Hypertension And Blood Pressure

Hypertension And Blood Pressure Hypertension is a common and major cause of stroke and other cardiovascular disease. There are many causes of hypertension, including defined hormonal and genetic syndromes, renal disease and multifactorial racial and familial factors. It is one of the leading causes of morbidity and mortality in the world and will increase in worldwide importance as a public health problem by 2020 (Murray and Lopez 1997). Blood pressure (BP) is defined as the amount of pressure exerted, when heart contract against the resistance on the arterial walls of the blood vessels. In a clinical term high BP is known as hypertension. Hypertension is defined as sustained diastolic BP greater than 90 mmHg or sustained systolic BP greater than 140 mmHg. The maximum arterial pressure during contraction of the left ventricle of the heart is called systolic BP and minimum arterial pressure during relaxation and dilation of the ventricle of the heart when the ventricles fill with blood is known as diastolic BP (Guyton and Hall 2006). Hypertension is commonly divided into two categories of primary and secondary hypertension. In primary hypertension, often called essential hypertension is characterised by chronic elevation in blood pressure that occurs without the elevation of BP pressure results from some other disorder, such as kidney disease. Essential hypertension is a heterogeneous disorder, with different patients having different causal factors that lead to high BP. Essential hypertension needs to be separated into various syndromes because the causes of high BP in most patients presently classified as having essential hypertension can be recognized (Carretero and Oparil 2000). Approximately 95% of the hypertensive patients have essential hypertension. Although only about 5 to 10% of hypertension cases are thought to result from secondary causes, hypertension is so common that secondary hypertension probably will be encountered frequently by the primary care practitioner (Beevers and MacGregor 1995). In normal mechanism when the arterial BP raises it stretches baroceptors, (that are located in the carotid sinuses, aortic arch and large artery of neck and thorax) which send a rapid impulse to the vasomotor centre that resulting vasodilatation of arterioles and veins which contribute in reducing BP (Guyton and Hall 2006). Most of the book suggested that there is a debate regarding the pathophysiology of hypertension. A number of predisposing factors which contributes to increase the BP are obesity, insulin resistance, high alcohol intake, high salt intake, aging and perhaps sedentary lifestyle, stress, low potassium intake and low calcium intake. Furthermore, many of these factors are additive, such as obesity and alcohol intake (Sever and Poulter 1989). The pathophysiology of hypertension is categorised mainly into cardiac output and peripheral vascular resistant, renin- angiotensin system, autonomic nervous system and others factors. Normal BP is determined and maintained the balance between cardiac output and peripheral resistant. Considering the essential hypertension, peripheral resistant will rise in normal cardiac output because the peripheral resistant is depend upon the thickness of wall of the artery and capillaries and contraction of smooth muscles cells which is responsible for increasing intracellular calcium concentration (Kaplan 1998). In renin-angiotensin mechanism endocrine system plays important role in maintain blood pressure; especially the juxtaglomerular cells of the kidney secrete renin in order to response glomerular hypo-perfusion. And also renin is released by the stimulation of the sympathetic nervous system which is later convert to angiotensin I then again it converts to angiotensin II in the lungs by the effect of angiotensin- converting enzyme (ACE). Angiotensin II is a potent vasoconstrictor and also it released aldosterone from the zona glomerulosa of the adrenal gland which is responsible for sodium and water retention. In this way, renin-angiotensin system increases the BP (Beevers et al 2001). Similarly, in autonomic nervous system sympathetic nervous system play a role in pathophysiology of hypertension and key to maintaining the normal BP as it constricts and dilates arteriolar. Autonomic nervous system considers as an important in short term changes in BP in response to stress and physical exercise. This system works together with renin-angiotensin system including circulating sodium volume. Although adrenaline and nor-adrenaline doesnt play an important role in causes of hypertension, the drugs used for the treatment of hypertension block the sympathetic nervous system which had played proper therapeutic role (Beevers et al 2001). Others pathophysiology includes many vaso active substance which are responsible for maintaining normal BP. They are enothelin bradikinin, endothelial derived relaxant factor; atrial natriuretic peptide and hypercoagulability of blood are all responsible in some way to maintain the BP (Lip G YH 2003). The seventh report of the Joint National Committee (JNC-VII) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure defines some important goals for the evaluation