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dr. Monte Selvanus

Information: CT Scan For Advance Services

Information: CT Scan For Advance Services

From now on, PKU Muhammadiyah Gombong Hospital has one unit of CT Scan.

What is a CT scan?

A computerized axial tomography scan is an x-ray procedure that combines many x-ray images with the aid of a computer to generate cross-sectional views and, if needed, three-dimensional images of the internal organs and structures of the body. Computerized axial tomography is more commonly known by its abbreviated names, CT scan or CAT scan. A CT scan is used to define normal and abnormal structures in the body and/or assist in procedures by helping to accurately guide the placement of instruments or treatments.

A large donut-shaped x-ray machine takes x-ray images at many different angles around the body. These images are processed by a computer to produce cross-sectional pictures of the body. In each of these pictures the body is seen as an x-ray "slice" of the body, which is recorded on a film. This recorded image is called a tomogram. "Computerized Axial Tomography" refers to the recorded tomogram "sections" at different levels of the body.

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Parent Smoking During Pregnancy Raises Kids' Heart Risks

Parent Smoking During Pregnancy Raises Kids' Heart Risks

By Ed Edelson
HealthDay Reporter

THURSDAY, Nov. 20 (HealthDay News) -- Damage to the arteries of children of smokers can be detected in the early decades of their lives, a new Dutch study finds.

"Smoking in families is harmful for children, including their cardiovascular system, as was found in many other studies," said research leader Dr. Cuno S.P.M. Uiterwaal, an associate professor of clinical epidemiology at the University Medical Center in Utrecht. "This study adds that tobacco smoke exposure may have such effects already in very early life."

Uiterwaal and his colleagues reported the finding in the December issue of Arteriosclerosis, Thrombosis and Vascular Biology that they used ultrasound to measure the thickness of the walls of carotid arteries, the major blood vessels to the brain, in 732 young adults, average age 28. Records showed that 29% of the mothers and more than 60% of the fathers smoked during the pregnancies.

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Group: Soft Plastic Toys Are Health Risk

Group: Soft Plastic Toys Are Health Risk

Consumer Group Concerned About Health Risks From Chemical Called Phthalates

By Todd Zwillich
WebMD Health News

Reviewed By Louise Chang, MD

Nov. 25, 2008 -- A consumer watchdog group is urging parents to avoid buying soft plastic toys this holiday season because of a risk that the toys may contain toxic chemicals.

Toys containing the chemicals, called phthalates, can no longer be manufactured or imported after February 2009, according to a product safety law that passed Congress over the summer.

But the group says the Consumer Product Safety Commission is allowing the toy industry to circumvent the law. The agency wrote a letter last week telling manufacturers they can still sell their existing stocks of phthalate-containing toys even after the ban takes effect in February.

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HEART FAILURE

HEART FAILURE

Definition

Heart failure, also known as congestive heart failure (CHF), means your heart can't pump enough blood to meet your body's needs. Over time, conditions such as coronary artery disease or high blood pressure gradually leave your heart too weak or stiff to fill and pump efficiently.

You can't reverse many conditions that lead to heart failure, but heart failure can often be treated with good results. Medications can improve the signs and symptoms of heart failure and lead to improved survival. Lifestyle changes, such as exercising, reducing salt intake, managing stress, treating depression, and especially losing excess weight, also can help prevent fluid buildup and improve your quality of life.

The best way to prevent heart failure is to control risk factors and aggressively manage any underlying conditions such as coronary artery disease, high blood pressure, high cholesterol, diabetes or obesity.

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Tuberculosis

Infection and transmission

Tuberculosis (TB) is a contagious disease. Like the common cold, it spreads through the air. Only people who are sick with TB in their lungs are infectious. When infectious people cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A person needs only to inhale a small number of these to be infected.

Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year. But people infected with TB bacilli will not necessarily become sick with the disease. The immune system "walls off" the TB bacilli which, protected by a thick waxy coat, can lie dormant for years. When someone's immune system is weakened, the chances of becoming sick are greater.

• Someone in the world is newly infected with TB bacilli every second.

• Overall, one-third of the world's population is currently infected with the TB bacillus.

• 5-10% of people who are infected with TB bacilli (but who are not infected with HIV) become sick or infectious at some time during their life. People with HIV and TB infection are much more likely to develop TB.
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LORATADINE

GENERIC NAME: LORATADINE

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Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD

BRAND NAME: Claritin, Claritin RediTabs, Alavert, others

DRUG CLASS AND MECHANISM: Loratadine is a long-acting antihistamine that is used for the treatment of allergy. Histamine is a chemical that causes many signs and symptoms of allergy. Histamine is released from histamine-storing cells (mast cells) and attaches to other cells that have receptors for histamine on their surfaces. Histamine stimulates the cells to release chemicals that produce effects that we associate with allergy. Loratadine blocks one type of histamine receptor (the H1 receptor) and thus prevents activation of cells with H1 receptors by histamine. Unlike some antihistamines, loratadine does not enter the brain from the blood and, therefore, does not cause drowsiness when taken at recommended doses. The FDA approved loratadine in April 1993. Continue...

Diet Plans & Programs

Diet Plans & Programs Comparing Popular Weight Loss Diets
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Author: Betty Kovacs, MS, RD
Medical Editors: Melissa Conrad Stöppler, MD and Ruchi Mathur, MD

Weight loss seems simple

A calorie is a calorie, the advice goes. Eat too many ... gain weight. Eat fewer ... lose weight. But many believe weight loss is more than a calorie equation, with so-called new-and-improved ways to lose weight being ever popular. Americans spend an estimated $42 billion annually on weight loss foods, products, and services. With that much money at stake, it's no surprise there are an overwhelming number of "fad" diets and other weight-loss products on the market.

Having so many diet options makes it difficult to know which ones to trust. For this reason, The Partnership for Healthy Weight Management has developed the "Voluntary Guidelines for Providers of Weight Loss Products or Services." The mission for these guidelines is to "promote sound guidance to the general public on strategies for achieving and maintaining a healthy weight." According to the guidelines, effective weight management involves:

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Nausea and Vomiting

Nausea and Vomiting

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Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

Introduction to nausea and vomiting

Nausea and vomiting are symptoms of an underlying disease and not a specific illness. Nausea is the sensation that the stomach wants to empty itself, while vomiting (emesis) or throwing up, is the act of forcible emptying of the stomach.

Vomiting is a violent act in which the stomach has to overcome the pressures that are normally in place to keep food and secretions within the stomach. The stomach almost turns itself inside out - forcing itself into the lower portion of the esophagus (the tube that connects the mouth to the stomach) during a vomiting episode. Continue...

