“Doctor I am absolutely normal and don’t have any symptoms, but my GP says that I have hypertension and I should take medicines. I don’t understand. Why I should take medicines, when I am, ok?” or “For me my normal BP is 150/90 Doctor and it’s been like this for many years and absolutely comfortable with it”. these are common questions faced by every physician day in and day out. So what is Hypertension?
Why is it important to keep it under control?
To put it simply, Blood pressure is the pressure build up in blood vessels of human body by pumping of heart. When the heart contracts it pushes the blood with force and this is measured as systolic blood pressure and when the heart relaxes, the pressure measured in the peripheries is named as diastolic pressure. In a normal human adult, it should be below 140(systolic)/90(diastolic) mmHg. If it exceeds this, it is harmful to humans and may lead to complications. As you can see, Hypertension is not a disease it is a physiological disorder which can lead to multiple diseases. This explains why a person with Hypertension should take medications for a long time to keep it under control as there is no way you can reverse the process of physiological disorder.
Broadly there are two types of Hypertension. One is Primary or Essential Hypertension which is present in 90% of people with Hypertension and the second is Secondary Hypertension which is present in 10% of the people with Hypertension. It is caused by certain endocrinological diseases, such as Con’s syndrome, Cushing syndrome etc., and they are curable if the causative factor is eliminated or treated.
There is a third type of Hypertension which is called as white-collar Hypertension where patient will have high blood pressure whenever he visits the doctor’s clinic or hospital settings, and it will be normal when he is at home. This happens due to anxiety and to confirm it we do a special test known as CABP (Continuous Ambulatory Blood Pressure) monitoring and if the results are normal in it, there is no need to treat him/her for Hypertension.
Why should we treat Hypertension?
Continuous high blood pressure above 140/90 mm Hg, leads up to thickening of peripheral blood vessels and enlargement of heart. This causes reduced blood flow to the target organs such as brain, kidneys, heart and eyes and causes diseases like
- Retinopathy or Eye damage and loss of vision
- Myocardial infarction or Heart attack
- Heart failure and Pulmonary oedema or fluid in the Lungs
- Irregular Heartbeats or Atrial Fibrillation
- Brain stroke or Cerebrovascular disease
- Kidney
So, treating Hypertension not only saves life but also reduces the impact in quality of life.
Risk factors for developing Hypertension
Who are all prone for developing hypertension? Anyone can develop Hypertension. But some factors which increases the risk are
- Genetics, those who have family history of Hypertension, are more at risk compared to general population.
- Old age
- Sedentary
- Overweight or Obesity
- High salt intake in the food
- Drinking too much
Diagnosing Hypertension
Around 1.28 billion people in the age group of 30-79 years are having Hypertension. Surprisingly, two-thirds of these people are from low and middle-income countries.
So, Hypertension is no more disease of West are affluent society. Unfortunately, 46% of those with Hypertension are unaware of it and only 42% of people with Hypertension are diagnosed and under treatment. Only, 21% or 1 in 5 adults with Hypertension are having controlled hypertension with treatment. One of the major cause for early death worldwide is Hypertension. It is a major health issue which needs urgent attention of healthcare.
Hypertension is diagnosed if the systolic blood pressure greater than 140 mmHg and or diastolic blood pressure greater than 90 mmHg, measured on two different days after resting for 5 minutes, in sitting or lying posture comfortably in a quiet environment.
What are the symptoms?
Majority of people with Hypertension are asymptomatic. That is why we call it as “Silent-Killer “. If blood pressure is very high (180/120 mmHg and above) people may have symptoms like
- Severe Headaches especially in the nape of neck
- Blurring of vision
- Nausea and Vomiting
- Bleeding from nose
- Vertigo or dizziness
- Chest pain
- Breathing difficulty
- Syncopal attacks
- Irregular heartbeats
- Confusion and weakness
As we can see that these are non-specific symptoms which can occur in many other medical conditions. The only way to diagnose Hypertension is periodic checking of blood pressure and consulting the physician.
Prevention and Treatment
Hypertension is classified into different stages as shown in the table below.
Those patients with normal high and Level 1 (mild) category, can go for Lifestyle modification initially and need not go for medications immediately. But those who fall in Level 2 or moderate Hypertension should start on medications simultaneously with Lifestyle changes. As for Level-3 is concerned it is medical emergency and needs treatment immediately and those who fall in this category should immediately seek medical attention.
The target for goal to prevent the complications is below 140/90 mmHg, if there are no other co-morbid illnesses such as Uncontrolled Diabetes, Heart disease, Brain Stroke, Chronic kidney disease. The target for these kind of patients is less than 130/80 mmHg.
Lifestyle modification not only helps people with Hypertension in reducing the blood pressure, but it also helps normal people to prevent developing Hypertension. It includes.
- Eating healthy low sodium diet. One of the most recommended diet plan is DASH (Dietary Approaches to Stop Hypertension). In this it is recommended to have food rich in potassium, calcium and magnesium and take reduced sodium and saturated fat.
- Physical activity- It is recommended to have minimum of 30 minutes of exercise a day and 150 minutes in a The intensity with which exercise can be done has to be discussed with your doctor based on your health condition. Normal walking, swimming, cycling can be done regularly.
- Losing weight is very If an overweight person losses 10% of bodyweight, his blood pressure can reduce a minimum of 5 mmHg to maximum of 10 mmHg.
- Stop or reduce
- Quit
- Sleep at least 6 to 7 hours per
It is important that patients take the prescribed medications regularly and follow up with the Physician as per appointment. There are different medications available, and they are prescribed according to the health condition of the patients by the concerned Physician. All these medications can cause adverse effects and if anything, abnormal felt on taking medications, patients should immediately report to Physician and change the medications instead of discontinuing it on their own.
To conclude Hypertension is a major health issue not only Globally but also for the individual and the family. The morbidity and mortality caused by its complications costs the society and the individual families. So, it is important to create awareness about it in the society and preventing it is the best solution. The global target set by WHO is to reduce the prevalence of hypertension by 33% between 2010 and 2030. It can only be achieved if all the stake-holders are involved and tirelessly work towards achieving the goal.
Dr. C.R.Sathyanarayanan
Specialist – Internal Medicine