Hypertension: The best ways to prevent the onslaught of this mass-killer

Hypertension: Quick Facts

• About 103 million US adults have high blood pressure according to the American Heart Association.
• The actual number of deaths due to high blood pressure increased by 38% between the years 2005 and 2015.
• According to the American Heart Association, 1 million people would die of heart disease in 2018.

What is hypertension?

Hypertension is an increase in blood pressure from the normal 120/80 mmHg systolic-diastolic levels to 130/80 mmHg levels or higher, which may be transitory or chronic. The systolic reading refers to the pressure as the heart pumps blood through the blood vessels. The diastolic reading refers to the pressure as the heart relaxes and refills with blood. Hypertension may or may not lead to cardiovascular damage.

Essential and Secondary Hypertension

Hypertension that develops by itself with age and without any underlying medical condition is called essential hypertension. Secondary hypertension is one that is one that is caused by an underlying medical condition. It is necessary to isolate the type of hypertension in the patient before he/she undergoes treatment as underlying causes may also need treatment sometimes. 

Measuring Hypertension

A high blood pressure need not always represent a medical condition of hypertension. Regular exercise or immediate anxiety or stress in an otherwise calm person could lead to a rapid change in blood pressure. There is something called White Coat Hypertension, where the blood pressure is higher in the patient because he is anxious about the appointment. This is also treated as a case different from normal hypertension.

What does blood pressure signify? 

Blood pressure measures the force exerted by the blood against the walls of the blood vessels. This depends on how fast the heart is pumping the blood and how much resistance is offered by the walls of the blood vessels. 

It’s a Vicious Circle 

With hypertension, in aged people, the heart still beats fast while the walls of the blood vessels become narrow or stiff. This is because of the buildup of plaque, made up of fat, cholesterol, calcium and other substances found in the blood over time. This build up of plaque is referred to as atherosclerosis. The walls then offer greater resistance to the flow of blood, which further increases the blood pressure.

Stages of Hypertension

There are distinct stages of hypertension, increasing from the normal blood pressure levels of less than 120/80 mmHg to as high as 180/120 mmHg. 

Elevated

The blood pressure is “elevated” when the readings range from 120-129 mmHg systolic and less than 80 mmHg diastolic. People with elevated blood pressure are at risk of developing stage 1 hypertension later on.

Stage 1 Hypertension

When your pressure ranges from 130-139 mmHg systolic and 80-89 mmHg diastolic, you have stage 1 hypertension. Lifestyle changes would need to be implemented to reduce blood pressure. The doctor may also prescribe medications if you are at risk of cardiovascular diseases such as heart attack or stroke.

Stage 2 Hypertension

When your pressure is higher than 140/90 (systolic-diastolic) mmHg, you have stage 2 hypertension. The doctors will prescribe a combination of medication and lifestyle changes to avoid any further increase in blood pressure, which will not only be undesirable but also may be harmful.

Hypertensive Crisis

When it reaches this point, it is termed a “hypertensive crisis”. If the blood pressure reading indicates a hypertensive crisis, it is repeated again. If the reading remains the same over two or three repetitions, the doctor checks for other symptoms. If there are other symptoms, such as numbness, chest pain, and so on, then the person may be suffering from cardiovascular disease or some other medical condition. This is then classified as a medical emergency.

Risk Factors for Hypertension

Age

It has been observed that people who are older than 60 run a greater risk of hypertension than others. With age, blood pressure increases steadily. As described earlier, the arteries meanwhile become stiffer and narrower due to atherosclerosis. This in turn further increases the blood pressure.

Ethnicity

Some ethnic groups are more prone to hypertension than others. Most studies in the United Kingdom and the United States point to the higher prevalence and the lower awareness of hypertension in the black community as opposed to whites. The data of hypertension that is available for other ethnic groups is sparse.

Sex

Hypertension is more prevalent in men of a younger age. However, with age, the risk of hypertension is greater in women. Men have a higher blood pressure than women through much of life regardless of race and ethnicity.

Causes of Hypertension

Obesity

Obesity leads to hypertension. Generally, diets excessively rich in carbohydrates increase the presence of a lipid called triglycerides in the blood. These triglycerides are a major factor which leads to atherosclerosis and consequently an increase in blood pressure.