Depression

Depression

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Medical Authors: Roxanne Dryden-Edwards, MD and Dennis Lee, MD

Medical Editor: William C. Shiel Jr., MD, FACP, FACR

What is a depressive disorder?

Depressive disorders have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time. Depression, also referred to as clinical depression, has been portrayed in literature and the arts for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, depression was seen as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his development of depression. Continue...

Albumin

Albumin

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Dr. Monte Selvanus Luigi Kusuma

PKU Muhammadiyah Gombong Hospital

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USES: Albumin is the protein portion of the blood. It is important in maintaining blood volume. It is used in the treatment of shock, burns or low blood protein to temporarily correct or prevent a blood volume deficiency.

HOW TO USE: This medication is administered by injection into a vein. The dose and frequency of use of this medication will be determined by your condition and response to therapy. Follow your doctor's instructions closely and be sure to ask any questions you may have about this therapy.

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Hemoglobin

Hemoglobin

Medical Author: Siamak Nabili, MD, MPH

Medical Editor: William C. Shiel, Jr., MD, FACP, FACR

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What is hemoglobin?

Hemoglobin is the protein molecule in red blood cells that carries oxygen from the lungs to the body's tissues and returns carbon dioxide from the tissues to the lungs.

Hemoglobin is made up of four protein molecules (globulin chains) that are connected together. The normal adult hemoglobin (Hbg) molecule contains 2 alpha-globulin chains and 2 beta-globulin chains. In fetuses and infants, there are only a few beta chains and the hemoglobin molecule is made up of 2 alpha chains and 2 gamma chains. As the infant grows, the gamma chains are gradually replaced by beta chains. Pay Per Click

Each globulin chain contains an important central structure called the heme molecule. Embedded within the heme molecule is iron that transports the oxygen and carbon dioxide in our blood. The iron contained in hemoglobin is also responsible for the red color of blood.

Hemoglobin also plays an important role in maintaining the shape of the red blood cells. Abnormal hemoglobin structure can, therefore, disrupt the shape of red blood cells and impede its function and its flow through blood vessels. Continue...

Weight Loss: The No-Diet Approach

Weight Loss: The No-Diet Approach

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Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

Introduction to weight loss

Whether you are trying to lose 5 pounds or more than 50, the same simple laws of physics determine whether or not you will lose weight and how fast your weight loss will occur. Remembering these simple guidelines and putting them into practice can lead to weight loss without the aid of any special diet plans, books, or medications.

Our weight is determined by the amount of energy that we take in as food and the amount of energy we expend in the activities of our day. Energy is measured in calories. If your weight remains constant, you are probably taking in the same amount of calories you burn each day. If you're slowly gaining weight over time, it is likely that your caloric intake is greater than the number of calories you burn through your daily activities. Pay Per Click

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Anorexia Nervosa

Anorexia Nervosa

Dr. Monte Selvanus Luigi Kusuma

PKU Muhammadiyah Gombong Hospital

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Definition :
Anorexia nervosa is an eating disorder in which a person refuses to stay at even the minimum body weight considered normal for their age and height. Persons with this disorder may have an intense fear of weight gain and a distorted body image. Inadequate eating or excessive exercising results in severe weight loss.

Cause :

The exact cause of anorexia nervosa is not known, but social attitudes towards body appearance, as well as family factors, are believed to play a role. Continue...

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Information -Do you have any Health Problem?

Information

You can now, access my website at www.doktermonte.co.cc
Thank you.

If you have any health problem just write on comment of related article, on guest book, or on comment of article Do You Have Any Health Problem?

"At the first we make habits, at the last habits make us"

Asthma Bronchiale

Asthma

Dr. Monte Selvanus Luigi Kusuma

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Definition

Asthma occurs when the airways in your lungs (bronchial tubes) become inflamed and constricted. The muscles of the bronchial walls tighten, and your airways produce extra mucus that blocks your airways. Signs and symptoms of asthma range from minor wheezing to life-threatening asthma attacks.

Asthma can't be cured, but its symptoms can be controlled. Management includes avoiding asthma triggers and tracking your symptoms. You may need to regularly take long-term control medications to prevent flare-ups and short-term "rescue" medications to control symptoms once they start. Asthma that isn't under control can cause missed school and work or reduced productivity due to symptoms. Because in most people asthma changes over time, you'll need to work closely with your doctor to track your signs and symptoms and adjust your treatment as needed. Continue...

Acute Renal Failure (ARF)

Acute Renal (Kidney) Failure

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Definition :
Acute (sudden) kidney failure is the sudden loss of the ability of the kidneys to remove waste and concentrate urine without losing electrolytes.

Cause :

There are many possible causes of kidney damage. They include:

• Decreased blood flow, which may occur with extremely low blood pressure caused by trauma, surgery, serious illnesses, septic shock, hemorrhage, burns, or dehydration
• Acute tubular necrosis (ATN)
• Infections that directly injury the kidney such as acute pyelonephritis or septicemia
• Urinary tract obstruction (obstructive uropathy)
• Autoimmune kidney disease such as interstitial nephritis or acute nephritic syndrome
• Disorders that cause clotting within the thin blood vessels of the kidney
• Idiopathic thrombocytopenic thrombotic purpura (ITTP)
• Transfusion reaction
• Malignant hypertension
• Scleroderma,
• Hemolytic-uremic syndrome

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Beta-carotene

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The name "carotene" was first coined in the early 19th Century by the scientist Wachenroder after he crystallized this compound from carrot roots. Beta-carotene is a member of the carotenoids, which are highly pigmented (red, orange, yellow), fat-soluble compounds naturally present in many fruits, grains, oils, and vegetables (green plants, carrots, sweet potatoes, squash, spinach, apricots, and green peppers). Alpha, beta, and gamma carotene are considered provitamins because they can be converted to active vitamin A.

The carotenes possess antioxidant properties. Vitamin A serves several biological functions including involvement in the synthesis of certain glycoproteins. Vitamin A deficiency leads to abnormal bone development, disorders of the reproductive system, xerophthalmia (a drying condition of the cornea of the eye), and ultimately death. Continue...

