lersus

Precautions

It should not be used in patients with a history of epilepsy or any psychiatric disorder

It should not be used in children below two years.

Avoid its use with quinine, quinidine or any other drugs which may cause disturbance of heart beat before or after mefloquine.

It should not be used during pregnancy.

Driving or operating any machinery should be avoided.

Quinine

This drug is obtained from the bark of the plant cinchona which is cultivated in eastern India. The plant originated in South America where it grew wild. For almost a century, until the 1940s, the drug enjoyed an unrivalled role in the treatment of malaria. Its value declined gradually with the discovery of newer drugs during the Second World War, which were more effective and less toxic. Its actions are similar to chloroquine. It is still used in the treatment of certain multiresistant strains of the malarial parasites causing brain fever (cerebral malaria).

Dosage: It is given in a dose of 300 to 600 mg orally, three to four times a day for 7 to 10 days. In cerebral malaria this drug has to be given by intravenous route with glucose and saline.

Adverse Effects: The adverse effects of large doses of quinine are quite serious and in some hypersensitive individuals maybe caused even by small doses. These include ringing sounds in the ears, loss of hearing, vertigo, blurring of vision, skin rashes, nausea, vomiting, diarrhoea, abdominal pain, fever, convulsions, fall in blood pressure, and depression of respiration. It may also cause destruction of red blood cells (haemolytic anaemia).

Precautions

Stop the drug immediately if allergy or pal our of skin (due to haemolytic anaemia) occur.

Avoid its use if you suffer from ringing in the ear or visual disturbances (optic neuritis).

Take the drug after meals.

Avoid its use during the first few months of pregnancy. It may cause abortion.

Primaquine

It is used for a complete cure. It is usually given along with or after chloroquine. Although it has prophylactic properties, it is not used for this purpose because of its toxic nature. Primaquine is given in a dose of 15 mg per day for 2 weeks, for a complete

cure.

Adverse Effects: In therapeutic doses it may cause abdominal discomfort and anaemia: Large doses may cause marked discomfort and alteration in blood (methaemoglobinaemia) and destruction of red blood cells (haemolytic anaemia) in individuals who have low level of an enzyme called G-6 PD. Spot tests are available for testing of G-6-PD deficiency state. If

C-6-PD deficiency is detected, bulaquin (AABLAQUIN) is available which is claimed to be tolerated well in a dose of 25 mg per day for 5 days.

Precautions

The drug should be taken under the supervision of a physician.

The drug should be stopped immediately if darkening of urine occurs.

Its concurrent use with quinacrine should be avoided.

Avoid its use if you are suffering from rheumatoid arthritis.

Note: Due to its toxic side-effects the drug is not allowed to be sold in regular chemist shops and is available only through the public health department.

About the author:
AdvCare is one of the leading Canada pharmacy website. First established in January 2000, its mission is to become the number one site for Discount Drugs and Generic Prescription Drugs searches.

New Generation Anti-depressants :

Due to a large number of side-effects caused by the tricyclic antidepressants and the monoamine oxidase inhibitors, efforts have been made by pharmaceutical research groups to bring out newer and safer drugs.

Selective Serotonin Reuptake Inhibitors (SSRIs)

The major drawback of conventional tricyclic antidepressants are unacceptable effects on heart (fall in BP, rhythm disturbances) anticholinergic and neurological adverse effects. Low safety margin, as fatalities are common. Slow onset of action. Propensity to precipitate fits; Sedation; Incomplete/poor response in some patients. Advent of SSRIs in 1980 have overcome above limitations to a great extent. SSRIs are becoming preferred drugs for th.el treatment of endogenous depression because of their merits, which are:

Quick onset of action.

Little or no sedation.

No interference with mental functions.

No postural fall in blood pressure so appropriate in elderly.

No precipitation of convulsions.

Little chance of overdose and heart rhythm disturbance.

Antidepressant efficacy equal to tricyclics.

Utility in anxiety, phobia and obsessive compulsive neurosis.

