Case Study : Primary Hypertension

NAME : Nurul Halilah bt Samsuddin MATRIC NO : MS1019552019 CLASS : 5h31a LECTURER S NAME : En Ahmad Rizal & Pn Norul Huda

INTRODUCTION

Hypertension is condition in which the pressure in the arteries is too high and exceed the normal blood pressure. It is also well known as high blood pressure. Normal blood pressure usually around 120/90 mmHg, where 120 mmHg refers to systolic blood pressure (the pressure in the arteries when the heart contracts and pumps blood out) where as 90 mmHg refers to diastolic blood pressure ( the pressure in the arteries when the heart relaxes and fills with blood). In general terms, people with a systolic blood pressure consistently above 160mmHg and/or a diastolic pressure over 100mmHg need treatment to lower their blood pressure. People with slightly lower blood pressures (140-159mmHg systolic or 9099mmHg diastolic) may also need treatment if they have a high risk of developing cardiovascular disease, eg stroke or angina (chest pains). There are three general types of high blood pressure. Essential hypertension occurs when the condition has no known cause. This is also known as primary hypertension or idiopathic hypertension. When high blood pressure is cause by another condition or disease process, it is called secondary high blood pressure or secondary hypertension. When only the systolic blood pressure number is high it is called isolated systolic hypertension, which is common in older adults. Isolated systolic hypertension refers to elevated systolic pressure with normal diastolic pressure and is common in the elderly. These classifications are made after averaging a patient's resting blood pressure readings taken on two or more office visits. Individuals older than 50 years are classified as having hypertension if their blood pressure is consistently at least 140 mmHg systolic or 90 mmHg diastolic. In this assignment, Ive only focus on primary hypertension only. Hypertension can caused many complication such as Atherosclerosis (narrowing of the arteries) , stroke (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 and eye damage. Hypertension is often called "the silent killer" because it generally has no symptoms until serious complications develop. When symptoms do occur, they can differ between individuals depending on such factors as the level of blood pressure, age, underlying cause, medical history, the presence of complications and general health.

Case Study :
Primary Hypertension

Background
Mrs Noraisyah (not her real name), 46 years old female, who was born on March 7, 1964 in Temerloh , Pahang . She is one of Malaysian who suffer primary hypertension. She, together with her 3 children currently live in Shah Alam, Selangor. She is presently working as teacher in one of the schools in Shah Alam. Shes now widow, after her ex-husband divorced her 3 years ago. This is one of the reason that lead for her to get hypertension. She is not a smoker and for sure, she didnt take alcohol. She is the eldest among her 6 siblings and has 2 unmarried sisters. This disease does not come from her family as none of them have hypertension. Mrs Noraisyah was diagnosed hypertension three years ago when blood pressure (BP) measured was noted to be consistently elevated in the range of 150/100 mmHg on three occasions. Physical exam reveals a height of 150 cm weight of 56 kg, blood pressure of 150/100. There is no clinical evidence of heart failure or peripheral vascular disease.

Factors
Mrs Noraisyah was only diagnosed to have essential / primary hypertension. Meaning, the specific cause of her hypertension is not known. It is likely that both genetic (inherited) and environmental factors, such as diet and life style, play a role. Mrs Noraisyah suffer hypertension just because of external factor, that is stress and unhealthy life style. She didnt affected by genetic inheritance as none of her family members has this disease. Stress is one of the factors that lead to hypertension. However, stress does not directly cause hypertension, but can have an effect on its development. Stress can cause hypertension through repeated blood pressure elevations as well as by stimulation of the nervous system to produce large amounts of hormones that increase blood pressure This patience has face this problem three years ago as the effect of job strain, social environment, and emotional distress. Her emotional was disturbed badly when her husband got affair with other women, leave her alone to grew up her children, with no money and debt (made by her husband) that she has to settle down. Starting from that, she lives with tension and stress all the time. She tends to mad when something is not right. Also, working as a teacher distributed to this problem. Working as a teacher in secondary school, is not easy as what we thought. All day, she has to put up with undisciplined and disrespectful student. With personal problem and environmental problem, she has to face the problem, and finally lead to hypertension. Besides, her life style may also lead to this problem. Busy with school and children that need more attentions, also with so many problem that have to be settle down, causing this patience having unhealthy life style. She didnt care about the amount of food she takes. More specifically, shes taking high salt diet . As we know, taking large amount of salt will causing kidneys retain more water inside body, resulting in increased blood pressure. Its came worst as she also didnt practice exercise regularly and eat healthily . Although most physicians do not believe that high salt intake alone causes hypertension, but they do believe it plays an important role. This condition became worst as she didnt practice regularly exercises and having healthy diet.

Symptom
Eventually, it is hard to detect the symptom of primary hypertension as it is remain unnoticed until it causes of its later complications such as a stroke or heart attack. But there are several symptom of hypertension such as headache and sleepiness. Mrs Noraisyah admit this fact. In fact, when she became stress, she will suffer headache and migraine, and sometimes she feel pain. Scientifically, when we are in stressful situation, body will produces a surge of hormones. These hormones increasing blood pressure by causing heart to beat faster and blood vessels become narrow. Thus increased blood pressure causes a process called autoregulation in the blood vessels that run through the tissue underneath the skull (where most headaches start). In other words, the autoregulation leads to constriction of these blood vessels, which is a very well known cause of headache symptoms.

