Hypertension: Understanding the Silent killer

What is Hypertension? 

High blood pressure, also known as hypertension, is a condition where the force of blood against the walls of the arteries is excessively high, causing the heart to work harder to pump blood. This condition is measured in millimetres of mercury (mm Hg), with hypertension generally defined as a reading of 130/80 mm Hg or higher.

The American College of Cardiology and the American Heart Association categorise blood pressure into four main groups:

• Normal blood pressure: A measurement of 120/80 mm Hg or lower.
• Elevated blood pressure: The systolic (top) number is between 120 and 129 mm Hg, and the diastolic (bottom) number is below 80 mm Hg.
• Stage 1 hypertension: The systolic number is between 130 and 139 mm Hg, or the diastolic number is between 80 and 89 mm Hg.
• Stage 2 hypertension: The systolic number is 140 mm Hg or higher, or the diastolic number is 90 mm Hg or higher.

Blood pressure readings exceeding 180/120 mm Hg are considered a hypertensive emergency or crisis, requiring immediate medical attention.

Why is Hypertension Called a Silent Killer? 

According to Dr Niraj Kumar, Associate Director, Max Hospital, Gurgaon, it is quite common to come across people who have had high BP for years without even knowing about it. Mostly, there are no symptoms, or sometimes minor symptoms, but it damages the arteries and vital organs of the body, which can lead to life-threatening medical emergencies. Typically, the higher the blood pressure, the greater the risk. If hypertension is left untreated, it can affect all organ systems, which can considerably shorten one's life expectancy by 10 to 20 years.

How Common is Hypertension in India?

In India, more than one-third of the urban adult population and more than one-fourth of the rural adult population have hypertension. The condition is reaching epidemic proportions in India, with an estimated 100 million patients. The status of hypertension awareness, treatment, and control is dismal in the country. Only about 1/3 of the hypertensive population is on treatment, and only about 20% of that is really under control. Moreover, hypertension is a critical risk factor for the global burden of disease and disability, as well as global morbidity and mortality.

What are the Causes and Risk Factors for Hypertension?

 Hypertension, or high blood pressure, is often caused by a combination of genetic and lifestyle factors. Its causes and risk factors can be broadly classified into two categories: primary (essential) hypertension and secondary hypertension.

Primary (Essential) Hypertension

For most adults, there's no identifiable cause of high blood pressure. This type of hypertension, known as primary (essential) hypertension, tends to develop gradually over many years. The reasons for the hypertension include:

• Age: The risk of hypertension increases as people age.
• Race/ethnicity: Hypertension is more common in certain racial and ethnic groups, such as African Americans.
• Family history: A family history of hypertension increases the risk.
• Obesity: Being overweight or obese can increase the risk, as more blood is needed to supply oxygen and nutrients to tissues.
• Physical inactivity: Lack of exercise can lead to higher heart rates and increased blood pressure.
• Tobacco use: Smoking or chewing tobacco raises blood pressure temporarily and can damage artery walls.
• High salt (sodium) diet: Too much sodium can cause the body to retain fluid, increasing blood pressure.
• Low potassium diet: Potassium helps balance the amount of sodium in cells; a low potassium diet can lead to higher blood pressure.
• Alcohol consumption: Excessive alcohol can raise blood pressure over time.
• Stress: High levels of stress can lead to a temporary increase in blood pressure.

Secondary Hypertension

Some people have high blood pressure caused by an underlying condition. This type of hypertension, known as secondary hypertension, tends to appear suddenly and causes higher blood pressure than primary hypertension. Causes include:

• Kidney disease: Problems with the kidneys can affect the balance of salts and fluid in the body, increasing blood pressure.
• Adrenal gland tumours: These can cause overproduction of certain hormones that can raise blood pressure.
• Thyroid problems: Both hypothyroidism and hyperthyroidism can result in high blood pressure.
• Certain defects in blood vessels: Congenital defects in blood vessels can raise blood pressure.
• Medications: Certain drugs, like birth control pills, cold remedies, decongestants, over-the-counter pain relievers, and some prescription drugs, can raise blood pressure.
• Drugs: Substances like cocaine and amphetamines can significantly increase blood pressure.

How does Hypertension Affect the Body? 

Over time, elevated blood pressure can have deleterious effects on various organs and systems in the body. The increased force damages the delicate tissues inside the arteries, leading to atherosclerosis, or the hardening of the arteries. This can reduce blood flow and oxygen supply to vital organs. The heart, being the pump of the circulatory system, is particularly burdened. It has to work harder to overcome the high pressure, which can lead to hypertrophy (thickening) of the heart muscle, especially the left ventricle, and eventually heart failure.

The kidneys, which filter blood, can also be damaged, leading to kidney failure. High blood pressure can also cause damage to the brain's blood vessels, leading to stroke. The eyes are not spared either; hypertension can lead to retinopathy, where the delicate blood vessels in the retina are damaged, potentially resulting in blindness.

What Medical Emergencies can Hypertension Lead to?

