Discuss about the Challenge and Response to Body Integrity.
1. When a secondary cause cannot be attributed to hypertension, it is called primary hypertension. Whereas, secondary hypertension is high blood pressure that is caused due to an underlying condition that affects the heart, arteries, kidneys or the endocrine system. Decreased renal perfusion that is caused due to narrowing of renal arteries and results in fibromuscular dysplasia has been recognised a common cause for secondary hypertension among women.
Disturbances in the secretion of the thyroid hormones can also cause hypertension. Since the hormone influences cardiac output and systemic vascular resistance, higher or lower secretion of the hormone can cause hypertension. Hypothyroidism can elevate the diastolic blood pressure while the systolic blood pressure is raised due to hyperthyroidism. Hypothyroidism is usually observed in patients in the older age group. Hyperthyroidism commonly causes hypertension in patients in the age group from 20 to 50 years.(Viera & Neutize, 2010).
iii. In older adults, renal artery stenosis can occur and it is usually secondary to the occurrence of atherosclerotic disease. Patients who have been known to have atherosclerosis elsewhere, and in whom cause for renal insufficiency is unclear or have shown an increase in serum creatinine levels between 0.5 to 1mg per dL could be suspected for this mode of secondary hypertension once they have been given an angiotensin receptor blocker or angiotensin- converting enzyme inhibitor. (Faselis, Doumas, & Papademetriou, 2011).
2. In asymptomatic patients, hypertension can become a 'silent killer'. Because the patient needs treatment for reducing the blood pressure to the normal range and the detection, diagnosis and treatment of the underlying cause need to be made. If left untreated, it could lead to serious complications that include, stroke, heart disease or renal failure. The patient could have secondary hypertension if the blood pressure cannot be controlled by regular medication. Also, if the systolic pressure exceeds 180mm of Hg and/or the diastolic blood pressure is more than 120mm of Hg or if blood pressure medication that was earlier effective and cannot control hypertension anymore could also point towards an underlying cause of hypertension. If the patient is not obese and does not have a family history of hypertension, it could signal the presence of cause for hypertension that needs to be diagnosed and treated.
The underlying causes could be diabetes complication- diabetic nephropathy. Diabetes can damage the ability of kidneys to filter. Cysts in the kidneys in polycystic kidney disease can raise blood pressure, but this condition is usually inherited. In glomerular disease the glomeruli can get swollen and interfere with normal kidney function and cause raised blood pressure. Higher than normal growth of cells in the adrenal gland or a tumour in the adrenal gland can cause higher than normal levels of the hormone aldosterone which in turn causes loss of too much sodium and retention of water and salt by the kidneys, leading to high blood pressure. Cushing syndrome is another likely underlying cause of hypertension. When corticosteroids are taken as medication, or when there is increased secretion of the hormone cortisol by the adrenal glands due to a pituitary tumour, hypertension could be the outcome. (dxc-20184438, 2016).
dxc-20184438. (2016). Retrieved from https://www.mayoclinic.org: https://www.mayoclinic.org/diseases-conditions/secondary-hypertension/symptoms-causes/dxc-20184438
Faselis, C., Doumas, M., & Papademetriou, V. (2011). Common Secondary Causes of Resistant Hypertension and Rational for Treatment. International Journal of Hypertension, 10.4061/2011/236239.
Viera, A., & Neutize, D. (2010). Diagnosis of Secondary Hypertension:An Age-Based Approach. American Family Physician, 82(12), 1471-1478. Retrieved from https://www.aafp.org: https://www.aafp.org/afp/2010/1215/p1471.pdf