A wide pulse pressure can indicate an aortic valve regurgitation, from, say, biscupid aortic valve, in which the heart is pumping hard and much longer to try and maintain a good tissue perfusion. To do that, it increases the stroke volume to compensate for blood returning to the heart during diastole as a result of a faulty valve. The systolic pressure rises. Since blood is returning to heart during diastole, diastolic pressure falls. The valve can be repaired and the patient will be fine. A normal aortic valve is tricuspid. Other treatment options exist. Left untreated, it can lead to heart failure consequent to cardiac dilation, hypertrophy, restriction, and obstruction.
In especially elderly subjects, a blockade of a cerebral artery will give rise bradycardia-induced hypertension. In this scenario, a bradycardia of less than 40 beats per minute, will give the heart a much longer time to pump a larger volume of blood out of the heart. The stroke volume increases so much that it overshadows the fall in the heart rate, and this leads to a rise in the systolic blood pressure. The systolic pressure may rise to as high as (220- 240)mmHg. On the other hand, the diastolic pressure will fall, given that the longer time of systole drives most blood out of arteries. The diastolic pressure will fall to as low as 40 mmHg. This can lead to a stroke, if the blockage is not corrected. The blockade can be cleared by an endovascular neurosugeon. Lifestyle changes, including diet, are advocated to prevent a further deterioration of blood flow.
The stiffening of the arteries raises the systolic pressure because the elasticity of the aorta is compromised. Since the aortic elasticity normally would dampen blood pressure, a stiffened aorta will experience a much higher systolic pressure. On the other hand, the diastolic pressure falls since blood vessels do not recoil and tighten up their grip on the lower volume of blood that flows during diastole. The impact of a high systolic pressure on a stiffened aorta can produce an aortic aneurysm.
Anemia increases the contractility of the heart to increase cardiac output, given the fall in tissue oxygenation. This is driven by the chemoreceptor-derived response, involving the brain. This increases the sympathetic outflow that raises the systolic pressure, but hypoxia causes vasodilation that reduces the diastolic pressure. The cause of anemia is identified, and an efffective treatment administered.
Hyperthyroidism raises metabolism, which raises the sympathetic drive that then increases the systolic pressure. At the same time, the metabolic products, put out in tissues, cause vasodilation that reduces the diastolic pressure.
Treatment options are many and varied.
am continually amazed at the number of people who ask this question in clinical practice.
If you stop the medications that bring down the blood pressure, it will immediately return to the same high level that it was before. The medications “control” the high blood pressure. The do not “cure” the high blood pressure.
Things that can “cure” high blood pressure:
1-Significant weight loss
2-Low salt diet
3-Smoking cessation
4-NO more ALCOHOL
5-Exercise/meditation
6-Stop eating licorice/taking certain supplements/drinking monster energy
7-Kick the coke habit
Yes, some people can get off blood pressure medications with significant changes in their lifestyle. OTOH, many people simply have high blood pressure, and nothing will change their requirement to continue medications.
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