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Nocturnal hypertension refers to high blood pressure at night. Hypertension symptoms and causes of high blood pressure can help treat hypertension.

Nocturnal Hypertension

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Nocturnal Hypertension Explained

Ismail Munir

Know Your Blood Pressure Numbers

Introduction

Blood pressure refers to the force applied by the flowing blood against the walls of the body&#39;s arteries<a href="#accordion">[1]</a>.&nbsp;Not only does this force help supply organs with oxygen and nutrients but also white blood cells and antibodies for immunity, and hormones like insulin<a href="#accordion">[2]</a>. Moreover, along with transporting oxygen and nutrients, blood pressure also plays a role in removing harmful metabolic end products, including carbon dioxide and other toxins cleared from the liver and kidneys.&nbsp; 
&nbsp;

Understanding blood pressure readings

When blood pressure exceeds the normal range, it is called <a href="https://www.merisehat.pk/disease/hypertension-57">hypertension</a>. Blood pressure is composed of a pair of numbers. The first (systolic) number represents the blood vessels&#39; pressure when the heart contracts. The second (diastolic) number is associated with the pressure in the vessels when the heart rests in between the beats<a href="#accordion">[1]</a>.&nbsp;The combination of the two allows doctors and health professionals to gauge the overall well-being of an individual. 
&nbsp;

Mild and temporary fluctuations in blood pressure are normal and can be triggered due to a myriad of reasons. However, if an individual deviates from the normal range for a chronic period, then that may indicate a deeper and more complex medical condition, and should be further explored by a licensed practitioner. To analyze quantitively, blood pressure has been categorized into five categories<a href="#accordion">[3]</a>. 
&nbsp;

<h5>Normal Range</h5>

The first range of blood pressure is defined as the normal range and is expected from every healthy individual. Numbers under 120/80mmHg are viewed as normal<a href="#accordion">[4].</a>&nbsp;Activities that encourage and support the heart&rsquo;s rhythmic motions, such as a well-balanced healthy diet and physical activity can help maintain the blood pressure in the normal range<a href="#accordion">[4]</a>. 
&nbsp;

At birth, the blood pressure stays at 64/40mmHg and then rises to 120/80mmHg as one reaches adulthood<a href="#accordion">[3]</a>. Several factors, both natural and human-induced, can then cause the blood pressure to fluctuate. For example, checking the blood pressure after delivering a fervent speech or running a marathon will likely give a high reading. This is perfectly normal as the increased adrenaline levels cause the body to increase the blood pressure, and supply the heart with more oxygen for fight or flight events<a href="#accordion">[3]</a>.&nbsp;

&nbsp;

<h5>Elevated Levels</h5>

This is a warning stage to alarm patients and usher them into hypertension treatment before it is exacerbated. Elevated levels are denoted by persistent high blood pressure readings. A doctor is likely to investigate for differential diagnosis if the systolic blood pressure is in the range of 120-129mmHg and the diastolic is less than 80mmHg<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

Individuals who constantly have elevated levels of blood pressure are more vulnerable and at risk of developing various coronary diseases early in their life<a href="#accordion">[5]</a>. An aneurysm is an abnormal bulge in the blood vessel wall that can result from prolonged and unattended elevated levels of blood pressure. Elevated blood pressure levels also increase the risk of cardiovascular failure. Moreover, damage to the renal vessels can affect healthy kidney functioning. Since little veins in the eyes are particularly defenseless against harm, hypertension can also prompt vision issues and even visual impairment<a href="#accordion">[4]</a>.&nbsp; 
&nbsp;

<h5>Hypertension Stage I</h5>

If not addressed, then elevated levels can deteriorate to advanced stages of hypertension. Stage 1 is defined by consistently high blood pressure levels of systolic 130-139mmHg and diastolic 80-89mmHg<a href="#accordion">[3]</a>. At this phase of hypertension, specialists endorse and stress a reconsideration of routine activities and life changes. They may also prescribe blood pressure medications based on the individual&#39;s risk of developing an atherosclerotic cardiovascular disease (ASCVD), such as a heart attack or a stroke<a href="#accordion">[3]</a>.&nbsp;&nbsp; 
&nbsp;

<h5>Hypertension Stage II</h5>

If treatment for hypertension stage 1 does not prove to be successful, then the individual is likely to progress to hypertension stage 2. Hypertension stage 2 is defined as blood pressure readings of 140/90mmHg or higher<a href="#accordion">[3]</a>. At this stage, specialists will probably recommend lifestyle changes and alternatives to the previously prescribed blood pressure prescriptions While treating a patient with stage 2 hypertension, the clinician should decide on the proper blood pressure (BP) objective, select the underlying anti-hypertensive routine, and change that routine, as required, to accomplish the objective BP. Likewise, the clinician ought to think about the effect of the treatment routine on both the patient&#39;s consistency with treatment and long-term risk for cardiovascular disease (CVD)<a href="#accordion">[6]</a>.&nbsp;

&nbsp;

If an individual has a history of high blood pressure, then they may be more likely to develop a hypertensive crisis. This phase of hypertension necessitates immediate and proper medical assistance. Therefore, it is important not to delay treatment. If during a routine blood pressure check, the readings out of nowhere surpass 180/120mmHg, try not to panic. Take a deep breath, wait for five minutes, and afterwards test the blood pressure once more. However, if the readings are bizarrely high twice in a row, immediately contact a hospital or a doctor<a href="#accordion">[3]</a>. Such high levels could indicate that the person is going through a hypertensive crisis.&nbsp; 
&nbsp;

Moreover, with the blood pressure reading being higher than 180/120mmHg the individual might witness other alarming and distressing symptoms. These suggest signs of conceivable organ harm<a href="#accordion">[7]</a>. They may range from chest pain to difficulty in breathing, body numbness and pain (especially in the back), visible change in vision, and communication problems. If these accompany the blood pressure readings, then an individual should not hesitate or wait for the shortness of breath to pass away, and immediately call for medical help<a href="#accordion">[7]</a>.

&nbsp;

<h4>"Stay on top of your blood pressure reading with our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a>!"</h4>

To maintain the blood pressure (BP) goal according to the individual&rsquo;s age, health, and stage, the patient must regularly monitor their readings for comparison and to confirm if the advised treatment is leading to any progress or not. Realistically, it is neither economical nor feasible to expect an individual to travel great lengths, and pay hefty consultation fees for a quotidian blood pressure reading. Therefore, a doctor may suggest investing in a home blood pressure monitor. 
&nbsp;

A home blood pressure apparatus is a more accessible and economical alternative than rushing to the hospital each day. Moreover, a patient does not require a doctor&#39;s prescription to purchase one. Thus, increasing its prevalence in every home. However, it should be stated that home blood pressure observation is not a substitute for visits to the primary care physician for more serious concerns and complications that might arise due to hypertension. Additionally, home blood pressure apparatuses might have a few shortcomings of their own<a href="#accordion">[7].</a> However, these can be avoided if the individual makes an informed purchase.&nbsp; 
&nbsp;

Don&#39;t hesitate to venture onto the world wide web and gather all necessary specifications before buying a home blood pressure monitor. You can even bother a doctor for suggestions for a reliable and approved gadget. Make sure to be diligent with the yearly check-ups of the apparatus. For the inauguration, bring it to the doctor&#39;s office and request a doctor or nursing staff to teach you the proper method of checking blood pressure at home. This will help guarantee correct readings<a href="#accordion">[7]</a>.&nbsp;

&nbsp;

Conclusion

Hypertension is a gateway to permanent damage and life-long complications. Therefore, it is important to understand the different stages of high blood pressure and the method to monitor it. The predominance of hypertension with increasing age is a result of the gradual rise in systolic blood pressure. 
&nbsp;

Systolic hypertension is the most common type of hypertension in people older than 50 years and reflects the pathologic decline in the blood vessel and arterial compliance<a href="#accordion">[6]</a>. The increase in systolic blood pressure is a more significant risk factor for cardiovascular disease than diastolic blood pressure rise. However, both should be regulated through prescribed treatments and lifestyle changes.

