Many people today suffer from high blood pressure without even knowing they have this condition. This is dangerous since hypertension ( high blood pressure) is associated with a number of serious long term effects on the body. It is a risk factor for the development of heart disease, heart failure, stroke, eye diseases, kidney disease including kidney failure and some life threatening emergencies.
Those with pre- existing conditions are at greater risk . So are those above 60 years of age. In recent years there has been a surge in non communicable diseases, including hypertension. According to Health Ministry officials over 137,000 Lankans died from NCDs in 2017. Since hypertension is one of the most significant causes for these deaths, an urgent call has been made by the President and the Health Minister to raise more awareness on this subject . The Sunday Observer spoke to General Physician and Co-ordinator of Directorate Health Care Quality and Safety, Dr Ramya Premaratne for more insights into the subject.
Excerpts…
Q. Although high blood pressure is a common condition, not many persons still understand what it means. What causes our blood pressure to rise?
A. When your heart beats, it pumps blood round your body to give it the energy and oxygen it needs. As the blood moves, it pushes against the sides of the blood vessels. The strength of this pushing is your blood pressure. If your blood pressure is too high, it puts extra strain on your arteries (and your heart.)
Q. What happens then?
A. This may lead to heart attacks and strokes. Hypertension is associated with a number of serious long-term effects on the body. High blood pressure is a risk factor for the development of heart disease, heart failure, stroke, eye disease, kidney disease including kidney failure and some life-threatening emergencies.
Q. What are the symptoms to show our blood pressure has risen?
A. Unfortunately, hypertension usually has no symptoms and is considered as a “silent killer.” Occasionally, someone with high blood pressure can experience headaches, confusion, nausea, and visual disturbance or in extreme rare cases even seizures. If you ignore your blood pressure because you think a certain symptom or sign will alert you to the problem, you are taking a dangerous chance with your life. In most cases, high blood pressure does not cause headaches or nosebleedsexcept in the case of hypertensive crisis, a medical emergency, when blood pressure is 180/120 mm Hg or higher. If you are experiencing severe headaches or nosebleeds and are otherwise unwell, contact your doctor.
Other inconclusively related symptoms
A variety of symptoms may be indirectly related to, but are not always caused by high blood pressure, such as:
- Blood spots in the eyes Blood spots in the eyes (subconjunctival hemorrhage) are more common in people with diabetes or high blood pressure, but neither condition causes the blood spots
- Facial flushing Facial flushing occurs when blood vessels in the face dilate.
- Dizziness Sudden dizziness, loss of balance or coordination and trouble in walking are all warning signs of a stroke. High blood pressure is a leading risk factor for stroke.
Q. It has been said, blood pressure changes every second, every minute. Is this true?
A. Changes in blood pressure reflect the body ability to adapt. Even walking, talking, singing or laughing can cause noticeable increases.
A mere laughter bout can raise the top number as high as 15 points in healthy people, people with absolutely perfect circulation. But laughter is not the only situation that causes spikes. Talking does the same thing. That’s why you are told not to talk or laugh when taking your readings. If you move, talk or laugh you may end up with elevated numbers.
Q. How do you measure blood pressure?
A. Blood pressure is measured with a simple painless test usually using blood pressure monitor. This consists of an inflatable cuff that is wrapped around the upper arm and is attached to a monitor that gives the readout of the blood pressure and the pulse. The systolic blood pressure number is always said first, and then the diastolic blood pressure number, e.g. your blood pressure may be read as 120/80. Blood pressure is measured in millimetres of mercury (mmHg).
Q. What is systolic BP and diastolic BP?
A. When your heart beats, it contracts and pushes blood through the arteries to the rest of your body. This force creates pressure on the arteries. This is called systolic blood pressure.
A normal systolic blood pressure is 120 or below. A systolic blood pressure of 120-139 means you have normal blood pressure that is higher than ideal or borderline high blood pressure. Even people with this level are at a greater risk of developing heart disease.
A systolic blood pressure number of 140 or higher, on repeated measurements, is considered to be hypertension, or high blood pressure.
Q. What does the diastolic blood pressure mean?
A. The diastolic blood pressure number or the bottom number indicates the pressure in the arteries when the heart rests between beats. A normal diastolic blood pressure number is 80 or less. A diastolic blood pressure between 80 and 89 is normal but higher than ideal. A diastolic blood pressure number of 90 or higher, on repeated measurements, is considered to be hypertension or high blood pressure.
Q. What are the complications of High Blood Pressure?
A. When blood pressure is high, it can damage the artery and blood vessel walls and leads to dangerous complications and even death if left untreated.
