HYPERTENSION CONTROLLING THE SILENT KILLER

Maryam Hamid M.D.

The number of people living with hypertension (high blood pressure) is predicted to be 1.56 billion worldwide by the year 2025. In the US, about 75 million American adults, 29% of the total population, have high blood pressure—that is 1 of every 3 adults. Only about half (54%) of people with high blood pressure have their condition under control.

WHAT IS HIGH BLOOD PRESSURE? Blood pressure is a measure of how hard the blood pushes against the walls of the arteries. It is normal for blood pressure to fluctuate throughout the day, within a small range of 10-20 mmHg. But if it stays up consistently, it is ‘High Blood Pressure’ medically called Hypertension.

UNDERSTANDING THE NUMBERS:

The top number, or systolic pressure, reflects the amount of pressure during the heart’s pumping or ejection phase which is called systole. As the heart contracts with each beat, pressure in the arteries temporarily increases as blood is forced through them. The bottom number, or diastolic pressure, represents the pressure in the arteries during the resting or relaxation phase of heart’s contraction cycle. Hypertension is defined as having a systolic reading of 140 mm Hg and above and/or a diastolic reading of 90 mm Hg and above.

American Heart Association (AHA) has defined the following ranges of blood pressure:

Normal blood pressure is below 120 systolic and below 80 diastolic
Prehypertension is 120-139 systolic or 80-89 diastolic
Stage 1 high blood pressure (hypertension) is 140-159 systolic or 90-99 diastolic
Stage 2 high blood pressure (hypertension) is 160 or higher systolic or 100 or higher diastolic
Severe hypertension (a medical urgency) is when blood pressure is above 180 systolic or above 110 diastolic
Emergent hypertension, if BP is above 210 systolic and 120 diastolic. At this level if immediate treatment is not given, organ damage starts to set in especially swelling of a round area in the retina, the optic disc. This condition is called papilledema and if present, the elevated BP is called malignant hypertension.

WHAT CAUSES HIGH BLOOD PRESSURE?

Modern lifestyle factors are responsible for a growing burden of hypertension. These are physical inactivity, salt-rich diets with processed and fatty foods, alcohol and tobacco use, lack of sleep and stressful life situations. High blood pressure can also be secondary to other conditions, for example, kidney disease, glandular abnormalities and effects of some medications. Frequently blood pressure increases with age as arteries become stiffer and sometimes narrower due to plaque build-up.

DIAGNOSING HYPERTENION:

Diagnosis of hypertension requires several readings of high blood pressure over time. Having high blood pressure as an isolated reading, could be a normal physiologic response to many stressful situations. It is when BP remains consistently high that medical attention becomes mandatory. However, a systolic reading of 180 mmHg or higher OR a diastolic reading of 110 mmHg or higher could be a sign of hypertensive crisis that warrants immediate medical attention. Anyone who gets such a reading when testing their own blood pressure should wait a couple of minutes and re-measure the blood pressure. If the reading remains high or increases, should seek medical treatment immediately.

WHAT ARE THE SYMPTOMS OF HIGH BLOOD PRESSURE?

One cannot see blood pressure nor can feel it. Despite what many people think, high blood pressure usually does not necessarily cause headaches, dizziness or lightheadedness. It usually has no symptoms. This is why hypertension is often referred to as “the silent killer”, because it can quietly damage the internal organs and result in serious illness.

WHAT ARE THE CONSEQUENCES OF HIGH BLOOD PRESSURE?

At high blood pressure the heart is working against increased load to pump blood through the body. This extra work can result in a weaker heart because of damage to the heart muscle. This condition is called congestive heart failure. Elevated blood pressure also causes kidney failure, stroke due to brain hemorrhage, micro-hemorrhages in the eye effecting vision and damage to the arterial walls causing a disease called atherosclerosis which results in narrowing of the arteries and sometimes total occlusion.

HOW CAN YOU PREVENT HIGH BLOOD PRESSURE?

To maintain a healthy weight and be physically active is the mainstay of prevention. At least 30 minutes of daily exercise on most days of the week should be the goal. Walking is a good choice of exercise among may other physical activities such as swimming, cycling, or playing team sports.
One should try to limit the amount of sodium as it has a proven direct correlation with hypertension. The diet should contain plenty of fruits, vegetables and low-fat dairy products.
Avoiding sources of stress, where possible, and developing healthy coping strategies for managing unavoidable stresses of life can help with blood pressure control, especially as many people adversely turn to alcohol, drugs, smoking and unhealthy foods or overeating. The US National Heart Lung and Blood Institute, recommends the DASH diet for people with high blood pressure.

DASH has been specially formulated to help people lower blood pressure. It is a flexible and balanced eating plan based on research studies sponsored by the institute, with the claim that it lowers high blood pressure, improves cholesterol levels and reduces the risk of developing cardiovascular disease. A brochure with complete information about DASH diet may be had from National Institute of Health, National Heart, Lung and Blood Institute, NHLBI Health Information Center, PO Box 30105, Bethesda, MD. 20824-0105 Phone: 3015928573 Fax: 3015928563 Web site: http://www.nhlbi.nih.gov

HOW IS HIGH BLOOD PRESSURE TREATED?

PREHYPERTENSION:

At this stage one needs to adopt a healthy lifestyle as mentioned above. There is generally no need to take any medicine if one does not have other health conditions like diabetes or kidney disease etc. But if these conditions are present, drug therapy under the care of a physician may be necessary.

STAGE 1 AND 2 HYPERTENSION:

Here drug treatment is indicated to bring the blood pressure under control. Patients with stage 1 & 2 hypertension should be under the care of a physician who will tailor down an effective regimen of medications. Physicians will also monitor the side effects of the drugs prescribed and balance them out with the benefits to be derived. It is highly likely that patients may not have any symptoms with increased levels of BP especially if hypertension develops gradually. This situation causes patients to be complacent or non-compliant with medicines thinking they are doing fine. Such noncompliance leads to catastrophic consequences of stroke or heart attack. Total compliance with diet, medications and regular check-ups by a physician are indispensable for good control of BP and prevention of devastating complications.