This article aims at making people understand hypertension and its bad effects on health as well as make people aware about how it can be prevented and treated so that many lives of dear and near ones can be saved.
Hypertension is a common clinical problem in modern society. HYPERTENSION defined as office blood pressure recording more than 140/90 mmHg affects around 75 million people in the USA and 1 billion(100 crores) people worldwide. High blood pressure affects between 16 and 37% of the population globally. In 2010 hypertension was believed to have been a factor in 18% of all deaths (9.4 million globally. Hypertension is the single most common readily identifiable and reversible cause of STROKE, HEART ATTACK, HEART FAILURE, AORTIC DISSECTION, and RENAL FAILURE. Global burden of hypertension is rising and projected to affect 1.5 billion (one third) of the world population by 2025. Hypertension is currently responsible for two-third off all STROKES and one-third of all heart attack related problems. Half of these disease burden occurs in people with Hypertension (Blood Pressure more than 140/90) and remaining half occurs in persons with a lesser degree of high blood pressure that is prehypertension.
HOW CAN I KNOW THAT I HAVE HYPERTENSION?
High blood pressure usually produces no symptoms on its own. High blood pressure is a silent killer because it is asymptomatic and if left undetected and untreated can slowly and silently damage blood vessels of heart, brain and kidneys resulting in heart attack, stroke, kidney failure. Hypertension is rarely accompanied by symptoms, and its identification is usually through screening, or when seeking healthcare for an unrelated problem. Some people with high blood pressure report headaches (particularly at the back of the head and in the morning), as well as light-headedness, vertigo, tinnitus (buzzing or hissing in the ears), altered vision or fainting episodes. These symptoms, however, might be related to associated anxiety rather than the high blood pressure itself Sometimes mild headache may be the only symptom and mostly attributable by patients that they have high blood pressure. Sometimes high blood pressure can cause palpitation (abnormal feeling of heartbeat). Occasionally high blood pressure may be associated with swelling of feet.
The best way to know whether one has high blood pressure is by measuring it in a cool and calm environment with appropriate size cuff in a sitting position. Smoking and caffeine (coffee) or alcohol should not be taken at least 30 minutes before checking blood pressure.
Blood pressure less than 120/80 is normal
Blood pressure more than 140/90 is abnormal called high blood pressure or HYPERTENSION
Blood pressure in between these is called PREHYPERTENSION
Prehypertension like hypertension also carries a risk of damage to vital organs like brain heart and kidney
WHAT IS WHITE COAT HYPERTENSION?
Many patients will have normal blood pressure at home whereas they can have high blood pressure in the clinic. Most of the times it may be due to apprehensiveness and unfamiliar environment. But once blood pressure recording is more than 140/90 patients need further repeated measurements and evaluation of high blood pressure.
WHAT ARE THE COMMON PREDISPOSING FACTORS FOR HYPERTENSION?
About 90–95% of cases are primary, defined as high blood pressure due to nonspecific lifestyle and genetic factors. Lifestyle factors that increase the risk include excess salt in the diet, excess body weight, smoking, and alcohol use. The remaining 5–10% of cases are categorized as secondary high blood pressure, defined as high blood pressure due to an identifiable cause, such as chronic kidney disease, narrowing of the kidney arteries (Renal Artery Stenosis), an endocrine disorder like diabetes, or the use of birth control pills.
High blood pressure runs in families so anybody whose parents are hypertensive is likely to develop hypertension as one grows older.
Although high blood pressure is usually a disease of elderly people, younger persons are not immune. Even small children are affected by hypertension.
Smoking, heavy alcohol consumption and lack of activity are common preventable causes.
Obese person, diabetics and patients of kidney problems are more prone to develop hypertension during the course of their disease process. Disorders of cholesterol is also a common clinical association with hypertension
HOW TO TREAT HYPERTENSION
Once a diagnosis is established certain basic investigations are required to look for any damage to vital organs
Basic investigations are complete blood count, blood sugar, renal function test, urine examination, ECG, ECHOCARDIOGRAM, Chest X-RAY, ultrasound of kidneys and Eye examination
Much of the disease burden of high blood pressure is experienced by people who are not labeled as hypertensive. Consequently, population strategies are required to reduce the consequences of high blood pressure and reduce the need for antihypertensive medications. Lifestyle changes are recommended to lower blood pressure, before starting medications. Following recommendations should be followed for the primary prevention of hypertension:
The first line of treatment for hypertension is lifestyle modification, including dietary changes, physical exercise and weight loss which decrease blood pressure. Their potential effectiveness is similar to and at times exceeds a single medication. If hypertension is high enough to justify immediate use of medications, lifestyle changes are still recommended in conjunction with medication. Dietary changes shown to reduce blood pressure include diets with low sodium, the DASH diet, vegetarian diets, and green tea consumption.
DASH diet basically comprises of following constituents
Increasing dietary potassium has a potential benefit for lowering the risk of hypertension, However, people who take certain antihypertensive medications (such as ACE-inhibitors or ARBs) should not take potassium supplements or potassium-enriched salts due to the risk of high levels of potassium. Physical exercise regimens are daily brisk walking and other supervised exercises which are safe from a cardiac point of view to be followed.
Medical treatment with medicines is a mainstay of treatment usually dictated by the cardiologist.
The essential of medical treatment is that no matter which drugs are used it should control the blood pressure to the recommended level. There are no best medicines and there is no one fits all approach.
The aim of treatment is to keep blood pressure adequately and to prevent major complications like heart attack, brain hemorrhage and kidney failure so that all stay healthy
In case any query the author can be contacted via Gmail
The author DR P.K. NAYAK is a senior cardiologist located in Delhi and author specializes in CORONARY INTERVENTION/PACEMAKER AND ICD IMPLANTATION AND TREATMENT OF MAJORITY OF HEART PROBLEMS