SUBMITTED FOR THE PARTIAL FULFILLMENT FOR DIPLOMA IN

PHYSIOTHERAPY 1ST YEAR.

A PROJECT ON-
“A CORRELATIVE STUDY ON HYPERTENSION AND HYPERGLYCEMIA”

SUBMITTED BY :
NAME – ASHOK SARMA
DEPARTMENT- DPT
SESSION - 1
YEAR – 2023
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 DECLARATION BY THE STUDENT

I ASHOK SARMA hereby certify that I had personally

written the project for my diploma in Physiotherapy 1st year
final examination entitled-
“A correlative study on hypertension and hyperglycemia.”

Signature of the student

Date

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 Certificate by the principal

This is to certify that ASHOK SARMA in the department of DPT

OXFORD PARAMEDICAL INSTITUTE, GUWAHATI has fulfilled the
requirements prescribed for the project report in partial
fulfillment for first year final examination.

The project report entitled

“A correlative study on hypertension and hyperglycemia”

Signature
Date

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 INTRODUCTION

Diabetes mellitus and hypertension are

among the most common diseases and cardiovascular risk factors,
respectively, worldwide, and their frequency increases with increasing age.1
Elevated blood pressure (BP) values are a common finding in patients with
type 2 diabetes mellitus (T2D) and are thought to reflect, at least in part,
the impact of the underlying insulin resistance on the vasculature and
kidney.1 On the contrary, accumulating evidence suggests that
disturbances in carbohydrate metabolism are more common in
hypertensive individuals,2,3 thereby indicating that the pathogenic
relationship between diabetes mellitus and hypertension is actually
bidirectional.

The development of hypertension in diabetic

individuals not only complicates treatment strategy and increases
healthcare costs but also heightens the risk for macrovascular and
microvascular complications considerably.2,4 Although BP lowering is
followed by a significant reduction in cardiovascular and microvascular
morbidity and mortality,5,6 a large proportion of diabetic subjects exhibit
poorly controlled hypertension. This observation may reflect not only
delayed recognition of the presence of hypertension, clinical inertia, and
poor adherence to the prescribed regimen but also uncertainty regarding
the treatment targets and pathogenic correlation.

A previous report from the MCDS

(Mexico City Diabetes Study) showed that, in ≈2/3 of patients with either
normoglycemia or impaired glucose tolerance, the development of overt
diabetes mellitus is characterized by an abrupt (within ≈3.5 years) increase
in plasma glucose values by ≈50 mg/dL.7 Whether a similar phenomenon is
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seen during the development of hypertension is not known. Therefore, the
first aim of the present analysis was to determine the pattern of BP changes
during the development of hypertension in patients with or without
diabetes mellitus in MCDS. The second aim was to quantify the longitudinal
association of T2D and hypertension in this population-based study during
the follow-up period of 7 years. Within this scope, we tried to identify
clinical and laboratory characteristics that may reflect an increased risk for
the development of diabetes mellitus, hypertension, or both. Because the
population of MCDS included Hispanic individuals from low-income areas
with a high risk for the development of diabetes mellitus, we explored the
generalizability of any results by asking the same questions in the
non-Hispanic white population of the FOS (Framingham Offspring Study).

Anthropometric Measurements
Diabetes mellitus in at least one parent or sibling was coded as a positive
family history of diabetes mellitus. Before examinations, all participants
were asked to fast for at least 12 hours. Height, weight, waist and hip
circumferences, and systolic and diastolic BP were measured; pulse pressure
was calculated as the difference between systolic and diastolic BP and mean
BP as the sum of diastolic BP and one third of pulse pressure.

Biochemical Measurements
Blood samples were obtained in the fasting state and 2 hours after a
standard 75-g oral glucose load. Serum samples were centrifuged, divided
into aliquots, and stored at −70°C until assayed. Fasting concentrations of
serum insulin, proinsulin, plasma glucose, total cholesterol, low-density

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lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides,
and plasma glucose and insulin concentrations 2 hours after an oral
glucose load were determined as described elsewhere7 at baseline and at
follow-up.

