Congestive Heart Failure: What Does It Mean?
When Should You Seriously Worry About Your Blood Pressure?
High blood pressure, or hypertension, is one of the leading contributors to heart disease worldwide. It affects an estimated 128 crore people globally aged between 30 and 79 years, according to the World Health Organization (WHO).
In an interaction with the OnlyMyHealth team, Dr Reshu Agarwal, Consultant - Internal Medicine, Manipal Hospital, Baner, Pune, shared that the majority of people with high blood pressure remain asymptomatic, meaning they do not have any symptoms, and are mostly diagnosed during routine checks. Many people are unaware of their condition and do not understand the implications of high blood pressure or when they should be concerned. To decode the same, here's what you need to know.
Also Read: Connection Between Pain And High Blood Pressure: Expert Explains How Pain Can Cause High Blood Pressure
What Are Normal Blood Pressure Levels?In general, blood pressure readings are measured in two numbers: systolic and diastolic. Systolic refers to the pressure when your heart beats and pushes blood out to the arteries, whereas diastolic represents the pressure when the heart relaxes between beats. Keeping this in mind, here's what's considered normal and what indicates high blood pressure:
Normal: 120/80 millimetres of mercury (mmHg) or less.
Elevated: Systolic pressure between 120-129 mmHg and diastolic pressure less than 80 mmHg.
Hypertension: High blood pressure is categorised into two stages, namely: stage 1 hypertension, diagnosed when systolic pressure reads between 130 and 139 mmHg or your diastolic pressure is between 80 and 89 mmHg; and stage 2 hypertension, which occurs when systolic pressure reaches 140 mmHg or higher or your diastolic pressure reaches 90 mmHg or higher.
When Should You Seriously Worry About Blood Pressure Levels?According to Dr Agarwal, you should seriously worry about your blood pressure:
Other common symptoms are headaches, blurred vision, dizziness, fatigue, chest heaviness, shortness of breath, nausea and vomiting, nose bleeds, and blood spots in the eyes.
Should Temporary Fluctuations Concern You?It is important to note that temporary fluctuations in blood pressure levels, also called labile hypertension (blood pressure that fluctuates between normal and high), do not necessarily indicate a higher risk of hypertension.
Possible causes include anxiety and stress and the consumption of too much caffeine or excessive salt in the diet, said Dr Agarwal, adding that controlling the risk factor mostly results in BP coming back to the normal range.
However, the doctor noted that long-term, frequent, or extreme fluctuations may contribute to hypertension over time.
Also Read: Hypertension Risk: How Much Salt Should You Consume To Keep Blood Pressure In Check
How To Reduce Your Risk Of High Blood PressureListing some of the effective ways to reduce the risk of high blood pressure, Dr Agarwal shared:
Blood pressure levels fluctuate throughout the day due to various factors. However, it is important to know when you should take them seriously. While temporary changes in your blood pressure levels do not necessarily indicate a high or low blood pressure, long-term and frequent spikes can be a source of alarm. The key is to get yourself examined by a doctor and mention any symptoms if you have them.
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Etiologies Of Splenic Venous Hypertension
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(A) Compression. Pancreatic cysts compress the splenic vein, increasing venous flow in the gastric veins and forming varices. Other causes of compression include pancreatic NET, lymphoma, SAA, Bochdalek hernia, enlarged lymph nodes, and RF. (B) Stenosis. Idiopathic splenic vein stenosis increases the venous blood flow in the gastric veins, forming varices. (C) Inflammation. Pancreatitis can lead to fibrosis with subsequent occlusion of the splenic vein, leading to increased flow to the gastric veins and the formation of varices. (D) Thrombosis. ET and PMF can lead to splenic vein thrombosis, increasing blood flow in the gastric veins with varix formation. (E) Surgically decreased splenic venous flow. PV-SMV resection performed in the setting of a pancreatic tumor can lead to increased congestion of the splenic vein with subsequent formation of gastric varices. ET, essential thrombocythemia; NET, neuroendocrine tumor; PMF, primary myelofibrosis; PV-SMV, portal vein-superior mesenteric vein; PV, portal vein; SAA, splenic artery aneurysm; SMV, superior mesenteric vein; SV, splenic vein; SVH, splenic venous hypertension.
view moreCredit: Jasmine Tidwell, Bianca Thakkar, Bianca Thakkar
Splenic venous hypertension (SVH), also known as left-sided portal hypertension, is a rare condition characterized by upper gastrointestinal (GI) bleeding in the absence of liver disease. This condition arises due to increased pressure in the splenic vein (SV), causing blood to drain through the short gastric veins to the stomach, leading to the dilation of submucosal structures and the formation of gastric varices. Unlike traditional portal venous hypertension (PVH), SVH does not involve elevated pressures in the main portal vein and is primarily an extrahepatic condition. Diagnosing SVH requires a high degree of clinical suspicion, especially in patients presenting with upper GI variceal bleeding, splenomegaly, and normal liver enzyme tests.
