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HYPERTENSION

High blood pressure is called "the silent killer" because it usually has no
symptoms. Some people may not find out they have it until they have trouble with their heart,
brain, or kidneys. When high blood pressure is not found and treated, it can cause: The heart to
get larger, which may lead to heart failure, Small bulges (aneurysms) to form in blood vessels.
Common locations are the main artery from the heart (aorta), arteries in the brain, legs, and
intestines, and the artery leading to the spleen, Blood vessels in the kidney to narrow, which
may cause kidney failure, Arteries throughout the body to "harden" faster, especially those in
the heart, brain, kidneys, and legs. This can cause a heart attack, stroke, kidney failure, or
amputation of part of the leg, Blood vessels in the eyes to burst or bleed, which may cause
vision changes and can result in blindness.
In many people with high blood pressure, a single specific cause is not known.
This is called essential or primary high blood pressure. Research is continuing to find causes.
In some people, high blood pressure is the result of another medical problem or
medication. When the cause is known, this is called secondary high blood pressure.
Compared to other groups, “colored” people like blacks and Hispanics Tend to get
high blood pressure earlier in life, Usually have more severe high blood pressures, Have a higher
death rate from stroke, heart disease, and kidney failure. Chances of getting high blood pressure
are also higher if you: Are overweight, Are a man over the age of 45, Are a woman over the age
of 55, Have a family history of high blood pressure and Have a "prehypertension (120-139/80-89
mmHg)" reading.
Other things that can raise blood pressure include: Eating too much salt, Drinking
too much alcohol, Not getting enough potassium, a sedentary lifestyle, is constantly
stressed and taking certain medications like oral contraceptives and Hormone replacement
pills. Many people get high blood pressure as they get older, but this is not a sign of
healthy living. A diagnosis of high blood pressure is given if repeated readings are 140/90
or higher or 130/80 or higher if the person has diabetes or chronic kidney disease.
To prevent or control high blood pressure, necessary lifestyle changes shoul be
done like maintaining a healthy weight, being physically active, following a healthy eating
plan that emphasizes fruits, vegetables and low-fat dairy foods, choosing and preparing
foods with less salt and sodium and drinking alcohol in moderation.

. When blood pressure stays too high even when the person makes the necessary
lifestyle changes, it is necessary to use medication to help lower blood pressure. Medicines will
control your blood pressure but they cannot cure it. Anti-hypertensive medications are usuall for
maintenance and should be taken for a long time.
Blood pressure medicines work in different ways to lower blood pressure. Often,
two or more drugs work better than one. Some drugs lower blood pressure by removing extra
fluid and salt from your body. Others affect blood pressure by slowing down the heartbeat, or by
relaxing and widening blood vessels. Below are the types of medicines used to treat high blood
pressure:
• Diuretics are sometimes called "water pills." They work by helping your kidneys flush
excess water and salt from your body. This reduces the amount of fluid in your blood,
and your blood pressure goes down. There are different types of diuretics. They are often
used along with other high blood pressure medicines and may be combined with another
medicine in one pill.
• Beta blockers help your heart beat slower and with less force. Your heart pumps less
blood through the blood vessels, and your blood pressure goes down.
• Angiotensin converting enzyme (ACE) inhibitors keep your body from making a
hormone called angiotensin II, which normally causes blood vessels to narrow. ACE
inhibitors prevents this narrowing so your blood pressure goes down.
• Angiotensin II Receptor Blockers (ARBS) are newer blood pressure drugs that protect
your blood vessels from angiotensin II. As a result, the blood vessels relax and become
wider, and your blood pressure goes down.
• Calcium channel blockers (CCBs) keep calcium from entering the muscle cells of your
heart and blood vessels. This causes blood vessels to relax, and your blood pressure goes
down.
• Alpha blockers reduce nerve impulses that tighten blood vessels, allowing blood to pass
more easily and causing blood pressure to go down.
• Alpha-beta blockers reduce nerve impulses to blood vessels the same way alpha blockers
do, but they also slow the heartbeat, as beta blockers do. As a result, blood pressure goes
down.
• Nervous system inhibitors relax blood vessels by controlling nerve impulses from the
brain. This causes blood vessels to become wider and blood pressure to go down.
• Vasodilators open blood vessels by directly relaxing the muscle in the vessel walls,
causing blood pressure to go down.

