Hypertension: Things you need to know

It used to be thought that hypertension, which is the technical term for high blood pressure, was only prevalent in the western world, among only the elderly, but recently, trends have shown a shift—both in geography and age group— in the prevalence of hypertension. This shift in trend is so subtle that so many people in sub-Saharan Africa only get to discover they’ve been hypertensive after the dreadful complications have set in. In Nigeria, for example, cardiovascular diseases, according to the Centre for Disease Control and Prevention, are the top non-infectious causes of adult mortality, and one way or the other, hypertension is always at the centre. Hypertension is also found to be the commonest cause of chronic renal failure, and ultimately, End Stage Renal Disease.

Moreso, The World Health Organization (WHO) estimates that out of the 1.28 billion people living with hypertension, two-thirds are from middle-income and low-income countries, and 46% are unaware of their having this condition.

In this article, our aim is to discuss general knowledge about hypertension in order to create awareness among our readers and help them protect themselves from the disease, which ranks high among the causes of premature deaths worldwide.

What is hypertension?

Hypertension simply means High Blood Pressure. This means, the force of blood pushing through your blood vessels to supply nutrients and other essential elements to your tissues is too high. That force is a function of how much blood is passing at a time, and the resistance it meets within the blood vessels, the more the volume, and the narrower the vessels, the higher the blood pressure.

How to understand blood pressure readings

A Blood pressure reading is taken with a cuff, and there are appropriate sizes of cuff for each age group. This is important because using the wrong size of cuff for an individual may produce a wrong blood pressure reading.

Blood Pressure (B.P) is denoted by two numbers, although not exactly a fraction, but written like one, with a numerator and a denominator. The number on top is called the Systolic Blood Pressure, which indicates the blood pressure when the heart chambers are contracting, while the number below, called the Diastolic Blood Pressure, indicates the pressure between contractions, that is, when the heart chambers are relaxed.

Blood pressure ranges

There are basically five categories based on the blood pressure readings:

1. Normal Blood pressure — 90/60 — 120/80 millimetres of Mercury (mm Hg)
2. Elevated B.P — 120-129/80 mm Hg or less
3. Stage 1 Hypertension (pre-hypertension) — 130-139/80-99 mm Hg
4. Stage 2 Hypertension — 140/90 mmHg or higher
5. Stage 3 Hypertension — 180/120 mm Hg or higher

For elevated B.P and stage 1 Hypertension, no medical treatment is advocated, but lifestyle modification is seriously stressed. Exercise, healthy diet is advocated for the individuals. Stage 2 requires medical treatment, usually oral drugs. Stage 3 requires urgent treatment, usually with intravenous medications, until the pressure is brought down to safer levels, from where oral drugs may be used to maintain the pressure.

Symptoms of hypertension

It is worthy of note that hypertension has no specific symptoms, it may vary from being symptomless and silent to having symptoms that denote underlying organ damage. Dizziness can be common in people with hypertension, but then, dizziness can be caused by many other conditions, and it is difficult to always attribute it to elevated blood pressure. The surest way to know if you’re hypertensive is to have a regular blood pressure check, especially as one advances in age. This is even more important for an individual with a family history of heart disease or hypertension itself especially in first-degree relatives.

Types of hypertension

There are broadly two types of hypertension, and each having several causes of it.

1. Essential (Primary) hypertension: In this, there is usually no one identifiable cause, but it’s seen to happen following some risk factors and they include;

• Age – seen with increasing age, usually above 65.
• Race — seen more among Blacks.
• Obesity
• Sedentary lifestyle
• Alcohol
• Genes

The risk of one developing hypertension increases with all the above.

2. Secondary Hypertension: This follows certain disease conditions, and it occurs suddenly. Once the underlying disease condition is treated, the blood pressure normalizes. This is unlike primary hypertension which requires a lifetime treatment and lifestyle modification. Some of the causes of this include:

• Kidney diseases
• Thyroid diseases
• Obstructive sleep apnea
• Use of illegal drugs
• Side effects of medications
• Diseases of the adrenal gland, etc

Making diagnosis

Now, because of its implications, the diagnosis of hypertension is not hastily made. It takes a minimum of 2 measurements, at least 6 hours apart to make a diagnosis of hypertension. This is because there are various conditions in the environment that can elevate an individual’s blood pressure, for example, some people are naturally apprehensive of the hospital environment, and therefore, such individuals require relaxation and reassurance to be at peace while their B.P is being measured.

Furthermore, some tests may need to be carried out to rule out any underlying conditions behind the elevation in blood pressure, or any complications of the raised B.P. These tests include:

1. Fasting Lipid Profile – especially the cholesterol and HDL, and LDL.
2. Thyroid Function Test
3. Kidney Function Test
4. Echocardiography – To look at the heart chambers and blood flow through them.
5. Electrocardiogram — To see the electrical activities of the heart.

