WHO 2022: Alarming 26.6% of the adult Gambian population having hypertension.

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One third of the adult population having high blood pressure, a high proportion of these are undiagnosed

What is high blood pressure (hypertension)?

High blood pressure, also called hypertension, is blood pressure that is higher than normal. The blood pressure changes throughout the day based on your activities. Having blood pressure measures consistently above normal may result in a diagnosis of high blood pressure.

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Hypertension is a global health challenge, with a higher burden risk. In 2008, the worldwide prevalence of hypertension among adults aged 25 years and above was 40% and was highest in Africa (46%). Of even greater concern, a large proportion of hypertension in Africa is undiagnosed.

Although hypertension is the commonest modifiable risk factor for stroke and other cardiovascular diseases (heart disease) in Africa, its prevention and control are not prioritized. Early detection and treatment are crucial for the effective control of hypertension and the prevention of complications.

Blood pressure is the force exerted by circulating blood against the walls of the body’s arteries (blood vessels), the major blood vessels in the body. Hypertension is when blood pressure is too high.

Blood pressure is written as two numbers. The first (systolic) number represents the pressure in blood vessels when the heart contracts or beats. The second (diastolic) number represents the pressure in the vessels when the heart rests between beats

Blood pressure is measured in millimeters of mercury (mm Hg). In general, hypertension is a blood pressure reading of 130/80 mm Hg or higher.

Divide blood pressure into four general categories. Ideal blood pressure is categorized as normal.)

Normal blood pressure. Blood pressure is 120/80 mm Hg or lower.

Elevated blood pressure. The top number ranges from 120 to 129 mm Hg and the bottom number is below, not above, 80 mm Hg.

Stage 1 hypertension. The top number ranges from 130 to 139 mm Hg or the bottom number is between 80- and 89-mm Hg.

Stage 2 hypertension. The top number is 140 mm Hg or higher or the bottom number is 90 mm Hg or higher.

Blood pressure higher than 180/120 mm Hg is considered a hypertensive emergency or crisis. Seek emergency medical help for anyone with these blood pressure numbers.

Untreated, high blood pressure increases the risk of heart attack, stroke and other serious health problems. It’s important to have your blood pressure checked at least every two years starting at age 18. Some people need more-frequent checks.

Healthy lifestyle habits —such as not smoking, exercising and eating well — can help prevent and treat high blood pressure. Some people need medicine to treat high blood pressure.

Primary hypertension, also called essential hypertension.

For most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure is called primary hypertension or essential hypertension. It tends to develop gradually over many years. Plaque buildup in the arteries, called atherosclerosis, increases the risk of high blood pressure.

Secondary hypertension

This type of high blood pressure is caused by an underlying condition. It tends to appear suddenly and cause higher blood pressure than does primary hypertension. Conditions and medicines that can lead to secondary hypertension include:

Blood vessel problems present at birth, also called congenital heart defects.

Cough and cold medicines, some pain relievers, birth control pills, and other prescription drugs.

Illegal drugs, such as cocaine and amphetamines, kidney disease.

Obstructive sleep apnea, thyroid problems.

Sometimes just getting a health checkup causes blood pressure to increase. This is called white coat hypertension.

Diagnosis of hypertension

To diagnose high blood pressure, your health care provider examines you and asks questions about your medical history and any symptoms. Your provider listens to your heart using a device called a stethoscope.

Your blood pressure is checked using a cuff, usually placed around your arm. It’s important that the cuff fits. If it’s too big or too small, blood pressure readings can vary. The cuff is inflated using a small hand pump or a machine.

The first time your blood pressure is checked, it should be measured in both arms to see if there’s a difference. After that, the arm with the higher reading should be used.

Tests

If you are diagnosed with high blood pressure, your provider may recommend tests to check for a cause.A longer blood pressure monitoring test may be done to check blood pressure at regular times over six or 24 hours. This is called ambulatory blood pressure monitoring. However, the devices used for the test aren’t available in all medical centers. Check with your insurer to see if ambulatory blood pressure monitoring is a covered service

Lab tests. Blood and urine tests are done to check for conditions that can cause or worsen high blood pressure. For example, tests are done to check your cholesterol and blood sugar levels. You may also have lab tests to check your kidney, liver and thyroid function.

