Hypertension: Caring for hypertensives

By: Dr T. Akinpelu

Source: http://schmallchiropractic.com/

Hypertension is one of the most common diseases afflicting people these days and is a major risk factor for stroke, heart attack and chronic kidney disease among others. It also tends to complicate the management of other medical conditions. Hypertension or high blood pressure is a chronic medical condition in which the blood pressure is elevated and this makes the heart to work harder than normal to circulate blood through the blood vessels.

Blood pressure reading is written as two numbers. The number on top is the systolic blood pressure (which tells you the pressure used to pump blood out of your heart and around your body) and the bottom number is the diastolic pressure (which tells you the pressure used to return blood back into the heart when it is relaxed). Your blood pressure is said to be high if it is persistently at or above 140/90 mmhg. One or both of these numbers can be too high.

CLASSIFICATION

Primary Hypertension (also called essential hypertension) may not have an identifiable cause and usually develops as a result of a combination of lifestyle, environmental or genetic causes and it accounts for 90-95% of cases. Secondary hypertension, on the other hand is caused by other medical conditions such as those affecting the kidneys, heart, arteries and endocrine system, and these account for the other 5-10% of the cases.

CLASSIFICATION OF HYPERTENSIVE READING	SYSTOLIC PRESSURE (mmhg)	DIASTOLIC PRESSURE (mmhg)
NORMAL	90-119	60-79
PRE-HYPERTENSION	120-139	80-89
STAGE 1 HYPERTENSION	140-159	90-99
STAGE 2 HYPERTENSION	≥160	≥100
ISOLATED SYSTOLIC HYPERTENSION	≥140	<90

SIGNS AND SYMPTOMS

Hypertension is rarely accompanied by any symptoms, thus the name “THE SILENT KILLER”. Even without symptoms, the damage to the blood vessels and the heart continues. Its identification is usually through random screening or when seeking healthcare for an unrelated condition. Some people may have headaches, feel dizzy, nausea, vomiting, visual impairments, nose bleeds or fainting spells, but these symptoms are usually seen in the severe stage.

HOW IS HYPERTENSION DIAGNOSED?

Occasionally due to stress, exercise or excitement, you may have a one-off elevated blood pressure reading, but this is not enough to make a diagnosis of hypertension. However, if you have repeated high blood pressure readings for about 3 times, this is relevant.

Your doctor would do a physical examination to look for signs of heart, liver, kidney disease also examine your eye to look out for damages.

Tests that could be carried out to assess you include:

1. Tests on the metabolic status of your body, your blood sugar level and cholesterol/ lipid profile.

2. Kidney disease using a kidney function test, urinalysis, blood urea nitrogen, creatinine test and ultrasound of the kidneys. 

3. The heart using an electrocardiogram, echocardiogram, chest radiograph and PCV.

FACTORS THAT INCREASE YOUR RISK OF HYPERTENSION:

Urban/city life: With urbanization comes a more sedentary inactive lifestyle with high stress levels and anxiety, which leads to higher heart rate meaning the heart works harder than it should.

Smoking: Smoking or using tobacco causes lasting damage on the arteries causing it to harden and this affects blood flow and increases blood pressure. This is especially significant as smokers get older

Obesity: The bigger you get, the more effort needed to supply oxygen to the tissues, the higher the volume of blood needed to achieve this, leading to increased pressure on the walls of the blood vessels

Drinking: If you must drink alcohol, then drink in moderation because heavy drinking can damage the heart.

Salt: Too much salt in your diet can cause your body to retain more water than necessary and this in turn increases the work load on the heart and your blood pressure.

Genetics: It is seen more in Africans, with men being more at risk

Age: The older you get the more you are at risk of being hypertensive

Family History: If there is an immediate family member with hypertension, the risk is high of others having it usually due to similar diet and lifestyle.

MANAGEMENT OF HYPERTENSION

The main goal is to bring the blood pressure down to the normal range and also reduce the risks of complications arising from it.

-For pre-hypertension (see table above), the main strategy for management is lifestyle modification. It's not common to also prescribe drugs. Such lifestyle modifications include:

1.  Eating a healthy diet, low in salt and fat,and high in potassium and fibre.
2. Regular exercises at least 30 minutes of aerobics daily.
3. Quit smoking.
4. Reduce your alcohol intake to the barest minimum.
5. Drink plenty of water.
6. If you are obese, lose weight.
7. And most importantly, reduce/ avoid your sources of stress.

-Use of medications in addition to lifestyle modifications is an essential part of the management of hypertension. There are different classes of drugs used to treat high blood pressure, and very often a single drug may not be adequate to control the blood pressure. Two or more drugs may be necessary. It is also very important to be compliant with medications given and to report any side effects noticed to your doctor.

Treatment goals-For people older than 60 years without any other medical complications, achieving a BP of <150/90 mmhg is the goal. For people less than 60 years without any medical complications, a BP of <140/90 mmhg is the goal. For hypertensive people of any age with medical complications such as co-existing kidney disease, diabetes or any heart condition, or people with high risks of having these conditions (eg. obese patients and heavy drinking) then a BP of <140/90 mmhg is the goal.

THE ROLE OF FAMILY MEMBERS

It is important for young people with hypertensive parents  or relatives to be involved in the lifestyle modifications, because they are basically normal activities necessary for a healthy life, thus benefiting the entire family.

• Fixing healthy meals for the whole family and not just the hypertensive member will save wear and tear on the cook. It will also make it easier for the patient to follow the diet by eliminating some of the temptation to return to old eating habits.
• The family member who does the meal planning and cooking should visit the doctor/dietician along with the patient. Both can learn about the best foods to use and other helpful ideas to make following the diet easier.
• Getting regular exercise helps keep blood pressure under control.  The benefits of exercise include feeling and looking better and reducing stress. Families can exercise together and enjoy these activities as part of their free time together. 
• Stopping smoking can be hard to do, especially if others in the family continue to smoke. Family members should consider stopping smoking together, therefore encouraging the hypertensive person to stop.
• One very common challenge faced is a family member who has high blood pressure and does not remember to take their medicines. Families can be supportive, as some patients may also have difficulty remembering whether they took their medicines or not. Setting alarms on their phones, marking it off on a calendar and visual reminders are quite helpful.

Some of the reasons patients give for not taking their medicines are that they don’t feel sick so it is not needed, or that they don’t feel any different from when they were not on any medications and when they are. Some patients also complain of headaches, tiredness, swelling of the legs and in some men problems with their sex life. Patients also complain of the cost of purchasing the medications.

Regardless of the reason, failing to take your medicine is dangerous and life threatening. and these medicines should never be stopped abruptly. You should encourage your family member who has high blood pressure to discuss any questions or concerns about their medicines or problems with side effects with their doctor as he is usually able to provide an alternative. 

There is evidence that high blood pressure tends to run in families.  That’s why EVERYONE in the family should make healthy lifestyle choices, along with their hypertensive family member. Family members should also have their blood pressure checked at least once a year.

IS HYPERTENSION A DEATH SENTENCE?
No it's not, a hypertensive patient can live as long as every other healthy person, but what is key is to accept the fact that you are hypertensive and need to make certain sacrifices. Take your medications, make the necessary lifestyle modifications, get a personal digital BP monitor to check your blood pressure at home and go for regular medical check-ups at least once a month.

About the author
Dr. T. Akinpelu is a medical doctor, avid reader, music and football lover and a die hard AC Milan fan. You can find him on twitter @tola_akinpelu