A Special Look at Hypertension and Pregnancy Part II

In the first part of this topic you learned about what Pre-eclampsia is, and the risk factors that your mom, sister, tantie, wife, niece or cousin may have, that predisposes her to developing this ailment. You also learnt about signs and symptoms of this sickness, and the importance of encouraging your pregnant loved one to go for her antenatal checkups.

For a review of Part I click here.

In Part II, we'll have a look at the complications of pre-eclampsia, for both mother and baby, as well as treatment, and prevention.

courtesy www.clipartbest.com

First let's have a look at complications for the Moms-to-be...

COMPLICATIONS

Maternal Complications

SEIZURES

For women suffering from preeclampsia, any type of convulsive activity or fit that she suffers after 20 weeks gestation or immediately after giving birth is known by the name of Eclampsia.
When suffering an eclamptic seizure, the mom-to-be may suffer involuntary repetitive, jerky movements of the arms and legs, or may have facial twitching.

STROKE

High blood pressure can cause a brain injury, due to an interruption of blood supply to the brain.

PULMONARY OEDEMA

In this complication fluid builds up inside of the lungs, preventing them from receiving oxygen and functioning properly.

KIDNEY FAILURE

Hypertension can cause more pressure on the kidneys of pregnant women, and the damage it causes allows to kidney to be unable to filter the toxins out of the body, which causes an increase of toxicity in the blood and body.

CLOTTING DISORDERS

This complication can cause an increase in blood clot formation within the mother´s body, or can cause excessive bleeding because the blood clotting system begins to fail.

HELLP SYNDROME

This is a complication that is characterized by:

1) Destruction of the mother's red blood cells, known by the term hemolysis.

2) An increase in the amount of certain liver proteins known as enzymes.

3)  A decrease in one of the blood elements responsible for clotting known as platelets. 

To read about more maternal complications, click here ....

courtesy www.etsy.com

Fetal Complications

Fetal complications stem from a decrease in blood flow to the uterus, the placenta is thus deprived of oxygen and nutrients essential to the baby's growth and development, as a result the baby can suffer:

• Intrauterine Growth Restriction in which the baby does not grow as it should according to its age in weeks. As a result after birth the baby may be smaller than it should be.
• Lack of oxygen while inside the uterus also known as Intrauterine asphyxia.
• Prematurity, or being  born before it is full term, that is, 37 weeks.
• Respiratory Problems after being born (Neonatal Asphyxia).
• Intrauterine Fetal Death.

courtesy www.cen.acs.org

TREATMENT

The optimum treatment of pre-eclampsia is induction of labour. However, the manner in which this is done is very much dependent on the severity of the pre-eclaampsia, the number of weeks the pregnancy currently has progressed to, and how the baby is doing. 

Possible treatment include used of  blood pressure medication such as, methyldopa, nifedipine or labetalol

Methyldopa or Aldomet is the treatment of choice in pregnancy and functions by relaxing blood vessels, reducing the pressure of the blood inside them, ensuring that the blood can circulate more efficiently around the body.

To understand how Nifedipine or Adalat works, read about Calcium Channel Blockers in the last section of the blog post from March:  So You Already Suffer from High Blood Pressure Pt I...

To understand how Labetalol functions, read about Beta-Adrenoceptor Antagonists in the last section of the blog post from April: So You Already Suffer from High Blood Pressure Pt II...

courtesy heart.org

PREVENTION

How can pre-eclampsia be prevented?  Can it be? 

It cannot be totally prevented. However, the risk or suffering from it during pregnancy can be reduced through the following ways:

1) Be aware of the risk factors that are present in your life.

2) Know the symptoms to look out for.

To read about risk factors and symptoms of pre-eclampsia read the first part of the blog post, A Special Look at Hypertension and Pregnancy Part I

3) Make certain that all antenatal appointments are attended. 

Never underestimate the value of the blood pressure checks, the blood and urine investigations done,the weight checks, as well as the constant focus on the growth and development of your baby. 