OBSERVATION OF THE STUDY

The first main finding of the present study is that not only does the
presence of hypertension predict future diabetes mellitus, in agreement
with earlier epidemiological observations,2,3,8,9 but also the incidence of
hypertension increases significantly in the presence of diabetes mellitus.
During the 7 years of follow-up, BP behaved as a tracking variable as
individuals who converted to hypertension (at the first or second follow-up
visit) had increased baseline BP values compared with nonconverters,
although still within the normal range.10 Indeed, baseline BP was the
strongest predictor of incident hypertension, and its inclusion in the
statistical model significantly attenuated the predictive value of diabetes
mellitus. More strikingly, hypertension and diabetes mellitus tracked each
other consistently (Figures 1 and 3), and people at high risk for the
development of either hypertension or diabetes mellitus share common
metabolic abnormalities, that is, abdominal obesity, hyperinsulinemia, and
hypertriglyceridemia (even more prominent in those destined to develop
both abnormalities). Thus, the general population contains a pool of
individuals with the phenotype of the metabolic (or insulin resistance)
syndrome from which new hypertension or diabetes mellitus (or both)
emerge over time. Importantly, weight gain may be one factor that
contributes to the development of both hypertension and diabetes mellitus.
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Parenthetically, the increased incidence of hypertension in patients with
diabetes mellitus may also reflect the closer surveillance of these individuals
(ie, a small detection bias). The second, and possibly the most important,
finding of this study is that the progression from normotension to
hypertension in individuals destined to become hypertensive is marked by
a steep increase in BP values averaging 20 mm Hg for systolic BP within 3.5
years. In >60% of the converters, the increase in BP values during the
period that preceded conversion was greater than the 90th percentile of
the changes in systolic BP observed in nonconverters. This biphasic BP
pattern is similar to that previously described for blood glucose values in
MCDS individuals developing diabetes mellitus.7 Finally, both the
coprediction of hypertension and diabetes mellitus and this biphasic
pattern of progression are not unique to Hispanic individuals because
essentially the same findings were observed in the non-Hispanic white
population of FOS.

One potential factor responsible for

the covariance of diabetes mellitus and hypertension is insulin resistance.1
Of note, in a subcohort of FOS with a shorter follow-up, an inverse
association between incident hypertension (or BP progression) and a proxy
of insulin resistance was seen principally in younger people.10 Here,
however, both fasting plasma insulin (a typical proxy for insulin resistance in
epidemiological studies) and plasma insulin concentrations 2 hours after
glucose ingestion were consistently higher at baseline in both hypertension
and diabetes mellitus converters. Furthermore, baseline insulin levels
copredicted both hypertension and diabetes mellitus after controlling for
age and BMI and also for baseline BP and plasma glucose values (Figure 4).
This pattern of results lends support to the notion that insulin resistance is
one common feature of both prediabetes and prehypertension, and one
antecedent of progression to the 2 respective disease states.

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 Apart from the detrimental
effects that disturbed insulin signaling exerts on carbohydrate metabolism,
the hyperinsulinemia that characterizes insulin resistance states leads to
vascular smooth muscle cell proliferation and increased vascular stiffness,
which predispose to the development of hypertension.11 Additionally,
insulin may directly or indirectly impair vasodilation and increase oxidative
stress and the inflammatory process in the vascular wall.12,13 The sum of
these effects is the impaired autoregulation of vascular tone, increased
vascular resistance, and BP elevation. Finally, the antinatriuretic properties
of insulin increase renal retention of sodium and water leading to volume
overload, thereby predisposing to the development of hypertension.14

A novel finding from both study

cohorts is that, in individuals who ultimately develop T2D, hypertension, or
both, the time trajectory of plasma glucose7 and BP values is not a
progressive slow increase but—in the majority of cases—a steep elevation
several-fold larger compared with changes observed in nonconverters (or,
in the case of patients converting at the second follow-up, compared with
the changes observed in the same patients between baseline and the first
follow-up visit). Although the pathophysiological basis of this relatively
acute decompensation remains indeterminate, it could be hypothesized
that it may be related to sympathetic excitation. The sequence of events
that lead to activation of the sympathetic nervous system is unknown.
However, in healthy volunteers, insulin dose dependently stimulates
norepinephrine release, particularly in skeletal muscle, and enhances
sympathetic neuronal discharge.15 In subjects with uncomplicated obesity

