HYPERTENSION
The Case:
The subject, a 46 year old male who resided in Boise, was found unresponsive in his shower. According to information from Police Detectives and the subject's roommates, the subject was living at a residence for recovering addicts. He had a long history of methamphetamine use as well as alcohol abuse, type 2 diabetes and hypertension. His roomates stated that he had been on prescribed medication for his hypertension - but had ran out and could not afford to buy it. The subject was heard getting into the shower at approximately 05:30 hours by one of his roommates. He was then heard turning off the shower, and shortly after falling to the floor. Staff tried to enter the shower and found the subject unresponsive on the floor in front of the shower door. They forced their way into the shower and called 911. EMS arrived and transported the subject to the emergency room at a local hospital where resuscitative efforts were to no avail. The subject was pronounced by dead by the ermergency room doctor and this office was contacted.
Investigation at the scene revealed the subject, unclothed, covered in a blanket lying face up on a bed in the exam room at the hospital. No rigor was present and lividity was consistent with the subject's found position. Evidence of resuscitative efforts was noted. The body was cold to the touch. No signs of trauma or foul play noted.
Following review of scene investigation notes and photos, medical records, toxicology results, and inspection results, the Forensic Pathologist at the Ada County Coroner's Office determined the cause of death to be Hypertensive Cardiovascular Disease (typically caused by uncontrolled and prolonged elevation of blood pressure, as this can lead to a variety of changes in the myocardial structure, coronary vasculature, and conduction system of the heart) with the manner of death being a natural event. Toxicology results were negative for drugs of abuse, alcohol and other tested prescription drugs.
________________________________________________________________________________________________________
It is estimated that 1 of 3 American adults has high blood pressure or hypertension. Having high blood pressure increases one’s chance for developing heart disease, a stroke, and other serious conditions.
High blood pressure is sometimes called the ‘silent killer’ because it usually has no noticeable warning signs or symptoms until other serious problems arise; therefore, many people do not know that they have it. All persons, including children, can develop high blood pressure. However, high blood pressure is easily detectable and usually can be controlled. Maintaining a healthy blood pressure is an important public health strategy. Therefore, it is important for you to know your blood pressure level and to check it regularly.
High blood pressure is a major risk factor for heart disease, the leading cause of death in the United States. It can lead to hardened or stiffened arteries, which causes a decrease of blood flow to the heart muscle and other parts of the body. Reduced blood to the heart muscle can lead to angina (chest pain or damage to the heart muscle due to a lack of blood carrying oxygen to the heart muscle) or to a heart attack (caused by a chronic spasm or blockage of blood and oxygen to the heart).
High blood pressure is a major risk factor for heart failure, a serious condition where the heart cannot pump enough blood for the body’s needs. It is also the major risk factor for stroke, which is the third leading cause of death in the United States. A stroke may be caused by a rupture or blockage of an artery that supplies blood and oxygen to the brain. In addition, high blood pressure can result in damage to the eyes, including blindness. The blood vessels in the eyes can rupture or burst from high blood pressure leading to impairment of sight.
High blood pressure can also result in kidney disease and kidney failure. The kidneys filter wastes from fluids in the body. High blood pressure can thicken and narrow the blood vessels of the kidneys, resulting in less fluid being filtered and wastes building up in the body. Also, diseases of the kidney can be a cause of high blood pressure.
What is Hypertension (High Blood Pressure)?
Blood pressure is the force of blood against the artery walls. It is often written or stated as two numbers. The first or top number represents the pressure when the heart contracts. This is called systolic pressure. The second or bottom number represents the pressure when the heart rests between beats. This is called diastolic pressure.
Blood pressure is traditionally measured with a device called a sphygmomanometer. It measures blood pressure in millimeters of mercury (mmHg). An inflatable cuff is wrapped around the arm and is inflated to squeeze the blood vessels in the arm. The health care provider uses a stethoscope to listen to the pulse as the pressure is released in order to determine the systolic and diastolic pressure. Some blood pressure testing devices are now electronic and provide digital readouts of the blood pressure measurement and pulse rate.
