Hypertension or high blood pressure is a very common condition and incidence increases with age. It is important to diagnose and treat hypertension early in order to prevent/reduce the risk of heart disease and stroke.

WHAT IS BLOOD PRESSURE?
Blood pressure is the force generated when the heart pumps blood and moves it through the blood vessels to various parts of the body. It is represented as two numerical values namely the systolic (upper reading) and diastolic (lower reading) blood readings (eg 120/80 mmHg).
Systolic blood pressure reflects the pressure while the heart is contracting. A normal systolic blood pressure is 140 mmHg or lower.
Diastolic blood pressure represents the pressure when the heart is resting between two successive contractions. A normal diastolic blood pressure measurement is 90 mm Hg or less

TYPES OF HYPERTENSION
? Primary or Essential Hypertension – In most patients the cause of hypertension cannot be identified. When there is no identifiable cause, it is termed primary hypertension.

The pressure within the blood vessels depends on how hard the heart contracts and the resistance to blood flow within the arteries. It is believed that slight narrowing of the arteries increases the resistance to blood flow, which in turn increases the blood pressure. The cause of the slight narrowing of the arteries is not clear. Various factors probably contribute

Risk Factors For Hypertension
• Increasing age
• African or Indian subcontinent origin
• Family history of hypertension
• Excess salt in the diet
• Overweight
• Stressful life situation
• Alcohol abuse
• Lack of exercise and sedentary life

? Secondary Hypertension
When high blood pressure occurs due to some other condition, it is termed as secondary. Causes of secondary hypertension include the following

• Concomitant type 2 diabetes
• Polycystic kidney disease
• Renovascular disease (narrowing of renal artery)
• Chronic kidney disease
• Cushing syndrome (cortisol excess)
• Thyroid problems
• Hyperaldosteronism (mineralocorticoid excess)
• Pheochromocytoma (adrenal tumor secreting epinephrine/norepinephrine)
• Pregnancy induced hypertension
• Coarctation of aorta
• Drug induced – analgesics, birth control pills, antidepressants, immunosuppressive drugs prescribed post-transplant, cocaine

SYMPTOMS OF HYPERTENSION
Many persons are asymptomatic from high blood pressure with damage to heart, kidneys, eyes and blood vessels going unrecognized. Some of the following symptoms may occur in hypertension namely

• Tiredness and frequent headaches
• Blurred vision
• Dizziness
• Shortness of breath
• Symptoms of heart disease such as chest pain

It is therefore important to regularly monitor the blood pressure with a doctor or learn to take one’s own readings to prevent or reduce complications.

COMPLICATIONS OF UNCONTROLLED HYPERTENSION
• Heart attack (thickened and narrowed coronary arteries)
• Heart failure (inability of heart to pump against increased resistance)
• Transient ischemic attacks and stroke (narrowed cerebral vessels)
• Kidney failure
• Peripheral vessel disease (narrowed vessels of the limbs)
• Visual problems (narrowed retinal vessels)
• Aortic aneurysm and rupture (weakening of wall of aorta)
• Metabolic syndrome – cluster of disorders of your body’s metabolism — including increased waist circumference, high cholesterol and triglycerides, high blood pressure and high insulin levels. Associated with increased risk of diabetes, heart disease and stroke

DIAGNOSIS OF HYPERTENSION
Typically a first high blood pressure reading will be in the doctor’s clinic. The doctor or nurse may then advise regular observation for a few days. These will usually be in the form of home (at rest) or ambulatory (while pursuing routine activities) readings and taking the average of the systolic and diastolic readings to obtain the average blood pressure over a few days.

The length of the observation period varies depending on the initial measurements and presence of other health risk factors.

If repeated measurements are high i.e. blood pressure that is 140/90 mm Hg or more each time it is taken at the doctor’s clinic, or home or ambulatory readings where the average is more than 135/85 mm Hg, a diagnosis of hypertension may be made.

High blood pressure can also be diagnosed if any one of the following criteria are satisfied

• Just a high systolic pressure – for example, 170/70 mm Hg.
• Just a high diastolic pressure – for example, 120/104 mm Hg.
• Or both – for example, 170/110 mm Hg

American College of Cardiology and the American Heart Association Task Force Guidelines on Hypertension

• Normal: <120/80 mm Hg.
• Elevated: 120-129/<80 mm Hg.
• Stage 1: 130-139/80-89 mm Hg.
• Stage 2: >140/90 mm Hg.

Once a diagnosis of hypertension is made, the treatment will depend on several factors. Some patients will not need medication and will be advised management through diet and exercise, to reduce their risks of complications. Older adults with high blood pressure, other underlying medical problems and limited life expectancy will be assessed individually and treatment customised ensuring optimal outcome for the patient.

FURTHER TESTS THAT MAY BE DONE ( to check for presence of heart or kidney disease)
• Urine test for presence of protein and/or blood
• Kidney function tests
• Blood sugar measurements
• Lipid profile
• ECG

TREATMENT OF HYPERTENSION
Lifestyle changes – In some patients, medication may be deferred and they will be advised to make lifestyle changes as below

• Regular exercise and weight reduction
• Reduce salt intake
• Avoiding fried foods
• Stress management
• Stop smoking and cut down alcohol

Medications
There are several medications that control blood pressure and the agent of choice depends on patient preference and other associated conditions that may be present and occurrence of side effects due to a specific drug. The five main groups of antihypertensive drugs include

• Angiotensin-converting enzyme (ACE) inhibitors
• Angiotensin receptor blockers (ARBs)
• Calcium-channel blockers
• ‘Water’ tablets (thiazide diuretics)
• Beta-blockers

It is important to take the medications as prescribed by the doctor and not to change the dose or stop any drug without the doctor’s consent.

LIVING WITH HYPERTENSION
High blood pressure is a chronic lifelong disease. Although it cannot be cured, it can be controlled. The following tips may ensure better blood pressure control and decreased risk of complications
•? Diet rich in fresh fruits and vegetables and whole grains
•? Reduce your salt and saturated fat intake
•? Reduce sugar and calorie intake
•? Cutting down on smoking and alcohol
•? Exercising regularly and losing weight
•? Stress management
•? Taking the medicines regularly
•? Monitoring your blood pressure regularly
•? Regular followup by the doctor