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Talking about Hypertension

A pressure is generated every time the heart beats. This pressure, known as Blood Pressure, pushes blood out of the heart into the blood vessels and beyond, till it reaches all the organs in the body. We can easily measure this pressure at our upper arms with a simple device. A person’s blood pressure is usually expressed in terms of the systolic (maximum) pressure over diastolic (minimum) pressure and is measured in millimeters of mercury (mm Hg). This is an important “vital sign” that your doctors use to assess your health.

We know that the normal blood pressure can vary widely within different times of the day (called circadian rhythm), different ages and activity. However, when the blood pressure remains persistently elevated, it becomes a problem over time. This is called Hypertension. Medically speaking, it is defined as persistent elevation of systolic BP of 140 mmHg or greater and/or diastolic BP of 90 mmHg or greater.

Now, lets talk numbers for a little bit.

It was estimated back in 2000 that a quarter (25%) of the world’s adult population have Hypertension. And the numbers are growing. By 2025, it is projected to affect almost 30%. In Malaysia, a national survey suggested that more than 30% of adults are Hypertensive in 2011.

What’s the Problem?

But wait a minute. What’s the problem with a High Blood Pressure? “I don’t feel any different most of the time.” True. High blood pressure is often called a “silent killer” because it has no warning signs or symptoms. You can’t see it. You can’t feel it. You can continue doing what you like… for a long time. And many people just ignore it. One study in Malaysia even estimated that only 33% of Malaysians with Hypertension are taking treatment for it.

Over time, the persistently high pressure causes damage to our organs, especially the brain, heart, kidneys, eyes etc. And the higher the blood pressure, the higher the risk. The heart will have to pump harder and this eventually leads to a thickened, enlarged and stiff heart. It also exerts mechanical stress on the arterial walls, promoting atherosclerosis, weakening the wall layers and increases the risk of aneurysms and subsequent rupture, resulting in catastrophic life threatening events.

In general the risk of cardiovascular disease doubles with every 20mmHg Systolic or 10mmHg Diastolic Blood Pressure increase. It is the number one risk factor for stroke. To avoid all these, we must first bring the Blood Pressure back to a normal level. The earlier the better, because once damage has set in, it may not be reversible even when we normalise the pressure. The best hope then will be to prevent further damage.

Some have it, some don’t

But why do some people have Hypertension while others don’t? Despite extensive research over the past several decades, we don’t really have a definitive answer to that, but the current beliefs are that the causes of Hypertension are multifactorial in about 90% of the time (Primary or Essential hypertension).

There are many factors associated with Essential Hypertension and part of the effort in preventing Hypertension involves tackling these factors. These include smoking, sedentary lifestyle, being overweight, excess amounts of salt intake, ageing, high stress levels, diabetes and excess alcohol consumption. Rarely (10%) of individuals develop Hypertension as an effect from other conditions (Secondary Hypertension). Those with Secondary Hypertension may potentially be cured of Hypertension with treatment of the underlying conditions.

So what can we do if we have Hypertension? Plenty, actually. A simple search on the Internet will return thousands of pages on how to treat Hypertension. Your family or friends may have a lot of ideas or remedies. And you may have read brochures of supplements and “medicinal products” that can “cure”

Hypertension and other ailments.

But I’m sure we all know about the dangers of self-doctoring. The main goal of treatment for is to lower blood pressure to less than 140/90 mmHg. It is important to understand that hypertension is a lifelong disorder. As such, long term commitments to the recommended therapies are paramount.

Nationally and internationally, there are many Hypertensive expert society and committees that are formed to offer the best guidance on Hypertension management. Most groups, including the American Diabetes Associate (ADA), and the American Heart Association/American Stroke Association (AHA/ASA), and Malaysian Society of Hypertension (MSH) recommend lifestyle modification as an important step in managing hypertension.

Take action with lifestyle modifications

Lifestyle modification including salt restriction to 5–6g per day, Moderation of alcohol consumption to no more than 20–30g of ethanol per day in men and to no more than 10–20g of ethanol per day in women, increasing consumption of vegetables, fruits, and low-fat dairy products, reduction of weight to BMI of 25 kg/m2 and of waist circumference to <102 cm in men and <88 cm in women, regular exercise (at least 30 min of moderate dynamic exercise on 5 to 7 days per week) and stop smoking.

If lifestyle modifications are insufficient to achieve the goal BP, the next step involves taking pharmacological therapy (Medications). There are many classes of hypertensive medications available, acting on different pathways or routes to lower the blood pressure. And recently, combination of up to 3 different hypertensive medications in a single pill is available to make it easier for patients to take the medications. And with ever continuing research, there will be newer therapies in the future to help treat this problem.

Good, so now that my blood pressure is back to normal, can I stop the medication? If you stop it, what will happen to the blood pressure? It will go back up. It is important to keep checking the blood pressure even when you are taking the medications regularly and feel well. Because blood pressure also increases with ageing, what may have worked for you two years ago may not be able to adequately control the blood pressure now. And besides just knowing the numbers, we also need to know if there are already damage to the organs. Your good doctor will be able to help you with that.

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