Blood pressure normally rises and falls throughout the day. When it consistently stays too high for too long, it is called hypertension. The Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure notes these levels for defining normal and high blood pressure in adults:
- High blood pressure or hypertension for adults is defined as a systolic blood pressure of 140 mmHg or higher or a diastolic blood pressure of 90 mmHg or higher.
- Normal blood pressure is a systolic blood pressure of less than 120 mmHg and a diastolic blood pressure of less than 80 mmHg.
- Prehypertension is defined as a systolic blood pressure of 120–139 mmHg or a diastolic blood pressure of 80–89 mmHg. Persons with prehypertension are at increased risk to progress to hypertension.
If the systolic and diastolic blood pressure levels are in different categories, blood pressure status is defined according to the higher category. For example, a person with a high systolic pressure but a normal diastolic pressure will be considered to have high blood pressure (sometimes referred to as systolic hypertension). A person with a high diastolic pressure but a normal systolic pressure will be considered to have high blood pressure also (sometimes referred to as diastolic hypertension).
High blood pressure for adults will usually be measured on at least two different doctor visits before a diagnosis of high blood pressure is made.
For children, high blood pressure is determined by comparing the child’s blood pressure with the distribution of blood pressure for children of similar sex, age and height. A child whose blood pressure is greater than or equal to 95% of children of similar sex, age, and height (at or above the 95th percentile) would be considered to have high blood pressure. Prehypertension in children is classified as a blood pressure of 120/80 mmHg or higher but below the 95th percentile. A diagnosis of high blood pressure should be based on blood pressure readings on at least three different visits. The correct–size blood pressure cuff must be used.
More importantly, high blood pressure can be prevented or controlled through lifestyle changes and with medications when needed.
Symptoms of High Blood Pressure
People with primary (essential) high blood pressure usually do not have any symptoms. Most people with high blood pressure feel fine and only find out they have high blood pressure during a routine exam or a doctor visit for another problem.
Very severe high blood pressure (160 over 100 or higher) may lead to hypertensive crisis. This is also called hypertensive emergency or malignant high blood pressure. Very severe high blood pressure is a medical emergency. Symptoms of very severe high blood pressure include:
- Headaches, especially pulsating headaches behind the eyes that occur early in the morning.
- Visual disturbances.
- Nausea and vomiting.
Over time, untreated high blood pressure can damage organs, such as the heart, kidneys, or eyes. This may lead to:
- Chest pain (angina), heart attack, or heart failure.
- Stroke.
- Kidney (renal) failure.
- Peripheral arterial disease.
- Eye damage (retinopathy).
- Abnormal heartbeat.
What Increases Your Risk?
Risk factors for high blood pressure include:
- A family history of high blood pressure.
- Aging.
- Eating a lot of sodium (salt).
- Drinking more than 2 alcohol drinks a day for men or more than 1 alcohol drink a day for women.
- Being overweight or obese.
- Lack of exercise or physical activity.
- High cholesterol.
- Race. African Americans are more likely to develop high blood pressure, often have more severe high blood pressure, and are more likely to develop the condition at an earlier age than others. Why they are at greater risk is not known.
Other possible risk factors include:
- Low intake of potassium, magnesium, and calcium.
- Sleep apnea and sleep-disordered breathing.
- Depression.
- Long-term use of pain medicines like NSAIDs—for example, naproxen (such as Aleve) or ibuprofen (such as Motrin or Advil)—or COX-2 inhibitors, such as celecoxib (Celebrex). Aspirin does not increase your risk for developing high blood pressure.
People who have high blood pressure along with any of the following risk factors are at increased risk for developing complications, such as coronary artery disease, heart attack, abnormal heartbeat, stroke, kidney failure, and eye damage (retinopathy). These risk factors are:
- Cigarette smoking.
- High cholesterol or low HDL ("good") cholesterol.
- Diabetes.
- One or more of your close relatives have or had early coronary artery disease.
- Being a male.
- Being an African American.
- Being overweight.
- Lack of exercise.
