Hypertension- Causes, Risks, Diagnosis and Treatment

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Overview

High blood pressure is known as a silent disease as it may not present with any symptoms. However, it may slowly damage your organs like heart, brain, kidneys, and eyes if not treated appropriately and by timely intervention. This untreated high blood pressure can lead to major illnesses like stroke and heart attack to name a few.
Luckily blood pressure can be easily detected and monitored. The blood is pumped by the heart and the resistance of the arteries would determine the blood pressure.
Symptoms: Generally most patients have no signs, some may present with a headache, chest pain and shortness of breath. Some may present with bleeding from the nose.

Causes

Blood pressure is categorized into two types. Essential Hypertension where the cause is unknown and Secondary Hypertension where the cause is known like obstructive sleep apnoea, kidney ailments, polycythemia medications like decongestants, oral contraceptives and nonsteroidal anti-inflammatory drugs like diclofenac. Other reasons could be congenital disorders of the blood vessels, excessive alcohol, and drugs like cocaine and methamphetamines. Genetic and environment over activation of sympathetic nervous and renin-angiotensin-aldosterone, blunting pressure natriuresis, cardiovascular and renal development variation, elevated intracellular sodium and calcium can also be implicated as a cause of hypertension.

High blood pressure has many risk factors, including:

    • Age- More common after 45 yrs of age in men, women over 65 yrs will be affected too.
    • Race- More common in Asians and blacks.
    • A familial trait is possible.
    • Being overweight or obese.
    • Physically inactive individuals.
    • Using tobacco increases your heart rate and causes damage to arteries.
    • Excessive salt intake.
    • Deficient potassium.
    • Hypovitaminosis D.
    • Drinking too much alcohol can damage your heart
    • Stress.

BP Check and diagnosis:

A doctor or nurse could check it. Now digital blood pressure monitors are available, and you could take the BP yourself. Blood pressure has two components systolic BP which is the pressure recorded when the heart is pumping blood and diastolic blood pressure when the heart is receiving blood.

Blood pressure measurements fall into four general categories:

Normal blood pressure: Your blood pressure is normal if it’s below 120/80 mm Hg. It is called as prehypertension if systolic pressure is ranging from 130 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg.

Stage 1 hypertension: The Systolic pressure of 140 mm Hg to 159 mm of Hg or a diastolic pressure of 90 mm Hg to 99 mm of Hg.

Stage 2 hypertension: Systolic pressure higher than 160 mm of Hg and diastolic blood pressure of 100 mm of Hg. Both numbers are given equal weight.

Blood pressure should be checked at least on two different occasions and to be checked at least twice on those visits. If it is still found high then it is diagnosed as hypertension. BP high at the doctor’s office but low at home is called white coat hypertension. BP should be checked in both arms to determine if any differences are present. Ensure that the arm is adequately covered with an appropriate size of arm cuff. Sometimes to confirm that there really is high blood pressure, a 24 hours blood pressure monitoring called ambulatory blood pressure is done. This provides a real-time evaluation of blood pressure readings over 24 hours and is more accurate. Home blood pressure monitors are available and useful in differentiating white coat hypertension. A condition called Masked Hypertension — which is normal blood pressure in the clinic, but high BP at home is also essential and should not be missed as this needs to be treated too.

Complications:

Blood Pressure not controlled can lead to thickening of the arteries this, in turn, can lead to a stroke or heart attack. The heart can go into failure, blood vessels in the eye can bleed resulting in loss of vision. High blood pressure also can lead to metabolic syndrome. It can also lead to difficulties in memory.

Investigations:

Urine test (urinalysis), blood tests, lipid profile, electrocardiogram, echocardiogram and Treadmill test. Additional tests may include elaborate blood workup, ultrasound abdomen, and pelvis and may consist of Doppler of renal arteries.

Treatment:

A healthy diet with less salt (1500 mg per day) and ensure you avoid processed food which has a high content of salt, include a lot of fruits, vegetables, and grains. Exercise regularly minimum 30 min per day to total 150 minutes per week. You can walk, swim, play games or hit the gym usually. Advice to quit smoking. Alcohol limits permissible: If you do so, drink in moderation—2 small per day 2 times per week for men and one small 2 times per week fall under the safe limits. Stress can be managed with deep breathing exercises, muscle relaxation, and meditation. Ensure that you get your adequate quota of sleep which is about 7-8 hours per night.
If overweight, you could reduce the blood pressure by losing a couple of kilos. The goal would be to get the weight within the acceptable BMI.

Medications to treat high blood pressure:

Diuretics(Water pills): Help eliminate sodium and water from the kidneys, thereby reducing blood volume. Common side effects may include excessive urination and electrolyte imbalance.

Beta blockers: These reduce the heart rate and reduce the workload on the heart. When prescribed alone, beta blockers don’t work as well, especially in black and older people, but may be effective when combined with other blood pressure medications.