The more antenatal clinic appointments attended the quicker any risk of developing pre-eclampsia will be detected. In Wadadli antenatal care is free, and thus ought to be taken advantage of. 

It is a privilege that many women on this planet do not have.

4) For women who have high risk of suffering from pre-eclampsia, low dose aspirin or calcium                 supplementation may be prescribed, to lower its appearance as well as its complications.

Pre-eclampsia is one variant of different categories of high-blood pressure related illnesses during pregnancy, to read more about the other variations click here.

You can also read more here.

With this we've ended not only our look at hypertension in pregnancy but our discussion about hypertension in general as a sickness that affects our Wadadlian population.

High blood pressure ought not to be played with whether pregnant or not, whether old or whether young. It is dark portal that leads to a pathway of other diseases and complications that will without doubt affect your daily life. 

Hopefully through these posts you are now able to identify any risk factors present in your life or that of your loved ones, and most importantly be able to share you knowledge with someone who you know may be at risk. 

Rememba wa dem say, "Prevenshan betta dan cyur"

#Wadadlianstrong

Blessings to you and yours, 

© June 2014

A Special look at Hypertension and Pregnancy Part I

Good-day everyone! 

It's been a while but we're back sharing information, and helping you learn more about conditions that affect our Wadadlian Community. 

To continue the series we have embarked upon about the Cardiovascular System and Hypertension on the Wadadlian Health Blog, we'd like to share a bit about Hypertension related to pregnancy. 

courtesy heart.org

Pregnancy is a beautiful period in a woman’s life where she is the nurturing element that propels new life into the world, but too often we see that at this time, where ideally she should be eating wholesome foods, resting adequately and allowing for the healthy development of her baby, she can be plagued with many ills which can further complicate her physiological condition. 

Today our focus will be on Pre-eclampsia also known as Toxemia, one of the most frequently seen complications during pregnancy. This variation of the ‘silent killer” can be asymptomatic in its early stages in pregnancy and only provoke symptoms when it is very advanced. 

In Part I we'll be touching on its definition, risk factors, as well signs and symptoms to look out for.

Pre-eclampsia can be defined as the elevation of blood pressure to at least 140/90 mmHg that is induced during pregnancy usually after 20 weeks of gestation, and often is associated with protein being found in the urine. The condition resolves 6 weeks after the baby is born.

courtesy American Pregnancy Association

The exact cause of pre-eclampsia is not verified but research suggests it may be a problem with the blood vessels in the placenta, and the way it is attached to the womb (the placenta or  afterbirth, is the structure that lies between your baby and your  womb.)

Bear in mind, all pregnant women can develop pre-eclampsia however there are some who may be more likely to have it during pregnancy due to certain risk factors in their life.

                                           

                                                           courtesy blackradionetwork.com

Risk Factors of Pre-eclampsia:

1. History of previous pre-eclampsia.  A personal or family history (mother or sister) of pre- eclampsia increases your risk of developing the condition.

2. First pregnancy. The risk of developing pre-eclampsia is highest during your first pregnancy.             

3. New paternity. Each pregnancy with a new partner increases the risk of pre-eclampsia.

4. Age. The risk of pre-eclampsia is higher for pregnant women younger than 20 and older than 40 years of age. 

5. Obesity. The risk of pre-eclampsia is higher if you're obese.

6. Multiple pregnancy.  Pre-eclampsia is more common in women who are carrying twins, triplets or other multiples.          

7. Prolonged interval between pregnancies. Specifically of 10 years or more seems to increase the risk of suffering from the condition.

8. Diabetes and gestational diabetes.  Women who develop gestational diabetes or already suffered from diabetes prior to becoming pregnant have a higher risk of developing pre-eclampsia as the pregnancy progresses.

9. History of certain pre-existing conditions.  Having certain conditions before you become pregnant- such as chronic high blood pressure, migraine headaches, urinary tract infection, vitamin D deficiency, diabetes, kidney disease, rheumatoid arthritis or lupus, amongst others increases the risk of pre-eclampsia.