SVH can develop through various mechanisms, including compression, stenosis, inflammation, thrombosis, and surgically decreased splenic venous flow.
Compression of the splenic vein is a significant cause of SVH, accounting for approximately 18% of cases. This can occur due to external compression by neighboring structures such as benign neoplasms, adenocarcinoma, non-functioning neuroendocrine tumors (NETs), anatomical variants, and Bochdalek hernia. These structures exert pressure on the splenic vein, obstructing blood flow and increasing venous pressure, leading to gastric varices.
Stenosis of the splenic vein is a rare cause of SVH. Idiopathic splenic vein stenosis can lead to increased venous blood flow in the gastric veins, resulting in varices. It is characterized by the narrowing of the splenic vein with post-stenotic dilatation and the absence of other common causes such as pancreatitis, pancreatic tumors, cysts, thrombosis, or arterial aneurysms.
Inflammatory conditions such as pancreatitis can lead to fibrosis and subsequent occlusion of the splenic vein, increasing venous pressure and causing gastric varices. Studies have shown that splenic vein obstruction due to inflammation is more frequent in males, with a median age of 48. Severe cases of acute pancreatitis (AP) have a higher incidence of SVH compared to mild cases.
Thrombosis of the splenic vein can occur due to conditions such as essential thrombocythemia (ET) and primary myelofibrosis (PMF). This leads to increased blood flow in the gastric veins, forming varices. Splenic vein thrombosis is a serious condition that requires prompt diagnosis and management to prevent complications.
Surgical interventions for pancreatic cancer, such as pancreatoduodenectomy (PD) and portal-superior mesenteric vein (PV-SMV) resection, can lead to decreased venous flow in the splenic vein. This results in vascular congestion, increased pressure within the venous system, and the formation of gastric varices. This complication is more common in the late stages of PD, as increased survival time due to surgery provides a greater length of time for the development and bleeding of varices.
Patients with SVH typically present with symptoms of upper GI bleeding, which often occurs due to ruptured gastric varices. Splenomegaly and normal liver function tests are common clinical findings. Asymptomatic presentations are also frequent, with many cases being identified incidentally. In symptomatic cases, abdominal pain and hypersplenism with thrombocytopenia and pancytopenia are common. Unlike portal hypertension caused by liver disease, ascites is uncommon in SVH due to the absence of underlying liver cirrhosis.
Diagnosis of SVH involves a combination of clinical suspicion and imaging studies. The typical presentation includes GI bleeding with gastric varices, splenomegaly, and normal liver function tests. Initial imaging usually involves transabdominal ultrasound (US) with Doppler, although this has limited efficacy for visualizing the SV. More detailed imaging, such as contrast-enhanced endoscopic ultrasound (EUS), computed tomography angiography (CTA), or magnetic resonance angiography (MRA), is often required to assess the patency and anatomy of the splenic vasculature. Endoscopic methods, such as esophagogastroduodenoscopy (EGD), are crucial for identifying and managing varices.
The management of SVH is primarily focused on addressing the underlying cause of splenic venous obstruction and managing variceal bleeding. Treatment options vary depending on the etiology:
Surgical and Endoscopic Approaches: For cases where the SV obstruction is due to tumors or anatomical anomalies, surgical interventions such as splenectomy or distal pancreatectomy may be necessary. Endoscopic interventions, such as band ligation or variceal injection, are critical for controlling acute bleeding episodes.
Splenic Artery Embolization: This less invasive procedure is often preferred in patients who are not candidates for splenectomy due to previous complex abdominal surgeries. It reduces splenic venous pressure and helps control variceal bleeding.
Pharmacological Treatments: Beta-blockers and octreotide are used to manage portal hypertension and prevent recurrent variceal bleeding. Lifelong anticoagulation therapy is recommended for patients with thrombosis-related SVH, particularly those with conditions such as factor V Leiden or paroxysmal nocturnal hemoglobinuria (PNH).
The prognosis of patients with SVH largely depends on the underlying cause. Patients with pancreatic cancer generally have poorer outcomes due to the aggressive nature of the disease and shorter life expectancy. For non-malignant causes, proper management of the underlying condition typically leads to a favorable prognosis. GI bleeding, although a severe complication, is relatively rare, and with appropriate management, the risk of fatality can be minimized.
In conclusion, SVH is a rare but significant condition that requires a high index of suspicion for diagnosis, particularly in patients presenting with variceal bleeding and splenomegaly without liver disease. The condition arises due to increased pressure in the SV from various causes, leading to variceal formation and bleeding. Effective management hinges on addressing the underlying cause and controlling bleeding. While surgical interventions like splenectomy remain a cornerstone of treatment, less invasive approaches such as splenic artery embolization and pharmacological management are becoming increasingly important. Continued research is needed to improve diagnostic modalities and develop less invasive treatment options.
