Hypertension: The silent killer

by Admin-Phmp

Text and Photo by Henrylito D. Tacio

It was already one in the morning sometimes when James finished writing his position paper to be presented at an international conference in Manila. He had been doing this for almost a week. He read his paper once more to see if there were still to be changed when he noticed something strange. He was having a headache, flushed face, blurry vision, and it seemed the world was turning upside down. 

His wife, Ellen, who woke up hearing him groaning, was surprised. “What happened?” she inquired. He told him what had happened. Alarmed by what she heard, she immediately asked their son to bring James to the nearest hospital. There, he was diagnosed of having high blood pressure or hypertension.

“Hypertension is a condition where the person’s blood pressure is persistently elevated beyond what is medically considered normal level,” explains Dr. Philip Chua, chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital.

Hypertension results from either an increase in the amount of blood that is pumped by the heart or an increased resistance to blood as it flows through the arteries. In other words, the flow of blood travels through narrowed arteries, requiring your heart to pump harder just to keep the blood flowing.

A blood pressure reading appears as two numbers, expressed in millimeters of mercury (mm Hg). The first and higher of the two is a measure of systolic pressure or the peak force of blood as it is actually being pumped by the heart. The second number measures diastolic pressure, or the force of blood when the heart is filling for the next beat.

A person is said to be hypertensive if they have persistent elevations of blood pressure: a systolic blood pressure greater than 140 mm Hg or diastolic blood pressure of more than 90 mm Hg. An individual has mild hypertension if the systolic blood pressure is between 140 to 159 mm Hg or the diastolic blood pressure is between 90 to 99 mm Hg. When the systolic blood pressure is higher than 160 mm Hg or diastolic blood pressure is greater than 100 mm Hg, a person is said to have moderate to severe hypertension.

Hypertension is a major public health problem around the world. In 2000, the global prevalence was 26% and was projected to increase by 29% by 2025. In the Philippines, the prevalence is 20%, and it increases year after year, studies show.

Lethal complications

“Hypertension per se does not kill, but the complications are the ones that disable and kill a hypertensive,” points out Dr. Rafael Castillo, a cardiologist at Manila Doctors’ Hospital. “Complications include increased risk of heart attack and stroke, kidney failure, heart failure, and blindness or impaired vision,” says Dr. Goh Ping Ping, a senior consultant cardiologist at the Changi General Hospital in Singapore.

Stroke results when arteries in the brain burst (bleeding) or become blocked (thrombosis). Part of the brain dies, and the patient becomes paralyzed. A study by Dr. Ng Wai Keong in Malaysia, for instance, found that people with hypertension are eight times more likely to suffer strokes than people with normal blood pressure. 

Yet, many stroke victims don’t even realize they have high blood pressure. “About 30 percent of patients have undetected high blood pressure when they present with a stroke,” says Dr. Ng.

A heart attack occurs when coronary arteries in the heart are blocked. The heart muscle dies and may stop beating. The patient dies as a consequence. Heart failure results when the heart pumps too hard for too long, trying to keep blood flowing through the body.

Eventually, the heart weakens. The patient now tires easily and is always out-of-breath. Studies have shown that hypertension triples the risk of dying from heart attacks and quadruples the risk of heart failure.

Kidney failure happens when tiny vessels in the kidneys are blocked. The kidneys malfunction and are unable to clean the body of wastes. The patient is slowly poisoned becomes weak and bloated. Unless the patient undergoes dialysis, he will die of poisoning from his own body wastes. Blindness or impaired vision occurs when tiny blood vessels in the eye rupture or become blocked, damaging the surrounding eye tissues.

Several studies have shown that the risk of death from heart disease and stroke begins to rise at blood pressures as low as 115 over 75 and that it doubles for each 20 over 10 mm Hg increase. “So, the harm starts long before people get treatment,” says Dr. Castillo.

Symptoms and Causes

Hypertension is stealthy. “The majority of patients don’t usually see or feel any clearly identifiable symptoms,” says Dr. Goh. If symptoms do occur, they may include headaches, transient weakness of the body (especially one side), transient blindness, poor vision, chest pain or tightness, shortness of breath, numbness, and tingling. 

In other people, the tell-tale signs include excessive perspiration, muscle cramps, palpitations, and frequent urination. Oftentimes, hypertension is detected on routine screening or when a patient sees a doctor for some other illness.

Unknowingly, hypertension is a dangerous condition. Patients can think that they have perfectly normal blood pressure until hypertension does its damage. “Many people do not realize that they may have it until they get a heart attack or stroke,” says Kong Voon Sin, president of the Malaysia Hypertension Club.

Medical scientists classify two types of hypertension: primary and secondary. When the cause is not known, it is called primary or essential hypertension. Studies have shown that nine out of 10 people who have hypertension do not have an apparent reason for it. “This is one of the reasons why most hypertensives don’t know they have the disease,” says Dr. Castillo.

When the cause is known, it is called secondary hypertension. Studies have shown that in 5-10 percent of people with hypertension, the cause is kidney disease. In 1-2 percent, the cause may be due to a hormonal disorder or certain drugs such as oral contraceptives (birth control pills).

