Hypertension: The Silent Killer

Systemic hypertension, more often known as High Blood Pressure or simply BP, is one of the commonest diseases related to life style. According to a 2014 research report that was published in the Journal of Hypertension, an alarming 29.8% of the entire Indian population is suffering from hypertension In other words, one in three Indians is a victim of this disease.

It is called the 'Silent Killer', because it gives no warning and many people do not know they have hypertension. Over time they become exposed to serious risks of heart disease, stroke and kidney failure. Increasing stress levels, obesity, sedentary life style, smoking and changing dietary habits are all responsible for this illness.

What is blood pressure?

When your heart pumps blood, the force of oxygenated blood pushes against the walls of the thick muscular tubes called arteries. Blood flows with this force through these tubes to various parts of your body. This force of blood is called blood pressure. When it happens to be too high, it becomes an illness known as high blood pressure. With the help of the BP equipment, your doctor actually reads two aspects of your blood pressure:

1. Systolic Pressure: Pressure of blood when your heart beats while pumping blood.

2. Diastolic Pressure: Pressure of blood when your heart is at rest between beats.

A blood pressure less than 120/80 mmHg (read out as 120 over 80 millimetres of mercury) for an adult is considered normal. The first number 120 indicates systolic pressure, and the second number 80 indicates diastolic pressure. You are called 'Pre hypertensive', if your systolic blood pressure is between 120-139 and diastolic pressure between 80-89. Blood pressure reading greater than 140/90 indicates hypertension.

Essential hypertension

There are no underlying identifiable causes for this illness in about 85-90% of the reported cases: this type of hypertension is called 'Essential hypertension'; but it has been linked to risk factors such as increased salt sensitivity,family history, age and race.

Secondary Hypertension

The remaining 10-15% of the patients with hypertension have identifiable underlying reasons for their increased blood pressure; examples include kidney diseases and a few endocrine diseases related to thyroid, adrenals, and narrowing of the main vessel in the arterial network (coarctation). This type of hypertension is called 'Secondary Hypertension'.

How to identify secondary hypertension?

Indications of secondary hypertension include sudden onset of hypertension before 25 or after 55 years of age, hypertension that is difficult to control, hypertension that needs multiple antihypertensive drugs, hypertension associated with swelling of the legs, or protein leakage in the urine, low hemoglobin and kidney failure. But every hypertensive patient should not be suspected to be a case of secondary hypertension.

What to do when your blood pressure is high?

The first step is to exclude secondary hypertension. The basic steps to follow would be early CHANGES IN LIFE STYLE: this includes 30 minutes of brisk walking or any moderate exercise, reduction of dietary salt by 50 % and reduction of 5 kg of body weight. By following these steps, mild increase in blood pressure can be controlled, without the need for medications.

If pressure remains high in spite of these measures or if the initial blood pressure itself is high, then you need medications.

What are the measures to be taken if your blood pressure is high?

Continue life style modification. Take blood pressure medications regularly. Monitor your blood pressure regularly. Monitor annually the well-being of the heart, kidneys and brain.

Why should you control blood pressure?

Uncontrolled blood pressure can lead to acute and long term complications. The commonest acute complication is heart failure, when the pressures are too high. Long term uncontrolled blood pressure leads on to increased risks of heart attack, heart failure, and stroke and kidney failure.

The good news is that well-controlled blood pressure decreases the risks of these life-threatening complications.

What else should you do to ensure good blood pressure control?

Home blood pressure monitoring: Like blood sugar monitoring, this is ideal to track the level of your blood pressure control.

24-hour blood pressure monitoring: Also known as Ambulatory Blood Pressure Monitoring, this will make available your blood pressure pattern over a 24-hour day-night period. It is useful in identifying the following two most important variables, which are necessary to study the quality of your sleep and general health in relation to your hypertension and risks of diseases:

1. 'Blood pressure dipping pattern': Normally your blood pressure is expected to fall by 10 to 20% when you sleep; if it happens so, you are called a dipper, and the pattern of fall, BP dipping pattern. In about one-fifth of the population, blood pressure may not dip and such patients are non-dippers. In certain other patients there may even be an alarming increase: those patients are reverse dippers. They run an increased risk of heart attack and stroke.

2. 'Early morning surge in blood pressure': A few patients who have night-time dipping of blood pressure may register an abrupt increase in the early morning. Win over the silent killer, and live a long, peaceful, healthy and happy life.

Article by Dr. R Balasubramaniam, Senior Consultant Nephrologist, Kauvery Hospital

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