&nbsp;

Key Points

While hypertension covers a range of sub-topics, it is important to remember that: 
&nbsp;

<ul>
	<li>Hypertension results from the normal blood pressure rising consistently. Blood pressure is measured through a pair of readings: systolic and diastolic.</li>
	<li>Systolic blood pressure results from the heart contracting, while diastolic pressure develops when the heart relaxes.</li>
	<li>The normal range of blood pressure is less than 120mmHg for systolic, and less than 80mmHg for diastolic.</li>
	<li>Elevated levels are defined as a systolic reading of 120-129mmHg and diastolic pressures of less than 80mmHg.</li>
	<li>Hypertension Stage 1 has blood pressure readings of 130-139mmHg and 80-89mmHg for systolic and diastolic respectively.&nbsp;</li>
	<li>Hypertension Stage 2 has blood pressure readings of 140mmHg or higher for systolic and 90mmHg or higher for diastolic.&nbsp;</li>
	<li>During a hypertensive crisis, systolic readings soar above 180mmHg while diastolic readings are higher than 120mmHg. This requires immediate medical attention.</li>
</ul>

&nbsp;

[1].World Health Organization (WHO). (2021, August 25). Hypertension. Retrieved from World Health Organization (WHO)

[2].Weatherspoon, D. (2022, March 20). What is a normal blood pressure reading? Retrieved from Medical News Today:

[3].American Heart Association. (2022). Understanding Blood Pressure Readings. Retrieved from American Heart Association:

[4].Jaret, P. (2021, September 17). High Blood Pressure. Retrieved from WebMD:

[5].Chobani, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., IzzoJr, J. L., . . . Rocella, E. J. (2003). Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension, Vol. 42, No. 6, 1206-1252

[6].Giles, T. D., & Materson, B. J. (2005). Treating stage 2 hypertension. Journal of clinical hypertension (Greenwich, Conn.), 7(8), 464–470.

[7].Mayo Clinic. (2021, July 1). High blood pressure (hypertension). Retrieved from Mayo Clinic:

Zarlish Kazmi

A. JABBAR DENTAL CLINIC

Sadia Khan

Nocturnal Back Pain In Children – What You Should Know

The condition affects around 30% of the population, usually girls more than boys, but is not considered a serious problem.<a href="#accordion">[4]</a> This is probably because the pain tends to subside on its own in the majority of cases, and very few individuals actually consult a doctor for pediatric back pain.

However, if the back pain has been going on for a long period and worsens with time, if disturbs your child&rsquo;s sleep at night, and if it causes them to have a stiff back in the morning, then it is a cause for concern. 
&nbsp;

Here&rsquo;s what you need to know about nocturnal back pain in children.

Understanding nocturnal back pain in children

A recent study established that there are associations between inflammation, nocturnal back pain, and fatigue in conditions such as ankylosing spondylitis.<a href="#accordion">[3]</a>

Juvenile ankylosing spondylitis manifests around 6-12 years of age, mostly affecting girls after puberty and boys before puberty. The pain especially disturbs sleep during the second half of the night.<a href="#accordion">[5] </a>Hence, the decrease in nocturnal back pain was shown to improve fatigue. 
&nbsp;

Research also shows it is more likely for children to inherit chronic back pain than acute back pain due to genes expressed in the central nervous system.<a href="#accordion">[2]</a> 
&nbsp;

<h5>Important!</h5>

Consult a doctor immediately if your child:

<ul>
	<li>Is 4 years old or younger</li>
	<li>Is unable to do anything due to stiffness or difficulty moving</li>
	<li>Has had back pain for more than 4 weeks</li>
	<li>Presents with unintentional weight loss, loss of appetite, and a general feeling of malaise</li>
	<li>Experiences numbness or weakness</li>
	<li>Experiences a growth spurt and develops a spine curvature 
	&nbsp;</li>
</ul>

It&rsquo;s important to thoroughly evaluate and proceed with appropriate imaging studies in children presenting to the emergency department with back pain.<a href="#accordion">[1]</a> This is important because subjecting children to scans, like MRI, CT, and X-rays, is not only unpleasant, but it also means exposure to a high dose of radiation. 
&nbsp;

Here&rsquo;s what you can look out for in children with back pain:

<ul>
	<li>A muscular strain particularly affects the lower back, sometimes going down the hips and back of the thigh, and worsens when the child stretches, bends, coughs, or sneezes.</li>
	<li>Common symptoms of a spinal fracture or malformation include back pain, which is aggravated by sitting, standing, bending, or twisting and alleviated by rest. It may be accompanied by tingling, numbness, weakness, difficulty walking, and bladder or bowel problems.</li>
	<li>A stress fracture or inflammatory arthritis may lack any physical signs.</li>
	<li>Degenerative spinal issues like kyphosis and scoliosis may present with a noticeable deformity of the spine.</li>
	<li>In rare instances, children who feel unwell for more than 2 weeks, experience weight loss, or are unable to sleep at night due to pain may be diagnosed with a tumor such as osteoid osteoma. The pain typically affects the middle or lower back. It is also constant and unrelated to activity.</li>
	<li>Another rare cause of back pain in children is infection of the disc or bone in the spine, which causes generalized pain and fever. 
	&nbsp;</li>
</ul>

Back pain at night in children is a multifaceted issue that requires a comprehensive understanding of its associations to ensure early intervention and management. Long-term back pain can affect their overall well-being, leading to disability and depression, for instance. Addressing this issue necessitates a holistic approach to prevent the child from developing any complications. 
&nbsp;

Key Takeaways

<ul>
	<li>One of the types of back pain in children is nighttime back pain.</li>
	<li>Frequent pain that awakens the individual child at night is related to infections or tumors, including aneurysmal bone cyst, discitis, Ewing&rsquo;s sarcoma, osteoblastoma, osteomyelitis, leukemia, osteoid osteoma, eosinophilic granuloma, and spinal cord tumors.</li>
	<li>Immediate medical attention is crucial for nighttime back pain in children.</li>
</ul>

[1] Bhatia, N., Chow, G., Timon, S., & Watts, H. (2008). Diagnostic modalities for the evaluation of pediatric back pain. Journal of Pediatric Orthopaedics, 28(2), 230-233.

[2] Bortsov, A., Parisien, M., Khoury, S., Zaykin, D., Martinsen, A., Lie, M., … & Diatchenko, L. (2020). Genome-wide analysis identifies significant contribution of brain-expressed genes in chronic, but not acute, back pain.

[3] Hammoudeh, M., Zack, D., Li, W., Stewart, V., & Koenig, A. (2013). Associations between inflammation, nocturnal back pain and fatigue in ankylosing spondylitis and improvements with etanercept therapy. Journal of International Medical Research, 41(4), 1150-1159.

[4] Hazell DT. Back pain in children: Causes, symptoms, and treatment. Patient.info.

[5] Georgie K. Philip M. Potential causes of back pain in children and teens. Spine

Staff Writer

Hypertension And Heart Attack

Your heart is responsible for pumping blood around your body. The pressure with which your blood pushes against the walls of the blood vessels continually changes. When your heart is relaxed, this pressure will be low. When your heart is squeezing the blood into arteries, this pressure will increase.

Your blood pressure reading is a measurement of the highest (systolic) and lowest (diastolic) recorded pressure. Normal blood pressure is less than 120/80 mmHg<a href="#accordion">[1]</a>. 
&nbsp;

High blood pressure or hypertension occurs when:

<ul>
	<li>Either the first number (systolic pressure) is above 140 mmHg</li>
	<li>Or the second number (diastolic pressure) is above 90 mmHg</li>
	<li>Or both 
	&nbsp;</li>
</ul>

Your blood pressure may vary at different times of the day depending on your activity and general health. Generally, high blood pressure is diagnosed if your readings on two separate days are higher than 140/90 mmHg.

It&rsquo;s important to monitor your blood pressure on a regular basis as high blood pressure can affect your blood flow to the organs. The higher the pressure, the greater the risk of complications. Often, it continues to damage the body quietly, without any symptoms. 
&nbsp;

Note: This limit (140/90 mmHg or higher) is based on 2003 guidelines. Some doctors diagnose high blood pressure when a patient consistently presents a reading of 130/80 mmHg or higher, as per the 2017 Guideline For The Prevention, Detection, Evaluation, And Management Of High Blood Pressure In Adults by the American College of Cardiology/American Heart Association<a href="#accordion">[1]</a>. 
&nbsp;

Understanding Hypertension and its risks

A heart attack occurs when the blood supply to your heart is blocked. The lack of oxygen causes the heart muscle to die. The longer the blood flow is blocked, the more damage it causes to your heart.

And where does hypertension fit in the picture? 
&nbsp;

A heart attack is basically a medical emergency due to high blood pressure. If your blood pressure is consistently high, you&rsquo;re at a higher risk of developing cardiovascular problems than those who don&rsquo;t.

