Are you a couch potato? Do you get angry easily? Do you love junk food? Are you overweight? Do you have a family history of hypertension? If your answer is yes to one or more of these questions, you need to watch out. Check if hypertension is silently killing you. Dr Tejal gives us a complete guide how to manage and combat this deadly disease that is killing millions of people all around the world.

In 2000, the estimated number of adults living with high blood pressure globally was 972 million. This is expected to increase to 1.56 billion by 2025! Lifestyle factors, such as physical inactivity, a salt-rich diet with high processed and fatty foods, and alcohol and tobacco use, are reasons for this increased disease burden, which is spreading at an alarming rate from developed countries to emerging economies, such as India, China and African countries.

What is Hypertension?

Hypertension (HTN or HT), also known as high blood pressure, is a long term medical condition in which the blood pressure in the arteries is persistently elevated.

High blood pressure is classified as either primary (essential) high blood pressure or secondary high blood pressure.

Primary hypertension, the most frequent and preventable type arises from a number of underlying contributing factors. Inadequate intake of nutrients including potassium, magnesium, Vitamin D and Vitamin K might also play a role.

Secondary hypertension represents only about 5-10% of hypertension cases, and results from an underlying condition, usually associated with diseases of the kidneys, endocrine, vascular, or central nervous system. Although antihypertensive drugs are sometimes used to manage secondary hypertension, correcting the underlying cause can often lead to a cure.

The heart pumps blood around the body through the blood vessels. Blood pressure is the amount of force exerted on the artery walls by the pumping blood. High blood pressure means that your blood is pumping with more force than normal through your arteries.

The added stress on the arteries can speed up the clogging of arteries with fatty plaques (atherosclerosis). Atherosclerosis contributes to many illnesses, such as heart attack and stroke. Other risk factors for atherosclerosis include cigarette smoking and high blood cholesterol.

Hypertension is a common disorder of the circulatory system. Hypertension usually produces no symptoms. This means most people don’t even realise they have it. Experts recommend that everyone should have their blood pressure checked regularly.

High blood pressure is the major risk factor for cardiovascular disease. Hence, in 2002, it was named ‘the number one killer’ by the World Health Organisation (WHO) in The World Health Report.

Symptoms and Signs

For most cases of mild to moderate hypertension, there are no symptoms. Hypertension is therefore, a silent killer, meaning many a time diagnosis is made only when the blood pressure is already very high, sometimes with complications, before the patient even approaches the doctor.

If your blood pressure is high, there may be certain symptoms to look out for, including:

• Severe headache                                                  
• Fatigue or confusion
• Vision problems
• Chest pain
• Difficulty breathing
• Irregular heartbeat
• Blood in the urine
• Pounding in your chest, neck, or ears

How blood pressure is measured

Hypertension can be mild, moderate or severe. Your blood pressure is naturally higher when you are exerting yourself, such as during physical exercise. It is only a concern if your blood pressure is high when you are at rest, because this means your heart is overworked and your arteries have extra stress in their walls.

Blood pressure is measured using an instrument called a sphygmomanometer.

• An inflatable pressure bag is wrapped around the upper arm. The bag is connected to the sphygmomanometer. The operator pumps up the bag with air until the circulation of the arm’s main artery is interrupted.
• The pressure in the bag is then slowly released until it equals the systolic pressure in the artery, indicated by blood once again moving through the vessel. This makes a ‘thumping’ sound. The systolic pressure is indicated on the sphygmomanometer and recorded.
• The blood pressure in the arm’s main artery drops to equal the lowest pressure, which is the diastolic pressure. This is the pressure at which the thumping sound is no longer heard. This figure is also recorded.
• The operator may take numerous readings to get the true picture. This is because many people tend to ‘tense up’ during the procedure and nervous tension may temporarily boost the blood pressure.
• The accuracy of electronic measuring and recording of both systolic and diastolic pressures is replacing manual blood pressure recording.

