Dr. Sushil Kumar Sharma
World Hypertension day is celebrated annually on the 17th May. The main aim of the day is to educate the public and increase awareness of hypertension, which is also commonly known as high blood pressure. The expanded theme for World Hypertension Day is to Measure Your Blood Pressure accurately, Control It, Live Longer, with a goal of increasing high blood pressure (BP) awareness in all populations around the world. Main crux of this theme is focusing on combating low awareness rates worldwide, especially in low to middle income areas, and accurate blood pressure measurement methods. Amid the resurgence of second wave of Covid particularly in our setup this task of creating awareness has become even more challenging but still we have to manage it with all the resources available whether in online or offline mode.
Prevalence: Hypertension is a major cause of a range of health problems such as strokes, heart attacks and kidney disease, and can also contribute to dementia. Globally, an estimated 26% of the world’s population (972 million people) has hypertension, and the prevalence is expected to increase to 29% by 2025, driven largely by increases in economically developing nations.The high prevalence of hypertension exacts a tremendous public health burden. As a primary contributor to heart disease and stroke, the first and third leading causes of death worldwide, respectively, high blood pressure was the top modifiable risk factor for disability adjusted life-years lost worldwide. In some recent studies both covid-19 case fatality rates and hypertension prevalence increases with age, reaching 8.0% and over 50% respectively for the 70 to 79 year age group.
Symptoms of hypertension :Hypertension is generally a silent condition. Many people won’t experience any symptoms.It may take years or even decades for the condition to reach levels severe enough that symptoms become obvious. Even then, these symptoms may be attributed to other issues.
Symptoms of severe hypertension can include:HeadachesShortness of breathEpistaxisFlushingDizzinessChest painLoss in VisionThese Symptoms require immediate medical attention .They don’t occur in everyone with hypertension, but waiting for a symptom of this condition to appear could be fatal.The best way to know if you have hypertension is to get regular blood pressure readings.
Risk factors for developing high blood pressure :Family HistoryAdvanced AgeGender Related risk patternLack of Physical ActivityPoor Diet, especially one that includes too much saltOverweight and obesityAlcohol ConsumptionStress and Ethnic back ground
Possible contributing factors : Stress , Second hand Smoke , Sleep Apnea.
Causes of Hypertension:There are two types of hypertension.Primary hypertension – Primary hypertension is also called essential hypertension. This kind of hypertension develops over time with no identifiable cause. Most people have this type of high blood pressure. Researchers are still unclear what mechanisms cause blood pressure to slowly increase. A combination of factors may play a role. These factors include:Genes: Some people are genetically predisposed to hypertension. This may be from gene mutations or genetic abnormalities inherited from your parents.Physical changes: If something in your body changes, you may begin experiencing issues throughout your body. High blood pressure may be one of those issues. For example, it’s thought that changes in your kidney function due to aging may upset the body’s natural balance of salts and fluid. This change may cause your body’s blood pressure to increase.Environment: Over time, unhealthy lifestyle choices like lack of physical activity and poor diet can take their toll on your body. Lifestyle choices can lead to weight problems. Being overweight or obese can increase your risk for hypertension.Secondary Hypertension – Secondary hypertension often occurs quickly and can become more severe than primary hypertension. Several conditions that may cause secondary hypertension include:kidney diseaseobstructive sleep apneacongenital heart defectsproblems with your thyroidadverse effects of certain group of medicationsalcohol abuse or chronic useadrenal gland problemscertain endocrine tumorsBasic and Optional Laboratory Tests for Primary HypertensionFasting blood glucoseComplete blood countLipid profileSerum creatinine with eGFRSerum sodium, potassium, calcium*Thyroid-stimulating hormoneUrinalysisElectrocardiogramOptional testing EchocardiogramUric acidUrinary albumin to creatinine ratioHigh blood pressure Emergencies : High blood pressure is usually a chronic condition that gradually causes damage over the years. But sometimes blood pressure rises so quickly and severely that it becomes a medical emergency requiring immediate treatment, often with hospitalization.In these situations, high blood pressure can cause:Memory loss, personality changes, trouble concentrating, irritability or progressive loss of consciousnessStrokeSevere damage to your body’s main artery (aortic dissection)Chest painHeart attackSudden impaired pumping of the heart, leading to fluid backup in the lungs resulting in shortness of breath (pulmonary edema)Sudden loss of kidney functionComplications in pregnancy (preeclampsia or eclampsia)BlindnessComplications of Uncontrolled HypertensionThe excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.Uncontrolled high blood pressure can lead to complications including:Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.Heart failure. To pump blood against the higher pressure in your vessels, the heart has to work harder. This causes the walls of the heart’s pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body’s needs, which can lead to heart failure.Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.Metabolic syndrome. This syndrome is a cluster of disorders of your body’s metabolism, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL) cholesterol, the “good” cholesterol; high blood pressure and high insulin levels.These conditions make you more likely to develop diabetes, heart disease and stroke.Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure.Dementia. Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular dementia.Prevention of high blood pressureHealthy lifestyle changes can help you control the factors that cause hypertension. Here are some of the most common home remediesDeveloping a healthy diet :A heart-healthy diet is vital for helping to reduce high blood pressure. It’s also important for managing hypertension that is under control and reducing the risk of complications. These complications include heart disease, stroke, and heart attack.A heart-healthy diet emphasizes foods that include:fruitsvegetableswhole grainslean proteins like fishIncreasing physical activityReaching a healthy weight should include being more physically active. In addition to helping you shed pounds, exercise can help reduce stress, lower blood pressure naturally, and strengthen your cardiovascular system.Aim to get 150 minutes of moderate physical activity each week. That’s about 30 minutes five times per week.Reaching a healthy weightIf you are overweight or obese, losing weight through a heart-healthy diet and increased physical activity can help lower your blood pressure.Managing stressExercise is a great way to manage stress. Other activities can also be helpful. These include:meditationdeep breathingmassagemuscle relaxationyoga or tai chiThese are all proven stress-reducing techniques. Getting adequate sleep can also help reduce stress levels.Adopting a cleaner lifestyleIf you’re a smoker, try to quit. The chemicals in tobacco smoke damage the body’s tissues and harden blood vessel walls.If you regularly consume too much alcohol or have an alcohol dependency, seek help to reduce the amount you drink or stop altogether. Alcohol can raise blood pressure.Key Message:Proper management can control hypertension and prevent its complications.Effective lifestyle and drug treatments are available that could control hypertension in most individuals. Newer drugs provide better control while avoiding the side effects that have limited therapy in the past.A close collaboration between the physician and patient is needed to optimize better health outcomes.The latest evidence shows that people with uncontrolled or untreated high blood pressure may be at risk of getting severely ill with COVID-19. It’s also important to note that people with untreated high blood pressure seem to be more at risk of complications from COVID-19 than those whose high blood pressure is managed with medication.There is as yet no evidence that hypertension is related to outcomes of COVID-19, or that ACE inhibitor or ARB use is harmful, or for that matter beneficial, during the COVID-19 pandemic. Use of these agents should be maintained for the control of blood pressure, and they should not be discontinued, at least on the basis of current evidence at this time. With the vaccination drive for covid going on at a faster pace every hypertensive patient particularly those with other co morbidities should get the jab so as to decrease the morbidity and mortality .When it comes to getting vaccinated, benefits far outweigh the risks for people with cardiovascular issues. Of note, every hypertensive is advised to take blood pressure medications, such as ACE-Inhibitors, beta-blockers, or blood thinners, before attending your vaccination appointment, especially if you have cardiovascular complications like cardiac chest pain or angina. The unintended consequences of discontinuing effective treatments for hypertension, without a suitable replacement titrated against blood pressure measurements under direct medical supervision, could put patients at needlessly increased cardiovascular and possibly corona virus risk. In addition, managing such titration currently, when primary care is prioritizing acute illness over routine contacts (including blood pressure checks), makes the proposed strategy impractical and risks further diluting access to care.The author is M.D, D.M, FACC, M.I.A.A and Head, Department of Cardiology, GMC & SSH Jammu
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