Menstrual Disorder

Menstrual Disorder
doctor Monte Selvanus Luigi Kusuma
PKU Muhammadiyah Gombong Hospital
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Metrorrhagia: Uterine bleeding at irregular intervals, particularly between the expected menstrual periods. Metrorrhagia may be a sign of an underlying disorder, such as hormone imbalance, endometriosis, uterine fibroids or, rarely, cancer of the uterus. Metrorrhagia may cause significant anemia

Menorrhagia: Excessive uterine bleeding occurring at the expected intervals of the menstrual periods. The bleeding from the uterus starts on schedule but is heavier than usual and may last longer than usual. Menorrhagia may be a sign of an underlying disorder, such as hormone imbalance, endometriosis, uterine fibroids or, rarely, cancer of the uterus. Menorrhagia may cause significant anemia

Menometrorrhagia: Excessive uterine bleeding, both at the usual time of menstrual periods and at other irregular intervals. Menometrorrhagia can be a sign of a number of different disorders including hormone imbalance, endometriosis, benign fibroid tumors in the uterus, and, rarely, cancer. Women who have abnormal menstrual bleeding should always consult their physician to rule out these conditions. Anemia may result from the excessive uterine bleeding. Treatment depends on the cause. If there does not appear to be a dangerous cause, such as cancer, hormone supplementation or the therapeutic use of birth control pills to better control the menstrual cycle may be recommended.

Erectile Dysfunction

Erectile Dysfunction
(Impotence, ED)

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Medical Author: Dennis Lee, MD
Medical Editors: Jay W. Marks, MD, and Jacob Rajfer, MD

What is erectile dysfunction?

Erectile dysfunction (ED), also known as impotence, is the inability to achieve or sustain an erection for satisfactory sexual activity. Erectile dysfunction is different from other conditions that interfere with sexual intercourse, such as lack of sexual desire and problems with ejaculation and orgasm. This article focuses on the evaluation and treatment of erectile dysfunction.

How common is erectile dysfunction?

Erectile dysfunction (ED, impotence) varies in severity; some men have a total inability to achieve an erection, others have an inconsistent ability to achieve an erection, and still others can sustain only brief erections. The variations in severity of erectile dysfunction make estimating its frequency difficult. Many men also are reluctant to discuss erectile dysfunction with their doctors, and thus the condition is under-diagnosed. Nevertheless, experts have estimated that erectile dysfunction affects 30 million men in the Untied States.

While erectile dysfunction can occur at any age, it is uncommon among young men and more common in the elderly. By age 45, most men have experienced erectile dysfunction at least some of the time. According to the Massachusetts Male Aging Study, complete impotence increases from 5% among men 40 years of age to 15% among men 70 years and older. Population studies conducted in the Netherlands found that some degree of erectile dysfunction occurred in 20% of men between ages 50 to 54, and in 50% of men between ages 70 to 78. In 1999, the National Ambulatory Medical Care Survey counted 1,520,000 doctor-office visits for erectile dysfunction.

Cirrhosis

Cirrhosis

Dr. Monte Selvanus Luigi Kusuma

Workstation PKU Muhammadiyah Gombong Hospital

You may download this full article. Download here

Definition

Cirrhosis is a condition that causes irreversible scarring of the liver. As scar tissue replaces normal tissue, blood flow through your liver is affected. This makes it increasingly difficult for your liver to carry out essential functions, such as detoxifying harmful substances, purifying your blood and manufacturing vital nutrients.

Cirrhosis rarely causes signs and symptoms in its early stages. But as liver function deteriorates, you may experience fatigue, nausea, unintended weight loss, and swelling in your legs and abdomen. In time, jaundice — a yellowing of your skin and the whites of your eyes — and intense itching can develop. You may also experience bleeding from your digestive system that could be severe.

Excessive use of alcohol and chronic infection with the hepatitis C virus are the leading causes of cirrhosis. But other factors — including damaged bile ducts, immune system problems and prolonged exposure to certain environmental toxins — can cause liver scarring, too.

Although liver damage from cirrhosis is irreversible, the disease usually progresses slowly and symptoms are often controllable. Specific treatment for cirrhosis depends on the underlying cause, but anyone with cirrhosis must avoid alcohol and other substances that harm the liver. When damage is so severe that liver function is seriously impaired, a liver transplant may be the only option.

Symptoms

You may not have signs and symptoms of cirrhosis in the early stages of the disease. But as more scar tissue replaces healthy tissue and liver function declines, you may experience some of the following:

* Lack of appetite

* Weight loss

* Nausea

* Small, red spider veins under your skin or easy bruising

* Weakness

* Fatigue

* Yellowing of your skin and eyes and dark, cola-colored urine

* Bleeding from engorged veins in your esophagus or intestines

* Loss of interest in sex

* Fluid in your abdominal cavity (ascites)

* Itching on your hands and feet and eventually on your entire body

* Swelling of your legs and feet from retained fluid (edema)

* Mental confusion, such as forgetfulness or trouble concentrating (encephalopathy)

Causes

A healthy liver performs hundreds of vital functions, including processing most of the nutrients absorbed from your intestine, removing drugs, alcohol and other harmful substances from your bloodstream, and manufacturing bile — the greenish fluid stored in your gallbladder that helps digest fats. The liver also produces cholesterol, substances to help your blood clot and certain other proteins.

Because of the complexity of the liver and its exposure to so many potentially toxic substances, it would seem especially vulnerable to disease. But the liver has an amazing capacity for regeneration — it can heal itself by replacing or repairing injured cells. In cirrhosis, however, the healing process seems to go slightly awry. In response to chronic injury, certain liver cells increase dramatically in size and number forming excess scar tissue that interferes with the liver's ability to function. And although groups of cells may continue to regenerate, the pattern of regeneration isn't normal.

What damages the liver?

Many people associate cirrhosis with alcohol abuse, and in fact, chronic alcoholism is the primary cause of cirrhosis in the United States. Alcoholic cirrhosis usually occurs after a decade or more of heavy drinking, although the amount of alcohol that can injure the liver varies from person to person. The liver is particularly vulnerable because it breaks down alcohol into highly toxic chemicals. Some of these chemicals trigger inflammation that eventually destroys liver cells. In time, web-like scars and small knots of abnormal tissue replace healthy liver tissue. In the initial stages of cirrhosis, the liver swells, but it later shrinks as larger areas of scar tissue form.

Osteoporosis

dr.Monte Selvanus Luigi Kusuma

Definition

Osteoporosis, which means "porous bones," causes bones to become weak and brittle — so brittle that even mild stresses like bending over, lifting a vacuum cleaner or coughing can cause a fracture. In most cases, bones weaken when you have low levels of calcium, phosphorus and other minerals in your bones.

A common result of osteoporosis is fractures — most of them in the spine, hip or wrist. Although it's often thought of as a women's disease, osteoporosis also affects many men. And aside from people who have osteoporosis, many more have low bone density.

It's never too late — or too early — to do something about osteoporosis. You can take steps to keep bones strong and healthy throughout life.