Adverse Effects: Nausea, interference with ejaculation, orgasm nervousness, restlessness, insomnia, loss of appetite, mild abnormal movements, headache and diarrhoea may occur. Sometimes discontinuation of SSRIs result in bowel upset, pins-needles sensations, bodyache and sleep disturbance. Importantly, these drugs may adversely interact with antihistaminics, antipsychotics, propranolol, carbamazepine and diazepam. Therefore, patients on such medications should have appropriate dose adjustments.

St John’s Wart (Hypericin, Hylax)

Hypericin is an active ingredient of aerial parts of St John’s Wart. It is an effective mood elevator and antidepressant in mild to moderate depression in a dose of 1 capsule three times twice a day. It is particularly used when depression is due to a serious medical illness, concurrent medications (amitryptyline, anti HIV drugs, theophylline and warfarin) interact with it.

Mono-amine Oxidase Inhibitors (MAO-Is)

These are older drugs effective in depression but show a lot of adverse interactions with drugs and food . The cheese reaction occurs when foods/beverages such as cheese, bean, red wine, over ripe fruits, broad beans, yeast and soya sauce (all contain a chemical tyramine) are patients on MAO-Is.

About the author:
AdvCare is one of the Canada leading pharmacy website. First established in January 2000, its mission is to become the number one site for prescription drug and drug store searches.

Blindness is a major health problem the world over. It is estimated that there are approximately 50,000,000 blind persons in the world and another approximately 150,000,000 with diminished or impaired vision who are unable to function effectively. The factors causing visual disability, are discussed briefly in this chapter.

Eye Infections

Allergic Conjunctivitis

It could be seasonal keratoconjunctivitis seen usually in summer season. Patient has complaints of eye discomfort and redness. It is treated with combination of anti-allergies and low dose of steroids. Another form of allergy is due to use of medication, for which the use of drug should be stopped.

Bacterial Infection

Infection of eye membrane (conjunctivitis) and eyelids (blepharitis) occurs both in children and adults. It may occur in a newborn baby (neonate) too. It is usually caused due to poor hygiene. There may be discharge from the eye. The eyelids may adhere to one another and it may be difficult to open the eye. Sometimes a boil may appear on the eyelash with pus in it (stye). In this case eyelash should be removed by a specialist followed with proper medication. Fomentation of the eyes with boiled water and a pinch of boric acid powder also provides some relief. Infection of cornea may be a severe condition, which if left untreated

may cause complete blindness, hence it requires aggressive treatment.

Fungal Infection

Injuries due to wooden stick or a thorn or vegetable matter can cause fungal infection. This a corneal ulcer, which is difficult to treat and needs a specialist’s intervention.

Viral Infection

Trachoma is a contagious inflammation of eye caused by Chlamydia trachomatis, which is not a true virus but resembles a virus in its properties. It develops slowly. Initially, the patients feels irritation in the eye with redness. This may progress to the formation of small follicles and scarring of eye membrane. If cornea is involved, it may lead to blindness.

Epidemic kertoconjunctivitis is usually seen after rainy season and is caused by Adenovirus. It has no specific treatment. Herpes, a common viral infection, can also cause corneal ulceration.

Treatment of Eye Infections

The treatment of infection of the eye requires anti-microbial eye drops or ointments.

About the author:
AdvCare is one of the leading Canada pharmacy website. First established in January 2000, its mission is to become the number one site for Discount Drugs and Generic Prescription Drugs searches.

Blindness is a major health problem the world over. It is estimated that there are approximately 50,000,000 blind persons in the world and another approximately 150,000,000 with diminished or impaired vision who are unable to function effectively. The factors causing visual disability, are discussed briefly in this chapter.

Eye Infections

Allergic Conjunctivitis

It could be seasonal keratoconjunctivitis seen usually in summer season. Patient has complaints of eye discomfort and redness. It is treated with combination of anti-allergies and low dose of steroids. Another form of allergy is due to use of medication, for which the use of drug should be stopped.

Bacterial Infection

Infection of eye membrane (conjunctivitis) and eyelids (blepharitis) occurs both in children and adults. It may occur in a newborn baby (neonate) too. It is usually caused due to poor hygiene. There may be discharge from the eye. The eyelids may adhere to one another and it may be difficult to open the eye. Sometimes a boil may appear on the eyelash with pus in it (stye). In this case eyelash should be removed by a specialist followed with proper medication. Fomentation of the eyes with boiled water and a pinch of boric acid powder also provides some relief. Infection of cornea may be a severe condition, which if left untreated

may cause complete blindness, hence it requires aggressive treatment.

