Hypertension the Silent Killer

Hypertension the silent killer

Dr. Pranab Jyoti Bhattacharyya

Hypertension or high blood pressure (BP) is considered to be a major risk factor that contributes to the increasing burden of chronic diseases in India including death and disability.

Several scientific studies have reported a disturbing trend that hypertension is increasing alarmingly and that there is low awareness and control among the general population.

Hypertension prevalence in India is high and has been reported to be around 30 per cent. The urban population suffers more than the rural population and males are affected in greater numbers compared to women.

Awareness of hypertensive status and those receiving treatment for their high blood pressure is abysmally poor. Only about 26% of treated patients in India have their BP under control.

Several scientific studies assessing the differences in regional estimates of hypertension prevalence in India revealed that high BP was maximum in eastern India in both rural and urban population (varying between 32 to 35 percent) compared to other regions of the country. This was even higher than the national average.

Uncontrolled or untreated hypertension is the leading cause of heart attack, heart failure, abnormal heart rhythm (atrial fibrillation), stroke and peripheral artery disease of the limbs leading to limb loss. It also contributes significantly to end-stage kidney disease, vision and memory loss.

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High BP is often referred to as the ‘silent killer’ because it typically does not cause any symptoms and those suffering from it are capable of doing normal daily activities without difficulty. This can be dangerous because the undetected high BP continues to cause damage to the vital organs of the body and sometimes may lead to catastrophic consequences.

However, 10 per cent of patients presenting with diastolic BP of above 120 mmHg may have symptoms such as headache, nasal bleed, shortness of breath, chest pain and faintness. Other common symptoms include waking up at night frequently to urinate, and unsteady gait, whereas treated patients often complain of fatigue in addition to symptoms related to specific side effects of medications like swelling of feet etc.

“The physician community and health care providers need to join hands to raise awareness about hypertension, its risks, and the importance of early detection and effective treatment. Educating people about healthy lifestyle choices, regular monitoring, and dietary habits that can prevent or control hypertension is the need of the hour.”

Early detection as well as prompt initiation of treatment and ensuring adherence to medications prescribed can ensure effective control of BP and reduce the risk of cardiovascular, kidney and brain disease, and death.

Knowledge of the ideal BP numbers is crucial for monitoring cardiovascular health and detecting undiagnosed high BP apart from managing any existing conditions. Normal BP is 120 over 80 millimeter of mercury (mmHg) or lower. The first number is called systolic and the bottom number is the diastolic pressure.

Readings between 130 to 139 and 80 to 89 mmHg is considered stage 1 hypertension and above 140 over 90 is stage 2 hypertension. Any reading between 120 to 129 by 80 mmHg is termed pre-hypertension and such individuals are not yet considered to be hypertensive. Any BP recording above 180 over 120 mmHg is termed as hypertensive crisis and requires immediate medical attention.

Risk factors for developing high BP are categorized as modifiable and non-modifiable. Non-modifiable factors cannot be changed and include older age, male sex, genetics, psychosocial stress and low socio-economic status, while modifiable risk factors are those that can be actively managed by adopting healthy life-style practices and include excessive weight gain, sedentary lifestyle, physical inactivity, sleep-disordered breathing, diabetes, smoking, use of tobacco products(including chewing tobacco, ‘gutkha’ etc.) and unhealthy diet (high calorie, high unrefined carbohydrate, high fat, high salt and high alcohol intake, low fruits, and vegetables intake).

Home BP measurement is important for thosenewly diagnosed with high BP, for people starting or changing medications to find if it is working and for people with risk factors or who have already developed complications related to high BP. Also, home recording of BP provide real life readings and encourages patient compliance and participation in the management.

Recommended home BP monitor is an automatic, cuff-style, upper arm monitor.Wrist and finger monitors are not recommended as they give inaccurate readings. Validation and periodic calibration of the home BP monitor is necessary.

Home BP readings should be taken in the morning before medication and at night. Each time, two readings should be taken, separated by 1 to 2 minutes between readings. Readings should be taken twice a day for 7 consecutive days. The readings of the first day should be discarded. The average of the remaining 12 readings is the home blood pressure measurement.

It is indeed important to emphasize that adoption of lifestyle modification strategies effectively provide the cornerstone of treatment and prevention of high BP along with regular intake of medicines prescribed by treating doctor. A majority of patients may need more than one medicine for control of BP. Combination therapy in single pill can lead to better compliance.

Although antihypertensive therapy is generally life long, an effort to decrease the dosage and number of medicines may be considered after effective control of hypertension (step-down therapy).

Despite the availability of effective and inexpensive medications, BP control continues to be unsatisfactory. Few major hindrances include rapid urbanization, poor dietary habits, physical inactivity, obesity, smoking and tobacco use, poverty, availability and access to healthcare facility, lack of awareness etc.

The physician community and health care providers need to join hands to raise awareness about hypertension, its risks, and the importance of early detection and effective treatment. Educating people about healthy lifestyle choices, regular monitoring, and dietary habits that can prevent or control hypertension is the need of the hour.

Dr. Pranab Jyoti Bhattacharyya, Professor of Cardiology, Gauhati Medical College and Hospital 

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