An overview of Hypertension & it's Prevention:

Dr. Sagardeep Datta

November 22, 2021, 11:06:35   

An overview of Hypertension & it's Prevention:

Hypertension is a common medical disorder across the world which has been growing in intensity with  changing life-styles, evolution of individual and collective world view, fast changing moral value system and also perhaps rapid changes in climate. Needless to say that Hyper tension is virtually a universal problem that creates a host of complications in human health leading to critical diseases including life-threatening ones . But how this problem is created and how this should be handled is the hottest topic in any discussion over health and well being. But the issue has to be seen  with a holistic approach, delving deep into roots and dwelling at length on  the ramifications. The following article is a modest attempt at this :

 

Before going to topic proper, let us understand the basics of the Circulatory system. This system deals with the transport of blood and thus various nutrients and oxygen to every nooks and corner of body .Blood is the red coloured fluid flowing through heart and blood vessels. Blood is rightly referred to as liquid Connective tissue. Blood is composed of two main constituents-Plasma, which is the liquid part of blood and Cellular elements- Red Blood Cell (RBC), White Blood Cell (WBC), Platelets. The total Blood volume is 5-6 litres. Blood flows through minute channels or tubes called Blood Vessels-Arteries, Veins, Capillaries.


Blood Pressure or Arterial Blood Pressure (BP) is the lateral (side) pressure exerted by the flowing column of blood on the wall of arteries. Blood Pressure (BP) is measured by Sphygmomanometer. Quite often you must have noticed that while measuring BP, the doctor puts on record two values-the upper value is called Systolic Blood Pressure (SBP) which is the maximum pressure generated in the arteries during Systole (a state of contraction of heart wherein heart pumps blood to all organs of body) and the lower  value is called Diastolic Blood Pressure(DBP) which is the minimum pressure generated in the arteries during Diastole(a state of relaxation of heart wherein heart receives blood).

 

There are many physiological factors which affect BP

 

  Age: As age increases both SBP and DBP increase. With ageing there is thickening of arteries ( a process called Arteriosclerosis) and there is increase in both SBP and DBP.

 

Gender: BP is higher in men than women at similar ages. After menopause, SBP in women becomes more than men of same age.

 

 Body Built: It has been seen in some studies that BP is more in obese persons than lean persons.

 

 Emotions: Excitement, fear, worry increase SBP.

 

 Meals: SBP increases by 5-6 mm Hg upto 1 hr after meals.DBP remains same or decreases slightly.

 

 Sleep: SBP falls by 15-30 mm Hg during early hours of sleep. But disturbed sleep causes increase in SBP.

 

 Diurnal variation: In a single day, a 5-10 mm Hg variation of SBP is common .Peak values of SBP recorded during afternoon and lowest values during early hours of morning.

 

 Exercise:  After exercise, there is increase in SBP but the DBP may remain unchanged or slightly decrease after moderate exercise.


Now understanding the definition of Hypertension, we will follow the ACC/AHA guidelines:

 

                Category

 SBP

DBP

  • Normal BP

Less than 120 mm Hg    &

Less than 80 mm Hg

  • Elevated BP

120-129 mm Hg              &

Less than 80 mm Hg

  •  Stage 1 Hypertension

130-139 mm Hg              or  

80-89 mm Hg

  • Stage 2 Hypertension

More than or equal to 140 mm Hg                                      or

More than or equal to 90 mm Hg.


While recording BP, two readings should be taken 5 mins or 30 mins apart and then again next day or 1 week apart. Therefore, two or more than two BP readings on two or more than two occasions is a must.

 

Hypertension is a disorder with multiple genetic and environmental contributions. The most common cause of Hypertension is Essential or Primary Hypertension (90-95%)  which means that there is no identifiable cause of Hypertension.  Secondary Hypertension is the other entity which means Hypertension in the presence of an identifiable cause such as-


ü  Kidney diseases( Chronic Kidney Disease, Acute glomerulonephritis)

 

ü  Hormonal causes(Thyroid disturbances- Hyper/Hypothyroid)

 

ü  Exogenous intake of steroids, Birth control pills and certain drugs.

 

ü  Pregnancy can also cause Hypertension.

 

ü  Acute stress including surgery.

 

ü  Pheochromocytoma ( tumour of Adrenal gland).

 

ü  Polycystic ovarian disease in females

 

ü  (ovary laden with cyst).

Coarctation of aorta (Narrowing of aorta, usually congenital).


Yet another entity is Malignant Hypertension characterised by severe hypertension with SBP 200 mm Hg and DBP 120 mm Hg with organ damage.

·        Risk factors of Hypertension:


Ø  Obesity:  Greater the weight gain, greater is the risk of High BP.

 

Ø  Smoking:

 

Ø  Salt intake:  High salt intake (7-8 gm/day) increases BP proportionately.