of the patient with elevated BP which are detection and confirmation of hypertension; detection of target organ disease (e.g. renal damage, congestive heart failure); identification of other risk factors for cardiovascular disorders (e.g. diabetes mellitus, hyperlipidemia) and detection of secondary causes of hypertension (Chobanian et al 2003). Most hypertensive patients remain asymptomatic until complications arise. Potential complications include stroke, myocardial infarction, heart failure, aortic aneurysm and dissection, renal damage and retinopathy (Zamani et al 2007).The drug selection for the pharmacologic treatment of hypertension would depend on the individual degree of elevation of BP and contradictions. Treatment of non-pharmacologic hypertension includes life-style, weight reduction, exercise, sodium, potassium, stop smoking and alcohol, relaxation therapy and dietary improvements, followed by pharmacology therapy. Commonly used antihypertensive drugs include thiazide diuretics, ÃŽ ²-blockers, ACE inhibitors, angiotensin receptor blockers, calcium channel blockers, direct vasodilators and ÃŽ ±-receptor antagonists which are shown in the following table. Diuretics have been used for decades to treat hypertension and recommended as first-line therapy by JNC-VII guidelines after antihypertensive and lipid-lowering treatment to prevent heart attack trail (ALLHAT) success. They reduce circulatory volume, cardiac output and mean arterial pressure and are most effective in patients with mild-to- moderate hypertension who have normal renal function. Thiazide diuretics (e.g. hydrochlorothiazide) and potassium sparing diuretics (e.g. spironolactone) promote Na+ and Cl- excretion in the nephrone. Loop diuretics (e.g. furosemide) are generally too potent and their actions too short-lived, however, they are useful in lowering blood pressure in patients with renal insufficiency, who often does not respond to other diuretics. Diuretics may result in adverse metabolic side effects, including elevation of creatinine; glucose, cholesterol, triglyceride levels, hypokalemia, hyperuricemia and decreased sexual function are potential side effects. The be st BP lowering response is seen from low doses of Thiazide diuretics (Kaplan 1998). Î’-blocker such as propranolol are believed to lower BP through several mechanisms, including reducing cardiac output through a decrease heart rate and a mild decrease in contractility and decreasing the secretion of renin, which lead to a decrease in total peripheral resistant. Adverse effects of b-blockers include bronchospam, fatigue, impotence, and hyperglycemia and alter lipid metabolism (Zamani et al 2007). Centrally acting ÃŽ ±2-adrenergic agonists such as methyldopa and clonidine reduce sympathetic outflow to the heart, blood vessels and kidneys. Methyldopa is safe to use during pregnancy. Side effect includes dry mouth, sedation, drowsiness is common; and in 20% of patients methyldopa causes a positive antiglobulin test, rarely haemolytic anaemia and clonidine causes rebound hypertension if the drug is suddenly withdrawn (Neal M J 2009). Systemic a1-antagonists such as prazosin, terazosin and doxazosin cause a decrease in total peripheral resistance through relaxation of vascular smooth muscle. Calcium channel blockers (CCB) reduce the influx of Ca++ responsible for cardiac and smooth muscle contraction, thus reducing cardiac contractility and total peripheral resistant. Thus long-acting members of this group are frequently used to treat hypertension. There are two classes of CCB dihyropyridines and non- dihyropyridines. The main side effect of CCB is ankle oedema, but this can sometimes be offset by combining with ÃŽ ²-blockers (Lip G YH 2003). Direct vasodilators such as Hydralazine and minoxidil lower BP by directly relaxing vascular smooth muscle of precapillary resistance vessels. However, this action can result in a reflex increase heart rate, so that combined ÃŽ ²-blocker therapy is frequently necessary (Neal M J 2009). ACE inhibitors works by blocking the renin-angiotensin system thereby inhibiting the conversion of angiotensin I to angiotensin II. ACE inhibitors may be most useful for treating patients with heart failure, as well as hypertensive patients who have diabetes. Using ACE inhibitors can lead to increased levels of bradikinin, which has the side effect of cough and the rare, but severe, complication of angioedema. Recent study demonstrated that captopril was as effective as traditional thaizides and ÃŽ ²-blockers in preventing adverse outcomes in hypertension (Lip G YH 2003). Angiotensin II antagonists act on the renin-angiotensin system and they block the action of angiotensin II at its peripheral receptors. They are well tolerated and very rarely cause any significant side-effects (Zamani et al 2007). Another helpful principle of antihypertensive drug therapy concerns the use of multiple drugs. The effects of one drug, acting at one physiologic control point, can be defeated by natural compensatory mechanism (e.g. diuretic decrease oedema occurring secondary to treatment with a CCB). By using two drugs with different mechanisms of action, it is more likely that BP and its complication are controlled and with