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February 2018 High blood pressure is a serious health problem. High blood pressure increases your risk of heart attacks, strokes, and kidney failure. Because high blood pressure can progress silently and without symptoms many people do not know they have high blood pressure until they have a heart attack or stroke. If high blood pressure is not detected and controlled, it can do damage to the heart, brain, and kidneys. Fortunately, with detection and proper treatment high blood pressure can be controlled. What is Blood Pressure Blood pressure is the pressure on the blood vessel walls. A blood pressure reading consists of two numbers, for example 120/80 or 120 over 80. The first number is called systolic pressure. The systolic pressure is the pressure on the blood vessels when your heart contracts, or pumps blood out. The second number is called diastolic pressure. The diastolic pressure is the pressure on the blood vessels when your heart is resting between contractions. Normal blood pressure is systolic less than 120 and diastolic less than 80. Elevated blood pressure is systolic 120 to 129 and diastolic less than 80. High blood pressure stage 1 is systolic 130 to 139 or diastolic 80 to 89. High blood pressure stage 2 is systolic 140 or greater or diastolic 90 or greater. You need to keep track of your blood pressure and have it checked regularly. High blood pressure means you have higher than normal pressure on the blood vessel walls. High blood pressure can occur when there is an increase in blood volume, when blood vessels are narrowed by atherosclerosis, or when blood vessels become rigid and do not expand with an increase in blood volume. High blood pressure causes the heart to work harder, and over time may damage the blood vessels. Damage to blood vessels in the heart may cause a heart attack; damage to blood vessels in the brain may cause a stroke. High blood pressure is not the same as stress, although stress may raise blood pressure temporarily. If you have high blood pressure it usually can be controlled with a combination of diet, lifestyle changes, and medication. Even children should have their blood pressure checked as part of their regular physical exams. High blood pressure in children may signal an underlying disease or the early onset of high blood pressure. Like high blood cholesterol, high blood pressure may develop early in life. Risk Factors for High Blood Pressure High blood pressure is a very complex condition. For most cases of high blood pressure, the exact cause is unknown. Only a small number of high blood pressure cases can be related to a known cause, such as kidney disease. However, there are factors that may affect your high blood pressure. Some of these factors include a family history of high blood pressure, being overweight, increasing age, physical inactivity, smoking, diabetes, high sodium intake (for sodium sensitive individuals), high alcohol intake, and a high saturated fat and trans fat intake. • Family history. High blood pressure tends to run in families. People may inherit a tendency for high blood pressure. People in the same family may also have similar lifestyle and dietary habits that increase their risk of