Hypertension – A Silent Killer

High blood pressure causes over 7.5 million deaths worldwide, approximately 13% of all annual deaths. According to the World Health Organization, approximately 46% of Africans have high blood pressure (also known as hypertension). This accounts for the highest rate of hypertension worldwide. In sub-Saharan Africa, an estimated 75 million individuals live with hypertension. It was once considered a “disease of affluence”; however, in recent years, due to rampant urbanization and changes in diet and lifestyle, hypertension is a rapidly-growing healthcare problem in poorer countries. For example, it is predicted that 3 in 4 adults in low & middle income countries (LMICs) will have hypertension by 2025. 

How is hypertension diagnosed?

An individual’s blood pressure is defined by two measurements – systolic BP and diastolic BP. Systolic blood pressure is the pressure in the arteries (the blood vessels that carry “fresh” blood to cells in the body) when the heart contracts (i.e. when the heart pushes blood out to the rest of the body). Diastolic blood pressure refers to the pressure in the arteries during the relaxation of the heart (i.e. when the heart fills up with blood coming from the rest of the body). High blood pressure is caused by the increase in force within the arterial walls. Blood pressure reading is stated in form of the systolic pressure over the diastolic pressure. For example, a blood pressure reading of 120/80 mmHg represents a systolic blood pressure of 120 mmHg and diastolic blood pressure of 80 mmHg.

Hypertension is defined as a consistent systolic pressure greater than 140 mmHg and diastolic pressure greater than 90 mmHg (i.e. 140/90 mmHg) taken over 3-4 intervals over 1-4weeks. It can also be diagnosed on a single doctor’s visit if the blood pressure is greater than 180/110 mm Hg with other evidence of cardiovascular disease.

Hypertension is considered a silent killer because it typically has no signs or symptoms, but can lead to multiple life-threatening conditions if left untreated. This is what makes hypertension dangerous and why it is important to know how to prevent it or control it.

What puts you at risk for developing hypertension?

• Familial history. Genetics plays a role in hypertension. An immediate family member (parent or sibling) with hypertension increases ones risk due to genetics, and the increased chances of similar lifestyle
• Age (>65 years old). As part of the natural aging process, plaque builds up in the arteries and the walls harden, leading to increased blood pressure
• Obesity. In obese or overweight bodies, the heart has to work significantly harder to distribute sufficient blood (and oxygen) to the rest of the body. An extended period of such increased workload on the heart eventually leads to high blood pressure.
• Cigarette smoking. Nicotine (the addictive ingredient in tobacco) causes damage to the heart and blood vessels, and raises blood pressure. In addition, breathing in carbon monoxide reduces the amount of oxygen the red blood cells can carry, hence, the heart has to pump harder to meet the body’s oxygen requirement. These combination of factors making smokers at extremely high risk of developing hypertension, as well as other severe cardiovascular conditions.
• Alcohol use. Drinking alcohol (more than 3 drinks in one sitting) temporarily raises the blood pressure. Extended periods of binge drinking (more than 2 drinks a day for men, and more than 1 drink for women) can lead to hypertension. In addition, alcohol contains calories which cause weight gain, which is another risk factor for hypertension.
• Diabetes. High blood glucose facilitates build up of plaque in the coronary arteries (the arteries that supply blood to the heart’s muscles) and the arteries all over the body. This build-up of plaque increases the risk of high blood pressure and heart attack. Diabetes is a significant risk factor for hypertension and complications of hypertension (such as the aforementioned heart attack); hence, people with diabetes are advised to maintain even lower blood pressure than non-diabetics, and the threshold for diagnosing hypertension is lower in diabetics.
• Stress. The body’s response to stress is to release a hormone called Cortisol – often referred to as the stress hormone. Cortisol helps to regulate multiple body functions, including blood pressure, to help one respond appropriately to a stressful situation. However, cortisol is only meant to work over short period of time. Hence, when a person is in constant extended state of stress, cortisol begins to have deleterious effects on the body — including leading to high blood pressure and increasing susceptibility to diabetes, as well as mental health issues.
• Race. Black people develop hypertension more often and at an earlier age than other races.

Management of High Blood Pressure 

1.) Lifestyle modification

Lifestyle modification is the cornerstone of hypertension management.  It helps to enhance the efficacy of pharmacotherapy (drugs). The medical team and patient can come up with a customized plan to suit his/her individual needs. Lifestyle modification includes weight reduction, monitoring sodium levels (fast food and frozen foods have higher sodium content than home-cooked meals), alcohol intake reduction, increase in physical exercise, tobacco avoidance (smoking cessation if patient is a smoker), closely monitoring potassium levels ( banana is a great source of potassium) – a decrease in potassium levels can induce arrhythmia( irregular heartbeat) consequently exacerbating hypertension.   

2.) Pharmacotherapy

Drug therapy is dependent on the specific cause(s) of hypertension and other conditions the patient has. A doctor will review each individual patient’s profile and make the necessary prescription. Prescription must be taken on time, consistently, and along with lifestyle modification. An important point to note is that most patients will need to take blood pressure lowering medications for the rest of their lives, so it is essential to discuss potential side effects and mechanisms of action of each drug prescribed with the doctor or nurse.

3.) BP monitoring

It is advised to monitor and record your blood pressure daily. This helps your doctor know if the current treatment plan is working, and thus, if there is need to adjust therapy. 

Long-term effects of hypertension

Heart attack — High blood pressure damages arteries that can become blocked and prevent blood flow to the heart muscle.

Stroke — High blood pressure can cause blood vessels in the brain to clog more easily or even burst (hemorrhage).

Heart failure — The increased workload from high blood pressure can cause the heart to enlarge and fail to supply blood to the body.

Kidney disease or failure — High blood pressure can damage the arteries around the kidneys and interfere with their ability to filter blood effectively.

Vision loss — High blood pressure can strain or damage blood vessels in the eyes causing blurry vision or blindness

Sexual dysfunction — High blood pressure can lead to erectile dysfunction in men or lower libido in women.