<ul>
	<li>Additional Strain: Hypertension forces your heart to work harder to pump blood throughout your body. It weakens the heart muscle, contributing to the development of multiple heart-related conditions, including heart attack. 
	&nbsp;</li>
	<li>Atherosclerosis: Hypertension also causes the thickening of the walls of your blood vessels. The damage makes them more susceptible to blockages. A buildup of plaque (composed of cholesterol, fat, and other substances) in the artery causes the hardening or thickening of the arteries. This puts you at a higher risk of developing conditions like vascular dementia, kidney failure, heart attack, and stroke. 
	&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/aortic-aneurysm">Aneurysm</a>: The increased pressure of the blood causes a section of the artery wall to enlarge and bulge out. While aneurysms can develop in any artery, they usually develop in the aorta. 
	&nbsp;</li>
	<li>Coronary Thrombosis: When the plaque ruptures, it can cause blood clots to form and block the blood flow. If it blocks the coronary arteries, it can trigger a heart attack. 
	&nbsp;</li>
</ul>

A heart attack is a life-threatening emergency. While symptoms vary from person to person, common warning signs include:

<ul>
	<li>Unexplained shortness of breath, with or without chest discomfort</li>
	<li>Chest discomfort (angina)</li>
	<li>Pain and discomfort extending beyond the chest to one or both arms, neck, jaw, teeth, stomach, and back</li>
	<li>Nausea or vomiting</li>
	<li>Anxiety</li>
	<li>Lightheadedness</li>
	<li>Cold sweats</li>
	<li>Indigestion</li>
	<li>Unexplained fatigue</li>
	<li>Coughing or wheezing</li>
	<li>Swelling in hands or feet 
	&nbsp;</li>
</ul>

Note: Seek medical attention immediately if you or a loved one has any of these symptoms. 
&nbsp;

Not all people who have a heart attack will experience intense pressure or pain to think they&rsquo;re having an episode and show due concern. In fact, some people have no symptoms at all. According to the American Heart Association, silent heart attacks make up about 20% of all heart attacks<a href="#accordion">[5]</a>.

They&rsquo;re pretty much the same as a heart attack, i.e., the heart muscle is deprived of oxygen and nutrients due to blockage, causing the person to feel pressure or pain, except that this time the problem goes unnoticed. 
&nbsp;

A general feeling of unease, for instance, that causes sleep disturbance at night should not be overlooked. Similarly, pain in the arm or shoulder should not be mistaken for simply an orthopedic issue. Sometimes, a pacemaker can disguise a heart attack as chest pain as well.

Rule of the thumb here is to see if this pain can be manipulated in some way. For instance, do you feel better if you change your position? If you experienced discomfort while you were sitting in a chair, does getting up and walking around improve or aggravate it? 
&nbsp;

The earlier this condition is identified and targeted, the better. According to a study, a silent heart attack is connected to a greater risk of heart failure<a href="#accordion">[5]</a>. 
&nbsp;

<ul>
	<li>Gender &ndash; Women have a greater risk because of high blood pressure during pregnancy, birth control pills containing estrogen, and depression. Women are thrice at risk of heart failure due to high blood pressure while men are twice as likely to get it<a href="#accordion">[3]</a>.</li>
	<li>Age &ndash; Men aged 45 or above and women aged 55 or above are at risk of having a high attack.</li>
	<li>Ethnicity &ndash; At least 3 out of 5 African American women have high blood pressure (&ge; 130/80 mmHg).</li>
	<li>Diet &ndash; Consuming more than the recommended amounts of salt and unhealthy fat raises blood pressure.</li>
	<li>Lifestyle &ndash; An unhealthy lifestyle choice, like not getting enough physical activity every day or smoking, also increases the risk of developing high blood pressure.</li>
	<li>Health &ndash; Certain health conditions, like obesity, sleep apnea, and diabetes, are major risk factors. A family history of heart disease may cause it, too. 
	&nbsp;</li>
</ul>

To reduce your risk of heart attack, you need to prevent and/or manage hypertension. This includes lifestyle changes mainly:

<ul>
	<li>Not smoking</li>
	<li>Relieve stress through meditation or yoga</li>
	<li>Quitting alcohol and smoking</li>
	<li>Maintaining a healthy weight</li>
	<li>Getting at least 30 minutes of physical activity every day</li>
	<li>Eating a healthy diet</li>
	<li>Monitoring cholesterol and diabetes closely and keeping their levels under control 
	&nbsp;</li>
</ul>

Your doctor may prescribe some medication (e.g., diuretics, vasodilators, beta-blockers, and calcium channel blockers) depending on your condition to help you control your blood pressure<a href="#accordion">[3]</a>. Do not change or stop medications without talking to your doctor. 
&nbsp;

Important!

All adults aged 18 and above should get their blood pressure checked every year. In case of the presence of risk factors, more frequent checkups may be needed<a href="#accordion">[2]</a>. 
&nbsp;

The global prevalence of hypertension is 26.4%. In particular, 1 in 3 US adults have hypertension with only 54% of these patients having adequate blood pressure control<a href="#accordion">[4]</a>. It requires constant surveillance to identify and slow the development of complications.

Always consult a healthcare professional if you think you have high blood pressure or a heart-related condition. They can recommend the appropriate preventive measures and treatment options to reduce your risk of heart attack. 
&nbsp;

[1] High blood pressure symptoms and causes. Centers for Disease Control and Prevention. May 18, 2021

[2] Hypertensive Heart Disease. Pennmedicine.

[3] Hypertensive heart disease: Symptoms, causes &amp; treatment. Cleveland Clinic.

[4] Tackling G, Borhade MB. Hypertensive Heart Disease.

[5] Nania R. How to recognize the signs of a silent heart attack. AARP.

Shermeen Zuberi

Pediatric Hypertension: Emerging Challenges And Treatment Strategies

In recent years, pediatric <a href="https://merisehat.pk/disease/hypertension">hypertension</a> has become a growing concern among healthcare professionals and parents alike.

At least 1 in 25 kids ages 12 to 19 have hypertension, more commonly seen in boys, those older than 12 years, and Hispanic or non-Hispanic Black ethnicity.<a href="#accordion">[2]</a>

Despite its relatively low prevalence compared to adult hypertension, the implications of high blood pressure in children can be severe and long-lasting. 
&nbsp;

Understanding The Evolving Nature Of Pediatric Hypertension

While the exact causes may vary, factors such as genetics, obesity, poor diet, teen pregnancy, smoking, and a lack of physical activity play significant roles in its development.

A family or personal history of conditions like hypertension, cholesterol, kidney disease, and diabetes should be considered as well.

Certain drugs and medications, including decongestants, caffeine, NSAIDs, and steroids, may also increase blood pressure.<a href="#accordion">[4]</a> 
&nbsp;

Pediatric hypertension can be classified into primary (essential) and secondary types.<a href="#accordion">[4]</a>

<ul>
	<li>Primary Pediatric Hypertension: Also known as essential hypertension, this type occurs when a child&#39;s blood pressure is consistently elevated without an identifiable cause. It often results from a combination of genetic, lifestyle, and environmental factors.</li>
	<li>Secondary Pediatric Hypertension: Secondary hypertension in children arises due to an underlying medical condition or external factor. Conditions such as kidney disease, heart defects, hormonal disorders, and certain medications can lead to elevated blood pressure in children. 
	&nbsp;</li>
</ul>

Diagnosing pediatric hypertension can be challenging since its symptoms often go unnoticed. Symptoms may include headaches, fatigue, vision problems, and difficulty breathing.

Accurate blood pressure measurement is crucial for diagnosing pediatric hypertension. Healthcare providers use age, height, and gender-specific norms to interpret blood pressure readings in children.

In addition to blood pressure measurement, laboratory tests such as urinalysis, blood tests, ECG, and renal ultrasound may be conducted to identify underlying conditions.