HYPERTENSION
The Case:
The subject, a 46 year old male who resided in Boise, was found unresponsive in his shower. According to information from Police Detectives and the subject's roommates, the subject was living at a residence for recovering addicts. He had a long history of methamphetamine use as well as alcohol abuse, type 2 diabetes and hypertension. His roomates stated that he had been on prescribed medication for his hypertension - but had ran out and could not afford to buy it. The subject was heard getting into the shower at approximately 05:30 hours by one of his roommates. He was then heard turning off the shower, and shortly after falling to the floor. Staff tried to enter the shower and found the subject unresponsive on the floor in front of the shower door. They forced their way into the shower and called 911. EMS arrived and transported the subject to the emergency room at a local hospital where resuscitative efforts were to no avail. The subject was pronounced by dead by the ermergency room doctor and this office was contacted.
Investigation at the scene revealed the subject, unclothed, covered in a blanket lying face up on a bed in the exam room at the hospital. No rigor was present and lividity was consistent with the subject's found position. Evidence of resuscitative efforts was noted. The body was cold to the touch. No signs of trauma or foul play noted.
Following review of scene investigation notes and photos, medical records, toxicology results, and inspection results, the Forensic Pathologist at the Ada County Coroner's Office determined the cause of death to be Hypertensive Cardiovascular Disease (typically caused by uncontrolled and prolonged elevation of blood pressure, as this can lead to a variety of changes in the myocardial structure, coronary vasculature, and conduction system of the heart) with the manner of death being a natural event. Toxicology results were negative for drugs of abuse, alcohol and other tested prescription drugs.
________________________________________________________________________________________________________
It is estimated that 1 of 3 American adults has high blood pressure or hypertension. Having high blood pressure increases one’s chance for developing heart disease, a stroke, and other serious conditions.
High blood pressure is sometimes called the ‘silent killer’ because it usually has no noticeable warning signs or symptoms until other serious problems arise; therefore, many people do not know that they have it. All persons, including children, can develop high blood pressure. However, high blood pressure is easily detectable and usually can be controlled. Maintaining a healthy blood pressure is an important public health strategy. Therefore, it is important for you to know your blood pressure level and to check it regularly.
High blood pressure is a major risk factor for heart disease, the leading cause of death in the United States. It can lead to hardened or stiffened arteries, which causes a decrease of blood flow to the heart muscle and other parts of the body. Reduced blood to the heart muscle can lead to angina (chest pain or damage to the heart muscle due to a lack of blood carrying oxygen to the heart muscle) or to a heart attack (caused by a chronic spasm or blockage of blood and oxygen to the heart).
High blood pressure is a major risk factor for heart failure, a serious condition where the heart cannot pump enough blood for the body’s needs. It is also the major risk factor for stroke, which is the third leading cause of death in the United States. A stroke may be caused by a rupture or blockage of an artery that supplies blood and oxygen to the brain. In addition, high blood pressure can result in damage to the eyes, including blindness. The blood vessels in the eyes can rupture or burst from high blood pressure leading to impairment of sight.
High blood pressure can also result in kidney disease and kidney failure. The kidneys filter wastes from fluids in the body. High blood pressure can thicken and narrow the blood vessels of the kidneys, resulting in less fluid being filtered and wastes building up in the body. Also, diseases of the kidney can be a cause of high blood pressure.
What is Hypertension (High Blood Pressure)?
Blood pressure is the force of blood against the artery walls. It is often written or stated as two numbers. The first or top number represents the pressure when the heart contracts. This is called systolic pressure. The second or bottom number represents the pressure when the heart rests between beats. This is called diastolic pressure.
Blood pressure is traditionally measured with a device called a sphygmomanometer. It measures blood pressure in millimeters of mercury (mmHg). An inflatable cuff is wrapped around the arm and is inflated to squeeze the blood vessels in the arm. The health care provider uses a stethoscope to listen to the pulse as the pressure is released in order to determine the systolic and diastolic pressure. Some blood pressure testing devices are now electronic and provide digital readouts of the blood pressure measurement and pulse rate.
