What is hypertension?
The pressure of air in a bus tyre must not be too high or too low. If it is too high it may burst without warning. If the pressure of water in a hose is too high it may suddenly burst. In the same way our blood flows to different parts of the body in blood vessels. If the pressure in the blood vessels is too high the blood vessels will become damaged over time. We do not always know why some people get high blood pressure. In a few people there are reasons like kidney disease and alcohol overuse.
What is the normal blood pressure?
Our heart is a pump that first fills with blood and then pumps it to the blood vessels. It then fills again and then pumps again. So blood pressure readings have 2 numbers. The first number or systolic BP is when the heart is pumping blood. The second number or diastolic BP is when it is filling. The normal blood pressure is 130 systolic and 80 diastolic and we write that as 130/80. Readings lower than 130/80 can be normal. However, the blood pressure of every person can vary from time to time. Anyone who keeps having readings over 140/90 has high blood pressure.
What are the effects of high blood pressure on the body?
If untreated high blood pressure damages the blood vessels to different parts of the body causing:
Strokes- we get sudden paralysis or numbness of one side of the body or speech which may not get better
Heart attacks- sudden blockage of blood vessel in the heart can cause severe chest pain and sudden death
Kidney failure
Damage to vision and many other problems Sadly these problems may happen very suddenly without warning.
When should I have my blood pressure checked?
You should check your blood pressure even if you feel well because in the early stages it causes no symptoms. All those over 18 years should have their blood pressure checked every 2 years. If you are overweight, have diabetes, do little exercise, smoke, drink alcohol, or have family members with high blood pressure you should have it checked once a year. Your health centre nurse or health worker can check your BP. You do not need to see a doctor to check BP.
Measurements
Long term diagnostic measurement of blood pressure in the clinic setting is required in it and it must be reliable. Other factors which affect the readings and thereby the reliability of this measurement.
The level of training of the observer.
The setting for the measurement of BP (home or clinic).
Timing of the day, preceding caffeine intake or smoking.
The position of the patient during the procedure.
The accuracy and validation of the BP measuring instrument as well as the provider is well trained.
The size and placement of the cuff, the number of readings taken.
Use of both existing mercury BP sphygmomanometers and digital oscillometric BP devices.
LIFESTYLE MODIFICATIONS IN HYPERTENSION
Physical Activity
Epidemiologic evidence suggests that physical activity reduces cardiovascular morbidity and mortality. Physical activity includes daily activity like walking and cycling, household work, work related activity, and leisure activity. Moderate intensity physical activity of 30 minutes per day or at least 2.5 hours (150 mins) per week should be advised to all individuals for its cardioprotective effect.
Weight Reduction
Reduced calorie diet, increased physical activity and behaviour modifications are the recommendations for weight reduction to shun off higher cardiovascular risk. BMI & WHR ratios well displayed in the following table.
| Normal | Over | Obese |
Body Mass Index (BMI) | 18.5 -20.9 | 23.0 - 24.9 | >25 |
Waist Hip Ratio (WHR) | < 0.85 | >0.85 | Above 1.0 |
Alcohol Consumption
Reducing alcohol intake can lower the blood pressure substantially. On other hand moderate drinking and binge drinking increases the blood pressure and risk of developing hypertension.Zero alcohol consumption is recommended for women who are pregnant or planning to have pregnancy and also for those hypertensives that had already suffered from a complication due to hypertension like stroke, heart disease or renal disease.
Tobacco cessation
Motivation therapies can be used to quit smoking. Brief advice from health professionals is effective in helping persons to quit smoking, increasing quit rates. Even 3–5 minutes taken to encourage smokers to attempt to quit can increase success rates. Smoking cessation may not reduce the blood pressure directly but markedly reduces overall cardiovascular risk. The risk of myocardial infarction is 2–6 times higher and the risk of stroke is 3 times higher in people who smoke than in non-smokers. Smokers who quit reduce their risk of coronary heart disease.
Dietary Recommendations
All patients should be encouraged to adopt a heart healthy diet. Screening, Diagnosis, Assessment, and Management of Primary Hypertension Full Document Fat: All individuals should be strongly encouraged to reduce total fat and saturated fat intake. Total fat intake should be reduced to about 30% of calories, saturated fat to less than 10% of calories, trans-fatty acids (present in margarine and bakery products) intake should be reduced as much as possible or eliminated and most dietary fat should be polyunsaturated (up to 10% of calories) or monounsaturated (10–15% of calories).
Salt intake
All individuals should be strongly encouraged to reduce daily salt intake by at least one third and, if possible, to <5g or <90mmol per day. Fruits, vegetables, fibre: All individuals should be encouraged to eat at least 400 g a day of a range of fruits and vegetables as well as whole grains and pulses. Reduction of salt intake through Pickles, chutneys, sauces and ketchups, papads, chips and salted biscuits, cheese and salted butter, bakery products and dried salted fish, should be recommended.
Stress Management
In today’s technology driven times where mobility is quite low, a variety of stress may be contributing to blood pressure elevation, stress management should be considered as an intervention. A recent systematic review and meta-analysis of Yoga as an adjunct to medical therapy, concluded that there were clinically important effects on cardiovascular disease risk factors and that Yoga could be considered an ancillary intervention to reduce cardiovascular risk.
If I have high blood pressure, what can I do to help it myself?
Several measures which can be taken into consideration are as follows:
Reducing smoking as it increases the damage caused by high blood pressure.
If you already do not do hard work, do some exercise you enjoy doing that makes you a little short of breath for at least 30 minutes each day.
If you are overweight, reducing your weight by even 5 kg over 6 months can lower blood pressure.
Otherwise reduce the salt you add in cooking by half.
Avoid fatty food like oils or oily fried food, fatty meat (take off the fat before you cook goat or take the skin off chicken).
Eat more vegetables and fish and avoid excessive alcohol and salt consumption.
Don’t drink more than 2 glasses of coffee each day.
Chronically sedentary individuals should not start a program of vigorous activity suddenly, but should gradually increase the duration and intensity of physical activity, diet management, and salt reduction to minimise these health risks. Any patient experiencing chest discomfort, jaw pain, palpitations, syncope or dyspnoea, should undergo evaluation before continuing with exercise. Patients with decompensated heart failure and acute coronary syndromes should not embark on an exercise program.
A person must undergo a complete formal check-up