Circulatory system
Damage caused by high blood pressure starts small and builds over time. The longer it goes undiagnosed or uncontrolled, the more serious your risks. Your blood vessels and major arteries carry blood throughout the body and supply it to vital organs and tissues. When the pressure at which blood travels gets increased, it begins to damage artery walls. Damage starts as small tears. As these artery wall tears begin to form, bad cholesterol flowing through the blood starts to attach itself to the tears. More and more cholesterol builds up in the walls, making the artery narrow. Less blood is able to get through. When the proper amount of blood can’t move through a blocked artery, it causes damage to the tissue or organ it’s supposed to reach. In the heart, this can mean chest pain, irregular heartbeat, or a heart attack. The heart also has to work harder, but is less effective with high blood pressure and blocked arteries. Eventually, the extra work can lead to an enlarged left ventricle, which is the part of the heart that pumps blood to the body. This also puts you at a higher risk of having a heart attack. When your heart becomes so weak and damaged from high blood pressure, or due to a previous heart attack, it is unable to pump blood through your body effectively. Signs of heart failure include:
- shortness of breath
- swelling in the feet, ankles, legs, or abdomen
- feeling tired
High blood pressure can also cause a bulge to form in a damaged artery. This is known as an aneurysm. The bulge gets larger and larger and often isn’t found until it causes pain by pressing on another area of the body, or bursts. A ruptured aneurysm can be deadly if it’s in one of your major arteries. This can happen anywhere in the body.
Nervous system
High blood pressure may play a role in dementia and cognitive decline over time. Reduced blood flow to the brain causes memory and thinking problems. You might have trouble remembering or understanding things, or lose focus during conversations. The same damage that high blood pressure causes to blood vessels and arteries in the heart can happen to the arteries in the brain. When a larger blockage of blood to the brain occurs, it’s called a stroke. If parts of the brain can’t get the oxygen they receive from blood, cells begin to die. Your survival rate and likelihood of permanent brain damage depends on how severe the stroke is and how fast you receive treatment. Blood vessels in the eyes can be damaged as well. If they burst or bleed, it can cause vision difficulties, like blurriness or blindness. Fluid buildup under the retina is called choroidopathy.
Skeletal system
High blood pressure can cause bone loss, known as osteoporosis, by increasing the amount of calcium your body gets rid of when you urinate. Women who have already gone through menopause are especially at risk. Osteoporosis weakens your bones and makes it easier for fractures and breaks to happen.
Respiratory system
Like the brain and heart, arteries in the lungs can be damaged and blocked. When the artery that carries blood to your lungs gets blocked, it’s called a pulmonary embolism. This is very serious and requires immediate medical attention. An aneurysm can also happen in the lung. Sleep apnea is a sleep disorder that causes loud snoring and breathing interruptions during a night’s sleep. People with sleep apnea often don’t feel rested when they wake up in the morning. Research has linked the condition to high blood pressure, since many people who are diagnosed with sleep apnea also have high blood pressure.
Urinary system
Your kidneys help remove waste from the blood, regulate blood volume and pressure, and filter waste out through urine. In order to do this well, they need healthy blood vessels. High blood pressure can damage the larger blood vessels leading to your kidneys and the smaller vessels inside your kidneys. This is called kidney disease and can lead to kidney failure. High blood pressure is one of the major causes of kidney failure. People with kidney failure no longer have the ability to remove waste from their body and will either need dialysis or a transplant.
Q. Is there an ideal level of blood pressure? Is it applicable to all ages?
A. Ideally, we should all have a blood pressure below 120 over 80 (120/80). This is the ideal blood pressure for people wishing to have good health. At this level, we have a much lower risk of heart disease or stroke. If your blood pressure is above 120/80mmHg, you will need to lower it.
If your blood pressure is 140/90, you should be taking steps to bring it down or stop it rising any further.
Q. Which age group is most at risk? Why?
A. High blood pressure is most common among people who have specific risk factors such as age (increased risk with age).
You are particularly at risk if you are a male over 45 or female over 55
For many people, the most significant contributor to high blood pressure is age. Our arteries stiffen with age. This means the same volume of blood is forced into a smaller area and so your blood pressure may rise, sometimes dramatically.
Sixty per cent of people aged 60 or older have high blood pressure. But age doesn’t have to be a factor.
Q. What factors contribute to elevating the BP?
A. Some of the risk factors for high blood pressure include obesity (defined as a body mass index greater than 30) and hypertension. Additionally, reducing salt and sugar intake, eliminating smoking, reducing alcohol intake, and reducing stress are often recommended by doctors.
Male over 45 or female over 55
- Family history
- Low physical activity People who spend a lot of time watching TV and little time on physical activity have been shown to have 3-4 mmHg higher blood pressure than more active people.