Blood pressure normally rises and falls throughout the day. When it consistently stays too high for too long, it is called hypertension. The Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure notes these levels for defining normal and high blood pressure in adults:
- High blood pressure or hypertension for adults is defined as a systolic blood pressure of 140 mmHg or higher or a diastolic blood pressure of 90 mmHg or higher.
- Normal blood pressure is a systolic blood pressure of less than 120 mmHg and a diastolic blood pressure of less than 80 mmHg.
- Prehypertension is defined as a systolic blood pressure of 120–139 mmHg or a diastolic blood pressure of 80–89 mmHg. Persons with prehypertension are at increased risk to progress to hypertension.
If the systolic and diastolic blood pressure levels are in different categories, blood pressure status is defined according to the higher category. For example, a person with a high systolic pressure but a normal diastolic pressure will be considered to have high blood pressure (sometimes referred to as systolic hypertension). A person with a high diastolic pressure but a normal systolic pressure will be considered to have high blood pressure also (sometimes referred to as diastolic hypertension).
High blood pressure for adults will usually be measured on at least two different doctor visits before a diagnosis of high blood pressure is made.
For children, high blood pressure is determined by comparing the child’s blood pressure with the distribution of blood pressure for children of similar sex, age and height. A child whose blood pressure is greater than or equal to 95% of children of similar sex, age, and height (at or above the 95th percentile) would be considered to have high blood pressure. Prehypertension in children is classified as a blood pressure of 120/80 mmHg or higher but below the 95th percentile. A diagnosis of high blood pressure should be based on blood pressure readings on at least three different visits. The correct–size blood pressure cuff must be used.
More importantly, high blood pressure can be prevented or controlled through lifestyle changes and with medications when needed.
Symptoms of High Blood Pressure
People with primary (essential) high blood pressure usually do not have any symptoms. Most people with high blood pressure feel fine and only find out they have high blood pressure during a routine exam or a doctor visit for another problem.
Very severe high blood pressure (160 over 100 or higher) may lead to hypertensive crisis. This is also called hypertensive emergency or malignant high blood pressure. Very severe high blood pressure is a medical emergency. Symptoms of very severe high blood pressure include:
- Headaches, especially pulsating headaches behind the eyes that occur early in the morning.
- Visual disturbances.
- Nausea and vomiting.
Over time, untreated high blood pressure can damage organs, such as the heart, kidneys, or eyes. This may lead to:
- Chest pain (angina), heart attack, or heart failure.
- Stroke.
- Kidney (renal) failure.
- Peripheral arterial disease.
- Eye damage (retinopathy).
- Abnormal heartbeat.
What Increases Your Risk?
Risk factors for high blood pressure include:
- A family history of high blood pressure.
- Aging.
- Eating a lot of sodium (salt).
- Drinking more than 2 alcohol drinks a day for men or more than 1 alcohol drink a day for women.
- Being overweight or obese.
- Lack of exercise or physical activity.
- High cholesterol.
- Race. African Americans are more likely to develop high blood pressure, often have more severe high blood pressure, and are more likely to develop the condition at an earlier age than others. Why they are at greater risk is not known.
Other possible risk factors include:
- Low intake of potassium, magnesium, and calcium.
- Sleep apnea and sleep-disordered breathing.
- Depression.
- Long-term use of pain medicines like NSAIDs—for example, naproxen (such as Aleve) or ibuprofen (such as Motrin or Advil)—or COX-2 inhibitors, such as celecoxib (Celebrex). Aspirin does not increase your risk for developing high blood pressure.
People who have high blood pressure along with any of the following risk factors are at increased risk for developing complications, such as coronary artery disease, heart attack, abnormal heartbeat, stroke, kidney failure, and eye damage (retinopathy). These risk factors are:
- Cigarette smoking.
- High cholesterol or low HDL ("good") cholesterol.
- Diabetes.
- One or more of your close relatives have or had early coronary artery disease.
- Being a male.
- Being an African American.
- Being overweight.
- Lack of exercise.