Fungal Infection

Injuries due to wooden stick or a thorn or vegetable matter can cause fungal infection. This a corneal ulcer, which is difficult to treat and needs a specialist’s intervention.

Viral Infection

Trachoma is a contagious inflammation of eye caused by Chlamydia trachomatis, which is not a true virus but resembles a virus in its properties. It develops slowly. Initially, the patients feels irritation in the eye with redness. This may progress to the formation of small follicles and scarring of eye membrane. If cornea is involved, it may lead to blindness.

Epidemic kertoconjunctivitis is usually seen after rainy season and is caused by Adenovirus. It has no specific treatment. Herpes, a common viral infection, can also cause corneal ulceration.

Treatment of Eye Infections

The treatment of infection of the eye requires anti-microbial eye drops or ointments.

About the author:
AdvCare is one of the leading Canada pharmacy website. First established in January 2000, its mission is to become the number one site for Discount Drugs and Generic Prescription Drugs searches.

You only have to see a patient of Parkinson’s disease once to be able to make an instantaneous diagnosis of this disease in another. The symptoms are distinct. James Parkinson after whom the disease is named, was the first to give a complete account of this disease in 1817: He described it thus:

‘Involuntary tremulous motion, with lessened muscular power, in part, not in action, and even when supported; with a propensity to bend the trunk forward and to pass from a walking to running pace, the senses and intellects being uninjured.’

Parkinson’s disease, or Parkinsonism, is a chronic malady of the central nervous system, more common amongst the elderly, and characterized by muscle rigidity, rhythmic tremor, akinesia or immobility, loss of associated movements, and postural instability. The presence of these signs impairs the ability of the patient to make proper voluntary movements and to maintain posture through reflexes. The patient presents a characteristic feature of an expressionless or a ‘mask-life’ face, and has tremors of the hands. It is called ’shaking palsy’.

Causes: The real cause of this disease is not known. It is a disease of old age, but may also occur in middle age, It has a sporadic onset which is very gradual and prolonged. It is not considered a hereditary disease, although in about 6% cases, it has been found to run in families. The disease effects. 1 in 250 persons after the age of 40 years. It is degenerative disease in which the centers of brain which normally maintain stance and movements lose functional nerve cells. Parkinsonism can sometimes be due to a known cause such as a late complication of viral encephalitis, injury to brain or arteriosclerosis but such cases are not common. Certain anti-psychotic drugs like reserpine, chlopromazine, and haloperidol may cause symptoms similar to Parkinson’s disease, but not the actual disease

itself.

Although we do not know the cause of this disease, recent biochemical researches suggest that it may be due to a deficiency of a neurohormone (dopamine) and/or abundance of another neurohormone (acetylcholine) in the brain.

Treatment and Drugs

Some drugs facilitate dopaminergic transmission and reduce the symptoms. These are amantadine and l-deprenyl (Selegiline). With this knowledge, it has now become possible to at least control the symptomes by using specific drugs to correct the neurochemical imbalance, if not to provide a complete cure. Besides drug therapy, it is very important for a patient to undertake suitable physical exercises regularly, to avoid permanent stiffness of the joints. The drugs used in the treatment of Parkinson’s disease can be divided into those which correct: 1) the deficiency of dopamine; and 2) the effects caused by excessive

acetylcholine.

About the author:
AdvCare is one of the Canada leading pharmacy website. First established in January 2000, its mission is to become the number one site for prescription drug and drug store searches

Precautions

It should not be used in patients with a history of epilepsy or any psychiatric disorder

It should not be used in children below two years.

Avoid its use with quinine, quinidine or any other drugs which may cause disturbance of heart beat before or after mefloquine.

It should not be used during pregnancy.

Driving or operating any machinery should be avoided.

Quinine

This drug is obtained from the bark of the plant cinchona which is cultivated in eastern India. The plant originated in South America where it grew wild. For almost a century, until the 1940s, the drug enjoyed an unrivalled role in the treatment of malaria. Its value declined gradually with the discovery of newer drugs during the Second World War, which were more effective and less toxic. Its actions are similar to chloroquine. It is still used in the treatment of certain multiresistant strains of the malarial parasites causing brain fever (cerebral malaria).

