High blood pressure, or hypertension, is diagnosed by the doctor when, after repeated examination, the pressure is found to be above the average for healthy young people in the area in which the person lives. In the United States, levels are around 120 to 140 systolic and 80 to 90 diastolic. The pressure may reach 180 systolic and 100 diastolic without the appearance of any symptoms.
If the person suffers with acute hypertension, such symptoms as convulsions, loss of vision, severe headaches and kidney inflammations may be indications. In chronic high blood pressure dizziness, headaches, hemorrhages in the eye or the brain, heart failure and uremia may be present. Still, cases are known in which people with definitely high blood pressures on measurement have failed to manifest any of these symptoms.
Associated with high blood pressure the doctor may find disturbances of the function of the kidneys; disturbances of function of the adrenal glands; or in some instances, apparently no immediate cause except some psychologic problem. When a cause cannot be found the case is called “essential hypertension.” Often the first indication of the condition may be changes in the blood vessels at the back of the eye, which the doctor sees with an ophthalmoscope. Definite relationships have been established between the blood-flow through the kidneys and the pressure of high blood pressure. A high salt or sodium chloride intake may set up high blood pressure. The kidney condition is believed to indicate some substances are elaborated by the kidney which may establish high blood pressure. The pressure with high salt intake is associated with the functioning of the adrenal glands.
In an examination of the patient with high blood pressure study of the urine, which indicates the condition of the kidneys, is important. A low specific gravity-under 1020-and the presence of albumin or pus may show that the kidney condition is responsible. If the kidney function, as determined by a variety of tests, is normal, the doctor then sees if the adrenal activity is proper. A number of laboratory and functional tests are available which the doctor can use.
Wise physicians recommend that patients be reassured and do not disturb themselves about the pressure, in the absence of severe symptoms and in failure to find anything wrong about the blood vessels of the retina of the eye, the heart size and action and the kidney function. If the patient has vague symptoms and sound organs, suggests Dr.William Dock, search should be made for sources of anxiety and frustration. The facts ascertained by the doctor in his study determine the nature of the treatment that may be prescribed.
The suggestion has been made that the first steps are: reassurance of the patient, sedation with the appropriate drugs and restricted use of salt. Rigid elimination of salt from the diet is recommended when there is headache, dizziness, and heart failure. Several drugs are known which will lower blood pressure but all are difficult to use and may have unfavorable effects. The operation called “sympathectomy” is tried when the condition cannot be controlled, but always with a recognition that it may have after-effects with annoying symptoms and disability. The rice diet is a form of salt restriction which also reduces weight.
Weight reduction, adequate rest, suitable mental hygiene, are among the best measures that can be recommended in a majority of cases of high blood pressure.