Hypertension / High Blood Pressure

Hypertension, or high blood pressure, refers to a condition in which the blood is pumped around the body at too high a pressure. It is a silent disorder and the only way to detect it is to have your blood pressure checked.

Hypertension is an important risk factor for coronary heart disease and cerebrovascular disease e.g. stroke. Prevention, early detection and adequate treatment of hypertension are necessary to prevent complications of hypertension.

When is it High Blood Pressure?
Blood pressure is not fixed. It varies with time of day or night, physical activity and emotional factors. Therefore, blood pressure has to be taken under resting condition and on more than one occasion.

A blood pressure reading of 120/80 is read as 120 over 80 millimetres of mercury. The top number is your systolic pressure. This is the pressure in your arteries when your heart pumps. The bottom number is your diastolic blood pressure. This is the blood pressure in your arteries when your heart relaxes between pumps.

Blood pressure may vary from 90/60 in a young healthy woman to 120/80. Hypertension is present when your blood pressure is persistently at or above 140/90. People with diabetes or kidney disease must strive to maintain their blood pressure at around 120/80 because they are at higher risk of complications of hypertension.

Symptoms
Hypertension often causes no noticeable symptom but can lead to damage of various organs in the body if the blood pressure remains persistently high. It is thus often called the silent killer. Over years it can lead to damage to the heart and blood vessels, making it more likely that the individual will develop a stroke or heart attack. Occasionally, especially when the blood pressure is extremely high, the individual may experience headaches, dizziness, or alterations in vision.

Causes
In 9 out of 10 cases, there is no definite known cause and it is known as essential hypertension. Older people and men are more likely to develop high blood pressure. It also tends to run in families. Although, you may inherit the tendency to get high blood pressure, other lifestyle choices (eating a unhealthy diet, smoking, not exercising) will often determine if you eventually get the disease. The other 10% of high blood pressure cases are due to kidney disease, glandular (hormone/endocrine) problems or a side effect of some medications and is called secondary hypertension.

Listed below are some causes of secondary hypertension.

Treatment
Every hypertensive patient or person at risk of developing high blood pressure should adopt a healthy lifestyle. This means eating wisely: a diet with reduced salt, low fat and high fibre. You will also need to keep your weight in the healthy range, exercise regularly, not smoke and manage your stress better.

Occasionally, marginally raised blood pressure goes back to within the normal range when the patient loses weight, exercises more and cuts down salt intake. If these measures are not successful, then drug treatment is necessary. Once medication is started, it important to continue treatment as well as continue with healthy lifestyle practices. Treatment for most people is life-long.

The goal of treatment is to reduce blood pressure to a level where there is decreased risk of complications. Your doctor will try to prescribe a single drug with minimal side effects to control your hypertension. But if a single drug does not work, he will prescribe two or more drugs.

Some of the common drugs used are:

• Diuretics which increase urination to reduce salt and water retention and lower blood volume. They may be used alone or in combination with other drugs.
• Beta blockers which slow the heart rate and cause the heart to beat less forcefully.
• Angiotensin-converting enzyme (ACE) inhibitors which block the production of angiotensin II (which causes arteries to constrict and stimulate the release of a hormone which causes salt retention).
• Angiotensin II receptor blockers (ARB) which relax blood vessels by blocking the action of angiotensin II.
• Calcium channel blockers which relax the blood vessels by slowing the entry of calcium into cells.

Prevention
You can adopt these lifestyle measures to reduce your risk of high blood pressure. Lifestyle changes are also important for those who already have high blood pressure.

• Lose weight, if overweight. Excess weight adds to strain on the heart. In some cases, weight loss may be the only treatment needed.
• Adopt a healthy diet. Dietary adjustments may be beneficial, especially a decrease of sodium in your diet. Sodium intake may have little effect in persons without hypertension but may have a profound effect in those with hypertension. Salt, MSG, and baking soda all contain sodium. Make sure you eat a diet rich in vegetables and fruit and low in fat.
• Stay active. Do at least 30 minutes of moderate intensity exercises five or more days a week. You can break up the 30 minutes of exercise a day into 10 minute bouts. As your fitness level improves, do vigorous intensity exercise for 20 minutes a day at least 3 times a week for example, jogging or swimming continuous laps. Remember to consult your doctor before you embark on any exercise plan. 
• Stop smoking. If you are a smoker, stop smoking. Smoking greatly adds to the risk of suffering a heart attack or stroke.
• Limit alcohol intake. Keep your alcohol intake to less than 1 or 2 standard drinks a day.