Hypertension (High Blood Pressure) — सम्पूर्ण Hindi Guide
High blood pressure (BP) एक आम पर अक्सर silent condition है जो stroke, heart attack, kidney failure और heart failure का risk बढ़ाती है। यह गाइड diagnosis, medicines, diet (DASH), lifestyle और prevention तक सबकुछ कवर करता है, साथ ही आपके ब्लॉग के related posts के साथ ।
सामग्री-सूची (Jump to)
1) Hypertension — परिचय 2) Types of Hypertension 3) Pathophysiology — BP कैसे बढ़ता है? 4) Risk Factors & Causes 5) Symptoms & Red Flags 6) Diagnosis — Office BP, ABPM, Home BP 7) Essential Tests (ECG, Echo, Renal) 8) Treatment Principles — Lifestyle & Medicines 9) Common Antihypertensives (classes & tips) 10) Resistant Hypertension — approach 11) Diet & DASH approach (Indian examples) 12) Complications 13) Prevention & Screening 14) Special situations (Pregnancy, Elderly, CKD) 15) FAQ 16) Internal Links & Resources 17) Quick Summary & Action Plan1) Hypertension — परिचय
Hypertension तब कहते हैं जब बड़ी धमनी (arterial) में रक्त का दबाव लगातार ऊँचा रहता है। वैश्विक गाइड (ACC/AHA 2017) में 130/80 mmHg से ऊपर को high BP माना गया है; पर कई देशों/गाइड में 140/90 mmHg का थ्रेसहोल्ड भी प्रयोग होता है। महत्वपूर्ण बात यह है कि BP एक continuum है — जितना ज्यादा, जोखिम उतना बड़ा।
BP के नियंत्रण से stroke, myocardial infarction, heart failure और chronic kidney disease (CKD) का खतरनाक वज़न घटता है।
2) Types of Hypertension
- Primary (Essential) Hypertension: 90–95% मामलों में कोई स्पष्ट कारण नहीं मिलता; multifactorial—genetics, salt sensitivity, vascular remodeling।
- Secondary Hypertension: किसी रोग/दवा से—renal parenchymal disease, renovascular disease, endocrine (hyperaldosteronism, pheochromocytoma, Cushing), obstructive sleep apnea, thyroid disease, medications (NSAIDs, steroids, OCPs).
- Isolated systolic hypertension: विशेषकर वृद्ध में — systolic ↑, diastolic normal/low — अक्सर arterial stiffness से।
- Malignant / Accelerated hypertension: तेज़ी से बढ़ा हुआ BP (eg. >180/120) के साथ end-organ damage — emergency।
3) Pathophysiology — BP कैसे बढ़ता है?
BP का मान cardiac output × systemic vascular resistance से तय होता है। Hypertension के मुख्य pathophysiologic drivers:
- Renin‑angiotensin‑aldosterone system (RAAS) overactivity
- Sympathetic nervous system activation
- Endothelial dysfunction (reduced NO, ↑vasoconstrictors)
- Structural vascular changes — increased stiffness, remodeling
- Volume expansion (high salt intake, kidney dysfunction)
4) Risk Factors & Causes
- Age, family history, ethnicity
- High salt intake, obesity, sedentary lifestyle
- Excess alcohol, smoking, high sugar/processed food
- Co-morbidities: Diabetes, CKD, obstructive sleep apnea
- Medications & illicit drugs
5) Symptoms & Red Flags
अधिकांश hypertensive asymptomatic रहते हैं — इसलिए इसे "silent killer" कहा जाता है। पर कुछ लक्षण हो सकते हैं:
- Headache (ठेंठ माथे/पिछला सिर), dizziness, blurred vision
- Palpitations, chest discomfort, shortness of breath
- Nosebleeds (epistaxis) — पर यह हमेशा BP का कारण नहीं; अगर बार-बार हो तो जाँच ज़रूरी: Epistaxis guide
- Red flags: sudden severe headache (possible stroke/ICH), chest pain, sudden weakness/vision loss, decreased urine output — emergency
6) Diagnosis — Office BP, ABPM, Home BP
सही diagnosis के लिए accurate BP measurement जरूरी है:
- आराम की स्थिति में कम से कम 5 मिनट बैठकर BP नापें
- दो अलग-अलग पलों पर 2–3 बार कीजिए और औसत लें
- Arm cuff सही साइज में हो; पैर जमीन पर रखें
Ambulatory BP Monitoring (ABPM)
24‑hour ABPM white coat hypertension और masked hypertension को पहचानने में सबसे अच्छा है।
Home BP monitoring
Morning and evening home recordings for 7 days give better prognostic information than single clinic readings.
7) Essential Tests (Baseline & Etiology Search)
- Basic: Fasting blood glucose / HbA1c, lipid profile, serum creatinine & eGFR, electrolytes (Na/K), urinalysis (protein, RBCs)
- Liver function tests (esp. in suspected metabolic syndrome) — see nutrition & liver links: Nutrition Guide
- ECG — LVH, ischemia
- Echocardiography — cardiac structure/function if suspected target organ damage
- Renal ultrasound / renin:aldosterone ratio / sleep study / endocrine workup as indicated for secondary causes
8) Treatment Principles — Lifestyle First + Medicines
8.1 Lifestyle modifications (cornerstone)
- Weight loss: BMI target > 5–10% weight reduction lowers BP
- DASH-style diet: low salt (<5–6 g/day), high fruits/vegetables, low‑fat dairy, whole grains — see detailed Indian meal examples below
- Regular aerobic exercise: 30 minutes most days
- Limit alcohol, stop smoking, manage stress & sleep (OSA evaluation)
8.2 When to start medicines
High‑risk patients (ASCVD, diabetes, CKD) and persistent BP above target despite lifestyle warrant pharmacotherapy. Targets individualized (often <130/80 in high-risk; <140/90 in low-risk older adults per guidelines).