developing high blood pressure. • Overweight. Being overweight increases your risk of high blood pressure. Where your body stores excess weight also makes a difference. People who carry excess weight around their abdomen have a greater risk of high blood pressure than those who carry excess weight in their hips and thighs. For some people bringing their weight down may be all they need to do to keep their blood pressure in control. • Age. Blood pressure tends to increase with age. Men typically begin having an increase in blood pressure by age 45 to 50. Women usually do not start having an increase in blood pressure until after menopause. The age at which menopause occurs varies, but the average age of onset is 50 years. However, just because you get older does not mean you will develop high blood pressure. • Physical activity. Participation in regular physical activities can lower your resting blood pressure. Regular physical activity can help you lose weight and thus lower the risk of high blood pressure and diabetes. In addition, regular physical activity can lower total blood cholesterol, LDL-cholesterol, and triglycerides, and increase HDL-cholesterol, all of which can lower the risk of atherosclerosis. As a result, regular physical activity may lower your risk of many diseases including high blood pressure, obesity, heart disease, and diabetes. • Smoking. Smoking increases your risk of high blood pressure. Smoking seems to raise blood pressure levels and heart rate. Smoking also lowers HDL-cholesterol. Smoking may increase the tendency of blood to clot and thus lead to a heart attack. In addition, smoking is a key factor in sudden death from cardiovascular disease. • Diabetes. High blood pressure is two to three times more common in people with diabetes, especially uncontrolled diabetes. Insulin resistance, most commonly associated with obesity, signals the pancreas to produce more insulin. High blood insulin signals the kidneys to retain sodium and thus may increase the risk of developing high blood pressure. Lowering your risk of developing high blood pressure is another reason to keep diabetes in control. • Sodium intake. Your kidneys regulate the sodium level in your body. Most people are not affected by excess dietary sodium because their bodies just get rid of excess sodium in the urine. However, some people are sodium-sensitive. For sodium-sensitive individuals, too much sodium in the diet can increase blood pressure. For someone who is sodium-sensitive, lowering sodium intake may help lower blood pressure. Unfortunately, there is no way to know who may be a sodium-sensitive individual. As a result, the Dietary Guidelines recommend people reduce daily sodium intake to less than 2,300 mg. This advice of moderation is given to all healthy people because there is no way to know if someone is sodium-sensitive. In addition, people do not need extra sodium. Processed foods have the most sodium, while unprocessed foods have the least. As much as 75 percent of the sodium in your diet comes from salt added to foods by manufacturers. About 15 percent comes from salt added during cooking and at the table, and only 10 percent comes from the natural content in foods. • Alcohol intake. Heavy drinking may increase