Treatment options

Treatment depends on the type of hypertension one is having:

• Primary Hypertension: This requires lifestyle modifications ranging from diet, physical activity, etc. If these are not enough to bring the B.P within normal limits, medications are used. These medications may need constant review at time intervals, and this makes follow up an important part of this therapy for success to be achieved.

• Secondary Hypertension: This requires the treatment of the underlying disease. Sometimes though, hypertension may persist even after successful treatment of the underlying disease, in which case a new dimension of treatment must be taken. Irrespective of the cause, blood pressure needs to be brought within normal limits to avoid the associated life-threatening complications.

Medications

There are several classes of drugs used in the treatment of hypertension, depending on which works for an individual, the doctor makes his selection and adjusts the dose accordingly. So, it’s highly important to see a physician for diagnosis and drug administration. Nevertheless, the most common classes of drugs being used include:

1. Angiotensin Converting Enzyme inhibitors (ACE inhibitors): It helps reduce the production of the chemical which helps in tightening blood vessels.
2. Angiotensin Receptor Blockers (ARBs): This works like the first one, but while the first one stops the production of the chemical, this stops the chemical from binding to its receptors.
3. Beta Blockers: These slow the heartbeat and reduce the amount of blood being pushed, also blocks certain hormones that raise the B.P.
4. Diuretics: These reduce water and sodium in the body by excreting them in urine, and by so doing, reduce the B.P.
5. Calcium Channel Blockers: These reduce the forceful beating of the heart by preventing calcium from re-entering the heart muscles. Also relaxes the blood vessels.

Lifestyle changes

Aside medications, lifestyle changes may help reduce the risk factors of hypertension or maintain a hypertension that’s already under good control. These include:

1. Dietary modification: eating heart-healthy diet like fruits and vegetables, fish, whole grains.
2. Physical activity: exercise at least 30 minutes, 5 times in a week. About 150 minutes a week.
3. Managing stress: this is achieved by adequate restful sleep. Others include meditation, deep breathing, yoga, body massage.
4. Quitting alcohol and smoking.

Complications of hypertension

It is not just the elevation in blood pressure that is most dreaded about this disease, it is the life-threatening complications associated with chronic uncontrolled elevation of the B.P. Some of the organs most severely hit by chronic hypertension include:

1. The Blood vessels: Arteries are normally obstructed, strong, and elastic enough to accommodate sudden increases in the blood volume without causing damage to the walls. Hypertension makes the walls of arteries stiff, inelastic, making it easier for fats to deposit along the walls, narrowing the hollow, and restricting blood flow. This may lead to blockages, and most importantly stroke and heart attack.
2. The Heart: increase in blood pressure makes the heart work harder to overcome that pressure, and as with all muscles, the heart muscles increase in size and number to meet this demand, producing an enlargement in the size of the heart. This may lead to heart failure, arrhythmias, heart attack and sudden cardiac death.
3. The Brain: As the brain depends on constant supply of oxygen, hypertension may restrict the flow of blood to the neural tissues, and temporary blockage may cause Transient Ischemic Attacks. In the more severe form, where there is significant blockage, Stroke occurs.
4. The Kidneys: Chronic elevation of blood pressure may overtime damage the cells of the kidney, which will ultimately end in Chronic Renal Failure. It is worth knowing at this point that disease in the kidney may be as a result of hypertension or may itself cause hypertension.

Special mention

Uncontrolled hypertension has severe effects in pregnancy, affects both the mother and the growing foetus. In the severest form, it may end up in preeclampsia and eclampsia, and these two have adverse outcomes both for the mother and the baby.

In conclusion, hypertension is highly responsive to medications and lifestyle modifications. It is always important to note that for essential hypertension, treatment is usually for life, but it is always easy if one incorporates it into his way of life. Hypertension usually presents with no symptoms; this makes it highly important to regularly check one’s B.P in order not to have its first presentation in one of the dreadful complications.

References

Chukwuonye, I. I., Ogah, O. S., Anyabolu, E. N., Ohagwu, K. A., Nwabuko, O. C., Onwuchekwa, U., Chukwuonye, M. E., Obi, E. C., & Oviasu, E. (n.d.). Prevalence of chronic kidney disease in Nigeria: systematic review of population-based studies. International Journal of Nephrology and Renovascular Disease, Volume 11, 165–172. https://doi.org/10.2147/ijnrd.s162230

Flyingdoctorsnigeria. (2020, May 6). Top 10 causes of death in Nigeria – Flying Doctors Nigeria. Flying Doctors Nigeria.

Managing Blood Pressure with a Heart-Healthy Diet. (2024, February 29). www.heart.org.

World Health Organization: WHO & World Health Organization: WHO. (2023, March 16). Hypertension.