9) Common Antihypertensives — Classes & Quick Tips
| Class | Examples | Key points |
|---|---|---|
| ACE inhibitors | Ramipril, Enalapril, Lisinopril | Good for diabetes/CKD (reduce proteinuria). Monitor K/creatinine; cough or angioedema possible. |
| ARBs | Losartan, Valsartan, Telmisartan | Alternative to ACEi if cough; reno-protective. Monitor K/creatinine. |
| Calcium channel blockers | Amlodipine, Nifedipine | Effective for isolated systolic HTN; watch ankle edema. |
| Thiazide diuretics | Chlorthalidone, Hydrochlorothiazide | Good first-line; monitor electrolytes, uric acid, glucose. |
| Beta-blockers | Metoprolol, Atenolol, Carvedilol | Useful with CAD, arrhythmia; less preferred as monotherapy for elderly isolated systolic HTN. |
| Mineralocorticoid receptor antagonists | Spironolactone, Eplerenone | Effective in resistant HTN (watch K/renal). |
Combination therapy (ACEi/ARB + CCB + thiazide) often required. Individualize by comorbidity, age, pregnancy status.
10) Resistant Hypertension — Approach
Resistant HTN: BP above target despite 3 drugs (including diuretic) at optimal doses, or controlled only with 4+ drugs. Steps:
- Confirm adherence & proper measurement (white coat effect ruled out via ABPM)
- Exclude secondary causes (renal artery stenosis, hyperaldosteronism, sleep apnea)
- Optimize diuretic (chlorthalidone/indapamide) and add spironolactone if appropriate
- Refer to specialist/consider device therapy in select cases (renal denervation experimental)
11) Diet & DASH approach — Indian examples
DASH (Dietary Approaches to Stop Hypertension) emphasizes fruits, vegetables, whole grains, low-fat dairy, lean proteins and low salt. Practical Indian plate:
- नाश्ता: दलिया/मिलेट porridge, फल (केला/अमरूद), 6–8 बादाम
- मध्याह्न: 1–2 multigrain rotis, sabzi (कम तेल), दाल/chole moderate, सलाद, curd
- शाम: sprouts / roasted chana
- रात: brown rice/quinoa + sabzi + grilled fish/tofu/low-fat paneer
Salt strategy: aim <5–6 g/day; avoid packaged/processed foods; use herbs/spices/ lemon/garam masala for flavor instead of excess salt. For heart failure comorbidity, follow specific sodium/fluid limits (see Heart Failure Diet: link).
Include potassium-rich fruits (banana), fiber-rich guava, figs (anjeer) in moderation as part of balanced diet: Banana, Guava, Anjeer.
12) Complications of uncontrolled Hypertension
- Stroke (ischemic/hemorrhagic)
- Coronary artery disease / Myocardial infarction
- Left ventricular hypertrophy → heart failure
- Chronic kidney disease, proteinuria
- Retinopathy → vision loss
13) Prevention & Screening
- Regular BP checks from adulthood; earlier if family history/diabetes
- Weight management, daily physical activity, low salt diet
- Limit alcohol, stop smoking, manage stress, treat sleep apnea
- Community screening and awareness — early detection saves lives
14) Special situations
Pregnancy (Hypertensive disorders)
Gestational hypertension, preeclampsia—monitor BP closely. Safe antihypertensives in pregnancy include labetalol, methyldopa, nifedipine; ACE inhibitors and ARBs contraindicated.
Elderly
Targets individualized—orthostatic hypotension risk; start low dose and titrate slowly.
HTN with CKD
ACEi/ARB often preferred for proteinuric CKD—monitor K and creatinine.
15) FAQ
क्या सिर दर्द का मतलब हमेशा हाई BP है?
नहीं — सिर दर्द कई कारणों से होता है; लगातार उच्च BP पर कुछ लोगों में headache हो सकती है लेकिन BP केवल symptom‑based नहीं diagnosed होता।
Home BP कैसे सही नापें?
बैठकर 5 मिनट आराम के बाद, arm supported, बराबर cuff size; सुबह और शाम 7 दिन के रिकॉर्ड्स का औसत लें।
कौन सी दवाएँ सबसे पहले दी जाती हैं?
कई factors पर निर्भर; आमतौर पर ACEi/ARB, CCB या thiazide diuretic से आरंभ और comorbidity के अनुसार संयोजन।
16) Internal Links & Resources
17) Quick Summary & Action Plan
- BP को नियमित चेक करें — घर पर और क्लिनिक दोनों; ABPM जहाँ शक हो लिया जाए।
- पहले lifestyle बदलें (DASH, salt reduction, exercise, weight loss), फिर दवाओं के साथ लक्ष्य हासिल करें।
- कम से कम हर 3–6 महीने doctors follow-up; comorbidities (diabetes/CKD) के साथ अधिक निगरानी।
- Emergency signs: chest pain, sudden neurological deficit, severe headache, decreased urine — तुरंत Emergency।
Disclaimer: यह जानकारी शैक्षिक है। मेडिकल निर्णय के लिए अपने डॉक्टर/कार्डियोलॉजी/मेडिकल टीम से सलाह लें।