In the early stage one of hypertension with blood pressure 140 to 159/90 to 99mmHg, most patients experience no symptoms and likewise, no signs are elicited by the doctor.
Ahead of World Hypertension Day, coming up on Wednesday, May 17 2017, Dr Ademola Orolu, a Consultant family physician spoke to PAUL ADUNWOKE on treatments, preventions and management of the disease.
What is hypertension?
Hypertension is a state of persistent or repeated elevation of the blood pressure at 140/90mmHg or above this. Blood pressure in normal individuals should be 120/80mmHg. In between having a normal blood pressure and being hypertensive is a stage of pre-hypertension in which repeated blood pressure values are in the range of between 120 to139/80 to 89mmHg.
Therefore, it means that if individuals have good health seeking attitude, they may be identified in the pre-hypertensive stage, when lifestyle modifications can prevent progression to hypertension. Being hypertensive means the pressure of blood in the vessels is elevated. Hence, the heart pumps against high pressures in the arteries. The body would try to adapt to this blood pressure elevation, until deleterious changes begin to occur, especially in the heart, brain, kidneys, the blood vessels themselves, and the eyes.
When these changes occur, some individuals may develop symptoms, which necessitate them to consult a doctor. Prior to these untoward changes, hypertension, known as Silent Killer, may go undetected.
Theme of this year is ‘know your numbers.’ What does this mean?
The negative impact of hypertension on the organs is proportional to the extent of elevation of the blood pressure. An individual with a blood pressure of 146/92mmHg is “relatively healthier,” when compared to another with a value of 186/120mmHg. The higher the blood pressure, the more work the heart does, the more damage to vital organs bearing the burden of these high pressures. Therefore, everyone needs to check their blood pressure numbers regularly to be assured of good health.
What are the causes of hypertension?
In broad classification, regarding the cause, hypertension can be divided into essential hypertension, which has no definite cause or secondary hypertension, which results from diseases of other organs of the body, such as Kidney, thyroid found in the neck and adrenal gland, which sits on each kidney, among others. Other secondary causes of hypertension include, habitual use of illicit drugs, such as cocaine and amphetamine, among others.
Essential hypertension is commoner in older persons. Meanwhile, in young individuals less than 40 years, secondary causes of hypertension are searched for in evaluation of the patient. When identified, these secondary causes must be treated along with general treatment of hypertension. Irrespective of the cause of hypertension, there are risk factors, which when combined, increase the probability of an individual developing hypertension. These include increasing age, being of black origin, male gender, family history of hypertension, poor activity or inactivity, stress, obesity, excessive salt intake, smoking and excessive alcohol intake.
What are the symptoms and signs of hypertension?
In the early stage one of hypertension with blood pressure 140 to 159/90 to 99mmHg, most patients experience no symptoms and likewise, no signs are elicited by the doctor. At higher values of blood pressure, however, due to the effect on the vital organs earlier mentioned, some patients may experience myriad of symptoms, including, but not limited to, fatigue, difficulty with breathing, headache, poor sleep, swollen feet, change in urinary habit, and poor vision. At very elevated values, hypertension increases the risk of having stroke, heart failure, kidney failure and visual impairment. The emphasis, therefore, is on the fact that individuals should not wait to experience these symptoms before they begin to manage their hypertension.
What are the next steps in case of symptoms and what are the possible treatments of hypertension?
Generally speaking, individuals should consult their doctors, when they experience any symptom at all and not only when hypertensive. Regarding hypertension, the clinician would evaluate the symptoms the individual experiences and also examines him/her to identify any effect of hypertension on the organs. Appropriate investigations are ordered to detect damage to organs like the heart, kidneys, and eyes as a result of the high blood pressure.
In addition, some diseases, which include diabetes mellitus, hyperlipidemia elevated blood fat may also be present in the individual. These are also screened for. All these are done in the work up to definitive management of patient so as to individualise treatment. Lifestyle modifications, including health education on moderation of habits, stress reduction, dietary adjustment and aerobic exercises are important in the management of every hypertensive patient.
Thirty minutes of moderate exercises, brisk walking, jogging, cycling, tread mill exercise, swimming not less than five days of the week, moderate salt intake, moderate alcohol intake if at all, avoidance of smoking, low consumption of saturated fat, replacement of red meat beef, mutton, chevron with white meat fish and skinned poultry, boiled or grilled are the essentials of lifestyle treatment of hypertension. These measures must be done in combination to achieve result. If these do not control the blood pressure, the patients are advised to commence use of medications, while they still continue the lifestyle measure. If the blood pressure is highly elevated and effect of hypertension on the vital organs is detected, medication is commenced immediately, in addition to lifestyle control.
Follow up in the clinic is essential to confirm improvement and challenges with treatment, which can be easily addressed. Most patients default in follow-up, due to the wrong belief that once the blood pressure normalises, it means cure. Unlike malaria or other acute infections, hypertension has no permanent cure. Lifestyle modification is a lifelong approach to management of hypertension with or without medication.
Of the risk factors listed above, a few cannot be modified, such as black origin, male gender, increasing age, and family history. Therefore, every individual is at risk of hypertension. However, the remaining risk factors of salt intake, smoking, alcohol consumption, inactivity and stress, are all modifiable. Once an individual adequately controls these modifiable risk factors of hypertension, prevention is almost possible.
Hypertension is a silent killer. This means individuals do not manifest any evidence of the disease in the early stage and even in cases of very elevated blood pressures, some individuals may feel apparently well, until catastrophe occurs. Emphasis is on prevention with lifestyle modification. For the asymptomatic hypertensive patients, regular medical check will help discover hypertension in its early stage, when intensive lifestyle adjustment may suffice. Every advice from the doctor and other health personnel should be strictly adhered to, if hypertension would be put in check. A stitch in time saves nine.