Hypertension is the medical term for the condition of sustained abnormally high blood pressure. The blood is pumped around the body under some pressure, but when this pressure is too high it puts a strain on the circulation and can increase the risk of heart attacks and strokes.
Why do we get high BP?
Well mostly we do not really know the answer to this. In most instances the precise cause of hypertension is not known, and this is referred to as “essential hypertension”. In a small number of cases the high BP is due to an underlying medical problem like kidney disease.
Who is likely to get hypertension?
We do know that certain things are more likely to be associated with hypertension. These include a high salt diet, overweight and obesity, lack of exercise, excessive alcohol intake and a family history of hypertension.
Why worry about hypertension?
Hypertension is regarded as a risk factor for heart disease (heart attacks) and blood vessel diseases ( strokes) —cardiovascular disease, in other words it increases the risk of getting these problems. The higher the BP, the higher the risk.
What else will increase the risk?
Other major risk factors for cardiovascular disease include a family history of early cardiovascular disease, smoking, high cholesterol, diabetes, increasing age (men over 55yrs., women over 65 yrs.), and obesity, -especially fat bellies, not fat bums! The combination of hypertension, diabetes, high cholesterol and obesity is often referred to as the “metabolic syndrome”.
How will you know if you have hypertension?
You will not, unless you get your BP checked. Hypertension is a silent process and most people will not be aware of it.
How should BP be checked?
BP fluctuates throughout the day and can be raised by fatigue, stress, and anxiety. Ideally BP needs to be checked when you are sitting, rested and relaxed, and should be raised on at least 3 separate occasions before a diagnosis of hypertension is made. Measurement of BP is not complicated but does rely on the skill of the person doing the measurement and good equipment. Automatic digital BP machines are convenient but are often inaccurate.
Some people get “white coat hypertension”—a bit anxious when the BP is measured in the doctor’s office, and this raises the BP giving a false impression of high BP.
When there is doubt, a 24 hour ambulatory BP measurement is best. This is done with a small portable device that measured the BP every 15 minutes in the day and every 30 minutes at night. This is the gold standard of BP measurement and gives an accurate picture of the BP over this time period. This is also very useful to monitor the control of hypertension is someone on treatment.
Why is BP given as two figures?
As the heart beats, it produces a wave of pressure that drives the blood through the body. We measure the pressure at the top of the wave (systolic pressure) and at the bottom of the wave between the heart beats (diastolic pressure). Both figures are important.
How should hypertension be managed?
Lifestyle changes are most important; Stop smoking, reduce the salt in your diet, reduce weight and try to exercise for 30 minutes a day. For those with mildly raised BP this alone may lower it to a normal level.
If there are other risk factors present like diabetes or high cholesterol, these should managed with more care.
What about medication?
Luckily there is a large range of relatively safe and effective medicines to treat hypertension. However, because our understanding of the problem is incomplete, one may need to try several medicines, singly or in combination before finding the correct treatment that does the job without side effects. Sometimes it can take several months of trying different medicines to find the correct tailor made solution. An additional complication is that your medical aid may only pay for a limited range of older less costly medicines.
How long should treatment continue?
Medicines do not “cure” hypertension but they do lower the BP and will lower the risk of strokes and heart attacks. If the medicines are stopped the BP will rise again. Treatment will need to be long term, possibly lifelong.
How often hypertension should be checked?
If the BP is well controlled 6 monthly checks will be sufficient. This will also include checking other risk factors for heart disease like weight, cholesterol and diabetes. More frequent checks will be needed if the BP is not well controlled.
Home BP checks with automatic digital machines is helpful in some instances, however in practice we find that these machines are often inaccurate and tend to cause more worry than necessary.
If you have concern about your blood pressure and your risk of heart disease, talk to your doctor about a multiple risk assessment to assess your personal risk. The good news is that by changing your lifestyle and lowering your blood pressure, you can reduce your risk of serious medical problems.