“You have been spending all your time at work. It makes me worry about your health,” said Mrs Tan to her husband, a 35-year-old business executive. “I have many deadlines to meet. I just don’t have the time to exercise and eat right,” he replied. She sighed, “Could you at least take some time for a health checkup at a clinic nearby?” “Sure,” Mr Tan nodded.
Mr Tan drops by the clinic during his lunch break. The doctor and nurses conduct a simple health screening for him. His blood report will be ready in a couple of days, but the doctor is concerned about his blood pressure readings, which is 145/90 mmHg.
The doctor informs Mr. Tan and explains that he has hypertension.
What is hypertension?
Blood pressure is a measure of how hard the heart pumps blood through our blood vessels. The ideal blood pressure reading should be below 120/80 mmHg. This means our heart and blood vessels are functioning optimally.
In hypertension, the blood pressure reading is higher than 140/90 mmHg. As we age, wear and tear could cause the blood vessels in our body to narrow and stiffen. Hence, the heart would have to pump much harder to deliver blood and oxygen to our organs. The increase in force which the heart and blood vessels experience reflect the higher blood pressure readings.
Mr. Tan is confused. “Doctor, I feel completely well. Why do I not have any symptoms?”
The doctor proceeds to explain.
What are the symptoms of hypertension?
There is a reason why hypertension is known as the “silent killer”.
Individuals with hypertension do not commonly exhibit any signs and symptoms.
A person usually finds out they have hypertension if they take regular blood pressure readings or perform a routine health checkup. Only a few individuals may experience symptoms such as vision changes, nosebleeds, and headaches.
Mr. Tan wonders if his lifestyle had contributed to his condition and asks the doctor to explain.
What are the risk factors of hypertension?
- Age – As we age, our body goes through wear and tear. Subsequently, our risk of having hypertension increases.
- Unhealthy diet – Frequently consuming a diet high in salt (sodium) can cause our body to retain fluid and increases blood pressure.
- Family history – High blood pressure tends to run in families. If your parents have hypertension, chances are likely that you would too.
- Lack of exercise – Exercise helps ensure the heart maintains its proper function.
- Being overweight – An overweight individual will have a higher volume of blood in the blood vessels. This will increase the blood pressure.
- Stress – Hectic work life can contribute to an unhealthy lifestyle such as lacking in exercise, consuming tobacco and alcohol, and a tendency to adopt an unhealthy diet.
- Co-existing disease – Certain individuals may have other conditions that contribute to higher blood pressure. Examples are diabetes and kidney disease.
Mr. Tan continues… “Okay, so it’s just a small increase in blood pressure. It can’t be too bad right, doctor?”
The doctor explains that hypertension should be taken seriously as it can cause various complications if not managed well.
What are the complications of hypertension?
Hypertension is a condition that can lead to a mixture of issues throughout the body. This is because blood vessels run through all our important organs.
High blood pressures can damage blood vessels, harming the surrounding organs.
Examples are:
- Stroke – the high blood pressure travelling through the arteries in the brain may rupture, leading to what is known as a cerebral haemorrhage (bleeding in the brain)
- Heart failure – With prolong exposure to high blood pressures, the heart will enlarge. This will weaken the heart and eventually cause decreased ability of the heart to function properly.
- Heart attack – Imagine water running through the pipes. If the water pressure increases, this will eventually lead to erosion of the pipes. The pipes are our arteries which are damaged by high blood pressures over time. This may lead to clogging of important arteries leading to the heart. This will cause the heart to stop working and require immediate treatment.
- Vision loss – The eyes contain small vessels that are easily harmed by prolonged high blood pressures.
- Kidney failure – High blood pressures can cause damage and thickening of the arteries entering the kidneys. This will decrease the ability of the kidney to function, eventually failing.
This was alarming for Mr. Tan to hear. His father recently passed because of a heart attack. He is hoping to not follow in his father’s footsteps at a younger age.
“What can I do to keep this condition in check? Do I take medication?” he asked the doctor. There are several options and the doctor proceeds to explain.
How to manage hypertension?
A doctor can prescribe one of several medications as first-line therapy for uncomplicated hypertension (hypertension without co-existing diseases).
Examples are ACE inhibitors (Angiotensin-converting enzyme inhibitors), ARBs (Angiotensin II receptor blockers), CCBs (Calcium channel blockers), and diuretics.
These medications work by several mechanisms. Some of them work to decrease the ability of the body to retain “salt” and water. This will decrease blood volume and contribute to lower blood pressures.
A subset of patients will have hypertension with co-existing conditions such as diabetes and renal disease. In this case, doctors may use a combination of several medications to get their blood pressures under control.
Mr. Tan pauses to voice his opinion. If his lifestyle contributes to him developing hypertension, could he fix the problem simply by taking medication? Will he need to change his lifestyle as well?
The doctor nods and explains.
An individual must take concrete efforts for healthy living. This plays an important role in the management of hypertension and helps to improve the overall health of the cardiovascular system (the heart and blood vessels).
Some recommendations are:
- Weight reduction – Evidence shows that an overweight individual can decrease his blood pressure by losing weight
- Healthy eating – Individuals should consume a diet low in salt (sodium) to lower blood pressure levels. They can also adopt diets rich in fruit, vegetables, and whole grains such as the Mediterranean diet. It has been shown to significantly lower blood pressures.
- Regular physical activity – Malaysian health guidelines encourage individuals to have at least 150 minutes of exercise per week to help reduce blood pressures.
- Lowering stress levels – Relaxation techniques such as yoga may be beneficial in reducing blood pressures
- Reducing alcohol intake and smoking cessation
Mr. Tan chuckles lightly to himself as he realizes the work ahead of him. To keep his blood pressure under control, he will need to make some changes to his daily life.
Even with our hectic work life, let us not neglect to watch our health! It will be good to attend regular health checkups at the doctor’s clinic.
References:
- https://specialty.mims.com/hypertension/diagnosis
- https://www.who.int/news-room/fact-sheets/detail/hypertension
- https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410
- https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/what-is-high-blood-pressure
- Clinical practice guidelines: Management of Hypertension 5th edition 2018 by MOH Malaysia
