Hypertension: Are your values safe?

TK wouldn’t have considered his doctor’s counsel to have a medical check. He has never missed a day at work. He has never felt unwell. He has always had good sleep. Life generally has been fine. However, when his buddy, CO, a known hypertensive patient, died from hemorrhagic stroke, he knew it was time to take his health seriously. Off to his clinic he went. His blood pressure read 176/98mmHg!!

Hypertension is a state of persistent or repeated elevation of the blood pressure at 140/90mmHg or above this. Blood pressure in normal individuals should be (<120/<80mmHg). In between having a normal blood pressure and being hypertensive is a stage of Pre-hypertension in which repeated blood pressure values are in the range (120-139/80-89mmHg). Therefore, it means that if individuals have good health seeking attitude, they may be identified in the pre-hypertensive stage when lifestyle modifications can prevent progression to hypertension. Most individuals experience no symptoms as a result of elevation of their elevated blood pressure until advanced stages of the disease. This is the reason hypertension is known as Silent Killer

The negative impact of hypertension on the organs is proportional to the extent of elevation of the blood pressure. An individual with a blood pressure of 146/92mmHg is “relatively healthier” when compared with another with a blood pressure of 190/120mmHg.
Regarding the cause of hypertension, hypertension can be Essential Hypertension, which has no definite cause as found commonly in older adults (more than 35 years) or Secondary hypertension in which the hypertension results from diseases of other organs of the body such as Kidney, Thyroid (found in the neck), Adrenal gland (sits on each kidney) among others. Other secondary causes of hypertension include prolonged use of steroids, habitual use of illicit drugs- cocaine, amphetamine, et cetera. Irrespective of the cause of hypertension, there are risk factors which when combined increase the probability of an individual developing hypertension. These include increasing age, being of black origin, male gender, family history of hypertension, poor activity or inactivity, stress, obesity, excessive salt intake, smoking, excessive alcohol intake.

What evidence suggests possibility of being
hypertensive?

In the early stage-stage 1 hypertension (with blood pressure 140-159/90-99mmHg)- most patients experience no symptoms, likewise, no signs are elicited by the doctor. At higher values of blood pressure however, due to the effect on the these organs (brain, heart, kidneys, and eyes) some patients may experience myriad of symptoms including, but not limited to, fatigue, difficulty with breathing, headache, poor sleep, swollen feet, change in urinary habit, and poor vision. At very elevated values, hypertension increases the risk of having stroke, heart failure, kidney failure and visual impairment. The emphasis therefore is on the fact that individuals should not wait to experience these symptoms before they begin to manage their hypertension. Damage to these organs may be irreversible, so prompt evaluation by the family doctor is life saving.

What are the next steps in case of symptoms/what are the possible treatments of hypertension?

The clinician would evaluate the symptoms the individual experiences and also examines him/her to identify any effect of hypertension on the organs. Appropriate investigations are ordered to detect damage to organs like the heart, kidneys, and eyes as a result of the high blood pressure. In addition, some diseases- diabetes mellitus, hyperlipidemia (elevated blood fat)- may also be present in the individual. These are also screened for. All these are done in the work up to definitive management of patient so as to individualize treatment. Lifestyle modifications, including health education on moderation of habits, stress reduction, dietary adjustment and aerobic exercises, are important in the management of every hypertensive patient. Thirty minutes of moderate exercises (brisk walking, jogging, cycling, thread mill exercise, swimming) not less than five days of the week, moderate salt intake, moderate alcohol intake if at all, avoidance of smoking, low consumption of saturated fat, replacement of red meat (beef, mutton, chevron) with white meat (fish and skinned poultry; boiled or grilled) are the essentials of lifestyle treatment of hypertension. These measures must be done in combination to achieve result. If these do not control the blood pressure over a six month period, the patients are advised to commence use of medications while they still continue the lifestyle measure.
At initial diagnosis, if the blood pressure is highly elevated and/or effect of hypertension on the vital organs is detected, medication is commenced immediately in addition to lifestyle control. Follow up in the clinic is essential to confirm improvement and challenges with treatment which can be easily addressed. Most patients default in follow up due to the wrong belief that once the blood pressure normalizes, it means cure. Unlike malaria or other acute infections, hypertension has no permanent cure. Lifestyle modification is a lifelong approach to management of hypertension with/without medication.

Can hypertension be prevented?

Yes! Of the risk factors listed above, a few cannot be modified such as black origin, male gender, increasing age, and family history. Therefore, most adult individuals are at risk of hypertension. However, the remaining risk factors of salt intake, smoking, alcohol consumption, inactivity, and stress, are all modifiable. Once an individual adequately controls these modifiable risk factors of hypertension, prevention is almost possible.

What should the public know about hypertension?

Hypertension is a silent killer. This means individuals do not manifest any evidence of the disease in the early stage and even in cases of very elevated blood pressures, some individuals may feel apparently well until catastrophe occurs. Emphasis is on prevention with lifestyle modification. For the asymptomatic hypertensive patients, regular medical check will help discover hypertension in its early stage when intensive lifestyle adjustment may suffice. Every advice from the doctor and other health personnel should be strictly adhered to if hypertension would be put in check. A stitch in time saves nine.

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I encourage everyone to check their blood pressure regularly

Very informative. The rate at which young folks are coming down with hypertension is rather too alarming.

Exactly