Symptoms of Hypertension : Uncomplicated high blood pressure usually occurs without any symptoms. Therefore, hypertension has been labeled "the silent killer." In other words, the disease can progress without symptoms (silently) to finally develop any one or more of the several potentially fatal complications of hypertension. As a matter of fact, uncomplicated hypertension may be present and remain unnoticed for many years, or even decades. This happens when there are no symptoms and those affected fail to undergo periodic blood pressure screening. Some people with uncomplicated hypertension, however, may experience symptoms such as headache, dizziness, shortness of breath, and blurred vision. The presence of symptoms can be positive in that they can prompt people to consult a doctor for treatment and make them more compliant in taking their medications. Not infrequently, however, a person's first contact with a physician may be after significant damage to the organs has occurred. In many cases, a person visits or is brought to the doctor or an emergency room with a heart attack, stroke, kidney failure, or impaired vision (due to damage to the back part of the retina). Greater public awareness and frequent blood pressure screening may help to identify patients with undiagnosed high blood pressure before significant complications have developed. About one out of every 100 (1%) people with hypertension is diagnosed with severe high blood pressure (accelerated or malignant hypertension) at their first visit to the doctor. In these patients, the diastolic blood pressure (the minimum pressure) exceeds 140 mm Hg! Affected persons often experience severe headache, nausea, visual symptoms, dizziness, and sometimes kidney failure. Malignant hypertension is a medical emergency and requires urgent treatment to prevent a stroke

Borderline hypertension : Borderline hypertension is defined as mildly elevated blood pressure that is found to be higher than 140/90 mm Hg at some times and lower than that at other times. In the elderly, a somewhat higher systolic blood pressure, between 140 and 160 mm Hg, is considered a borderline value, as long as the diastolic pressure is below 90. As in the case of white coat hypertension, patients with borderline hypertension need to have their blood pressure taken on several different occasions and their end-organ damage assessed in order to establish whether their hypertension is significant. Keep in mind that people with borderline hypertension may have a tendency, as they get older, to develop more sustained or higher elevations of blood pressure. Accordingly, they have a modestly increased risk of developing heart-related (cardiovascular) disease. Therefore, even if the hypertension does not appear to be significant initially, people with borderline hypertension should have continuing follow-up of their blood pressure and monitoring for the complications of hypertension. If, during the follow-up of a patient with borderline hypertension, the blood pressure becomes persistently higher than 140/ 90 mm Hg, an anti-hypertensive medication is usually started.

Isolated systolic hypertension : Remember that the systolic blood pressure is the top number in the blood pressure reading and represents the pressure in the arteries as the heart contracts and pumps blood into the circulation. A systolic blood pressure that is persistently higher than 140 mm Hg is usually considered elevated, especially when associated with an elevated diastolic pressure (over 90). Isolated systolic hypertension, however, is defined as a systolic pressure that is above 160 mm Hg with a diastolic pressure that still is below 90. This disorder primarily affects older people and is characterized by an increased (wide) pulse pressure. The pulse pressure is defined as the difference between the systolic and diastolic blood pressures. An elevation of the systolic pressure without an elevation of the diastolic, as occurs in isolated systolic hypertension, therefore, increases the pulse pressure. Once considered to be harmless, an elevation of the pulse pressure is now thought to lead to future health problems. In other words, a high pulse pressure is considered an important precursor or indicator of potential end-organ damage. Thus, an isolated systolic hypertension is associated with a 2 to 4 times increased future risk of an enlarged heart, a heart attack (myocardial infarction), a stroke (brain damage), and death from heart disease or a stroke. Clinical studies in patients with isolated systolic hypertension have indicated that a reduction in systolic blood pressure by at least 20 mm to a level below 160 mm Hg reduces these increased risks.

Diagnosis of Posttraumatic Stress Disorder : If symptoms last more than one month and causes significant distress, or the symptoms impair the person's ability to function, then the diagnosis of PTSD can be made. In addition, if the duration of symptoms is more than three months, a diagnosis of chronic (long duration) PTSD is made. In some cases, oddly enough, the onset of symptoms is not until six months after the stressful events. This situation is referred to as delayed onset of PTSD, for which the outcome (prognosis) is often worse. Research has shown that an immediate reduction of symptoms can be harmful in terms of the long-term outcome and persistent psychological illness. In other words, allowing an early peaking of the symptoms of depression and other PTSD problems is appropriate and preferable. Therefore, many of the treatments that psychiatrists have adopted are under the category (rubric) of what is referred to as stress debriefing (reviewing) of the critical incident (traumatic event). That is, we meet with the victims as soon as possible after the traumatic event. The purpose of the meeting is to discuss (debrief) the traumatic event in detail primarily with those most involved, and secondarily with those individuals who are involved at some distance. The specific goal is not to push the trauma away, but to get the people to talk about all aspects of the trauma and how it is affecting them. Clinicians need to inquire very quickly about all aspects of the trauma and the person's response to it. This information will lead to a more rapid, specific diagnosis. We have found that with early management (intervention) techniques, we are able to reduce the number of patients who go on to develop full-blown acute (early) posttraumatic stress disorder and chronic (long duration) posttraumatic stress disorder.