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monitored for 24 hours, there is episodic sympathetic dominance in phase
with postprandial hyperinsulinemia, which abates after weight loss.16 The
autonomic contribution to BP is greater in obesity, and ganglionic blockade
of the autonomic nervous system results in BP decrease that is more
pronounced in obese individuals.17 Obese subjects with hypertension
display increased sympathetic nerve activity, an abnormality that is partially
corrected after diet-induced weight loss.18 Leptin, an adipokine that has
been found to circulate in increased concentrations in obese and insulin
resistant subjects, can act centrally to activate the sympathetic nervous
system19; not all studies have confirmed this hypothesis.20 In addition,
experimental models suggest that leptin may also contribute to the
pathogenesis of hypertension via aldosterone-dependent mechanisms.21 In
line with these suggestions, in our population, BMI values at baseline and
weight gain during the observation period were significant predictors of
both incident hypertension and diabetes mellitus, whereas heart rate and
pulse pressure, both raw indices of sympathetic nervous system activity,
were found to be elevated in patients who converted to hypertension.
Finally, obese individuals with or without diabetes mellitus have been
shown to have reduced concentrations of circulating natriuretic peptides.
Because these molecules favorably affect intravascular volume status and
vascular tone, this mechanism may be involved in the pathogenesis of
hypertension in patients with diabetes mellitus.22

Our findings may have implications

in the everyday care of patients with diabetes mellitus. Thus, diabetic
patients with BP values near the upper limit of normal should be monitored
for the development of hypertension, especially if they have a positive
family history of hypertension and the phenotypic features of the metabolic
syndrome. Because development of hypertension in patients with diabetes

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mellitus is marked by a significant increase in macrovascular and
microvascular risk,2,23 efforts should be made to delay or ideally prevent
the increase in BP. Obviously, the follow-up scheme of both MCDS and FOS
does not reflect everyday clinical practice, as is generally true of
observational population-based studies. Under ideal conditions, patients
with diabetes mellitus or hypertension are seen 2 or 3 times per year.
However, the time pattern of BP progression we describe here may still
emerge from more frequent follow-up visits. On the contrary, in an era of
continuously increasing pressures on healthcare systems, understanding
the factors that predispose to, or precipitate, the development of an
outcome should increase clinicians’ awareness and may facilitate the timely
diagnosis of conditions that might otherwise go unnoticed.

Apart from lifestyle modification, several

classes of antidiabetic drugs such as SGLT2 (sodium-glucose cotransporter
2) inhibitors and GLP-1 (glucagon-like peptide 1) receptor agonists have
been shown to lower BP24,25 (although the data for liraglutide is less
convincing26) and reduce cardiovascular events in secondary
prevention.25,27 Thus, use of these drugs might be prioritized in diabetic
patients at high risk for the development of hypertension, although the
clinical value of this strategy in terms of hard end point reduction has been
unequivocally proven only in individuals with established cardiovascular
disease.

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OVERVIEW

Identifying hypertension and diabetes

Some relatively simple tests are available to help a person identify whether
they have diabetes or hypertension.

Identifying hypertension

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The American Heart Association (AHA)Trusted Source states that most
people who have hypertension do not experience any symptoms. People
usually discover that they have hypertension following a routine blood
pressure check.

A blood pressure reading will display numbers representing two different

types of blood pressure: systolic and diastolic.

 Systolic: This number appears at the top. It represents the maximum

pressure the heart exerts when beating.

 Diastolic: This number appears at the bottom. It represents the

amount of pressure in the arteries between heartbeats.

The AHATrusted Source categorizes blood pressure readings according to

the following parameters:

 Normal: Systolic is below 120 and diastolic is below 80.

 Elevated: Systolic is 120–129 and diastolic is below 80.

 Hypertension stage 1: Systolic is 130–139 or diastolic is 80–89.

 Hypertension stage 2: Systolic is 140 or higher, or diastolic is 90 or

higher.

 Hypertensive crisis: Systolic is higher than 180 or diastolic is above

120.

A hypertensive crisis is a medical emergency, and a person requires

immediate medical attention to prevent severe complications.

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Identifying diabetes
According to the American Diabetes Association (ADA), not everyone with
diabetes will experience symptoms of the disease.