ISCHEMIC STROKE

Ischemic stroke occurs when an artery to the brain is blocked. The brain depends
on its arteries to bring fresh blood from the heart and lungs. The blood carries oxygen and
nutrients to the brain, and takes away carbon dioxide and cellular waste. If an artery is blocked,
the brain cells (neurons) cannot make enough energy and will eventually stop working. If the
artery remains blocked for more than a few minutes, the brain cells may die. This is why
immediate medical treatment is absolutely critical.
Ischemic stroke can be caused by several different kinds of diseases. The most
common problem is narrowing of the arteries in the neck or head. This is most often caused
atherosclerosis, or gradual cholesterol deposition. If the arteries become too narrow, blood cells
may collect and form blood clots. These blood clots can block the artery where they are formed
(thrombosis), or can dislodge and become trapped in arteries closer to the brain
(embolism). Another cause of stroke is blood clots in the heart, which can occur as a result of
irregular heartbeat (for example, atrial fibrillation), heart attack, or abnormalities of the heart
valves. While these are the most common causes of ischemic stroke, there are many other
possible causes. Examples include use of street drugs, traumatic injury to the blood vessels of the
neck, or disorders of blood clotting.
Ischemic stroke can further be divided into two main types: thrombotic and
embolic. A thrombotic stroke occurs when diseased or damaged cerbral arteries become blocked
by the formation of a blood clot within the brain. Clinically referred to as cerebral thrombosis or
cerebral infarction, this type of event is responsible for almost 50% of all strokes. Cerebral
thrombosis can also be divided into an additional two categories that correlate to the location of
the blockage within the brain: large-vessel thrombosis and small-vessel thrombosis. Large-vessel
thrombosis is the term used when the blockage is in one of the brain's larger blood-supplying
arteries such as the carotid or middle cerebral, while small-vessel thrombosis involves one (or
more) of the brain's smaller, yet deeper penetrating arteries. This latter type of stroke is also
called a lacuner stroke. An embolic stroke is also caused by a clot within an artery, but in this
case the clot (or emboli) was formed somewhere other than in the brain itself. Often from the
heart, these emboli will travel the bloodstream until they become lodged and can not travel any
further. This naturally restricts the flow of blood to the brain and results in almost immediate
physical and neurological deficits.
Ischemic stroke is by far the most common kind of stroke, accounting for about
88% of all strokes. Stroke can affect people of all ages, including children. Many people with
ischemic strokes are older (60 or more years old), and the risk of stroke increases with older
ages. At each age, stroke is more common in men than women, and it is more common among
African-Americans and Hispanics than white Americans. Many people with stroke have other
problems or conditions which put them at higher risk for stroke, such as high blood pressure
(hypertension), heart disease, smoking, or diabetes.
Certain medical conditions greatly increase your likelihood of having a stroke (or
another stroke). Medical conditions that increase stroke risk are: Previous stroke or "mini-
stroke" (transient ischemic attack, TIA), Hypertension which is one of the leading risks for heart
disease and stroke. The next is Diabetes mellitus, then Heart diseases, particularly heart beat
irregularities (atrial fibrillation), disease of the heart valves, congestive heart failure or recent
heart attack.
The controllable risk factors & life style choices are: Smoking, Obesity, elevated
cholesterol, and elevated lipids, Physical inactivity, Excessive alcohol intake, Illegal drug use,
while the uncontrollable risk factors are: Increasing age (Stroke is more common in people over
60), Male sex (Men and women both have strokes, although stroke is more common at younger
ages in men), Heredity and ethnicity, (Stroke is more common in people whose close relatives
have had stroke at an early age. African-Americans and Hispanic Americans are at higher risk
than white Americans. This may be due in part to high blood pressure and dietary differences).
People who have had a stroke have an increased risk of another stroke, especially
during the first year after the original stroke. The risk of another stroke goes up with older age,
high blood pressure (hypertension), high cholesterol, diabetes, obesity, having had a transient
ischemic attack (TIA), heart disease, cigarette smoking, heavy alcohol use, and drug abuse.
While some risk factors for stroke (such as age) cannot be changed, the risk factors for the others
can be reduced through use of medicines or changes in lifestyle.
Each stroke is different depending on the part of the brain injured, how bad the
injury is, and the person's general health. Some of the effects of stroke are:
Weakness (hemiparesis) or paralysis (hemiplegia) on one side of the body.
This may affect the whole side or just the arm or the leg. The weakness or paralysis is on
the side of the body opposite the side of the brain injured by the stroke.

