Download Understanding Hypertension

Hypertension
Examining The Silent killer
Hypertension (high blood pressure or “pressure”) is known by both practitioners and the
public as the silent killer! Why is this? The main reason is that affected persons (those
who are either developing the condition or already have it but it is worsening) will have
no symptoms or awareness of it, whilst the condition is already damaging the body.
Unfortunately but frequently, the first time the problem is revealed is when an affected
person presents to the doctor with other concerns and the routine blood pressure check is
done. This again reinforces why even well patients must go to their private practitioner
at least once a year for a check-up!
Yes it is true! Black people are predisposed to have hypertension, and scientists around
the world are trying to discover why. In some Jamaican families, almost every one has
this diagnosis (and is often unaware of the devastating effects that it is causing!!). Now
you can continue to hide your head in the sand like the proverbial ostrich, but as I tell all
my patients, it will continue to reek the havoc it wants to, whether you opt to do
something about it or not.
The human heart is basically a pump, and it works by generating pressures to move fluids
(in this case, blood) through a series of pipes (blood vessels). Our “pumps” are set to
work efficiently at a normal blood pressure; however as an affected person’s pressures
starts to rise, the pump has to work harder and harder to meet the needs of the body. This
explains why patients’ with uncontrolled blood pressures for a long time can develop
heart failure (the heart is not able to meet the demands of the body). In addition, the
higher pressures over time can damage the vessels supplying essential parts of the body,
in particular the brain (causing stroke), the retina i.e. the back of the eyes which picks up
what we see (causing blindness), the kidneys (causing renal impairment or worse kidney
failure!) and the lower legs (causing peripheral arterial disease that in severe cases
requires amputation of the affected legs to treat). There is even a connection between
hypertension and development of endometrial cancer.
So what can we do to prevent these devastating problems? Obesity, high salt intake,
excessive stress and a sedentary lifestyle all predispose to the development of this
disorder; so preventing these situations reduces the risk of hypertension. If you have a
medical condition that predisposes to hypertension like thyroid disease and other
hormonal disorders, diabetes, and certain medications, please ensure that they are being
managed correctly. Also if you develop “pressure” under the age of 40 years, some
investigations should be carried out by your medical practitioner to ensure that you don’t
have an underlying medical condition.
Alright, but let’s say you already have hypertension. Nine out of ten people will have no
underlying cause. This is called Essential Hypertension. If you have it, you need to treat
any modifiable problems as mentioned above. Lose the weight, de-stress, reduce your
salt intake, and start low intensity exercising like walking, swimming, and even cycling
to actually improve your heart and vessel (cardiovascular) health. But if your
practitioner believes you need medication, YOU NEED TO TAKE IT! And every day
too!!! In addition, you need to ensure that you have repeat prescriptions to cover when
the previous pills are running out. The primary goal in the management of high blood
pressure is to normalize it and keep it normal!!! Very important as well, is to make sure
that you see your doctor at least every 3 months to ensure that no changes are required.
A final word. One of the most common complications that affects pregnant women in
Jamaica is Pre-eclampsia. What is this? It is the development of high blood pressure after
20 weeks (5 months) of pregnancy with associated protein in the urine. This can be a
particularly devastating disorder for it can place both the mother and her unborn child at
high risk for disability and even death. Despite knowing it existence for over 2000 years,
the medical community still does not understand why it occurs in one woman and doesn’t
in another. There is some indication from the Human Genome Project that points to
genetic causes, but this is still being elucidated. Yet some of the same prescriptions
stated above, for example, weight loss et cetera and healthy diet long before pregnancy
(preconceptionally) are essential for mitigating its development. However, if you are at
high risk for its development (previous pregnancy complicated by preeclampsia/eclampsia, a hypertensive or diabetic patient prior to pregnancy, obesity,
placental problems in previous pregnancies), please see your doctor if you suspect you
are already pregnant or contemplating pregnancy.
As always, take care of yourselves.
Let me know how you are doing!
July 2010