High Blood Pressure

Blood pressure is the force exerted by blood on the walls of the arteries as it flows through them. High blood pressure (hypertension) is a condition where the extreme amount of force exerted by the blood when traveling through the blood vessels (artery walls) causes health problems such as heart disease.

It is determined by both the amount of blood pumped by the heart and the amount of resistance it receives at if flows through the arteries. The narrower your arteries and the more the heart pumps blood, the higher your blood pressure.

World Health Organization reports that hypertension causes about 7.5 million deaths which represent 12.8% of total deaths in the world. It also produces about 57 million Disability Adjusted Life Years (DALYS) which signifies 3.7% of total DALYs in the world. 

Regionally, the prevalence of hypertension was highest in Africa, at 46% for both male and female. The lowest rates are reported in the region of America where it stands at about 35% for both sexes.

In Kenya, hypertension is a serious concern for the Ministry of Health with 8 out of 100 people reported to be suffering from severe hypertension. According to the survey by Kenya STEPWise, 8% of Kenyans aged between 40 and 69 years have a cardiovascular disease which represents a risk of 30% or more with only 6.2% of them currently undertaking drug therapy and counseling services to prevent stroke and heart attacks.  

Unfortunately, unlike many diseases that have specific signs and symptoms, hypertension does not, and one can suffer the condition for years without symptoms and without realizing. The person may experience some headache, nosebleed, or shortness of breath but these signs are not specific and do not occur until hypertension has reached a life-threatening stage.

Without treatment, high blood pressure can lead to grave health conditions such as vision loss, heart failure, kidney disease, and stroke. It is advisable to get routine checks for blood pressure at least after every two years starting at the age of 18.

If you are 40 years or older or between 18 and 39 but classified as being at high risk of blood pressure, make sure you check your blood pressure every year.

Causes

Blood pressure is categorized into primary (essential) and secondary hypertension. Primary hypertension tends to develop slowly over several years, and thus, it does not have specific cause especially in adults.

However, secondary hypertension is mostly caused by the underlying condition. It appears suddenly and causes higher (severe/extreme) blood pressure compared to primary hypertension. Secondary hypertension develops because of various conditions and medications that include:

  • Kidney problems
  • Obstructive sleep apnea
  • Thyroid problems
  • Adrenal gland tumors
  • Certain medications such as cold remedies, birth control pills, over-the-counter pain relievers, decongestants, and prescription drugs
  • Congenital defects in the blood vessels
  • Illegal drugs such as amphetamines and cocaine

Risk Factors

The risk factors for hypertension include:

  • Race: Very common among individuals of African heritage where it mostly develops at tender age compared to whites. That is the reason serious complications such as kidney failure, heart attack, and stroke are higher among individuals of African heritage.
  • Age: The more you age, the higher the risk of hypertension. Until approximately 64 years, hypertension is common among men. Women are more likely to develop it after 65 years.
  • Family history: Hypertension tends to run in families.
  • Not being physically active: Those who do not exercise tend to have higher heart rates and the higher the heart rates, the higher the risk of hypertension.
  • Being obese or overweight: The more body mass you accumulate, the more blood you require to circulate nutrients and oxygen to tissues. The more the blood circulates the more pressure on your artery walls.
  • Using Tobacco: Besides the immediate effect of raising blood pressure, chewing or smoking tobacco releases chemicals that also damage the lining of the artery walls. Consequently, arteries narrow down and increase the risk of hypertension and heart disease.
  • Too little potassium in your diet: It helps balance the amount of sodium in the blood cells.
  • Too much salt (sodium) in your diet: Extreme sodium leads to retaining more fluids in the body which increases blood pressure.
  • Drinking too much alcohol: Heavy drinking can damage the heart hence difficulties in pumping blood.
  • Mental stress
  • Certain chronic conditions such as kidney disease, sleep apnea, and diabetes

In rare cases, hypertension is caused by pregnancy. Even though children are not at high risk, certain diseases such as kidney problems or heart complications may lead to hypertension.

Diagnosis

Diagnosis of high blood pressure is done using sphygmomanometer alongside stethoscope. Additional tests include urine and blood tests, exercise stress test, electrocardiogram (ECG), Holter monitoring, and echocardiogram. 

Treatment

Treatment of hypertension depends on factors such as severity and related risks of developing stroke or heart disease. The doctor will recommend different medications and treatment approaches as blood pressure increases:

  • Slightly elevated: At this stage, a person is still at low risk of developing heart disease, and thus, the doctor may recommend lifestyle changes in terms of diet, avoiding substance abuse and alcohol, tobacco smoking or chewing, and embracing exercises
  • Moderately high: If the doctor has all the reasons to believe that the risk of developing heart disease in the next 10 years or so is more than 20%, he or she will likely prescribe medication and suggest lifestyle changes.
  • Severe: If blood pressure levels reach 180/120 mmHg or above, you are in a hypertensive crisis. The doctor will immediately change the dosage or type of medication you are using to reduce the rate.

Lifestyle adjustments recommended to reduce hypertension include regular exercises (3-4 days/week), losing weight, relaxation techniques, enough sleep, and medications.

Note that exercise is only effective when it is regular which means weekend exercises and doing nothing during weekdays does not help a lot compared to daily exercising.

Moderate weight loss of between 5 and 10 pounds (about 2 to 4.5kgs) can critically help lower elevated blood pressure.

Enough sleep that can help achieve ideal body weight is at least 7 hours every night. This goes hand in hand with a healthful diet in conjunction with exercising.

Relaxation techniques mostly recommended by doctors include meditation, yoga, and guided breathing – they have a short-term and low-level effect on blood pressure.

There are various medications to manage hypertension. The first one is Angiotensin-converting enzyme (ACE) inhibitors that block the actions of certain hormones such as angiotensin II that regulate blood pressure. ACE inhibitors are effective in enhancing blood floor, but they have some side effects such as fatigue, dizziness, weakness, and headaches.

Other medications include calcium channel blockers (CCBs), thiazide diuretics, Beta-blockers, and Renin inhibitors. All these medications are useful but must be prescribed and used under close monitoring by the doctor because they have some side effects that might be dire.  

Sources

aphrc.org/wp-content/uploads/2016/04/Steps-Report-NCD-2015.pdf

https://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/

https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410

https://www.medicalnewstoday.com/articles/159283.php

https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/managing-weight-to-control-high-blood-pressure