There are certain groups of people, however, who are at higher risk of developing high blood pressure, according to Dr. Tan Kok Soon, senior consultant cardiologist at the Mount Elizabeth Medical Center in Singapore.

Those who drink too much caffeine and smoke are most likely to have increased blood pressure. “Caffeine, consumed in the form of coffee, tea or cola drinks, raises both the systolic and diastolic blood pressure, which can persist for a few hours,” says Dr. Soon. “This effect is more likely to occur in hypertensives, especially if they are smokers also.”

Recent studies have shown that smoking is the number one cause of sudden death due to heart attack. The New England Journal of Medicine recently reported that hypertensive smokers are three times more likely than nonsmokers to suffer strokes and twice as likely to have heart attacks.

What about alcoholic beverages? “Drinking 60 grams of alcohol – roughly equivalent to 5 glasses of wine, 5 shots of whiskey or 5 mugs per half-pint of beer – causes an immediate drop in blood pressure followed 6 hours later by a persistent rise in blood pressure,” Dr. Soon says. “As such, individuals who drink more than 5 drinks a day are more likely to be diagnosed as hypertensives.”

Salt, which most Filipinos love to overindulge, has also something to do with it. “When one eats salty food, water is retained in the body, increasing the volume of total body fluids, which leads to elevation of blood pressure, especially among hypertensives,” says Dr. Chua.

Hypertension also tends to run in the family. “Hypertension clusters in families,” explains Dr. Jayaram Lingamanaicker, acting head of the cardiology division at the Changi General Hospital in Singapore. “A sibling of hypertensive person has a 3.5 times risk of developing hypertension compared to his counterpart without a hypertensive parent.”

Jonathan, an executive of a computer firm, is now 48. During a recent health check-up conducted by his company, he was one of those singled-out as having hypertension. “How can that be?” he inquired. “I am very healthy.” 

Looking at his family history, the doctor explained to him that his father died of a stroke while his mother has a kidney problem. Both were suffering from hypertension.

What should a person with hypertension do once hypertension sets in? Health experts recommend the following:

Know your blood pressure

Until now, there is still no known cure for hypertension, but it can be controlled with prescription medications available today. But hypertensives have to check their blood pressure regularly. “It depends,” says Dr. Chua on how often a hypertensive should check his blood pressure. 

“If the blood pressure is erratic or hard to control, like when the patient is starting on a new medication for hypertension, the blood pressure should be taken once a day until the medication is adjusted and the blood pressure is basically controlled. If the blood pressure is within normal limits, as a response to treatment, the medications should be continued for life, and the blood pressure could be taken once a week. If it is really stable at the normal range, then it could be done once every two weeks or once a month. It is important to continue taking medications daily or regularly (as prescribed by the physician) for life, even if the blood pressure is well-controlled and now normal.” 

Live a Healthy Lifestyle

A healthy lifestyle keeps a hypertensive less likely to develop high blood pressure. “Though initially it may be hard to change your lifestyle and habits, a resolute determination, help from your friends and loved ones will make it easier to overcome the difficulties you may encounter along the way,” says Dr. Castillo.

Among the healthy lifestyle hypertensives should consider are as follows: watching their weight, keeping stress under control, avoiding too much caffeine, limiting alcohol intake, and avoiding salty and fatty foods. 

“Fatty food increases blood lipid levels and the bodyweight increases,” points out Dr. Lingamanaicker. “Obesity worsens hypertension.” He advises hypertensives to eat fresh fruits and vegetables to increase their intake of potassium, which lowers blood pressure.

Quitting smoking also helps. “Hypertensive should not smoke because this adds tremendously to the risk of heart attack and stroke,” Dr. Goh. Cigarette smoking causes the blood vessels to narrow which, then tends to increase blood pressure.

Regular exercise may also do the trick. “The benefits of exercise are enormous, and if you have hypertension, it just might save your life,” says Dr. Willie T. Ong, an internist, and cardiologist. “Regular exercise strengthens the heart and helps normalize blood pressure.” Among the recommended exercise activities are aerobics, bicycling, dancing, jogging, swimming, tennis, and walking.

Take your medication regularly.

If a person is consistently hypertensive despite undergoing a healthy lifestyle, the doctor will prescribe a drug to combat his high blood pressure. Medications can safely and effectively lower high blood pressure. “If hypertensive does not take his medicine, he can get dangerously high blood pressure and is at risk of deadly complications,” says Dr. Goh.

Take the case of 50-year-old Filipina businesswoman Aida. She was diagnosed with hypertension, and her doctor prescribed her an effective anti-hypertensive drug. 

Unfortunately, she refused to take the drugs thinking she would be addicted to them. “I told her that in 24 hours, the medicines are already out of her system so she won’t get used to them,” said Dr. Ong, the physician who prescribed the drugs. 

It was until Aida suffered a minor stroke that she completely changed her mind. She’s now taking the drugs regularly.

“Hypertension once diagnosed, the treatment is usually for life. As such, you should not discontinue your medications,” advises Dr. Lingamanaicker. “Even if you feel well, do not stop taking your medication.”

Or else…

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