If symptoms of high blood glucose levels do appear, they may include:

 excessive thirst

 excessive hunger

 frequent need to urinate

 extreme fatigue

 blurred vision

 delayed wound healing

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A person may also find that they become more susceptible to infections,
such as:

 urinary tract infections (UTIs)

 thrush

 upper respiratory tract infections

People can take a fasting glucose test to help identify diabetes. The ADA
provides the following parameters for blood glucose levels following a
fasting period of at least 8 hours:

 Normal: This is less than 100 milligrams per deciliter (mg/dl).

 Prediabetes: This is between 100–125 mg/dl.

 Diabetes: This is a reading of 126 mg/dl or above.

Other tests for diabetes can show blood glucose levels after drinking a
sugary drink.

Types of diabetes and their symptoms

There are three kinds of diabetes, all of which have different causes:

Type 1 diabetes

Type 1 diabetes is an autoimmune disorder in which the body mistakenly

attacks cells in the pancreas that produce insulin. The disease tends to
appear during childhood or adolescence, though it can occur later in life.

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Type 2 diabetes

Type 2 diabetes occurs as a result of insulin resistance. This is where body

cells lose their ability to respond to insulin. The pancreas tries to
compensate by producing more insulin, but the process is not sustainable.

Current guidelines recommend diabetes screening for everyone ages 45

years or above, and anyone younger who has risk factors for the disease.
Early diagnosis and treatment can help slow or even reverse the disease,
reducing the risk of complications.

Learn more about type 1 and type 2 diabetes.

Gestational diabetes
Gestational diabetes occurs only in pregnancy, though around 50%Trusted
Source of females with this form go on to develop type 2 diabetes.

If a routine screening shows high blood sugar levels during pregnancy, a

doctor will monitor the person’s condition until a few weeks after delivery.
In most cases, blood sugar levels return to normal immediately after
delivery.

Diabetes and hypertension complications

The combined impact of diabetes and high blood pressure can increase the
riskTrusted Source of cardiovascular disease, kidney disease, and other
health issues.

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Without treatment, diabetes and high blood pressure may lead to serious
complications, such as:

 eye problems

 kidney failure

 heart attack

 stroke

Managing blood sugar levels and blood pressure can help prevent
complications.

Risk factors
Hypertension and type 2 diabetes share similar risk factorsTrusted Source.
These include:

 being overweight or having obesity

 having a sedentary lifestyle

 following an unhealthy diet

 experiencing chronic stress

 having poor sleep habits

 smoking tobacco

 being exposed to air pollution

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Additional risk factorsTrusted Source for hypertension include:

 a diet high in sodium

 low levels of potassium

 high alcohol consumption

Having a family history of hypertension increases the riskTrusted Source of

hypertension, suggesting a role for both genetic and environmental factors.
A close family history of diabetes also increases the riskTrusted Source of
both type 1 and type 2 diabetes.

Having hypertension appears to increase the riskTrusted Source of type 2

diabetes, and having diabetes increases the riskTrusted Source of
hypertension.

Prevention
The following lifestyle factors are crucial for managing both blood glucose
levels and blood pressure.

Maintaining a healthy weight

For people with excess weight, losing even a little can help reduce the risk
of both high blood pressure and diabetes.

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The National Heart, Lung, and Blood Institute (NHLBI) notes that a 3–5%
lossTrusted Source of body weight can improve blood pressure readings.

Similarly, the CDCTrusted Source notes that a 5–7% loss of body weight can
help stop prediabetes from developing into diabetes. This equates to a loss
of 10–14 pounds for a person who weighs 200 pounds.

Being physically active

Regular physical activity can lower blood pressure and help manage blood
glucose levels, besides providing other health benefits.

Current CDC guidelinesTrusted Source recommend a minimum of 150

minutes of moderate-intensity aerobic exercise each week or 75 minutes of
vigorous-intensity exercise each week. Moderate exercise includes brisk
walking and swimming. People should also consider doing muscle
strengthening exercises.

People who have not been active for a while can speak with their doctor for
advice on a suitable exercise plan.

Following a healthy diet

People with diabetes and hypertension can ask their doctor for information
and advice on an appropriate diet plan.

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Doctors often recommend the Dietary Approaches to Stop Hypertension
(DASH) dietTrusted Source for managing blood pressure and overall
well-being. This typically includes:

 eating plenty of fresh fruits and vegetables

 focusing on high fiber foods, including whole grains

 limiting added salt and sugar

 avoiding or limiting unhealthy fats, such as trans fats and animal fats

 Learn more here about what to eat on the DASH diet.

