DR. JAYARAM LINGAMANAICKER

MBBS, LRCP (Edin), LRCS (Edin),
LRCP&S (Glas), MRCP (UK),
FRCP (London), FACA (USA),
FAMS (Cardiology), FACC (USA)

Lifeline Heart Centre
#11-10 Mount Elizabeth
Medical Centre
3 Mount Elizabeth
Singapore 228510

Tel: (65) 6836 2611 /
  (65) 6836 9038 /
  (65) 6836 1990

Fax: (65) 6836 9037

E-mail:    

lifelineheart@gmail.com /
lifelineheart@singnet.com.sg



Patient Guide > High Blood Pressure
Patient Guide > High Blood Pressure


Introduction

Uncontrolled high blood pressure increases the risk cardiovascular diseases including heart attack and stroke. Typically it develops without signs or symptom; hence high blood pressure is called the silent killer. Fortunately, high blood pressure can be easily detected. Once you know you have high blood pressure, with medications your doctor can help control it.

Causes of high blood pressure

In over 90 percent of high blood pressure cases, there's no identifiable cause. This type of high blood pressure is known as essential hypertension or primary hypertension. This type of blood pressure tends to develop gradually over many years. The remaining 5 percent to 10 percent of high blood pressure cases usually have an underlying cause. This type of high blood pressure is called secondary hypertension, and it appears suddenly and causes higher blood pressure than does primary hypertension. Conditions like kidney abnormalities, adrenal gland tumors, certain medications and some rare congenital heart defects can produce secondary hypertension.

Risk factors
  • Age
    The risk of high blood pressure increases as you age. From early middle age, high blood pressure is more common in men. Women are more likely to develop high blood pressure after menopause.

  • Family history
    High blood pressure tends to run in families.

  • Excess weight
    Obese patients tend to have raised blood pressure. The more obese you are, the more blood you need to supply oxygen and nutrients to your body. The volume of blood circulated increases, so does the pressure on your artery walls.

  • Race
    High blood pressure is particularly common among certain races. Blacks, often develop at an earlier age than it does in whites.

  • Physical inactivity
    Lack of physical activity increases the risk of being overweight. Inactive people tend to have higher heart rates and blood pressure.

  • Smoking
    Cigarette smoking can damage the lining of your artery walls, which promotes narrowing of the arteries Ė atherosclerosis.

  • Salt intake
    Too much sodium in your diet can lead to fluid retention and increased blood pressure.

  • Potassium intake
    Potassium helps balance the amount of sodium in your cells. If your potassium intake is low you may accumulate too much sodium in your blood which leads to high blood pressure.

  • Excessive alcohol
    Heavy drinking can damage your heart.

  • Stress
    High levels of stress can lead to a temporary but dramatic increase in blood pressure.
Certain chronic conditions like diabetes, kidney disease and sleep apnea increase your risk of high blood pressure. Occasionally pregnancy contributes to high blood pressure.

Screening and diagnosis

A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The lower, number measures the pressure in your arteries between beats (diastolic pressure).

The latest blood pressure guidelines, divide blood pressure measurements into four general categories:
  1. Normal blood pressure
    Your blood pressure is normal if it's below 120/80 mm Hg.

  2. Prehypertension
    Prehypertension is a systolic pressure ranging from 120 to 139 or a diastolic pressure ranging from 80 to 89. Prehypertension tends to get worse over time. Within four years of being diagnosed with prehypertension, nearly one in three adults ages 35 to 64 and nearly one in two adults age 65 or older progress to definite high blood pressure.

  3. Stage 1 hypertension
    Stage 1 hypertension is a systolic pressure ranging from 140 to 159 or a diastolic pressure ranging from 90 to 99.

  4. Stage 2 hypertension
    The most severe hypertension, stage 2 hypertension is a systolic pressure of 160 or higher or a diastolic pressure of 100 or higher.
A single reading usually isn't enough for a diagnosis. Blood pressure normally varies throughout the day and sometimes specifically during visits to the doctor it may be raised. The diagnosis is based on more than one reading taken on more than one occasion. Your may be asked to record your blood pressure at home and at work to provide a true picture.

Complications

Complications

Uncontrolled high blood pressure can damage your vital organs. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.
  • Atherosclerosis
    Poor blood pressure control can result in hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.

  • Heart failure
    Your heart muscle thickens as the blood is pumped against high pressure. Eventually, the thickened muscle may not be able to pump enough blood to meet your body's needs, which can lead to heart failure.

  • Stroke
    A blocked or ruptured blood vessel in your brain leads to stroke.