- Kidney disease Inflammation and infection can cause kidney disease, which is a major cause of high blood pressure. Once you have high blood pressure, it can make kidney disease worse.
Someone with normal kidney function who is in the early stages of high blood pressure is likely to develop kidney disease in the next six years if they don’t receive treatment for high blood pressure.
- Diabetes
High blood pressure is much more common in people with diabetes (60 per cent of people with type 2 diabetes and 40 per cent of people with type 1 have high blood pressure).
- Too much salt ( sodium) in your diet
As sodium in our blood increases, the blood vessels retain water to try to balance the sodium concentration. This extra water increases the volume of blood in vessels, causing high blood pressure. The recommended maximum salt intake is less than 6 grams a day.
Q. How does being tense or excited impact on the BP?
A. Blood pressure naturally fluctuates throughout the day. No matter how healthy you are, you’re going to have higher blood pressure and lower blood pressure depending on what you eat, how much sleep you got, how much you’re moving, and even how stressed you feel.
Anxiety can have an effect on your blood pressure, that make your blood pressure higher. But, it can make your blood pressure lower as well.
Different types of anxiety can affect your blood pressure in different ways as follows:
- Increased Heart Rate
Your increased heart rate is one of the contributors to an increase in blood pressure. But, that increase in cardiac output causes an increase in pressure that raises your systolic heart rate. It should be noted that your diastolic is generally untouched.
- Contracting Ventricles
This is directly related to heart rate because they’re all part of the same system. But blood normally travels through the ventricles at some amount of pressure, and when you have anxiety the ventricles contract while blood is pumping through them, causing an increase in that pressure.
Q. When is it necessary to get treatment for BP?
A. Normal blood pressure is 120/80 or lower. When the systolic blood pressure, the top number, is between 121 and 139, and the diastolic blood pressure, the lower number, is between 81 and 89, this is a condition known as pre-hypertension.
Pre-hypertension doesn’t necessarily raise your risk for heart attack or stroke. But without attention, it will usually progress to full high blood pressure, which definitely does raise those risks.
Q. Treatment options?
A. There are several types of drugs used to treat high blood pressure
Q. New technologies to manage hypertension developed in recent years? Are they available in Sri Lanka? Where?
A. Particularly with hypertension, the condition can effectively be managed remotely via new tools such as connected devices. Telemonitoring and electronic submission of readings are becoming more popular and, with smartphones becoming ever more sophisticated, it seems likely that this will play a role in diagnosing and managing hypertension in the future.
However, barriers to using telemonitoring include, the initial set-up costs among other obstacles.
Q. Recent inputs by the Health Ministry with regard to creating more awareness about Blood Pressure among the public?
A. Hypertension is the leading risk factor for death and immobility. Most cardiovascular diseases have been attributed to high blood pressure/hypertension. In Sri Lanka, hypertension is an important public health problem. To provide primary health care, community-based Non Communicable Disease [NCD] programs have been organized by the Ministry of Health. It consists of teams of doctors, nurses, and community health physicians in predefined areas. One of the main goals of the program is to prevent and treat chronic diseases such as, hypertension, cardiovascular diseases, diabetes etc.
The objectives of this program were to determine the prevalence and awareness of hypertension, the use of anti hypertensive drugs and the rate of patients with uncontrolled hypertension in a predefined area and to analyze the feasibility of the NCD program to collect data about hypertensive patients.
Q. Any advice for our readers regarding on how to avoid getting high blood pressure with diet using local foods?
A. banana a day can keep HBP at bay. The more potassium you take in, the more sodium you excrete through urine. That’s not all this super important mineral does to help lower blood pressure either. “Potassium eases tension in your blood vessel walls, which helps reduce blood pressure. A medium banana has about 420 mg of potassium and is easy to include in your breakfast or as a mid-afternoon snack. The recommended potassium intake for an average adult is 4,700 milligrams (mg) per day.
Sweet potatoes, chicken, peas, beans, tomatoes, potatoes, raw spinach and citrus fruits are excellent sources of potassium. A diet high in harmful fats can play a role in developing heart disease or raising blood pressure.
- Potatoes bananas, avocados, yogurt, and beans contain more potassium.
- Avoid salt high foods ( 10 categories) : bread and rolls, cold cuts/cured meats, pizza, poultry, soups, sandwiches, cheese, pasta mixed dishes, meat mixed dishes and savoury snacks.
Don’t:ingest harmful fats.
Saturated and trans fats are two types of dangerous fats found in many commercial baked goods and animal products (red meat and dairy products like whole milk, cheese, sour cream, butter and ice cream).