A person with diabetes will need to monitor their intake of carbohydrates

and check their blood glucose levels to ensure that their blood glucose
remains within the healthy range.

Limiting alcohol consumption

High consumption of alcohol can increase the riskTrusted Source of the
following:

 excess calorie intake

 weight gain and diabetes

 thickening of the artery walls

 raised blood pressure

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The AHATrusted Source recommends a maximum of one alcoholic drink
per day for females and two alcoholic drinks per day for males. One drink
equates to one of the following:

 one 12-ounce beer

 one 4-ounce glass of wine

 one 1.5-ounce serving of 80-proof spirits

 one 1-ounce serving of 100-proof spirits

Mixers can also add carbohydrates and calories. Sparkling water is a

healthier option than sweetened soda.

People may wish to speak with their doctor about how much alcohol is
safe for them to consume.

Avoiding or quitting smoking

Tobacco smoking causes blood vessels to constrict, resulting in a temporary

increaseTrusted Source in blood pressure. It also increases the buildup of
plaque within the arteries, which can lead to increases in blood presssure
over time.

Tobacco smoking can also increase the riskTrusted Source of type 2

diabetes. Smokers with diabetes have a higher risk of developing serious
complications, including:

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  heart or kidney disease

 retinopathy, which is an eye disease that may lead to blindness

 poor blood flow, making infection and the risk of foot or leg
amputation more likely

 peripheral neuropathy, which can cause nerve pain in the arms and
legs

A person who has diabetes or high blood pressure, or is at risk of either

condition, can speak with their doctor about how to quit smoking.

Treatment with medication

In addition to lifestyle measures, a doctor may prescribe medications to

help manage diabetes and hypertension.

Treatments for diabetes

The treatment for diabetes will depend on the type a person has.

For type 1 diabetes, a person will need to use insulin. They may also require
medications to manage any complications, such as hypertension.

For type 2 diabetes, some people will need to use insulin. Others may use
non-insulin medication, such as metformin, to help reduce blood pressure.
People may also require medications to manage any complications, such as
hypertension.

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Current guidelines also recommend using one of the following if a person
with type 2 diabetes has a high risk of atherosclerotic cardiovascular
disease, diabetes-related kidney disease, or both:

 sodium-glucose cotransporter 2 inhibitors (SGLT2)

 glucagon-like peptide 1 (GLP-1) receptor agonists

These drugs offer protection to the heart and kidneys by helping to

manage blood sugar levels.

Treatments for hypertension

Numerous medications are available to help manage hypertension. A

doctor may prescribe a combination of medications. Some examples
includeTrusted Source:

 Angiotensin-converting enzyme (ACE) inhibitors: ACE inhibitors

reduce production of the hormone “angiotensin.” This allows the
blood vessels to relax and dilate, thereby lowering blood pressure.

 Angiotensin II receptor blockers: These medications block the

effects of angiotensin, which is a chemical that causes the arteries to
narrow. Without angiotensin, the blood vessels remain open, thereby
reducing blood pressure.

 Beta-blockers: These medications cause the following effects on the

heart, which help to lower blood pressure:

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 i
reducing heart rate

ii
reducing the heart’s workload

iii
reducing the heart’s output of blood

 Calcium channel blockers: Calcium causes the smooth muscles of

the heart and arteries to contract. Calcium channel blockers prevent
this action, resulting in less forceful heart contractions and a
relaxation of the blood vessels. Both result in a reduction in blood
pressure.

 Diuretics: These medications help the body remove excess sodium

and water, which reduces blood volume and helps manage blood
pressure.

 Vasodilators: These are medications that cause the muscular walls of

the blood vessels to relax and dilate. This allows blood to flow
through more easily, thereby reducing blood pressure.

