Stress is simply a fact of nature -- forces from the outside world affecting the individual. Hence, all living creatures are in a constant interchange with their surroundings (the ecosystem), both physically and behaviorally. This interplay of forces, or energy, is of course present in the relationships between all matter in the universe, whether they are living (animate) or not living (inanimate). However, there are critical differences in how different living creatures relate to their environment. These differences have far reaching consequences for survival. Because of the overabundance of stress in our modern lives, we usually think of stress as a negative experience. But from a biological point of view, stress can be neutral, negative, or positive. Stress has driven evolutionary change (the development and natural selection of species over time). Thus, the species that adapted best to the causes of stress (stressors) have survived and evolved into the plant and animal kingdoms we now observe. Man, because of the evolution of the human brain, especially the part called the neo-cortex, is the most adaptive creature on the planet. This adaptability is largely due to the changes and stressors that we have faced and mastered. Therefore, we, unlike other animals, can live in any climate or ecosystem, at various altitudes, and avoid the danger of predators. Moreover, most recently, we have learned to live in the air, under the sea, and even in space, where no living creatures that we know of have ever survived. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions. These include anxiety disorders, depression, high blood pressure, certain ulcers and other gastrointestinal diseases, some cancer, and even aging itself. Stress also seems to increase the frequency and severity of migraine headaches, asthma attacks, and blood sugar fluctuations in diabetics. Overwhelming psychological stress (such as the events of Sept. 11th) can cause both temporary (transient) and long lasting (chronic) symptoms of a serious psychiatric illness called posttraumatic stress disorder.

Medications for Hypertension : Any one of the several classes of medications may be started, except the alpha-blocker medications. The alpha-blockers are used only in combination with another anti-hypertensive medication in specific medical situations. (See the next section for a more detailed discussion of each of the several classes of anti-hypertensive medications.) In some particular situations, certain classes of anti-hypertensive drugs are preferable to others as the first line (choice) drugs. For example, ACE inhibitors or ARB drugs are the drugs of choice in patients with heart failure, chronic kidney failure (in diabetics or non-diabetics), or heart attack (myocardial infarction) that weakens the heart muscle (systolic dysfunction). Also, beta-blockers are sometimes the preferred treatment in hypertensive patients with a resting tachycardia (racing heart beat when resting) or an acute (rapid onset, current) heart attack. Angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin receptor blockers (ARB) The ACE inhibitors and the ARB drugs both affect the renin-angiotensin hormonal system, which, as mentioned previously, helps regulate the blood pressure. The ACE inhibitors work by blocking (inhibiting) an enzyme that converts the inactive form of angiotensin to its active form. The active form of angiotensin constricts or narrows the arteries, but the inactive form cannot. With an ACE inhibitor as a single drug treatment (monotherapy), 50 to 60 percent of Caucasians usually achieve good blood pressure control. Black patients may also respond, but they require higher doses and frequently do best when an ACE inhibitor is combined with a diuretic. As an added benefit, ACE inhibitors may reduce an enlarged heart (left ventricular hypertrophy) in patients with hypertension. These drugs also appear to slow the deterioration of kidney function in patients with hypertension and protein in the urine (proteinuria). Moreover, they have been particularly useful in slowing the progression of kidney dysfunction in hypertensive patients with kidney disease resulting from diabetes. Accordingly, ACE inhibitors are usually are the first line drugs of choice to treat high blood pressure in cases that also involve congestive heart failure, chronic kidney failure in both diabetics and non-diabetics, and heart attack (myocardial infarction) that weakens the heart muscle. Expensive blood pressure medications, especially if insurance does not cover the costs, may also reduce compliance. The reason for this is that people attempt to save money by skipping doses of the prescribed medication. Remember that the least expensive medication regimes use generic (not brand name) drugs, such as are readily available for some of the diuretics and beta-blockers. Reduced costs of medication may also be achieved by lifestyle changes such as losing weight, reducing dietary sodium, decreasing consumption of alcohol, and exercising regularly. If these changes in lifestyle are effective, the patient may require less medication.

Symptoms of Posttraumatic Stress Disorder : In general, posttraumatic stress disorder can be seen as an overwhelming of the body's normal psychological defenses against stress. Thus, after the trauma, there is abnormal function (dysfunction) of the normal defense systems, which results in certain symptoms. The symptoms are produced in three different ways: Re-experiencing the trauma Persistent avoidance Increased arousal First, symptoms can be produced by re-experiencing the trauma, whereby the individual can have distressing recollections of the trauma. For example, the person may relive the experience as terrible dreams or nightmares or as daytime flashbacks of the event. Furthermore, external cues in the environment may remind the patient of the event. As a result, the psychological distress of the exposure to trauma is reactivated (brought back) by internal thoughts, memories, and even fantasies. Persons also can experience physical reactions to stress, such as sweating and rapid heart rate. The second way that symptoms are produced is by persistent avoidance. The avoidance refers to the person's efforts to avoid trauma-related thoughts or feelings and activities or situations that may trigger memories of the trauma. This so-called psychogenic (emotionally caused) amnesia (loss of memory) for the event can lead to a variety of reactions. For example, the patient may develop a diminished interest in activities that used to give pleasure, detachment from other people, restricted range of feelings, and a sad affect that leads to the view that the future will be shortened. The third way that symptoms are produced is by an increased state of arousal of the affected person. These arousal symptoms include sleep disturbances, irritability, outbursts of anger, difficulty concentrating, increased vigilance, and an exaggerated startle response when shocked.

High blood pressure or hypertension means high pressure (tension) in the arteries. The arteries are the vessels that carry blood from the pumping heart to all of the tissues and organs of the body. Hypertension does not mean excessive emotional tension, although emotional tension and stress can temporarily increase the blood pressure. High blood pressure is generally defined as a level exceeding 140/90 mm Hg that has been confirmed on multiple occasions. The systolic blood pressure, which is the top number, represents the pressure in the arteries as the heart contracts and pumps blood into the circulation. The diastolic pressure, which is the bottom number, represents the pressure in the arteries as the heart relaxes after the contraction. The diastolic pressure, therefore, reflects the minimum pressure to which the arteries are exposed. An elevation of the systolic and/or diastolic blood pressure increases the risk of developing heart (cardiac) disease, kidney (renal) disease, hardening of the arteries (arteriosclerosis), eye damage, and stroke (brain damage). These complications of hypertension are often referred to as end-organ damage because damage to these organs is the end result of chronic (long duration) high blood pressure. Accordingly, the diagnosis of high blood pressure in an individual is important so that efforts can be made to normalize the blood pressure and, thereby, prevent the complications.