10. Ethnicity. Pre-eclampsia is found to be more common amongst the black race. Click here to read more.             

                                                    courtesy womenshealthency.com

Bear in mind it is possible that pre-eclampsia may be asymptomatic, with only high levels of blood pressure and proteins found in urine aiding in its diagnosis, this is why it is SO VERY IMPORTANT  to have regular checks of your blood pressure while pregnant. 

If you are unsure about the values of blood pressure readings and what they mean, no worries, you can read LAWD MA PRESSHA PART II from an earlier post in February.

Please note that in pregnancy values between:

                                               140/90 to 149/99 mmHg = mild hypertension 

                                               150/100 to 159/109 mmHg = moderate hypertension

                                               160/ 110 mmHg and above = severe hypertension

                                                                    

courtesy American Heart Association

Signs and Symptoms of Pre-eclampsia:

Apart from high levels blood pressure (hypertension), and the kidneys leaking proteins into the urine, pregnant women may experience:

Dizziness 

Blurry vision or seeing marks or spots in your vision

Photophobia or the eyes being irritated in the presence of light 

Headaches that are constant, or repetitive

Swelling of the feet, hand, and face (now this happens normally during pregnancy, but if this suddenly becomes worse it must be taken into consideration)

Sudden weight gain

Decrease in urination

Nausea and vomiting, (that is different from morning sickness in the early stages of pregnancy)

Decrease in the baby's movements

Belly pain, most frequently on the right side below the ribs

Shortness of breath

It is important to be aware of these symptoms and signs not only during pregnancy but after giving birth as pre-eclampsia extends for 6 weeks after the baby is born.

In Antigua and Barbuda full antenatal care is provided in our district clinics, this a privilege to be taken advantage of. It cannot be expressed how IMPORTANT it is to receive regular checkups during pregnancy, whether it is the first time being pregnant or the fifth. Pre-eclampsia is a form of hypertension that is harmful to both mother and child when undiagnosed. 

Feeling well, by no means indicates that you actually are, and without proper checkups and antenatal care, it is possible that both the mother and unborn child will suffer in the deadly silence of hypertension.

If you have a loved one who is currently pregnant, encourage them to get their checkups done at the clinic, blood pressure screening will always be done.

In Part II we'll be addressing the complications of Pre-eclampsia as well as the treatment, and most importantly the aim of this blog PREVENTION.

Keep your family, both future and present, #wadadlianstrong.

Blessings to you and yours,

 

© June 2014

So You Already Suffer from High Blood Pressure...Pt II

In the last post you were introduced to five groups of anti-hypertensive medication:

1. Diuretics
2. Calcium Channel Blockers
3. ACE Inhibitors
4. Angiotensin II Receptor Antagonists
5. Beta-Adrenoreceptor Antagonists.

We touched on the first two, for a refresher click here.

In this post we'll be touching on ACE Inhibitors, also known as Angiotensin Converting Enzyme Inhibitors, Angiotensin II Receptor Antagonists, and Beta-Adrenoreceptor Antagonists.

courtesy hotwallpaperz.com

• ACE INHIBITORS

To understand how ACE (Angiotensin Converting Enzyme) Inhibitors function to lower blood pressure, it is important to have an idea of what Angiotensin is.

Angiotensin is nothing more than a protein in the body, there are two types, Angiotensin I and Angiotensin II. Angiotensin I is made from a hormonal reaction in the kidneys, when the body detects that blood pressure is low. After being produced, Angiotensin I is converted to Angiotensin II by an enzyme in the lungs known as the Angiotensin Converting Enzyme.

Angiotensin II is the most powerful substance known to constrict blood vessels, thereby increasing blood pressure. 

Now think of the name of the medication, Angiotensin Converting Enzyme Inhibitors. 
Can you guess where I am going with this in terms of how this anti-hypertensive medication functions?

ACE inhibitors literally block the enzyme which is its namesake, from converting Angiotensin I to Angiotensin II, therefore, no Angiotensin II, no increase in blood pressure.