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers(ARB’S): By inhibiting the enzyme or blocking the action it may help relax blood vessels.

Calcium channel blockers help relax the muscles of your blood vessels. These drugs work better in older and black and Asian people.

Other Drugs: These may be used if you are not able to reach your target BP.

Special Situations: Pregnancy can cause hypertension and this should be controlled aggressively so as not to impact both mother and child.

Alternative medicine:

Supplements: Some of them can be beneficial in controlling and keeping BP under check like Fiber and wheat bran, magnesium, calcium and potassium minerals can control the blood pressure. Omega 3 fatty acids which are found in fatty fish or fish supplements and flax seed can contribute to keeping Bp under control.

Coping and support in Hypertension Management

Blood pressure treatment goals; Ideally 120/80 mm of Hg but 140/90 mm of Hg is acceptable with diet, exercise, and medications. An important aspect to note is that blood pressure should not go uncontrolled and once diagnosed should be aggressively treated to attain target BP goals. High BP needs to be managed for rest of your life. To do this, medications should be taken consistently and at no point should medicines be stopped abruptly. If you develop any side effects, it is advisable to visit your health care provider to ascertain if any other options need to be considered. At all times BP should be maintained at the safe level, and you and the doctor need to work together as a team to keep it there. Following lifestyle changes may be difficult, and you may need a very high level of motivation. Friends and family can help you with their timely support. Please do remember the risks associated with uncontrolled high blood pressure.

Diet and Hypertension

Low salt (sodium) intake

  • For a hypertensive patient aim for consuming 2300 mg of sodium i.e 1 tsp (5 g) of salt per day. Depending on the severity it can be lowered down to 1500 mg sodium i.e 1/2 tsp (3 g) salt per day.
  • Get in habit of reading nutrition labels before buying a food product.Buy foods labeled “no salt added,” “sodium-free,” “low sodium” or “very low sodium” . Try to buy foods that have 5% or less of the “Daily Value” of sodium. Foods that might have 20% or more Daily Value of sodium should be avoide completely.
  • Avoid any food that might contain salt such as pickles,papads,sauces,canned foods,preserved foods, savoury snacks.
Tips to cut back on sodium
  • Buy sodium-free spices or flavorings.
  • Don’t add salt while cooking rice, pasta or preparing dough for chapati.
  • Rinse canned foods to drain some of the sodium .
  • Adding other herbs & spices might reduce the requirement of salt like onion, vinegar,lemon,cinnamon,coriander,dill,cumin,mint,nutmeg ,ginger ,garlic,basil,cardmom,chilli,,turmeric,blackpepper.
  • Using cooking methods like grilling, roasting, & sautéing can bring natural flavors thereby reducing the usage of salt while cooking.
  • Avoid adding salt to your salad & curd preparations.

Low saturated, trans fats & cholesterol

  • Always pay attention to nutrition food labels on products for trans fat and saturated fat content. Even if a product says “zero trans fat“, avoid its regular consumption.
  • Watch for the words “hydrogenated” or “partially hydrogenated” on food labels.
  • Limit your consumption of fried and processed foods.
  • Limit commercially prepared baked goods (like cookies, doughnuts, and crackers) .
  • Prefer broiling, grilling, poaching, and baking. Avoid high-fat dressings or sauces.

DASH Diet (Dietary Approaches to Stop Hypertension )

The DASH diet focuses on a diet low in saturated fat, cholesterol, and sodium, and higher in potassium, magnesium, and calcium, protein and fiber.

Table 2. The DASH (Dietary Approaches to Stop Hypertension) Dietary Pattern.
Food Group Daily Servings Important Components for Lowering Blood Pressure
Whole grains and grain products 7 – 8 Carbohydrates and fiber
Vegetables 4 – 5 Potassium, magnesium and fiber
Fruits 4 – 5 Potassium, magnesium and fiber
Low-fat or fat free milk or milk products 2 – 3 Calcium, protein, potassium and magnesium
Lean meats, poultry and fish 2 or less Protein and magnesium
Nuts, seeds and beans 4 – 5 a week Magnesium, potassium, protein and fiber
Source: “DASH Diet Eating Plan” www.dashdiet.org.

Measures to Control Blood Pressure

  • Maintain a healthy weight.
  • Exercise regularly
  • Eat healthy and fresh foods.
  • Keep a track of what you eat.
  • Reduce salt (sodium ) intake
  • Limit alcohol consumption.
  • Quit smoking
  • Cut back on caffeine.
  • Relieve down stress.
  • Monitor blood pressure and visit your doctor regularly.

About The Author
Dr.Belliappa– MBBS, MD, Aerospace Medicine, DIH, FCGP, PGDHA
Ms. Ratika Vinchurkar– MSc, Food & Nutrition, TeleradRxDx.

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