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Looking beyond the numbers: strategies to counter high blood pressure

High blood pressure or “hypertension” is responsible for approximately half of all strokes and heart attacks globally. It is one of the most common reasons for hospital and GP office visits in Pakistan.

High blood pressure may remain undetected for years owing to the paucity of symptoms in most patients. That said, anyone with poorly treated or un-diagnosed hypertension at least doubles his or her risk of developing stroke, heart disease and kidney failure — “the silent killer”.

A successful treatment strategy begins with an accurate understanding of the mechanisms behind its causation, complications and proposed treatment plans.

What exactly is “blood pressure”?

“Blood pressure” is the force exerted by the blood against the walls of the arteries (blood channels). It is always given as two numbers, the systolic (top number) and diastolic (bottom number) pressures. Each time the heart beats the blood pressure is at its highest and this measurement constitutes the “systolic” pressure whereas the “diastolic” reading indicates the pressure maintained in the arteries while the heart rests between beats. Both numbers are important. Your blood pressure is normal if it’s below 120/80 mm Hg .It is lowest while you sleep and rises with excitement and activity.

What causes a “high blood pressure”?

Majority of patients, in whom a specific cause cannot be identified, are labeled with “essential” or “primary” hypertension.
Some people have “secondary” hypertension where the high blood pressure is a result of another medical problem or medication.

 How does a high blood pressure affect us?

It is considered the most important risk factor for coronary artery (heart) disease, being more common than diabetes, cigarette smoking and high cholesterol levels.

It can also lead to stroke, atrial fibrillation (irregular heart beat), vision loss, kidney damage, memory loss, erectile dysfunction and peripheral arterial disease (hardening of arteries outside the heart).

If you are diagnosed with any type of high blood pressure, your doctor will review your medical history, conduct a physical examination and recommend routine tests, such as a urine test (urinalysis), blood tests and an electrocardiogram (ECG) — a test that measures the heart’s electrical activity. The doctor may also recommend additional tests, such as fasting cholesterol and sugar levels, a kidney ultrasound and an echocardiogram (ultrasound of the heart).

What sort of symptoms will you typically feel with a high blood pressure?

Although high blood pressure is a life threatening illness, symptoms don’t develop until our blood pressure becomes so high that the body cannot tolerate it. Therefore, we shouldn’t make the mistake of assuming that symptoms will alert us to a high blood pressure.

Commonly reported symptoms are headaches (particularly at the back of the head and in the morning), dizziness, flushing, nose bleeds, fainting episodes, tinnitus (buzzing or ringing in the ears) and impaired vision.

 What are the factors that influence blood pressure?

High salt diet, family history (genetics), obesity, cigarette smoking, alcohol intake, decreased physical activity, stress, sleep apnea, old age, medications (steroids, birth control pills etc), narrowing of arteries that supply blood to the kidneys and hormone disorders (pituitary, thyroid, adrenal etc) are some of the factors that can affect your blood pressure.

 What can we do to lower our blood pressure?

According to American Society of Hypertension (ASH), less than one third of high blood pressure patients are able to achieve the target blood pressure control. While there is no cure, high blood pressure is manageable and lifestyle changes form the fundamental basis of any blood pressure lowering plan.

“Diet cures more than doctors”

 DASH Diet or (Dietary Approaches to Stop Hypertension):

Keeping fat intake under 27% of total calories, eating many servings of fruits and vegetables, choosing whole instead of processed grains, including low-fat or nonfat dairy products and small portions of poultry, fish, and nuts as your primary source of protein rather than red meat constitutes the DASH diet (source: New Eng Journal of Med). Reduced dietary sodium/salt to less than 2,400 milligrams or about 1 teaspoon a day is a fundamental component of any DASH plan. These interventions can drop the systolic blood pressure by 7-12 mmHg points (source: Harvard Medical School, Mayo Clinic).

High potassium foods:

Addition of foods rich in potassium (e.g bananas, dairy products, salt substitutes etc) can help lower your blood pressure.

 “Commit to be fit”

Engage in regular moderate intensity physical activity, such as brisk walking for at least 30 minutes per day. The best strategy is to mix multiple activities as it will help you stay motivated. Also, making it socially interactive by exercising with your spouse or friend helps keep interest. Regular aerobic exercise can decrease systolic blood pressure by 4-9 mmHg points (source: Mayo Clinic).

 “Don’t wait to lose weight”

A BMI more than 25 and a waist measurement of more

than 35 inches in women and 40 inches in men is consistent with obesity (BMI stands for Body Mass Index, a numerical value of your weight in relation to your height).

A major study (source: Framingham database) found that hypertension is about twice as prevalent in the obese as compared to the non-obese.

You should try to maintain a normal weight with a target BMI of 18.5 to 24.9. An analysis of 25 controlled studies showed approximately 1 mmHg drop in blood pressure for each kilogram lost (source: Hypertension journal).

Maintaining weight loss over the long term can be difficult. Three keys to success are setting realistic goals, following a healthy diet, and aiming for 30 minutes of physical activity most days of the week.

Alcohol and tobacco consumption

Smoking should be abandoned completely. Alcohol intake should be limited to less than two alcoholic drinks per day in men and one drink per day in women. Limiting the amount of alcohol to this quantity is expected to reduce the systolic blood pressure by 2-4 mmHg points (source: Hypertension journal). This also protects your liver and kidneys from damage.

 High blood pressure medications

If your blood pressure remains uncontrolled despite the lifestyle modifications and/or some of your body parts are showing affects of uncontrolled high blood pressure, you might need medications as well. Keeping notes, putting mobile phone alarms and friendly reminders from close relatives and friends can help you adhere to medication regimes.

Managing blood pressure is a lifelong commitment. A key to improved blood pressure control is a good doctor-patient relationship. Adherence to lifestyle modifications and prescribed medications along with regular checkups with your doctor can help you trump the blood pressure menace.

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