• Saturday, 07 July 2007 08:00

“Among the relatively young population of this country, 20 million would have unacceptable high blood pressure by 2025,” said the British doctor who recently came to the country.

When blood pressure is checked, two values are recorded.  The higher one occurs when the heart contracts (systole); the lower occurs when the heart relaxes between beats (diastole).  Blood pressure is written as the systolic pressure followed by a slash followed by the diastolic pressure.

High blood pressure is defined as a systolic pressure at rest that averages 140 millimeters of mercury (mm Hg) or more, a diastolic pressure at rest that averages 90 mm Hg or more, or both.  In high blood pressure, usually both the systolic and diastolic pressures are elevated.

“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.

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 bloods flowing through the body. Eventually, the heart weakens. The patient now tires easily and is always out-of-breath.  “A person with
hypertension has twice the risk of having heart failure compared to those who do not have hypertension,” points out Dr. Romeo Divinagracia, a cardiologist and professor at the St. Luke’s Medical Center-William Quasha College of Medicine.

Kidney failure happens when tiny vessels in the kidneys are blocked. The kidneys malfunction and are unable to clean the body of wastes. 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.

A study published in the “New England Journal of Medicine” shows that blood pressure is highest from 6-10 in the morning and that there is an increased incidence of stroke and sudden death between six and eight a.m. compared to any two-hour period during the day.

Hypertension is like a thief in the night. Hypertensives usually do not have any symptoms, which is why it is called a silent killer.  In fact, studies have shown that only 14 percent of the 12.6 million Filipinos having the ailment are aware of their
condition.  Of those who know they're hypertensive, only half are taking medications; and of those who are taking medications, less than half have their blood pressures controlled to optimal levels.

“Practically nine out of 10 hypertensive patients have uncontrolled BPs, which make them good candidates to develop heart attacks and strokes, or literally drop dead before they could realize what was wrong with them,” deplores Dr. Esperanza Cabral, head of the Philippine Society of Hypertension.

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.

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 apparent reason for it. “This is one of the reasons why most hypertensives don’t know they have the disease,” says Dr. Castillo.

When a direct cause can be identified, the condition is described as secondary hypertension.   ‘The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments’ informs: “Among the known causes of secondary hypertension, kidney disease ranks highest.  The condition can also be triggered by tumors or other abnormalities that cause the adrenal glands to secrete excess amounts of the hormones that elevate blood pressure.  Birth-control pills (specifically those containing estrogen) and pregnancy can boost blood pressure, as can medications that constrict blood vessels.”

Recent studies showed that essential hypertension is greatly influenced by diet and lifestyle.  Reports ‘The Medical Advisor’: “The link between salt and high blood pressure is especially compelling.  People living on the northern islands of Japan eat more salt per capita than anyone else in the world and exhibit the highest incidence of essential hypertension.  By
contrast, people who add no salt to their food show virtually no traces of essential hypertension.”

Other factors that have been associated with essential hypertension include obesity; diabetes; stress; insufficient intake of potassium, calcium, and magnesium; lack of physical activity; and chronic alcohol consumption.

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.”

Until now, there is still no known cure for hypertension but it can be controlled with prescription medications available today.  Should hypertensives check their blood pressure regularly? “It depends,” says Dr. Philip Chua, chairman of Cardiovascular Surgery of the Cebu Cardiovascular Center at the Cebu Doctors' Hospital and College of Medicine in central Philippines.

“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 checked once a day until the medication is adjusted and the blood pressure is basically controlled,” Dr. Chua continues.  “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.”

“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.”

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 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 his weight, avoiding too much caffeine, limiting alcohol intake, and avoiding salty and fatty foods.  “Fatty food increases blood lipid levels and the body weight increases,” says Dr Lingamanaicker.  “Obesity worsens hypertension.”  He advises hypertensives to eat fresh fruits and vegetables to increase intake of potassium, which lowers blood pressure.

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

Lose weight.  Carrying extra weight causes the heart to work more, forcing blood even harder through the vessels.  A regular exercise may do the trick.  “The benefits of exercise are enormous, and if you have hypertension, it just might save your life,” says Dr. Willie Ong, a consultant with the Manila Doctors Hospital.  “Regular exercise strengthens the heart and
helps normalize blood pressure.”  Among the recommended exercise activities are aerobics, bicycling, dancing, jogging, swimming, tennis and walking.

Avoid stress. You can’t always avoid stress, but you can learn better ways to cope with it.  Researchers believe that stress does not come simply from having too much to do.  Rather, it arises from situations that leave you feeling you have no control over matters.  Next time you feel stressed, ask yourself why, then concentrate on solving the problem.

Do these recommended lifestyle changes, and you can expect to buy many more healthy years.  As ‘Time’ magazine puts it: “It’s that simple transaction – vigilance for life span – that makes blood pressure so worth controlling.  There are many diseases that resist everything science can throw at them.  This is one you can beat.”