Hypertension : The Silent Killer

 

Have you ever wondered what your doctor’s report of a 120/80mm Hg normal BP means? Blood pressure measurement is a routine part of a visit to a doctor’s clinic. A normal blood pressure status reflects your vital status, which is to say, your body is in an acceptable functional state. While most conditions can manifest themselves with outwardly presenting symptoms, high blood pressure may often go unnoticed until it comes as a shocker to you in the doctor’s cabin.

Take a close look at the diagram shown below. This infamous “Rule of Halves,” is a pictorial representation of the statistical analysis that, while half of an entire community may have hypertension, only half are diagnosed with it, half of which are adequately treated for the same. According to a recent survey done by WHO in 2021, the global burden of Hypertension is an estimated 1.28 billion adults aged 30-79y.

 

Source : notes.medicalstudent.blogspot

So, what is Hypertension and what do those two numbers on your BP reading imply?

Hypertension as explained by the WHO is as follows, “Blood pressure is the force exerted by circulating blood against the walls of the body’s arteries, the major blood vessels in the body. Hypertension is when blood pressure is too high.” To explain further, there is a minimum amount of pressure required to be present in the vessels in the body for each organ to be adequately perfused. For this reason, the body maintains a certain pressure in the vessels for the blood to be pumped from the heart across a gradient to the perfused organ. This pressure is variable and is subject to various neuro-hormonal effects in the body. If for any reason there is an increase in the pressure on these vessel walls, it is referred to as hypertension.

High blood pressure may be encountered during either of the two circumstances

1.       High pressure exerted when the heart contracts – Systolic hypertension
2.       High pressure exerted when the heart relaxes – Diastolic hypertension

Systolic hypertension is the pressure with which the heart pumps blood forward into the various vessels emanating from the heart. Diastolic hypertension is the pressure against which the heart has the pump to get blood into the vessels. Intuitively, the pressure against which the heart has to pump is strongly affected by the resistance offered by the peripheral vessels in the body.

In conclusion, the two values in the BP reading are a reflection of the systolic/ diastolic pressure in your body.

 

Can anyone be a patient with hypertension? If so, what activities in our life modify our risk of developing it?

Through a variety of serially conducted studies and evidence drawn from them, scientists across the world have identified risk factors for developing high blood pressure. Some of these risk factors are potentially modifiable; the others unfortunately cannot be modified. While some individuals may be slated to live with hypertension by their genetic makeup, their risk of developing an uncontrolled variety of hypertension is drastically reduced by keeping the modifiable risk factors at bay.

Common modifiable activities leading to an increased risk include tobacco consumption, smoking, heavy drinking habit, a sedentary lifestyle, high-stress levels, poor eating habits, and a high BMI.

Other risk factors like increased age, male sex, genetic predisposition, and ethnicity cannot be controlled.

 

While most Hypertension is asymptomatic, are there any symptoms we can look for?

First described as “fullness disease,” with symptoms of headache, sluggishness, and redness, and warmth, hypertension we know now is infamous for being asymptomatic. However, some individuals may present with the following symptoms:

1.       Headaches

2.       Blurred vision

3.       Nose bleeds

4.       Flushing

5.       Sleep disturbances, Fatigue

6.       Chest pain

While symptoms may appear in some individuals, in most, hypertension is a silent ticking bomb and needs to be explored before any further damage is done.

 

If hypertension is not symptomatic, why is it even a problem?  What could go wrong if you don’t get it checked?

Hypertension is a chronic disease. There is a long latent period before anything could go wrong because of it. High blood pressure increases the wall stress of major vessels and the organs they supply eventually causing damage and increased stress. Hypertension has been implicated in the development of heart attacks (Myocardial infarctions), strokes, peripheral vascular diseases, damage to the retinal layer in the eye causing retinopathy, kidney damage, and vascular dementia. Each of these conditions has an irreversible pathophysiology, a worse prognosis, and an altogether downhill disease course. Well-controlled hypertension can avoid these complications and encourage a healthier quality of life. Needless to say, we must get checked for this “tip of the iceberg disease” and get treated appropriately too.

 

How do you treat hypertension?

American Heart Association (AHA) guidelines define hypertension as a blood pressure of       ≥ 130/80 mm Hg. If you do meet these criteria, your doctor may take another two readings to confirm your diagnosis of hypertension. Once diagnosed with hypertension, the best evidence-based treatment to control hypertension and its unwanted complications is to start antihypertensive therapy. This therapy is a lifelong therapy consisting of a cocktail of antihypertensive drugs that by different mechanisms keep your BP in control.

Additionally, other lifestyle measures are used to control hypertension, each of which contributes offering proportions to reducing blood pressure.

Weight loss is the most effective measure of them all, contributing to a 1mm Hg reduction in BP for every kg lost. Other measures include dietary measures like the introduction of DASH diets, reduction in sodium intake, reduction in alcohol intake, etc. Aerobic exercise of up to 2h/ week also has a tremendous impact on reducing blood pressure.

How can we prevent hypertension?

In the study of preventive and social medicine, prevention is a graded process. Prevention can be achieved at any level of the disease process, before having acquired the disease or preventing complications once the disease has set in. After having discussed the grave morbidity associated with hypertension, a discussion aimed at preventing the disease is a genuine attempt to support awareness amongst the masses about an alternative healthier happier lifestyle.

 

What are some lesser-known facts and myths about hypertension?

1.       All Hypertensive diseases can be treated with drugs

-          No, sometimes hypertension is a “secondary phenomenon” caused by other disease processes causing the blood pressure to rise. In such conditions, unless the underlying condition is treated, hypertension will not resolve.

-          In such cases though, there will be a reversal of hypertension with the treatment of the underlying condition.

-          Examples of such conditions include Hyperthyroidism, Cushing syndrome, kidney disease, etc.

-          This can be detected if your blood pressure does not reduce despite taking your pills regularly. In such cases, you should pay a timely visit to your provider.

 

2.       Hypertension is only seen in older people

-          No, there has been a steadily increasing trend of younger patients developing hypertension.

 

3.       Once your BP is controlled, you may stop taking medications

-       Hypertension is a chronic lifelong disease. Once you’re on the pills, there’s no getting off them. Abrupt cessation in taking your medications can only worsen the condition, sometimes causing a rebound of higher blood pressure that is harder to control.