the risk for high blood pressure. Health experts advise not more than one alcoholic drink a day for women, and not more than two a day for men. Alcohol also contributes extra calories, which may increase body weight. • High fat, saturated fat and trans fat intake. A high fat, high saturated fat and trans fat intake has been linked to high blood cholesterol, LDL-cholesterol, and triglycerides. High blood cholesterol, especially high LDL-cholesterol, and high triglycerides contribute to both atherosclerosis and high blood pressure. Atherosclerosis narrows the blood vessels and thus decreases blood flow to the kidneys. The kidneys try to increase blood pressure by expanding blood volume and constricting smaller blood vessels. However, the pressure increases not only in the kidneys, but also all over the body. The resulting increase in blood pressure can further damage blood vessel walls and intensify atherosclerosis. A diet low in total fat, saturated fat and trans fat helps lower blood cholesterol and triglycerides, which may decrease your risk of developing atherosclerosis. Reducing fat intake can also help with weight loss, which may lower blood pressure. The Dietary Guidelines recommendations for fat intake are: • Consume less than 10 percent of calories from saturated fatty acids and keep trans fatty acid consumption as low as possible. • Keep total fat intake between 20 percent to 35 percent of calories, with most fats coming from sources of polyunsatruated and monunsaturated fatty acids, such as fish, nuts, and vegetable oils. • Intake of other nutrients. Too little of some other nutrients including potassium, calcium, and magnesium, may have an important link to high blood pressure. Adequate intakes of these minerals may actually have a protective effect against high blood pressure. Potassium is found in a wide variety of foods, but especially fruits and vegetables. Milk and dairy products are a good source of all three nutrients, calcium, magnesium, and potassium. The best recommendation is to consume the recommended amounts of food from the USDA MyPlate food groups. Recommended amounts from each USDA MyPlate food group each day for a reference 2,000 calorie diet are: • 6 oz. of grains • 2 1/2 cups of vegetables • 2 cups of fruit • 3 cups of dairy • 5 1/2 oz. of protein foods • 6 teaspoons of oil • Emotional stress. For some people, stress may be a factor for high blood pressure. Although the evidence is not clear, learn how to relieve stress for the overall quality of your life. Lowering Your Risk of High Blood Pressure You can take some preventive measures to lower your risk of developing high blood pressure. Some things you can do to lower your risk are to maintain a healthy weight, be physically active, and if you smoke, quit. Some other recommendations are to use sodium and alcohol in moderation and to eat following the USDA MyPlate Daily Checklist to make sure you get enough calcium, potassium, and magnesium. References Whitney, E.N. & Rolfes, S.R. (2015). Understanding Nutrition, 14th ed., Wadsworth, Cengage Learning, Belmont, CA. United States Department of Agriculture. Dietary Guidelines for Americans 2015-2020. Accessed at https://health.gov/dietaryguidelines/2015/guidelines/ United States Department of Agriculture. ChooseMyPlate.gov. Accessed at: www.choosemyplate.gov Janice R. Hermann, Ph.D., RD/LD Nutrition Specialist