Blood pressure readings are a combination of two measurements. These are:

• Systolic – is the highest pressure against the arteries as the heart pumps. The normal systolic pressure is usually between 110 and 130mmHg.
• Diastolic – is the pressure against the arteries as the heart relaxes and fills with blood. The normal diastolic pressure is usually between 70 and 80mmHg.

(Values are different for children)

Pre-hypertension is a ‘pre-disease state, which carries an increased risk of progression to hypertension. Those in the 130/80 to 139/89 mmHg blood pressure range (which is already high) are twice as likely to develop clinical hypertension.

Diagnosis

Normal blood pressure is defined by a range of values.Bloodpressurelowerthan120/80 mm Hg is considerednormal. A number of factors such as pain, stress or anxiety can cause a temporary increase in blood pressure. For this reason, hypertension is not diagnosed on one high blood pressure reading. If a bloodpressurereading is 120/80 or higher for the first time, the physician will have the person return for another blood pressure check. Diagnosis of hypertension usually is made based on two or more readings after the first visit.

Systolic hypertension of the elderly is common and is diagnosed when the diastolic pressure is normal or low, but the systolic is elevated, e.g.170/70 mm Hg. This condition usually co-exists with the hardening of the arteries (atherosclerosis).

Blood pressure measurements are classified in stages, according to severity:

• Normal blood pressure: less than 120/80 mm Hg
• Pre-hypertension:120-129/80-89 mm Hg
• Stage 1 hypertension:140-159/90-99 mm Hg
• Stage 2 hypertension: at or greater than 160-179/100-109 mm Hg

A typical physical examination to evaluate hypertension includes:

• Medical and family history
• Physical examination
• Ophthalmoscopy: Examination of the blood vessels in the eye
• Chest x ray
• Electrocardiograph (ECG)
• Blood and urine tests.

The medical and family history help the physician determine if the patient has any conditions or disorders that might contribute to or cause the hypertension. A family history of hypertension might suggest a genetic predisposition for hypertension.

The physical exam may include several blood pressure readings at different times and in different positions. The physician uses a stethoscope to listen to sounds made by the heart and blood flowing through the arteries. The pulse, reflexes, and height and weight are checked and recorded. Internal organs are palpated, or felt, to determine if they are enlarged. Because hypertension can cause damage to the blood vessels in the eyes, the eyes may be checked with a instrument called an ophthalmoscope. The physician will look for thickening, narrowing or hemorrhages in the blood vessels.

A chest x ray can detect an enlarged heart, other vascular (heart) abnormalities, or lung disease. An electro cardiogram (ECG) measures the electrical activity of the heart. It can detect if the heart muscle is enlarged and if there is damage to the heart muscle from blocked arteries.

Urine and blood tests may be done to evaluate health and to detect the presence of disorders that might cause hypertension.

Who is more likely to have high blood pressure?

• People with family members who have high blood pressure, cardiovascular disease, or diabetes
• Women who are pregnant
• Women who take birth control pills
• People over 35
• People who are overweight
• People who are not active
• People who drink a lot of alcohol
• People who eat too many fatty foods or foods with too much salt
• People who smoke

Hypertension is more common in men than women and in people over the age of 65 than in younger persons. More than half of all Indians over the age of 65 have hypertension.

Hypertension is serious because people with the condition have a higher risk for heart disease and other medical problems than people with normal blood pressure. Serious complications can be avoided by getting regular blood pressure checks and treating hypertension as soon as it is diagnosed.

If left untreated, hypertension can lead to the following medical conditions:

• arteriosclerosis, also called atherosclerosis
• heart attack
• stroke
• enlarged heart
• kidney damage.

Arteriosclerosis is hardening of the arteries. The walls of arteries have a layer of muscle and elastic tissue that makes them flexible and able to dilate and constrict as blood flows through them. High blood pressure can make the artery walls thicken and harden. When artery walls thicken, the inside of the blood vessel narrows. Cholesterol and fats are more likely to build up on the walls of damaged arteries, making them even narrower. Blood clots also can get trapped in narrowed arteries, blocking the flow of blood.

