Hypertension causes and treatment

Do you want to live a healthy and disease-free life? Then try to maintain your blood pressure within a normal range (A healthy blood pressure is below 120/80 mmHg). Hypertension (commonly known as high blood pressure) is a disease in which the pressure of the blood against the artery walls becomes so high, that it leads to heart disease, stroke and other diseases. Blood pressure is determined both by the volume of blood your heart pumps and the resistance to blood flow in the arteries. Hypertension is commonly asymptomatic - you may feel perfectly normal. However, symptoms such giddiness and headache may appear if blood pressure is very high.

There are generally 2 types of hypertension

Primary hypertension:

Usually, there is no detectable cause of hypertension. This type of hypertension is known as primary or essential hypertension and usually develops slowly over many months or years. This is the most common type of hypertension.

Secondary hypertension:

Some people have hypertension due to underlying causes. Such secondary causes include kidney disease, sleep apnoea, tumors of the adrenal gland, thyroid disorders, some medicines including pain relievers, oral contraceptives and recreational drugs such as amphetamines and cocaine.

Are you at risk of hypertension?

Anyone can develop hypertension, but some factors increase the risk of developing high blood pressure, namely:

• Age: As you grow older, your blood vessels lose their flexibility due to the reduction of elastic tissue in your arteries. They become harder and stiffer, which increases blood pressure.
• Weight: If you are overweight (BMI > 23), you are at higher risk of developing hypertension as compared to normal-weight individuals.
• Family history of hypertension: Having first degree family members with hypertension puts you at greater risk of developing hypertension.
• Sedentary lifestyle: A sedentary lifestyle is a risk factor for hypertension. It can also lead to weight gain which can also lead to hypertension.
• Diet: A diet high in sodium (table salt) increases blood pressure.
• Smoking: Tobacco and nicotine increases blood pressure.

Complications of hypertension:

Common complications of hypertension are kidney failure, heart attack, vision loss, metabolic syndrome, peripheral artery disease, stroke, dementia and erectile dysfunction. It is also known as a ‘silent killer’ in that it usually does not cause bodily discomfort, but gradually lead to long term and severe complications, which may result in death.

Screening and diagnosis:

Screening for hypertension is done through an automatic or manual sphygmomanometer (blood pressure machine). The World Health Organization recommends annual blood pressure screening for people aged 40 years and above.

You can get your blood pressure checked by a doctor or trained healthcare professional at a clinic or with a home blood pressure monitor. A blood pressure monitor with upper arm cuff is preferred.

It is important to check home blood pressure because 10-30% of people have white coat hypertension – these people have normal blood pressure at home, but elevated blood pressure whenever they are in a clinic or healthcare setting.

The following diagram shows you how to check your blood pressure properly at home.

Hypertension management:

High blood pressure is treated through medications, diet, and lifestyle modification. Generally, treatment is needed when your blood pressure is consistently above 140mmHg systolic OR above 90mmHg diastolic.

1. Medications:

Common medicines for hypertension include angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin II receptor blockers (ARBs), beta-blockers, calcium channel blockers and diuretics (drugs that help your kidney to remove extra water and sodium from the body). These are easily remembered as ABCD. Depending on the severity of hypertension, most doctors will prescribe one to two medications or a combination pill containing two medications.

2. Diet and Hypertension

Dietary Approaches to Stop Hypertension (DASH) diet is one dietary plan aimed at reducing blood pressure. It focuses on reducing salt intake, and taking more vegetables, fruits, lean protein and whole grain.

You can reduce your salt intake by:

1. - Cooking with less salt and sauces. Instead enhance the taste of food with herbs and spices
2. - Avoiding preserved and salted food like salted eggs, luncheon meat and sausages
3. - Asking for less sauce and gravy when eating out
4. - Choosing fresh food over processed food

Other beneficial foods include those high in magnesium, calcium and potassium such as avocados, nuts, seeds and tofu.

HPB (Health Promotion Board) has introduced an approach to healthy eating called My Healthy Plate. Quarter, Quarter, Half is an easy way to remember the right proportions of food in a well-balanced healthy meal:

1. - Quarter plate of whole grains
2. - Quarter plate of healthy source of protein
3. - Half plate of fruits and vegetables

3. Lifestyle modifications:

Maintain a healthy body weight:

Maintain a healthy body weight with an active lifestyle and healthy diet. Aim for a BMI (Body mass index) below 23 (for Asians). The formula for BMI is weight in kilograms divided by height in meters squared.

Do regular exercise:

An active lifestyle is important in maintaining healthy body weight and preventing hypertension. Aim for 150 minutes of physical activity per week. Lifestyle activities like mopping the floor and climbing stairs also count towards the 150 mins weekly goal. Generally, moderate intensity aerobic exercise such as walking, cycling, jogging and swimming are beneficial in the prevention and treatment of hypertension.

Limit alcohol consumption:

Too much alcohol intake can put you at risk of hypertension. It is also harmful to the liver.

The recommended daily limit for alcohol consumption is 2 standard drinks for men and 1.5 for women.

Stop smoking:

Being a smoker increases your risk of developing stroke, heart diseases, lung diseases, and high blood pressure. Quitting smoking will reduce your blood pressure. If you already have high blood pressure, quitting smoking will lower your risk of developing complications such as stroke or heart attack.

Manage stress and anxiety:

Stress and anxiety may contribute to high blood pressure. Proper management of depression, anxiety, and stress help in lowering blood pressure. You can manage stress with proper counseling, adequate sleep, a healthy diet, and exercise. Some studies have shown that practices like mindfulness and meditation have beneficial effects in lowering blood pressure.

Take home messages:

1) High blood pressure often does not cause any symptoms or bodily discomfort.

2) It is a silent killer. It can gradually lead to long term complications if it is not detected or treated.

3) A normal blood pressure is about 120/80 mmHg

4) Treatment is usually initiated when blood pressure is above 140mmHg systolic or above 90mmHg diastolic.

5) If medications are warranted and prescribed, it is important to take them regularly every day. Hypertension is a long-term disease, so medications should not be stopped unless advised by the doctor.

6) A healthy diet, lifestyle changes, exercise, smoking cessation and moderation of alcohol intake are all important aspects of blood pressure management.

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This article is presented to you by GP+ Co-operative