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Hypertension

Key facts

  • Hypertension or elevated blood pressure is a serious medical condition that significantly increases the risks of heart, brain, kidney and other diseases.

  • An estimated 1.28 billion adults aged 30-79 years worldwide have hypertension, most (two-thirds) living in low- and middle-income countries

  • An estimated 46% of adults with hypertension are unaware that they have the condition.

  • Less than half of adults (42%) with hypertension are diagnosed and treated.

  • Approximately 1 in 5 adults (21%) with hypertension have it under control.

  • Hypertension is a major cause of premature death worldwide.

  • One of the global targets for non-communicable diseases is to reduce the prevalence of hypertension by 33% between 2010 and 2030.

  • The prevalence of hypertension in Uganda is high, with no significant differences in distribution by geographical location.


What is blood pressure?
Blood pressure is the pressure of blood in your arteries – the vessels that carry your blood from your heart to your brain and the rest of your body. You need a certain amount of pressure to get the blood moving round your body.


Your blood pressure naturally goes up and down throughout the day and night, and it’s normal for it to go up while you’re moving about. It’s when your overall blood pressure is consistently high, even when you are resting, that you need to do something about it.


High blood pressure is medically known as hypertension. It means your blood pressure is consistently too high and means that your heart has to work harder to pump blood around your body. High blood pressure is serious. If you ignore it, it can lead to heart and circulatory diseases like heart attack or stroke. It can also cause kidney failure, heart failure, problems with your sight and vascular dementia.


Although your arteries are stretchy to cope with your blood pressure going up and down, if you have high blood pressure, your arteries lose their stretchiness and become stiff or narrow. The narrowing makes it easier for fatty material (atheroma) to clog them up.


If the arteries that carry blood to your heart get damaged and clogged, it can lead to a heart attack. If this happens in the arteries that carry blood to your brain it can lead to a stroke.


What is a healthy or normal blood pressure?


Your blood pressure should be under 140/90 mmHg.

  •  Low

    • Systolic: lower than 90 mmHg

    • Diastolic: lower than 60 mmHg

  • Normal

    • Systolic: lower than 140 mmHg

    • Diastolic: lower than 90 mmHg

  • Possible hypertension

    • Systolic: between 140 and 180 mmHg

    • Diastolic: between 90 and 110 mmHg


Further checks such as home monitoring or ABPM would normally be needed to make a diagnosis of hypertension.


  • Severe hypertension


  • •    Systolic: higher than 180 mmHg


  • •    Diastolic: higher than 110 mmHg


Monitoring your blood pressure at home

If you’ve been asked to monitor your blood pressure at home, your doctor may ask you to check your blood pressure over several days. This can include checking your blood pressure twice a day – for example, once in the morning and once in the evening.


By looking at all your blood pressure readings over a few days, your doctor can work out what your normal blood pressure may be. This will be called your ‘average blood pressure’.


Your blood pressure is measured the same way as it would be if done by a GP or nurse. It’s made up of two numbers. Although the blood pressure you want depends on you, the current guidelines suggest aiming for:

  • 135 or lower (systolic)

  • 85 or lower (diastolic)


You might hear these numbers said as ‘135 over 85’.


An average blood pressure of 135/85mmHg (135 over 85) or higher when monitoring your blood pressure at home could mean you have high blood pressure (hypertension).


Discuss your results with your doctor and ask any questions you have. They may want you to aim for a different blood pressure that’s right for you.


Causes

There isn’t always an explanation for the cause of high blood pressure, but most people develop high blood pressure because of their diet, lifestyle or medical condition.


Sometimes high blood pressure runs in families and can also worsen with age. People living in deprived areas are at higher risk of having high blood pressure, and it is also more common if you are of black African or black Caribbean descent. Even in these cases, you may still be able to improve your blood pressure by changing your diet and being active.


High blood pressure that is not due to another condition or disease is known as primary or essential hypertension. If an underlying condition is a cause of increased blood pressure, doctors call this secondary hypertension.


Primary hypertension can result from multiple factors, including:

  • Having obesity

  • Insulin resistance

  • High salt intake

  • Excessive alcohol intake

  • Having a sedentary lifestyle

  • Smoking


Secondary hypertension has specific causes and is a complication of another health problem.


Chronic kidney disease (CKD) is a common cause of high blood pressure, as the kidneys no longer filter out fluid. This excess fluid leads to hypertension. Hypertension can also cause CKD.


Other conditions that can lead to hypertension include:

  • Diabetes, due to it causing kidney problems and nerve damage

  • Pheochromocytoma : a rare cancer of an adrenal gland

  • Cushing’s syndrome: a disorder that occurs when your body makes too much of the hormone cortisol over a long period of time.

