Who Could Be Labeled Hypertensive

High blood pressure and heart conditions are our top fear and health concerns. Not only high blood pressure (hypertension) but the low blood pressure (hypotension) could also harm our body. Who could be labeled hypertensive is a million dollar question? Anybody showing high blood pressure at a given moment could not be labeled as hypertensive. There is a procedure to be followed before labeling a person hypertensive and starting treatment. The variability of blood pressure increases with age and is more marked with systolic (upper limit) than with diastolic (lower limit) blood pressure. Even in normal individuals, the blood pressure varies throughout the day. Blood pressure may be highest in early morning hours and lowest at night. The measurement of blood pressure needs precision (there should be less than 3% variation in the measurements at regular intervals of time) and consideration of a number of factors before labeling a person as hypertensive. At the first stage the blood pressure should be measured in both arms, and all the subsequent measurements should be performed on the arm with high blood pressure. There is a scope for postural variations in blood pressure.

Blood pressure should always be measured in lying down or sitting position as well as in standing position. The experience of the physician measuring your blood pressure matters a lot. Postural hypertension is common in elderly patients and diabetics. There are many patho-physiological conditions associated with hypertension. Only an expert physician could make accurate diagnosis of hypertension. A number of readings on regular intervals for some days are required to label a person as hypertensive. All hypertensive do not need drugs as the life style modifications may help to control the blood pressure. There is a need to maintain normal body weight. Body Mass Index (BMI) is an important indicator to check the health disorders and health fitness. You can calculate BMI by the following formula:

BMI = [^{Weight (in Kg)}/_{Height (M}²₎]

If your BMI is between 18 to 25, you have normal body weight as per your height. BMI >25 indicates, you are over weight and BMI >30 indicates, you are fatty or obese. Salt restriction and diet modifications as per the advice of your physician may help you to stay fit.

Kidney Biopsy Evaluation and Clinicopathological Understanding

Kidney biopsy evaluation is must to understand the renal lesions in association with clinical picture. An adequate kidney biopsy should contain five to ten glomeruli and corresponding tubules and cortical tissue. The adequacy of needle biopsy of kidney depends on the expertise of nephrologist, performing the biopsy technique. Pathologist performs a methodic approach in the microscopic evaluation of kidney biopsy (renal biopsy). Patient may find microscopic description of glomeruli, tubules, blood vessels and interstitial tissue in the surgical pathology (histopathology) report of kidney biopsy. There are several categories of kidney diseases in which histomorphologic features obtained from renal biopsy may prove clinically helpful. Some such conditions are:

1. Nephritic syndrome and acute renal failure (Sudden impairment of renal function).
2. Nephrotic syndrome (Clinical picture characterized by marked edema, massive albuminuria, hypoproteinemia together with high blood cholesterol, normal blood pressure and absence of signs of renal failure)
3. Systemic diseases with associated renal disorders.
4. Evaluation of asymptomatic patients in whom routine laboratory examination has disclosed proteinuria (protein in urine) and/or microscopic hematuria (blood in urine).
5. Evaluation of prospective kidney donors, to be sure that they did not have any occult renal disease.
6. Assessment of renal microstructure of patients with renal transplant.
7. Evaluation of siblings of patients with hereditary renal disorders like Alport's syndrome.

The biopsies are classified by combining the clinical presentation, the histopathology, the immunopathology and ultrastructural pathology. There are several defined patterns of renal lesions and syndromes and these would be discussed separately.