Hypertension – a silent killer

May 17, 2021

Hypertension or high blood pressure is one of the leading risk factors for cardiovascular deaths around the world and is a major contributor for cardiovascular mortality. Worldwide hypertension affects 1 billion individuals and approximately 7.1million deaths per year are caused due to hypertension. In India the prevalence is estimated to be 30 – 40 percent in various studies.

Sagar( name changed) an accountant in an MNC, had bouts of headaches often. Attributing the reason to work-related stress, he ignored the headaches till they became unbearable. He consulted his doctor at the behest of his wife. “I was shocked when the doctor told me my blood pressure had shot through the roof,” he says. Now he has been put on medication to keep his blood pressure under control and follows it up with a morning walk everyday and a healthy diet on the dietician advice. “I do not want to invite any complications since cardiovascular disease runs in my family,” he adds.

Hypertension a silent killer

Sagar was lucky he had symptoms to indicate he had high blood pressure. "Approximately 30 percent of adults are unaware they have hypertension as there are no symptoms till it damages the organs of the body,"" says Dr.Naveen chandra G S, interventional cardiologist, Columbia Asia Hospital - Whitefield. "More than 40 percent of individuals with hypertension are not on any treatment and in 60 percent of patients on treatment, due to poor follow up, the hypertension is not well-controlled," he informs.

Increased incidence in urban areas

Our lifestyle has changed with modernization. We walk less, eat more of junk foods, eat preserved food high in salt content, overwork, sleep less and abuse our body with alcohol and smoking. increased stress levels and lack of availability of healthy food choices in schools, workplaces and restaurants,” the doctor adds.

Rise in cardiovascular diseases

By 2030, almost 23.6 million people will die from cardiovascular diseases, mainly from heart disease and stroke, says a WHO report. These are projected to remain the single leading causes of death. Hypertension is a major health problem throughout the world because of its high prevalence and its association with increased risk of cardiovascular disease. Advances in the diagnosis and treatment of hypertension and the practice of regular annual health screening have played a major role in recent dramatic declines in coronary heart disease and stroke mortality in industrialized countries. Of greater concern is that cardiovascular complications of high blood pressure are on the increase, including the incidence of stroke, end-stage renal disease and heart failure.

Collective effort by healthcare institutions and doctors, and lifestyle modifications on the part of people can bring down healthcare costs and create a healthy society.

Cut down salt intake to keep BP away

Eating processed foods high in salt content can be a health hazard especially to your blood pressure levels. While the recommendation is a maximum of 6g per day, the current average salt intake is 8.6g. As you get older it is important to make dietary changes, including reducing salt intake. By reducing the daily amount of salt can help reduce the risk of getting high blood pressure. For those already having hypertension, cutting down on salt can lower their blood pressure.

  • Reduce or stop the amount of salt added to food in cooking and at the table and try using alternatives for seasoning such as black pepper, herbs and spices.
  • Avoid eating too much processed food as this accounts for 75 percent of our salt intake for example, salted bread, pies and pastry products, ready meals, soups, sausages, baked beans, pizzas, stews, etc.
  • If possible make meals from scratch using fresh and frozen ingredients such as homemade bread or pies, casseroles, fresh meat and products with no added salt. Nowadays tinned fish is preserved in distilled water instead of brine and is safer for those with high blood pressure
  • For snacks, try eating unsalted nuts or homemade fruit bars as these make good low salt snacks
  • Choose foods that are low in salt. Remember to check the nutrition labelling when shopping, and look for products that contain less than 1.5g salt (0.6g sodium) per 100g

“In more than 90 percent of hypertension cases, the cause is unknown”

Dr.Naveen chandra G S, Interventional Cardiologist, Columbia Asia Hospital - Whitefield, throws light on what hypertension is and how it can be life-threatening if left untreated

What is hypertension or high blood pressure and what causes it?

Hypertension is the term used to describe high blood pressure (BP). Blood pressure is a measurement of the force against the walls of your arteries as your heart pumps blood through your body.

Blood pressure readings are usually given as two numbers, for example, 120 over 80 written as 120/80 mmHg. The first number is called the systolic blood pressure, and the second number is called the diastolic blood pressure. Normal blood pressure is when your blood pressure is lower than 120/80 mmHg most of the time. When your blood pressure is 140/90 mmHg or above most of the time, it is called hypertension. If your blood pressure numbers are 120/80 or higher, but below 140/90, it is called pre-hypertension. If you have pre-hypertension, you are more likely to develop high blood pressure. More than 90 percent of hypertension does not have any underlying causes and is termed as idiopathic. About 10 percent of them have an identifiable cause like kidney disease, endocrine tumours, certain drugs, narrowing of arteries of kidney, etc., and is termed as secondary hypertension.

What are the risk factors for developing hypertension?

The risk factors are genetic, excess body weight, increased salt intake, reduced physical activity, stress, decreased consumption of fruits and vegetables, excess alcohol intake and smoking.

What happens if hypertension is left untreated?

If untreated there is a greater risk of developing a heart attack, heart failure, stroke, kidney failure and may affect other organs.

What are the benefits of recognizing and treating hypertension?

It has been estimated that a 5 mm hg reduction of BP in the population would result in 14 percent reduction in death from stroke, a nine percent reduction in death due to a heart attack and a seven percent reduction in overall death rate.

Can children develop hypertension and what is the reason?

Hypertension occurs in one to two percent of children and usually an underlying cause is found. In majority of cases it is related to kidney disease. Being overweight and lack of exercise in childhood may make them susceptible to hypertension in adolescence. Increased incidence of hypertension in children is a major cause of concern in a country like India.

How do we treat hypertension?

If the hypertension is borderline or mild, lifestyle modification can be tried for 3- 6 months. If still the BP is not controlled, there should not be any hesitation in starting medications because if treated early, complications can be prevented and also the dose of medication required to control BP will be small. For moderate to severe hypertension, medications should be started once the diagnosis is made along with lifestyle modifications as listed in the table.

Intervention Recommendation BP reduction
Weight reduction Maintain ideal body mass index below 23 kg/m2 5-20mm hg for 10 kg weight loss
Diet (DASH diet *) Consume diet rich in fruits, vegetables and low fat dairy products. 8-14mmhg
Dietary sodium restriction Reduce dietary sodium to < 2.4gm/d or sodium chloride to < 6gm/d 2-8mmhg
Physical activity Engage in regular aerobic physical activity for atleast 30 min/d for most days of the week 4-9mmhg
Alcohol moderation Abstinence is preferred. < 60ml /day for men & < 30ml/day for women 2-4mmhg
Smoking Total abstinence  

* DASH = Dietary Approaches to Stop Hypertension

If a patient has diabetes or kidney disease what should the BP be?

In patients with diabetes & kidney disease, BP should be kept below 130/80 mm hg & not 140/90mmhg. This lower level will delay or prevent the development of complications.

Are the medications used to treat hypertension safe?

Most of the newer medications available to treat hypertension are safe, effective and the side effects are comparable to placebo. However, in patients with pre-existing kidney disease and diabetes, periodic monitoring of lab parameters such as creatinine and potassium levels, should be done for certain medications.

How often should BP be monitored?

Initially till the BP is brought under control, weekly or monthly monitoring should be done. Once BP is controlled monitoring can be done once in three months.

Can we monitor the BP at home?

Yes, digital BP apparatus are available and BP can be monitored at home using one of these. However, these devices should be calibrated periodically. It helps to know whether lifestyle changes and medications you are taking are working and also helps the doctor to know the control of BP in-between office visits.

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