  • Congenital adrenal hyperplasia: a group of genetic disorders that affect the adrenal glands, a pair of walnut-sized organs above the kidneys. The adrenal glands produce important hormones, including: Cortisol, which regulates the body's response to illness or stress

  • Hyperthyroidism, or an overactive thyroid gland

  • Hyperparathyroidism, which affects calcium and phosphorous levels

  •  Pregnancy: Did you know around one in ten women develop hypertension (high blood pressure) during pregnancy? This significantly increases a new mother’s risk of long-term high blood pressure

  • Sleep apnea: a potentially serious sleep disorder in which breathing repeatedly stops and starts

  • Obesity: abnormal or excessive fat accumulation with a body mass index (BMI) over 30.


Risk factors

A number of factors increase the risk of hypertension.

  • Age: Hypertension is more common in people who are over 65 years old Trusted Source. Blood pressure can increase steadily with age as the arteries stiffen and narrow due to plaque buildup.

  • Ethnicity: Some ethnic groups are more prone to hypertension than others. African Americans have a higher risk Trusted Source than other ethnic groups, for example.

  • Weight: Obesity is a primary risk factor for hypertension.

  • Alcohol and tobacco use: Regularly consuming large quantities of alcohol or tobacco can increase blood pressure.

  • Sex: According to a 2018 review Trusted Source, males have a higher risk of developing hypertension than females. However, this is only until females reach menopause.

  • Existing health conditions: Cardiovascular disease, diabetes, chronic kidney disease, and high cholesterol levels can lead to hypertension, especially as people age.


Symptoms

A person with hypertension may not notice any symptoms. Without detection, hypertension can damage the heart, blood vessels, and other organs, such as the kidneys.


It is vital to check blood pressure regularly. In rare and severe cases, high blood pressure can cause:

  • Sweating

  • Anxiety

  • Sleeping problems

  • Blushing


However, most people with hypertension will experience no symptoms at all.


If high blood pressure becomes a hypertensive crisis, a person may experience headaches and nose bleeds.


Complications
Long-term hypertension can cause complications through atherosclerosis, where plaque develops on the walls of blood vessels, causing them to narrow.


This narrowing worsens hypertension because the heart must pump harder to circulate the blood.


Hypertension-related atherosclerosis can lead to:

  • Heart failure and heart attacks

  • Aneurysm, or an atypical bulge in the wall of an artery that can burst

  • Kidney failure

  • Stroke

  • Amputation

  • Hypertensive retinopathies in the eye, which can lead to blindness


Regular blood pressure monitoring can help people avoid these more severe complications.


Measuring blood pressure
Having high blood pressure for a short time can be a normal response to many situations. Acute stress and intense exercise, for example, can briefly elevate blood pressure in an otherwise healthy person.


For this reason, a diagnosis of hypertension requires several readings that show sustained high blood pressure over time.


Your blood pressure is usually measured using a sphygmomanometer. This is usually a digital electronic monitor, which is connected to an inflatable cuff that is wrapped around your upper arm.


When you have your blood pressure measured, the reading is written as two numbers. The first is when the pressure is at its highest (or systolic pressure), and the second at its lowest (or diastolic pressure). For example, your reading will be something like: 140/90 mmHg (mmHg is a unit for measuring blood pressure). You’ll be told something like ‘140 over 90’.


Systolic pressure: This is the highest level of your blood pressure – when your heart beats and contracts to pump blood through your arteries.


Diastolic pressure: This is the lowest level of your blood pressure – when your heart relaxes between beats.


High blood pressure is to have it measured. So, it’s important to get your blood pressure checked.


Is the cuff size on a blood pressure monitor important?

Yes. A blood pressure cuff size that’s too big or small could give the wrong reading. If the cuff is too small, the monitor might squeeze your arm too much and give you a reading which is too high. If the cuff is too big, your monitor may under-read your blood pressure.


Most new monitors state their arm size on the box and there’s usually a size guide on the cuff. However, a lot of monitors come with just a medium cuff.


How do I measure my arm for a blood pressure cuff?


The cuff should wrap snugly around your upper arm, with just enough space to slide two fingertips underneath.


You might need to buy a different cuff or monitor if the cuff isn’t the right size for your arm.  


Management and treatment

Lifestyle adjustments are the standard, first-line treatment for hypertension.


Regular physical exercise


Current guidelines recommend that all people, including those with hypertension, engage in at least 150 minutes Trusted Source of moderate-intensity aerobic exercise every week or 75 minutes per week of high-intensity exercise.


People should exercise at least 5 days every week. Examples of suitable activities are:

  • Walking

  • Jogging

  • Cycling

  • Swimming


Studies show that strength, or resistance, training can also reduce blood pressure Trusted Source in hypertensive people.


Stress reduction

Avoiding or learning to manage stress can help a person control blood pressure.


A few relaxation techniques that can help relieve stress are:

  • Meditation

  • Warm baths

  • Yoga

  • Going on long walks


People should avoid consuming alcohol and recreational drugs to cope with stress, as these can contribute to elevated blood pressure and the complications of hypertension.


Smoking can also increase blood pressure. Avoiding or quitting smoking reduces the risk of hypertension, serious heart conditions, and other health issues.


