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Hypertension: a Preventable Silent Killer

Hypertension is one of the most commonly diagnosed diseases in hospitals and which is attributed to be responsible for an estimated 7.5 million deaths globally (WHO) and 500,000 deaths in the United States annually (CDC). Although hypertension is preventable, yet about 1.13 billion people worldwide are living with the condition.

The risk factors that can predispose one to having hypertension can be categorized into two: modifiable risk factors (such as high salt intake, obesity, tobacco use and sedentary lifestyle), and non-modifiable risk factors (such as age > 65 years, and having a family history of hypertension). Symptoms such as migraine, dizziness, blurry vision and fatigue can occur when a person becomes hypertensive. It can be effectively managed with appropriate lifestyle changes and compliance with prescribed antihypertensives (if medically required).


Female Doctor assessing patient's blood pressure by Ivan-balvan _ iStock
Ivan-balvan _ iStock


What is Hypertension?


This condition is also called High blood pressure. It occurs when the pressure with which blood follows through the arteries increases beyond normal values. Arteries are blood vessels that transports oxygenated blood from the heart to other parts of the body. Two numbers are used to record the pressure of blood as it flows through the arteries - the upper number is known as the systolic blood pressure while the lower number is known as the diastolic blood pressure.


The systolic blood pressure measures the pressure within the arteries when the heart beats while the diastolic blood pressure measures the pressure of blood flow when the heart relaxes between each beat. A blood pressure of <120/80mmHg is considered normal; however, blood pressure readings are not static, they change throughout the day depending on the intensity of your daily tasks.


How are Blood Pressure Readings Categorized?


According to ACC/AHA (2017) Guideline, categories of blood pressure (BP) readings include:


- Normal BP: Systolic bp <120 mm Hg; Diastolic bp <80 mm Hg.

- Elevated BP: Systolic bp 120 - 129 mm Hg; Diastolic bp <80 mm Hg

- Hypertension Stage 1: Systolic bp 130 - 139 mm Hg; Diastolic bp 80 - 89 mm Hg.

- Hypertension Stage 2: Systolic bp >140 mm Hg; Diastolic bp >90 mm Hg.


Your blood pressure can be classified as high, if on 2 or more different visits to the hospital, the average measurement for 2 or more of your blood pressure assessment is > or equal to 130/90 mm Hg.


Hypertension Crisis


This refers to a blood pressure reading >180/120 mm Hg. It can be furthered classified as Hypertensive urgency and Hypertensive emergency.


- Hypertensive urgency: bp >180/120 mm Hg with no sign of progressive organ dysfunction.

- Hypertensive Emergency: bp >180/120 mm Hg with evidence of progressive organ dysfunction.


What are the Types of Hypertension?


There are 2 major types of hypertension which include: Primary hypertension and Secondary hypertension.


Primary Hypertension: It's also known as essential hypertension. It is the most common type of hypertension that is caused by environmental or genetic factors. They are not caused by existing medical conditions and tend to develop over many years if not managed adequately.


Secondary Hypertension: This type of hypertension is not as common as primary hypertension. People who are diagnosed of this type of hypertension usually have an existing medical condition such as diabetes mellitus, kidney failure, adrenal gland tumor etc. It could also be caused by some prescribed medications such as cold & cough medicines or by illegal drugs such as nicotine & amphetamine.


What are the Risk Factors of Hypertension?


There are certain factors that put one at risk of having high blood pressure. These factors can be classified into two: modifiable and non-modifiable risk factors.


- Modifiable Risk Factors: These factors are associated with lifestyle or behaviours that lead to hypertension such as cigarette smoking /tobacco use, excessive alcohol intake, consumption of high salt diet, obesity, sedentary lifestyle etc. They are called 'modifiable' because addressing these factors through appropriate lifestyle changes reduces the risk of having hypertension.


- Non-modifiable Risk Factors: These factors are associated structural makeups such as having a family history of hypertension, advanced age (>65 years), race and gender. These factors are described as 'non-modifiable' because they cannot be changed or controlled.


What are the Signs and Symptoms of Hypertension?


Below are warning signs of high blood pressure:

  •  Migraine

  •  Blurry vision

  •  Dizziness

  •  Confusion

  •  Dyspnea (difficulty in breathing)

  •  Fatigue

  •  Nausea & vomiting

  •  Chest pain

  •  Nose bleed

  •  Tinnitus (Ringing or buzzing in the ears)

When hypertension is not properly managed, it can escalate into serious medical complications which can affect vital body organs such as cardiovascular diseases (e.g. heart attack), kidney diseases (e.g. renal failure), eye problems (e.g. retinopathy).


How to Manage Hypertension


High blood pressure can be effectively controlled and managed with lifestyle changes and drug therapy.


- Lifestyle changes: To regulate your blood pressure and to have a healthy heart, you need to make some lifestyle adjustments. The highly recommended lifestyle changes include:

  • Monitor your blood pressure regularly.

  • Reduce your salt intake to no more than 2.3g per day (AHA).

  • Cut down on foods high in saturated fat.

  • Engage in physical activities and exercise (150 minutes of exercise per week is highly recommended).

  • Lose excess weight to maintain adequate body weight.

  • Quit smoking and excessive alcohol consumption.

- Drug Therapy: Your healthcare provider may prescribe you one or a combination of antihypertensives to control your blood pressure when it is persistently high and when lifestyle changes alone aren't effective in regulating it. You need to comply with your antihypertensive prescription and regularly monitor your Bp so that your healthcare provider can assess the effectiveness of the prescribed drugs in regulating your blood pressure. Examples of the commonly prescribed antihypertensives include:

  • Angiotensin Converting Enzyme (ACE) inhibitors e.g. Lisinopril 

  • Angiotensin-2-Receptor Blockers e.g. Lorsatan

  • Calcium Channel Blockers e.g. Amlodipine

  • Diuretics e.g. Hydrochlorothiazide.


How to Prevent Hypertension


Prevention of hypertension is centered on lifestyle changes which helps to keep your blood pressure normal or at least lower it, if already high. The following are lifestyle routines that can be adopted in preventing high blood pressure:


- BP Monitoring: Ensure you monitor your blood pressure at least once every 5 years if you at a lower risk of having hypertension and your blood pressure is normal. On the other hand, if you are at a higher risk of developing hypertension, you should monitor your blood pressure at least once every year.


- Adequate Diet: Eat food low in salt and saturated fat, but eat food high in potassium, magnesium and calcium. Eat lots of vegetables and fruits.


- Physical Activity: Avoid sedentary lifestyle; sit less, exercise more.


- Weight Management: Maintain a moderate weight; seek help losing weight if you are

obese or overweight.


- Avoid Substance Use: Seek help quitting tobacco use, cigarette smoking and use of illicit drugs such as methamphetamine, cocaine etc.


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