Problems with balance or coordination.


These can make it hard for the person to sit, stand, or walk, even if muscles are strong
enough.

Problems using language (aphasia and dysarthria).


A person with aphasia may have trouble understanding speech or writing. Or, the person
may understand but may not be able to think of the words to speak or write. A person
with knows the right words but has trouble saying them clearly.

Being unaware of or ignoring things on one side of the body (bodily neglect or
inattention).
Often, the person will not turn to look toward the weaker side or even eat food from the
half of the plate on that side.

Pain, numbness, or odd sensations.


These can make it hard for the person to relax and feel comfortable.

Problems with memory, thinking, attention, or learning (cognitive problems).


A person may have trouble with many mental activities or just a few. For example, the
person may have trouble following directions, may get confused if something in a room
is moved, or may not be able to keep track of the date or time.

Being unaware of the effects of the stroke.


The person may show poor judgment by trying to do things that are unsafe as a result of
the stroke.

Trouble swallowing (dysphagia)


This can make it hard for the person to get enough food. Also, care must sometimes be
taken to prevent the person from breathing in food (aspiration) while trying to swallow it.

Problems with bowel or bladder control.


These problems can be helped with the use of portable urinals, bedpans, and other
toileting devices.

Getting tired very quickly.


Becoming tired very quickly may limit the person's participation and performance in a
rehabilitation program.
Sudden bursts of emotion, such as laughing, crying, or anger.
These emotions may indicate that the person needs help, understanding, and support in
adjusting to the effects of the stroke.

Depression.
This is common in people who have had strokes. It can begin soon after the stroke or
many weeks later, and family members often notice it first.

A "disability" is difficulty doing something that is a normal part of daily life.


People who have had a stroke may have trouble with many activities that were easy before, such
as walking, talking, and taking care of "activities of daily living" (ADLs). These include basic
tasks such as bathing, dressing, eating, and using the toilet, as well as more complex tasks called
"instrumental activities of daily living" (IADLs), such as housekeeping, using the telephone,
driving, and writing checks.Some disabilities are obvious right after the stroke. Others may not
be noticed until the person is back home and is trying to do something for the first time since the
stroke.

Treatment options of an ischemic attack are: Medications

Clot-dissolving medications
Much of the damage caused by an ischemic stroke (a stroke due to a blood clot in the brain)
occurs in the first few hours. Injection of a clot-busting (thrombolytic) drug -- such as a tissue
plasminogen activator (TPA) -- into the veins to dissolve a blood clot may increase chances of a
full recovery compared with other treatment methods.
If used intravenously, therapy with clot-busting drugs for the treatment of an ischemic stroke
must be started within three hours. After that, the risks of bleeding or other complications from
this type of therapy begin to outweigh potential benefits. After three hours, these medications
may sometimes be given directly into the site of the clot (intra-arterial therapy) by a
neuroradiologist. With the diagnosis of an acute stroke, the patient or family members, and the
doctor must work together to weigh the risks versus benefits of thrombolytic therapy.

Anticoagulants
Often called blood thinners, anticoagulants may be prescribed by physicians following a stroke.
By reducing the ability of the blood to clot, they may help to keep blood vessels open and
delivering oxygen and nutrients to brain cells.

Antiplatelet drugs
In addition to a stroke-preventive measure, these drugs may be administered during or
immediately after a stroke to help prevent clot formation. While they work differently from
anticoagulants, the result is similar. They help to keep blood vessels open and delivering oxygen
and nutrients to brain cells.
Experimental medications:

Neuroprotective drugs
During an ischemic stroke, complex chemical and electrical processes leads to the death of nerve
cells. Neuroprotective drugs work to minimize the damage that results when brain cells are
deprived of oxygen and nutrients. Although no neuroprotective agents are available
commercially, several types of these drugs are in clinical trials for acute ischemic stroke. Like
thrombolytics, most neuroprotectives need to be administered quickly after a stroke to be
effective.

