Is Your Blood Pressure High?

BP

Without looking into a crystal ball one can say that the answer to this question would be one of the following:

  1.  No
  2.  Don’t know
  3. Yes (always, most times, sometimes…)
You may be aware that high blood pressure (Hypertension) is not a disease but a risk factor for heart attack, heart failure and stroke. If you don’t have hypertension, it means that in the last year (or recently) you have checked your BP and it is within normal limits. BP readings can be affected by the device used and the so-called ‘white coat syndrome’. The latter is a temporary elevation of the BP due to the real or apparent stress felt by the individual. BP machines should be validated and measurement taken with the correct sized arm cuff. A person with an irregular pulse whose BP is checked with an electronic device could have a wrong reading.
If you are not sure whether you have high blood pressure, get your BP checked as soon as possible especially if you are 40 or older.
What is hypertension?
Blood pressure is created by the force of blood pushing against the walls of blood vessels (arteries) as it is pumped by the heart.[i] It is measured when the heart muscles contract to pump out blood (systole) and when they relax and fill up (diastole). According to the World Health Organisation[ii], when systolic blood pressure is equal to or above 140 mm Hg and/or a diastolic blood pressure equal to or above 90 mm Hg, the blood pressure is considered to be raised or high and the person has hypertension.
Only 5% of hypertensive people have an obvious cause. The vast majority are said to have Essential Hypertension (no obvious cause) and over time progress from occasional, persistent to complicated hypertension.
To understand high blood pressure better, here is a little mathematical equation:
Blood Pressure = Cardiac Output x Peripheral Resistance
Why do people become hypertensive?
Anything that causes an upsurge in the volume of blood being pumped out of the heart and/or increases the resistance to the flow of blood through the blood vessels will increase the blood pressure. When these factors become persistent, people become hypertensive.
The regulation of BP is a complicated process. When the arteries relax, resistance to blood flow is less  and blood pressure is reduced. The part of the nervous system which overworks when we are stressed, certain chemical messengers, the calibre of the blood vessels, the elasticity of the blood vessel wall, the thickness of the blood flowing through the arteries are factors that affect peripheral resistance.
Salt and water balance in the body, blood pooling in the peripheral veins or increased flow back to the heart are other factors which determine how much blood is pumped out. The higher the cardiac output, the more likely it is for the BP to be raised.

Who gets hypertension?

Age, gender and our genes are factors that cannot be modified. If your mum, dad, or sibling is hypertensive, chances are that you will also become hypertensive … unless you have ‘chosen your parents carefully’! As we grow older, our blood vessels become stiff and begin to resist the flow of blood. Before age 45, men are more likely to be hypertensive. It evens out from then until age 65 after which women seem to overtake men in becoming hypertensive.

Most chronic medical conditions have the same modifiable risk factors:
Inactivity invariable leads to weight gain which affects the blood vessels. Moderate or vigorous exercise keeps the heart and blood vessels in good shape.
High salt diet, foods high in fat and sugars can contribute to hypertension. People of African descent are particularly sensitive to salt and studies have shown that reduction of salt intake can lower blood pressure and reduce the risk of stroke and heart disease.[iii] High salt intake makes people retain water in the body which increases the blood volume and ultimately raises blood pressure.
Obesity puts a strain on the heart. In addition, it causes fatty deposits in the arteries which become narrow and stiff with effects on the BP. It also puts people at risk of diabetes which can damage blood vessels to the heart and the kidneys.
Alcohol above sensible limits and smoking (which also damages the arteries) can worsen hypertension.
Stress can cause a temporary increase in blood pressure. How one responds to the stress e.g. high calorie food, alcohol, smoking can ultimately lead to hypertension if the situation is left unchecked.
A small percentage of people may have secondary hypertension due to pre-existing problems – diseases of the kidney or adrenal gland, narrowing of arteries like the aorta or renal artery.
How do we manage Hypertension?
  1. Get the diagnosis right: The practice of checking the BP once or twice and commencing patients on blood pressure medication (if the reading is greater than 140/90) is outdated. The current advice is to do a 24-hour Ambulatory Blood Pressure Measurement (ABPM). Where the device is not available, the next best option is for the patient with a raised BP to be loaned a BP machine and taught to take and record two readings each in the morning and evening for seven days. The clinician reviews the readings, calculates the average and decides if the patient has Normal BP, Stage 1 or Stage 2 Hypertension.
  2.  Check for End Organ Damage: Complicated hypertension affects certain organs and the following examination and tests  will uncover such damage – fundoscopy [eye], electrocardiogram (ECG) [the heart], blood and urine test [kidneys, diabetes, high cholesterol].
  3. Lifestyle Changes: There is no wonder pill to make us more active, eat the right foods, cut back on salt in diet (not just cooking/table salt, but the excess salt in everything including bread, breakfast cereal, fast foods, ready meals etc.); stop smoking or drink sensibly. It’s all about making the right choices and keeping them.
  4. Drugs: Stage 1 Hypertension may be managed initially by lifestyle modification. If there is end organ damage or the patient is adjudged to have high risk factors, drug treatment should commence. Stage 2 Hypertension requires treatment. There are four main classes of anti-hypertensive drugs. Each drug has its benefits and possible side effects. The most important factor is your health behaviour and approach to taking prescribed medication. Some people simply refuse to take tablets to bring down their BP despite best advice. If a man refuses to continue with his BP medication, it may be bringing something else down – erectile dysfunction is a sensitive side effect! It is important to tell your doctor if you are having side effects. In some countries, there is a huge problem with fake drugs.

The health professional’s clinical experience and rapport with the patient are other factors that contribute to management and influence patient outcome.

What are your thoughts about hypertension?
The British Medical Journal published a review of patients thought about hypertension.[iv]
Please be aware that:

  • Hypertension is not a temporary illness that would resolve.
  • The absence of headaches and dizziness does not mean good hypertension control.
  • There is no need to experiment with stopping treatment to see if symptoms recurred
  • Do not stop medication because of lack of symptoms
  • Do not wait for symptoms before you take your medicine.
  • Long-term medication is not harmful and does not have any risk of tolerance, dependence or the drug ‘building up’ to harmful levels
  • Alternative medicines are not more effective but may result in complications and ‘too little too late’

Conclusion

If you do not know your BP, have it checked. Hypertension is a ‘silent killer’. In every part of the world, some people only got to know they were hypertensive when they had suffered a stroke. The management of hypertension is complex. Success largely depends on patients taking responsibility for their health through lifestyle modification, taking medicines as prescribed, monitoring their BP and keeping up with planned follow-up checks.

If you are hypertensive, remember it is you and not your doctor who has the risk factor. Let your doctor work with you as an informed patient to arrive at the best management option, tailored to meet your needs. By so doing, you will live a healthier, happier life, away from avoidable end organ damage in the brain, eyes, heart and kidneys.

Our goal in KayHector Consulting Ltd is to have well-informed people/patients who take responsibility for their health and become experts at differentiating trivial symptoms from even subtle ones that require prompt attention and a visit to a health professional. Taking responsibility for one’s health will be recurring themes here as well as medical information in plain English.

Thanks to modern technology, our health information may only be a fingertip distance from you! We can also signpost you to Private GP/Specialist consultation via telephone, video link, online chat or face-to-face.

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Doctor Hector
KayHector Consulting Ltd


[iv] So what do patients think about hypertension? (BMJ 2012;345:e3953): in GP Update Handbook 2016

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