Hypertension – The Silent Killer

Hypertension is the clinical term for high blood pressure. Blood pressure is the force exerted against the walls of blood vessels by blood. How high your blood pressure is, depends on the resistance of your blood vessels to the flow of blood, and how hard your heart works.

Blood pressure is measured at two levels namely the systolic and diastolic. Blood pressure is considered normal when the systolic is at or below 120 mmHg and diastolic is at or below 80 mmHg. Levels higher than these are considered elevated. When this condition continues for a prolonged period, it may result in severe health complications such as an increased risk of stroke, heart disease, and in some cases, death.

Hypertension is a major risk factor for cardiovascular conditions, such as heart attack, stroke, aneurysm, and heart failure. Regulating your blood pressure plays a very important role in health preservation. It also reduces the risk of these conditions. Prevalence of hypertension is increasing in Nigeria. Recent studies have shown a prevalence rate of about 38% among adults 18 years and older in the country. They also show that the gap in prevalence which once existed between rural and urban dwellers is closing.

Stages of Hypertension

According to the American Heart Association, blood pressure is considered above normal when it rises above 130/85 mmHg. The following are the respective categories of blood pressure measurements:

  • Normal: the systolic blood pressure is less than 130mmHg while the diastolic blood pressure less than 85 mmHg.
  • High Normal: the systolic blood pressure is between 130 – 139 mmHg while the diastolic blood pressure is also less than 85 – 89 mmHg.
  • Stage 1: the systolic blood pressure is within the range of 140-159 mmHg while the diastolic may be within the range of 90-99 mmHg.
  • Stage 2: the systolic blood pressure is equal to or greater than 160 mmHg while the diastolic will be at least 100 mmHg.

People in Stage 1 require treatment especially if they have heart disease or other underlying health conditions, like diabetes.

Types of Hypertension and Their Causes

Primary Hypertension

Primary hypertension is also known as essential hypertension. Many hypertensive adults are in this category. To date, no specific cause of this condition has been identified. However, it is believed that diet, genetics, age, and lifestyle may play a role in this condition. Lifestyle factors that may constitute a risk for this condition include alcoholism, smoking, stress, excessive salt intake, being overweight, and living a sedentary lifestyle.

Lifestyle and dietary changes can cause a reduction in your blood pressure. They can also reduce your risk of complications from this condition.

Secondary Hypertension

In secondary hypertension, there is an identifiable cause. In many cases, this cause is potentially reversible. It is important to note that 5-10% of hypertensive cases globally are of the secondary type. There is a higher prevalence of secondary hypertension among younger people. A 2017 study suggests that over 30% of hypertensive people between the ages of 18-40 have secondary hypertension.

Factors that may contribute to secondary hypertension include:

  • Adrenal gland disease
  • The arteries that supply blood to the kidneys narrows
  • Thyroid conditions
  • Obstructive sleep apnea
  • As a side effect of some medications, including diet aids, birth control pills, antidepressants, stimulants, and certain over-the-counter medications
  • Hormone abnormalities

Treatment and Management of Hypertension

The initial approach to managing hypertension is lifestyle adjustments. Here are some recommendations:

Regular Exercise

Everyone, both hypertensive and non-hypertensive must engage in at least 150 minutes of aerobic exercise weekly. This exercise may be of moderate intensity. A second option would be 75 minutes of high-intensity exercises weekly.

Exercise should be done for at least 5 days weekly. Exercises that will help in the management of hypertension include jogging, walking, swimming, and cycling amongst others.

Destressing (Stress Management or Stress Reduction)

Managing or avoiding stress can help with blood pressure control. Examples of relaxation techniques that can relieve stress include:

  • Meditation
  • Yoga
  • Warm baths
  • Going on long walks

Social Habits

The use of drugs, alcohol, and tobacco also contribute to an increase in blood pressure as well as complications of high blood pressure. Reducing or eliminating their use helps to reduce the risk of hypertension and complications from cardiovascular disease.

High consumption of alcohol can increase blood pressure. Men should take at most two drinks daily, while women should take no more than a drink per day. The following counts as a drink of alcohol:

  • 4 oz of wine
  • 12-ounce of beer
  • 1 oz of 100-proof spirits
  • 1.5 oz of 80-proof spirits

Diet

Adopting a heart-healthy diet can help prevent high blood pressure. You can do this by:

  • Reducing salt intake: In most places in Nigeria, people take between 9-12g of salt daily. This is due to the proliferation of junk foods. The World Health Organization recommends taking no more than 5g of salt daily.  This will help reduce your risk of hypertension and related heart conditions. Reducing salt intake is beneficial even to those without hypertension.
  • Reduction of fat intake: Hypertensive people or people who are at risk should reduce their intake of saturated or total fat. Rather, you may eat foods like:
  • Different fruits and vegetables
  • Whole grains and high fiber foods
  • Nuts, pulses, and beans
  • Low-fat dairy products
  • Skinless fish and poultry
  • Olive oil, and other non-tropical vegetable oils

Hydrogenated vegetable oils, trans fats, and animal fats should be avoided. Large portion sizes should also be avoided. Fats found in olive oil and oily fish are heart healthy. However, the fact remains that they are fats. As such, hypertensive people should limit their consumption of them.

Weight Management

Being overweight is a major risk factor for hypertension. Weight loss is accompanied by a reduction in blood pressure because the workload on the heart will reduce. In overweight people, the heart must pump blood around the body, and that’s a lot of hard work.

A good diet and regular exercise are effective mechanisms for managing weight.

Medication

Some specific medications can be used for the treatment of hypertension. Initially, clinicians will recommend a low dose of these medications and adjust them over time as their effectiveness on the individual is clear. Over time, hypertensive people will need to combine a couple of medications to manage their condition. The medications used to treat hypertension are in several categories including:

  • Central agonists
  • Calcium-channel blockers
  • Diuretics, such as chlorthalidone, thiazides, and indapamide
  • Vasodilators
  • Angiotensin receptor blockers
  • Angiotensin-converting enzyme inhibitors
  • Peripheral adrenergic inhibitors

The kind of medications administered depends on the individual and any other underlying conditions they may have. These drugs should only be used under the guidance of a medical doctor.

Conclusion

Hypertension is known as a “silent killer” because it rarely shows symptoms. There are several risk factors which make individuals susceptible to it. While some of the factors cannot be controlled (e.g., genetic factors), many factors can be effectively controlled. Regular monitoring of blood pressure levels is essential in effectively managing the overall condition of the heart.

References

  1. Adeloye D, Basquill C, Aderemi AV, Thompson JY, Obi FA. An estimate of the prevalence of hypertension in Nigeria: a systematic review and meta-analysis. J Hypertens. 2015; 33:230–42.
  2. Alley WD, Schick MA. Hypertensive Emergency. [Updated 2020 Nov 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470371/
  3. Lesley C, Jean T, Bonnie D. Secondary Hypertension: Discovering the Underlying Cause. Am Fam Physician. 2017. 96(7): 453-461
  4. Odili et. al. Prevalence, Awareness, Treatment and Control of Hypertension in Nigeria: Data from a Nationwide Survey 2017. Glob Heart. 2020; 15(1): 47
  5. Unger et. al. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension. 2020. 75(6): 1334–1357