High Blood Pressure: A Silent Killer Affecting 1 in 8 Individuals Worldwide

Hypertension Increases Risk of Organ Damage and Cardiovascular Deaths, Regular Check-Ups Crucial

Hypertension, a condition where blood pressure readings consistently exceed 130/80 mm Hg, affects one in every eight individuals worldwide, with the ratio increasing with age. As the most common heart disease and a leading cause of cardiovascular-related deaths, high blood pressure poses a significant threat to organ health, potentially damaging the brain, heart, kidneys, retina, and large arteries.

Dr. Aloke

Chief Medical Officer, Tata Main Hospital, Jamadoba

Blood is carried from the heart to all parts of the body in the vessels. Each time the heart beats, it pumps blood into the vessels. Blood pressure measures the force at which blood rushes against the walls of the arteries as heart pumps it through the body. Blood pressure readings are given as two numbers.

The top number is called systolic blood pressure (SBP). That’s the force of blood in your arteries whenever your heart beats. The bottom number measures diastolic blood pressure (DBP), or the force of blood in between heartbeats.

Normal blood pressure is when your blood pressure is lower than 120/80 mm Hg. High blood pressure (hypertension) is when one or both of your blood pressure readings are 130/80 mm Hg or higher most of the time.

Elevation to this level or more increases risk for organ damage like brain, heart, kidneys, retina and large arteries. Higher levels of BP can be life threatening. 1 in every 8 individuals are suffering from this disease and ratio increases with age.

Hypertension is the most common heart disease and accounts for the maximum cardiovascular related deaths thus it is important to regularly visit your family doctor.

In 90 % cases of hypertension the cause is not known and is called primary hypertension. Rest 10 % comprises of secondary hypertension.

Causes of secondary hypertension include renal diseases, endocrine related like hypothyroidism, drugs or alcohol induced etc.

Known modifiable risk factors that contribute to the development of hypertension are overweight/obesity, high intake of sodium (common salt), low physical activity, high alcohol consumption, low dietary intake of potassium, and stress.

In most of the cases elevated BP is discovered in asymptomatic individuals during routine health visits. Patients should get their BP check up while sitting in a chair, with feet on the floor, back supported and arm resting at heart level for 5 minutes.

If found high should undergo basic laboratory tests like complete blood counts, blood glucose, lipid profile, urine analysis, thyroid test and ECG. May have to undergo additional tests as per need.

Goal is to lower BP < 130/80 for most adults with hypertension to prevent end- organ damage. All should adopt to lifestyle modification (LSM) as primary prevention for hypertension. Lifestyle modification should also be a part of management for patients already having hypertension.

LSM includes:

Weight loss in case of overweight and obese as it reduces 5 to 20 mm Hg of SBP per 10 kg weight loss. Maintaining Body mass Index to 20 to 25 kg/m2 and waist circumference < 94 cm in men and less than 80 cm in women helps in controlling BP.

Aerobic exercise like 30 minutes brisk walking, jogging, dancing, cycling etc daily reduces BP by 4 to 9 mm of Hg.

Diet plays important role in prevention and control of hypertension. Diet should be low in sodium (not more than 6 gm of salt ie one table spoon in a day), high in potassium (daily consumption of fresh fruits and vegetables), adequate intake of low fat dairy products.

Smoking should be stopped as causes stiffness of arteries leading to heart complications. Stop or limit alcohol intake. This will reduce BP by 4 to 5 mm of Hg.

Stress also contributes to hypertension by releasing hormones which causes heart to beat fast and constricts blood vessels. Emphasis should be given to reduce stress by yoga, meditation and disciplined life (proper 7 to 8 hours of sound sleep). People should not hesitate to consult psychiatrist for stress management. Let treating physician decide drug therapy in addition.

Numerous oral drugs of multiple classes are available to treat high BP. Some of them like Beta blockers e.g., metoprolol, Angiotensin converting enzyme inhibitors e.g., enalapril or ramipril, Angiotensin II receptor blockers e.g., telmisartan or losartan, Calcium channel blockers e.g., amlodipine and diuretics e.g., thiazides are commonly used as first line therapy. Other classes of drugs are also freely available.

But all these classes of drugs have specific indications and adverse effects. Patients should consume only those antihypertensive medicines which are prescribed by treating physician and avoid over the counter medicines.

Some may require two or more drugs to achieve optimal BP control. Strict adherence to prescribed medication helps in achieving target BP.

Assessments are done monthly until Target BP is achieved.

Some common adverse effects like swelling of feet (amlodipine), cough, hyperkalemia (losartan), hyponatremia (thiazide diuretics), slow pulse rate (metoprolol) may need reduction of dosage or change to other class of drugs.

Most of the patients have to take medications lifelong. It has been observed once BP is controlled some patients stop taking medicines, hence inviting complications. There are also group of patients who are noncompliant with follow up, All these leads to poor BP control.

On this World Hypertension Day let us spread awareness aiming to prevent hypertension by lifestyle modification and control hypertension by strict adherence to treatment.

(Guest Article on World Hypertension Day, Authored by Dr Aloke, Chief Medical Officer, Tata Main Hospital, Jamadoba)