Some doctors suggest ambulatory monitoring to check if the child has high blood pressure. This means the child wears a special device for a short time to track their blood pressure all day, even while sleeping and playing. It ensures that high blood pressure isn&#39;t just because the child feels nervous at the doctor&#39;s office. 
&nbsp;

The new Clinical Practice Guidelines (CPG) released by the American Academy of Pediatrics (2017) state:[1]

<table cellspacing="0" class="1" style="border-collapse:collapse; border:none; width:464px">
	<tbody>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:36px; vertical-align:top; width:99px">
			&nbsp;
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:36px; vertical-align:top; width:182px">
			Systolic and/or Diastolic BP
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:36px; vertical-align:top; width:182px">
			Systolic and/or Diastolic BP
			</td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:99px">
			Age category
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&lt;13 years
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&ge;13 years
			</td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:99px">
			Normal BP
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&lt;90th percentile
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&lt;120/80 mmHg
			</td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:99px">
			Elevated BP
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&ge;95th &lt;95th percentile + 12

			or

			120-130/&lt;80 mmHg
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			120-130/&lt;80 mmHg
			</td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:99px">
			Hypertension Stage 1
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&ge;95th &lt;95th percentile + 12

			or

			130-140/80-90 mmHg
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			130-140/80-90 mmHg
			</td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:99px">
			Hypertension Stage 2
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&ge;95th + 12 or &ge;140/90 mmHg
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&ge;140/90 mmHg
			</td>
		</tr>
	</tbody>
</table>

The new method helped with accurate diagnosis and understanding of the impact of different criteria on estimating high blood pressure prevalence and associated health risks:

<ul>
	<li>The approach lowered the levels used to define high blood pressure by 1&ndash;3 mmHg for children and over 4 mmHg for adolescents.</li>
	<li>It led to more children being identified as at risk of high blood pressure compared to the old criteria, sparking debates among scientists, especially with European researchers involved in setting guidelines.</li>
	<li>It resulted in higher estimates of high blood pressure prevalence compared to the old criteria.</li>
	<li>It identified that the prevalence of high blood pressure varied based on factors like age, weight, and the study setting. For instance, some children may experience higher blood pressure readings initially due to stress (white coat hypertension), which could lead to overestimation of high blood pressure prevalence.</li>
	<li>Studies show that children identified as hypertensive under the new criteria had a higher risk of cardiometabolic problems compared to those classified under the old criteria. 
	&nbsp;</li>
</ul>

Early intervention helps prevent the progression of pediatric hypertension and reduces the risk of complications later in life.

Untreated pediatric hypertension can lead to heart disease, stroke, kidney damage, and cognitive impairment.

<ul>
	<li>Lifestyle Modifications &ndash; Lifestyle modifications such as adopting a healthy diet, increasing physical activity, reducing sodium intake, and managing stress are essential to pediatric hypertension treatment.</li>
	<li>Medications &ndash; In some cases, medications such as ACE inhibitors, calcium channel blockers, angiotensin II receptor blockers, and diuretics may be prescribed to help lower blood pressure levels in children and adolescents. These medications are typically used in conjunction with lifestyle changes.</li>
</ul>

Note: Regular monitoring and follow-up appointments are necessary to track the effectiveness of treatment and make adjustments as needed. 
&nbsp;

Coping with a child&#39;s diagnosis of hypertension can be challenging for parents. Seeking support from healthcare professionals and connecting with other parents facing similar challenges can be helpful.

Moreover, collaboration among healthcare providers, parents, schools, and community organizations is important to promote a supportive environment for children and adolescents to effectively manage the condition. 
&nbsp;

Preventing pediatric hypertension involves promoting healthy lifestyle habits early on, including proper nutrition, regular physical activity, and stress management techniques. Make sure that they get quality sleep and avoid vaping, smoking, or even exposure to secondhand smoke.

Other precautions include:

<ul>
	<li>Children (aged 2-3 years) &lt;1200 mg of sodium a day</li>
	<li>Older children &lt;1500 mg of sodium a day</li>
	<li>All children 60 minutes of physical activity a day</li>
</ul>

Also, children should have their blood pressure checked at least once a year as part of their routine healthcare visits, starting at age 3. 
&nbsp;

<ul>
	<li>Pediatric hypertension refers to elevated blood pressure levels in children and adolescents. Stage II hypertension is diagnosed if a child&#39;s BP is greater than the 99th percentile plus 5 mm Hg.</li>
	<li>Symptoms of pediatric hypertension include headaches, fatigue, vision problems, and difficulty breathing.</li>
	<li>Diagnosis involves measuring blood pressure and conducting laboratory tests like urinalysis and blood tests to assess kidney function and identify underlying conditions.</li>
	<li>Causes and risk factors include genetics, obesity, poor diet, lack of physical activity, family history, excess weight, sedentary lifestyle, high-sodium diet, and certain underlying medical conditions.</li>
	<li>Treatment of pediatric hypertension includes lifestyle modifications such as diet and exercise changes, and medications may be prescribed in some cases.</li>
	<li>Untreated pediatric hypertension can lead to heart disease, stroke, kidney damage, and cognitive impairment.</li>
	<li>Promoting a healthy lifestyle from an early age through proper nutrition, regular physical activity, and stress management techniques can help prevent pediatric hypertension.</li>
</ul>

[1] Di Bonito P, Di Sessa A. New Diagnostic Criteria for Hypertension in Children and Adolescents: Lights and Shadows. Children (Basel). 2020;7(11):196. Published 2020 Oct 24.

[2] High blood pressure in children. Cleveland Clinic. Accessed February 23, 2024.

[3] Ashraf M, Irshad M, Parry NA. Pediatric hypertension: an updated review. Clin Hypertens. 2020;26(1):22. Published 2020 Dec 1.

[4] High blood pressure in children. Mayo Clinic. Accessed February 23, 2024.

Everything You Need To Know About Hypertension And Dementia

Why do some people with high blood pressure end up having memory problems later in life? High blood pressure and memory loss and thinking problems might seem like unrelated pieces, but they share a surprising connection. 
 
&nbsp;

Blood pressure refers to the pressure exerted by blood on the walls of the arteries during the heart&#39;s pumping action, circulating blood throughout the body.

Blood pressure around 120/80 mmHg is usually considered normal. When this pressure is consistently high, above 140/90 mmHg, it is known as hypertension. It is estimated that by 2025, 1.6 billion people around the world will have hypertension.<a href="#accordion">[1]</a>

Hypertension may not have distinct signs and symptoms. But it can strain the heart and blood vessels and cause various health problems. For instance, according to research, women with hypertension in their 40s are at high risk of developing dementia.<a href="#accordion">[6]</a> 
&nbsp;

Dementia is not a specific disease but rather a term used to describe a group of symptoms affecting memory, thinking, and social abilities severely enough to interfere with daily functioning. 
&nbsp;

Understanding the link between hypertension and dementia

First and foremost, hypertension can damage blood vessels throughout the body, including those in the brain. It may cause the narrowing of arteries due to fat deposits (plaques), and the arterial walls may get thicker and stiffer.

The brain needs one quart of blood every minute on average to work efficiently.<a href="#accordion">[3]</a> Not only does hypertension impair blood flow to crucial areas of the brain, depriving it of oxygen and nutrients essential for proper function, but it also causes inflammation of the brain cells. As a result, the individual experiences cognitive decline over time.

According to one study, an early onset of hypertension (diagnosed before age 35) is associated with the greatest change in brain size and a greater likelihood of developing dementia as compared to those who have normal blood pressure.<a href="#accordion">[7]</a>

According to another study, the more an individual&rsquo;s blood pressure varies over 8 years, the more they are at risk of developing dementia.<a href="#accordion">[5]</a> 
&nbsp;

The good news is that certain preventive measures for hypertension can also help reduce the risk of dementia.

<ul>
	<li>Regularly monitor the blood pressure and work with a healthcare provider to keep it within a healthy range.</li>
	<li>Adopting a healthy lifestyle e.g. exercising regularly, eating a balanced diet and avoiding smoking. can lower blood pressure and reduce the risk of dementia.</li>
	<li>In particular, DASH and Mediterranean diets have proved effective in reducing blood pressure. Similarly, overweight or obese people who lose around 11 pounds can keep their blood pressure under control.<a href="#accordion">[5]</a></li>
	<li>If lifestyle changes alone are not sufficient to control hypertension, the healthcare provider may prescribe medications to help lower the blood pressure. 
	Existing antihypertensive medications, especially those that influence the renin-angiotensin hormone system (RAS), reduce the risk of dementia as well.<a href="#accordion">[2]</a> These drugs include valsartan, losartan, amlodipine, and hydrochlorothiazide.<a href="#accordion">[4]</a> 
	&nbsp;</li>
</ul>

While more research is needed to fully understand the link between hypertension and dementia, evidence suggests that controlling high blood pressure may help reduce the risk of developing dementia later in life. By adopting a healthy lifestyle and working closely with healthcare providers, individuals can take proactive steps to protect their cognitive health.