Brand Name                                           Scientific Name  

Capoten                                                                  Captopril

Prinivil, Zestril                                                       Lisinopril

Lotensin                                                                    Benzaepril

Univasc                                                                     Moexipril

Read more here.

• ANGIOTENSIN II RECEPTOR ANTAGONISTS

The Angiotensin II Receptor Antagonists have a similar approach as the ACE Inhibitors to lowering blood pressure, but it goes a step further.

In order for Angiotensin II to carry out constriction of the blood vessels or vaso-constriction it would have to first attatch itself to receptors on found on the arteries. This is where this anti-hypertensive medication comes in; since they are antagonists. This simply means they will compete with Angiotensin II for attatchment to the receptor on the arteries. As they bind to the receptor, they prevent Angiotensin II from causing vessel constriction, therefore causing blood pressure to be lowered.

Brand Name                                           Scientific Name  

Diovan                                                                      Valsartan

Cozaar                                                                         Losartan

Teveten                                                                      Eprosartan 

Click here to read more.

• BETA-ADRENOCEPTOR ANTAGONISTS

Do you remember the term antagonist? Scroll upwards if you don't its highlighted in red.
Beta adrenoceptor Antagonists drugs follow the same principle as the Angiotensin II Receptor Antagonists. They compete with certain hormones at their attatchment sites in order to lower blood pressure.
The hormones in question are norepinephrine and epinephrine, also known as adrenaline.

Courtesy thinkingonthemargin.blogspot.com

Ever heard the term fight or flight? Well these are the hormones responsible for that reaction.

Norepeniphrine and adrenaline (epinephrine) are released from our nerve endings all over the body and function as neurotransmitters since they help our nerves to communicate in their own way. They are also released into the blood, and their effects as stress hormones are most popularly documented in the fight or flight reaction just mentioned.

So... how do the beta-adrenoreceptors medications function? 

They block norepinephrine and adrenaline from binding to the beta receptors found, for example on the cells of the heart, blood vessels, kidney amongst other sites, by binding to them. In doing so, they reduce the narrowing of blood vessels, and decrease the force at which the heart pumps blood, causing the blood pressure to become lower.

Brand Name                                           Scientific Name  

Tenormin                                                               Atenolol
Inderal, InnoPran                                              Propanolol
Trandate, Normodyne                                             Labetolol
Corgard                                                                      Nadolol
Coreg                                                                         Carvedilol
Lopressor, Toprol-XL                                              Metoprolol                        
                                                                                
For more information click here... and click here, as well.

There you go. 
You should now have a general idea about the five groups of high blood pressure medication:

1. Diuretics
2. Calcium Channel Blockers
3. ACE Inhibitors
4. Angiotensin II Receptor Antagonists
5. Beta-Adrenoreceptor Antagonists.

You could be using any of the medication in these groups to currently to treat your hypertension. Remember I've not included any side effects, so look those up! That would be your homework. :)

If you would like to review to first two groups previously discussed click here.  
Remember to keep interested in what medications you are using, why they help you, and what possible side-effects they may have.
Its all well and good to ask your doctor, never be afraid to, always ask questions, but also be interested enough in your body to do the research, self-education is a beautiful thing.

Blessings to you and yours, 

#wadadlianstrong

©April 2014

So You Already Suffer from High Blood Pressure...Pt I

Over the last few months we've looked at the way the heart works and factors that contribute to the appearance of hypertension in our lives, and Dr. Smith in her post enlightened us about steps that can be used for preventative purposes...but what about those of you who have already past the risk factor stage, and are now living and suffering from the disease?

Well in today's post I'd like you to learn a bit about how medications you may be taking for your hypertension works. Many people are delinquent in the treatment of this disease sometimes for lack of understanding of how the treatment works. 

Its IMPORTANT  for me to say, that the treatment for hypertension like most other diseases is INDIVIDUALIZED, that means... 

courtesy theexecutiveconsultant.com

...that just because Susie down the road is using a particular medication for her pressure, and you're not using it DOES NOT mean that Susie's treatment is better. Not just because Susie has it, it is good for you to have. 

Why?