Dosage: It is given in a dose of 300 to 600 mg orally, three to four times a day for 7 to 10 days. In cerebral malaria this drug has to be given by intravenous route with glucose and saline.

Adverse Effects: The adverse effects of large doses of quinine are quite serious and in some hypersensitive individuals maybe caused even by small doses. These include ringing sounds in the ears, loss of hearing, vertigo, blurring of vision, skin rashes, nausea, vomiting, diarrhoea, abdominal pain, fever, convulsions, fall in blood pressure, and depression of respiration. It may also cause destruction of red blood cells (haemolytic anaemia).

Precautions

Stop the drug immediately if allergy or pal our of skin (due to haemolytic anaemia) occur.

Avoid its use if you suffer from ringing in the ear or visual disturbances (optic neuritis).

Take the drug after meals.

Avoid its use during the first few months of pregnancy. It may cause abortion.

Primaquine

It is used for a complete cure. It is usually given along with or after chloroquine. Although it has prophylactic properties, it is not used for this purpose because of its toxic nature. Primaquine is given in a dose of 15 mg per day for 2 weeks, for a complete

cure.

Adverse Effects: In therapeutic doses it may cause abdominal discomfort and anaemia: Large doses may cause marked discomfort and alteration in blood (methaemoglobinaemia) and destruction of red blood cells (haemolytic anaemia) in individuals who have low level of an enzyme called G-6 PD. Spot tests are available for testing of G-6-PD deficiency state. If

C-6-PD deficiency is detected, bulaquin (AABLAQUIN) is available which is claimed to be tolerated well in a dose of 25 mg per day for 5 days.

Precautions

The drug should be taken under the supervision of a physician.

The drug should be stopped immediately if darkening of urine occurs.

Its concurrent use with quinacrine should be avoided.

Avoid its use if you are suffering from rheumatoid arthritis.

Note: Due to its toxic side-effects the drug is not allowed to be sold in regular chemist shops and is available only through the public health department.

About the author:
AdvCare is one of the leading Canada pharmacy website. First established in January 2000, its mission is to become the number one site for Discount Drugs and Generic Prescription Drugs searches.

Precautions

It should not be used in patients with a history of epilepsy or any psychiatric disorder

It should not be used in children below two years.

Avoid its use with quinine, quinidine or any other drugs which may cause disturbance of heart beat before or after mefloquine.

It should not be used during pregnancy.

Driving or operating any machinery should be avoided.

Quinine

This drug is obtained from the bark of the plant cinchona which is cultivated in eastern India. The plant originated in South America where it grew wild. For almost a century, until the 1940s, the drug enjoyed an unrivalled role in the treatment of malaria. Its value declined gradually with the discovery of newer drugs during the Second World War, which were more effective and less toxic. Its actions are similar to chloroquine. It is still used in the treatment of certain multiresistant strains of the malarial parasites causing brain fever (cerebral malaria).

Dosage: It is given in a dose of 300 to 600 mg orally, three to four times a day for 7 to 10 days. In cerebral malaria this drug has to be given by intravenous route with glucose and saline.

Adverse Effects: The adverse effects of large doses of quinine are quite serious and in some hypersensitive individuals maybe caused even by small doses. These include ringing sounds in the ears, loss of hearing, vertigo, blurring of vision, skin rashes, nausea, vomiting, diarrhoea, abdominal pain, fever, convulsions, fall in blood pressure, and depression of respiration. It may also cause destruction of red blood cells (haemolytic anaemia).

Precautions

Stop the drug immediately if allergy or pal our of skin (due to haemolytic anaemia) occur.

Avoid its use if you suffer from ringing in the ear or visual disturbances (optic neuritis).

Take the drug after meals.

Avoid its use during the first few months of pregnancy. It may cause abortion.

Primaquine

It is used for a complete cure. It is usually given along with or after chloroquine. Although it has prophylactic properties, it is not used for this purpose because of its toxic nature. Primaquine is given in a dose of 15 mg per day for 2 weeks, for a complete

cure.