<ul>
	<li>Hypertension, or high blood pressure, is a condition where the force of blood against artery walls is consistently high.</li>
	<li>Dementia is not a single disease but a term used to describe a decline in cognitive abilities severe enough to interfere with daily life.</li>
	<li>Studies suggest a potential link between hypertension and an increased risk of developing dementia.</li>
	<li>High blood pressure may contribute to the formation of plaques, tangles, inflammation, and damage to brain cells, contributing to cognitive decline over time.</li>
	<li>Controlling high blood pressure through lifestyle changes, such as a healthy diet, regular exercise, maintaining a healthy weight, and avoiding smoking, can help reduce the risk of developing dementia.</li>
	<li>Regular check-ups with healthcare providers are essential for monitoring blood pressure levels and assessing overall health, especially for individuals at risk of hypertension and dementia.</li>
</ul>

[1] High blood pressure and the risk of dementia. Alzheimer’s Society. Accessed March 6, 2024.

[2] Zissimopoulos J, Thunell J, Garland H. Blood pressure medication and dementia prevention: The promising link. USC Schaeffer. October 26, 2023. Accessed March 6, 2024.

[3] Untreated hypertension can lead to memory loss by cutting down ... Accessed March 6, 2024

[4] Solan M. Some blood pressure drugs may lower dementia risk. Harvard Health. April 1, 2023. Accessed March 6, 2024.

[5] Blood pressure and alzheimer’s risk: What’s the connection? Johns Hopkins Medicine. March 10, 2022. Accessed March 6, 2024.

[6] High blood pressure in women linked to increased dementia risk. Alzheimer’s Research UK. Accessed March 6, 2024.

[7] Earlier onset of high blood pressure affects brain structure, may increase dementia risk. American Heart Association. Accessed March 6, 2024.

7 Common Blood Pressure Mistakes And How To Fix Them For Accurate Readings

Measuring blood pressure at home is a convenient and effective way to monitor your cardiovascular health. However, many people make common mistakes that can lead to inaccurate readings.

Understanding Blood Pressure Mistakes

<ol>
	<li style="list-style-type:decimal">
	<h5>Incorrect Cuff Size</h5>
	</li>
</ol>

If a cuff is too large or too small, it can lead to inaccurate readings.&nbsp;

Fix: A study found that using the wrong cuff size can lead to significant inaccuracies in blood pressure readings.<a href="#accordion">[1]</a> Make sure the cuff fits snugly around your arm without being too tight. Measure the circumference of your upper arm and choose a cuff that matches the size. Most blood pressure monitors come with guidelines on selecting the right cuff size. 
&nbsp;

<ol start="2">
	<li>
	<h5>Improper Arm Position</h5>
	</li>
</ol>

Holding the arm too high or too low during measurement can result in false readings.

Fix: The American Heart Association (AHA) emphasizes the importance of keeping the arm at heart level to ensure accurate readings.<a href="#accordion">[2]</a> You can rest the arm on a table or use a pillow for support. 
&nbsp;

<ol start="3">
	<li>
	<h5>Measuring Over Clothes</h5>
	</li>
</ol>

Clothing can interfere with the accuracy of the readings.

Fix: Always place the cuff on bare skin. Roll up your sleeve or remove any clothing that covers your upper arm. 
&nbsp;

<ol start="4">
	<li>
	<h5>Talking Or Moving</h5>
	</li>
</ol>

Talking, moving, or being restless can affect the reading.

Fix: A study found that talking can increase systolic blood pressure by 10 mmHg.<a href="#accordion">[3]</a> Sit still and remain quiet during the measurement. 
&nbsp;

<ol start="5">
	<li>
	<h5>Not Resting Before Measurement</h5>
	</li>
</ol>

Taking a blood pressure reading without resting can lead to elevated readings.

Fix: The European Society of Hypertension recommends resting before measurements to avoid transient increases in blood pressure. Rest for at least 5 minutes in a quiet environment before measuring the blood pressure.<a href="#accordion">[4]</a> Avoid caffeine, exercise, and smoking for 30 minutes before taking a reading.<a href="#accordion">[5]</a> 
&nbsp;

<ol start="6">
	<li>
	<h5>Taking Only One Reading</h5>
	</li>
</ol>

Relying on a single blood pressure reading can provide an inaccurate assessment of the blood pressure.

Fix: The AHA suggests averaging multiple readings to get a more accurate measure of blood pressure. Take 2-3 readings, 1 minute apart, and record the average.<a href="#accordion">[6]</a> This approach helps to account for variability and provides a more accurate picture of the blood pressure. 
&nbsp;

<ol start="7">
	<li>
	<h5>Using The Wrong Device</h5>
	</li>
</ol>

Using an outdated or inaccurate blood pressure monitor can result in unreliable readings.

Fix: Use a validated, calibrated digital blood pressure monitor.<a href="#accordion">[6]</a> Ensure that the device is regularly checked and maintained for accuracy. One study highlights that digital monitors are reliable and user-friendly, making them ideal for home use. 
&nbsp;

<ul>
	<li>Accurate blood pressure measurement is essential for effective monitoring and management of hypertension.&nbsp;</li>
	<li>Avoiding these common mistakes and following proper techniques can ensure reliable readings at home.&nbsp;</li>
	<li>Always consult a healthcare provider for the best practices for managing and monitoring blood pressure.</li>
</ul>

[1] When it comes to accurate blood pressure readings, cuff size matters. www.heart.org. January 24, 2023. Accessed July 17, 2024.

[2] Steps for accurate BP measurement. Accessed July 17, 2024.

[3] Rehman S, Hashmi MF. Blood Pressure Measurement. [Updated 2022 Dec 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan

[4] Mahe G, Comets E, Nouni A, et al. A minimal resting time of 25 min is needed before measuring stabilized blood pressure in subjects addressed for vascular investigations. Sci Rep. 2017;7(1):12893. Published 2017 Oct 10. doi:10.1038/s41598-017-12775-9

[5] Measure your blood pressure. Centers for Disease Control and Prevention. Accessed July 17, 2024.

[6] Monitoring your blood pressure at home. www.heart.org. May 24, 2024. Accessed July 17, 2024.

Does Postpartum Hypertension Go Away?

Bringing a new life into the world is an incredible journey, but sometimes unexpected challenges can pop up, like postpartum hypertension.

In simple words, postpartum hypertension is high <a href="merisehat.pk/disease/blood-pressure">blood pressure</a> that shows up after you give birth. 
&nbsp;

Understanding postpartum hypertension

However, it doesn&#39;t stick around forever. It&#39;s like the body&#39;s way of saying, &quot;Hang on, I need a little more time to get back to normal.&quot;

The duration and severity of postpartum hypertension varies from woman to woman. Factors such as pre-existing health conditions and the presence of risk factors may influence the resolution of postpartum hypertension.

A recent study found that the condition was more commonly present in mothers who smoked, had delivered via C-section, were aged 35 and above, and were Black Americans.<a href="#accordion">[1]</a> 
&nbsp;

Other risk factors include:<a href="#accordion">[2]</a>

<ul>
	<li>Obesity</li>
	<li>Family or individual history of preeclampsia</li>
	<li>High blood pressure during pregnancy</li>
	<li>Multiple births</li>
	<li>Diabetes</li>
	<li>Autoimmune conditions 
	&nbsp;</li>
</ul>

High blood pressure usually peaks within 48 hours after delivery, which is when most women leave the hospital.

Call your doctor immediately if you have a reading of 140/90 mm Hg or higher or postpartum hypertension symptoms, such as changes in vision, shortness of breath, persisting and severe headache, abdominal pain, nausea or vomiting, and decreased urination.

Delayed treatment can lead to serious complications, including pulmonary edema, seizures, strokes, blood clots, and even death. 
&nbsp;

For a new mom, postpartum hypertension can be scary. Will it go away on its own? Will I need medications?

Postpartum hypertension treatment often revolves around a healthy lifestyle. Eating well, staying active, and catching those precious zzz&#39;s all contribute to your body&#39;s speedy recovery.

Regular check-ups with your healthcare provider ensure that any lingering high blood pressure is noticed and managed. Sometimes, they may prescribe blood pressure medicine, antiseizure medicine, and anticoagulant medications to treat it.

