It is determined by the amount of blood pumped by your heart and the resistance in your blood vessels. Every time you visit your doctor, blood pressure will be measured on your upper arm using a special machine that gives a set of numbers like 120/80.
The first number, usually written on top, is the systolic blood pressure, which is the pressure when your heart pumps and the second number is the diastolic blood pressure, which is the pressure between your heartbeats.
There are two types of HIGH BLOOD PRESSURE Primary Hypertension - basically has no identifiable cause and common in adults. Secondary Hypertension - There is an underlying condition that causes the blood pressure to be high e.g. pregnancy and medications.
What are the risk factors for high blood? Age: The older you get the more likely to develop hypertension Race: More common in Africans than Caucasians Family history: If your immediate family members have high blood pressure, you are more likely to have it. Overweight and obesity: The heavier you get the more resistant your blood vessels will be hence high blood pressure.
Sedentary lifestyle: Lack of exercise increases the risk of developing high blood pressure. Excessive alcohol intake: Too much alcohol consumption predisposes to vascular damage and increases resistance of the blood vessels. Pregnancy: During pregnancy a lot of circulatory changes due to the hormonal changes and in some instances raise the blood pressure. Stress: Stressful situations increase chances of high blood pressure as it increases chances of bingeing on unhealthy foods and alcohol.
What can happen if your blood pressure is not controlled?
Acute complications - these are complications that can occur at any time when the blood pressure is high. Stroke - rupture of blood vessel in the brain. Heart attack - blockage of a heart’s blood vessel.
Chronic complications - these are complications that can occur after a long time of poorly or uncontrolled high blood pressure. Heart failure: Due to pumping against resistant blood vessels, your heart may ultimately fail in performing its pumping functions. Kidney failure/damage: High blood pressure damages the tiny blood vessels in the kidneys compromising their function.
Diagnosis Hypertension is a condition that alters one’s life hence the diagnosis must be made as accurately as possible. Every time you consult your doctor, blood pressure is checked as a vital sign. Normal blood pressure: less than 140/90 mmHg Stage 1 hypertension: 140-159/90-110 mmHg Stage 2 Hypertension; more than 160/110mmHg The BP readings must be repeated at intervals to make accurate diagnosis.
Screening for other causes of the elevated blood pressure is also necessary to address the causes.
Depending on how elevated the blood pressure is when consulting your doctor, a decision to monitoring your blood pressures over time can be made before pharmacological intervention can be made.
This is to cater for the anxieties that come with going to the clinic and feeling unwell at the time of checking your BPs. WHO recommends pharmacological treatment initiation for everyone with BPs more than 140/90 mmHg. Individuals with existing cardiovascular diseases, diabetes and chronic kidney disease start treatment with systolic BP >130 mmHg.
Management of hypertension
Hypertension is a lifestyle condition hence its mainstay of management is lifestyle changes. This includes • Reducing salt intake (less than 5g daily) • Physical activity at least 30mins a day for at least 5 days a week - this is specific for activities that raises your heart beat like walking or jogging as tolerated. • Eating more fruits and vegetables
• Weight management - reducing fatty foods or junk and carbonated sweetened drinks
• Avoiding tobacco and moderate alcohol intake Pharmacological treatment If lifestyle modifications on their own do not lower down the BPs, treatment will be initiated, also paying attention to the other existing medical conditions. WHO recommends the following drug classes individually or in combination:
1. Thiazide and thiazide like agents e.g. Hydrochlorothiazide (HCT)
2. Angiotensin - converting enzyme inhibitors (ACE-i)/Angiotensin receptor blockers (ARBS) e.g. enalapril and telmisartan
3. Calcium channel blockers e.g. Nifedipine Pharmacologic treatment is used together with lifestyle modification for better control of the BPs.
Treatment can also be modified by attending doctor depending on the control and tolerability of the medication and adverse outcomes. Hypertension is known as a silent killer because of the effects it has on vital organs without showing any symptoms therefore regular check-ups with your doctor for routine medical examination can be a priceless healthy decision.
Lifestyle modification is also vital in prevention of developing hypertension; make it a habit to eat healthy and be physically active as this prevents other lifestyle diseases such as diabetes.
Dr Kgosi Mocuminyane General Practitioner Doctors Inn Health Centre, Maun.
