In this series of articles every Friday I will explain your body to you, and how you can use this understand¬ing to improve your health, and hopefully live a longer and more enjoyable life. You will learn how your body works, and how you can avoid damage to it. You will also learn how we doctors examine you and treat illnesses. And most importantly, you will learn how you can change your lifestyle to stay healthy.
This articles will help you to know more about your body, about health and disease. I will answer your questions in a column every Thursday. Send your questions to: email@example.com
ONE of the most prominent ‘life-style diseases’ is high blood pressure, or hypertension.
This is a serious disease that can and will, over time, damage the blood vessel walls and increase a person’s risk of heart attack, stroke and other damaging conditions.
Blood pressure is recorded as two numbers and written as a ratio: the top number, called the systolic pressure, is the pressure as the heart beats. The bottom number, called the diastolic pressure, is the measurement as the heart relaxes between beats. According to guidelines announced in November 2017 by the American Heart Association (AHA), people’s blood pressure measurements fall into the following categories:
- Elevated: Between 120-129 for systolic, and less than 80 for diastolic.
- Stage 1 hypertension: Between 130-139 for systolic or between 80-89 for diastolic.
- Stage 2 hypertension: At least 140 for systolic or at least 90 mm Hg for diastolic.
Risk factors – High blood pressure has many risk factors. “Risk factors” are conditions which are likely to contribute to the dangers of high blood pressure. Some, like aging or inherited family history you cannot influence, but others you can. You can stop smoking, stop drinking, start sports to reduce the risks of high blood pressure.
Risk factors include:
Age and gender. The risk of high blood pressure increases as you age. High blood pressure is more common in men.
Family history. High blood pressure tends to run in families.
Being overweight or obese. The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
No sports. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart disease. Secondhand smoke also can increase your heart disease risk.
Too much salt (sodium) in your diet will cause your body to retain fluid, which increases blood pressure.
Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you don’t get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.
Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than one drink a day for women and more than two drinks a day for men may affect your blood pressure.
Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, such as kidney disease, diabetes and sleep apnea.
Sometimes pregnancy contributes to high blood pressure, as well.
You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.
“We call it the ‘silent killer,'” because patients are often asymptomatic,” said Dr Monika Kubina, the specialist cardiologist at Pacific International HospitaI (PIH).
In rare cases, some people with high blood pressure experience headaches.
Although many patients may not have symptoms at first, over time, high blood pressure can lead to “wear and tear” on the body, Dr Kubina said. For example, high blood pressure can stretch and damage blood vessels, which in turn, can increase the risk of health problems. Stretched blood vessels can have weak spots that are more likely to rupture, leading to a hemorrhagic strokes or aneurysms. Stretching of the blood vessels can also cause tears and scars that create places for cholesterol or blood to build up.
High blood pressure is diagnosed from a blood pressure test. Typically, doctors place a blood pressure cuff on the arm. Patients should avoid drinking coffee or smoking cigarettes for 30 minutes before the test, because such behaviors can increase blood pressure temporarily.
Because a person’s blood pressure can vary depending on a number of factors, including the time of day, a doctor will usually check blood pressure several times and different appointments before diagnosing someone with high blood pressure.
Dr Kubina said that she would often have patients use a device called an ambulatory blood pressure monitor, which patients wear at home, and which takes a blood pressure reading about every 30 minutes. This device can show whether a person really does have hypertension, and how well they are responding to treatment, she said.
“High blood pressure is really a life style disease of the whole world, and if we can do our best to work on diet and exercise and stress relief, we could take a huge amount of this burden down,” said Dr Kubina.
When to see a doctor
You will likely have your blood pressure taken as part of a routine doctor’s appointment.
Ask your doctor for a blood pressure reading at least every two years starting at age 18. If you’re aged 40 or older, or with a high risk of high blood pressure (like smoking, obesity, diabetes, no sports), ask your doctor for a blood pressure reading at least every year.
Blood pressure generally should be checked in both arms to determine if there’s a difference.
Lifestyle changes — including changes in diet and physical activity — and medications are recommended for treating high blood pressure.
Treatment: Many people with hypertension will need to take medications, as well as make lifestyle changes. For example, the new guidelines recommend that doctors only prescribe blood pressure medication for patients with Stage I hypertension if they have already had a cardiovascular “event” such as a heart attack or stroke; or if they are at high risk for a heart attack or stroke based on other factors, such as diabetes.
People with Stage 1 hypertension who don’t meet these criteria should be treated with lifestyle modifications. These include: starting the “Dash” diet (Dash stands for: Dietary Approaches to Stop Hypertension), which is high in fruit, vegetables and fiber and low in saturated fat and sodium (less than 1,500 mg per day); exercising for at least 30 minutes a day, three times a week; and restricting alcohol intake to less than two drinks a day for men and one drink a day for women.
Potential consequences of high blood pressure
If you have high blood pressure without treatment, you risk very serious damage to your body, and even life threatening sudden emergencies, such as sudden heart or blood vessel failure, or blindness.
The higher your blood pressure and the longer it remains untreated, the greater the damage.
Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
Heart failure. To pump blood against the higher pressure in your vessels, the heart has to work harder. This causes the walls of the heart’s pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body’s needs, which can lead to heart failure.
Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss and becoming blind.
Metabolic syndrome. This syndrome is a cluster of disorders of your body’s metabolism, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL) cholesterol, the “good” cholesterol; high blood pressure and high insulin levels. These conditions make you more likely to develop diabetes, heart disease and stroke.
Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure.
Dementia. Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia (vascular dementia). A stroke that interrupts blood flow to the brain also can cause vascular dementia.
Next week: The heart – what is beating in our chest, and why.
- Dr Fasol is an academic sur¬geon from the University of Vienna in Austria, and has worked, built and managed hospitals in Europe, Africa and China