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The study was recently published in the Journal of Clinical and Translational Hepatology.
The Journal of Clinical and Translational Hepatology (JCTH) is owned by the Second Affiliated Hospital of Chongqing Medical University and published by XIA & HE Publishing Inc. JCTH publishes high quality, peer reviewed studies in the translational and clinical human health sciences of liver diseases. JCTH has established high standards for publication of original research, which are characterized by a study's novelty, quality, and ethical conduct in the scientific process as well as in the communication of the research findings. Each issue includes articles by leading authorities on topics in hepatology that are germane to the most current challenges in the field. Special features include reports on the latest advances in drug development and technology that are relevant to liver diseases. Regular features of JCTH also include editorials, correspondences and invited commentaries on rapidly progressing areas in hepatology. All articles published by JCTH, both solicited and unsolicited, must pass our rigorous peer review process.
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JournalJournal of Clinical and Translational Hepatology
Article TitleEtiologies of Splenic Venous Hypertension: A Review
Article Publication Date20-May-2024
Will Statins Lower My Blood Pressure?
Research suggests statins may help lower blood pressure by reducing some risk factors, such as plaque buildup and inflammation. However, conventional hypertension drugs may still be more effective.
Blood pressure is a measurement of the force of the bloodstream against the inside walls of the arteries. These are the blood vessels that carry blood from the heart to the rest of the body.
High blood pressure, also called hypertension, is when this force is too high.
If left untreated, hypertension may damage your arteries, making them less effective at moving blood throughout your body. It may also increase your risk of developing life threatening conditions, such as stroke and heart attack.
Treatment for hypertension may include a combination of lifestyle and dietary changes, as well as medications.
Statins are medications typically used to help lower LDL ("bad") cholesterol. Some research suggests they may help lower blood pressure.
Keep reading to learn more about the link between statins and high blood pressure.
Statins are a type of medication used to help lower LDL cholesterol.
High levels of LDL cholesterol may cause plaque to build up in your arteries.
Over time, cholesterol plaque can narrow your blood's pathways, reducing the amount of blood that reaches your organs and muscles. This may also increase blood pressure, as your heart needs to work harder to pump blood.
If a coronary or heart artery becomes occluded or blocked, a heart attack results. If blood flow to the brain is blocked, a stroke occurs.
Can statins lower blood pressure?A 2023 review of 49 studies involving altogether 45,173 participants found that statins could help lower blood pressure in people with hypertension. Statins may do this by reducing:
However, the authors conclude that statins don't significantly lower blood pressure and that more research is needed to fully assess the link between statins and hypertension.
As such, it's important to speak with a healthcare professional if you have high blood pressure. They could provide a proper diagnosis and develop a treatment plan that's right for you. This may include more conventional medications for hypertension.
Types of statinsThere are several different types of statins. The best type and dosage for you will depend on several factors, such as your cholesterol levels and your risk of cardiovascular disease.
According to the American Heart Association (AHA), the following statins are available by prescription in the United States:
A healthcare professional may also recommend a combination of certain statins or alternatives to statins for lowering cholesterol.
Statins are best used by people who have a family history of cardiovascular disease and a high risk of heart problems.
According to the AHA, you may benefit from taking statins if you have:
Like any medication, statins may have some potential side effects. These may include:
Sometimes, statins may cause more severe side effects. Speak with a healthcare professional if you experience any of the following symptoms when taking statins. They could modify the dosage or suggest an alternative medication:
Learn more about the potential side effects of statins.
Medications used to treat high blood pressure are known as antihypertensives.
There are several different types. The best one for you will depend on several factors, such as the severity of your condition, whether you take other medications, and your risk of side effects.
Antihypertensives available to lower blood pressure include:
Medications are most effective if they're part of an overall treatment plan. Your treatment plan should address other cardiovascular risks, such as smoking, obesity, and high cholesterol.
Learn more about medications for high blood pressure.
How much can statins lower blood pressure?Some research suggests that statins may lower systolic and diastolic blood pressure. However, these effects aren't as significant as antihypertensives, which are the usual medication treatment for high blood pressure.
What is the biggest side effect of statins?According to the Food and Drug Administration (FDA), common side effects of statins include muscle pain, constipation, diarrhea, nausea, and headache.
Can atorvastatin affect blood pressure?A 2023 review found that atorvastatin reduced blood pressure more than other types of statins.
Can I take blood pressure tablets and statins at the same time?A healthcare professional can help determine whether you should take blood pressure medications and statins at the same time.
Statins are medications used to help lower cholesterol levels.
A doctor will likely recommend antihypertensives and lifestyle changes if your blood pressure needs to decrease significantly.
However, they may recommend statins to lower cholesterol levels if these are contributing to your hypertension.
A heart-healthy diet and regular exercise are key components of managing blood pressure.
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