 

Ø  Excess intake of saturated fat:

 

Ø  Excess alcohol consumption:

 

Ø  Sedentary lifestyle:

 

Ø  Stress:

 

Ø  Ethnicity: Studies reveal consistently high BP in black communities than other ethnic groups.

 

Ø  Hereditary: Familial tendencies of Hypotension (Low BP) or Hypertension with SBP are common.

 


Effects of Uncontrolled Hypertension/Untreated Hypertension on various organs:

Ø  Heart:  Risk of Heart failure ( Heart is unable to pump blood) increases.

 

Ø  Brain: Risk of stroke, encephalopathy increases.

 

Ø  Kidney: Risk of Renal/Kidney failure increases.(kidney is unable to clear waste products)

 

Ø  Eyes:  There is also eye damage (Retina, inner layer of eye is damaged: Hypertensive retinopathy).

 

The constellation of Hypertension, Obesity, Insulin Resistance (Insulin which maintains normal blood glucose level is unable to work), Dyslipidemia ( Altered fat levels in body leading to increased cholesterol level) is called Metabolic Syndrome, which is the modern epidemic.

 

Hypertension remains asymptomatic and undiagnosed for many years so it should be diagnosed at the earliest to prevent complications subsequently. For this purpose, proper medical care is essential. Consult with a health care professional at the earliest. Routine BP monitoring is essential. With the advances in biomedical research, we have plentiful drugs for managing Hypertension which should be taken religiously if prescribed by a health care professional.


PREVENTIVE ASPECT:

To prevent the emergence of risk factors, the following measures should be adopted:


Ø  Weight Reduction is the first and foremost step. Attain and maintain BMI (Body Mass Index: Weight in Kg÷ Height in meter²):18.5 -24.9.

 

Ø  Dietary salt reduction: To less than 6 g salt(sodium chloride) per day

 

Ø  DASH diet: Dietary approaches to stop Hypertension. Consume a diet rich in fruits (75 gm), green leafy vegetables (300 gm) and low fat dairy products with a reduced content of saturated fat and total fat.

 

Ø  According to WHO, the total Fat intake should be less than 30% per day incase of adult. Saturated fat should be less than 10% per day. Most animal fats are saturated. Saturated fat is present in processed foods like sausages, ice cream, cheese, butter.

 

Ø   Sugar intake should be less than 50 gm per day. Remember excess carbohydrate in the body gets converted to fat.

 

Ø  Intake of PUFA (Poly unsaturated Fatty Acids) should be encouraged in therapeutic doses. PUFA are seen in vegetable oils like sunflower oil & fish oils. Omega () 3 fatty acid like linolenic acid (sources include marine fish oil) is also a type of PUFA and their consumption has shown cardio protection in many studies. However don’t self medicate. Seeking expert opinion is of paramount importance.

 

Ø  Protein should account for approximately 10-15% of daily intake. Normal protein requirement is 1gm/Kg in a healthy adult.

 

Ø  Plant derived fiber reduces blood level of cholesterol. So intake of dietary fiber should be considered. Onion and garlic also reduce blood cholesterol and triglyceride.

 

Ø  Refrain from smoking at all cost. Smoking increases the level of LDL (Bad Cholesterol)

 

Ø  Avoid Junk foods. They contain Trans Fatty Acid which has many deleterious effect on heart.

 

Ø  Antioxidants like vitamin E and selenium prevent fat deposition in liver and can be considered after proper consultation.

 

Ø  Alcohol in moderate quantity can increase HDL (Good cholesterol) and can dilate blood vessels. For males 2 drinks per day. For females ≤1 drink per day.(1 drink=15 gm ethanol)

 

Ø  Don't take exogenous steroids to enhance muscle mass and birth control pills without proper consultation with a doctor.

 

Ø  Regular aerobic exercise e.g. Brisk walking for atleast 30 mins per day is the most effective intervention.

 

Ø  Ensure adequate intake of water. A simple way to remember is 8 glasses of water per day or 2-3 litres of water per day on an average.

 

Ø  A proper 7-8 hrs of sleep is of utmost importance.

 

Ø  Regular checkup of BP and if needed Lipid profiles.

 

Ø  Regular visit to health care professional.

 

Ø  Compliance to drugs should be ensured if the patient is on antihypertensives. Don’t stop antihypertensives without consulting a doctor.

 

Ø  Don't selfmedicate at any time.

Practicing some mind relaxing exercise such as Meditation or Breathing exercise will help you in keeping a positive mindset.


Remember, the Body, Mind & Intellect are our assets. In this era, where there is competition in all spheres of life, taking care of your body and mind is of paramount importance inorder to sustain yourself.

Take the first step towards your health care & you will see the result.





   (Tripurainfo)