Symptoms

In the early stages of bone loss, you usually have no pain or other symptoms. But once bones have been weakened by osteoporosis, you may have osteoporosis symptoms that include:

* Back pain, which can be severe if you have a fractured or collapsed vertebra

* Loss of height over time, with an accompanying stooped posture

* Fracture of the vertebrae, wrists, hips or other bones

Causes

The strength of your bones depends on their size and density; bone density depends in part on the amount of calcium, phosphorus and other minerals bones contain. When your bones contain fewer minerals than normal, they're less strong and eventually lose their internal supporting structure.

The process of bone remodeling

Scientists have yet to learn all the reasons why this occurs, but the process involves how bone is made. Bone is continuously changing — new bone is made and old bone is broken down — a process called remodeling, or bone turnover.

A full cycle of bone remodeling takes about two to three months. When you're young, your body makes new bone faster than it breaks down old bone, and your bone mass increases. You reach your peak bone mass in your mid-30s. After that, bone remodeling continues, but you lose slightly more than you gain. At menopause, when estrogen levels drop, bone loss in women increases dramatically. Although many factors contribute to bone loss, the leading cause in women is decreased estrogen production during menopause.

Your risk of developing osteoporosis depends on how much bone mass you attained between ages 25 and 35 (peak bone mass) and how rapidly you lose it later. The higher your peak bone mass, the more bone you have "in the bank" and the less likely you are to develop osteoporosis as you age. Not getting enough vitamin D and calcium in your diet may lead to a lower peak bone mass and accelerated bone loss later.

What keeps bones healthy

Three factors that you can influence are essential for keeping your bones healthy throughout your life:

* Regular exercise

* Adequate amounts of calcium

* Adequate amounts of vitamin D, which is essential for absorbing calcium

Infertility Treatment: 7 Tips to Manage Stress

Infertility Treatment: 7 Tips to Manage Stress

Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: Jay W. Marks, MD

Infertility treatment can be physically uncomfortable, time-consuming, exhausting, and costly — all without a guarantee of success. The infertility experience for many can range from multiple diagnostic procedures through progressively more aggressive treatment options, all of which impose demands upon the emotional and physical self. It's no wonder that many women experience severe stress, depression, or anxiety during treatment for infertility.

It is possible although difficult to relieve some of the stress and pressure of infertility treatment. Some tried-and-true stress control suggestions from former infertility patients and counselors include the following:

1. Accept that you are experiencing a time of heightened stress and don’t try to downplay or deny its effects. You may find that you need to cut back on some or all of your nonessential obligations or activities for a while. Give yourself permission to say 'no' to nonessential commitments and demands on your time.

2. Don’t suffer alone. Confide in a trusted friend, loved one, or support group. Social support networks can tremendously reduce feelings of stress and emotional pain. Many infertility clinics also offer support groups and/or counseling services. If you’re trying to conceive as a couple, accept that your partner may also feel stress, depression, or anxiety and may not be able to provide all the emotional support you require right now.

3. Join RESOLVE, the National Infertility Association. You should be able to find a local chapter in your area. Individual chapters sponsor support groups, newsletters, and seminars and lectures on treatment options. Both health care providers and patients make up the membership of this valuable organizational resource.

4. Empower yourself with knowledge about the procedures and treatments you may need. After researching on the Web, write down a list of questions to take with you to your next appointment if you feel there are issues you'd like to clarify.

5. Decide in advance with whom you want to share your experience, and plan some strategies for avoiding inappropriate questions and unwanted advice from colleagues and acquaintances.

6. Discuss the possibility of treatment breaks with your doctor, if you feel that you need "time off" from the experience. Some people prefer to be treated every other month or every few menstrual cycles, while others are stressed by the waiting periods. Work with your doctor to find a treatment schedule that is comfortable for you.

7. Know that it's common for women in the midst of treatment to experience feelings of depression or sadness, and sometimes these feelings are strongest when participating in baby or child centered functions. Don't feel guilty if you want to pass up the baby shower or child's birthday party you're invited to. Taking care of yourself and your emotional needs is the top priority now.

1 in 4 Teen Girls Infected With an STD

1 in 4 Teen Girls Infected With an STD

Researchers' 'Alarming' Find: 25% of Teen Girls, Half of African-American Teen Girls Have a Sexually Transmitted Disease

By Todd Zwillich
WebMD Health News


Reviewed By Louise Chang, MD

March 11, 2008 — One in four teenage girls in the United States is infected with a sexually transmitted disease, according to data released Tuesday by the CDC.

The figures, based on research conducted in 2003 and 2004, show that nearly one in five girls between 14 and 19 years old is infected with human papillomavirus (HPV), which can cause of cervical cancer and genital warts. About one in 25 girls carries chlamydia, a sexually transmitted bacterium.

"What we found is alarming," says Sara Forhan, MD, a CDC researcher who conducted the study among 838 girls nationwide.

"These numbers translate into 3.2 million young women aged 14 to 19 who are infected with an STD," Forhan says.

The study also showed that nearly half of adolescent African-American girls are infected with an STD. Researchers say poorer access to testing for sexually transmitted diseases contributed to the increased STD incidence in that group.

"This does not mean that African-Americans are taking greater risks individually," says John Douglas Jr., MD, director of the CDC's division of STD prevention.
Screening Falling Short

The CDC recommends regular chlamydia screening at least yearly for all sexually active women and for females 25 years old and younger. All pregnant women should also be screened because the infection can pass to the baby during delivery. But only about one-third of females get proper screening, Douglas says.

Experts recommend regular screening primarily because most women with chlamydia infections don't have noticeable symptoms. That means women can carry the infectious for years without knowing they have it, putting them at risk for pelvic inflammatory disease and infertility.

The CDC also recommends HPV vaccination for all women and girls between 11 and 26. The vaccine comes in three doses and covers four strains of the virus.

Still, Douglas says STD testing is rife with "missed opportunities." Another study unveiled by the CDC showed that only 40% of female patients who go to a doctor for emergency contraception, such as the "morning after pill," also receive advice and testing for STDs.

Both studies were presented at the National STD Prevention Conference in Chicago.

"An emergency contraception prescription is a missed opportunity because by definition that was unprotected sex," Elizabeth Alderman, MD, director of adolescent medicine at Children's Hospital at Montefiore in New York, tells WebMD.

Alderman says many clinics don't have easier-to-use urine-based testing for chlamydia.

Douglas says abstinence is "the surest way to prevent getting an STD." The agency also pushes monogamous sexual relationships and the consistent use of condoms, he says.

Alderman says the majority of sexually active teens in her practice use condoms. If you ask, "some of the time, all the time, or most of the time,' you'll usually get a "most of the time," she says.