It could take several days to a few weeks for the blood pressure to return to a safe or manageable level. Remember, you&rsquo;ll also be recovering from childbirth itself during this time, too. So, you may experience physical and emotional changes, such as fatigue, tender breasts, cramping or vaginal discharge, and mood swings. 
&nbsp;

Your body has this remarkable ability to self-regulate and heal, ensuring that postpartum hypertension often resolves on its own. However, regular monitoring and doctor check-ups during this period can further help with a smooth transition back to pre-pregnancy blood pressure levels. 
&nbsp;

<ul>
	<li>Postpartum hypertension, or high blood pressure after giving birth, is a rare condition that affects some women during the weeks or months following delivery.</li>
	<li>Postpartum is a healing period for the body, and as it recovers from the stress of childbirth, blood pressure levels often return to normal.</li>
	<li>However, it&#39;s important to monitor postpartum hypertension through regular check-ups with a healthcare provider to ensure that it does not persist or lead to complications.</li>
	<li>Maintaining a healthy lifestyle, including a balanced diet, regular physical activity, and sufficient rest, helps blood pressure levels return to normal.</li>
	<li>In some cases, medical intervention, such as medication, may be required to manage postpartum hypertension.</li>
</ul>

[1] Sullivan K, Rauf D, Welch A, et al. New moms at risk of developing high blood pressure 6 weeks after childbirth, study finds. EverydayHealth.com. Accessed January 26, 2024.

[2] Postpartum preeclampsia: Causes, symptoms & treatment. Cleveland Clinic. Accessed January 26, 2024

Humza Khizer

Link Between Diabetes And Hypertension

According to the World Health Organization (WHO), diabetes and <a href="https://merisehat.pk/disease/hypertension-57">hypertension</a> are major public health concerns worldwide. The prevalence of both conditions has been increasing over the past few decades.

Data from the International Diabetes Federation (IDF) indicates that around 547 million adults have diabetes, which translates to 10.5% of the adult population<a href="#accordion">[1]</a>. The number is expected to rise to 783 million by 2045; this would be an increase of 46%<a href="#accordion">[1]</a>. Type 2 diabetes continues to be the predominant type of diabetes affecting people worldwide. The increasing prevalence of obesity, a sedentary lifestyle, and an aging population are all believed to be contributing factors to the rise in the prevalence of type 2 diabetes. 
&nbsp;

Approximately 3 in 4 adults with diabetes reside in middle- and low-income countries, such as Pakistan. As per estimates, 26.7% of Pakistani adults suffer from diabetes<a href="#accordion">[2]</a>. The country currently ranks third in the world in terms of diabetes prevalence.

Hypertension, on the other hand, affects an estimated 1.28 billion people globally, as reported by the WHO[3]. More than two-thirds of these people reside in middle- and low-income countries. 
&nbsp;

In Pakistan, the prevalence is 18%<a href="#accordion">[4]</a>. However, 70% of patients are unaware of their disease and only less than 3% have controlled hypertension<a href="#accordion">[4]</a>. This is quite alarming considering hypertension is a leading cause of mortality worldwide and accounts for 45% of deaths due to heart attacks<a href="#accordion">[5]</a>.

With the prevalence of both diabetes and hypertension increasing worldwide, the question arises - is there a link between the two chronic conditions? Is one leading to the other? Let&rsquo;s find out! 
&nbsp;

Understanding the link of Diabetes and Hypertension

Both diabetes and hypertension are common chronic diseases that often coexist in individuals, and their interaction can significantly increase the risk of cardiovascular complications and other health issues. Hypertension is twice as common in diabetics as in people who do not have diabetes<a href="#accordion">[6]</a>. Moreover, hypertension exacerbates the occurrence of cardiovascular disease in people with diabetes, which is a major cause of mortality and morbidity. 
&nbsp;

However, the two chronic conditions are interlinked in several ways<a href="#accordion">[6][7]</a>.

<ul>
	<li>Shared Risk Factors - Several risk factors contribute to the development of both diabetes and hypertension. Lifestyle factors such as unhealthy diet, physical inactivity, and obesity play a significant role in the development of these conditions. The &quot;Diabesity&quot; concept, which combines diabetes and obesity, emphasizes the strong connection between the two conditions and their mutual association with hypertension. Studies have shown that overweight and obesity increase the risk of developing both diabetes and hypertension. 
	&nbsp;</li>
	<li>Insulin Resistance And Hypertension - Insulin resistance is a key feature of type 2 diabetes, where the body&#39;s cells do not respond properly to insulin, leading to high blood sugar levels. Insulin resistance also has implications for blood pressure regulation. Research demonstrates that insulin resistance is linked to increased sympathetic nervous system activity, sodium retention, and altered vasodilation, all of which can contribute to hypertension. 
	&nbsp;</li>
	<li>Endothelial Dysfunction - Endothelial cells line the inner surface of blood vessels and play a crucial role in vascular health. In both diabetes and hypertension, there is evidence of endothelial dysfunction, which can lead to impaired blood flow regulation and promote the development of atherosclerosis. 
	&nbsp;</li>
	<li>Renin-Angiotensin-Aldosterone System (RAAS) - The RAAS is a hormonal system that regulates blood pressure and fluid balance. It has been implicated in the pathogenesis of both diabetes and hypertension. Hyperactivation of the RAAS can lead to vasoconstriction and sodium retention, contributing to increased blood pressure. Studies have demonstrated that components of the RAAS are dysregulated in both diabetes and hypertension. 
	&nbsp;</li>
	<li>Cardiovascular Complications - The combination of diabetes and hypertension significantly increases the risk of developing cardiovascular complications, such as coronary artery disease, stroke, and heart failure. Individuals with diabetes and hypertension had a substantially higher risk of cardiovascular events compared to those with either condition alone. 
	&nbsp;</li>
</ul>

Managing both diabetes and hypertension together requires careful consideration of treatment strategies. Some antihypertensive medications, such as thiazide diuretics and beta-blockers, may adversely affect glucose metabolism and insulin sensitivity. Therefore, individualized treatment plans that address both conditions while minimizing potential side effects are essential. 
&nbsp;

In conclusion, diabetes and hypertension share common risk factors and pathophysiological mechanisms, which contribute to their frequent coexistence in individuals. Their interaction significantly increases the risk of cardiovascular complications and underscores the importance of comprehensive management for individuals with both conditions. Regular medical check-ups, lifestyle modifications, and appropriate medications are crucial in effectively managing these two chronic diseases together. 
&nbsp;

[1] Facts & Figures. International Diabetes Federation.

[2] Azeem S, Khan U, Liaquat A. The increasing rate of diabetes in Pakistan: A silent killer. Ann Med Surg (Lond). 2022;79:103901. Published 2022 Jun 3. doi:10.1016/j.amsu.2022.103901

[3] Hypertension. World Health Organization.

[4] Akram M, et al. (2023). Prevalence of Hypertension and Associated Co-Morbidities in Pakistan. Mathews J Nurs. 5(1):11.

[5] Riaz M, Shah G, Asif M, Shah A, Adhikari K, Abu-Shaheen A. Factors associated with hypertension in Pakistan: A systematic review and meta-analysis. PLoS One. 2021;16(1):e0246085. Published 2021 Jan 29. doi:10.1371/journal.pone.0246085

[6] Petrie JR, Guzik TJ, Touyz RM. Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms. Can J Cardiol. 2018;34(5):575-584. doi:10.1016/j.cjca.2017.12.005

[7] Berbari, A.E., Daouk, N.A., Nasr, E.M. (2023). Coexistence of Diabetes Mellitus and Hypertension. In: Berbari, A.E., Mancia, G. (eds) Blood Pressure Disorders in Diabetes Mellitus. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. doi:10.1007/978-3-031-13009-0_1

Nimrah H. Sattar

Iqra Mazhar

Hypertension In Women

This is because most people with high blood pressure have no symptoms at all, at least not until the condition has become severe. Even then, it may not be visible.<a href="#accordion">[1]</a>

A common misconception is that this &ldquo;silent killer&rdquo; affects men only. On the contrary, the American Heart Association states that almost half of the adult population with high blood pressure are women.

Moreover, according to the Centers for Disease Control and Prevention, the number of women dying from stroke is greater than the figure for men. Additionally, the number of women dying from heart disease every year in the US is almost the same as men<a href="#accordion">[2]</a>. 
&nbsp;

Hypertension occurs when the force with which blood pushes against the inside lining of the arteries increases and stays high for a period. High blood pressure means:

<ul>
	<li>The diastolic pressure is 80 or above</li>
	<li>The systolic pressure is 130 or above</li>
	<li>Both systolic and diastolic pressures are high 
	&nbsp;</li>
</ul>

Gender usually does not influence how the condition affects an individual. However, the onset of menopause does increase the risk of developing high blood pressure in some women. 
&nbsp;

The risk increases further with increasing age. According to a study, this is also related to estrogen-only pills that women take to manage menopause symptoms. Those who prefer estrogen-only creams or patches are less likely to be diagnosed with high blood pressure than those who take pills<a href="#accordion">[3]</a>.

