Professional Documents
Culture Documents
RRL Final
RRL Final
A lot of factors may influence the disease that may lead to its reduction towards
normal or further elevation. The considered risk factors include age, race, sex, smoking,
alcohol intake, serum cholesterol, glucose intolerance, weight, family history and
physical activity). The The Seventh Report of the Joint National committee reported that
prevalence of hypertension increases with advancing age to the point where more than
50% of people 60–69 years of age and approximately 75% of those 70 years of age and
older are affected. The age related rise in SBP is primarily responsible for an increase in
both incidence and prevalence of hypertension with increasing age. However, the
younger the patient when hypertension first noted, the greater the life expectancy if the
hypertension is left untreated. In the United States urban blacks have about twice the
prevalence of hypertension as whites and more than four times the hypertension-induced
morbidity rate. At all ages and in both white and nonwhite populations, females with
hypertension fare better than males up to the age of 65, and the prevalence of
hypertension in premenopausal females is substantially less than that in age-matched
males or postmenopausal women. Yet, compared with their normotensive counterparts,
females with hypertension run the same relative risk of a morbid cardiovascular event as
do males ( Harrison, et. al, 2008). Cigarette smoking transiently increases blood pressure,
likely because the effect of nicotine on the automic ganglia, and a risk factor for the
development of sustained hypertension. In addition, the atherogenic effect of smoking
may contribute to the development of renovascular hypertension. Cigarette usage is
associated with many other health hazards, and all patients should be discouraged from
smoking. The chronic intake of alcoholic beverages correlates with high blood pressure.
The reason for this link remains incompletely understood experimental evidence shows
that blood pressure (especially systolic) may rise acutely following alcohol consumption.
In people with hypertension, who are obese or have type 2 diabetes there is impaired
insulin independent transport of glucose into many tissues termed insulin resistance. As a
result serum glucose levels rise, stimulating the pancreas to release additional insulin.
Elevated insulin levels may contribute to hypertension via increased sympathetic
activation or by stimulation of vascular smooth cell hypertrophy, which increases
vascular resistance. Obesity itself has been directly associated with hypertension. The
current epidemic of obesity has led to a dramatic increase in the number of people with
metabolic syndrome. This condition represents a clustering of atherogenic risk factors,
including hypertension, hypertriglyceridemia, low serum HDL, a tendency toward
glucose intolerance and truncal obesity (Lily, 2007). About 90-95% of hypertension is
idiopathic (no known cause) which appears to be primary (essential hypertension), while
the remaining 5-10% is mostly secondary. Essential hypertension may be caused by
generalized or functional abnormalities while secondary hypertension may be either
benign or malignant. The most dangerous of which is malignant or accelerated
hypertension that leads to death within a year or two in about 5% of hypertensive persons
that show a rapidly rising blood pressure when left untreated (Cotran, et.al , 1996).
The choice of treatment of hypertension is such that a satisfactory program to
control arterial pressure with minimal side effects can be developed for most patients. A
reasonable guideline would be that all patients with a diastolic arterial pressure that
persistently exceeds 90mmHg, unless contraindications exist should be treated and that
all patients with a systolic arterial pressure over 180mmHg should be treated if they are
over age 65.
Nondrug therapeutic intervention is probably indicated in all patients with
sustained hypertension and probably in most with labile hypertension. The general
measures employed include (1) relief of stress, (2) dietary management, (3) regular
aerobic exercise, (4) weight reduction (if needed), and (5) control of other risk factors
contributing to the development of arteriosclerosis through restriction in the intake of
cholesterol and saturated fats and other dietary management aimed to control risk factors
such as sodium restriction. Probably the most significant additional step that could be
taken in this area would be to convince the smoker to give up cigarettes.
In general, there are seven classes of drugs: diuretics, ACE inhibitors, angiotensin
receptor antagonists, calcium channel antagonists; antiadrenergic agents, vasodilators,
and mineralocorticoid receptor antagonists. The aim of drug therapy is to use these agents
above or in combination, to return arterial pressure to normal levels with minimal side
effects. Ideally a therapeutic program should be chosen which specifically corrects to
underlying defect, resulting in the elevated blood pressure, taking into consideration
efficacy, saety, imapct on quality life, compliance, ease of administration and cost
(Harrison, et. al., 2008).
Patel et. al. in 2011 stated that diuretics are the oldest and most studied
antihypertensive agents. It increases the kidneys' excretion of salt and water, decreasing
the volume of fluid in the bloodstream and the pressure in the arteries. With continued
diuretic therapy, blood volume is restored, and vasodilator mechanisms sustain the
antihypertensive action. Traditionally thiazide diuretics have formed the cornerstone of
most therapeutic programs designed to lower arterial pressure, and they are usually
effective within 3 to 4 days. Furthermore, they have been shown to reduce mortality and
morbidity in long-term trials.
Lemon grass has no potential toxic properties. Leite et. al. in 1986 conducted a
study on the effect of lemon grass as eventual, toxic, hypnotic, and anxiolytic effects on
humans. A herbal tea (called an abafado in Brazil) prepared from the dried leaves of
lemongrass was administered to healthy volunteers. Following a single dose or 2 weeks
of daily oral administration, the abafado produced no changes in serum glucose, urea,
creatinine, cholesterol, triglycerides, lipids, total bilirubin, indirect bilirubin, GOT, GPT,
alkaline phosphatase, total protein, albumin, LDH and CPK. Urine analysis (proteins,
glucose, ketones, bilirubins, occult blood and urobilinogen) as well as EEG and EKG
showed no abnormalities. There were slight elevations of direct bilirubin and of amylase
in some of the volunteers, but without any clinical manifestation. These results taken
together indicate that lemon grass as used in Brazilian folk medicine is not toxic for
humans.