YÜKSEK TANSİYONUN BÜTÜNSEL TIPTA TEDAVİSİNE GENEL YAKLAŞIM

SAMPLE PATIENT : MALE OF 50 YEARS OLD

1. Condition/Assessment of the patient:

Blood pressure: systolic 180, diastolic 120.  The disorder has to be suspected as secondary hypertension.

Check for the symptoms of urgent or emergency hypertension to seek immediate medical attention which may include hospitalization for treatment with oral or intravenous (IV) medications.

Physical check: Forgetting to take the blood pressure medication, stroke, heart attack, heart failure, kidney failure, and rupture of the body’s main artery (aorta), interaction between medications, severe chest pain, severe headache accompanied by confusion and blurred vision, nausea and vomiting, severe anxiety, shortness of breath, seizures, unresponsiveness.

Check again if there is an urgent situation to call a doctor.

The patient has to be  also evaluated for:

1. Resistant hypertension: High blood pressure that doesn’t respond to blood pressure medications.  Sudden-onset high blood pressure. No family history of high blood pressure, no obesity.
2. Diabetes complications (diabetic nephropathy). Diabetes can damage the kidneys’ filtering system, which can lead to high blood pressure.

• Polycystic kidney disease. In this inherited condition, cysts in the kidneys prevent the kidneys from working normally and can raise blood pressure.

1. Glomerular disease. The kidneys filter waste and sodium using microscopic-sized filters called glomeruli that can sometimes become swollen. If the swollen glomeruli can’t work normally, high blood pressure may develop.
2. Renovascular hypertension. This is a type of secondary hypertension caused by narrowing (stenosis) of one or both arteries leading to the kidneys. Renovascular hypertension can cause severe hypertension and irreversible kidney damage. It’s often caused by the same type of fatty plaques that can damage the coronary arteries (atherosclerosis) or a separate condition in which the muscle and fibrous tissues of the renal artery wall thicken and harden into rings (fibromuscular dysplasia).
3. Cushing syndrome. In this condition, corticosteroid medications themselves may cause secondary hypertension, or hypertension may be caused by a pituitary tumor or other factors that cause the adrenal glands to produce too much of the hormone cortisol. This raises blood pressure.

• Aldosteronism. In this condition, a tumor in the adrenal gland, increased growth of normal cells in the adrenal gland or other factors cause the adrenal glands to release an excessive amount of the hormone aldosterone. This makes the kidneys retain salt and water and lose too much potassium, which raises blood pressure.
• Pheochromocytoma. This rare tumor, usually found in an adrenal gland, increases production of the hormones adrenaline and noradrenaline, which can lead to long-term high blood pressure or short-term spikes in blood pressure.

1. Thyroid problems. When the thyroid gland doesn’t produce enough thyroid hormone (hypothyroidism) or produces too much thyroid hormone (hyperthyroidism), high blood pressure can result.
2. Hyperparathyroidism. The parathyroid glands regulate levels of calcium and phosphorus in the body. If the glands secrete too much parathyroid hormone, the amount of calcium in the blood rises which triggers a rise in blood pressure.
3. Coarctation of the aorta. Born with this defect, the aorta is narrowed (coarctation). This forces the heart to pump harder to get blood through the aorta and to the rest of the body. This, in turn, raises blood pressure, particularly in the arms.

• Sleep apnea. In this condition, often marked by severe snoring, breathing repeatedly stops and starts during sleep, causing not to get enough oxygen. Not getting enough oxygen may damage the lining of the blood vessel walls, which may make the blood vessels less effective in regulating the blood pressure. In addition, sleep apnea causes part of the nervous system to be overactive and release certain chemicals that increase blood pressure.
• Obesity. As one gains weight, the amount of blood circulating through the body increases. This puts added pressure on the artery walls, increasing the blood pressure. Excess weight often is associated with an increase in heart rate and a reduction in the capacity of the blood vessels to transport blood. In addition, fat deposits can release chemicals that raise blood pressure.
• Medications and supplements. Various prescription medications, such as pain relievers, antidepressants and drugs used after organ transplants, can cause or aggravate high blood pressure. Decongestants and certain herbal supplements, including ginseng, licorice and ephedra, may have the same effect. Many illegal drugs, such as cocaine and methamphetamine, also increase blood pressure.