Alcohol and tobacco use

High doses of alcohol also increase the triglyceride count in the body. This increase in triglycerides, as stated earlier, leads to atherosclerosis and consequently an increase in blood pressure.  A study was conducted based on the results obtained from the cross-sectional data over 3 years (1994-1996) among respondents older than 16 years of age in the Health Survey for England. These data show that any independent chronic effect of smoking on BP is small, but existent nevertheless.

Obstructive sleep apnea

Obstructive sleep apnea is a condition when the throat muscles relax and the breathing becomes labored as the throat becomes narrow. The amount of carbon dioxide also increases in the blood. Some signs of obstructive sleep apnea are snoring and a feeling of sleepiness throughout the next day. Obstructive sleep apnea can lead to secondary hypertension resulting from a lack of sleep.

Other medical conditions

Chronic kidney disease, diabetes, and other conditions such as high cholesterol levels can also lead to hypertension.

Excessive Sodium 

Excessive intake of salt can lead to hypertension as it increases the sodium content in the body. Again this depends on the sensitivity of the body to sodium. In some individuals, the excess sodium will be excreted through the urine. Hence, the intake of salt affects different individuals differently. According to the WHO, adults must have no more than 6g of salt a day (approximately a teaspoon)

Lower levels of Potassium

Potassium helps regulate the blood pressure levels in the body. So a fall in potassium levels probably due to the use of alcohol, chronic kidney disease, or diarrhea could also lead to hypertension. 

Symptoms of Hypertension

Hypertension is often referred to as a “silent killer”. This is because nearly one-third of the people who have hypertension do not realize that they have it. However, there are certain symptoms to look out for in patients suffering from hypertension. These are listed below:

• • Severe headache

• • Sight impairment

• • Pounding in your chest

• • Throbbing in your neck or ears

• • Irregular heartbeat

• • Difficulty breathing

• Blood in the urine

Complications Arising from Hypertension

Heart attack

Hypertension or high blood pressure exerts excessive pressure on the walls of the arteries making them vulnerable to plaque build-up. This plaque build-up over time can restrict the flow of blood by the formation of blood clots, which would then cut off the supply of blood, and in turn oxygen, to a certain region of the heart leading to myocardial infarction, or a heart attack.

Stroke

A stroke happens when a region of the brain does not get oxygen or nutrients from the blood. Hypertension damages your brain’s blood vessels by causing them to rupture or leak. It can also cause a blood clot to develop in the brain which can then prevent the blood and hence oxygen from reaching that part of the brain.

Chronic Kidney Disease

Hypertension can lead to kidney failure by damaging the walls of arteries leading to the kidney as well as the glomeruli (the tiny blood vessels within the kidney). The kidneys will not be able to filter the waste from the blood because of damage to these arteries. This leads to a dangerous accumulation of waste and fluid within the kidneys leading to kidney failure and often requiring dialysis. 

Damage to Eyes

Hypertension can damage the blood vessels leading to the retina, which in turn leads to bleeding in the eyes, blurred vision, or sometimes even a total loss of vision. If the person is suffering from diabetes as well, then he is at an increased risk of developing sight impairments.

Aneurysm

Hypertension or increased blood pressure can cause the artery walls to develop bulges over time. These mostly develop at the points that they branch out. These bulges can remain over a long period of time, especially in the brain, without causing any problem at all. It is only when an aneurysm burst that it leads to a break in the artery and a consequent loss of blood, which prevents the blood from reaching the desired location in the brain. The internal bleeding from the rupture of an aneurysm, if not stopped, can lead to death. 

Medical treatment for Hypertension

The medical treatment of hypertension involves the use of drugs with recommended lifestyle changes that will help to lower blood pressure. The following drugs are used in the treatment of hypertension:

Diuretics

Diuretics increase urination in the body, thereby lowering sodium and fluid levels in the blood. This means that the volume of blood is reduced, which automatically will bring down the blood pressure. They are generally used in combination with other medicines for the treatment of hypertension.

Beta-blockers

Beta-blockers help control the heart rate and relax the blood vessels by blocking the effects of epinephrine or adrenaline in your body. This in turn reduces the blood pressure. It’s not used in cases of asthma, as beta-blockers can aggravate this respiratory condition.

