and overweight people.
There are also other types of diabetes.
  • Pregnancy diabetes. This is known as gestational diabetes. It's associated with pregnancy and symptoms usually disappear after the birth. If you get gestational diabetes, you have an increased risk of developing one of the main types of diabetes later in life.
  • Secondary diabetes. This is when diabetes is caused as the result of another condition, eg inflammation of the pancreas, or by the use of certain medication such as diuretics or steroids (the most common cause).

How common is diabetes?

There are currently 2.3 milion people with diabetes in the UK. However, it's estimated that more than half a million people have the condition but are unaware of it.
The last 30 years has seen a threefold increase in the number of cases of childhood diabetes. This is especially worrying in respect of the rising numbers of children and teenagers with type 2 diabetes, usually only seen in older people, and which reflects obesity levels in young people.
Obesity levels have also risen and this has led to Type 2 diabetes, which is linked to diet, being seen for the first time in young people in Europe and America.
But obesity doesn't explain the increase in the numbers of Type 1 diabetes in children, who make up the majority of new cases.

What causes diabetes?

 nsulin is a hormone produced by the pancreas gland in the abdomen. It controls the use of glucose within the body.
The blood sugar level will rise if:
  • the pancreas produces little or no insulin (Type 1 diabetes)
  • the pancreas produces insulin, but it's inadequate for the body’s needs and its effectiveness is reduced (Type 2 diabetes).
It's thought Type 2 diabetes is related to factors associated with a Western lifestyle, since it's most common in people who are overweight and who don't get enough exercise.
Gestational diabetes is brought about by the many hormone changes and demands placed upon the body during pregnancy.
Secondary diabetes is much like Type 2 diabetes. It's quite variable, depending on the underlying cause. It can be caused by damage to the pancreas (eg by alcohol), and drugs such as steroids and diuretics can impair insulin secretion from the pancreas.

Common symptoms of diabetes

Glucose is one of the body’s main fuels. If there isn't enough, blood sugar levels rise and glucose is secreted into urine. This causes:
  • increased thirst
  • frequent urination
  • tiredness
  • weight loss, although appetite often increases (especially in Type 1 diabetes)
  • itchiness, especially around the genitals
  • recurrent infections on the skin, eg boils.
People with Type 1 diabetes usually develop these symptoms within days or weeks.
In Type 2 diabetes, these symptoms often don't show for years. Many are diagnosed by chance through routine medical check-ups.
Heredity plays a part in diabetes, but only 10 per cent of people with Type 1 have a family history of diabetes. For Type 2, this rises to 30 per cent.

How is a diagnosis made?


Glucose levels are measured in blood samples. This is done using the following tests:
  • random glucose test: glucose levels are taken at a random time on two occasions. Any figure above 11.1mmol/l is a diagnosis of diabetes
  • fasting glucose test: the glucose level is measured after an overnight fast and on two different days. Above 7.0mmol/l is a diagnosis of diabetes.
You may only need to give one blood sample if you have other symptoms of diabetes.

Glucose tolerance test

If the diagnosis is still unclear from these tests, a glucose tolerance test can be carried out.
A glucose drink is given containing a standard amount of glucose (75g). Blood samples are taken before the drink is given and two hours later. The test is done after an overnight fast.
  • A two-hour blood glucose level above 11.1mmol/l is a diagnosis of diabetes.
  • A level below 7.8mmol/l is normal.

If the level falls between these values, it suggests a decreased tolerance for glucose.
This is known as impaired glucose tolerance (IGT).
Impaired glucose tolerance is more than just a pre-diabetic state.
People who have IGT are at increased risk of developing some of the conditions associated with diabetes, such as heart disease.
Pregnant women with IGT have an increased risk of miscarriage and stillbirth

How is diabetes treated?

 Diabetes is treated in two ways: 

Insulin injections increase the amount of insulin in your body and bring down the blood sugar level. Insulin injections are used in Type 1 diabetes and in some cases of Type 2.
These can be given once a day as a long-acting insulin, or as shorter-acting injections given more frequently through the day, and can be used in combination with tablet treatment if necessary.
There are different types of oral medication for treating Type 2 diabetes:
  • some increase the amount of insulin secreted by the pancreas
  • some increase the action of insulin in the body
  • some delay the absorption of glucose from the digestive system
  • some suppress a hormone called glucagon, which is secreted by the pancreas and stops insulin from working.
Treatment for diabetes depends on the individual.
It starts the first time you give yourself an insulin injection or take a diabetes tablet, and continues through eating a well-balanced diet and starting an exercise programme.
To help you get the most out of treatment, consult your GP or hospital healthcare team, which should include a diabetes nurse specialist.

Blood sugar levels

Monitoring blood sugar levels is an important aspect of treatment, especially in Type 1 diabetes where levels can change markedly.
This can be done easily at home with a small blood glucose meter.
Depending on the reading, you may need to adjust your diet, the amount you exercise or your insulin intake.

Managing diabetes

In the long term, diabetes is monitored through routine check-ups by your doctor and/or annual check-ups at the hospital on an outpatient basis.
Their purpose is to determine if treatment is satisfactory and to look out for any evidence of longer-term complications such as eye or kidney disease.
Tests for these complications are usually done at the annual check-up, while routine check-ups may be carried out every three to six months.

Routine check-ups

  • Blood sample to check the level of HbA1c (a measure of long-term glucose) in the blood.
  • Evaluation of home glucose readings.
  • Discussion of diet.
  • Blood pressure.
  • Weight check.
  • Other tests and examinations as determined by your doctor.

Annual check-ups

  • Blood sample to check the amount of HbA1c in the blood.
  • Blood sample to determine the amount of fats in the blood.
  • Blood sample to check kidney function and various salts in the blood (mainly sodium and potassium).
  • Blood pressure.
  • Urine sample to determine the presence of protein (albuminuria). The appearance of protein can indicate that the small blood vessels (capillaries) in the kidneys are beginning to be affected by the diabetes.
  • Foot examination, including a check of various pulse points on the foot to assess circulation, and a check for vibration sensation to determine if there's any neuropathy (nerve damage) to the foot.
  • Weight check.
  • Measuring the waistline.
  • Discussion of exercise habits.
  • Discussion of smoking habits.

Long-term prospects

Both types of diabetes have the risk of complications.

Acute complications

  • Low glucose level, caused by treatment with insulin or oral hypoglycaemic drugs that increase insulin secretion from the pancreas.
  • Diabetic acidosis, a life-threatening condition caused by the lack of insulin.

Late-stage diabetic complications

Late-stage complications do not usually develop for 10 to 15 years with Type 1 diabetes.
In Type 2 diabetes, however, symptoms can appear close to the time of actual diagnosis because the disease may go undetected for longer.
Many studies now show that good glucose control can significantly reduce or even stop complications. This means keeping the blood sugar level as close to normal as possible.
Recent studies have also confirmed the need for people with diabetes to reduce their risk of atherosclerosis (fatty deposits in your arteries).
This is because if you have Type 2 diabetes, you have a four to five times greater risk of developing serious problems with your circulation that can lead to a heart attack or a stroke.
The main factors that increase your risk are:
  • smoking
  • high blood pressure
  • raised levels of fats such as cholesterol in the blood.
By taking measures to address these issues, you will reduce your chance of developing complications such as heart disease.

 http://www.netdoctor.co.uk/focus/heart/index.shtml

 
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