Surgery and other procedures:

Carotid endarterectomy
This procedure is used to remove atherosclerotic plaque from the carotid (neck) artery when it is
narrowed. The surgeon makes an incision in the neck, the artery is opened and the plaque is
removed. In people with substantial blockages in the carotid artery who are good candidates for
the surgery, the procedure may reduce the risk of ischemic stroke.

Revascularization (Bypass)
This technique is used to establish a new route for blood to reach the brain, usually by grafting
another vessel to a cerebral artery.

Endovascular therapy
Endovascular therapy is a radiological procedure that is an alternative to surgery. Endovascular
procedures are performed within the blood vessel. Mayo Clinic has extensive experience with
this technique and has found it is an effective treatment in properly selected patients.

• Angioplasty and stenting


Angioplasty can widen the inside of an artery leading to the brain. In this procedure, a
balloon-tipped catheter is maneuvered into the obstructed area of the artery. The
balloon is inflated, compressing the plaque against the artery walls. A metallic mesh
tube (stent) is usually left in the artery to prevent recurrent narrowing. A doctor may
recommend angioplasty for patients who are not good candidates for endarterectomy,
or for narrowing in arteries that are not accessible with surgery.
Introduction

Blood vessels are hollow tubes that carry blood through miles and miles of blood vessels in a
never ending stream. If you could take all the blood vessels of a average size child and line them
up they could reach about 60,000 miles long. In an adult the blood vessels could reach 100,000
miles long.

The blood vessels carry blood between the heart, different tissues, and organs of the body. There
are three types of blood vessels: arteries, veins, and capillaries. These blood vessels have the
ability to expand to allow more blood to flow through them. They can also contract to help
control the flow of blood. The blood flows through the big arteries into smaller ones. The
smallest arteries, called arterioles, direct the blood flow into the capillaries. The capillaries
connect to the smallest veins called venules. The Veins then return blood to the heart.

Arteries

The arteries are elastic, muscular tubes that carry the blood from the left ventricle of the heart to
the capillaries. The walls of the arteries are thicker than the other vessels because of the high
pressure. The largest artery is the aorta it is about 1 inch in diameter. The walls of the arteries are
3 layers thick. The inner layer, or tunica intima, consists of single flatten cells called
endothelium. The middle layer, or tunica media, is the thicker part of the artery wall. The outer
layer, or tunica externa is composed of fibrous connective tissue that give strength to the wall of
the artery. The thickness of arteries depends on where it is located within the arterial system. The
wall thickness of the arteries prevent the arteries from collapsing. Sometimes there is a weakness
in a wall of an artery and this causes the artery to bulge. This abnormal expansion of the artery is
called an aneurysm. There is also a problem of the arteries that involves lack of elasticity. This
disease comes about because the wall of arteries becoming harden. This abnormal harding is
called arteriosclerosis.

Veins

The veins carry blood from capillaries to the heart. The veins increase in size as they progress
toward the heart. The veins that connect to the capillaries are venules.They are the smallest of the
veins. The veins tend to follow a path parallel with the arteries. However, there are more veins
than arteries this is due to the draining of large areas when needed. The veins at any one moment
carries about 70 percent of the blood.

The veins are like the arteries in that they have three layers in their walls. However, they are not
as thick as arteries. This would also correlate with the lower pressure of blood within them.
Located with the veins are valves that allow blood to flow toward the heart but does not allow
blood to flow backwards. The veins that are in the lower part of the body tend to have more
valves to counteract the force of gravity. The only vein that does not have valves is the vena
cava. The valves in the legs sometimes breakdown and allow the blood to flow backwards. This
is called varicose veins and is more prevalent in person who stand for long periods of time on
hard surfaces.