Angiotensin Converting Enzymes (ACEs)

Angiotensin is a hormone that narrows the blood vessels, leading to hypertension. ACE inhibitors convert the angiotensin, thereby reducing the hormone in the body and avoid this condition.

Calcium Channel Blockers (CCBs)

Calcium increases the force of contractions in your heart and the blood vessels. Calcium channel blockers prevent the calcium from reaching smooth muscle tissue. This reduces the heart beat rate and relaxes the blood vessels. This helps to reduce blood pressure.

Alpha-1 Blockers

Alpha-1 blockers reduce blood pressure by dilating the blood vessels. They work by keeping the hormone norepinephrine from tightening the blood vessels. 

Alpha-2 Receptor Agonist

Methyldopa, an Alpha-2 receptor agonist was developed for the treatment of blood pressure more than 50 years ago. It is still used for the treatment of blood pressure during pregnancy. Alpha-2 receptor agonists are also used when the body cannot tolerate ACE inhibitors. It lowers the blood pressure by acting on the central nervous system.

Vasodilators

Vasodilators relax the artery wall muscles, reducing hypertension.

Prevention and Self-Care for Hypertension

Eating a heart-healthy low-sodium diet

Reduce the consumption of sodium

There is a delicate sodium-potassium balance that is maintained in the body. Eating too much salt increases the sodium in the body. This affects the renal function of the kidneys. Eating potassium-rich foods like bananas and potatoes etc. and reducing the intake of common salt helps to improve the balance and reduces hypertension. To reduce sodium intake take note of the following steps:

• • Keep a food diary to keep track of the salts that you eat every day.

• • Aim for less than one teaspoonful of salt (2300 mg) a day in all of your food. Ask your doctor if you must aim for a lower level, that is 1500 mg of salt a day.

• • Check the nutritional labels on every food package. Select foods that have 5% or less of the daily value of sodium and avoid foods that have more than 20% of the daily value.

• • Avoid canned foods, processed foods, lunch meats, and fast foods.

• Use salt-free seasonings.

Diet to Lower Hypertension

To increase the amount of natural potassium, magnesium, and fiber you take in, include the following in your diet:

Fruit

• • Pome fruit: Apples

• • Stone fruit: Apricots, peaches etc.

• • Exotic fruit: Bananas and mangoes

• • Citrus fruit: Oranges and grapes

• • Melons

• • Pineapples

• • Strawberries

• Tomatoes

Vegetables

• • Leafy greens: Spinach and beet greens

• • Cruciferous: Broccoli

• Roots: Sweet potatoes, potatoes, carrots

Legumes

• • Green beans

• Green peas

Fish

• Tuna

Dairy Products

• Yogurt (fat-free)

Remember to consume whole fruits and veggies as the juice is devoid of fiber.

The DASH Diet

Do not worry if the mere addition of the fruits and vegetables is not helping. There is a whole diet called DASH (Dietary Approaches to Stop Hypertension) that helps in fighting hypertension. The DASH diet cuts out desserts, sweetened beverages, processed meat, fats, and red meat. It, therefore, has less salt and sugar than a regular American diet. It is a diet rich in whole grains, fruit, legumes, fish, poultry, nuts, and low-fat diary. These are high in key ingredients like potassium, magnesium, calcium, fiber, and protein, key ingredients that combat hypertension. 

Physical Activity and Maintaining a Healthy Body Weight

Aim for at least 30 minutes of aerobic activity on most days of the week. This exercise helps not only to improve the breathing but also reduces the risk of cardiovascular disease and keeps your blood pressure in check.

Avoid Smoking

Avoid smoking at any cost. The nicotine in cigarettes not only raises the blood pressure temporarily but also damages the arteries, narrowing them and making their walls hard. It increases the chances of the formation of blood clots and can, therefore, cause a heart attack or a stroke.

Reduce the Consumption of Alcohol

Limit the consumption of alcohol to two drinks a day if you are less than 65 years of age and male to one drink a day if you are female.  A drink is approximately 12 ounces of beer, 5 ounces of wine, and 1.5 ounces of 80-proof (40% alcohol by volume) distilled spirits. 

