08/03/2024 Hypertension, Non-Communicable Diseases

High blood pressure (HBP) / Hypertension (HT)

What is high blood pressure?

Hypertension or high blood pressure is diagnosed when your blood pressure (BP) is more than 140/90 millimeters of mercury (mmHg) when measured repeatedly.

High blood pressure can cause long-term problems. It is a major risk factor for heart disease, arterial disease, stroke, kidney disease, heart failure, and loss of vision.

Raised blood pressure is estimated to cause 7.5 million deaths worldwide. Nearly one in three adults in Sri Lanka has high blood pressure.

 

When should you get your BP checked?

BP screening is an important part of general health care. How often you should get your blood pressure checked depends on your age and overall health.

In Sri Lanka, all individuals of 35 years or older, should get their BP checked at least annually. You should get your BP checked at an earlier age if you have other risk factors such as diabetes, heart attacks, stroke, high cholesterol, obesity, and lack of exercise.

 

What are the symptoms of high blood pressure?

Most people can have high blood pressure without any symptoms. The only way to know is to get your blood pressure checked.

Sometimes they can present with:

  • Headache, nausea, vomiting
  • Bleeding from nose
  • Dizziness
  • Blurred vision
  • Buzzing in the ears

However, these symptoms are not specific. They usually do not occur until blood pressure has reached a severe stage. Therefore, it can be considered as a silent killer.

What are the causes of high blood pressure?

  • In most patients, there is no identifiable cause.
  • The risk factors for developing high BP are:
    • Advancing age
    • Family history of high BP
    • Overweight or obesity
    • Smoking
    • Drinking excessive alcohol
    • Unhealthy diets (excessive salt consumption, diets high in saturated fat and trans fats, low intake of fruits and vegetables)
    • Lack of physical activity
    • Stress
    • In some patients, there can be an underlying cause such as kidney disease, diabetes, or high cholesterol

When high blood pressure is found at a young age, an underlying cause needs to be excluded. It is important to catch this group early.

Certain medications such as painkillers, over-the-counter medications like herbal preparations, and recreational drugs (cocaine, amphetamine/ecstasy) can increase blood pressure.

 

How do we confirm/diagnose high BP?

Blood pressure (BP) can vary with time, mental status (e.g.: anger), and physical activity/exercise. Therefore, if the initial blood pressure reading is high, your doctor will ask you to get it checked several times before diagnosing high blood pressure. It is important to note that a single BP reading cannot confirm the diagnosis of high BP.

 

 

This could be done at a clinic by a doctor, at home, or while you are doing your day-to-day activities using a portable recorder.

Sometimes when you see the doctor your blood pressure can falsely go up. We call it ‘white coat high BP’. In this situation, checking blood pressure leisurely at home or while ambulating would be helpful to get the exact blood pressure.

Your doctor might order necessary investigations after diagnosing high BP.

 

Do’s and don’ts when checking blood pressure

There are a few things that need to be done before and during the blood pressure check. To get the correct BP readings, these things are very important.

  • Do not drink coffee or any caffeine-containing drinks, exercise, or smoke at least 30 minutes before the BP measurement.
  • Empty the bladder before the BP measurement.
  • Sit at least for 5 minutes comfortably on a chair without talking.
  • The back and arms should be supported/rested.
  • Keep the feet flat on the ground touching the floor. Legs should not be crossed.
  • The arm is at the level of the heart.
  • The BP measurement should be done in a quiet environment.
  • Remove all the clothing covering the upper arm for cuff placement. BP cuff should not be placed over clothes.
  • Please wear a light jacket to facilitate exposure.
  • Try to relax and avoid talking during BP measurement.

What are the complications of High BP?

HBP can give rise to damage in most of the organs of the body. It includes damage to the heart, brain, kidneys, arteries, and eyes.

  • If we start treatment early, most of the damage can be reversed.
  • With long-standing hypertension, damage may become irreversible despite improved blood pressure control.
  • High BP can also be associated with other diseases such as diabetes, fatty liver, obesity, and high cholesterol.

 

How is high BP treated?

You will be advised to follow a healthy lifestyle and to start on medications by your doctor.

 

What are the lifestyle interventions?

Lifestyle changes can be very important to reduce blood pressure.

The following are some examples:

  • Losing weight if overweight/obese
  • Your waist circumference should be:
    • Less than 80 cm in females
    • Less than 90 cm in males
  • Eat more vegetables, fruits, whole grains, and protein from plant sources or fish.
  • Reduce intake of foods high in sugar, saturated fat, and trans fats (e.g.: deep-fried foods, bakery items, fast foods).
  • Limit your daily salt intake to 5 g (1 teaspoon).
  • DO NOT ADD SALT TO YOUR RICE.
  • If you are eating dry fish, make sure you wash them in hot water thoroughly to remove extra salt.
  • Reduce excessive salt-containing foods, including those with added salts – cashews, murukku chips, bread, sauces, etc.
  • Quit all forms of tobacco use.
  • Stop, avoid, or at least cut down on all forms of alcohol use.
  • Engage in moderate-intensity aerobic exercise (e.g.: brisk walking, cycling, swimming, and gardening) for 30 minutes at least 5 days a week.
  • Engage in muscle-strengthening exercises (e.g.: pushups, squats) 2 to 3 days per week.
  • Take a good sleep at least 6-8 hours a day.
  • Make sure your stress levels are kept to a minimum by engaging in yoga, relaxation activities like listening to music, and meditation

 

What you should know about blood pressure pills

  • If your doctor has started you on blood pressure-lowering treatment you should take it lifelong until your doctor advises otherwise.
  • If he/she says that the blood pressure is controlled, that indicates the medications given for the blood pressure are working and if the medications are stopped the blood pressure will rise again. Therefore, it is advised to continue the usual medications.
  • The type of medicine used to treat hypertension depends on your overall health and how high your blood pressure is.
  • Several medications can be used for high BP.
  • It can take some time to find the exact medication or combination of medications that work best for you.
  • Always take blood pressure medicines as prescribed by your doctor.
  • Don’t change your treatment without your doctor’s advice.
  • Never skip a dose or abruptly stop taking blood pressure medications.
  • Sudden cessation of certain medications, can cause a sharp rise in blood pressure.
  • If you skipped the medications due to cost, side effects, or forgetfulness, talk to your doctor about solutions.
  • There is no harm in taking the same pill for a long time. It will not cause any kidney damage.

 

What is the BP Goal?

When taking blood pressure medications, it is important to know your goal blood pressure level. Your blood pressure should be less than 140/90 mmHg.

Your doctor may define individual BP targets according to your health and co-existing diseases and special situations.

 

What are the reasons your BP is not under control?

  • Poor adherence to BP medications.
  • Taking other medications (e.g.: pain killers) or substances (e.g.: alcohol, recreational substances) that increase the blood pressure
  • Any underlying cause (e.g.: Kidney failure)
  • Unhealthy lifestyle: poor sleep, unhealthy diet
  • High salt intake
  • Stress

 

How will the doctor follow you up?

  • A three monthly follow-up is adequate if your BP is under control.
  • If you are having very high BP or difficult-to-treat BP you will be asked to come for follow-up more frequently.
  • You need to check for organ damage and arrange investigations at least once a year or as prescribed by the doctor.

 

Summary

  • High BP is a silent killer.
  • It can result in damage to many organs including the heart, kidneys, blood vessels, brain, and eyes.
  • Lifestyle interventions are recommended for all.
  • Reducing salt intake can cause a reduction in blood pressure.
  • Quit all forms of tobacco use.
  • Avoid or stop all forms of alcohol use.
  • Engage in moderate-intensity aerobic exercise.