Sometimes cases are noticed, where drug treatment is started straight in the first visit of a newly diagnosed patient of hypertension. I, somehow could not digest this. If it is too high when first noticed drug treatment may be started but with mild to moderate rise in pressure, some other things should be tried first. Researchers also agree to it. It may have a cause to be designated as secondary hypertension. When a cause is not found it is termed as idiopathic or primary hypertension. However many theories are advanced to explain it.

• Atherosclerosis is the main contributing factor. Here fat plaques form on the inner layer of the blood vessels, thereby narrowing the lumen. That gives resistance to flow of blood and the pumping force of heart has to increase to maintain adequate flow. So, the result is increased pressure.
• Stress and strain induces a variety of endocrine hormones such as corticosteroids and adrenaline play a major role in sustaing it.
• Rennin, angiotensin and aldosterone axis also plays a major role.
• Obesity is a major cause of it. It is measured by what is called body mass index (BMI), which is arrived at by the formula body weight in kgs/body surface in square meter. If it is more than 30 the person is obese. And around 25 is normal

Blood pressure has two components namely systolic and diastolic. Systolic is the pressure when the heart pumps blood and diastolic is the pressure when the heart receives blood from vein and getting filled. Normally systolic blood pressure ranges from 90 mm. to 130 mm. of mercury and diastolic pressure ranges from 60 mm. to 90 mm. of mercury. When its value exceeds 130/90 mm. it is termed as hypertension. However, the patient should not be stamped as hypertensive right in the first visit, because simple tension of being examined may raise the blood pressure of a person. We usually take three recordings in three different occasions to confirm the disease.
Relevant investigations for diabetes mellitus, lipid profile, ECG, ultrasonogram, kidney profile and urine examination are to be done to exclude any other cause for it or to find out associated diseases. If no specific cause is found it is termed as idiopathic and presumed to be due to atherosclerosis.
The hierarchy of treatment should be as follows.

• Life style modification. Patients leading a sedentary life should be encouraged to go for physical exercise. That will give relaxation, reduce weight, mobilize fat and keep the arteries clean from the deposits of atheromatous plaques. That will streamline blood flow and reduce hypertension.
• Restriction of salt intake will go a long way in reducing the hypertension influencing the rennin-angiotensin-aldosterone axis.
• Meditation will give relaxation and reduce stress which in turn will reduce the steroid hormone level to facilitate reduction of blood pressure.
• Taking a few petals of garlic is said to have positive health benefits,as well as Yogic practices.
• Thereafter, comes the role of drugs and first being a diuretic. And there is a long list of drugs which are to be prescribed by the expert physician.

Therefore, hypertension should be treated in a planned way. If pre-drug treatment practices are followed a number of patients may not require medications at all.

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