SOURCES: Sara Forhan, MD, CDC. John Douglas Jr., MD, director, CDC division of STD prevention. Elizabeth Alderman, MD, Children's Hospital at Montefiore, New York, chairwoman, Executive Committee, Section of Adolescent Health, American Academy of Pediatrics.

HEMORRHOID

HEMORRHOID

Medical Author: Jay W. Marks, MD

Medical Editor: Thomas P. Sokol, MD, FACS, FASCRS

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What are hemorrhoids?

A precise definition of hemorrhoids does not exist, but they can be described as masses or clumps ("cushions") of tissue within the anal canal that contain blood vessels and the surrounding, supporting tissue made up of muscle and elastic fibers. The anal canal is the last four centimeters through which stool passes as it goes from the rectum to the outside world. The anus is the opening of the anal canal to the outside world.

Although most people think hemorrhoids are abnormal, they are present in everyone. It is only when the hemorrhoidal cushions enlarge that hemorrhoids can cause problems and be considered abnormal or a disease.

Prevalence of hemorrhoids

Although hemorrhoids occur in everyone, they become large and cause problems in only 4% of the general population. Hemorrhoids that cause problems are found equally in men and women, and their prevalence peaks between 45 and 65 years of age.

Anatomy of hemorrhoids

The arteries supplying blood to the anal canal descend into the canal from the rectum above and form a rich network of arteries that communicate with each other around the anal canal. Because of this rich network of arteries, hemorrhoidal blood vessels have a ready supply of arterial blood. This explains why bleeding from hemorrhoids is bright red (arterial blood) rather than dark red (venous blood), and why bleeding from hemorrhoids occasionally can be severe. The blood vessels that supply the hemorrhoidal vessels pass through the supporting tissue of the hemorrhoidal cushions.

The anal veins drain blood away from the anal canal and the hemorrhoids. These veins drain in two directions. The first direction is upwards into the rectum, and the second is downwards beneath the skin surrounding the anus. The dentate line is a line within the anal canal that denotes the transition from anal skin (anoderm) to the lining of the rectum.

Formation of hemorrhoids

If the hemorrhoid originates at the top (rectal side) of the anal canal, it is referred to as an internal hemorrhoid. If it originates at the lower end of the anal canal near the anus, it is referred to as an external hemorrhoid. Technically, the differentiation between internal and external hemorrhoids is made on the basis of whether the hemorrhoid originates above or below the dentate line (internal and external, respectively).

As discussed previously, hemorrhoidal cushions in the upper anal canal are made up of blood vessels and their supporting tissues. There usually are three major hemorrhoidal cushions oriented right posterior, right anterior, and left lateral. During the formation of enlarged internal hemorrhoids, the vessels of the anal cushions swell and the supporting tissues increase in size. The bulging mass of tissue and blood vessels protrudes into the anal canal where it can cause problems. Unlike with internal hemorrhoids, it is not clear how external hemorrhoids form.

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Make Money From Internet (Indonesian Version: Nyari Duit Lewat Internet)

Wealth is important, but Wealth without health is nothing. I have an article to make money from internet. This is a halal way, no trick, no hack. Download here.

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Dengue Hemorrhage Fever

Dengue Hemorrhage Fever

dr. Monte Selvanus Luigi Kusuma

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Definition

Dengue Hemorrhage Fever is an infection disease, caused by virus from flavovirus.

Etiology
Etiology of this disease is a virus from flavovirus (Arbovirus group B). Dengue virus is a termolabil viral that can be stored in a frozen (-70^oC). It shapes likely the stem, sensitive to inactivation by Diethyl Ether and Na Dioxycolate, stable at temperatures 70^oC. 4 serotypes known dengue, they are D1, D2, D3, D4. Each type can cause symptoms and the most severe is type 3.

Vector
Dengue virus can be transmitted by:

1. Aedes aegypti mosquitoes

2. Aedes albopictus mosquitoes

OBESITY

OBESITY
dr. Monte Selvanus Luigi Kusuma
Workstation PKU Muhammadiyah Gombong Hospital

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What is obesity?

The definition of obesity varies depending on what one reads, but in general, it is a chronic condition defined by an excess amount body fat. A certain amount of body fat is necessary for storing energy, heat insulation, shock absorption, and other functions. The normal amount of body fat (expressed as percentage of body fat) is between 25-30% in women and 18-23% in men. Women with over 30% body fat and men with over 25% body fat are considered obese.

How common is obesity?

Obesity has reached epidemic proportions in the United States. One in three Americans is obese. Obesity is also increasing rapidly throughout the world, and the incidence of obesity has nearly doubled form 1991 to 1998.

Being Overweight Doesn't Mean You're Unhealthy!

Being overweight or obese does not mean you are unhealthy or at a higher risk for diseases like high blood pressure, high cholesterol, or diabetesThe results of a study published in the Archives of Internal Medicine should not come as a shock to most people. Being overweight doesn't necessarily make you unhealthy, according to researchers in both the United States and Germany. Sports fans have known this forever; elite athletes can have an appearance ranging from tiny Olympic gymnasts to massive NFL linemen. Athletes at both extremes- and all those in between- are in shape and trained to perform at high levels.

The new research confirmed this. People who are overweight have a fifty-fifty chance of having high cholesterol, high blood pressure, or elevated blood sugar levels. Pretty good odds, but not as good as those for people who are within the normal weight range. They have a 75% chance of having normal results on blood tests for cholesterol and blood sugar. And for those who are obese, the chance of having normal results falls to one-third.

Body fat distribution associated with mortality risk

Body fat distribution associated with mortality risk

Wednesday, Nov. 12, 2008; 5:26 PM

NEW YORK (Reuters Health) - New research indicates it is not just overall body fat but also how the fat is distributed that determines a person's risk of dying over a given period.

According to the report in The New England Journal of Medicine for November 13, both waist circumference and the waist-to-hip ratio were independent predictors of mortality in a study that began in 1992.

Most studies have used body mass index (BMI: the ratio of height to weight) to gauge the impact of body fat on mortality, so it was unclear if the distribution of body fat per se had an effect on the risk, Dr. Tobias Pischon, from the German Institute of Human Nutrition, Potsdam-Rehbruecke, and colleagues explain.

To investigate this topic, the research team analyzed BMI, waist circumference and waist-to-hip ratio data from 359,387 subjects from nine countries who were enrolled in the European Prospective Investigation into Cancer and Nutrition (EPIC). During an average follow-up of 9.7 years, 14,723 of the subjects died.

A J-shaped curve was noted between BMI and mortality. A BMI of 25.3 in men and 24.3 in women carried the lowest risks of death, the report indicates.