The condition remains undiagnosed and untreated because of the myth that hypertension affects only men. Doctors assuming that women are healthy or immune to high blood pressure don&rsquo;t check it then while measuring other vitals during an examination, leading to delays in proper care. 
&nbsp;

Understanding the Hypertension in Women

When symptoms occur, they may include:

<ul>
	<li>Red spots in front of the eyes</li>
	<li>Flushing</li>
	<li>Dizziness 
	&nbsp;</li>
</ul>

The only way to know the person has high blood pressure is consistently high blood pressure readings, which is why regularly monitoring blood pressure helps with early diagnosis. If not treated or controlled, hypertension can lead to serious health issues, including:

<ul>
	<li>Stroke</li>
	<li>Heart attack</li>
	<li>Dementia</li>
	<li>Kidney failure</li>
	<li>Vision problems</li>
	<li>Amputation 
	&nbsp;</li>
</ul>

High blood pressure is responsible for 8.5 million deaths globally from ischemic heart disease, stroke, and renal diseases<a href="#accordion">[4]</a>. 
&nbsp;

High blood pressure during pregnancy can be dangerous for both mother and the baby. Whether it&rsquo;s a preexisting condition (chronic hypertension) or pregnancy-induced hypertension (gestational hypertension), it can cause preeclampsia, which is one of the major causes of maternal and infant mortality.

Preeclampsia, a critical blood pressure condition that develops during pregnancy, usually presents itself after the 20th week of pregnancy. However, it can occur earlier or during postpartum as well. It is characterized by headaches, nausea or vomiting, and abdominal pain. In some cases, it also causes swelling, sudden weight gain, and kidney, liver, and brain damage. 
&nbsp;

The risk of developing high blood pressure during pregnancy increases if the mother is:

<ul>
	<li>Obese</li>
	<li>Under 20 or over 40</li>
	<li>On a diet high in fat and salt</li>
	<li>Living with chronic stress</li>
	<li>Not physically active</li>
	<li>Pregnant for the first time</li>
	<li>Had preeclampsia during a previous pregnancy</li>
	<li>Pregnant via IVF</li>
	<li>Have chronic kidney disease, hypertension, diabetes/gestational diabetes, and an immune system disorder like lupus</li>
	<li>Have a history of thrombophilia</li>
	<li>Certain medications, including some pain relievers and birth control pills</li>
	<li>Having multiple pregnancies (twins, triplets, etc.)</li>
	<li>Have a family history of hypertension or preeclampsia</li>
	<li>Environmental factors 
	&nbsp;</li>
</ul>

High blood pressure during pregnancy is dangerous for the mother because it can cause complications, such as seizures, blood clotting problems, stroke, liver problems, and temporary kidney failure. It can also necessitate a c-section delivery. 
&nbsp;

Moreover, it prevents the placenta from receiving enough blood. This restricts the food and oxygen supply for the fetus, causing:

<ul>
	<li>Labor induction before the baby is full-term</li>
	<li>Premature birth</li>
	<li>Low birth weight</li>
	<li>Stillbirth 
	&nbsp;</li>
</ul>

The risk of these serious complications increases if the condition is not diagnosed in the early stage. As such, it&rsquo;s important that women are screened for hypertension during pregnancy just like any other condition. 
&nbsp;

A woman taking medicine, as advised by the doctor throughout the pregnancy, should take it during labor, too.

In the case of mild-moderate hypertension, the blood pressure is to be monitored closely every hour during labor. Blood pressure within the acceptable range increases the chances of a natural birth. 
&nbsp;

In the case of severe hypertension, the blood pressure is to be monitored every 15-30 minutes during labor. Also, doctors may suggest using forceps or opting for a cesarean section to deliver the baby.

Post-delivery, the mother&rsquo;s blood pressure will be monitored again. If they had hypertension before pregnancy, the doctor may need to review their treatment program again two weeks after delivery.

Postpartum preeclampsia is typically diagnosed within two days after delivery and treatment proceeds accordingly. 
&nbsp;

If the doctor approves it, it&rsquo;s okay to breastfeed while taking hypertension medicine. That said, some medications are not recommended for pregnant or breastfeeding women. It&rsquo;s best to always check the warnings mentioned in the manufacturer&rsquo;s information provided<a href="#accordion">[5]</a>. 
&nbsp;

Understanding the individual risk and warning signs of high blood pressure is important to prevent it. Additionally, women should:

<ul>
	<li>Eat a healthy diet and reduce the salt intake</li>
	<li>Maintain a healthy weight</li>
	<li>Quit smoking and alcohol</li>
	<li>Be active</li>
	<li>De-stress</li>
	<li>Get plenty of rest 
	&nbsp;</li>
</ul>

Excess fat, particularly abdominal fat, can raise blood pressure. Losing just 7.7 pounds can reduce this risk by 50%<a href="#accordion">[6]</a>.

Exercising and other forms of physical activity not only help shed the extra weight but also help keep the arteries flexible. According to the American Heart Association, regular exercise can lower the numbers by 8-10 points<a href="#accordion">[6]</a>. 
&nbsp;

Moreover, fat-free dairy products, dried beans, and fresh produce have a high content of calcium, potassium, and magnesium and help regulate blood pressure. However, evidence is needed to validate the effectiveness of dietary supplements (e.g., fish oils, folic acid) in preventing hypertension in women.

Besides, it pays if the individual avoids high amounts of sodium and saturated fat. Also, a 2017 report showed that a moderate intake of coffee is safe for consumption in case of high blood pressure<a href="#accordion">[7]</a>. 
&nbsp;

Meditation and other relaxation techniques, like breathing exercises, warm baths, and yoga, are also beneficial since stress hormones raise blood pressure. And while sleep alone cannot treat hypertension, poor sleep quality or sleeping less than five hours a night increases the risk of high blood pressure. 
&nbsp;

Important!

Women aged 30-60 should monitor their blood pressure even when their levels generally remain low. Compared to men, women have lower blood pressure but it increases earlier and also progresses faster. One reason could be that their blood vessels age faster than men&rsquo;s, making them more susceptible to developing hypertension and related problems<a href="#accordion">[8]</a>. 
&nbsp;

It&rsquo;s normal for blood pressure to fluctuate throughout the day. For instance, blood pressure is different while sleeping or relaxing compared to when a person is under stress or excited. However, when the resting blood pressure level is too high, it can stiffen, scar, or weaken blood vessels. A person may not necessarily feel unwell if they have hypertension or high blood pressure. 
&nbsp;

Do not start or stop any medication without first talking to a doctor. Women who are already taking medicine to lower their blood pressure and trying to get pregnant should consult their doctor first. If they&rsquo;re pregnant already, it&rsquo;s important to inform the doctor immediately. This is so the doctors can change the medication as soon as possible because some medicines are simply not safe to take during pregnancy.

Other than medications, lifestyle changes like eating a balanced diet and physical activity (e.g., walking or swimming) are important to reduce high blood pressure. 
&nbsp;

[1] Hypertension. World Health Organization.

[2] Nania R. Women may overlook risk of hypertension. AARP.

[3] Estrogen-only pills for menopause may raise women’s High Blood Pressure Risk. WebMD.

[4] Worldwide trends in hypertension prevalence and progress in treatment

[5] High blood pressure (hypertension) and pregnancy. NHS choices.

[6] Durso SC. Hypertension: What you need to know as you age. JHM.

[7] High blood pressure: What is high, symptoms, causes, and more. Medical News Today.

[8] High blood pressure: What women need to know. Cedars.

Does Chronic Kidney Disease Cause Hypertension?

Did you know that more than 50% of patients with chronic kidney disease also have high blood pressure?<a href="#accordion">[2]</a>

It is possible if you have chronic kidney disease (CKD). The damage to the kidneys leads to a build-up of harmful substances in your body that, in turn, triggers an increase in your blood pressure. It also increases the likelihood of the worsening of CKD. This type of <a href="https://merisehat.pk/disease/hypertension-57">hypertension</a> is called renal hypertension. 
&nbsp;

Understanding the impact of CKD on hypertension

One of the key players causing this complication is a hormone called renin. When the kidneys sense a drop in blood flow or filtration, they release renin into the bloodstream. Renin then kicks off a series of events that result in the narrowing of blood vessels and an increase in blood pressure. If you have CKD, this process can become dysregulated, further contributing to hypertension. 
&nbsp;

Your doctor may order imaging tests, such as duplex ultrasound, computerized tomographic angiography, catheter angiogram, or magnetic resonance angiogram, to determine if the CKD has caused narrowing of your renal arteries.

