How to effectively manage hypertension?

Hypertension, or high blood pressure is considered globally a major risk factor for coronary artery disease, cerebrovascular disease, kidney failure and heart failure. It has also been called a ‘silent killer’ because many sufferers don’t realize that they have this disease. But what exactly is hypertension, and how do we classify a person as hypertensive; read on to find out:

What is hypertension?

Hypertension, or high blood pressure occurs when the excessive force of blood against the arterial walls is high enough to put pressure on the heart, and eventually cause health problems. When there is persistent high blood pressure, the walls of the arteries harden, and the heart has to work harder to overcome this resistance. This causes undue pressure on the heart, and can lead to heart failure in the long run.High blood pressure can be present for years before it is diagnosed. Even without symptoms it continues to damage the blood vessels and the heart. In fact, many people do not see signs of disease despite dangerously high levels. For some people, hypertension can cause headaches, nosebleeds or shortness of breath. However, there can be non-specific signs and symptoms until the levels reach dangerously high.

New guidelines of hypertension

The American College of Cardiology and American Heart Association, have revised their guidelines for the diagnosis of hypertension. According to the new guidelines, only pressures lower than 120/80 mm Hg are considered normal; in the range of 120-129 mm Hg systolic and diastolic less than 80 the blood pressure is considered elevated. Furthermore, stage I hypertension will now be considered between the range of 130-139, as opposed to the previous range of above 140/90 mm Hg. The latter is now classified as stage II hypertension.

The newer guidelines have also eliminated the former category of ‘prehypertension’. The new guidelines also stress on the importance of proper techniques to measure blood pressure, with usage of accurate home devices. These 2017 guidelines of American College of Cardiology and American Heart Association, have the potential to increase the awareness of hypertension among the masses, and encourage lifestyle modification.

Situation of hypertension in Pakistan?

The South Asian region, including Pakistan shows a very high prevalence rate of hypertension. Hypertension is a harbinger of cardiovascular disease, and can be a huge burden on the healthcare system of a country. In the National Health Survey Of Pakistan , it was estimated that about 33 percent of adults above the age of 45 years suffered from hypertension, while 18 percent adults overall had hypertension.

In another meta-analysis , comprising over 40,000 participants, there was a high prevalence (around 26 percent) of hypertension in adolescents. In comparison to data from international journals, this is a high prevalence rate and this rate is expected to increase in the coming years.

A great challenge for treating hypertension is that only about half the patients of hypertension are diagnosed, and of these, only 50 percent seek treatment.

How to manage hypertension?

The first step for the management of hypertension is lifestyle modification. You don't have to start taking a bunch of pills to control the high blood pressure straight away. Some tips for you to manage hypertension include:

Weight loss : is one of the most effective techniques to manage hypertension. According to Dr. Naomi Fisher, associate professor of medicine at Harvard Medical School , losing weight is the most effective means of reversing high blood pressure. A weight loss of even 10 pounds can help immensely in lowering blood pressure.

Lower sodium intake : salt (sodium chloride) helps to retain water in the blood vessels and increase the blood pressure. Decreasing the dietary sodium and drinking less salt can greatly help in lowering blood pressure. In our daily menu, we have items like soup, sandwiches, pizza, bread and rolls that can have high amounts of sodium lurking in them.

One way of lowering sodium in the diet is to keep a food diary. It can help you make a record of all that you eat, and how much. Another way to decrease dietary sodium is to increase the consumption of potassium. Higher potassium in the body, encourages the kidneys to excrete sodium, and thereby helps in reducing high sodium levels.

Quit smoking : the chemicals in cigarettes cause narrowing and hardening of blood vessels, causing hypertension to worsen, and the risk of a cardiovascular event to increase. Therefore, patients of hypertension should quit smoking and even avoid secondhand smoke.

Healthy diet : the ideal diet for hypertension is known as DASH diet—Dietary Approach to Stop Hypertension. This diet was designed to treat and stop hypertension without medication in research backed by the National Institute of Health. Following this diet can help lower the blood pressure by as many as 14 points, which can significantly reduce the health risk in people prone to hypertension.

Not only does the DASH diet offer health benefits for hypertension, it is also effective in weight loss and a generally healthier way of life. The DASH diet lays emphasis on fruits, vegetables, moderate amounts of whole grains, nuts and poultry. There is also a limitation of sodium intake in the DASH diet, with the standard DASH diet allowing up to 2300 mg of sodium a day, and the lower sodium DASH allowing only 1500 mg of sodium per day.

Even though the DASH diet has shown very good results for a lot of patients, it is important to consult a doctor and a nutritionist before actually implementing it. Bahria international hospital is a very competent facility in this regard as it has multiple general physicians and nutritionists on its panel.

Pharmacological therapy : if the non-pharmacological therapies are not working, your healthcare provider can advise certain medication for controlling hypertension. These can include: thiazide diuretics, ACE inhibitors, ARBs, calcium channel blockers and beta blockers. Your healthcare provider will choose the one that fits best for your profile.

If by following all these tips you are still not able to manage hypertension, you should consult with a general physician. The general physician might refer you to a cardiologist depending upon the intensity of your situation. The Northwest General Hospital in Karachi can be an ideal facility to visit in this regard as it has both general physicians and cardiologists on its panel.