Medication

People can use specific medications to treat hypertension. Doctors will often recommend a low dose at first. Antihypertensive medications will usually only have minor side effects.


Eventually, people with hypertension may need to combine two or more Trusted Source drugs to manage their blood pressure.


Medications for hypertension include:

  • Diuretics, including thiazides, chlorthalidone, and indapamide

  • Beta-blockers and alpha-blockers

  • Calcium-channel blockers

  • Central agonists

  • Peripheral adrenergic inhibitors

  • Vasodilators

  • Angiotensin-converting enzyme (ACE) inhibitors

  • Angiotensin receptor blockers


  • The choice of medication depends on the person and any underlying medical conditions they may have.


Anyone taking antihypertensive medications should carefully read the labels of over-the-counter (OTC) drugs they may also take, such as decongestants. These OTC drugs can interact with the medications they are taking to lower their blood pressure.


Diet

People can prevent high blood pressure by following a heart-healthy diet.


Reducing salt intake

High sodium consumption contributes Trusted Source to high blood pressure. The main source of sodium in the diet is salt.


The AHA recommends that people without hypertension consume less than 2,300 milligrams (mg)Trusted Source of sodium per day. This roughly equates to one teaspoon. People with hypertension should consume less than 1,500 mg of sodium per day to manage their condition.


Moderating alcohol consumption

Moderate to excessive alcohol consumption can increase blood pressure.


The AHA recommends a maximum of two alcoholic drinks per day Trusted Source for males and one for females.


The following would count as one drink:

  • A 12-ounce (oz) bottle of beer

  • 4 oz of wine

  • 1.5 oz of 80-proof spirits

  • 1 oz of 100-proof spirits


A healthcare professional can help people reduce consumption if they find it difficult to moderate their alcohol intake.


Eating more fruits and vegetables and less fat


People who have high blood pressure or people at high risk of developing it should reduce their intake of saturated fats in favor of unsaturated fats.


Experts recommend Trusted Source that people with high blood pressure prioritize more heart-healthy foods, such as:

  • Whole grain, high-fiber foods

  • A variety of fruits and vegetables

  • Pulses, such as chickpeas, beans, and lentils

  • Nuts

  • Fish rich in omega-3 twice per week

  • Non tropical vegetable oils, such as olive oil

  • Skinless poultry and fish

  • Low-fat dairy products


Limiting trans fats, hydrogenated vegetable oils, animal fats, and processed fast foods can help manage blood pressure.


However, some fats can be a healthful addition to diet plans. Omega-3 fatty acids, such as oily fish and olive oil, have protective effects on the heart. While these are typically healthful, people with a risk of hypertension should still include them in their total fat intake.


Managing body weight

Excess body weight can contribute Trusted Source to hypertension. A fall in blood pressure usually follows weight loss because the heart does not have to work so hard to pump blood around the body.


A balanced diet with a calorie intake that matches the person’s size, sex, and activity level will help.


The DASH diet
DASH is a flexible and balanced eating plan with a firm grounding which says that the diet:

  • Lowers high blood pressure

  • Improves levels of fats in the bloodstream

  • Reduces the risk of cardiovascular disease


OUTLOOK / PROGNOSIS


What can I expect if I have this condition?

Since high blood pressure doesn’t cause many symptoms at first, you probably won’t feel any different with a high blood pressure diagnosis. But it’s important to follow your provider’s instructions to bring your blood pressure down so it doesn’t cause serious illnesses later in life.


How long does high blood pressure last?

If you have primary high blood pressure, you’ll need to manage it for the rest of your life.


If you have secondary high blood pressure, your blood pressure will most likely come down after you receive treatment for the medical problem that caused it. If a medication caused your high blood pressure, switching to a different medicine may lower your blood pressure.


What is the outlook for high blood pressure?


You can get seriously ill if you don’t treat your high blood pressure. However, if you take the medicines your provider ordered, you can manage your blood pressure. Exercising and eating healthy foods also helps lower your blood pressure.


LIVING WITH


How can I be more active?

  • Check first with your healthcare provider before increasing your physical activity. Ask your provider what type and amount of exercise is right for you.

  • Choose aerobic activities such as walking, biking or swimming.

  • Start slowly and increase activity gradually. Aim for a regular routine of activity five times a week for 30 to 45 minutes each session.


What if lifestyle changes don’t help lower my blood pressure?

If diet, exercise and other lifestyle changes don’t work to lower your blood pressure, your healthcare provider will prescribe medications to help lower your blood pressure. Your provider will take into account other conditions you may have, such as heart or kidney disease and other drugs you’re taking when prescribing medications to treat your high blood pressure. Be sure to follow your provider’s dosing directions exactly.


A note from Pan Medical Kampala

Physical relaxation and calming breathing exercises can help lower blood pressure in periods of extreme stress. Taking relevant medication and practicing healthy lifestyle habits are often the fastest way to lower blood pressure in the short to medium term.

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