Arteries narrowed by arteriosclerosis may not deliver enough blood to organs and other tissues. Reduced or blocked blood flow to the heart can cause a heart attack. If an artery to the brain is blocked, a stroke can result.

Hypertension makes the heart work harder to pump blood through the body. The extra workload can make the heart muscle thicken and stretch. When the heart becomes too enlarged it cannot pump enough blood. If the hypertension is not treated, the heart may fail.

The kidneys remove the body’s wastes from the blood. If hypertension thickens the arteries to the kidneys, less waste can be filtered from the blood. As the condition worsens, the kidneys fail and wastes build up in the blood. Dialysis or a kidney transplant is needed when the kidneys fail.

About 25% of people who receive kidney dialysis have kidney failure caused by hypertension.

Prognosis

There is no cure for hypertension. However, it can be well controlled with the proper treatment. Therapy with a combination of lifestyle changes and antihypertensive medicines usually can keep blood pressure at levels that will not cause damage to the heart or other organs. The key to avoiding serious complications of hypertension is to detect and treat it before damage occurs. Because antihypertensive medicines control blood pressure, but do not cure it, patients must continue taking the medications to maintain reduced blood pressure levels and avoid complications.

Prevention

Prevention of hypertension centers on avoiding or eliminating known risk factors. Even persons at risk because of age, race, or sex or those who have an inherited risk can lower their chance of developing hypertension.

The risk of developing hypertension can be reduced by making the same changes recommended for treating hypertension:

• Reducing salt intake
• Reducing fat intake
• Losing weight
• Getting regular exercise
• Quitting smoking
• Reducing alcohol consumption
• Managing stress

Management of Hypertension

Medications

• Several classes of medications, collectively referred to as antihypertensive medications, are available for treating hypertension.
• First line medications for hypertension include thiazide-diuretics, calcium channel blockers, angiotensin converting enzyme inhibitors and angiotensin receptor blockers. These drugs may be used alone or in combination; the latter option may serve to minimise counter-regulatory mechanisms that act to revert blood pressure values to pre-treatment levels.The majority of people require more than one medication to control their hypertension.

Lifestyle Changes

Controlling blood pressure means radically reducing disease risk. Lifestyle changes are recommended to lower blood pressure, before starting drug therapy. The 2004 British Hypertension Society guidelines proposed the following lifestyle changes consistent with those outlined by the US National High BP Education Program in 2002 for the primary prevention and treatment of hypertension:

• Maintain normal body weight for adults (e.g. body mass index 20–25 kg/m2)
• Reduce dietary sodium intake to <100 mmol/ day (<6 g of sodium chloride or <2.4 g of sodium per day)
• Engage in regular aerobic physical activity such as brisk walking (≥30 min per day, most days of the week)
• Limit alcohol consumption to no more than three units/day in men and no more than two units/day in women
• Consume a diet rich in fruit and vegetables (e.g. at least five portions per day)
• Work on controlling anger and managing stress.
• Take high blood pressure medicine if your health care provider prescribes it, and follow the health care provider’s directions carefully

Effective lifestyle modification may lower blood pressure as much as an individual antihypertensive drug. Combinations of two or more lifestyle modifications can achieve even better results. Thus, effective management is rarely achieved through a single intervention. Instead, optimal management often requires a broad-based approach including lifestyle modification, nutritional components, pharmaceutical medication(s), and regular self-monitoring with regular physician visits.

Dr. Tejal Shah

Dr. Tejal Shah, M.D. (Obstetrics and Gynecology), is a nutrition and fitness consultant. She did her schooling from Bombay and medical education from Karad. She is fond of dogs and other animals. Tejal loves reading, cooking, travelling, listening to music and dancing. She is passionate about books, gadgets and plants. She stays with her doctor husband and school going son at Dhule, Maharashtra, India.

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