Electrocardiogram (ECG or EKG). This quick and painless test measures the heart’s electrical activity. It can tell how fast or how slow the heart is beating. During an ECG, sensors called electrodes are attached to the chest and sometimes to the arms or legs. Wires connect the sensors to a machine, which prints or displays results.

High blood pressure has many risk factors, including:

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 high blood pressure after age 65

Race. High blood pressure is particularly common among Black people. It develops at an earlier age in Black people than it does in white people.

Family history. You’re more likely to develop high blood pressure if you have a parent or sibling with the condition.

Obesity or being overweight. Excess weight causes changes in the blood vessels, the kidneys and other parts of the body. These changes often increase blood pressure. Being overweight or having obesity also raises the risk of heart disease and its risk factors, such as high cholesterol.

Lack of exercise. Not exercising can cause weight gain. Increased weight raises the risk of high blood pressure. People who are inactive also tend to have higher heart rates

Tobacco use or vaping. Smoking, chewing tobacco or vaping immediately raises blood pressure for a short while. Tobacco smoking injures blood vessel walls and speeds up the process of hardening of the arteries. If you smoke, ask your care provider for strategies to help you quit

Too much salt. A lot of salt — also called sodium — in the body can cause the body to retain fluid. This increases blood pressure.

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

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

Stress. High levels of stress can lead to a temporary increase in blood pressure. Stress-related habits such as eating more, using tobacco or drinking alcohol can lead to further increases in blood pressure.

Certain chronic conditions. Kidney disease, diabetes apnea is some of the conditions that can lead to high blood pressure.

Pregnancy. Sometimes pregnancy causes high blood pressure.

High blood pressure is most common in adults. But kids can have high blood pressure too. High blood pressure in children may be caused by problems with the kidneys or heart. But for a growing number of kids, high blood pressure is due to lifestyle habits such as an unhealthy diet and lack of exercise.

How can the burden of hypertension be reduced?

Reducing hypertension prevents heart attack, stroke, and kidney damage, as well as other health problems.

Prevention

Reducing salt intake (to less than 5g daily)

Eating more fruit and vegetables.

Being physically active on a regular basis

Avoiding use of tobacco.

Reducing alcohol consumption.

Limiting the intake of foods high in saturated fats.

Eliminating/reducing trans fats in diet.

Reducing and managing stress.

Regularly checking blood pressure

Treating high blood pressure.

Lose weight

Being overweight forces your heart to work harder to pump blood around your body, which can raise your blood pressure., If you do need to lose some weight, it’s worth remembering that just losing a few pounds will make a big difference to your blood pressure and overall health.

Get active

Being active and taking regular exercise lowers blood pressure by keeping your heart and blood vessels in good condition., Regular exercise can also help you lose weight, which will also help lower your blood pressure.

Adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or fast walking, every week.

Physical activity can include anything from sport to walking and gardening.

Cut down on caffeine

Drinking more than 4 cups of coffee a day may increase your blood pressure.

If you’re a big fan of coffee, tea or other caffeine-rich drinks, such as cola and some energy drinks, consider cutting down.

It’s fine to drink tea and coffee as part of a balanced diet, but it’s important that these drinks are not your main or only source of fluid.

Stop smoking

Smoking does not directly cause high blood pressure, but it puts you at much higher risk of a heart attack and stroke., Smoking, like high blood pressure, will cause your arteries to narrow.

If you smoke and have high blood pressure, your arteries will narrow much more quickly, and your risk of heart or lung disease in the future is dramatically increased.

For further information: WHO and UN websites, send email to [email protected], send text message only to Dr Azadeh WhatsApp. 002207774469 between 3 to 6pm weekdays only.

Dr H. Azadeh MD, senior lecturer at the University of The Gambia, clinical director at Medicare Health Services.