HIGH BLOOD PRESSURE
What is high blood pressure?
High blood pressure (hypertension) occurs when blood pressure is high for a certain amount of time during the day. Blood pressure is expressed in millimeter of mercury (mmHg). Systolic blood pressure (systole) is determined at 120 mmHg, diastolic blood pressure (diastole) is determined at 80 mmHg. Generally, 120-129/80-84 mmHg is considered normal, 130-139/85-89 mmHg is considered high, and 140/90 mmHg is considered as hypertension.
How prevalent is it?
In Turkey, one person in three suffers from high blood pressure. It is more prevalent in women than in men. A significant part (53%) of hypertensives are in their middle ages, a period considered to be productive economically. The prevalence of hypertension (12%) seen in people under 30 years old is at a non-negligible level in Turkey. The prevalence of hypertension at 60 years and above goes as high as 60-80%. Although there is a high prevalence of high blood pressure, only 40% of patients are aware of it.
What are the causes?
The root cause of high blood pressure that is not associated with another known disease (essential hypertension) is not known in 90-95% of patients.
While in 5-10% of patients, high blood pressure is associated with another disease. A significant part of diseases that cause high blood pressure are kidney related.
Endocrine (hormonal) causes constitute another group. It is striking that an important part of these diseases are treatable.
What are the results of high blood pressure?
High blood pressure is an insidious disease. It can be seen at any age. It can occur without any symptoms. If not taken under control, high blood pressure may result in problems such as cardiac diseases, paralysis, embolism in neck-leg vessels, heart failure, renal failure and loss of sight.
Who are at risk?
People with a family history of high blood pressure, aged 40 and above, who are overweight, who smoke, who have diabetes, a family history of diabetes and who are pregnant are under risk of high blood pressure.
What should people with high blood pressure do?
The person should know what their healthy weight is and remain at that weight. Salt consumption should be limited, and consumption of fruits and vegetables should be increased. Consumption of saturated fats and specifically, total consumption of fats should be decreased, medications prescribed by the doctor should be taken regularly. Smoking and consumption of alcohol should be stopped. Regular activity and workout is recommended.
What is varicose and how does it occur?
The dilatation of veins just below the skin in our legs is called "varicose".
Veins in our legs are in charge of transmitting the venous blood to the lungs and the heart in a counter-gravity motion so that these organs can clean the blood. These veins have valves that facilitate upward circulation and that prevent downward blood accumulation. With the activation of leg muscles and the help of these valves, the blood advances in a single upwards direction. However, when these valves are damaged, the blood creates downward pressure due to gravity and varices occur on the superficial veins.
Damage in vein valves and increase in downward pressure (venous statis) result in varices of various sizes.
Although scientific journals have different classifications, there are roughly 3 types of varicose:
Large varices: These varices appear as pronounced bulges protruding from the skin and their diameter vary from 4 to 15 mm.
Medium varices: These varices appear as slight bulges protruding from the skin, they are greenish and have a diameter that varies between 2 to 4 mm
Capillary varices: These are non-protruding reddish-purple varices with a diameter varying between 1 to 2 mm.
Who presents with varicose?
While women are more at risk of this disease, the latter needs special care since it has also a genetic nature.
At what age does varicose start?
Varicose is not very frequent in children. The risk usually starts after 15 years of age and starts to increase with age.
Since it bears genetic predisposition, especially young people should check whether their parents suffer from the condition and receive treatment for it. When parents do have the disease, children become at risk due to heritability.
What about those who work long hours standing?
People who have to stand for long hours without moving much are among those at risk. These people are under continuous risk of vasodilatation because veins are under continuous pressure and this may cause damaging of the valves.
What about pregnant women / women who have given birth?
Although also seen in men, varicose is seen at least ten times more in women than men. Weight gain by the mother during pregnancy, her moving less and the pressure made by the baby may cause vasodilatation.
What is deep venous thrombosis?
Deep venous thrombosis (DVT) occurs when thrombus forms in the deeper veins of the legs. The thrombus is present in the deep veins that are hard to see from the exterior. The thrombus prevents blood circulation partially or totally and causes an accumulation of venous blood in the leg.
Why does it matter?
Although DVT is mostly painless, it is critical since the thrombus that has already formed may detach from its principal location and have very serious results if it occludes lung vessels. This phenomenon is called pulmonary embolism. Unless urgently treated, it may result in mortality.