Effect
Having this disease leave a huge effect on herself, especially in first year her ex-husband divorced her. According to Mrs Noraisyah, she has to face the problem alone, and its really hard. Every day, shes been thinking about her life without husband and at the end, because too stress and depress, shes got hypertension. She realized that, she always mad and easily angry although sometimes people around her do not do something badly. For instance, she easily mad towards her children whenever her ex-husband spoke to them. Also, she always got headache and felt unconscious. On the bright side, having this disease make her realized that shes been wasting her time thinking about someone who didnt care about herself. Finally, she decided to have back her normal life and love her new life. In society, when having this disease, people around her become more sensitive and protective toward her. She said, people around her, especially the closer one which is her children, tried to understand her and treat her with patience. They try not making her angry and stressing, as to control the hypertension from increase. They also become sensitive toward her problem and become the ear-listener to her problem. In school, her relationship with her student does not good as before as she becomes fierce and the students are scared of her. In the nutshell, having this disease leave the effect just not on herself but people around her.

Steps To Prevent
i) Lifestyle Modification Doctor advices Mrs Noraishah to have a healthy lifestyle, which mean she has to do exercise regularly and limit amount of sodium intake. Take 4 grams per day is adequate and helps her blood pressure to be under control. She cut in eating canned foods, salted nuts, chips and frozen foods which are rich in sodium and ensure her total sodium intake doesnt exceed 1.6 grams/day. Besides, she has to control and avoid stress as stress free life helps to relax all the muscles of body including heart which in turn reduces blood pressure. Shes been advised to share her problem with people around her. So far, she said, that is one of the step that shes taking in order to reduce her blood pressure. Mostly, she will shared and tell her problem with her first daughter and her best friends. She also has been advised to relax and control her feeling. Doing exercise actually helping her to relax and reduce the blood pressure. Besides, shes now practice an exercise every weekend with her children and try to control her emotion by always think the positive things. She also said, everything she do now is to make sure shes healthy and of course, to control her blood pressure. Also, she has to ensure shes check the blood pressure regularly. It is important to make sure her blood pressure under control and to avoid the chronic cardiovascular diseases such as Atherosclerosis.

ii) Medicine Mrs Noraishah was provided with several types of medicine, in order to ensure her blood pressure is under control. One of it is methyldopa. Methyldopa is a medicine used to treat hypertension. It works by relaxing the blood vessels so that blood can flow more easily through the body. Methyldopa controls high blood pressure but does not cure it. Methyldopa comes as a tablet and liquid to take by mouth. It usually is taken two to four times a day. Methyldopa can also be replaced by propanolol or labetalol. Both of it contain betablocker act on that part of the central nervous system that controls mental alertness, lung function, heart rate, and blood vessels. Propranolol is available in 10- to 90-mg tablets.

Conclusion
The goal of this study is to analysed and study about the cardiovascular diseases, which is one of it is hypertension. Through the observation, reading and interview, I finally knew about hypertension, more detail. Generally, when talking about hypertension, people will think about the excessively stress and tension, which actually hypertension is more than that. Hypertension is a disease that that involved in blood pressure and arteries. There are several types of hypertension actually, which is primary hypertension, secondary hypertension and Isolated systolic hypertension. But in this assignment, I only focus on primary hypertension. Basically, 90-95% of patients diagnosed to have primary hypertension. A person will be diagnosed to have primary hypertension when the specific cause of the hypertension is not known. The factors that may lead to this disease include family history, environment (family size, crowding, eating patterns, occupation, obesity), salt ingestion and sensitivity (there is controversy over whether the sodium or chloride part of the salt molecule is the principal factor), race (blacks have more primary hypertension and more morbidity and mortality than whites), smoking, and diet. There are several ways to prevent the development of this disease such as practice healthy diet, stress management and take a medicine, as what Mrs Noraishah ( the patience that has been interviewed) done in order to control her blood pressure. So, as a conclusion, I finally realized the danger of hypertension toward people and how to avoid it. I also knew about hypertension specifically, the types and factor that may lead to this silent killer disease. Thus, it really important for us to take seriously about our life style, diet and environment, to ensure we didnt get hypertension.

References
i) Books
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Eldra P. Solomon , Linda R.Berg , Diana W. Martin , 2006 , Biology Seventh Edition, Thomson Books Cole Page 821-824 Lee Ching , J. Arunasalam 2007 , Biology Matriculation Study Guide Semester 1 , Pearson Longman Page 182-183

ii) Internet
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http://www.netdoctor.co.uk/diseases/facts/hypertension.htm http://www.myhealth.gov.my/myhealth/bm/dewasa_content.jsp?l http://www.patienthealthinternational.com/hypertension/

iii) Interview
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Pn Noraisyah bt Abdullah Pn Noralia bt Abdullah

Appendix

Figure 1 : Propanolol

Figure 2 : Labetalol

Chart 1: Prevalence of hypertension per Region in 2004