Hypertension or high blood pressure, as the name suggests, refers to an elevated blood pressure.
Unfortunately, most of the cases of hypertension in our region are either undiagnosed or poorly managed, leading to complications.
Blood pressure is the pressure that blood exerts on the vessels. The blood pressure depends on the resistance that the blood is subjected to as it passes through the vessels and the amount of work the heart has to do to maintain the flow.
Hypertension is a chronic condition that develops over a long time. At first, it may not show any manifestations and an individual with high pressures could be looking just fine, hence the moniker ‘the silent killer.’ It is therefore vital to get regular blood pressure (BP) measurements to catch it earlier and curb its progression.
What Causes Hypertension?
Before we look at the possible causes of hypertension, it is essential to understand that there are two main types of hypertension.
Primary Hypertension or Essential Hypertension
Primary hypertension is the type that develops with no identifiable cause. It is not clear what causes the elevated pressures but scientists have identified some factors that put one at risk of developing essential or primary hypertension.
- A Sedentary lifestyle
- Poor diet
- Genetic predisposition
Secondary hypertension occurs as a result of an underlying condition. Unlike primary hypertension, there is an identifiable disease process in the body which can be linked to the elevated pressures. These conditions include:
- Kidney disease
- Thyroid disease
- Congenital heart defects
- Adrenal gland disease
- Alcohol abuse
It is important to note that some medications can also cause increased blood pressure.
The Major Risk Factors for Developing Hypertension
- Diabetes mellitus
- Age: men above 55 years and women above 65 years
- Having close family member with hypertension
- Deranged blood lipid levels (dyslipidaemia)
The Symptoms of High Blood Pressure
Before you read the list of symptoms that might be a manifestation of high blood pressure, always remember that the disease can exist in silence, what is called asymptomatic in medical lingo.
- Irregular heart rhythms
- Chest pain
- Muscle tremors
- Vision changes
- Buzzing ears
- Shortness of breath
You don’t have to wait for the symptoms to come before you see a doctor. Make a habit of having your blood pressure checked. If you have any of the risk factors we have listed in the previous section, you could consider visiting your doctor more often.
Diagnosis of Hypertension
To diagnose high blood pressure, your doctor will do a measure of your blood pressure in a quick and painless process.
If your reading is not within the normal range, the doctor will request a few more readings. This can be done over the course of a few days. Hypertension is not diagnosed on the basis of a single reading because there are many conditions that can alter your blood pressure such as stress and anxiety.
Reading Blood Pressure
The blood pressure reading comes in two numbers which denote the systolic and diastolic pressure.
The numerator is the systolic BP which is the force exerted in the blood vessels when the heart is contracting. The contraction phase of the heart is called systole.
The denominator is the diastolic blood pressure is the pressure when the heart is relaxed. The relaxation phase is also called the diastole.
Based on the readings, blood pressure can be classified differently.
- Optimal Blood Pressure: This is defined by a blood pressure reading of less than 120/80 millimetres of mercury (mmHg).
- Elevated Blood Pressure: systolic BP between 120 to 129 and diastolic less than 80mmHg.
- Stage 1 Hypertension: systolic BP is between 130 and 139 and the diastolic reading is between 80 and 89mmHg.
- Stage 2 Hypertension: the systolic blood pressure is 140 or higher and the diastolic is 90mm Hg or higher.
- Hypertensive Crisis: The systolic BP is over 180mm Hg and the diastolic is above 120mm Hg. This requires urgent medical attention.
To measure blood pressure accurately, you need to have the correct technique.
- Ensure that you have a cuff that fits. The standard cuff size for adults is 12cm. Use appropriate cuffs for children and teenagers.
- The person who is having their blood pressure measured should be relaxed, seated with the back supported and the arm exposed and supported at the level of the heart.
- They shouldn’t have taken caffeine or smoked within the past 30 minutes.
The other tests that your doctor can order to aid in the diagnosis and management of hypertension are:
- Urine tests
- Thyroid function tests
- Blood lipid levels
- Blood electrolytes
- Blood creatinine
- Full haemogram
- ASO titres
This list is not conclusive. The test ordered will depend on the doctor’s judgment of your condition.
Complications of Hypertension
Sustained high blood pressure affects your blood vessels and different organs of the body. Here are the complications that can arise due to uncontrolled hypertension.
Stroke: chronic high blood pressure leads to hardening of blood vessels which can compromise the blood flow to the brain leading to a stroke.
Heart Attack: the deranged blood vessel calibre can lead to compromised blood supply to the heart leading to a heart attack.
Aneurysm: the increased blood pressure causes weakening of blood vessels and formation of a bulge called an aneurysm which can rupture leading to life-threatening events.