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डा. कमल शर्मा लम्साल फिजिसियन तथा मुटुरोग विशेषज्ञ, सिभिल अस्पताल शरीरका सम्पूर्ण अंगमा रक्तसञ्चार गर्नका लागि मुटुले निरन्तर पम्पको काम गरिरहेको हुन्छ । मुटु खुम्चिँदा शरीरका विभिन्न अंगमा शुद्ध रगतको सञ्चार हुन्छ । मुटु फुक्दा शरीरका विभिन्न अंगबाट आएको अशुद्ध रगत मुटुमा जम्मा हुन्छ । मुटुमा यसरी जम्मा हुन आएको रगत अर्कोपटक मुटु खुम्चिँदा रक्तनलीहरुमार्फत अगाडि बढ्छ । चिकित्सकीय भाषामा मुटु खुम्चिने प्रक्रियालाई सिस्टोल र फुक्ने प्रक्रियालाई डायस्टोल भनिन्छ । समग्रमा मुटुमा हुने सिस्टोलिक र डायस्टोलको निरन्तर प्रक्रियाले समस्त शरीरमा रक्तप्रवाह गराइरहन्छ । रक्तनलीमार्फत रक्तसञ्चार हुँदा उत्पन्न हुने विशेष किसिमको दबाबलाई नै रक्तचाप भनिन्छ । मुटु खुम्चिएको समयमा मुटुबाट वेगसाथ निस्केको रगतले रक्तनलीमा दिएको चापलाई सिस्टोलिक रक्तचाप भनिन्छ भने मुटु एकैचोटी धड्किसकेपछि फुकेको अवस्थाको चापलाई डायस्टोलिक रक्तचाप भनिन्छ । साधारणतया स्वस्थ व्यक्तिको रक्तचाप औसतमा १२०÷८० मिमि हुन्छ । माथिको अंकलाई सिस्टोलिक रक्तचाप तथा तलको अंकलाई डायस्टोलिक रक्तचाप भनिन्छ । सामान्यतया सिस्टोलिक वा माथिको प्रेसर १२० मि.मि. र डायल्टोलिक वा तलको ८० मि.मि. सम्म हुनु सबैभन्दा राम्रो हो । उच्च रक्तचाप साइलेन्ट किलर उच्च रक्तचापलाई मेडिकल भाषामा हाइपरटेन्सन भनिन्छ । जसको शाब्दिक अर्थ मुटु तथा रक्तनलीहरुमा दबाब बढ्नु हो । विश्वस्वास्थ्य संगठनले उच्च रक्तचापलाई सुषुप्त हत्यारा अर्थात् साइलेन्ट किलरको संज्ञा दिएको छ । उच्च रक्तचापले तत्कालै कुनै ठूलै असर पार्ने सम्भावना कम भए पनि लामो समयको अन्तरालपछि मानिसलाई बिस्तारै रोगी बनाउँदै मृत्युशै्यामा पु¥याइरहेको हुन्छ । उमेर बढ्दै जाँदा उच्च रक्तचापको खतरा पनि क्रमिक रुपले बढ्दै जान्छ । उच्च रक्तचाप महिला पुरुष दुवैमा हुन्छ । सामान्य भाषामा भन्दा माथिको प्रेसर १४० वा सोभन्दा बढी र तलको ९० वा सोभन्दा बढी हुनुलाई उच्च रक्तचाप भनिन्छ । उच्च रक्तचापका लक्षण सामान्यतया उच्च रक्तचापका बिरामीमा कुनै लक्षण नदेखिन पनि सक्छन् । कुनै व्यक्तिमा एक वा बढी लक्षण हुन्छन् भने कोहीमा केही पनि लक्षण नहुन सक्छ । कसैलाई अत्यधिक रक्तचाप तथा त्यसको जटिलताले बेहोस नै हुन सक्ने भएकाले लक्षणमा एकैनाशको निश्चितता हुँदैन । उच्च रक्तचापका मुख्य लक्षणमा विशेषगरी टाउकोको पछाडिको भागमा दुख्ने, वाकवाकी लाग्ने तथा बान्ता हुने हुन्छ । रिंगटा लागेर हुत्तिने, शरीरले हलुंगोपना महसुस गर्ने, आँखाको दृष्टिमा परिवर्तन भई धमिलो देख्ने लक्षण हुन्छ । कुनै काम नगरे पनि थकाइको महसुस हुने र कमजोरी अनुभव हुन्छ । श्वास लिन गाह्रो हुने, मुटुको ढुकढुकी अनियमित हुने,थोरै परिश्रम गर्दा पनि धेरै पसिना आउने उच्च रक्तचापको लक्षण हुन् । यौन चाहना कम हुने, नाथ्री फुटेर नाकबाट रगत आउने, खुट्टा तथा अनुहार सुन्निने, रातो हुने लगायतको उच्च रक्तचापका लक्षण हुन्छन् । रक्तचाप धेरै नै बढी भएपछि रक्तनलीहरु बढी तन्किएर फुट्न सक्छ । मस्तिष्कभित्रको रक्तनली फुटे पक्षघात हुन्छ । मुटुको रक्तनली बन्द भए हृदयाघात हुन्छ । आँखाको रक्तनली फुटे अन्धोपन तथा मिर्गौलाको रक्तनलीमा घात भएर मिर्गौलाले काम नगर्ने हुन्छ । कहिलेकाहीँ बढी प्रेसर भएको व्यक्ति बेहोस हुने, हातखुट्टा नचल्ने, पिसाब कम हुने तथा हृदयाघात भएको अवस्थामा अस्पतालको आकस्मिक कक्षमा पुग्ने अवस्था हुन्छ । त्यसैले उच्च रक्तचापका लक्षण पनि रक्तचापको तह तथा यसले विभिन्न अंगमा गरेको असरको आधारमा देखा पर्छन् । रक्तचाप बढी भैरहेका धेरै बिरामीमा केही पनि लक्षण नहुन सक्छ । लक्षण नदेखिँदा पनि रक्तचाप हुने भएकाले रक्तचाप छैन होला भन्ठानेर बिरामीले