Blood Pressure - Now is the time to get it right
High blood pressure or hypertension is regarded as one of the modern epidemics. It is perhaps one of the commonest diseases affecting mankind. It causes elevated levels of blood pressure in the human body. It is often a consequence of a sedentary lifestyle, mismanaged stress, and unhealthy dietary habits.
May 17 is observed as World Hypertension Day and the theme chosen for this year is "Measure Your Blood Pressure Accurately, Control It, Live Longer”. The objective is to focus on low awareness rates worldwide, especially in low to middle income areas, and accurate blood pressure measurement methods. It aims at raising awareness about the condition across the world and promotes its accurate measurement and management methods.
Hypertension affects about one third of the world population. It can be seen at any age groups although the prevalence is more common as age increases. It is estimated that about 26% of the world's total population has hypertension and it is expected to increase to 29% by 2025.
The Kidney plays a crucial role in salt handling and dysregulation of this is the primary cause of high blood pressure in essential Hypertension. In young people under 35 years of age high blood pressure is most often due to underlying kidney disease. High blood pressure over a long period of time also causes kidney damage.
The heart too gets affected by high blood pressure but is not the cause of high blood pressure. Good blood pressure control protects the kidney, heart and the brain.High blood pressure continues to play an important role even after kidney transplantin prolonging the life of the transplanted kidney .
Hypertension and COVID are closely interlinked. During COVID times the prevalence of hypertension is believed to be increasing. The two main reasons are increased: stress and lack of a regular exercise schedule leading to weight gain. This has further been worsened by the fact that patients are reluctant to go to hospitals or doctors’ clinic because of fear of COVID. Studies have shown that the severity of the COVID infection is also more in patients who have comorbidities like hypertension. Hence there is even a greater need to achieve blood pressure control in COVID times!.
Your blood pressure can change during the day with changes in posture, exercise or sleeping, but it should normally be less than 120/80 mm Hg for an adult.
What Is Hypertension?
The only way to tell whether you have high blood pressure is to have it measured accurately with a blood pressure cuff . Blood pressure (BP) is classified as follows:
• Normal BP: Systolic less than 120 mm Hg; diastolic less than 80 mm Hg.
• High Normal: Systolic 120-139 or diastolic 80-89 mm Hg.
• High BP Stage 1: Systolic 140-159; diastolic 90-99 mm Hg.
• High BP Stage 2: Systolic more than 160; diastolic more than 100 mm Hg.
High blood pressure
It usually causes no symptoms but can still cause serious complications. Hence it is often called the "silent killer."
• Many people have high blood pressure but don't even know it.
• The key complications of high blood pressure include kidney failure, heart disease, heart attack, congestive heart failure, stroke, andperipheral artery disease, especially aortic aneurysms or outpouchings of the aorta.
• However, good news is that the progress of heart disease as well as the kidney disease caused by high blood pressure can be slowed down by optimal blood pressure control.
How common is High BP?
It is estimated that more than 1 billion people world wide have high blood pressure which is about 1 in 3 adults aged 18 years and older. Yet nearly one-third of these people don't know they have it.
In India too with the changing lifestyle, increasing urbanization and fat food culture there is an increasing prevalence of high BP. In a recent study the estimated prevalence of hypertension for the Indian population aged 45 years and older was as high as 46% which means nearly 1out of 2 adults were suffering from hypertension.
Overall, 4 out of 10 adults over 45 years of age in India are not aware of their hypertensive condition, and of those who are aware, 73% are currently taking medication. What is alarming is that in our country only 10% of these have their hypertension under control.
How do I know if I have high blood pressure?
High blood pressure usually has no symptoms. In fact, many people have this disease for years without knowing it. Having high blood pressure (hypertension) doesn't mean you're tense, nervous or hyperactive. You can be a calm, relaxed person and still have hypertension. A single high reading doesn't mean you have high blood pressure, but it's a sign that you need to watch it carefully.
The mercury sphygmomanometer remains the most accurate way of measuring blood pressure. This device consists of a gauge and a rubber cuff that is placed around your arm and inflated. Having your blood pressure measured is painless and takes just a few minutes. If you are using electronic devices they need to be periodically cross calibrated with the mercury sphygmomanometer.
Here are 10 tips to ensure accurate BP reading at home:
(1) Pass urine prior to measuring your BP as high urinary pressure can increase BP by 10 mm.
(2) Sit and rest for 5 mins as measuring BP immediately after sitting gives a false high reading.