Capillaries

The capillaries are the smallest working unit in the blood vessels that connect the arterioles to the
venules. The walls of the capillaries are only 1 cell thick this allows for the exchange of nutrients
and other substances like oxygen and carbon dioxide. Each of the cells in the walls of the
capillaries have openings between them so that the exchange can take place. The number of
capillaries vary depending on the need for oxygen and other nutrients. The blood flow through
the capillaries is regulated by a sphincter, a ring of muscle, that contracts to control the flow of
blood through the capillaries. This is important because there would not be enough blood to fill
all the blood vessels at one time. This is understandable when one sees that an individual could
have between 25,000 to 60,000 miles of capillaries.

Introduction:

The blood volume in the body varies according to size of individual. The blood accounts for
about 7 percent of the body weight. The Blood is an intricate part of the Circulatory System. It
tries to keep the body in an equilibrium state. The body systems are always changing the balance
of the blood. Its major function is to transport all the vital substances necessary to maintain
bodily life processes.

Each cell must receive oxygen and nutrients if cell life is to be maintained. The oxygen and
nutrients the cells use to carry out their functions produce waste that must be removed. The
blood also transports hormones from the different glands located throughout the body. These
hormones act as messengers that depended on the blood for travel. Another function is to help us
keep immune from disease that may enter the body. If you ever been cut thank your blood for its
ability to clot. The clotting process not only stops you from bleeding to death, but also assists in
stopping microbes from entering and causing infection.

To learn more about the blood use the diagram of the blood above. Click on the labels of the
blood components and learn more about their functions. After viewing this page and the other
pages on this site you may wish to take a quiz an see how much you have learned about the
Circulatory System.

Plasma

Plasma makes up a little more than 50 percent of the blood. The composition of blood is 90
percent water and 10 percent dissolved substance. The color of Plasma is like the color straw.
Plasma contains thousands of different substances like proteins, glucose, salts, vitamins,
hormones, and antibodies. Plasma is what keeps the blood flowing.
Red Blood Cells:

The red blood cells are also known as erythrocytes. The red blood cells have a unique appearance. They
have been described as looking like a donut because they are thinner in the center and thicker around the
edges. They are very flexible with the ability to twist and bend through the blood vessels. The red blood
cells are only 1/25,000 of an inch in size.

A major function of the red blood cells is to carry oxygen to all the tissues from the lungs. The red blood
cells than transport the carbon dioxide from the cells because of breaking down the nutrients

The reason the erythrocytes are known as red blood cells is because of a substance called hemoglobin.
Hemoglobin is composed of simple protein and iron pigments and when combined with oxygen their
color becomes a bright scarlet.

Red blood cells are made in the red bone marrow. In infants every bone in their body produces red blood
cells. In the adult the red blood cells can be produced in the thoracic bones, vertebrae, cranial bone and
ends of femur and humerus bones. Red blood cells only live for approximately 120 days. The blood
contains about 25 trillion red blood cells and has to replace them at about 3 million per second. If for
some reason there is a red blood cell deficiency a problem called anemia can arise.

White Blood Cells

The white blood cells are also known as leukocytes. They defend the body against bacteria and other
enemies. The name white blood cells can be very misleading. The white blood cells are colorless. White
blood cells come in many varieties. Each fights the body enemies in a different way. Some white blood
cells produce antibodies, detoxify foreign substances, and digest bacteria.

White blood cells are formed in the the red bone marrow, lymphatic tissue, spleen, lymph nodes, and
thymus. The white blood cells are less numerous than the red blood cells and larger than red blood cells.
Compared to the red blood cells the white blood cells number only 1 white blood cell to 700 red blood
cell.

The life span of white blood cells varies depending on the service they have to perform. They travel
throughout the circulatory system to sites that they are needed.

Platelets

Platelets are also known as thrombocytes. They are small fragments of cells that clump together and stick
to inner surface of blood vessels to plug up leaks. The platelets release a substance for clotting of blood.
The platelets cause the injured site to shrink and seal off. Platelets have a life span of 5 to 9 days.

The platelets are formed in the bone marrow.The number of platelets fall between the number of white
blood cells and red blood cells. The number of platelets can be between 250,000 and 350,000 in normal
volume of blood. The platelets get their name from their shape. They look like oval plates.
Regulating Blood Pressure: The Renin-Angiotensin-Aldosterone system

The Renin-Angiotensin-Aldosterone system is a series of reactions designed to help regulate


blood pressure.