1. She might be at a different stage of hypertension than you are, (To see the Stages of Hypertension click here)  
2. You might have a particular allergy to certain types of medication that Susie does not have. 
3. Susie may suffer from Hypertension and other diseases that make her medication better suited for her use.

I just listed 3 but to tell the truth, the factors are endless. 
The bottom line is your treatment should cater to your body and circumstance, not someone else's.

Having said that, here's my version of an explanation. 

Anti-hypertensive drugs can be grouped or classified in scores of different ways. For easier reference I've decided to use the following:

1. Diuretics
2. Calcium Channel Blockers
3. ACE Inhibitors
4. Angiotensin II Receptor Antagonists
5. Beta-Adrenoreceptor Antagonists.

Don't worry. I'll make it as simple as I can, In this post, Part I mind you, we'll tackle the first two. 

Diuretics and Calcium Channel Blockers.

• DIURETICS

Generally speaking, this group of medication lowers blood pressure and water retention by increasing the amount of urine you produce. 

Diuretics primarily reduce the amount of salt (principally sodium) in the body, causing the overall amount of blood or blood volume to be reduced, if there is less volume of blood in the arteries this means the blood pressure is reduced, and the heart can pump blood to the rest of the body more effectively.

Here are some examples of diuretics that you may use. I have bolded those which some of my family members use.

Brand Name                                           Scientific Name                    

Diuril                                                                  Chlorothiazide                         
Esidrex, Microzide, Oretic                                     Hydrochlorothizide               
Lasix                                                                   Furosemide                             
Lozol                                                                   Indapamide
Thalitone, Hygroton                                              Clorthalidone

The large diuretic group has sub-classifications dependent on how each drug acts specifically, if interested you can read a general overview here, or get into the details here.

• CALCIUM CHANNEL BLOCKERS

Let me give you a bit of background first.

Calcium is the element that is linked to the heart contracting, think of it as an activator. Our heart has electrical impulses flowing through it, and these impulses allow calcium to enter the muscle cells of the heart and release calcium stores that are already present inside them.

Now, if there is calcium coming from the outside in, and on top of that releasing more calcium on the inside, of course the amount of overall calcium will increase, and when it has reached a certain level it activates the heart muscles to contract, causing the heart to pump blood.

courtesy alessiodevecchi

The higher the amount of calcium the greater the contraction, and the harder the heart pumps blood. The electrical impulse will eventually pass and when it does calcium can no longer enter the heart cells. This means that it can no longer release the calcium stores inside it. So, its levels are reduced and the muscles of the heart relax. 

All this happens in less than a second, believe it or not.

Now. How does this anti-hypertensive drug group reduce blood pressure? 
Read on.

Calcium Channels Blockers prevents calcium from entering the heart, this means that the forceful contraction of the heart is reduced, this means that the heart will not pump as forcefully, reducing the heart rate, also calcium channel blockers help to open up blood vessels that are narrow, which means the pressure of the blood will be reduced.

Brand Name                                           Scientific Name              

Adalat, Procardia                                                     Nifedipine
Cardene                                                                   Nicardipine
Norvasc                                                                  Amlodipine
Cereleen, Isoptin, Covera                                         Verapamil
Diltia, Dilacor, Cardizem                                           Diltiazem


Read more about the general mechanism of calcium channel blockers here.

Your homework?
Revise this post again, and when you are finished, check to see if you take any medications from these first two groups we've discussed.  (Google it if you're not sure) and look up the side effects.

These are my ABCD's for taking medication:

Always ask your doctor about the side effects of any and every drug you take. 
Be interested in what you put into your body. 
Crave information.
Do a little digging, inform your self. Self-education is always necessary to maintain health.

In the next post we'll have a look at ACE Inhibitors, Angiotensin II Receptor Antagonists and Beta-Adrenoreceptor Antagonists.

Stay #wadadlianstrong. 
Blessings to you and yours,

© March 2014

Preventing High Blood Pressure...Guest Post by Dr. Tadia Smith

Since I've started the Wadadlian Health blog, other Antiguan Cuban-trained doctors who also want to make a difference in our Community Health have become interested in participating and have decided to lend a hand in ensuring our islands become #wadadlianstrong.