  • Kidney failure
    Poor blood pressure control over time leads to narrowing of blood vessels in your kidneys. This can damage the kidneys and produces renal failure.

  • The Eyes
    Thickened, narrowed blood vessels in the eyes. This can result in vision loss.
Uncontrolled high blood pressure also may affect your mental ability. Cognitive impairment and dementia are more common in people who have high blood pressure.

Treatment

Blood pressure treated early can help prevent serious complications some of which may be life-threatening ó complications. Your doctor also may also aggressively treat co existing conditions, such as diabetes and high cholesterol.

The goal for blood pressure control isnít the same for everyone. Doctors recommend lower readings for people with certain conditions.

Blood pressure treatment goals
140/90 mm Hg or lower If you are a healthy adult
130/80 mm Hg or lower If you have chronic kidney disease, diabetes or coronary artery disease or are at high risk of coronary artery disease
120/80 mm Hg or lower If your heart is weak and not pumping well (left ventricular dysfunction or heart failure) or in chronic kidney diseases

Lifestyle modification can go a long way toward controlling high blood pressure. But sometimes lifestyle changes aren't enough. In addition to diet and exercise, your doctor may recommend medication to lower your blood pressure. The major types of medication used to control high blood pressure include:
  • Thiazide diuretics
    These medications are diuretics which act on your kidneys to eliminate sodium and water, reducing blood volume. Usually thiazide diuretics are prescribed as first choice in treating high blood pressure.

  • Beta blockers
    It slows your heartbeat, relax your heart muscle, and decrease blood pressure making your heart as a pump to work without strain. Beta blockers can limit the amount of heart muscle damage and prevent future heart attacks.

  • Calcium channel blockers
    These medications help relax the muscles of your blood vessel wall thereby reducing the blood pressure. Some calcium channel blockers slow your heart rate.

  • Angiotensin-converting enzyme (ACE) inhibitors
    These medications help relax blood vessels by blocking the enzyme which helps in the formation of a natural chemical that narrows blood vessels. ACE inhibitors are the first choice if you have a weak heart or if you are a diabetic.

  • Angiotensin II receptor blockers
    These medications help relax blood vessels by blocking the action of a natural chemical that narrows blood vessels. Like ACE inhibitors, angiotensin II receptor blockers are often prescribed for diabetics, kidney patients and people with a weak heart.

  • Other medications
    If the above medications are not effective reaching your blood pressure goal, your doctor may prescribe:

    • Alpha blockers
      These medications decrease nerve impulses to the arteries, reducing the effects of natural chemicals that narrow the arteries.

    • Central-acting agents
      These medications act on the brain and prevent it from signalling your nervous system to increase your heart rate or blood pressure.

    • Vasodilators
      These medications work directly on the muscles in the walls of your arteries, preventing the muscles from contracting and increasing the blood pressure.
Self-care

Lifestyle modification can help you control and prevent high blood pressure. Here's what you can do:
  • Healthy foods
    Try the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low-fat dairy foods. Limit the amount of sodium in your diet. Although 2,400 milligrams (mg) of sodium a day is the current limit for otherwise healthy adults, limiting sodium intake to 1,500 mg a day will have very good effect on your blood pressure.

  • Weight reduction
    If you're overweight, losing even a few kilograms can lower your blood pressure.

  • Exercise
    Regular physical activity can help lower your blood pressure and keep your weight under control. Try and do at least 25 to 30 minutes of physical activity 5 days a week.

  • Alcohol in moderation
    Alcohol can raise your blood pressure; hence do so in moderation ó up to one drink a day for women, two drinks a day for men.

  • Quit smoking
    Cigarette smoking accelerates atherosclerosis (plaque formation inside blood vessels). This leads to cardiovascular disease namely heart disease and stroke. It also raises the blood pressure.

  • Stress
    Reduce stress as much as possible. It is a risk factor for heart disease.
Coping with blood pressure

High blood pressure is a condition you need to manage for the rest of your life. To keep your blood pressure under control:
  • Home monitoring of blood pressure
    Home blood pressure monitoring can help you keep closer tabs on your blood pressure, show if medication is working.

  • Take your medications regularly
    Take your medications regularly, donít stop taking them. Medications are for life.

  • Visit your doctor regularly
    It takes a team effort to treat high blood pressure successfully. Your doctor can't do it alone, and neither can you. Work with your doctor to bring your blood pressure to an acceptable level.
Sticking with all this can be difficult ó especially if you don't have any symptoms of high blood pressure. Remember hypertension is a silent killer and the risks associated with uncontrolled high blood pressure can be disastrous.