Main Difference – Pulmonary Hypertension vs Hypertension
The human body consists of two circulation systems known as Systemic circulation and Pulmonary circulation. Systemic circulation distributes blood throughout the body and Pulmonary circulation receives oxygenated blood from the lungs and brings it back to the heart to be pumped all over the body. The individual pressures and pressure gradients, developed within the corresponding systems are described in a numerical manner with the term – tension. This can either be referred to the overall systemic network of blood circulation or only to the pulmonary circulation. Exceeding the normal levels of this tension or pressure gives rise to HYPER-tension, which then becomes a pathology. The main difference between pulmonary hypertension and hypertension is that pulmonary hypertension is defined as an excessive pressure created in the arteries, extending to the lungs whereas hypertension is a systemic increase in blood pressure.
This article discusses,
1. What is Pulmonary Hypertension?
– Definition, Types, Causes, Signs and Symptoms, Diagnosis, Management, Complications
2. What is Hypertension?
– Definition, Types, Causes, Signs and Symptoms, Diagnosis, Management
3. What is the Difference between Pulmonary Hypertension and Hypertension?
What is Pulmonary Hypertension
Pulmonary Hypertension is defined as an excessive pressure created in the arteries, extending to the lungs. It reflects the pressure our heart muscle should exert in order to pump blood from the heart through the arteries, to supply blood to the lungs. Usually, this value is very low than systolic blood pressure.
In simpler terms, this separate aspect of blood pressure mainly focuses on the blood flow in our lungs. The right side of the heart gains oxygen-deprived blood, returning from the body through superior and inferior vena cava and pumps into the blood vessels of the lungs, where they become oxygenated. From there, it leaves lungs and enters the left side of the heart to distribute oxygen-rich blood all over the body again.
The pulmonary artery pressure in a normal individual is around 14 mm Hg. In case this value exceeds the normal pressure, i.e. if the pulmonary artery pressure is greater than 25 mm Hg at rest and 30 mm Hg during exercise, this condition is called pulmonary hypertension.
Types, Causes, Signs and Symptoms
There are 2 types of pulmonary hypertension.
- Primary pulmonary hypertension – occurs without any underlying pathologies predisposing to the condition. It is mostly seen in women between 21 and 40 years of age and linked with the use of appetite suppressive drugs such as Fenfluramine and Dexfenfluramine.
- Secondary pulmonary hypertension – It is a hypertension triggered by a pre-existing condition such as congenital heart defect, intracardiac left-right shunts and problems in heart valves such as narrowing or thickening (mitral valve stenosis).
The main etiology of pulmonary hypertension includes the thickening of pulmonary arteries, which result in a difficulty of carrying the necessary volume of blood around the body. Similar to water squeezing out from a kinked garden hose, there will be a pressure building up inside the vessels in order to maintain the required perfusion. This will make the heart pump harder with an increased force. If this pressure is very high, our heart cannot keep on pumping as it is required; the overall distribution of blood through lungs will reduce and result in a less effective oxygenation.
The majority of the patients with this condition experience shortness of breath, fatigue, and dizziness. When it progresses, there can be cyanosis-bluish discoloration of lips and skin, chest pain, and swelling of lower limbs and ankles.
Diagnosis and Treatment
- Echocardiogram
- CT scan
- Ventilation-perfusion scan (V/Q scan)
- Electrocardiogram (EKG or ECG)
- Chest X ray
- Exercise ECG
Being a serious medical condition diagnosed by regular follow-ups, pulmonary hypertension can be effectively treated with oxygen, heart contractors (which help the heart to pump better), diuretics, anticoagulants or blood thinning agents and medications to lower blood pressure. Some patients who are severely affected and not responding to pharmacological treatment are directed for lung transplantation.
Complications
- Heart failure
Pulmonary hypertension is a not a life threatening condition if managed properly as soon as the diagnosis is made. However, it is important to address underlying cardiac and respiratory pathologies effectively in order to maintain the blood pressures in a healthy range.
Exercise ECG
What is Hypertension
Blood pressure is usually expressed by two different measurements: systolic (maximum) and diastolic (minimum). These values in a healthy individual at rest is within the range of 100–140 mmHg (systolic) and 60–90 mmHg (diastolic). Hypertension as a pathology is a chronic medical condition where blood pressure in the arteries is persistently elevated at or above 140/90 mmHg for most adults; this may vary in children.
Types, Causes, Signs and Symptoms
There are two types of hypertension as primary and secondary.
- Primary hypertension (90-95%)- Also known as essential hypertension, this is defined as high blood pressure occurring due to non-specific lifestyle including excessive intake of salt, obesity, smoking, and alcohol and genetic predisposition.
- Secondary hypertension (5-10%) – Defined as high blood pressure occurring due to an identifiable cause like chronic kidney disease, renal artery stenosis, endocrine disorders like hyper/hypothyroidism, Cushing’s disease and long-term use of contraceptive pills. Other rare causes can be pregnancy, obesity, sleep apnea and coarctation of the aorta.
Even though high blood pressure usually does not cause any significant symptoms, long-term prevalence can give rise to coronary artery disease, stroke, heart failure, peripheral vascular disease, vision loss, and chronic kidney disease. However, some patients with very high blood pressure will complain of lightheadedness, dizziness, fatigue, vertigo, tinnitus, impaired vision and fainting attacks. But most of the time, these symptoms are said to be associated with anxiety due to hypertension rather than an altered physiology.
Diagnosis
This condition is diagnosed by persistently elevated blood pressure levels which will be traditionally measured by 3 separate sphygmomanometer measurements at monthly intervals. According to some literature, Ambulatory blood pressure monitored over a period of 12-24 hours is said to be more accurate than usually office measurement.
Management and Treatment
Lifestyle modifications
- Maintaining a normal body weight of a body mass index of 20–25 kg/m2
- Reduction of the dietary sodium intake to <100 mmol/ day
- Regular aerobic or physical activity like brisk walking ≥30 min per day, 3-4 days of the week)
- Reduce alcohol consumption (not more than 3 units/day in men and not more than 2 units/day in women
- Consumption of a diet rich in fruit, vegetables, and green leaves
Pharmacological interventions
Antihypertensive medications including thiazide-diuretics, calcium channel blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are the drugs of choice. These can be used alone or in combination and the majority of individuals will need more than one drug to reach the desired outcome.
Hypertension is the commonest preventable risk factor for premature death worldwide. Therefore, it is important to identify underlying comorbidities which should be dealt accordingly in addition to the symptomatic control of hypertensive features.
Difference Between Pulmonary Hypertension and Hypertension
The major difference between these two conditions is in terms of definition:
Pulmonary hypertension is defined as an excessive pressure created in the arteries, extending to the lungs.
Hypertension is a systemic increase in blood pressure.
Image Courtesy:
“Stress test NIH” By National Heart Lung and Blood Insitute (NIH) – National Heart Lung and Blood Insitute (NIH), (Public Domain) via Commons Wikimedia
“Main complications of persistent high blood pressure” By Häggström, Mikael. “Medical gallery of Mikael Häggström 2014”. Wikiversity Journal of Medicine 1 (2). DOI:10.15347/wjm/2014.008. ISSN 20018762. (Public Domain) via Commons Wikimedia
