Hypertension

Hypertension

High blood pressure is a common condition in which the force of the blood against the artery walls is high such that it eventually causes health problems, such as heart disease and stroke. The normal blood pressure in an adult ranges from 100-140mmHg systolic to 60-90mmHg diastolic. The pressure of the blood against the vessel is what determines blood pressure. It is dependent on the amount of blood the heart pumps and the amount of resistance to blood flow in the arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure. Therefore, it is clear that blood pressure is not a disease of the heart but a problem with the blood vessels. Therefore, the heart and other organs such as the brain and kidneys bear the brunt of high blood pressure and it is the damage in these organs that causes complications and death to the patient.

Someone can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and the heart continues and can be detected. Uncontrolled high blood pressure increases the risk of serious health problems, including heart attack, stroke and kidney failure. High blood pressure is the single most important cause of the three above conditions. If prevented or treated, it offers the largest benefit to the community in the preventing long term complications and disability.

High blood pressure generally develops over many years, and it affects up to a third of Kenyans above the age of 40 years. Fortunately, high blood pressure can be easily detected, and through a blood pressure measuring machine, and once detected one can work with the doctor to control it.

Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels. Although a few people with early-stage high blood pressure may have dull headaches, dizzy spells or a few more nosebleeds than normal, these signs and symptoms usually don't occur until high blood pressure has reached a severe or life-threatening stage.

When to see a doctor

Blood pressure should taken as part of a routine doctor's appointment. A blood pressure reading should be obtained at least once every two years starting at age 18. Blood pressure should be checked in both arms to determine if there is a difference. The doctor will likely recommend more frequent readings if you've already been diagnosed with high blood pressure or other risk factors for cardiovascular disease. 

If you don't see a doctor regularly, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. 

There are two types of high blood pressure.

Primary (essential) hypertension

For most adults, there is no identifiable cause of high blood pressure. This type of high blood pressure, called essential hypertension or primary hypertension, tends to develop gradually over many years.

Secondary hypertension

Some people have high blood pressure caused by an underlying medical condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:

• Kidney problems
• Adrenal gland tumors
• Thyroid problems
• Certain defects in blood vessels that someone is born with (congenital)
• Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
• Illegal drugs, such as cocaine and amphetamines
• Alcohol abuse or chronic alcohol use
• Obstructive sleep apnea

Risk factors

High blood pressure has many risk factors, including:

• Age. The risk of high blood pressure increases as you age. Through early middle age, or about age 45, high blood pressure is more common in men. Women are more likely to develop high blood pressure after age 65. In Kenya we see the blood pressure rising in both sexes while most people are in the 4th decade (30’s) and most people are diagnosed with hypertension in the 5th decade (40’s).
• Race. High blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites. Serious complications, such as stroke, heart attack, and kidney failure, also are more common in blacks.
• Family history. High blood pressure tends to run in families. If both of your parents are hypertensive then the risk of developing higher blood pressure is higher than either of them individually.
• Being overweight or obese. The higher the weight the more blood one needs to supply oxygen and nutrients to the tissues. As the volume of blood circulated through the blood vessels increases, so does the pressure on the artery walls.
• Not being physically active. People who are inactive tend to have higher heart rates. The higher the heart rate, the harder the heart must work with each contraction and the stronger the force on the arteries. Lack of physical activity also increases the risk of being overweight. When one is physically active the body produces substances that enhance myocardial functionality and improve the health of the arteries and their lining.
• Using tobacco. Not only does smoking or chewing tobacco immediately raise the blood pressure temporarily, but the chemicals in tobacco can damage the lining of the artery wall. This causes the arteries to narrow, increasing the blood pressure. Second hand smoke causes the same effect as first hand tobacco.
• Too much salt (sodium) in the diet. Too much sodium in the diet causes the body to retain fluid thereby increasing blood pressure.
• Too little potassium in the diet. Potassium helps balance the amount of sodium in the cells. If the body does not get enough potassium in the diet or retain enough potassium, the tendency is to accumulate too much sodium in the blood.
• Drinking too much alcohol. Over time, heavy drinking can damage the heart. Taking more than two drinks a day for men and more than one drink a day for women may cause elevation of blood pressure and may render drug treatment ineffective.
• Stress. High levels of stress can lead to a temporary increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure. Stress may be reduced by try relaxation methods such as Yoga.
• Certain chronic conditions. Certain chronic conditions also may increase the risk for high blood pressure, such as kidney disease and sleep apnea. Sleep apnoea commonly occurs in obese who snore heavily at night and is associated with daytime somnolence and fatigue.

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