Adverse Effects: In therapeutic doses it may cause abdominal discomfort and anaemia: Large doses may cause marked discomfort and alteration in blood (methaemoglobinaemia) and destruction of red blood cells (haemolytic anaemia) in individuals who have low level of an enzyme called G-6 PD. Spot tests are available for testing of G-6-PD deficiency state. If

C-6-PD deficiency is detected, bulaquin (AABLAQUIN) is available which is claimed to be tolerated well in a dose of 25 mg per day for 5 days.

Precautions

The drug should be taken under the supervision of a physician.

The drug should be stopped immediately if darkening of urine occurs.

Its concurrent use with quinacrine should be avoided.

Avoid its use if you are suffering from rheumatoid arthritis.

Note: Due to its toxic side-effects the drug is not allowed to be sold in regular chemist shops and is available only through the public health department.

About the author:
AdvCare is one of the leading Canada pharmacy website. First established in January 2000, its mission is to become the number one site for Discount Drugs and Generic Prescription Drugs searches.

Dihydroergotamine Mesylate (Dihydergot, DHE 45)

This can be used by the intramuscular or intravenous route. Its effect is less pronounced than ergotamine. Only a small percentage of persons respond to this drug. The adverse effects and precautions for dihydroergotamine are the same as those for ergotamine.

Triptans (Sumatriptian, Sumitrex, Migratan, 50 mg, 100 mg tablet; 60 mg/5 ml amp.)

These are newer drugs and are very effective in acute migraine. These are better tolerated than ergotamine. About three-fourths of the patients get complete relief within 2 to 3 hours. However, in some cases the pain may recur in 24 hours, due to short duration of action of the drug. Sumatriptan constricts dilated blood vessels and reduces swelling and inflammation which causes pain. Usual dose is 50 to 100 mg orally at the onset of pain and repeated after 24 hours. It can be used by subcutaneous injection (3 to 6 mg). This injection is painful.

Adverse Effects and Precautions

Tightness of head and chest, abnormal sensations (paraesthesia) in arms and legs, weakness and dizziness are common short lasting adverse effects. Serious effects are slow pulse (bradycardia) and precipitation of heart attack (acute myocardial infarction). In rare cases it may cause sudden death. Some cases of fits and drug allergy have also reported. Therefore, it should never be taken by patients suffering from heart disease (coronary artery disease), epilepsy and high blood pressure. Other contraindication are pregnancy, liver and kidney diseases. It is never combined with ergotamine.

Drugs for Prevention of Future Attacks

Preventive treatment is needed if the attacks occur more than twice or thrice a month . Before starting this kind of treatment one must try to avoid or treat the above-mentioned precipitating factors. In most cases, it occurs unpredictably or develops in relation to such provoking factors as the work situation, which cannot be avoided or modified. The drugs for the prevention of attacks of migraine are described in the order in which they might be useful for this purpose.

Beta-Adrenergic Receptor Blockers

Propranolol (Inderal, Betaspan)

This is moderately effective in preventing attacks of migraine and remains the most commonly used drug in this condition. In the beginning low doses of 20 mg are given 2 to 3 times daily; these are increased every 2 to 3 weeks until either the migraine attacks become significantly less frequent and/or dose of 160 mg/day is reached.

Adverse Effects: It may decrease the working capacity of the heart, specialiy if large doses are used. In asthmatic patients it aggravates the disease. Some patients experience a feeling of weakness or lassitude and leg pains.

Precautions

It should be used with great caution if the heart is weak.

It should not be used in patients suffering from asthma or related lung disease like bronchitis and emphysema (enlargement of the air sacs of the lungs, causing breathlessness).

Diabetes patients should get their blood sugar checked regularly while taking this drug.

It should never be stopped abruptly as it may precipitate a heart attack. Always consult a doctor if you want to stop this drug.

Do not increase the dose if a feeling of weakness or lassitude develops.

About the author:
AdvCare is one of the Canada leading pharmacy

website. First established in January 2000, its mission is to become the number one site for

prescription drug and

href=”http://www.adv-care.com/”>drug store searches.

What is Blood Pressure?

