HYPERTENSION OR HIGH BLOOD PRESSURE

Blood is carried from the heart to all parts of the body in blood vessels. Each time the heart beats, it pumps blood into the vessels. Blood pressure is created by the force of blood pushing against the walls of blood vessels (arteries) as it is pumped by the heart. Hyper tension, also known as high or raised blood pressure, is a condition in which the blood vessels have persistently raised pressure. The higher the pressure in blood vessels the harder the heart has to work in order to pump blood. if left uncontrolled, hyper tension can lead to a heart attack, an enlargement of the heart and eventually heart failure. Blood vessels may develop bulges (aneurysms) and weak spots due to high pressure, making them more likely to clog and burst. the pressure in the blood vessels can also cause blood to leak out into the brain. this can cause a stroke. Hyper  tension can also lead to kidney failure, blindness, rupture of blood vessels and cognitive impairment.

How hyper tension is defined?

Blood pressure is measured in millimeters of mercury (mm Hg) and is recorded as two numbers usually written one above the other. The upper number is the systolic blood pressure - the highest pressure in blood vessels and hap-pens when the heart contracts, or beats. The lower number is the diastolic blood pressure - the lowest pressure in blood vessels in between heartbeats when the heart muscle relaxes. Normal adult blood pressure is defined as a systolic blood pressure of 120 mm Hg and a diastolic blood pressure of 80 mm Hg. However, the cardiovascular benefits of normal blood pressure extend to lower systolic (105  mm  Hg) and lower diastolic blood pressure levels (60 mm Hg). 

Hyper tension is defined as a systolic blood pressure equal to or above 140 mm Hg and/or diastolic blood pressure equal to or above 90 mm Hg. 

Normal levels of both systolic and diastolic blood pressure are particularly important for the efficient function of vital organs such as the heart, brain and kidneys and for overall health and well being.

Causes of hyper tension

There are many behavioural risk factors for the development of hyper tension including :

• consumption of food containing too much salt and fat, and not eating enough fruit and vegetables
• harmful levels of alcohol use 
• physical inactivity and lack of exercise 
• poor stress management.
• these behavioural risk factors are highly influenced by people’s working and living conditions.

In addition, there are several metabolic factors that increase the risk of heart disease, stroke, kidney failure and other complications of hyper  tension, including diabetes, high cholesterol and being overweight or obese. Tobacco and hyper tension interact to further raise the likelihood of cardiovascular disease.

Social determinants of health, e.g. income, education and housing, have an adverse impact on behavioural risk factors and in this way influence the development of hyper tension. For example, unemployment or fear of unemployment may have an im-pact on stress levels that in turn influences high blood pressure. 

The symptoms of high blood pressure

Most hypertensive people have no symptoms at all. There is a common misconception that people with hyper tension always experience symptoms, but the reality is that most hypertensive people have no symptoms at all. Sometimes hyper tension causes symptoms such as headache, shortness of breath, dizziness, chest pain, palpitations of the heart and nose bleeds. It can be dangerous to ignore such symptoms, but neither can they be relied upon to signify hyper tension. Hyper tension is a serious warning sign that significant lifestyle changes are required. The condition can be a silent killer and it is important for every-body to know their blood pressure reading.

Hypertension and life-threatening diseases

It is dangerous to ignore high blood pres-sure, because this increases the chances of life-threatening complications. The higher the blood pressure, the higher the likelihood of harmful consequences to the heart and blood vessels in major organs such as the brain and kidneys. This is known as cardiovascular risk, and can also be high in people with mild hyper tension in combination with other risk factors e.g.,  tobacco use, physical inactivity, unhealthy diet, obesity, diabetes, high cholesterol, low socioeconomic status and family history of hyper tension. Low socioeconomic status and poor access to health services and medications also increase the vulner-ability of developing major cardiovascular events due to uncontrolled hyper tension.

Diagnosing hyper tension

Blood pressure measurements need to be recorded for several days before a diagnosis of hyper tension can be made. Blood pressure is recorded twice daily, ideally in the morning and evening. Two consecutive measurements are taken, at least a minute apart and with the person seated. Measurements taken on the first day are discarded and the average value of all the remaining measurements is taken to confirm a diagnosis of hyper  tension.

If hyper tension is detected early it is possible to minimize the risk of heart attack, heart failure, stroke and kidney failure. All adults should check their blood pressure and know their blood pressure levels. Digital blood pressure measurement machines enable this to be done outside clinic settings. If hyper tension is detected people should seek the advice of a health worker. For some people, lifestyle changes are not sufficient for controlling blood pres-sure and prescription medication is needed. Blood pressure drugs work in several ways, such as removing excess salt and fluid from the body, slowing the heartbeat or relaxing and widening the blood vessels.

Self-monitoring of blood pressure is recommended for the management of hyper  tension in patients where measurement devices are affordable. As with other noncommunicable diseases, self care can facilitate early detection of hyper tension, adherence to medication and healthy behaviours, better control and awareness of the importance of seeking medical advice when necessary. Self-care is important for all, but it is particularly so for people who have limited access to health services due to geographic, physical or economic reasons.

How to tackle hyper tension?

While some people develop hyper tension as they get older, this is not a sign of healthy ageing. All adults should know their blood pressure level and should also find out if a close relative had or has hyper tension as this could place them at increased risk.

The odds of developing high blood pressure and its adverse consequences can be minimized by : 

Healthy diet

• promoting a healthy lifestyle with emphasis on proper nutrition for infants and young people
• reducing salt intake to less than 5 g of salt per day
• eating five servings of fruit and vegetables a day
• reducing saturated and total fat intake.

Alcohol

• avoiding harmful use of alcohol.

Physical activity

• regular physical activity, and promotion of physical activity for children and young people. WHO recommends physical activity for at least 30 minutes a day five times a week. 
• maintaining a normal body weight. 

Tobacco

• stopping tobacco use and exposure to 
• tobacco products 

Stress

• proper management of stress

If proper diet and regular physical activity are not enough to keep your blood pressure within safe limits, your doctor will prescribe a medication.

Diuretics

Diuretics, or “water pills,” are often the first medication chosen. These drugs help control blood pressure by ridding the body of excess salt and water. If diuretic therapy doesn't bring your blood pressure down to normal, your doctor may have you take other medications. 

Beta Blockers

Beta blockers lower blood pressure by slowing the heart rate and reducing the force of the heartbeat, easing the heart’s workload.

Calcium Channel Blockers

Calcium channel blockers can decrease the heart’s pumping strength and relax blood vessels.

ACE Inhibitors

ACE (angiotensin converting enzyme) inhibitors interfere with the body’s production of angiotensin II, a chemical that causes the arteries to narrow.

ARBs

The ARBs (angiotensin receptor blockers) block the effects of angiotensin II.

Vasodilators

Vasodilators, another useful group of drugs, can cause the muscle in blood vessel walls to relax, allowing the vessel to widen. They’re especially effective in the arterioles, very small arteries that connect larger arteries to the tiny capillaries. 

In most cases, these drugs lower blood pressure. Quite often, however, people respond very differently to them. That’s why most patients must go through a trial period to find out which medications work best with the fewest side effects. Patients frequently must take two to three medications to control their blood pressure.