the low dose range of combined drugs also help to reduce the side-effects as well (Frank 2008) . The following two-drug combinations have been found to be effective and well tolerated which are diuretic and ÃŽ ²-blocker; diuretic and ACE inhibitor or angiotensin receptor antagonist; CCB (dihydropyridine) and ÃŽ ²-blocker; CCB and ACE inhibitor or angiotensin receptor antagonist; CCB and b-diuretic; ÃŽ ±-blocker and ÃŽ ²-blocker and other combinations (e.g. with central agents, including ÃŽ ±2-adrenoreceptor agonists and imidazoline- I2 receptor modulators, or between ACE inhib itors and angiotensin receptor antagonists) can be used (ESH and ESC 2003). If necessary, three or four drugs may be required in many cases for the treatment. The use of a single drug will lower the BP satisfactorily in up to 80% of patients with hypertension but combining two types of drugs will lower BP about 90%. If the diastolic pressure is above 130 mmHg then the hypertensive emergency is occurred. Although it is desirable to reduce the diastolic pressure below 120 mmHg within 24 hours in accelerated hypertension, it is usually unnecessary to reduce it more rapidly and indeed it may be dangerous to do so. This is because the mechanisms that maintain cerebral blood flow at a constant level independent of peripheral BP are impaired in hypertension. However, it is important to reduce the BP quickly by giving the intravenous drugs but caution should be taken to avoid cerebrovascular pressure inducing cerebral ischemia (Grahame-Smith and Aronson 2002). In conclusion, hypertension emerges as an extremely important clinical problem because of its prevalence and potentially devastating consequences. The major classes of antihypertensive drugs: diuretics, ÃŽ ²-blockers, CCB, ACE inhibitors and angiotensin receptor antagonists, are suitable for the initiation and maintenance of antihypertensive therapy which helps in reduction of cardiovascular morbidity and mortality.

Script on aboriginal

I have chosen to do my following script from when Molly, Daisy and Gracie have just been captured and are being taken to Moore River Native Settlement. The reason I have chosen to start my script from there is because there will be a range of emotions that will be felt by the girls at that time I and will develop on them and hopefully get a bit of understanding of the torment they must have been going through. Molly Daisy and Gracie are in the back of Mr. Neville's care on the way to Moore River. Gracie is crying and Daisy is shaking. Molly: (Whispers to Daisy) It's going to be all right Daisy, I will get us back home. Daisy: (Still shaking) OK Molly, I trust you. Molly: (Turns to Gracie and whispers) Remember the spirit bird Gracie, remember spirit bird†¦ Gracie: (Tears running down her face, wipes her nose with her hand) The spirit bird will guide us home. Where are we going Molly, I'm scared Molly, I want to go home. Daisy: (in aboriginal) Molly is going to get us home Gracie. I know she will. Mr Neville: (sharp cold tone) Oi! Enough of your filth language. If you are to talk, talk in English. (to himself) Bleeding half-breeds. Molly: (Now shaking herself) Where are you taking us? Mr Neville: (not even looking at Molly) You will see in due time. But first I need to stop And fill up the tank. (He turns to Molly with a frightening look on his face) if You even think about trying to run away, I will do something even your spirit Bird can't guide you through. Mr Neville exits the car to talk to the petrol pump attendant. We see Molly's Grandmother enter the scene running and screaming in aboriginal. She runs to the car and tries to open the door, but Mr Neville was too quick. He whipped his cane across the face of the helpless old lady. Molly: (in shock, speaking in aboriginal) Grandmother! Molly covers Gracie's eyes as she begins to cry. Daisy tries to open the door of the car, but Mr Neville gets back in. Mr Neville: (laughing) I don't suppose you girls want to go the same way as your Grandmother, do you? No I didn't think so. Now you know what the Punishment will be if you ever try to escape from under my nose. Gracie: (still crying) Your big nose! Mr Neville: (fury overwhelming him) What did you just say?! Molly: (quickly) Nothing Mr Neville, sir. Honest. Mr Neville: (deciding not to take any action) As I was saying, even if you do succeed in Escaping, you won't ever see your grandmother again. Daisy: (with courage) You an evil- Molly: (coughs loudly) Mr Neville: (evil sneer) Where your going will change you lives forever. And it will be all Down to me. Over the years you will realise how much good is doing†¦ They slow down as they approach there destination. Molly looks around, already thinking about how they were going to escape. This script shows elements of power, freedom and control throughout. Mr Neville who is one of the most powerful people in the process of biological absorption has control over the aboriginals. He mentions what would happen to them if they tried to escape because all they want is freedom. It was an important part of the play because it was the first time that they were being taken to the camp. Everyone in the scene had different feelings and they all showed them in different ways.