All the tissues and organs of the body need nourishment in the form of oxygen, glucose, and minerals for their normal functioning. This nourishment is carried by the blood to various sites through the blood vessels by the pumping action of the heart. With each contraction of the heart, blood is pushed into the arteries. In healthy persons this pressure is normal, but in some it may be more than normal. This above normal pressure in the arteries is called high blood pressure or hypertension. In some cases it may be less than normal and is then termed low blood pressure or hypotension. Blood pressure has two components – Systolic (upper) and Diastolic (lower). It is written as 120/80 mm Hg which means 120 mm Hg systolic and 80 mm Hg diastolic. The abbreviation ‘mm Hg’ stands for millimeter of mercury.

Correct Way to Measure BP: Routine office BP measurement is done in a sitting position. One has to sit quietly with back supported for 5 minutes and arm placed at the level of heart. Coffee tea or smoking are not allowed in the preceding hour. For establishing hypertension at least three readings, one week apart must be taken. At each sitting two readings should be taken to confirm diagnosis. Readings are taken in both arms and if there is a significant difference then the arm with higher reading is selected for subsequent measurements.

In diabetics, BP is taken in supine or lying down position and repeated, 2 minutes later, in upright position. This is done to detect any fall in BP in upright position. This is very important in diabetics and elderly lest they may fall under the effect of medicines used to control hypertension. In a number of cases BP is higher in the physician’s clinic than at home. This is due to a stress in the presence of doctor and is called as ‘white-coat hypertension’. This phenomenon is more common in females. Self-check provide useful information on blood pressure response to treatment, may improve adherence to therapy and is useful in evaluating the extent of ‘white-coat’ hypertension. Home measurements can be done by ‘dial type’ variant of BP instrument, electronic self-inflating sets or by miniature versions which are placed on wrists. These instruments are reasonably accurate. However, they must be calibrated from time to time.

This can be determined by measuring the blood pressure with an instrument called sphygmomanometer (BP measuring instrument). Normally, blood pressure varies from individual to individual, depending upon factors such as heredity, age, sex, nutrition, and body weight. A diastolic blood pressure of 90 mmHg or above is classified as hypertension and requires medical consultation.

The treatment of BP is generally determined by the rise of systolic and diastolic BP. However, one should not get apprehensive if the BP goes above the normal limit once in a while.

Types and Causes of Hypertension: Hypertension has been divided into two categories: essential or primary hypertension, and secondary hypertension. The exact cause of primary or essential hypertension is not known but there is generally a narrowing of the blood vessels. In secondary hypertension, there is involvement of other organs or systems such as the kidney, adrenal glands, and disorders like toxaemia of pregnancy. In secondary hypertension, the cause can be treated and blood pressure brought to normal. Primary hypertension lasts a lifetime and needs continuous treatment. Almost 90% cases of hypertension are of primary variety. Syndrome-X is given to a constellation of obesity, high BP, insulin resistance and raised blood lipids. It is commonly seen in our country.

When Does Blood Pressure Become High?

BP depends upon three important factors: force of contraction, the rate of beating of the heart, and the resistance to blood flow caused by the inner diameter of the blood vessels. Besides these, the volume of blood may also affect the BP. It is a common experience that emotional trauma or excitement, physical exercise or exertion increase the heart rate, which is experienced in the form of palpitation (bouncing or beating of the heart against the chest wall), resulting in a rise in BP. This is generally short-lived and does not require any treatment. The dangerous form of high BP is one which persists on repeated examinations.

What Happens When the Blood Pressure Is High? The symptoms of high blood pressure may be related to elevated pressure itself, a disease of the blood vessel, or some other underlying diseases responsible for elevation of blood pressure. The most common symptom of elevated blood pressure is headache, specially in the back portion of the head. This is usually more

severe when the person wakes up in the morning. Other symptoms are dizziness, giddiness, palpitation, and easy fatigability. In more severe cases the symptoms are bleeding through the nose or blood in the urine, blurring of vision due to changes in the arteries of the retina (screen for vision in the eye), incidence of dizziness or fainting due to transient decrease in blood flow to the brain, pain in the chest, and breathlessness. When blood supply of brain is drastically reduced, paralysis or ’stroke’ may occur.

What is Blood Pressure?