Diagnosis

High Blood sugar

Your health care provider sets your target blood sugar range. For many
people who have diabetes, Mayo Clinic generally recommends the
following target blood sugar levels before meals:

 Between 80 and 120 milligrams per deciliter (mg/dL) (4.4 and 6.7

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 millimoles per liter (mmol/L)) for people age 59 and younger who
have no medical conditions other than diabetes

 Between 100 and 140 mg/dL (5.6 and 7.8 mmol/L) for:

i. People age 60 and

older

ii. Those who have

other medical conditions, such as heart, lung or kidney disease

iii People who have

a history of low blood sugar (hypoglycemia) or who have difficulty
recognizing the symptoms of hypoglycemia

For many people who have diabetes, the American Diabetes Association
generally recommends the following target blood sugar levels:

 Between 80 and 130 mg/dL (4.4 and 7.2 mmol/L) before meals

 Less than 180 mg/dL (10 mmol/L) two hours after meals

Your target blood sugar range may differ, especially if you're pregnant or
you have other health problems that are caused by diabetes. Your target
blood sugar range may change as you get older. Sometimes, reaching your
target blood sugar range can be a challenge.

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High blood pressure:

To diagnose high blood pressure, your health care provider examines you
and asks questions about your medical history and any symptoms. Your
provider listens to your heart using a device called a stethoscope.

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Your blood pressure is checked using a cuff, usually placed around your
arm. It's important that the cuff fits. If it's too big or too small, blood
pressure readings can vary. The cuff is inflated using a small hand pump or
a machine.

The first time your blood pressure is checked, it should be measured in

both arms to see if there's a difference. After that, the arm with the higher
reading should be used.

Blood pressure is measured in millimeters of mercury (mm Hg). A blood

pressure reading has two numbers.

 Top number, called systolic pressure. The first, or upper, number

measures the pressure in the arteries when the heart beats.

 Bottom number, called diastolic pressure. The second, or lower,

number measures the pressure in the arteries between heartbeats.

High blood pressure (hypertension) is diagnosed if the blood pressure

reading is equal to or greater than 130/80 mm Hg. A diagnosis of high
blood pressure is usually based on the average of two or more readings
taken on separate occasions.

Blood pressure is grouped according to how high it is. This is called staging.
Staging helps guide treatment.

 Stage 1 hypertension. The top number is between 130 and 139 mm

Hg or the bottom number is between 80 and 89 mm Hg.

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  Stage 2 hypertension. The top number is 140 mm Hg or higher or
the bottom number is 90 mm Hg or higher.

Sometimes the bottom blood pressure reading is normal (less than 80 mm

Hg) but the top number is high. This is called isolated systolic hypertension.
It's a common type of high blood pressure in people older than 65.

Tests

If you are diagnosed with high blood pressure, your provider may
recommend tests to check for a cause.

 Ambulatory monitoring. A longer blood pressure monitoring test

may be done to check blood pressure at regular times over six or 24
hours. This is called ambulatory blood pressure monitoring. However,
the devices used for the test aren't available in all medical centers.
Check with your insurer to see if ambulatory blood pressure
monitoring is a covered service.

 Lab tests. Blood and urine tests are done to check for conditions that
can cause or worsen high blood pressure. For example, tests are done
to check your cholesterol and blood sugar levels. You may also have
lab tests to check your kidney, liver and thyroid function.

 Electrocardiogram (ECG or EKG). This quick and painless test

measures the heart's electrical activity. It can tell how fast or how slow
the heart is beating. During an ECG, sensors called electrodes are
attached to the chest and sometimes to the arms or legs. Wires
connect the sensors to a machine, which prints or displays results.

 Echocardiogram. This noninvasive exam uses sound waves to create

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 detailed images of the beating heart. It shows how blood moves
through the heart and heart valves.

Treatment
Changing your lifestyle can help control and manage high blood pressure.
Your health care provider may recommend that you make lifestyle changes
including:

 Eating a heart-healthy diet with less salt

 Getting regular physical activity

 Maintaining a healthy weight or losing weight

 Limiting alcohol

 Not smoking

 Getting 7 to 9 hours of sleep daily

Sometimes lifestyle changes aren't enough to treat high blood pressure. If

they don't help, your provider may recommend medicine to lower your
blood pressure.

Medications

The type of medicine used to treat hypertension depends on your overall

health and how high your blood pressure is. Two or more blood pressure
drugs often work better than one. It can take some time to find the
medicine or combination of medicines that works best for you.

