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1. Case Study :
Primary Hypertension
NAME : Nurul Halilah bt Samsuddin
MATRIC NO : MS1019552019
CLASS : 5h31a
LECTURER’S NAME : En Ahmad Rizal & Pn Norul Huda

2. INTRODUCTION
Hypertension is condition in which the pressure in the arteries is too high and exceed
the normal blood pressure. It is also well known as high blood pressure. Normal blood
pressure usually around 120/90 mmHg, where 120 mmHg refers to “systolic” blood pressure
(the pressure in the arteries when the heart contracts and pumps blood out) where as 90
mmHg refers to “diastolic” blood pressure ( the pressure in the arteries when the heart relaxes
and fills with blood). In general terms, people with a systolic blood pressure consistently
above 160mmHg and/or a diastolic pressure over 100mmHg need treatment to lower their
blood pressure. People with slightly lower blood pressures (140-159mmHg systolic or 90-
99mmHg diastolic) may also need treatment if they have a high risk of developing
cardiovascular disease, eg stroke or angina (chest pains).
There are three general types of high blood pressure. Essential hypertension occurs
when the condition has no known cause. This is also known as primary hypertension or
idiopathic hypertension. When high blood pressure is cause by another condition or disease
process, it is called secondary high blood pressure or secondary hypertension. When only the
systolic blood pressure number is high it is called isolated systolic hypertension, which is
common in older adults. Isolated systolic hypertension refers to elevated systolic pressure
with normal diastolic pressure and is common in the elderly. These classifications are made
after averaging a patient's resting blood pressure readings taken on two or more office visits.
Individuals older than 50 years are classified as having hypertension if their blood pressure is
consistently at least 140 mmHg systolic or 90 mmHg diastolic. In this assignment, I’ve only
focus on primary hypertension only.
Hypertension can caused many complication such as Atherosclerosis (narrowing of the
arteries) , stroke (blood clot in the brain) , Aneurysm(dangerous expansion of the main artery
either in the chest or the abdomen, which becomes weakened and may rupture), heart attack,
heart failure (reduced pumping ability), kidney failure and eye damage.
Hypertension is often called "the silent killer" because it generally has no symptoms until
serious complications develop. When symptoms do occur, they can differ between
individuals depending on such factors as the level of blood pressure, age, underlying cause,
medical history, the presence of complications and general health.

3. Case Study :
Primary
Hypertension

4. Background
Mrs Noraisyah (not her real name), 46 years old female, who was born on March 7, 1964
in Temerloh , Pahang . She is one of Malaysian who suffer primary hypertension. She,
together with her 3 children currently live in Shah Alam, Selangor. She is presently working
as teacher in one of the school’s in Shah Alam. She’s now widow, after her ex-husband
divorced her 3 years ago. This is one of the reason that lead for her to get hypertension. She is
not a smoker and for sure, she didn’t take alcohol. She is the eldest among her 6 siblings and
has 2 unmarried sisters. This disease does not come from her family as none of them have
hypertension.
Mrs Noraisyah was diagnosed hypertension three years ago when blood pressure (BP)
measured was noted to be consistently elevated in the range of 150/100 mmHg on three
occasions. Physical exam reveals a height of 150 cm weight of 56 kg, blood pressure of
150/100. There is no clinical evidence of heart failure or peripheral vascular disease.

5. Factors
Mrs Noraisyah was only diagnosed to have ‘essential / primary hypertension’.
Meaning, the specific cause of her hypertension is not known. It is likely that both genetic
(inherited) and environmental factors, such as diet and life style, play a role. Mrs Noraisyah
suffer hypertension just because of external factor, that is stress and unhealthy life style. She
didn’t affected by genetic inheritance as none of her family member’s has this disease.
Stress is one of the factors that lead to hypertension. However, stress does not directly
cause hypertension, but can have an effect on its development. Stress can cause hypertension
through repeated blood pressure elevations as well as by stimulation of the nervous system to
produce large amounts of hormones that increase blood pressure This patience has face this
problem three years ago as the effect of job strain, social environment, and emotional
distress. Her emotional was disturbed badly when her husband got affair with other women,
leave her alone to grew up her children, with no money and debt (made by her husband) that
she has to settle down. Starting from that, she lives with tension and stress all the time. She
tends to mad when something is not right. Also, working as a teacher distributed to this
problem. Working as a teacher in secondary school, is not easy as what we thought. All day,
she has to put up with undisciplined and disrespectful student. With personal problem and
environmental problem, she has to face the problem, and finally lead to hypertension.
Besides, her life style may also lead to this problem. Busy with school and children that
need more attentions, also with so many problem that have to be settle down, causing this
patience having “ unhealthy” life style. She didn’t care about the amount of food she takes.
More specifically, she’s taking high salt diet . As we know, taking large amount of salt will
causing kidneys retain more water inside body, resulting in increased blood pressure. Its
came worst as she also didn’t practice exercise regularly and eat healthily . Although most
physicians do not believe that high salt intake alone causes hypertension, but they do believe
it plays an important role. This condition became worst as she didn’t practice regularly
exercises and having healthy diet.