Hypertension can lead to coronary heart disease (Angina, Heart attack), stroke, end-stage renal disease, congestive heart failure and peripheral vascular disease. However, even though hypertension is a risk factor for these critical medical conditions, it can be easily controlled. Hence, it is necessary to identify and control hypertension by encouraging a healthy lifestyle. Furthermore, preventive strategies can help decrease the prevalence of hypertension in the general population. One can also consult the doctors at the best heart hospital in Delhi for precautions.

How is Hypertension Diagnosed? 

Hypertension, or high blood pressure, is diagnosed through a simple and routine test that measures the pressure in your arteries as your heart beats. Here's how the diagnosis is typically made:

Blood Pressure Measurement 

• A healthcare provider will use a blood pressure cuff (sphygmomanometer) and a stethoscope or electronic sensor to measure your blood pressure.
• You'll likely be asked to sit quietly for five minutes before the test and to avoid caffeine, exercise, and smoking for at least 30 minutes prior.
• Blood pressure is measured in millimetres of mercury (mm Hg) and recorded with two numbers: systolic pressure (the higher number) over diastolic pressure (the lower number).

Diagnostic Tests for Hypertension 

• Ambulatory monitoring: This involves monitoring blood pressure at regular intervals over a period of six or 24 hours, known as ambulatory blood pressure monitoring. However, not all medical centres have the necessary devices, and insurance coverage for this test varies.
• Lab tests: Blood and urine tests are conducted to identify conditions that might cause or exacerbate high blood pressure. These tests include checking cholesterol and blood sugar levels and assessing kidney, liver, and thyroid function.
• Electrocardiogram (ECG or EKG): This quick, painless test measures the heart's electrical activity. Electrodes attached to the chest and sometimes limbs connect to a machine that prints or displays the heart's activity.
• Echocardiogram: This noninvasive test uses sound waves to create detailed images of the heart in motion, showing blood flow through the heart and its valves.

Home Blood Pressure Monitoring 

• Patients may be advised to regularly monitor their blood pressure at home. Home monitoring helps healthcare providers assess if treatments are effective or if the condition is worsening.
• Home blood pressure monitors can be purchased at local stores and pharmacies. The American Heart Association recommends using a monitor with an upper arm cuff for the most accurate readings.
• Wrist or finger blood pressure devices are not recommended by the American Heart Association due to potentially less reliable results.

What are the Treatment Options for Hypertension? 

Hypertension treatment typically involves a combination of lifestyle changes and medications. The specific approach depends on the severity of the condition and whether the patient has other health issues. Here's an overview of common treatment strategies:

Lifestyle Changes 

Lifestyle modifications are often the first line of treatment and can significantly help in controlling high blood pressure:

• Healthy diet: Adopting a diet rich in fruits, vegetables, and whole grains, and low in saturated fats and cholesterol. The DASH (Dietary Approaches to Stop Hypertension) diet is often recommended.
• Salt reduction: Limiting salt (sodium) intake can have a significant effect on blood pressure levels.
• Weight management: Losing weight if overweight or obese can help lower blood pressure. Even a small amount of weight loss can make a difference.
• Regular physical activity: Engaging in regular physical exercise, like 150 minutes of moderate exercise or 75 minutes of vigorous exercise per week.
• Limiting alcohol and quitting smoking: Reducing alcohol intake and quitting smoking can improve heart health and lower blood pressure.
• Stress management: Adopting stress reduction techniques such as meditation, deep breathing, and relaxation exercises.

Medications 

If lifestyle changes are not sufficient, or if the hypertension is severe, medications may be prescribed:

• Diuretics: Often the first choice for high blood pressure, diuretics, or water pills, help the kidneys flush excess water and salt from the body.
• ACE Inhibitors and Angiotensin II Receptor Blockers (ARBs): These medications help relax blood vessels by blocking the formation or effect of a natural chemical that narrows blood vessels.
• Calcium channel blockers: These drugs help relax the muscles of your blood vessels or slow the heart rate.
• Beta-blockers: They work by slowing down the heart, which decreases the heart's workload and the force of the heart's contractions.
• Other medications: In some cases, other types of medications might be needed, such as alpha-blockers, alpha-beta blockers, central agonists, peripheral adrenergic inhibitors, vasodilators, and aldosterone antagonists.

Monitoring and Follow-up

Patients with hypertension should have regular follow-up appointments with their healthcare provider to monitor blood pressure, assess the effectiveness of treatments, and make any necessary adjustments. It's also important to manage any coexisting conditions like diabetes or high cholesterol.

Conclusion

Hypertension, often termed the "silent killer," stealthily undermines health without obvious symptoms, posing serious risks to vital organs. Unchecked, it can lead to life-altering complications. To combat this invisible threat, Max Healthcare offers comprehensive screening and personalised treatment plans. Embrace proactive health management by scheduling regular check-ups with Max Healthcare. Our dedicated team of experts is committed to guiding you towards a healthier, hypertension-free life.