Learning Stress Management Techniques

There are several stress management techniques that keep your blood pressure in check. Some of them are:

Yoga 

Generally, yoga postures that do not involve inverting your head are useful for those with high blood pressure. Leg stretches like the One-legged Leg Stretch (Janusirsana) and gentle hip openers like the Supine Pigeon (Supta Kapotasana) are effective poses to relieve oneself of high pressure.

The poses that put the spine in a horizontal position greatly help in lowering the blood pressure because the heart is slowed down, and blood can more easily flow from the heart to the brain. Bound Angle Pose (Baddhakonasana), Hero Pose (Virasana), and Wide-Angle Seated Forward Bend (Upavista Konasana) are examples of some of the best poses for getting rid of hypertension.

Mild inversions can be introduced over time. A great alternative to Legs Up the Wall (Viparita Karani) pose is the Supported Bridge Pose (Setu Bandha Sarvangasana) that is done on bolsters. This helps soothe the central nervous system and energizes the kidneys.

Deep Breathing

Since breathing is something we can control and regulate, it is a useful tool for achieving a relaxed and clear state of mind. If breathing can be controlled so can one’s blood pressure, to a great extent even if not in entirety. Deep breathing works by soothing the sympathetic nervous system and increasing blood flow to the tissues, particularly to the heart as the diaphragm moves up and down.

Some of the techniques used are Sama Vritti or “Equal Breathing” and “Abdominal Breathing”. In Sama Vritti, to start, inhale for a count of four, then exhale for a count of four (all through the nose, which adds a natural resistance to the breath). More experienced yogis can aim for six to eight counts per breath. This can be done at any place and at any time.

In abdominal breathing, take a deep breath through the nose with one hand on your chest and one hand on your belly. Make sure that it is your diaphragm that expands and stretches your lungs. Take six to 10 deep, slow breaths per minute for 10 minutes each day to experience immediate reductions to heart rate and blood pressure. If one persists for six to eight weeks, the results will last longer. This works best before an exam or a stressful event.

Progressive Muscle Relaxation

The technique of PMR (progressive muscle relaxation) was developed by Edmund Jacobson in the 1930s, and it is based upon the premise that mental calmness is a natural result of physical relaxation. PMR can be learned by nearly anyone and requires only 10 minutes to 20 minutes per day to practice. In PMR, each group of muscles is first tensed and then relaxed beginning with the lower extremities and ending with the face, abdomen, and chest. When this is done, the blood pressure is also lowered. Breathing exercises can be combined with PMR for better results.

Meditation

Transcendental meditation involves sitting comfortably and closing the eyes for 20 minutes, twice a day, to achieve a quality of rest in the mind and body. In a study conducted by Kent State University, it was found that meditation is helpful in lowering the blood pressure but it is a combination of medication and meditation that works well in reducing hypertension.

A new study to understand its benefits was led by Dr. Robert Schneider, Director of the Institute for Natural Medicine and Prevention at the Maharishi University of Management in Fairfield, IA. This suggests the technique stimulates genes that produce telomerase – an enzyme linked with reduced blood pressure and mortality. This increased gene expression reduces blood pressure and helps to prevent cardiovascular disease.

Guided Imagery

Relax in a place where you are most comfortable. Listen to your therapist, a coach or even a recording to replace your negative thoughts with positive ones. In other words, guided visualization puts your mind in the place where it should be than being drawn into a stressful internal dialogue. It works at any place where you can feel free to close your eyes and let go.

Getting Good Sleep

Insomnia is a risk factor for hypertension. This is because a lack of sleep could affect your body’s capability to regulate stress hormones. The unregulated stress hormones then lead to hypertension. A study concluded that those who slept for less than 6 hours a night are 3 times more likely to develop insomnia than those who slept for more than 6 hours. 

Final Words

More than 60 years ago, when we did not have as clear a picture of hypertension, it may have been difficult to treat it medically. The first real breakthrough against hypertension was achieved in the 1950s with the discovery of oral diuretics. This was followed by the discovery of beta-blockers in the 1960s. So today, with a much better understanding of the human body, we have finally developed drugs that can treat this condition effectively.

Of course, the treatment methodology and success would depend on how early the diagnosis is made. Blood pressure kits are easily available and one can monitor their blood pressure easily. Certain phones too come with blood pressure sensors. Prevention is better than cure, so monitor your blood pressure regularly, and keep it within healthy limits.

References

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