6. Symptom
Eventually, it is hard to detect the symptom of primary hypertension as it is remain
unnoticed until it causes of its later complications such as a stroke or heart attack. But there
are several symptom of hypertension such as headache and sleepiness. Mrs Noraisyah admit
this fact. In fact, when she became stress, she will suffer headache and migraine, and
sometimes she feel pain. Scientifically, when we are in stressful situation, body will
produces a surge of hormones. These hormones increasing blood pressure by causing heart to
beat faster and blood vessels become narrow. Thus increased blood pressure causes a
process called autoregulation in the blood vessels that run through the tissue underneath the
skull (where most headaches start). In other words, the autoregulation leads to constriction of
these blood vessels, which is a very well known cause of headache symptoms.
Effect
Having this disease leave a huge effect on herself, especially in first year her ex-husband
divorced her. According to Mrs Noraisyah, she has to face the problem alone, and its really
hard. Every day, she’s been thinking about her life without husband and at the end, because
too stress and depress, she’s got hypertension. She realized that, she always mad and easily
angry although sometimes people around her do not do something badly. For instance, she
easily mad towards her children whenever her ex-husband spoke to them. Also, she always
got headache and felt unconscious. On the bright side, having this disease make her realized
that she’s been wasting her time thinking about someone who didn’t care about herself.
Finally, she decided to have back her normal life and love her new life.
In society, when having this disease, people around her become more sensitive and
protective toward her. She said, people around her, especially the closer one which is her
children, tried to understand her and treat her with patience. They try not making her angry
and stressing, as to control the hypertension from increase. They also become sensitive
toward her problem and become the ear-listener to her problem. In school, her relationship
with her student does not good as before as she becomes fierce and the students are scared of
her. In the nutshell, having this disease leave the effect just not on herself but people around
her.

7. Steps To Prevent
i) Lifestyle Modification
Doctor advices Mrs Noraishah to have a healthy lifestyle, which mean she has to do
exercise regularly and limit amount of sodium intake. Take 4 grams per day is adequate and
helps her blood pressure to be under control. She cut in eating canned foods, salted nuts,
chips and frozen foods which are rich in sodium and ensure her total sodium intake doesn’t
exceed 1.6 grams/day. Besides, she has to control and avoid stress as stress free life helps to
relax all the muscles of body including heart which in turn reduces blood pressure. She’s
been advised to share her problem with people around her. So far, she said, that is one of the
step that she’s taking in order to reduce her blood pressure. Mostly, she will shared and tell
her problem with her first daughter and her best friends. She also has been advised to relax
and control her feeling. Doing exercise actually helping her to relax and reduce the blood
pressure. Besides, she’s now practice an exercise every weekend with her children and try to
control her emotion by always think the positive things. She also said, everything she do now
is to make sure she’s healthy and of course, to control her blood pressure.
Also, she has to ensure she’s check the blood pressure regularly. It is important to
make sure her blood pressure under control and to avoid the chronic cardiovascular diseases
such as Atherosclerosis.
ii) Medicine
Mrs Noraishah was provided with several types of medicine, in order to ensure her
blood pressure is under control. One of it is methyldopa. Methyldopa is a medicine used to
treat hypertension. It works by relaxing the blood vessels so that blood can flow more easily
through the body. Methyldopa controls high blood pressure but does not cure it. Methyldopa
comes as a tablet and liquid to take by mouth. It usually is taken two to four times a day.
Methyldopa can also be replaced by propanolol or labetalol. Both of it contain beta-
blocker act on that part of the central nervous system that controls mental alertness, lung
function, heart rate, and blood vessels. Propranolol is available in 10- to 90-mg tablets.

8. Conclusion
The goal of this study is to analysed and study about the cardiovascular diseases,
which is one of it is hypertension. Through the observation, reading and interview, I finally
knew about hypertension, more detail. Generally, when talking about hypertension, people
will think about the “excessively stress” and tension, which actually hypertension is more
than that. Hypertension is a disease that that involved in blood pressure and arteries. There
are several types of hypertension actually, which is primary hypertension, secondary
hypertension and Isolated systolic hypertension. But in this assignment, I only focus on
primary hypertension.
Basically, 90-95% of patients diagnosed to have primary hypertension. A person will
be diagnosed to have primary hypertension when the specific cause of the hypertension is
not known. The factors that may lead to this disease include family history, environment
(family size, crowding, eating patterns, occupation, obesity), salt ingestion and sensitivity
(there is controversy over whether the sodium or chloride part of the salt molecule is the
principal factor), race (blacks have more primary hypertension and more morbidity and
mortality than whites), smoking, and diet. There are several ways to prevent the development
of this disease such as practice healthy diet, stress management and take a medicine, as what
Mrs Noraishah ( the patience that has been interviewed) done in order to control her blood
pressure.
So, as a conclusion, I finally realized the danger of hypertension toward people and
how to avoid it. I also knew about hypertension specifically, the types and factor that may
lead to this ‘ silent killer’ disease. Thus, it really important for us to take seriously about our
life style, diet and environment, to ensure we didn’t get hypertension.

9. References
i) Books
 Eldra P. Solomon , Linda R.Berg , Diana W. Martin , 2006 , Biology Seventh Edition,
Thomson Books Cole Page 821-824
 Lee Ching , J. Arunasalam 2007 , Biology Matriculation Study Guide Semester 1 ,
Pearson Longman Page 182-183
ii) Internet
 http://www.netdoctor.co.uk/diseases/facts/hypertension.htm
 http://www.myhealth.gov.my/myhealth/bm/dewasa_content.jsp?l
 http://www.patienthealthinternational.com/hypertension/
iii) Interview
 Pn Noraisyah bt Abdullah
 Pn Noralia bt Abdullah

10. Appendix
Figure 1 : Propanolol
Figure 2 : Labetalol
Chart 1: Prevalence of hypertension per Region in 2004