Even though the thrombus may dissolve with time, it may still cause occlusion in the vessels and may damage the valves of the venous blood system since it does not totally dissolve most of the time. Once the thrombus has formed, the blood that needs to circulate back from the legs starts to pond inside the vessels.
In this case, venous insufficiency may develop and is characterized by swelling of the legs, pain, change in color and wounds in the ankles (venous ulcer) resulting from the high blood pressure in the veins damaging tissues.
Albeit rarely, the occluded vein may prevent the blood that has ponded in the leg from eliminating, resulting in the swelling of the leg, damaging venous circulation and therefore causing the development of gangrene of the leg.
Groups that are at risk of DVT
Risk of thrombosis increases following bone fractures, hip/knee prosthetics, major surgeries, cancer, pregnancy, previous deep vein thrombosis in the leg, long-term bedrests, advanced age, adiposity and the genetic lack of some auxiliary substances that prevent coagulation.
What are the symptoms?
Almost half of patients with DVT may not present with any severe symptoms. However, the most frequent symptom is pain in the leg, swelling and a changing of the color of the leg to purple or blueish when the patient is standing.
If the thrombus reaches the lungs, symptoms such as shortness of breath, chest pain, coughing and hemoptysis may develop.
How is it diagnosed?
The occurrence of the above-stated symptoms in a patient who presents the risk factors and the clinical findings should suggest DVT.
The easiest and most reliable method in the diagnosis of DVT is colored Doppler ultrasonography. With the latter, DVT diagnosis can be made easily, cheaply and accurately.
How is it treated?
The main objective of DVT treatment is the prevention of pulmonary embolism and the reoccurrence of DVT development. Other objectives of treatment are the relief of symptoms in the patient's leg and the prevention of future problems.
To that end, your doctor will determine for you the best treatment methods among blood thinners and varicose socks.
Recommendations for daily life with DVT
When DVT occurs, the movements and lives of patients become more difficult due to pain and swelling. Therefore, getting back to normal may take some time. Your doctor will advise you on the process of the disease. However, it would be beneficial to take the following into consideration:
- The patient should not be seated for a long time and should be able to move their legs when needed.
- Short walks on the hour are recommended while awake.
- Clothes that are too tight should not be worn.
- Varicose socks should be used as recommended by the doctor.
- Heavy movements that could cause injuries should be avoided.
Prevention of DVT
Having the potential to cause significant problems, DVT is a disease that is preventable in varied ways and with varied methods. Risk factors that could cause the development of DVT should be decreased. Administering low doses of anticoagulants following major surgeries and long-term hospitalizations, ensurring that patients recover and start to walk as soon as possible, wearing varicose socks prior and following surgery significantly decrease the risk of DVT development.
Additionally, moving the legs with intermittent exercises during long trips and consuming high amounts of water can also decrease the risk of DVT.
PAH
What is PAH (Pulmonary Arterial Hypertension)?
PAH is a progressive disease that includes a wide clinic spectrum called Pulmonary Hypertension that is monitored under the disease upper group and that may cause heart failure and death when left untreated. Early diagnosis and treatment of the disease are very important since the disease significantly hinders the patient's daily functions and mortality.
How prevalent is it?
Although data pertaining to the incidence of pulmonary hypertension on a global scale is lacking, the disease affects an average of approximately 50 people per million. As for pulmonary arterial hypertension monitored as a subclass, its incidence varies between 5-15 in a million. Among these, cases whose causes are unknown constitute the largest ratio. Although in the past diagnosis was made much later in these groups, today, the age of diagnosis has dropped to the middle of the 30s, especially for the group whose root cause is unknown. When all groups are taken into consideration, age of diagnosis is observed to be around 50-60.
What are diagnostic and treatment methods?
Even though the main methods for diagnosis are EKG, ECHO, pulmonary function tests and imaging methods (graphy, CT, MRI, etc.), a pressure measurement should be carried out by penetrating the affected arteries with cardiac catheterization to be able to make a pulmonary hypertension diagnosis, and some drug reaction tests should be conducted to select the high-tech and complex drug groups to be used during monitoring. If diagnosis can be made after these tests, before all else, the patient's functional class should be determined by also taking into account their effort capacity, and treatment should be started with one or more drug groups that have an existing effect via three pathways.
Advanced cases that are nonresponsive to treatment can present with severe results going as far as organ transplant.