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When taking blood pressure medicine, it's important to know your goal
blood pressure level. You should aim for a blood pressure treatment goal of
less than 130/80 mm Hg if:

 You're a healthy adult age 65 or older

 You're a healthy adult younger than age 65 with a 10% or higher risk
of developing cardiovascular disease in the next 10 years

 You have chronic kidney disease, diabetes or coronary artery disease

The ideal blood pressure goal can vary with age and health conditions,
particularly if you're older than age 65.

Medicines used to treat high blood pressure include:

 Water pills (diuretics). These drugs help remove sodium and water
from the body. They are often the first medicines used to treat high
blood pressure.

 There are different classes of diuretics, including thiazide, loop and

potassium sparing. Which one your provider recommends depends
on your blood pressure measurements and other health conditions,
such as kidney disease or heart failure. Diuretics commonly used to
treat blood pressure include chlorthalidone, hydrochlorothiazide
(Microzide) and others.A common side effect of diuretics is increased
urination. Urinating a lot can reduce potassium levels. A good balance
of potassium is necessary to help the heart beat correctly. If you have
low potassium (hypokalemia), your provider may recommend a
potassium-sparing diuretic that contains triamterene.

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 Angiotensin-converting enzyme (ACE) inhibitors. These drugs help
relax blood vessels. They block the formation of a natural chemical
that narrows blood vessels. Examples include lisinopril (Prinivil,
Zestril), benazepril (Lotensin), captopril and others.

 Angiotensin II receptor blockers (ARBs). These drugs also relax

blood vessels. They block the action, not the formation, of a natural
chemical that narrows blood vessels. ARBs include candesartan
(Atacand), losartan (Cozaar) and others.

 Calcium channel blockers. These drugs help relax the muscles of the
blood vessels. Some slow your heart rate. They include amlodipine
(Norvasc), diltiazem (Cardizem, Tiazac, others) and others. Calcium
channel blockers may work better for older people and Black people
than do ACE inhibitors alone

 Don't eat or drink grapefruit products when taking calcium

channel blockers.Grapefruit increases blood levels of certain calcium
channel blockers, which can be dangerous. Talk to your provider or
pharmacist if you're concerned about interactions.

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 CONCLUSION OF THE STUDY
HIGH BLOOD PRESSURE

The definition of High blood pressure is a measurement of the force

applied against the walls of the arteries as the heart pumps blood through
the body. The pressure is determined by the force and amount of blood
pumped and the size and flexibility of the arteries. The blood pressure is
continually changing depending on activity‚ temperature‚ diet‚ emotional
state‚ posture‚ physical state‚ and drugs. The blood pressure is ussually
taken while the person

1.Hypertension is one of the most common chronic diseases worldwide.

However, many people have hypertension without awareness and
treatment of the disease, indicating it is necessary to provide some basic
knowledge and essential information of hypertension to our audience,
upper primary pupils at early stage of their lifes to prepare them early in
prevention or management of this disorder in their future life.

2.Many risk factors are related with hypertension. Avoiding the factors
help to prevent hypertension, reduce symptoms and prolong lives.

3.Complications of hypertension are major sources of mortality. Reducing

blood pressure with medication or keeping it within normal range will
prevent, attenuates or reduce these complications.

4.The products (PowerPoint slides, poster, website and pamphlet) created in

this project will be important and useful resources for future education on
hypertensio

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High Blood sugar

Hyperglycemia, often known as high blood sugar, is a significant problem

for people with diabetes. Not taking the right actions may result in
long-term metabolic health impairment.

The body needs enough energy to survive and perform at its best. The
body’s internal systems require energy to maintain life, even while resting.
The only source of energy for the human body is food. It contains
carbohydrates, proteins, fats, and trace amounts of vitamins, minerals, and
salts. The body breaks down this complex ingested food into various
simpler components.

Carbohydrates make up a significant portion of the diet. They break down

into glucose (a type of sugar) in the stomach and the small intestines.

The bloodstream then absorbs glucose from the body. As a result, the
words “blood sugar levels” and “blood glucose levels” are synonymous.

Glucose is the primary energy source for almost all body parts. It is the only
energy source for the brain and is thus extremely important for survival.
Maintaining an optimum level is critical as all the organs receive glucose
through blood.

The regulation of the blood glucose level relies on many interdependent

processes involving multiple body systems. When these processes function
harmoniously, the blood sugar levels stay within normal ranges. Certain
internal or external factors, however, do disturb normal functioning leading
to instability of blood glucose levels.

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