After accounting for BMI, waist circumference and waist-to-hip ratio also showed J-shaped curves with respect to mortality. In men, those with the highest waist circumference and waist-to-hip ratio conferred a relative mortality risk of 2.05 and 1.68, respectively, compared with men with the lowest percentage. In women, the corresponding relative risks were 1.78 and 1.51.

Nonetheless, BMI was still a significant predictor of death in models that accounted for the influence of waist circumference or waist-to-hip ratio.

"The results support the use of waist circumference or waist-to-hip ratio in addition to BMI in the assessment of the risk of death, particularly among persons with a low BMI," the authors conclude.

SOURCE: The New England Journal of Medicine for November 13, 2008.

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Do You Have Any Helth Problems Today?

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Drugs Information: Cefixime

Cefixime

Cefixime is a cephalosporin antibiotic used to treat infections caused by bacteria such as pneumonia; bronchitis; gonorrhea; and ear, lung, throat, and urinary tract infections. Antibiotics will not work for colds, flu, or other viral infections.

Cefixime comes as a tablet and liquid to take by mouth. It is usually taken once a day or every 12 hours (twice a day) for 5-14 days. Gonorrhea may be treated in 1-10 days. Shake the liquid well before each use to mix the medication evenly. The tablets should be swallowed whole and taken with a full glass of water.

Side effects

Cefixime may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

* upset stomach

* diarrhea

* vomiting

* mild skin rash

* headache

If you experience any of the following symptoms, call your doctor immediately:

* severe skin rash

* itching

* hives

* difficulty breathing or swallowing

* wheezing

* vaginal infection

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store the tablets at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Keep liquid medicine in the refrigerator, closed tightly, and throw away any unused medication after 14 days. Do not freeze, that may caused broken this drugs.

Hypertension

Hypertension

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Definition

Hypertension is high blood pressure. Blood pressure is the force of blood pushing against the walls of arteries as it flows through them. Arteries are the blood vessels that carry oxygenated blood from the heart to the body's tissues.

Description

As blood flows through arteries it pushes against the inside of the artery walls. The more pressure the blood exerts on the artery walls, the higher the blood pressure will be. The size of small arteries also affects the blood pressure. When the muscular walls of arteries are relaxed, or dilated, the pressure of the blood flowing through them is lower than when the artery walls narrow, or constrict.

Blood pressure is highest when the heart beats to push blood out into the arteries. When the heart relaxes to fill with blood again, the pressure is at its lowest point. Blood pressure when the heart beats is called systolic pressure. Blood pressure when the heart is at rest is called diastolic pressure. When blood pressure is measured, the systolic pressure is stated first and the diastolic pressure second. Blood pressure is measured in millimeters of mercury (mm Hg). For example, if a person's systolic pressure is 120 and diastolic pressure is 80, it is written as 120/80 mm Hg. The American Heart Association has long considred blood pressure less than 140 over 90 normal for adults. However, the National Heart, Lung, and Blood Institute in Bethesda, Maryland released new clinical guidelines for blood pressure in 2003, lowering the standard normal readings. A normal reading was lowered to less than 120 over less than 80.

Hypertension is a major health problem, especially because it has no symptoms. Many people have hypertension without knowing it. In the United States, about 50 million people age six and older have high blood pressure. Hypertension is more common in men than women and in people over the age of 65 than in younger persons. More than half of all Americans over the age of 65 have hypertension. It also is more common in African-Americans than in white Americans.

Hypertension is serious because people with the condition have a higher risk for heart disease and other medical problems than people with normal blood pressure. Serious complications can be avoided by getting regular blood pressure checks and treating hypertension as soon as it is diagnosed.

If left untreated, hypertension can lead to the following medical conditions:

Arteriosclerosis is hardening of the arteries. The walls of arteries have a layer of muscle and elastic tissue that makes them flexible and able to dilate and constrict as blood flows through them. High blood pressure can make the artery walls thicken and harden. When artery walls thicken, the inside of the blood vessel narrows. Cholesterol and fats are more likely to build up on the walls of damaged arteries, making them even narrower. Blood clots also can get trapped in narrowed arteries, blocking the flow of blood.

Arteries narrowed by arteriosclerosis may not deliver enough blood to organs and other tissues. Reduced or blocked blood flow to the heart can cause a heart attack. If an artery to the brain is blocked, a stroke can result.

Hypertension makes the heart work harder to pump blood through the body. The extra workload can make the heart muscle thicken and stretch. When the heart becomes too enlarged it cannot pump enough blood. If the hypertension is not treated, the heart may fail.

The kidneys remove the body's wastes from the blood. If hypertension thickens the arteries to the kidneys, less waste can be filtered from the blood. As the condition worsens, the kidneys fail and wastes build up in the blood. Dialysis or a kidney transplant are needed when the kidneys fail. About 25% of people who receive kidney dialysis have kidney failure caused by hypertension.

Causes and symptoms

Many different actions or situations can normally raise blood pressure. Physical activity can temporarily raise blood pressure. Stressful situations can make blood pressure go up. When the stress goes away, blood pressure usually returns to normal. These temporary increases in blood pressure are not considered hypertension. A diagnosis of hypertension is made only when a person has multiple high blood pressure readings over a period of time.

The cause of hypertension is not known in 90 to 95 percent of the people who have it. Hypertension without a known cause is called primary or essential hypertension. When a person has hypertension caused by another medical condition, it is called secondary hypertension. Secondary hypertension can be caused by a number of different illnesses. Many people with kidney disorders have secondary hypertension. The kidneys regulate the balance of salt and water in the body. If the kidneys cannot rid the body of excess salt and water, blood pressure goes up. Kidney infections, a narrowing of the arteries that carry blood to the kidneys, called renal artery stenosis, and other kidney disorders can disturb the salt and water balance.

Cushing's syndrome and tumors of the pituitary and adrenal glands often increase levels of the adrenal gland hormones cortisol, adrenalin, and aldosterone, which can cause hypertension. Other conditions that can cause hypertension are blood vessel diseases, thyroid gland disorders, some prescribed drugs, alcoholism, and pregnancy.

Even though the cause of most hypertension is not known, some people have risk factors that give them a greater chance of getting hypertension. Many of these risk factors can be changed to lower the chance of developing hypertension or as part of a treatment program to lower blood pressure.

Risk factors for hypertension include:

Some risk factors for getting hypertension can be changed, while others cannot. Age, male sex, and race are risk factors that a person can't do anything about. Some people inherit a tendency to get hypertension. People with family members who have hypertension are more likely to develop it than those whose relatives are not hypertensive. People with these risk factors can avoid or eliminate the other risk factors to lower their chance of developing hypertension. A 2003 report found that the rise in incidence of high blood pressure among children is most likely due to an increase in the number of overweight and obese children and adolescents.