All the tissues and organs of the body need nourishment in the form of oxygen, glucose, and minerals for their normal functioning. This nourishment is carried by the blood to various sites through the blood vessels by the pumping action of the heart. With each contraction of the heart, blood is pushed into the arteries. In healthy persons this pressure is normal, but in some it may be more than normal. This above normal pressure in the arteries is called high blood pressure or hypertension. In some cases it may be less than normal and is then termed low blood pressure or hypotension. Blood pressure has two components – Systolic (upper) and Diastolic (lower). It is written as 120/80 mm Hg which means 120 mm Hg systolic and 80 mm Hg diastolic. The abbreviation ‘mm Hg’ stands for millimeter of mercury.

Correct Way to Measure BP: Routine office BP measurement is done in a sitting position. One has to sit quietly with back supported for 5 minutes and arm placed at the level of heart. Coffee tea or smoking are not allowed in the preceding hour. For establishing hypertension at least three readings, one week apart must be taken. At each sitting two readings should be taken to confirm diagnosis. Readings are taken in both arms and if there is a significant difference then the arm with higher reading is selected for subsequent measurements.

In diabetics, BP is taken in supine or lying down position and repeated, 2 minutes later, in upright position. This is done to detect any fall in BP in upright position. This is very important in diabetics and elderly lest they may fall under the effect of medicines used to control hypertension. In a number of cases BP is higher in the physician’s clinic than at home. This is due to a stress in the presence of doctor and is called as ‘white-coat hypertension’. This phenomenon is more common in females. Self-check provide useful information on blood pressure response to treatment, may improve adherence to therapy and is useful in evaluating the extent of ‘white-coat’ hypertension. Home measurements can be done by ‘dial type’ variant of BP instrument, electronic self-inflating sets or by miniature versions which are placed on wrists. These instruments are reasonably accurate. However, they must be calibrated from time to time.

This can be determined by measuring the blood pressure with an instrument called sphygmomanometer (BP measuring instrument). Normally, blood pressure varies from individual to individual, depending upon factors such as heredity, age, sex, nutrition, and body weight. A diastolic blood pressure of 90 mmHg or above is classified as hypertension and requires medical consultation.

The treatment of BP is generally determined by the rise of systolic and diastolic BP. However, one should not get apprehensive if the BP goes above the normal limit once in a while.

Types and Causes of Hypertension: Hypertension has been divided into two categories: essential or primary hypertension, and secondary hypertension. The exact cause of primary or essential hypertension is not known but there is generally a narrowing of the blood vessels. In secondary hypertension, there is involvement of other organs or systems such as the kidney, adrenal glands, and disorders like toxaemia of pregnancy. In secondary hypertension, the cause can be treated and blood pressure brought to normal. Primary hypertension lasts a lifetime and needs continuous treatment. Almost 90% cases of hypertension are of primary variety. Syndrome-X is given to a constellation of obesity, high BP, insulin resistance and raised blood lipids. It is commonly seen in our country.

When Does Blood Pressure Become High?

BP depends upon three important factors: force of contraction, the rate of beating of the heart, and the resistance to blood flow caused by the inner diameter of the blood vessels. Besides these, the volume of blood may also affect the BP. It is a common experience that emotional trauma or excitement, physical exercise or exertion increase the heart rate, which is experienced in the form of palpitation (bouncing or beating of the heart against the chest wall), resulting in a rise in BP. This is generally short-lived and does not require any treatment. The dangerous form of high BP is one which persists on repeated examinations.

What Happens When the Blood Pressure Is High? The symptoms of high blood pressure may be related to elevated pressure itself, a disease of the blood vessel, or some other underlying diseases responsible for elevation of blood pressure. The most common symptom of elevated blood pressure is headache, specially in the back portion of the head. This is usually more

severe when the person wakes up in the morning. Other symptoms are dizziness, giddiness, palpitation, and easy fatigability. In more severe cases the symptoms are bleeding through the nose or blood in the urine, blurring of vision due to changes in the arteries of the retina (screen for vision in the eye), incidence of dizziness or fainting due to transient decrease in blood flow to the brain, pain in the chest, and breathlessness. When blood supply of brain is drastically reduced, paralysis or ’stroke’ may occur.