Hypertension

Hypertension is a common condition affecting one in four adults. It is a leading cause of cardiovascular morbidity and mortality and appropriate treatment strategies that are both clinically and cost effective are key to the management of this condition. Recent guidelines have focused on addressing total cardiovascular risk and recommended rational combinations of antihypertensives as well as highlighting the importance of lifestyle intervention. Recent advances have increased understanding of the pathogenesis of hypertension and have opened the possibility of novel interventions for treatment.     

Cadmium Hypertension

The kinetics of the change in the concentration of polonium-210 in the peripheral blood of six cigarette smokers has been studied up to 89 days altar sudden complete cessation of smoking. Circulating polonium-210 levels declined an average of 14% after three to four days, and 20.5% after 11 to 14 days. The results indicate that a major fraction of the Isotope inhaled in cigarette smoke is absorbed directly into the blood stream.     

Hypertension.

1. Accurate measurement of blood pressure using a regularly serviced sphygmomanometer is essential. 2. Severe hypertension requires early treatment. Uncomplicated mild to moderate hypertension requires repeated blood pressure measurements up to three or four months before the diagnosis is confirmed. 3. Personal and family histories, relevant examination and investigations precede treatment. 4. Initial management should aim at reducing weight, improving diet and exercise, and stopping cigarette and excess alcohol consumption. 5. Patients with other risk factors require drug treatment at an earlier stage and at lower blood pressure levels. Essential hypertension is associated with an increased prevalence of risk factors which may need attention. 6. Treatment of asymptomatic hypertension should be considered in patients up to the age of 80. 7. First-line treatment: thiazide diuretics and beta blockers, used in the lowest effective doses, are of proven value and acceptability. The former are by far the cheapest antihypertensive drugs. 8. Second-line treatment: if thiazides and beta blockers are contra-indicated or ineffective, ACE inhibitors, calcium antagonists and alpha blockers should be used. With drugs of these classes the absence of adverse cardiovascular metabolic effects is a theoretical advantage but of uncertain magnitude. 9. Follow-up of patients with borderline levels of raised blood pressure as well as for those on treatment is essential.