1. When blood pressure falls (for systolic to 100 mmHg or lower), the kidneys
release the enzyme rennin into the bloodstream.
2. Renin splits angiotensinogen, a large protein that circulates in the bloodstream,
into pieces. One piece is angiotensin I.
3. Angiotensin I, which is relatively inactive, is split into pieces by angiotensin-
converting enzyme (ACE). One piece is angiotensin II, which is very active.
4. angiotensin II, a hormone, causes muscular walls of small arteries (arterioles) to
constrict, increasing blood pressure. Angiotensin II also triggers the release of the
hormone aldosterone from the adrenal glands.
5. aldosterone causes the kidneys to retain salt (sodium) and excrete potassium. The
sodium causes water to be retained, thus increasing blood volume and blood
pressure.

The Female Reproductive System

The female reproductive system consists of the internal and external genital
organs. However, other parts of the body also affect the development and functioning of the
reproductive system. They include the hypothalamus (an area of the brain), the pituitary gland
(located directly below the hypothalamus, and the adrenal glands (located on top of the kidneys).
The hypothalamus orchestrates the interactions among the genital organs, pituitary gland and the
adrenal gland. These parts of the body interact with each other by releasing hormones. The
hypothalamus release gonadotropin-releasing hormone, which stimulates the pituitary gland to
produce luteinizing hormone (LH) and follicle stimulating hormone (FSH). These hormones
stimulate the ovaries to produce the female sex hormones, estrogen and progesterone, and some
male sex hormones (androgens).
The external genitalia organs consists of the mons pubis, a rounded mound of
fatty tissue the covers the pubic bone, labia majora, which are relatively large, fleshy folds of
tissue that enclose and protect the other external genital organs, the labia minora which can be
very small (2 inches wide) lies just inside the labia majora and surround the openings to the
vagina and urethra. The area between the vaginal opening and the anus, at the back of the labia
majora is called the perineum. The vaginal opening is the entryway of the penis during sexual
intercourse and the exit for menstrual blood and vaginal discharge as well as the baby. The
opening to the urethra, which carries urine from the bladder to the outside, is located above and
in front of the vaginal opening. The clitoris, located between the labia minora, is a small
protrusion that corresponds to the penis of the male, like the penis it is very sensitive to sexual
stimulation and can become erect. The external genital organs have 3 main functions: enabling
sperm to enter the body, protecting the internal genital organs from infectious organisms, and
proving sexual pleasure.
The internal genital organs form a pathway (the genital tract). This pathway
consists of the Vagina (part of the birth canal), where sperm are deposited and from which a
baby can emerge, the Uterus, where an embryo can develop into a fetus, the fallopian tubes
(oviducts), where a sperm can fertilize an egg, the Ovaries, which produces and release the
chicken.

The Brain

Amygdala – limbic structure involved in many brain functions, including emotion, learning and
memory. It is part of a system that processes "reflexive" emotions like fear and anxiety.

Cerebellum – governs movement.

Cingulate gyrus – plays a role in processing conscious emotional experience.

Fornix – an arch-like structure that connects the hippocampus to other parts of the limbic system.

Frontal lobe – helps control skilled muscle movements, mood, planning for the future, setting
goals and judging priorities.

Hippocampus – plays a significant role in the formation of long-term memories.

Medulla oblongata – contains centers for the control of vital processes such as heart rate,
respiration, blood pressure, and swallowing.

Limbic system – a group of interconnected structures that mediate emotions, learning and
memory.

Occipital lobe – helps process visual information.

Parahippocampal gyrus – an important connecting pathway of the limbic system.


Parietal lobe – receives and processes information about temperature, taste, touch, and
movement coming from the rest of the body. Reading and arithmetic are also processed in this
region.

Pons – contains centers for the control of vital processes, including respiration and
cardiovascular functions. It also is involved in the coordination of eye movements and balance.

Temporal lobe – processes hearing, memory and language functions.

Thalamus – a major relay station between the senses and the cortex (the outer layer of the brain
consisting of the parietal, occipital, frontal and temporal lobes).

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