1. Anxiety. It doesn’t cause long-term high blood pressure but episodes of anxiety can cause dramatic, temporary spikes in the blood pressure. If those temporary episodes occur frequently, such as every day, they can cause damage to the blood vessels, heart and kidneys, as can chronic high blood pressure.

• Some medications to treat anxiety, such as selective serotonin reuptake inhibitors (SSRIs), also can increase the blood pressure.
• Asthma. Beta blockers generally aren’t prescribed for people with hypertension and asthma, as they can increase muscle spasms in the lungs.
• Therapeutics/Results:

Considerations for Recommendations:

1. Lifestyle changes such as eating healthy foods, increasing physical activity and maintaining a healthy weight.
2. possible drug choices discussed include:
3. Thiazide diuretics. Diuretics, sometimes called water pills, are medications that act on the kidneys to help the body eliminate sodium and water, reducing blood volume. The patient has been informed about the possible side effects include an increased need to urinate and a higher risk of sexual dysfunction.
4. Beta blockers. These medications reduce the workload on the heart and open the blood vessels, causing the heart to beat slower and with less force. Possible side effects include fatigue, sleep problems, a slowed heart rate, and coldness in the hands and feet.

• Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. ACE inhibitors may be especially important in treating high blood pressure in people with coronary artery disease, heart failure or kidney failure. Angiotensin II receptor blockers. These medications help relax blood vessels by blocking the action, not the formation, of a natural chemical that narrows blood vessels.

1. Calcium channel blockers. These medications help relax the muscles of the blood vessels. Some slow the heart rate. Possible side effects include water retention, dizziness and constipation. Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication and putting at higher risk of side effects.
2. Direct renin inhibitors. Recent treatment for hypertension includes direct renin inhibitors, such as aliskiren. Aliskiren relaxes and widens the arteries by preventing the action of renin. Renin is the initial enzyme in a cascade of steps in the production of chemicals (angiotensin, aldosterone, others) important in cardiovascular health and disease. Using aliskiren in combination with ACE inhibitors or angiotensin II receptor blockers in people with diabetes can cause moderate to severe kidney problems.

Recommendations as sample medication:

1. A polypill that contains a combination of aspirin (300 mg/day), diuretics -lazol (1,25 mg/day) and Vitamin C (500 mg/ twice a day)
2. A special diet with garlic and onions, nuts and seeds or their oils for their essential fatty acid content. Flaxseed oil, green leafy vegetables for their rich source of calcium and magnesium. Whole grains and legumes for their fiber and foods rich in vitamin C as broccoli and citrus fruits instead of cholesterol-lowering medications (statins) and beta blockers and ACE inhibitors
3. Suggested Supplementation/Treatments:

Recommended:

1. Allium Cepa or Gelsemium or Ignatia, or Belladonna,
2. Ayurveda, yoga therapy, relaxation therapy,

• Hawthorn tea.

The patient has to be referred to have a specialist consultation for kidney, artery, heart or endocrine system problems.

The patient has  also  to be asked for:

1. A blood test. To check the potassium, sodium, total cholesterol and triglycerides.
2. Urinalysis. To check the urine for markers that could show the high blood pressure is caused by another medical condition.

• Ultrasound of the kidneys. Since many kidney conditions are linked to secondary hypertension, ultrasound of the kidneys and blood vessels has been recommended.

1. Electrocardiogram (ECG). The secondary hypertension may be caused by a heart problem.
2. Notes for further consideration:

The patient has to be informed that being late in the treatment, secondary hypertension can also be associated/complicated with other medical conditions, such as:

1. Damage to the arteries. This can result in hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
2. Aneurysm. Increased blood pressure can cause the blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.

• Heart failure. To pump blood against the higher pressure in the vessels, the heart muscle thickens. Eventually, the thickened muscle may have a hard time pumping enough blood to meet the body’s needs, which can lead to heart failure.

1. Weakened and narrowed blood vessels in the kidneys. This can prevent these organs from functioning normally.
2. Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
3. Metabolic syndrome. This syndrome is a cluster of disorders of the body’s metabolism including increased waist circumference, high triglycerides, low high-density lipoprotein (HDL) cholesterol, high blood pressure, and high insulin levels. The more components, the greater the risk of developing diabetes, heart disease or stroke.

• Trouble with memory or understanding. Uncontrolled high blood pressure also may affect the ability to think, remember and learn.