Hypertension
Hypertension is another name for high blood pressure. It can lead to severe health complications and increase the risk of heart disease, stroke, and sometimes death.
High blood pressure (BP) is ranked as the third most important risk factor for South Asia’s attributable burden of disease.
The overall prevalence for hypertension in India was 29.8%About 33% urban and 25% rural Indians are hypertensive.
Of these, 25% rural and 42% urban Indians are aware of their hypertensive status. Only 25% rural and 38% of urban Indians are being treated for hypertension. One-tenth of rural and one-fifth of urban Indian hypertensive population have their BP under control.
Factors causing hypertension:
Primary hypertension can result from multiple factors, including:
- blood plasma volume
- hormone activity in people who manage blood volume and pressure using medication
- environmental factors, such as stress and lack of exercise
Secondary hypertension has specific causes and is a complication of another health problem.
Chronic kidney disease(CKD) is a common cause of high blood pressure, as the kidneys no longer filter out the fluid. This excess fluid leads to hypertension.
Conditions that can lead to hypertension include:
- diabetes, due to kidney problems and nerve damage
- kidney disease
- pheochromocytoma, a rare cancer of an adrenal gland
- Cushing syndrome that corticosteroid drugs can cause
- congenital adrenal hyperplasia, a disorder of the cortisol-secreting adrenal glands
- hyperthyroidism, or an overactive thyroid gland
- hyperparathyroidism, which affects calcium and phosphorous levels
- pregnancy
- sleep apnea
- obesity
Risk factors
Several factors increase the risk of hypertension.
- Age: Hypertension is more common in people who are more than 60 years of age. Blood pressure can increase steadily with age as the arteries stiffen and narrow due to plaque buildup.
- Ethnicity: Some ethnic groups are more prone to hypertension than others. African Americans have a higher risk. Size and weight: Being overweight or obese is a primary risk factor.
- Alcohol and tobacco use: Regularly consuming large quantities of alcohol or tobacco can increase blood pressure.
- Sex: males have a higher risk of developing hypertension than females. However, this is only until after women reach menopause.
- Existing health conditions: Cardiovascular disease, diabetes, chronic kidney disease, and high cholesterol levels can lead to hypertension, especially as people age.
Other risk factors include:
- sedentary lifestyle
- salt-rich, high-fat diet
- low potassium intake
Symptoms of hypertension:
A person with hypertension may not notice any symptoms, and so people often call it the “silent killer.” Without detection, hypertension can damage the heart, blood vessels, and other organs, such as the kidneys.
It is vital to check blood pressure regularly.
In rare and severe cases, high blood pressure causes sweating, anxiety, sleeping problems, and blushing. However, most people with hypertension will experience no symptoms at all.
If high blood pressure becomes a hypertensive crisis, a person may experience headaches and nosebleeds.
Complications:
Long term hypertension can cause complications through atherosclerosis, where plaque develops on the walls of blood vessels, causing them to narrow.
Hypertension-related atherosclerosis can lead to:
- heart failure and heart attacks
- aneurysm, or abnormal bulge in the wall of an artery that can burst
- kidney failure
- stroke
- amputation
- hypertensive retinopathies in the eye, which can lead to blindness
Hypertensive cutoff:
The AHA 2017 guidelines define the following ranges of blood pressure:
Management and treatment
Lifestyle adjustments are the standard, first-line treatment for hypertension.
Regular Physical Exercise:
Current guidelines recommend that all people, including those with hypertension, engage in at least 150 minutes of moderate-intensity, aerobic exercise every week, or 75 minutes a week of high intensity exercise.
People should exercise on at least 5 days of the week.
Examples of suitable activities are walking, jogging, cycling, or swimming.
Stress reduction:
Avoiding or learning to manage stress can help a person control blood pressure.
Meditation, warm baths, yoga, and simply going on long walks are relaxation techniques that can help relieve stress.
People should avoid consuming alcohol, recreational drugs, tobacco, and junk food to cope with stress, as these can contribute to elevated blood pressure and the complications of hypertension.
Smoking can increase blood pressure. Avoiding or quitting smoking reduces the risk of hypertension, serious heart conditions, and other health issues.
Medication:
People can use specific medications to treat hypertension.
People with hypertension will need to combine two or more drugs to manage their blood pressure.
Medications for hypertension include:
- diuretics, including thiazides, chlorthalidone, and indapamide
- beta-blockers and alpha-blockers
- calcium-channel blockers
- central agonists
- peripheral adrenergic inhibitor
- vasodilators
- angiotensin-converting enzyme (ACE) inhibitors
- angiotensin receptor blockers
The choice of medication depends on the individual and any underlying medical conditions they may experience.
Diet :
People can prevent high blood pressure by following a heart-healthy diet.
Reducing salt intake:
People’s average salt intake is between 9 grams (g) and 12 g per day in most countries around the world.
The World Health Organization (WHO) recommend reducing intake to 5 gm, a day to help decrease the risk of hypertension and related health problems.
Lowering salt intake can benefit people both with and without hypertension.
Moderating alcohol consumption :
Moderate to excessive alcohol consumption can increase blood pressure.
The American Heart Association (AHA) recommend a maximum of two alcoholic drinks a day for men, and one for women.
Eating more fruit and vegetables and less fat
People who have high blood pressure or people at high risk of developing high blood pressure should eat as little saturated and total fat as possible.
Instead, experts recommend:
- whole grain, high fibre foods
- a variety of fruit and vegetables
- beans, pulses, and nuts
- fish rich in omega-3 twice a week
- nontropical vegetable oils, for example, olive oil
- skinless poultry and fish
- low-fat dairy products
It is important to avoid trans fats, hydrogenated vegetable oils, and animal fats, as well as large portion sizes.
Some fats, such as those in oily fish and olive oil, have protective effects on the heart. However, these are still fats. While they are typically healthful, people with a risk of hypertension should still include them in their total fat intake.
Managing bodyweight:
Excess body weight can contribute to hypertension. A fall in blood pressure usually follows weight loss, as the heart does not have to work so hard to pump blood around the body.
A balanced diet with a calorie intake that matches the individual’s size, sex, and activity level will help.
The DASH diet
DASH stands for “Dietary Approaches to Stop Hypertension.”
DASH is a flexible and balanced eating plan with a firm grounding in research by the NHLBI who advise that the diet:
- lowers high blood pressure
- improves levels of fats in the bloodstream
- reduces the risk of cardiovascular disease