However, a narrowed kidney artery alone is not responsible for your hypertension. Some patients can also present with essential hypertension.<a href="#accordion">[3]</a> 
&nbsp;

If you have chronic kidney disease, it&#39;s crucial to work closely with your healthcare team to manage hypertension effectively.

<ul>
	<li>Your doctor may prescribe medications, including ACE inhibitors, angiotensin II receptor blockers, diuretics, or water pills.</li>
	<li>Additionally, lifestyle modifications, such as adopting a kidney-friendly and heart-friendly diet, maintaining a healthy weight, and staying physically active, can all make a significant difference.</li>
	<li>Avoid self medicating &nbsp;and long-term exposure to heavy metals like lead to prevent kidney disease.</li>
	<li>Regular monitoring of blood pressure and kidney function is essential, allowing for timely detection and intervention.</li>
</ul>

Other procedures, including angioplasty, renal bypass surgery, or kidney transplant, are reserved for severe cases only. For instance, you may have pulmonary edema, rapidly worsening kidney function, or experience unacceptable side effects from blood pressure medications.&nbsp;

Note: Left untreated, renal hypertension causes end-stage renal disease or kidney failure. Do not ignore it. Seek professional help immediately! 
&nbsp;

Understanding the connection between hypertension and CKD is the first step towards effective management of the conditions. A holistic approach that includes lifestyle changes and regular medical check-ups can help improve your overall well-being. 
&nbsp;

<ul>
	<li>Kidneys play a key role in keeping blood pressure in a healthy range.</li>
	<li>Diseased kidneys cannot regulate blood pressure. As a result, blood pressure increases.</li>
	<li>If you have CKD, high blood pressure makes it more likely that your kidney disease will get worse and you will have heart problems.</li>
	<li>It is important to follow your treatment plan and keep your blood pressure under control to avoid complications.</li>
</ul>

[1] Kidney disease caused by high blood pressure: Symptoms and treatments. WebMD. Accessed January 25, 2024.

[2] High blood pressure and chronic kidney disease. Accessed January 25, 2024.

[3] Renal hypertension: Cause & treatment. Cleveland Clinic. Accessed January 25, 2024.

You&rsquo;re probably familiar with the term &lsquo;hypertension,&rsquo; which refers to blood pressure that is consistently higher than normal. However, this high blood pressure lowers when the patient is asleep. 
&nbsp;

Now, let&rsquo;s talk about the other condition which reverses this situation. In this scenario, you have normal blood pressure throughout the day, but it shoots up as soon as you fall asleep. It is known as &lsquo;nocturnal hypertension&rsquo;.&nbsp; 
&nbsp;

Understanding Nocturnal Hypertension

It is believed to be a complication of essential and secondary hypertension<a href="#accordion">[1]</a>. The increased blood pressure during sleep has been identified as an elevated risk factor for several cardiovascular issues, including heart failure and cerebrovascular diseases<a href="#accordion">[2]</a>. Several studies have revealed that nocturnal hypertension may be an initial symptom of later target organ damage.&nbsp; 
&nbsp;

There are 2 types of blood pressure patterns in nocturnal hypertension: 
&nbsp;

<h5>1. Non-Dipping Blood Pressure</h5>

During sleep, the body is not doing a lot of work; it is at rest and the person feels calm. It&rsquo;s why the blood pressure is also lower than what it is during the day time. This phenomenon is called dipping. Normally, there is at least a 10-20% dip expected from daytime to nighttime while sleeping. 
&nbsp;

However, when the dip in blood pressure at night time is less than 10%, it is then considered as non-dipping blood pressure. People with essential hypertension are more exposed to it and it is highly associated with target organ damage<a href="#accordion">[5]</a>. 
&nbsp;

<h5>2. Reverse Dipping Blood Pressure</h5>

Also known as inverted dipping, this phenomenon refers to blood pressure that is higher during the night time as compared to the daytime. People with hypertension, diabetes type 2, sleep apnea, and chronic kidney disease usually suffer from reverse dipping blood pressure<a href="#accordion">[3]</a>. This pattern of nocturnal hypertension is most common among old people and smokers.&nbsp; 
&nbsp;

Reverse dipping pattern is further considered a risk factor for <a href="https://merisehat.pk/disease/atherosclerosis">atherosclerosis </a>and is believed to promote the formation of carotid plaque<a href="#accordion">[4]</a>. 
&nbsp;

The WHO reported the number of adults suffering from hypertension in 1975 was 594 million. According to their assessment in 2015, the number has gone up to 1.13 billion<a href="#accordion">[7]</a>. The increased instance of hypertension has also led to better controlling therapies. There is new research and newer concepts being proposed every other day.&nbsp; 
&nbsp;

The latest direction in the management of high blood pressure is to target the problem earlier and aim towards lowering the blood pressure throughout the day<a href="#accordion">[8]</a>. According to the 2017 guideline by American College of Cardiology (ACC), all blood pressure readings taken during the awake period of a patient must be less than 130/80 mm Hg. It is now considered a universal blood pressure goal.&nbsp; 
&nbsp;

Despite these measures, the risk of masked nocturnal hypertension remains and poses an increased risk for cardiovascular diseases<a href="#accordion">[7]</a>. 
&nbsp;

Sleep apnea and obstructive sleep apnea in particular, has been closely related to hypertension. Nocturnal hypertension is very commonly found in patients of sleep apnea. Coexistence of these two issues tend to increase the chances of the development of other cardiovascular issues.&nbsp; 
&nbsp;

Continuous positive airway pressure, which is the main therapy for sleep apnea, has little to no effect on the elevated blood pressure experienced in nocturnal hypertension and thus goes unnoticed<a href="#accordion">[9]</a>.&nbsp; 
&nbsp;

While there is no specific treatment targeted towards nocturnal hypertension, it is believed that taking blood pressure medications even during the day keeps the pressure at bay at night.&nbsp; 
&nbsp;

Other approaches towards the treatment would mainly include lifestyle changes, like taking potassium supplements, monitoring and reducing sodium intake, and avoiding any sleep-interrupting stimulants like alcohol or caffeine. Regulating sleep and following a proper sleep hygiene routine is a crucial fix to nocturnal hypertension<a href="#accordion">[9]</a>.&nbsp; 
&nbsp;

Considering that nocturnal hypertension is closely linked to diabetes, maintaining blood sugar level and even overall sugar intake is very important to the process. Lastly, it helps to keep a check on and maintain the other underlying health conditions<a href="#accordion">[10]</a>. 
&nbsp;

<ul>
	<li>Nocturnal hypertension refers to high blood pressure of a person while they are asleep.</li>
	<li>It has been related to several health conditions and is believed to increase the chances of several cardiovascular issues, including heart failure and stroke.</li>
	<li>There are no targeted medicines that work specifically for nocturnal hypertension. The ideal way to combat it is through lifestyle changes.</li>
</ul>

[1] Vij R, Peixoto AJ. Management of nocturnal hypertension. Expert Review of Cardiovascular Therapy. 2009;7(6):607-618. doi:10.1586/erc.09.42

[2] Tadic M, Cuspidi C, Grassi G, Mancia G. isolated nocturnal hypertension: What do we know and what can we do? Integrated Blood Pressure Control. 2020;Volume 13:63-69. doi:10.2147/ibpc.s223336

[3] Cuspidi C, Sala C, Tadic M, et al. Clinical and prognostic significance of a reverse dipping pattern on ambulatory monitoring: An updated review. The Journal of Clinical Hypertension. 2017;19(7):713-721. doi:10.1111/jch.13023

[4] Yan B, Peng L, Han D, et al. Blood pressure reverse-dipping is associated with early formation of carotid plaque in senior hypertensive patients. Medicine. 2015;94(10). doi:10.1097/md.0000000000000604

[5] Routledge F, McFetridge-Durdle J. Nondipping blood pressure patterns among individuals with essential hypertension: A review of the literature. European Journal of Cardiovascular Nursing. 2007;6(1):9-26. doi:10.1016/j.ejcnurse.2006.05.001

[6] Hypertension. World Health Organization.

[7] Whelton PK, Carey RM, Aronow WS, et al.. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Hypertension. 2018; 71:e13–e115. doi: 10.1161/HYP.0000000000000065

[9] Kario K. Nocturnal hypertension. Hypertension. 2018;71(6):997-1009. doi:10.1161/hypertensionaha.118.10971

[8] Kario K, Hettrick DA, Prejbisz A, Januszewicz A. Obstructive sleep apnea–induced neurogenic nocturnal hypertension. Hypertension. 2021;77(4):1047-1060. doi:10.1161/hypertensionaha.120.16378