Double Indemnity: Love of Manipulation or Manipulation of Love? Essay

â€Å"The basic tool for the manipulation of reality is the manipulation of words. If you can control the meaning of words, you can control the people who must use the words† (Phillip K. Dick). Manipulation in this book can be summed up in one phrase: It takes two to tango. This dance takes total control of the manipulator and the person being manipulated. Beauty and lust are two common methods of manipulating others. This novel successfully portrays the manipulation of two very clever women through their full and utter control of Walter Huff. In the book Double Indemnity, the author James Cain describes women as manipulators and clearly shows their power to negatively affect men. He illustrates this through the characters Phyllis and Lola. In extensively flirting with Mr. Huff, Phyllis was able to manipulate him into killing Mr. Nirdlinger, leaving her free of any punishment linking her to the murder. James Cain proficiently uses Phyllis’ character to emphasize the power of cruel manipulation used effectively by this woman. This is a reoccurring theme throughout the three literary time periods: Classic, Cozy, and Hard Boiled. The women in this story are powerful users of manipulation due to their beauty, which feeds Huff’s most fundamental emotions. These emotions are: being loved, cared for, a sense of belonging, and inflating their sense of self. With Phyllis’ relationship with Huff, â€Å"She is wholly coquettish as she woos Walter into her scheme to kill her husband. She even says she loves her husband, but shortly afterwards the repulsive side of her character reveals itself in her comment that they would be doing her husband a favor by killing him† (Beetz). Mr. Huff is an intelligent man who can plan and scheme a course of action. He hardly shows weakness of emotion and effortlessly completes the murder of Mr. Nirdlinger. Mr. Huff followed his script with ease and serenity. Walter’s downfall was Phyllis’ ability to manipulate him to her ends. Phyllis makes herself look dim and useless in Walter’s eyes in order to get him to take initiative, plan, and execute the murder. Phyllis skillfully has Huff commit the murder and then deceitfully shifts the blame onto him. While she was using him for her final solution, â€Å"Phyllis ferrets out the weakness in Walter’s character–his need to feel superior to others–and proves herself capable of sophisticated manipulation. For example, she fabricates preposterous ideas of how she might do away with Mr. Nirdlinger, like drowning him in the swimming pool and making it look like a diving accident, so that Walter can strut his knowledge and develop an idea that will pass muster with the insurance investigators but will also yield the greatest payout† (Beetz). Phyllis controls Walter shrewdly throughout the book, whether by devious manipulation or self-portrayed, feigned stupidity. Although Walter seemed as if he were the smarter of the two, Phyllis had full control of him for the duration of the entire novel. Women may use their beauty as an ill-hearted power to get what they want with this game of love. Many professional females may secure positions of power by utilizing their flirtatious skills and their sexual attraction as an influence on men’s emotions. Although James Cain portrays Phyllis and Lola as polar opposites, Lola is still able to use her naà ¯vetà ©, youth, and beauty as leverage and exploits the two men in her life: Nino Sachetti, her boyfriend, and Walter Huff, her paramour. Lola uses her innocent beauty as a coercive force to secure her intended goal with Huff. Huff is attracted to her and influenced by her persona of caring, comfort, and beauty. Many believe that, â€Å"The symbolism is in the [checkers] game that Phyllis and Lola play nearby. Lola says she’s going out to meet her girlfriend, denies any intent of meeting her boyfriend, the penniless Nino Sachetti. Yet when Huff leaves the house, he finds the sexy young Lola waiting for him in his coupe†¦ and once again he finds himself being manipulated by a woman. But who is manipulating who? As it develops, Huff’s ambiguous relationship with Lola fits perfectly with Phyllis’ second agenda† (Russell). Walter is a victim of manipulation, for his lust for these two women promotes and decides his actions more than his common sense. One should nott kill for love, as it is uncharacteristic and hypocritical. He’s killing to secure his sense of love, which was not found with Phyllis. Walter tries to abide his conscience when he settles for Lola as a consolation prize. Lola notices his weakness and exploits his emotions with her promiscuous behavior toward him. Lola’s entrapment of her innocent beauty gave her the upper hand in her relationship with Walter, eventually leading to her complete control of him: â€Å"She had made a fool of me. She had used me for a cat’s paw so she could have another man, and she had enough on me to hang me higher than a kite† (Cain, 80). His willing submissiveness verifies the overpowering influence that the emotional and physical attributes of these women use to their own ends. Walter believes that he is meeting his needs with this devil’s bargain. Mr. Huff allowed himself to be easily manipulated by women because he made himself believe that the women had something to give that he so truly desired. Walter killed Nirdlinger not out of hate—Huff did not have anything against him, he killed Nirdlinger out of pure lust for his mistress. Walter Huff kills for love, but he will die without being loved. Phyllis and Lola use the three poisons for love: manipulation, intimidation, and domination. These poisons make the foundation for securing their financial and emotional stability.

