Understanding Hypertension

By Charles Davies O.A

High blood pressure is a common condition in which the long-term force of the blood against the artery walls is high enough that it may eventually cause health problems, such as heart disease.

 High blood pressure usually does not cause symptoms but long-term high blood
Pressure is a major risk factor for stroke, coronary artery disease, heart failure, vision loss, dementia, and chronic kidney disease. Besides this, blood pressure is a constant variable and there is a continuous relationship between levels of blood pressure (both systolic and diastolic) and reduction in lifespan.
 Blood pressure in a given individual is under both genetic and environmental influence. It is measured using a mercury sphygmomanometer showing a reading of 120/80 mmHg is considered as an average for an adult male, for a female, it should be 110/70 mmHg. A person whose reading is consistently above 130/80 mmHg may be said of hypertension (high blood pressure).

How Common Is Hypertension?

Hypertension is a disease affecting one billion people and is the commonest risk factor for death throughout the world. World health statistics in 2012 has estimated the prevalence of hypertension to be 29.2% in males and 24.8% in females. Approximately 90 per cent of men and women who are nonhypertensive at 55 or 65 years will develop hypertension by the age of 80–85. Hypertension is not limited to rich population and affects countries across all income groups. Out of total 58.8 million deaths worldwide in the year 2004, high blood pressure was responsible for 12.8% (7.5 million deaths). World over hypertension is responsible for 51% of cerebrovascular disease and 45% of ischemic heart disease deaths. Unlike the popular belief that hypertension is more important for high-income countries, people in low- and middle-income countries have more than double the risk of dying of hypertension.

What Causes Hypertension?

 Primary hypertension is high blood pressure that doesn’t have a known secondary cause. It’s also referred to as essential hypertension. It is the most common type of hypertension, affecting 95% of hypertensive patients.

Causes of primary hypertension:

* Family History: having a family history of hypertension increases the likelihood of an individual to develop it
* Age: Hypertension can also be age-related. The risk of hypertension increases as you age.
* Obesity: Obesity can increase the risk of hypertension as compared with normal weight, and up to two-thirds of hypertension cases can be attributed to excess weight. More than 85% of cases occur in those with a Body mass index (BMI) greater than 25. The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
* Lack of exercise: People who do not exercise regularly tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Regular physical exercise reduces blood pressure.
* Too much of salt (sodium) in your diet: Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.  Approximately one-third of the essential hypertensive population is responsive to sodium intake.
* Alcohol: Excessive alcohol consumption will increase blood pressure over time. Alcohol also contains a high density of calories and may contribute to obesity.
* Tobacco: Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart disease.
* Stress: High levels of stress can lead to a temporary, but dramatic, increase in blood pressure. Relaxation and meditation techniques effectively lower the blood pressure.

Secondary hypertension is a type of hypertension which by definition is caused by an identifiable underlying primary cause. It is also known as inessential hypertension. It is much less common than the other type, called primary hypertension, affecting only 5% of hypertensive patients.

Causes of secondary hypertension:

* Diabetes complications: Diabetes can damage your kidneys’ filtering system, which can lead to high blood pressure.
* Polycystic kidney disease:  In this inherited condition, cysts in your kidneys prevent the kidneys from working normally and can raise blood pressure.
* Aldosteronism: In this condition, a tumor in the adrenal gland, increases the growth of normal cells in the adrenal gland or other factors cause the adrenal glands to release an excessive amount of the hormone aldosterone. This makes your kidneys retain salt and water and lose too much potassium, which raises blood pressure.
* Thyroid problems: When the thyroid gland doesn’t produce enough thyroid hormone (hypothyroidism) or produces too much thyroid hormone (hyperthyroidism), it results to a rise in blood pressure.
* Sleep apnea: In this condition, often marked by severe snoring, breathing repeatedly stops and starts during sleep, causing you to not get enough oxygen. Not getting enough oxygen may damage the lining of the blood vessel walls, which may make your blood vessels less effective in regulating your blood pressure. In addition, sleep apnea causes part of the nervous system to be overactive and release certain chemicals that increase blood pressure.
* Pregnancy: Pregnancy can make existing high blood pressure worse, or may cause high blood pressure to develop.
* Medication: Various prescription medications such as pain relievers, birth control pills, antidepressants and drugs used after organ transplants can cause high blood pressure in some people. Over-the-counter decongestants and certain herbal supplements, including ginseng, licorice, and ephedra (ma huang), may have the same effect. Many illegal drugs, such as cocaine and methamphetamine, also increase blood pressure.

Symptoms of Hypertension:
Hypertension is generally a silent condition. Many people won’t experience any symptoms. But there are symptoms of severe hypertension which are:
* Headache
* Shortness of breath (dyspnea)
* Fatigue or confusion
* Nosebleeds
* Flushing
* Dizziness
* Vision problems
* Chest pain
* Blood in urine

Diagnosis of hypertension:
Medical history:
* Family history of hypertension or hypertensive complications
* History of cardiovascular, cerebrovascular, or renal disease of diabetes mellitus
* Medication history for drugs that elevate blood pressure
* Effectiveness or side effects of previous drug treatment
* Duration and level of elevated blood pressure
* Lifestyle and health habits
* Smoking
* Sodium intake
* Caffeine
* Stress
Physical examination
* Two or more blood pressure measurements. Measurements may be taken from both the left and right arms and legs and may be taken in more than one position, such as lying down, standing, or sitting. Multiple measurements may be taken and averaged.
* Measurement of your weight, height, and waist (Body mass index)
* Abdomen examination using a stethoscope. A doctor will listen to the blood vessels in the abdomen for abnormal sounds. These sounds may be caused by blood flow through a narrowed artery in the abdomen
* Neck examination for enlarged thyroid
* Extremity examination for edema
* Cardiac examination

Laboratory tests:
* Serum potassium
* Serum creatinine
* Serum uric acid
* Urinalysis
* Fasting plasma glucose
Treatment of hypertension:

* Physical exercise: Aerobic activity for 20-30 minutes, 5 days a week improves cardiovascular health
* Stress management: Pursuing an enjoyable activity or verbalizing frustration to reduce stress and improve mental health.
* Low sodium diet: A diet that restricts salt (sodium chloride) and other forms of sodium to no more than 1,500 to 2,400 mg per day
* Quitting smoking and tobacco
Someone who’s been diagnosed with hypertension may be placed on medications like:
* ACE inhibitors
* Angiotensin receptor blockers (ARBs)
* Beta-blockers
* Vasodilators
* Calcium channel blockers

Prevention Of Hypertension:
By living a healthy lifestyle, you can help keep your blood pressure in a healthy range and lower your risk of heart disease and stroke. A healthy lifestyle includes:
* Eating a healthy diet: Choosing healthful meal and snack options can help you avoid high blood pressure and its complications. Be sure to eat plenty of fresh fruits and vegetables. Eating foods low in salt (sodium) and high in potassium can lower your blood pressure.
* Maintaining a healthy weight: Being overweight or obese increases your risk for high blood pressure. To determine if your weight is in a healthy range, doctors often calculate your body mass index (BMI).
* Getting enough physical activity: Physical activity can help you maintain a healthy weight and lower your blood pressure. If you can’t make it to the gym, you can get home equipment for exercising like indoor bikes.
* Not smoking: Cigarette smoking raises your blood pressure and puts you at higher risk for heart attack and stroke. If you do not smoke, do not start. If you do smoke, quitting will lower your risk for heart disease.
* Limiting alcohol use: Avoid drinking too much alcohol, which can raise your blood pressure.

Curled from Nigerian Tribune

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