BENGALURU : Hypertension refers to excessive blood pressure or high blood pressure. Ideally, blood pressure or BP must range between a systolic of 120 and a diastolic of 80. However, a variation of 10 on either side is normal — that is a high of 130 and a low of 70. Anything above this range is called hypertension and any BP below 70 is hypotension. Hypotension is generally a pathological condition that calls for a cause-based treatment. Hypertension, however, has emerged as a social problem. Hypertension cases are steadily increasing. Disturbingly enough, an increasing number of young people are now being diagnosed with high BP. Though considered a heart or vascular system related disease, high BP is known to affect and damage every other organ.
In popular perception, it is normal for the young to be hypotensive and the old hypertensive. This is wrong. According to the World Health Organisation, such an age-related assumptions are invalid. Regardless of age, blood pressure needs to be kept within the normal range. According to a study published in the International Journal of Contemporary Pediatrics, conducted by the Department of Pediatrics, Indira Gandhi Institute of Child Health, Bengaluru, 3.6 per cent of 748 students in the 9-11 age-group were hypertensive.
When the condition can be attributed to a cause like cardiac, vascular, renal, endocrinal or metabolic disease, high BP is described as secondary hypertension. However, the far more common form of high BP has no ascribable cause and is known as idiopathic or essential hypertension. Brain attack is a dangerous problem related to hypertension. It is responsible for ischemic and even more so for haemorrhagic brain attacks, also called brain haemorrhage. Brain haemorrhage is responsible for 18-30 per cent of all cases of brain attack. Various kinds of internal bleeding can cause an attack.
They are: 1) Brain haemorrhage, or the leakage of blood into the brain parenchyma; 2) Intraventricular haemorrhage (IVH), also known as intraventricular bleeding, when the bleeding is into the brain’s ventricular system; 3) Sub-arachnoid haemorrhage, which happens when a blood vessel bulges or balloons excessively (aneurism) and eventually ruptures causing bleeding around the brain.
Brain haemorrhage is much more dangerous than stroke. When blood vessels rupture inside the brain, a large amount of blood gushes through the brain surface leading to permanent damage, which may cause paralysis and lifetime disability.
Brain haemorrhage presents itself with sudden severe headache, neck pain, loss of consciousness and paralysis with or without seizures. The extent of neurological damage depends on the location of the bleed and the size of the blood clot. In the case of reactive hypertension the headache is very severe. The commonest sites of brain haemorrhage are putamen, lobar, thalamus, cerebellum and brain stem.
A CT scan is considered to confirm the clinical findings. However, if there is an associated blood vessel abnormality like angioma, aneurism or arteriovenous malformation (AVM), an angiography may be required to establish the diagnosis. Hospitalisation is mandatory in all cases as vital functions like blood pressure and other risk factors need to be controlled to stop the bleeding.
Surgical intervention is advised when the clot size is significant. These days’ blood clots can be treated also with MIS using neuro endoscopes. Post treatment patients need long-term neuro rehabilitation.
The author is the founder & chief Neurosurgeon, Brains Neuro Spine Centre.