Hypertension: a silent killer

Blood pressure (BP) is the pressure or force of blood against the walls of the blood vessels (arteries) as it circulates throughout the body. Hypertension is characterised by high arterial pressure, that is, the blood exerting too much pressure on the arterial walls.

Hypertension or high blood pressure is often referred to as the silent killer because the affected person usually does not experience any symptoms. But it continues to damage various organs in the body leading to many complications and premature death.

High blood pressure cannot be cured. However, it can be managed very effectively through lifestyle changes and medications.

The burden of hypertension in India

Hypertension is one of the most important public health problems and the most common lifestyle disease in India. Currently, there are an estimated 100 million people with hypertension in India. It is estimated that by 2020, almost 1/3rd of the population will be hypertensive. Among the hypertensive patients, only about 15-20% have their blood pressure under control.

Complications of high BP

The consequences of hypertension are formidable. The organs most often affected are:

*Heart: Hypertension can lead to heart attack, heart failure, progressive weakness of the heart muscles, etc.

*Kidneys: It can damage the kidneys leading to renal failure.

*Brain: It can cause stroke, TIA, dementia (decline in memory and other thinking skills).

*Eyes: It can lead to retinopathy (damage to the retina which may impair vision).

*Sometimes uncontrolled hypertension can lead to some acute life-threatening conditions like aortic dissection, rupture of the aortic aneurysm or acute pulmonary oedema (inability to breathe due to fluid in the lungs)

Symptoms of high BP

It is important to emphasize here that high blood pressure seldom has any symptoms. Sometimes it can cause headache, nosebleeds, dizziness, fatigue, shortness of breath, etc.

Primary and secondary hypertension

In more than 90% of patients, the cause of hypertension is not known. It is called primary, essential or idiopathic hypertension. In the rest, hypertension is secondary to some other causes. It is called secondary hypertension. The common causes of secondary hypertension are chronic kidney disease, tumour or other diseases of the adrenal gland, sleep apnoea, coarctation (narrowing) of the aorta, thyroid dysfunction, narrowing of the arteries supplying blood to the kidneys, alcohol or other drug and substance abuse and some rare hormonal problems.

Classification of blood pressure

The most recent guideline on hypertension defines the optimum blood pressure as less than 120/80 mm of Hg. Normal blood pressure is said to be between 120-129 mm of Hg systolic and between 80-84 mm Hg diastolic. High normal blood pressure is between 130-139 mm of Hg systolic and 85-89 mm of Hg diastolic. Grade 1 hypertension is systolic BP between 140-159mm Hg and diastolic BP between 90-99 mm Hg. Grade 2 hypertension is systolic BP between 160-179 mm Hg and diastolic BP between 100-109 mm Hg. A systolic BP >�180 mm Hg and a diastolic BP>� 110 mm Hg is termed as Grade 3 hypertension.

Risk factors

If one is over 55-year-old, family history of high BP, diabetes, sleep apnoea or renal disease, obese, consumption of a large amount of alcohol, smoking, sedentary lifestyle, a diet rich in salt and fat, stress, et al.

What should you do if you have high BP?

Although you can measure your blood pressure by yourself or get it checked at the pharmacy, only a doctor can establish a diagnosis with certainty. Once a diagnosis is made, you must make some lifestyle changes, such as: losing weight, quitting smoking, engaging in physical activity, reducing your salt and alcohol intake, reducing your stress level and increasing the intake of potassium in the diet.

Patients with grade 1 hypertension and above usually require anti-hypertensive medicines in addition to lifestyle changes. Many patients require more than one anti-hypertensive medication to fully control blood pressure.

Irregular intake of anti-hypertensive medication is one of the commonest causes of uncontrolled blood pressure and various complications in the long run. Such medications should not be stopped unless told to do so by your doctor.

If not taken seriously, hypertension can cause a lot of damage to your health. It is very important to recognise and treat it at an early stage to prevent its complications and lead a long and healthy life.