Diagnosis

Because hypertension doesn't cause symptoms, it is important to have blood pressure checked regularly. Blood pressure is measured with an instrument called a sphygmomanometer. A cloth-covered rubber cuff is wrapped around the upper arm and inflated. When the cuff is inflated, an artery in the arm is squeezed to momentarily stop the flow of blood. Then, the air is let out of the cuff while a stethoscope placed over the artery is used to detect the sound of the blood spurting back through the artery. This first sound is the systolic pressure, the pressure when the heart beats. The last sound heard as the rest of the air is released is the diastolic pressure, the pressure between heart beats. Both sounds are recorded on the mercury gauge on the sphygmomanometer.

The latest blood pressure guidelines, issued in 2003 by the National Heart, Lung, and Blood Institute, divide blood pressure measurements into four general categories:

1. Normal blood pressure. Your blood pressure is normal if it's below 120/80 mm Hg. However, some doctors recommend 115/75 mm Hg as a better goal. Once blood pressure rises above 115/75 mm Hg, the risk of cardiovascular disease begins to increase.

2. Prehypertension. Prehypertension is a systolic pressure ranging from 120 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. Prehypertension tends to get worse over time. Within four years of being diagnosed with prehypertension, nearly one-third of adults ages 35 to 64 and nearly half the adults age 65 or older develop high blood pressure.

3. Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg.

4. Stage 2 hypertension. The most severe hypertension, stage 2 hypertension is a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher.

Normal blood pressure is defined by a range of values. Blood pressure lower than 120/80 mm Hg is considered normal. A number of factors such as pain, stress or anxiety can cause a temporary increase in blood pressure. For this reason, hypertension is not diagnosed on one high blood pressure reading. If a blood pressure reading is 120/80 or higher for the first time, the physician will have the person return for another blood pressure check. Diagnosis of hypertension usually is made based on two or more readings after the first visit.

Systolic hypertension of the elderly is common and is diagnosed when the diastolic pressure is normal or low, but the systolic is elevated, e.g.170/70 mm Hg. This condition usually co-exists with hardening of the arteries (atherosclerosis).

Blood pressure measurements are classified in stages, according to severity:

A typical physical examination to evaluate hypertension includes:

The medical and family history help the physician determine if the patient has any conditions or disorders that might contribute to or cause the hypertension. A family history of hypertension might suggest a genetic predisposition for hypertension.

The physical exam may include several blood pressure readings at different times and in different positions. The physician uses a stethoscope to listen to sounds made by the heart and blood flowing through the arteries. The pulse, reflexes, and height and weight are checked and recorded. Internal organs are palpated, or felt, to determine if they are enlarged.

Because hypertension can cause damage to the blood vessels in the eyes, the eyes may be checked with a instrument called an ophthalmoscope. The physician will look for thickening, narrowing, or hemorrhages in the blood vessels.

A chest x ray can detect an enlarged heart, other vascular (heart) abnormalities, or lung disease.

An electrocardiogram (ECG) measures the electrical activity of the heart. It can detect if the heart muscle is enlarged and if there is damage to the heart muscle from blocked arteries.

Urine and blood tests may be done to evaluate health and to detect the presence of disorders that might cause hypertension.

Class I–mild Diastolic pressure 90-104 mm Hg

Class II–moderate Diastolic pressure 105-119 mm Hg

Class III–severe Diastolic pressure > than 120 mm Hg

Hypertension types

A. Essential hypertension Idiopathic Hypertension (HTN)

The major form comprising 90% of all HTN

Malignant hypertension

A sustained Blood Pressure (BP) > 200/140 mm Hg, resulting in arteriolar necrosis, most marked in the brain, eg. cerebral hemorrhage, infarcts, and hypertensive encephalopathy, eyes, eg papilledema and hypertensive retinopathy and kidneys, eg acute renal failure and hypertensive nephropathy; if malignant HTN is uncorrected or therapy refractory, may suffer a hypertensive crisis in which prolonged high BP causes left ventricular hypertrophy and CHF

Paroxysmal hypertension

Transient or episodic waves of BP of any etiology, punctuated by periods of normotension, typical of pheochromocytoma

Portal hypertension

Portal vein pressure caused by a backflow of blood through splenic arteries, resulting in splenomegaly and collateral circulation, resulting in esophageal varices and/or hemorrhoids; PH may be intra- or extrahepatic, and is often due to cirrhosis, or rarely portal vein disease, venous thrombosis, tumors or abscesses

Pulmonary hypertension

A condition defined as a 'wedge' systolic/diastolic pressure > 30/20 mm Hg–Normal: 18-25/12-16 mm Hg, often secondary to blood stasis in peripheral circulation, divided into passive, hyperkinetic, vasoocclusive, vasoconstrictive and secondary forms.

B. Secondary hypertension

· Aging

· Cardiovascular Open heart surgery, coarctation of aorta, cardiac output–anemia, thyrotoxicosis, aortic valve insufficiency

· Cerebral Intracranial pressure

· Endocrine Mineralocorticoid excess, congenital adrenal hyperplasia, glucocorticoid excess, eg Cushing syndrome, hyperparathyroidism, acromegaly

· Gynecologic Pregnancy, oral contraceptives

· Neoplasia Renin-secreting tumors, pheochromocytoma

· Peripheral vascular resistance AV shunts, Paget's disease of bone, beri-beri

· Renal disease Vascular, parenchymal

Treatment

There is no cure for primary hypertension, but blood pressure can almost always be lowered with the correct treatment. The goal of treatment is to lower blood pressure to levels that will prevent heart disease and other complications of hypertension. In secondary hypertension, the disease that is responsible for the hypertension is treated in addition to the hypertension itself. Successful treatment of the underlying disorder may cure the secondary hypertension.

Guidelines advise that clinicians work with patients to agree on blood pressure goals and develop a treatment plan for the individual patient. Actual combinations of medications and lifestyle changes will vary from one person to the next. Treatment to lower blood pressure may include changes in diet, getting regular exercise, and taking antihypertensive medications. Patients falling into the pre-hypertension range who don't have damage to the heart or kidneys often are advised to make needed lifestyle changes only. A 2003 report of a clinical trial showed that adults with elevated blood pressures lowered them as mush as 38% by making lifestyle changes and participating in the DASH diet, which encourages eating more fruit and vegetables.

