Hypertension

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UTG Medical Students’ Association

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By Sainabou Cham
4th year medical student

Hypertension, notoriously known as a silent killer by many is a deadly disease that affects millions around the world and can go undetected until late in its course but when detected early detection can ease management and aid in the prevention of its many complications. Many people with hypertension eventually die without ever being diagnosed with it. Most people die due to the complications of hypertension, especially in chronic stress situations or just receiving a shocking message leading to acute stress. As it is initially asymptomatic and leads to many complications, managing it is important, especially when detected earlier.

What is hypertension?

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Also known as High Blood Pressure, It is a sustained elevation in the resting systolic Blood Pressure above 139mmHg (normal 100mmHg to 139mmHg), and diastolic pressure above 89mmHg (normal 60mmHg to 89mmHg) or an increase in both of them above their normal levels.

Causes

Hypertension is known to be primary, essential, or formerly if its cause is not known.

Primary Hypertension is the most frequently seen Hypertension, about 85% of cases.

Also, Hypertension can arise due to underlying health conditions, this is referred to as secondary hypertension.

For example, in cases of Diabetes when it becomes complicated, it can lead to Hypertension in Chronic Kidney Disease of course; as the kidney is one of the most important organs responsible for regulating Blood Pressure, and maintaining homeostasis.

Obesity is a risk factor for many diseases including Hypertension. Primary aldosteronism as well, as Aldosterone acts on the kidney tubules and retains salt and water and thus can cause hypertension.

Hypertension is known to be malignant or resistant when the blood pressure remains above the treatment goal despite the use of at least 3 different antihypertensive drugs including diuretics at their optimal doses.

Risk factors for developing hypertension

There are many risk factors associated with the development of Hypertension, which include:

Age. The risk of high blood pressure increases with age. Until about age 64, high blood pressure is more common in men. Women are more likely to develop it after age 65.

Race. High BP is particularly common in black people. It develops at an earlier age in black people than it does in white.

Family history. You are most likely to develop high blood pressure if you have a parent or sibling with hypertension.

Obesity or being overweight. This is a risk factor for many diseases including high blood pressure. Excess in weight causes changes in the blood vessels. These changes often increase blood pressure. It also raises the risk of developing heart disease and its risk factors, such as high cholesterol. It can also cause disrupted breathing while you sleep (sleep apnea) which further increases blood pressure.

Lack of exercise. Not exercising or being very inactive coupled with too much eating causes an energy imbalance-more energy consumption than expenditure, which results in weight gain. Increased weight raises the risk of high blood pressure.

Tobacco use or vaping. Smoking, chewing tobacco, or vaping immediately increases blood pressure for a short while. Tobacco smoking injures blood vessels and speeds up the process of hardening of arteries. If you smoke, look for strategies to quit it as soon as possible as smoking itself is a major risk for many diseases as well

Too much salt intake. As salt and water follow each other. Too much salt or sodium intake will cause an increase in fluid retention. This increases the blood volume, in turn, increases blood pressure.

Drinking too much alcohol. It has been linked with increased blood pressure, particularly in men

Stress. High levels of stress can lead to a temporal increase in blood pressure. Therefore, hypertensive patients should really avoid being stressed for long periods of time as this further increases their blood pressure and can lead to complications, even death. Also, stress-related habits such as eating more, using tobacco, or drinking alcohol can lead to further increment in blood pressure

Certain chronic conditions. The kidney is one of the most important organs in the regulation of blood pressure, if there’s kidney disease, diabetes, or sleep apnea, this can lead to high blood pressure.

Low potassium levels. Potassium helps to balance the amount of salt in the body’s cells. A proper balance of potassium is important for good heart health. Low potassium may be due to a lack of potassium in diet or certain health conditions, including dehydration.

Pregnancy. Sometimes pregnancy causes high blood pressure.

Prehypertension. This is when the blood pressure falls under the normal range but closer to the high blood pressure range. For example, a systolic pressure of 121mmHg to 139mmHg and a diastolic pressure of 80mmHg to 89mmHg. With this, there’s a risk of developing Hypertension.

Symptoms and signs including complications           

As it is referred to as a “silent killer” because usually it is Asymptomatic until complications develop in target organs. Dizziness, facial flushing, headache, fatigue, and nervousness are NOT caused by uncomplicated hypertension. One can be suffering from Hypertension without actually having any manifestation of the disease. The earlier it is detected, the better for the individual for it can be controlled and patients can go on living their normal lives with no or little complications (no target organ affected) of Hypertension compared to when detected late. When it’s detected very late in its course, it might become more severe and thus complications and symptoms would arise because target organs like the kidney, heart, blood vessels, and Brain have been affected.

Complications:

o          Cardiovascular disease and Myocardial Infarction

o          Heart failure

o          Stroke (particularly Hemorrhagic)

o          Kidney failure

o          Death

Diagnosis of hypertension

Hypertension is diagnosed using a sphygmomanometer (a manual device that measures blood pressure) but with multiple measurements to confirm that the blood pressure is sustainably above normal because blood pressure can rise for some time and go back to normal after a while during exercise, coffee intake or even acute stress. History, physical examination, and other tests may be done to determine the cause, assess the damage, and identify other cardiovascular risk factors.

The blood pressure used for formal diagnosis should be an average of 2 or 3 measurements taken at 2 or 3 different times with the patient:

o          Seated in a chair (not examination table) for 5 minutes, feet on the floor, back supported

o          With their limbs supported at a heart level with no clothing covering the area of cuff placement

o          Having had no exercise, caffeine, or smoked for at least 30 minutes prior to measuring the blood pressure.

From right, Sphygmomanometer, stethoscope, a cuff rotated on a hand during blood pressure measurement with a sphygmomanometer

Ways to prevent/control hypertension

o          Eating a healthy diet (balanced diet)- Increase fruit and vegetable intake

o          Be physically active or regular exercise

o          Lose extra pounds and watch your waistline

o          Do not smoke

o          Reduce alcohol intake

o          Get enough sleep

o          Keep yourself at a healthy weight

o          Reduce stress

o          Monitor your blood pressure regularly at home and get regular checkups

o          Reduce salt (sodium) intake

o          Regular intake of medications (when prescribed by the doctor)

Although primary hypertension has no cure, some causes of secondary hypertension can be corrected. What is however certain in all cases, is that early detection and proper control of blood pressure can significantly reduce symptoms and prevent complications!