औषधी नखाँदा जोखिम हुन्छ । ढिला भैसकेपछि औषधि खाँदा ज्यानको समेत जोखिम हुन्छ । टिनेजरमा रक्तचाप टिनेजरमा पनि रक्तचापको समस्या हुन सक्छ । कम उमेरमा रक्तचाप परीक्षण गर्नका लागि विशेष किसिमको सानो मेसिनको प्रयोग गर्नुपर्छ । वयस्क व्यक्तिका लागि प्रयोग गरिने मेसिनले टिनेजरको रक्तचाप नाप्दा सहि मापन नहुन सक्छ । कम उमेरमा देखिने उच्च रक्तचाप परीक्षण गर्ने यन्त्र फरक किसिमको भए पनि नाप्ने तरिका भने उस्तै हुन्छ । को व्यक्तिका लागि कति रक्तचाप ठिक हो भन्ने कुरा बच्चा तथा टिनेजरको उमेर,उचाइ, लिंगअनुसारका विशेष किसिमका चार्ट हेरेर पत्ता लगाउन सकिन्छ । वयस्क व्यक्तिका लागि ठिक मानिने रक्तचाप टिनेजर तथा बच्चाका लागि बढी हुन सक्छ । रक्तचापको सही मापन गर्न २४ घण्टासम्म घरमै यन्त्र जडान गरी हेर्नुपर्ने हुन सक्छ । अस्पतालमा रक्तचाप परीक्षण गर्दा मनोवैज्ञानिक अवस्थाले उचित मापन फरक पर्न सक्छ । स्वाथ्यकर्मीको अगाडि कतिपय बालबालिका तथा टिनेजर तर्सिन सक्छन्, जसको असरले रक्तचाप सामान्यभन्दा केही बढी देखिन सक्छ । केही अनुसन्धानले अमेरिकी बालबालिका तथा टिनेजरमा ४ प्रतिशतमा उच्च रक्तचाप देखिएको छ भने नेपालमा सो उमेरमा हुने उच्च रक्तचापबारे अझैसम्म अध्ययन हुन सकेको छैन । विभिन्न हर्मोनसम्बन्धी रोगहरु तथा मिर्गौलासँग सम्बन्धित हुने विभिन्न प्रकारका रोगले रक्तचाप बढाउन सक्ने हुनाले बालबालिका तथा टिनेजरलाई यस्तो रोग छ कि छैन भनेर परीक्षण गर्नमा बढी केन्द्रित हुनुपर्छ । बालबालिका तथा टिनेजरको तौल बढी वा बुबा–आमामा उच्च रक्तचाप छ भने जेनेटिक कारणअनुसार कम उमेरमै उच्च रक्तचाप देखिने सम्भावना हुन्छ । कम उमेरदेखि नै मुटुलगायतका सबै अंगलाई बढी दबाब पर्ने हुनाले हृदयाघात, मस्तिष्कघात लगायतका जटिलता युवावस्थामै देखिन सक्छन् । भ्रम र उपचार कम उमेरमा रक्तचाप बढ्ने केही निश्चित कारण हुन सक्ने भएकाले आवश्यक परीक्षण गरी सम्बन्धित कारण पत्ता लगाएर उपचार गरेमा जीवनभर औषधि सेवन गर्नुपर्ने नहुन सक्छ । त्यस्तै मुटुसँगै जोडिएको मुख्य रगतको नली एर्वोटामा जालो बसेर पनि उच्च रक्तचाप हुन सक्छ । जसलाई खुर्केर फाल्ने वा स्टेन्ट राखेर उपचार गर्न सकिन्छ । रक्तचाप कम भयो भने पनि जोखिम हुन्छ । माथिको सिस्टोलिक रक्तचाप ९० भन्दा कम हुनु हुँदैन । ब्लड प्रेसर कम हुँदा किड्नी फेल हुनुका साथै मस्तिष्कमा हुने रक्तप्रवाह घट्छ । रक्तचाप कम हुनबाट बच्न प्रशस्त पानी पिउनु पर्छ । नुनको मात्रा मिलाएर खानु पर्छ । रक्सी सेवन गर्नु हुँदैन । रक्तचापलाई सन्तुलित राख्नु सन्तुलित भोजन गर्नुका साथै शारीरिक व्यायाम गर्नुपर्छ । प्रायः सबै प्रकारका रोगको अन्तिम अवस्थातिर रक्तचाप कम हुन सक्छ, यस्तो अवस्थामा मुख्य रोगको सघन तरिकाले उपचार गरेमा रक्तचाप सन्तुलनमा आउन मद्दत गर्छ । कतिपय टिनेजरले धूमपान तथा मद्यपान सेवनले गर्दा पनि रक्तचापको जोखिम हुन्छ । आहारविहारले पनि रक्तचाप सन्तुलनमा नआए चिकित्सकको सल्लाह लिन जरुरी हुन्छ । रक्तचापको औषधि खाँदा चिकित्सकको सल्लाहमा खानु पर्छ । ठिक भयो भनेर जथाभावी ह्वात्त औषधि छोड्दा ज्यानको जोखिम पनि हुन सक्ने भएकाले चिकित्सकको परामर्शविना औषधि छोड्नु हुँदैन । कतिपय औषधि एक्कासि छोड्दा रक्तचाप अति नै बढी भएर ज्यानको जोखिम हुन सक्छ । मिर्गाैला, थाइराइडलगायतका रोगका कारणले रक्तचाप बढेको छ भने सो कारणको उपचार भैसकेपछि उच्च रक्तचापको औषधि नचाहिन पनि सक्छ । उच्च रक्तचापको औषधिको सेवनले मिर्गौलालगायतको शरीरका अंगमा असर हुन्छ भन्ने कतिपयको भ्रम छ । औषधिले मिर्गौलालई खराबी गर्नु नभई बचाउँछ । तर चिकित्सकको सल्लाहमा खानु पर्छ । रक्तचाप बढ्यो भन्दैमा नुन पूरै रोक्ने नभई कम मात्रामा सेवन गर्नुपर्छ । नुन पूरै रोक्दा नकारात्मक असर हुन सक्छ । त्यसैले खानपानमा ध्यान दिनु पर्छ, जथाभावी खानपान गर्नु हुँदैन । बेला–बेलामा स्वास्थ्य जाँच गराउनु पर्छ । प्रस्तुति ः उपेन्द्र खड्का