Hypertension is the leading cause of death globally and usually tagged the “the silent killer”.  About 1.13 billion people around the world have high blood pressure with the majority coming from low-income and middle-income country according to a World Health Organization report in 2019. In Nigeria, 38percent of the population have hypertension according to the data from the Nationwide survey.

Blood pressure is the force with which the blood moves through the walls of the arteries. When the force exerted on the blood vessels becomes too high, it is termed high blood pressure or hypertension and this can result in heart diseases, stroke, and premature death if not properly managed.

Know the Figures

The readings of blood pressure are usually written as two numbers; the first is the systolic blood pressure (the number at the top) which indicates the pressure in the blood vessel when the heart contracts or beats.

The second is the diastolic blood pressure (the number at the bottom) which is the pressure in the blood vessel when the heart rests between beats.

Both pressures are measured in millimeters of mercury (mmHg).

Most cases of stroke and coronary heart diseases are attributed to high systolic blood pressure. However, the diastolic readings cannot be ignored as a recent study linked the occurrence of death from ischemic heart disease and stroke with every 10mmHg to 20mmHg rise in diastolic readings from ages 40 to 89 years.

Symptoms

Most people with Hypertension usually present no symptoms, the condition is often discovered during routine health screening or when overt signs of cardiovascular disease (CVD) develop.  These symptoms may include feeling dizzy often, having constant headaches, irregular heartbeat, shortness of breath, difficulty sleeping, always tired, and feeling feverish.

Causes and Risk Factors

The causes of hypertension are divided into primary and secondary causes:

Primary: this accounts for about 90percent of all cases of Hypertension in which the exact cause is unknown but usually associated with genetic (family history), the effect of aging on kidney, smoking, stress, unhealthy diet, excess salt intake, and excess alcohol intake.

Secondary: this accounts for the remaining 10percent of hypertension cases and usually occurs as a result of underlying diseases such as diabetes, kidney diseases, liver disease, pregnancy, or intake of certain medications. The symptoms usually improve after treating the underlying cause of the disease condition.

The Blood Pressure Categories

Blood pressure categories in the new guidelines are:

• Normal: <120/80 mm Hg;
• Elevated(Pre-Hypertension): Systolic between 120-129 and diastolic less than 80;
• Stage 1: Systolic between 130-139 or diastolic between 80-89;
• Stage 2: Systolic at least 140 or diastolic at least 90 mmHg;
• Hypertensive crisis: Systolic over 180 and/or diastolic over 120, with patients needing prompt changes in medication if there are no other indications of problems, or immediate hospitalization if there are signs of organ damage.

Complications

Excessive pressure in the arteries can reduce blood flow and make the heart pump faster than normal. It can also reduce the flow of blood and oxygen to the heart resulting in:

• Chest pain also called angina.
• Heart failure(when the heart can no longer pump enough blood and oxygen to other vital body organs).
• Heart attack(this occurs when the heart cells and tissues die due to a low supply of blood and oxygen).
• Irregular heartbeat which can lead to sudden or premature death.

When Should You Consider Taking Drugs?

Diet and lifestyle modification are usually the first-line treatment especially for those with Prehypertension (elevated) and stage 1 Hypertension. The effectiveness of diet and lifestyle measures alone should be evaluated for up to 6 months, after which drug therapy should be considered. It is recommended that patients with stage 2 Hypertension or underlying conditions such as Type 2 diabetes and chronic kidney diseases should combine drug therapy with dietary management for effective blood pressure control

The following has been shown to help lower blood pressure significantly:

1. Weight-loss: elevated blood pressure has been shown to be 2-6times higher among overweight and obese individuals. Consequently, a gradual and sustained weight loss through diet and physical activity helps to lower blood pressure in hypertensive people.
2. Low salt intake: Although the effect of low salt intake on blood pressure varies and is more significant in certain people termed salt-sensitive individuals, it is generally advised that people diagnosed with hypertension reduce their salt intake to 1.5g/day. The salt reduction can enhance the action of antihypertensive medication and reduce the need for drug therapy.
3. Reduced alcohol intake: To lower your blood pressure, alcohol intake should be less than two drinks per day (24 oz of beer, l0 oz of wine, or 3 oz of 80-proof whiskey) in men and not more than one drink in women. Also taking alcohol with food rather than on an empty stomach also helps to reduce the effect on blood pressure.
4. A healthy diet: Eating more fruits and vegetables up to 4-6 portions per day, replacing unhealthy fats with unsaturated fats, and taking more whole grains have been linked to lower blood pressure. Your dietitian can help you achieve this through proper menu planning.

Summary:

Hypertension is one of the leading causes of coronary heart disease and premature death. It is important to do routine health checks as the condition presents no symptoms during the early stage. Also, work with your Dietitian to know how to adopt a healthier eating habit and lifestyle.

References

https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings

https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410

https://www.cdc.gov/bloodpressure/about.htm

https://www.who.int/health-topics/hypertension#tab=tab_3

https://www.who.int/news-room/fact-sheets/detail/hypertension

National Institute for Health and Care Excellence (NICE). (2011) Hypertension – the clinical management of primary hypertension in adults in primary care. CG127. Available at www.nice.org.uk.

https://www.health.harvard.edu/blog/new-high-blood-pressure-guidelines-2017111712756#:~:text=The%20guidelines%2C%20in%20a%20nutshell,vague%20category%20called%20%E2%80%9Cprehypertension.%E2%80%9D