The major types of medication used to control high blood pressure include:

• Thiazide diuretics. Diuretics, sometimes called "water pills," are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume. Thiazide diuretics are often the first — but not the only — choice in high blood pressure medications. Still, diuretics are often not prescribed. If you're not taking a diuretic and your blood pressure remains high, talk to your doctor about adding one or replacing a drug you currently take with a diuretic.

If you're age 80 or older, a special type of thiazide diuretic, indapamide (Lozol), may be particularly effective in lowering your blood pressure. In this age group, indapamide has been shown to reduce deaths from stroke, heart failure and other cardiovascular disease causes.

• Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force. When prescribed alone, beta blockers don't work as well in blacks — but they're effective when combined with a thiazide diuretic.
• Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. ACE inhibitors may be especially important in treating high blood pressure in people with coronary artery disease, heart failure or kidney failure. Like beta blockers, ACE inhibitors don't work as well in blacks when prescribed alone, but they're effective when combined with a thiazide diuretic.
• Angiotensin II receptor blockers. These medications help relax blood vessels by blocking the action — not the formation — of a natural chemical that narrows blood vessels. Like ACE inhibitors, angiotensin II receptor blockers often are useful for people with coronary artery disease, heart failure and kidney failure.
• Calcium channel blockers. These medications help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for blacks than do ACE inhibitors or beta blockers alone. A word of caution for grapefruit lovers, though. Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication and putting you at higher risk of side effects. Talk to your doctor or pharmacist if you're concerned about interactions.
• Renin inhibitors. Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your kidneys that starts a cascade of chemical steps that increases blood pressure. Tekturna works by reducing the ability of renin to begin this process. The drug is still being studied to figure out its ideal use and dosage for people with high blood pressure.

If you're having trouble reaching your blood pressure goal with combinations of the above medications, your doctor may prescribe:

• Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels.
• Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels.
• Central-acting agents. These medications prevent your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels.
• Vasodilators. These medications work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.

Lifestyle changes that may reduce blood pressure by about 5 to 10 mm Hg include:

Patients whose blood pressure falls into the Stage 1 hypertension range may be advised to take antihypertensive medication. Numerous drugs have been developed to treat hypertension. The choice of medication will depend on the stage of hypertension, side effects, other medical conditions the patient may have, and other medicines the patient is taking.

If treatment with a single medicine fails to lower blood pressure enough, a different medicine may be tried or another medicine may be added to the first. Patients with more severe hypertension may initially be given a combination of medicines to control their hypertension. Combining antihypertensive medicines with different types of action often controls blood pressure with smaller doses of each drug than would be needed for just one.

Antihypertensive medicines fall into several classes of drugs:

Diuretics help the kidneys eliminate excess salt and water from the body's tissues and the blood. This helps reduce the swelling caused by fluid buildup in the tissues. The reduction of fluid dilates the walls of arteries and lowers blood pressure. New guidelines released in 2003 suggest diuretics as the first drug of choice for most patients with high blood pressure and as part of any multi-drug combination.

Beta-blockers lower blood pressure by acting on the nervous system to slow the heart rate and reduce the force of the heart's contraction. They are used with caution in patients with heart failure, asthma, diabetes, or circulation problems in the hands and feet.

Calcium channel blockers block the entry of calcium into muscle cells in artery walls. Muscle cells need calcium to constrict, so reducing their calcium keeps them more relaxed and lowers blood pressure.

ACE inhibitors block the production of substances that constrict blood vessels. They also help reduce the build-up of water and salt in the tissues. They often are given to patients with heart failure, kidney disease, or diabetes. ACE inhibitors may be used together with diuretics.

Alpha-blockers act on the nervous system to dilate arteries and reduce the force of the heart's contractions.

Alpha-beta blockers combine the actions of alpha and beta blockers.

Vasodilators act directly on arteries to relax their walls so blood can move more easily through them. They lower blood pressure rapidly and are injected in hypertensive emergencies when patients have dangerously high blood pressure.

Peripheral acting adrenergic antagonists act on the nervous system to relax arteries and reduce the force of the heart's contractions. They usually are prescribed together with a diuretic. Peripheral acting adrenergic antagonists can cause slowed mental function and lethargy.

Centrally acting agonists also act on the nervous system to relax arteries and slow the heart rate. They are usually used with other antihypertensive medicines.

Prognosis

There is no cure for hypertension. However, it can be well controlled with the proper treatment. Therapy with a combination of lifestyle changes and antihypertensive medicines usually can keep blood pressure at levels that will not cause damage to the heart or other organs. The key to avoiding serious complications of hypertension is to detect and treat it before damage occurs. Because antihypertensive medicines control blood pressure, but do not cure it, patients must continue taking the medications to maintain reduced blood pressure levels and avoid complications.

Prevention

Prevention of hypertension centers on avoiding or eliminating known risk factors. Even persons at risk because of age, race, or sex or those who have an inherited risk can lower their chance of developing hypertension.

The risk of developing hypertension can be reduced by making the same changes recommended for treating hypertension:

Resources

Periodicals

McNamara, Damian. "Obesity Behind Rise in Incidence of Primary Hypertension." Family Practice News April 1, 2003: 45-51.

McNamara, Damian. "Trial Shows Efficacy of Lifestyle Changes for BP: More Intensive Than Typical Office Visit." Family Practice News July 1, 2003: 1-2.

"New BP Guidelines Establish Diagnosis of Pre-hypertension: Level Seeks to Identify At-risk Individuals Early." Case Management Advisor July 2003: S1.

"New Hypertension Guidelines: JNC-7." Clinical Cardiology Alert July 2003: 54-63.

Organizations

American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300. http://www.americanheart.org.

National Heart, Lung and Blood Institute. PO Box 30105, Bethesda, MD 20824-0105. (301) 251-1222. http://www.nhlbi.nih.gov.

Texas Heart Institute. Heart Information Service. PO Box 20345, Houston, TX 77225-0345. http://www.tmc.edu/thi.

Key terms

Arteries — Blood vessels that carry blood to organs and other tissues of the body.

Arteriosclerosis — Hardening and thickening of artery walls.

Cushing's syndrome — A disorder in which too much of the adrenal hormone, cortisol, is produced; it may be caused by a pituitary or adrenal gland tumor.

Diastolic blood pressure — Blood pressure when the heart is resting between beats.

Hypertension — High blood pressure.

Renal artery stenosis — Disorder in which the arteries that supply blood to the kidneys constrict.

Sphygmomanometer — An instrument used to measure blood pressure.

Systolic blood pressure — Blood pressure when the heart contracts (beats).

Vasodilator — Any drug that relaxes blood vessel walls.

Ventricle — One of the two lower chambers of the heart.