Hypertension: The bringer of premature cardiac death

Hypertension: The bringer of premature cardiac death

Did you know that around 10 million people die needlessly each year due to hypertension-related complications, but only half of the people with high blood pressure are aware of it? Hypertension or “high blood pressure” is a global public health challenge and is considered to be the No. 1 contributing risk factor for cardiovascular mortality worldwide. It is a silent killer, as most patients with hypertension are asymptomatic or they present with no symptoms at all. It is often an incidental finding of routine medical check-ups or of consultations made for other medical problems. The public health burden posed by hypertension is reflected in the local statistics as well with the latest studies showing an age-adjusted prevalence among Sri Lankan adults to be as high as 23.7%.

The purpose of this article is to identify the signs and symptoms of a person with hypertension, the predisposing risk factors, and the possible long-term adverse complications of uncontrolled hypertension. We will also explore the treatment options and lifestyle modifications that a person with hypertension can adopt to manage their condition effectively.

Signs and Symptoms

Hypertension is largely a silent disease, but a few clues may be gathered in the clinical presentation which would serve as red flags of an underlying disease, as shown below.

• Blood spots in the eyes (Sub-conjunctival hemorrhage)

• Facial flushing (Rapid reddening of the face that is warm to touch)

• Dizziness

• Headaches and Nosebleeds (only in the case of hypertensive crisis)

It has to be noted however that these symptoms are highly non-specific and patients may alternately present with a complication of hypertension rather than a symptom indicative of hypertension itself. The definitive diagnosis comes from the readings made by a mercury or digital “sphygmomanometer” (a.k.a. blood pressure monitor). Two or more readings are used to obtain an average before arriving at a diagnosis. You may have seen blood pressure (BP) expressed as a fraction by doctors. This is, in fact, the accepted method of denoting the systolic BP (pressure of blood within the arteries when the heart is contracting) which is the numerator and the diastolic BP (pressure of blood within the arteries when the heart is relaxing) which is the denominator, expressed in mmHg units. The normal value of BP is accepted as 120/80. The revised guidelines of the American Heart Association (AHA) adopted in 2017 identify values equal to or greater than 140/90 as cases of definitive (Stage 2) hypertension.

Risk factors

About 90% of cases of hypertension are described as primary or essential hypertension, but hypertension can occur

secondary to underlying disease conditions like Renal artery stenosis, CKD (Chronic Kidney Disease), and endocrine

abnormalities like thyrotoxicosis, Cushing’s disease, and phaeochromocytoma. The predisposing risk factors can be

described as modifiable and non-modifiable.

Non-modifiable risk factors:

• Family history of hypertension

• Old age

• Gender: Until age 64 there is a male preponderance which shifts to females after age 65

Modifiable risk factors:

• Smoking

• Lack of physical activity

• An unhealthy diet with an excess of Sodium

• Being overweight/obese

• Drinking too much alcohol

• High cholesterol

• Diabetes

• Obstructive Sleep Apnoea and Stress

Adverse Complications of Untreated Hypertension

Persistently elevated pressures within your arteries can add to the workload of your already overtaxed heart and can

damage the walls of the arteries which can lead to the formation of blood clots. What's more, the stream of blood

can dislodge one of these clots, causing the clot to shoot up to the small vessels of your brain and cause a fatal

stroke. Let us have a look at the serious sequelae that await those who take their high blood pressure for granted.

•  Heart attack

•  Stroke

•  Systolic heart failure

•  Renal failure

•  Vision loss

•  Erectile dysfunction

•  Peripheral Vascular Disease

•  Atherosclerosis

Treatment options and Lifestyle Modifications

The management approach to hypertension begins with the exclusion of secondary hypertension. Here it is important to treat the underlying cause of hypertension than hypertension itself. Essential Hypertension is treated with a class of drugs known as “Anti-hypertensives”. These drugs should be used as prescribed by a doctor adhering to the correct dosage with close monitoring of the treatment outcomes while keeping an eye out for possible Adverse Drug Reactions. (ADRs) Some of the drugs that you may be prescribed include,

1.  ACE Inhibitors (drugs ending with “pril”)

2.  Angiotensin-II receptor blockers – ARBS (drugs ending with “sartan”)

3.  Beta-blockers (drugs ending with “lol” :-p)

4.  Alpha-blockers (Eg. Prazosin)

5.  Calcium Channel Blockers - CCB (Eg. Amplodipine, Verapamil, Diltiazem)

6.  Diuretics – Thiazide diuretics, Loop diuretics and Potassium-sparing diuretics

7.  Others – Methyldopa, Clonidine, Hydralazine, Sodium nitroprusside, etc

Despite the existence of these drugs, one can’t effectively control his/her pressure without adopting lifestyle modifications. The NICE (National Institute of Clinical Excellence) has recommended the following interventions:

1. Weight reduction (to maintain an ideal BMI of 18.5-24.9 kg/m 2 )

2. Reduce consumption of saturated and trans fats

3. Reduce sugar intake and consume wholegrain varieties of starchy food

4. Salt reduction in the diet (no more than 5-6g per day)

5. Reduce caffeine consumption

6. Avoid consuming alcohol

7. Complete cessation of smoking

8. Adequate exercise: The AHA recommends at least 150 minutes of moderate-intensity aerobic exercises per week spread evenly throughout the week (i.e. 150/7 = At least 22 minutes of exercise per day)

Your health is your responsibility. So be responsible and know your numbers. Early detection and correction are keys in the prevention of complications, so don’t be afraid of your routine medical check-ups especially if you have the risk factors discussed earlier. Remember that health is wealth, so don’t take it for granted.

By,

Rtr. Minura Manchanayake

Rotaract Club of Faculty of Medicine, University of Colombo