World Health Day 2013: Hypertension - the silent killer

April 7 is World Health Day and the theme this year is hypertension. Also Read - Primary aldosterone may be a common cause of high blood pressure

High blood pressure or hypertension as of today remains inadequately controlled in India as large numbers of cases go undetected. And it is estimated that the number of patients in India with high blood pressure is likely to rise from about 140 million in 2008 to nearly 215 million by 2030. And it’s not just an old age problem anymore. More and more young people are suffering from high blood pressure related ailments. As per the World Health Organization (WHO), high blood pressure affects every third person above the age of 18. The proportion increases with age, from 1 in 10 people in their 20s and 30s to 5 in 10 people in their 50s. Also Read - Did you know there is no 'perfect' blood pressure reading? (+ other facts about hypertension)

Blood pressure (BP) is one of the principal, critically important signs of life (vital signs). It is the pressure exerted by circulating blood upon the walls of blood vessels and is expressed as systolic/diastolic blood pressure. ‘Systolic’ refers to blood pressure when the heart beats while pumping blood and ‘diastolic’ refers to blood pressure when the heart is at rest between beats. The range of systolic blood pressure for most healthy adults is between 90 and 120 mm Hg. Normal diastolic blood pressure ranges between 60 and 80 mm Hg. Blood pressure doesn’t stay the same all the time. It lowers as you sleep and rises when you wake up. Blood pressure also rises when you’re nervous, excited or active. Also Read - World Hypertension Day 2020: Why yoga is a must for managing prehypertension

What is hypertension or high blood pressure?

If your blood pressure is lower than 120/80 mmHg most of the time, it is considered normal blood pressure. If your systolic pressure is between 120 and 140, and your diastolic pressure is between 80 and 90, it is called pre-hypertension. A high blood pressure or hypertension is when your blood pressure is persistently above 140/90 mmHg. Hypertension is a chronic medical condition. Your heart needs to work harder than normal to circulate blood through your blood vessels.

Read: Don’t neglect that borderline hypertension

A high blood pressure with no obvious underlying medical condition is categorized as primary (essential) hypertension, which make up for about 90–95% of the cases. Secondary hypertension is caused by medical conditions that affect your kidneys, heart, arteries or hormone system. Often in older people with hypertension, the difference between systolic and diastolic blood pressure (pulse pressure) is increased. It is termed isolated systolic hypertension. When very high blood pressure comes on suddenly and quickly it is termed malignant hypertension. It is a medical emergency. The diastolic blood pressure reading is often above 130 mmHg.

What causes high blood pressure?

Blood pressure rises with aging because your blood vessels become stiffer as you age. Hence, there is considerable risk of becoming hypertensive in later life. In most of the cases (90-95%) the cause for hypertension is unknown. Primary hypertension is considered to be a result of a complex interaction of genes and environmental factors. Family history of high blood pressure, obesity, stress, smoking, excess alcohol consumption, increased salt consumption and diabetes increase your risk for high blood pressure. Some studies have associated low birth weight, maternal smoking and lack of breast feeding as risk factors for primary hypertension later on in life. The most common cause of secondary hypertension is kidney disease. Other causes are hormone conditions (hyperthyroidism, hypothyroidism, acromegaly, Cushing’s syndrome, pheochromocytoma, etc.), obesity, diabetes, pregnancy, sleep apnoea, coarctation of aorta, certain prescription medicines, etc. Malignant hypertension occurs in people with kidney problems, collagen vascular disorders, etc. Renal hypertension and kidney failure are high risk factors for malignant hypertension.

Read more about causes, symptoms, diagnosis and treatment of hypertension.

What are the signs and symptoms of high blood pressure?

There are no symptoms most of the time. High blood pressure in most cases is established during a visit to the doctor. Hence, you may develop heart and kidney problems without knowing you have high blood pressure. Malignant hypertension, a severe and dangerous form of high blood pressure, may manifest as a severe headache, nausea or vomiting, bad headache, confusion, anxiety, sleepiness, changes in your vision, chest pain, weakness or numbness of body or bleeding from the nose. Upon examination, your doctor may notice several signs such as swelling in the legs and feet, abnormal heart sounds, fluid in the lungs, changes in reflexes, etc. He/she may also look for tell-tale signs in the eye like narrowing of the eye blood vessels, bleeding of the retina, etc. There may also be signs of kidney failure.

Read: Symptoms of hypertension – could you be ignoring them?

How is hypertension diagnosed? What are the tests involved?

Normally, the blood pressure varies throughout the day. Hence, a single reading of high blood pressure is not the basis for diagnosing hypertension. If you have a persistently high blood pressure reading, you will be diagnosed as having a hypertension.

Blood pressure is measured with an apparatus called sphygmomanometer. It has an inflatable cuff to wrap around your arm and a mercury or mechanical manometer to measure the pressure. Manual sphygmomanometers are used with a stethoscope and are of two types – mercury sphygmomanometers in which blood pressure measurement is based on the height of a column of mercury and aneroid sphygmomanometers which are mechanical types with a dial to display measurement. Digital sphygmomanometers are electronic devices that measure blood pressures by oscillometric (wave) method and display the reading on a screen.

You will be examined for signs of heart disease, damage to the eyes, etc. Several tests may be done to assess your cholesterol levels and to look damages to your heart and kidneys.

What is the treatment for hypertension?

The main of treatment is to lower the risk of complications by keeping your blood pressure within normal range. If you have been diagnosed with pre-hypertension, you will be advised to make dietary and lifestyle changes – a healthy diet, decreased salt intake, regular exercise, quit smoking, reduce stress, etc. If you are obese or overweight, you need to lose those extra kilos. If these changes are ineffective in controlling your increased blood pressure your will be prescribed medicines to lower your blood pressure.

Read: Cut down on salt and increase exercise to keep hypertension at bay

High blood pressure can be controlled with medicine and lifestyle changes. Antihypertensive drugs like diuretics, calcium channel blockers, ACE inhibitors, vasodilators, etc. are used to treat high blood pressure. If a control over your blood pressure is not achieved with a single drug may you may be prescribed two or more drugs.

Read: Herbal remedies for hypertension

What happens if you are not treated for high blood pressure?

Long standing hypertension can cause problems with your vision (hypertensive retinopathy) and decrease blood supply to your legs. Hypertension is a major risk factor for heart attacks, heart failure, stroke, bleeding from large blood vessel (aortic aneurysm), chronic kidney disease (hypertensive nephropathy), etc.

Read: Why hypertension is more dangerous than you think

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Watch: Complications of Hypertension

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Published : April 5, 2013 3:20 pm | Updated:April 3, 2015 3:55 pm

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