Compare the Philosophies of Martin Luther King, Jr. and...

Compare the philosophies of Martin Luther King, Jr. and Malcolm X. how their goals for the African American community similar and/or different? How their strategies for reaching those goals similar and/or different? During the past century there were two influential people Martin Luther King, Jr. and Malcolm X who grappled with the problem of inequality between black and white people. They both wanted to bring hope to blacks in the US through their powerful, hard-hitting speeches, but the methods and styles they followed were completely different from each other. While one followed non-violence, peaceful way for bringing racial harmony, the other encouraged his followers to rise up and protest†¦show more content†¦He wanted to black get an independent existence where everyone would get the voting power to express their political opinion as the white could do. He wanted the black people to be treated as the white citizen in the US not along with the identity of Negro. He called the people to become â€Å"politically matured† to have their rights for voting, and if they can’t â€Å"cast a ballot,† they are gong to â€Å"cast a bullet.† Although King and Malcolm X both trued to infused power and strength within the black community, King was inclined to look through rose-colored spectacles to achieve the goal whereas Malcolm X had a different perspective. King wished that â€Å"one day every valley shall be exalted, every hill and mountain shall be made low. The rough places will be made plane, and the crooked places will be made straight† (2459) He dreamt â€Å"to work together,† â€Å"to pray together,† â€Å"to struggle together,† to got to jail together,† â€Å"to stand up for freedom together†. (2459) On the contrary, Malcolm X didn’t â€Å"see any American dream;† he â€Å"saw an American nightmare.†(2470) He fought against the conspiracy of the white and wanted to make them aware of the fact that the eyes of the black people were not closed. He wanted to expose the hypocrite white society in front of the world. He wanted to promote the philosophy of Black Nationalism by removing â€Å"the evils, the vices, alcoholism, drug addiction, and otherShow MoreRelatedThe Dream and the Ballot or the Bullet1038 Words   |  5 PagesIndependence was far from a reality. Martin Luther King Jr., a Baptist minister delivered his famous speech â€Å"I Have a Dream† August 28th, 1963 in Washington DC. He is credited with mobilizing supporters of desegregation and prompted the 1964 Civil Rights Act. Malcolm X delivered his famous speech â€Å"The Ballot or the Bullet† on April 12th, 1964 in Detroit. Though many people say Malcolm X was violent he made many good key points. Martin Luther King Jr. and Malcolm X both helped encourage African AmericansRead MoreMartin Luther King Jr. and Malcolm X1491 Words   |  6 Pagesinfluence of this period. Two strong leaders from this era were Martin Luther King Jr. and Malcolm X. 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He used this speech as a call toRead MoreAfrican American Social And Political Thought Of Today1785 Words   |  8 PagesSayfur R Shuyeb FP7735 AFS 2210-001 African-American Social and Political Thought of Today I might not be a person like Martin Luther King Jr., W.E.B Du Bois, Malcolm X, Elijah Muhammad, Bell Hooks, and Jesse Jackson, or I might not be a part of organizations like the NAACP, SCLC, Afro American Unity, and Black Panther Party, but if I ever get an opportunity to make a difference these people and organizations made to the lives of African-Americans, I would never hesitate to take it. Although, theseRead MoreBible Versus the Toran12356 Words   |  50 Pages PAGE 24-28 VII. FIVE PILLARS OF ISLAM COMPARED TO THE TEN PAGE 29-34 COMMANDMENTS VIII. 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