(3) Do not talk or watch TV as this can cause increase in BP by upto 10 mm.
(4) Sit in proper posture with back and feet supported as improper posture can add upto 6 mm to your BP.
(5) Keep legs uncrossed as crossedlegs add between 2-8 mm to your BP.
(6) Please use the correct cuff size (the inflatable part of the blood pressure cuff should cover about 40% of the circumference of your upper arm. And 80% of the area from your elbow to your shoulder) as too small a cuff can cause elevations of upto 2-10 mm in BP.
(7) Place your arm at the level of your heart as unsupported arm can add upto 10 mm to your BP.
(8) Place cuff on your bare arm and not over a shirt or sweater as this too can add 5- 50 mm to your pressure.
(9) Use a well validated BP instrument that has been cross checkedwith a standard mercury instrument.
(10) Take an average of 3 readings or use instruments which measure 3 times and give you an average. The first reading is almost always high so a single reading should never be taken.
What are causes of High Blood Pressure?
Hypertension is primary or essential in the vast majority (90%).In about 10% of people, high blood pressure is caused by another disease (this is called secondary hypertension). In such cases, when the root cause is treated, blood pressure usually returns to normal. These causes include the following conditions:
1. Chronic kidney disease.
2. Tumors or other diseases of the adrenal gland.
3. Coarctation of the aorta - A narrowing of the aorta that you are born with that can cause high blood pressure in your arms.
4. Alcohol addiction.
5. Thyroid dysfunction.
What investigations are a must?
The minimum baseline tests that should be done are:
• Blood tests including measurement of electrolytes, blood urea, and creatinine levels (to assess kidney involvement).
• Lipid profile for levels of various kinds of cholesterol.
• Special tests for hormones of the adrenal gland or thyroid gland.
• Urine tests for electrolytes and hormones.
A noninvasive, painless eye examination with an ophthalmoscope will look for ocular damage.
Ultrasound of the kidneys may be done to assess damage or enlargement of the kidneys and adrenal glandsif any.
Any of the following may be performed to detect damage to the heart or blood vessels :
(1) Electrocardiogram (ECG) is a noninvasive test that detects the electrical activity of the heart.
(2)Echocardiogram is an ultrasound examination of the heart taken through the chest. Sound waves take a picture of the heart as it beats and relaxes and then transmits these images to a video monitor. The echo can detect problems with the heart such as enlargement, abnormalities in motion of the heart wall, blood clots, and heart valve abnormalities. It also gives a good measurement of the strength of the heart muscle (ejection fraction). The echo is more accurate than an ECG, but also more expensive.
Measures to prevent developing high blood pressure
1. Overweight (obesity): It is defined as being 30% or more over your healthy body weight. It is very closely related to high blood pressure. It is strongly recommended that all obese people with high blood pressure lose weight until they are within 15% of their healthy body weight. Your doctor can help you calculate your healthy range of body weight.
2. Sodium (salt) sensitivity: Some people have high sensitivity to sodium (salt), and their blood pressure goes up if they use salt. Reducing sodium intake tends to lower their blood pressure. The typical Indian diet contains very high sodium. Fast foods and processed foods contain particularly high amounts of sodium. Many over-the-counter medicines, such as painkillers, also contain large amounts of sodium. Read labels to find out how much sodium is contained in food items. Avoid those with high sodium levels.
3. Limit Alcohol use: Drinking more than 1-2 drinks of alcohol per day tends to raise blood pressure in those who are sensitive to alcohol.
4. Stop Smoking.
5. Regular exercise and Yoga at least 30 mins daily. A sedentary lifestyle contributes to the development of obesity and high blood pressure. This is one of the most important reasons for an increasing incidence of hypertension.
6. Avoid unnecessary drugs: Certain drugs, such as birth control pills, amphetamines (stimulants), diet pills, and some pills used for cold and allergy symptoms, tend to raise blood pressure.
7. Avoid weigh gain: As body weight increases, the blood pressure rises. Obese people are 2-6 times more likely to develop high blood pressure than people whose weight is within a healthy range.
Not only the degree of obesity is important, but also the manner in which the body accumulates extra fat. Some people gain weight around their belly (central obesity or "apple-shaped" people), while others store fat around their hips and thighs ("pear-shaped" people). "Apple-shaped" people tend to have greater health risks than "pear-shaped" people and this pattern is gain more common in the Indian population.
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