High Blood Pressure ‘Doc, I’m just a bit stressed’

It’s not an uncommon scenario when a patient walks through the door and while you address their agenda, you put on the blood pressure cuff. The reading gets you alarmed
10 Jul 2017 13:25
High Blood Pressure ‘Doc, I’m just a bit stressed’
Dr Krupali Tappoo

It’s not an uncommon scenario when a patient walks through the door and while you address their agenda, you put on the blood pressure cuff.

The reading gets you alarmed and while you calmly continue talking to the patient, you repeat the reading.

This has improved slightly, but not within the normal range.

Upon mentioning to the patient that their blood pressure is high, on most occasions the response would be that I’m really stressed at work, or that I just walked up a flight of stairs.

Many others will say that its always high when I see the doctor, but normal otherwise (white-coat hypertension).

Most will respond, “but I don’t have any symptoms so how can my blood pressure be high?”

Hypertension, also known as high blood pressure is a long-term medical condition in which the blood pressure in the arteries is persistently elevated.


A major risk factor

High blood pressure usually does not cause any symptoms however it has health implications.

Long-term high blood pressure is a major risk factor for coronary artery disease (heart attacks), stroke, heart failure, vision loss and chronic kidney disease.

Hypertension is usually classified as primary (essential) or secondary.

Primary hypertension accounts for about 90-95 per cent of cases and is because of nonspecific lifestyle and genetic factors.

Secondary hypertension accounts for about five per cent – 10 per cent and is due to a specific identifiable cause such as chronic kidney disease, narrowing of the arteries in the kidney, disease of the adrenal glands or the use of the oral contraceptive pill in women.

Extremely high blood pressure and symptoms such as chest pain or headache would be concerning and require a visit to the emergency department to exclude heart attack and possible stroke.

In other situations with asymptomatic patients a repeat BP in a few days would be warranted. Genes play a role as well and hence enquiry into a family history of hypertension, diabetes, heart disease and stroke are important for risk stratification.


Lifestyle factors

Lifestyle factors are also a very important part and upon enquiry it is evident that processed and packaged foods with a high salt content have become a part of the lives of most people.

Busy work schedules put exercise on the backburner and the weight that was gained during the festive season continues to pile up.

The so -called few drinks escalate to a night long of drinking alcohol and become much more than the recommended two standard drinks.

Many people claim that cigarette smoking relaxes them and this is yet another risk factor for elevated BP.

Globally, the overall prevalence of raised blood pressure in adults aged 25 and over was around 40 per cent in 2008 (WHO).

As a result of population growth and ageing, the number of people with uncontrolled hypertension rose from 600 million in 1980 to nearly one billion in 2008- this is about 1/7 of the world’s total population.

In Fiji 21.5 per cent of the adult population between the ages of 25-64 had hypertension (NCD risk factor STEPS report 2005-2010). Such alarming global and local statistics!

So how then can we manage this condition, which is so rampant in the world?


What needs to be done

Essentially it’s a lifestyle disease and until we work on lifestyle changes, not much can be achieved.

This includes reduction in dietary salt, processed and packaged foods, reducing alcohol intake, increasing fruits and vegetables in the diet. Regular physical exercise, and weight reduction will all have positive effects on blood pressure.


Treating hypertension

When it comes to treating hypertension, it is essential to calculate a patient’s absolute cardiovascular risk.

Absolute cardiovascular risk is the numerical probability of a cardiovascular event occurring within a five-year period.

It reflects a person’s overall risk of developing cardiovascular disease (heart attacks and stroke) replacing the traditional method that considers various risk factors such as high cholesterol or high blood pressure in isolation.

In essence, the reason for treating elevated blood pressure is reducing the risk of heart attacks and stroke.

The components of this calculator are age, gender, smoking status, history of diabetes, total cholesterol level, HDL cholesterol (good cholesterol), systolic BP.

If a person is classified as low risk – <10 per cent, lifestyle changes should be implemented, which include a healthy diet, exercise, salt reduction, weight loss and if the BP remains consistently elevated >160/100, antihypertensive medication needs to be commenced.

For those at moderate risk 10-15 per cent, lifestyle changes need to be implemented and if there is no change in three to six months or if blood pressure is significantly elevated, medications need to be commenced.

If the absolute cardiovascular risk is high >15 per cent, lifestyle changes together with medications to reduce blood pressure need to be commenced. Diabetics and patients with kidney disease fall into the high risk category and needs aggressive treatment of blood pressure and their diabetes.

As Mehmet Oz says “ If you don’t know your blood pressure, its like not knowing the value of your company”.

The only way to find out what the value of your blood pressure is by getting it measured. There is simply no other way of finding out.

Urge your doctor to check you blood pressure even if you are visiting for some other unrelated medical issue.

Don’t wait till it’s too late.

Feedback: maraia.vula@fijisun.com.fj


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