The Hypertension Pandemic

Hypertension is commonly known as high blood pressure by most of us. Its not uncommon to hear someone say “Alipatikana na pressure” or “pressure yangu hukuwa sawa” Hypertension is a condition where our body is unable to keep our blood pressure levels within normal range. High blood pressures slowly cause detrimental changes in the body. This changes lead to destruction of essential organs in our bodies. As with most non communicable diseases, most people live with high blood pressure for a long time, years even without its diagnosis and only see a doctor when there is a complication.

I recently managed an early 30s gentleman who had developed a sudden severe headache followed by sudden weakness on this right side. He could not use his right arm nor right leg. One sided weakness is classic for a stroke and after proper medical history and examination, he was found to have suffered a stroke secondary to high blood pressure. His heart also showed some changes that are consistent with hypertensive heart disease (was slightly dilated). This is evidence that he had had high blood pressure for a while. He was hospitalized for a couple of days and discharged after much improvement. A stroke is one of the complications of undiagnosed and untreated high blood pressure. Sadly, this is not an isolated case, and daily in many hospital floors, many patients with undiagnosed hypertension walk in with life changing complications.

A huge number of people do not know they are hypertensive, some of those who know they are hypertensive wish it way or are not on medication while some of those on medication have poor adherence. Hypertension is a major and primary risk factor for cardiovascular diseases such as heart failure, stroke, heart attack and even kidney disease. 40% of deaths caused by cardiovascular diseases are due to hypertension. worldwide, it is the biggest contributor to the global burden of disease and to global mortality, leading to 10.8 million deaths each year (global burden of disease 2019)

Locally, Most hospitals have dedicated a special clinic day for follow up for non communicable diseases, mostly hypertension and diabetes. This is in an effort to reduce the incidence of complications that come about if this conditions are poorly controlled. The number of patients seen in this clinics is on a constant upward trend. However, measures to frequently screen for non communicable diseases, especially in asymptomatic have not caught up.

Blood pressure is the measure of the force exerted by circulating blood on the walls of blood vessels. This pressure is determined by how hard the heart beats and the resistance of blood vessels. Think of our body having a closed pipe circuit. The heart is the pump and the blood vessels are malleable pipes that can expand and contract at the influence of body hormones and some other factors. The expansion and contraction of the blood vessels and how fast and hard our heart beats controls the pressure of the blood within.

Blood pressure is determined by measurements. The measurements is done and recorded in two numbers as follows;

• Systolic blood pressure – This number indicates the blood pressure exerted against the walls of arteries when the heart beats.
• Diastolic blood pressure – This refers to how much pressure is exerted against artery walls while the heart is resting between beats.

Blood pressure categories

According to the American Heart Association, there are five categories of blood pressure, namely;

1. Normal
2. Elevated
3. Hypertension stage 1
4. Hypertension stage 2
5. Hypertensive crisis

Each stage is determined by the amount of systolic and or diastolic pressure and the effect the pressure has on body organs, as in the following table.

What causes High Blood Pressure?

The cause of most adult hypertension cases remains unknown despite a lot of research in the area. About 90 to 95% of hypertensive cases are of unknown origin. Hypertension that is not caused by an underlying condition is referred to as essential hypertension or primary hypertension. It’s thought that this primary type could be as a result of both environmental and genetic factors.

If an underlying condition is the cause, its known as secondary hypertension.

Secondary hypertension is caused by a condition or complication of another health problem. For example, Chronic Kidney Disease (CKD) commonly causes hypertension.

Other conditions that lead to secondary hypertension include the following;

• Diabetes due to kidney problems.
• Cushing syndrome.
• Pregnancy
• Obesity; being overweight or obese increases the work the heart has to do to pump blood. This strains both the heart and the blood vessels.
• Pheochromocytoma, a rare cancer of an adrenal gland.
• Aldosteronism. The adrenal glands produce too much of the hormone aldosterone. This makes your kidneys retain salt and water and lose too much potassium, which raises blood pressure.
• Thyroid problems. When the thyroid gland doesn’t produce enough thyroid hormone (hypothyroidism) or produces too much thyroid hormone (hyperthyroidism), high blood pressure can result. 
• Medications and supplements – For some people, prescribed medications can cause or worsen high blood pressure. These for instance are pain relievers, antidepressants, birth control pills and drugs used after organ transplants. Illegal drugs like cocaine and methamphetamine also cause high blood pressure.

What are the symptoms of high blood pressure?

The danger of hypertension is that you may not know that you have it. Approximately one-third of people who have high blood pressure do not know, because it does not present any symptoms for starts. The best way to determine if your blood pressure is high is through regular checkups. The following are some of the symptoms of severe blood pressure;

• Nose bleeding.
• Blood in urine
• Irregular heart beat
• Severe headaches
• Chest pains
• Difficulty in breathing
• Pounding in your chest, neck or ears.
• Fatigue
• Vision problems.

If you have any of these symptoms, it’s important to see a doctor. You could be having a hypertensive crisis that could lead to a complication eg a heart attack or stroke. this, how ever are not exclusive symptoms to hypertension and could be symptoms to another health condition, hence the importance of seeing a doctor and regular health checks

Most of the time, high blood pressure doesn’t cause headaches or nosebleeds. But, this can happen in a hypertensive crisis when blood pressure is above a certain range. Very high reading of blood pressure is considered a medical emergency and should be attended by qualified healthcare worker. For those already diagnosed with hypertension and on medication, it is important to have home based blood pressure measurements. This enables proper follow up, warns when there is need to see a doctor and also enables drug monitoring.

What are the complications of high blood pressure?

Without proper medication, high blood pressure can cause other health problems such as;

1. Arteries being damaged – hypertension can cause the hardening of arteries which in effect can cause heart attack.
2. Aneurysm – increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
3. Heart failure – When the heart pumps against high blood pressure in the blood vessels, its muscles thickens. Eventually, thick muscles gives it a hard time pumping enough blood to meet the needs of the body. This can lead to heart failure.
4. Trouble with memory or understanding – This is common with people with high blood pressure.
5. Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
6. Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from working properly.

Risk factors of high blood pressure

Developing medical conditions that can cause high blood pressure is a great risk factor. Examples of these conditions are kidney problems, heart problems, and artery and endocrine problems. However it is important to keep in mind that most cases of adult hypertension are of unknown cause.

The following are the categories of people who are more likely to develop high blood pressure;

1. Smokers
2. People whose family members have high blood pressure.
3. Pregnant women.
4. Those above the age of 35.
5. Those who are overweight and obese
6. Those who are not active in physical exercise.
7. Those who drink alcohol excessively
8. People who eat too many fatty foods or foods with too much salt

Remember that hypertension may be asymptomatic for a long time and may only present when it’s late, with a complication (e.g. a stroke, heart attack, kidney failure). Therefore, it is recommended that you see a doctor for regular checks. The American Heart Association recommends that adults with normal blood pressure should have their blood pressure checked every year at routine heath visits. If you have developed high blood pressure, the doctor might recommend that you monitor it often at home and have more frequent hospital checks. Home monitoring works better as the record kept can be shown to a doctor. Being intentional about your health seeking behaviour is key in ensuring an optimally healthy life. Make daily healthy lifestyle changes that optimise your health

Dr Wanjira Wachira