Today's post summarizes different measures that we all can use in our lives to live healthier and decrease the risk of the "silent-killer" hypertension. It is contributed by fellow colleague, Doctor Tadia S. S. Smith, currently training in our CARICOM neighbour, St. Lucia.

Enjoy...

                     

PREVENTING HIGH BLOOD PRESSURE   

  

Factors that can be managed in order to avoid the presence of hypertension, fit easily under the topic of lifestyle, specifically when it comes to diet and exercise. The following measures, if implemented can not only contribute to a healthier you, but reduce the risk of hypertension.

A high fiber diet is very important (whole grains, beans, fruits and vegetables). Eat lots of fresh fruits, fresh vegetables (raw if possible) rich in potassium, calcium and magnesium, and limit products containing saturated animal fats (margarine etc.). 

courtesy www.fodors.com

The DASH Diet– Dietary Approaches to Stop Hypertension has been reported to substantially lower Blood Pressure (BP).

The DASH diet-eating plan is a diet rich in fruits, vegetables, low fat or nonfat dairy. It also includes grains, especially whole grains; lean meats, fish and poultry; nuts and beans. It is high fiber and low to moderate in fat. Since the DASH diet is a healthy way of eating, it offers health benefits besides just lowering blood pressure. The DASH diet is also in line with dietary recommendations to prevent osteoporosis, cancer, heart disease, stroke and diabetes.

It is a plan that follows US guidelines for sodium content. In addition to lowering blood pressure, the DASH eating plan lowers cholesterol and makes it easy to lose weight. It is a healthy way of eating, designed to be flexible enough to meet the lifestyle and food preferences of most people; and, it contains all the healthy foods from the Mediterranean diet. (Read more here.)

The DASH eating plan used along with other lifestyle changes can help you prevent and control blood pressure. This eating plan also has other benefits, such as lowering LDL (“bad”) cholesterol, which, along with lowering blood pressure, can reduce your risk for getting heart disease.

Other dietary suggestions include limiting the amounts of red meats such as beef, liver, kidneys in the diet, and instead increasing the amounts of white meats such as chicken and fish that are rich in Omega-3.

The use of Onions, garlic and cloves are also helpful, as these natural herbs contain compounds that lower Blood Pressure (BP) and cholesterol levels. Of notable use is parsley which is a natural diuretic and also high in potassium.

It is important to try to reduce the amount of salt in your diet. Salt contains sodium that causes the blood to retain fluid, and as a result, increases the Blood Pressure (BP).

Reduce your intake of caffeinated products, and limit the consumption of alcohol. Moderation is key in life.

Keep active; do not lead a sedentary or inactive life. 

Exercise regularly and systematically for 30-45 minutes daily or walking at least 2-3 blocks. The type of exercise must be individualized depending on your age and condition. Aerobic exercises are recommended. 

Losing excess weight and trying to maintain an ideal body weight influences blood pressure values. Here's an easy to calculate what is ideal for you:

                Ideal Body weight in Kg = (Body Height in cm – 100) Non diabetics

                Ideal Body weight in Kg = (Body Height in cm - 105) Diabetics

Quit smoking and avoid secondhand smoke since nicotine causes the blood vessels to constrict, thus increasing Blood Pressure (BP). 

Remember that when your Mind, Body and Spirit are in total equilibrium, there is no room for DISEASE!!!! 

The risk of high blood pressure can be lessened by making intelligent lifestyle choices that include a healthy, nutritionally complete diet, daily exercise and avoidance of stress.

An ounce of Prevention is better than a pound of Cure – So eat healthy, exercise regularly and maintain a positive attitude towards life.

Periodic Blood Pressure Checks are advised, particularly if you are over 30 years, so that you can begin treatment early in the event that you develop hypertension.

Hypertension is a chronic and non-transmissible disease that poses as a threat to life if not treated adequately. Find the cause and treat it!

© March 2014