Heart Failure: hypertension causes a strain on the heart because it has to work harder to overcome the resistance. In the long run, the heart undergoes changes such as enlargement of chambers, in an attempt to adapt. However, this causes reduced capacity to function normally and leads to heart failure.
Kidney Failure: damage of blood vessels in the kidney leads to progressive failure of the kidneys to perform their functions normally.
Problems with Vision: damaged and narrowed blood vessels in the eye leads to poor vision and can progress to absolute vision loss.
Poor Cognition: Because of the effects of hypertension on the brain, one can lose their cognitive ability. People with hypertension are highly likely to develop memory problems as well as dementia.
Treatment of Hypertension
There are different management options for hypertension. Your doctor will make a decision depending on different factors such as the type of hypertension.
For primary hypertension, lifestyle changes can be tried before opting for medication. For secondary hypertension, the primary aim is to treat the underlying condition. If your elevated blood pressures are linked to hyperthyroidism, for instance, focus will be on reducing your thyroid hormone levels. However, your doctor will give medication to optimise blood pressure in the short term.
The aim of managing hypertension is to get the blood pressure to the optimum levels in order to prevent complications.
The non-Medical Home Remedies for Hypertension
Living a healthy lifestyle can help you manage the other risk factors for hypertension. Here are some of the life changes that you can undertake:
A healthy diet will help reduce your blood pressure and keep other vital modalities under control. A diet that is healthy for the heart includes
- A good share of fruits, whole grains and vegetables.
- Low trans fats
- Reduced salt intake to less than 5g per day
- Low dietary sodium (between 1500 and 2300 mg per day)
Physical activity or exercise helps to reduce blood pressure among a host of other benefits to the body. The recommended amount of exercise is at least 150 minutes of moderate intensity activity every week.
30 minutes of walking, jogging, swimming or cycling for a minimum of 5 days a week will achieve the needed workout.
Aim for Optimum Weight
Shed those extra pounds and you will be able to cut down the fat which puts you at a higher risk for disease progression and complications.
Manage your stress and anxiety levels because they have awful physiological effects on your cardiovascular system. Some of the things you can do include reading a book, meditating, yoga and exercise.
Tobacco destroys your blood vessels and your heart leading to increased blood pressure, not to mention the other detrimental effects it has on your health and social life.
Avoidance of Alcohol
Alcohol raises your blood pressure and it is advisable to cut down the intake or stop drinking altogether. If you are addicted, seek professional help.
The Medical Treatment for Hypertension
Your doctor will determine if you need medication and he or she will give an appropriate prescription. The choice of medication is dependent upon a number of factors such as the stage of hypertension, interaction with other medications, and presence of other conditions. You should never self-medicate on antihypertensive meds because you can expose yourself to adverse effects.
Here are the common drug classes that are used in the management of hypertension in Kenya.
Calcium Channel Blockers: These drugs cause a reduction in blood pressure by reducing the force of contraction of the heart and by reducing the resistance of blood flow in the blood vessels.
Examples of meds in this class include Amlodipine, Nifedipine, and Felodipine.
Diuretics: Diuretics work by increasing sodium excretion by the kidneys. This then causes fluid to tag along and thus the strain in the cardiovascular system is relieved. Diuretics dilute the urine.
Examples of diuretics include Hydrochlorothiazide(HCTZ), Chlorthalidone and Furosemide or Lasix.
ACE-Inhibitors: Angiotensin is an important chemical in the cardiovascular system whose effect is narrowing of blood vessels and consequently, an increase in blood pressure. ACE-inhibitors block the action of angiotensin converting enzyme (ACE) which promotes formation of angiotensin thus causing relaxation of blood vessels and consequent blood pressure reduction.
Examples of ACE-inhibitors are Enalapril, Captopril, Lisinopril and Ramipril.
Angiotensin II Receptor Blockers (ARBs): This class of drugs affect the same system as the ACE-inhibitors. It acts by blocking the action of angiotensin II and this results in relaxed blood vessels and a lowered blood pressure.
Examples of ARBs are Candesartan, Telmisartan and Valsartan.
Beta Blockers: Beta blockers block the beta receptors in your heart and this causes the heart to pump with less force thus delivering less blood to the vessels. the result is a reduction in blood pressure.
Examples of beta blockers are atenolol, labetalol and carvedilol.
“Hypertension .” World Health Organization , WHO, 13 Sept. 2019, www.who.int/news-room/factsheets/detail/hypertension#:~:text=The%20WHO%20African%20Region%20has,prevalence%20of%20hypertension%20(18%25).. Accessed 29 June 2020
KENYA NATIONAL GUIDELINES FOR CARDIOVASCULAR DISEASES MANAGEMENT. Ministry of health Kenya, 2018.