High Blood Pressure

The most striking feature of high blood pressure is that it can go unnoticed as most of the time it can be without any symptoms. Most people with high blood pressure are unaware of their condition. Hence, it is necessary to visit your doctor regularly so that you will not miss any changes in your blood pressure levels.
If you have  uncontrolled blood pressure, then you may notice the following symptoms:

• Severe headache – You may feel a heaviness in head or pain because of high blood pressure.
   
• Fatigue or confusion- You may feel weak or uneasiness or disorientation.
   
• Vision problems – You may experience blurring of vision or double vision.
   
• Chest pain – You may feel sharp pain or heaviness in the chest.
   
• Difficulty breathing – You may feel you are unable to breathe properly.
   
• Palpitation- You may feel your own heartbeats.
   
• Blood in the urine – Rarely, you may notice dark colored urine or slightly brownish color urine.

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• Most times, the cause can be unknown or unidentifiable.
   
• High blood pressure can be secondary to increased weight, diabetes, kidney disease, and difficulty in breathing while sleeping.
   
• Obesity – excessive weight can lead to an increase in blood pressure.
   
• Stress – Stressful life can affect blood pressure significantly.
   
• Genetic factors- high blood pressure runs in families. 
   
• Unhealthy lifestyle-  Tobacco smoking and chewing, drinking excessive alcohol, junk food.
   
• Pregnancy- Pregnancy-induced high blood pressure can be seen in some females.
   
• Drugs- Some drugs which you are taking may be responsible for developing high blood pressure.

• Age- Blood pressure increases as your age increases.
   
• Sex- It is more common in men than women.
   
• Family history- If your maternal or paternal family members have a  history of high blood pressure, then you should do regular checkup for blood pressure as you may develop high blood pressure as well. 
   
• Obesity- Increase in weight increases the chances of developing high blood pressure.
   
• Sedentary lifestyle- Avoiding physical activities and a sedentary lifestyle can increase your weight which can increase your blood pressure. So, exercise and physical activity are important in order to maintain your blood pressure.
   
• Tobacco use- Tobacco chewing is a most dangerous risk factor as it is responsible for narrowing of your arteries by increasing the thickness of walls of arteries.
   
• Excessive salt intake- Increased salt intake is an important risk factor for high blood pressure as it holds the fluids in our body which will increase the load on the heart.
   
• Alcohol- Drinking too much alcohol is hazardous for the heart. Taking more than one drink for women and 2 drinks for men increases the risk of developing high blood pressure. 
   
• Stressful life- More you take on stress in your life, the more you will suffer from high blood pressure 
   
• Secondary conditions- Conditions like diabetes can increase the risk of developing hypertension.
   
• Pregnancy- It can lead to high blood pressure in some females.

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It is possible to prevent or delay the onset of high blood pressure by making changes in your lifestyle. Here are factors that help in keeping a check on blood pressure and can in turn help in preventing high blood pressure:

• Healthy eating habits
  Avoid junk food and limit eating out. Always choose healthy options over unhealthy options. Read the contents of the food package to keep a check on what you are eating and how much you are eating. This will help to maintain weight.
   
• Mild-Moderate regular physical exercises A 30-minute walk or 15 minutes jogging is sufficient to maintain your health. So, adopt these exercises in your daily routine.
   
• Avoiding or limiting alcohol intake and smoking
  This can help prevent the development of hypertension. Smoking and alcohol are risk factors for high blood pressure, therefore, try to limit them or if possible, avoid them completely.

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For the diagnosis of high blood pressure, you need to visit the doctor for measurement of your blood pressure. The blood pressure is measured using an instrument called sphygmomanometer. This instrument is designed to measure the blood pressure by folding a cuff around your upper arm and pumping air into it by hand. Alternately, blood pressure measurement can also be performed using electronic machines.

The reason for placing the cuff on the upper arm is that it has a blood vessel called the brachial artery. Beneath the brachial artery, is a big artery of arm compression. During blood pressure measurement, inflating air will stop the flow of blood and the release of air will allow your doctor to hear using the stethoscope and look for  blood pressure readings on the mercury containing numerical scale. If the blood pressure measurement machine is automatic, it does not contain the mercury numerical scale but has a direct electronic reading display.The display screen directly shows the blood pressure readings.

Blood pressure is recorded as systolic and diastolic blood pressure. Systolic blood pressure means the pressure measured during heartbeats, whereas, diastolic blood pressure means the pressure measured during the rest period of the heart. Blood pressure measured is represented as systolic pressure by diastolic pressure and the unit is the millimeter of mercury i.e., mm of Hg.
Results of blood pressure measured can be interpreted as:

• Normal blood pressure – 120/80 mm Hg or below
• Higher than normal – above 120/80 mm Hg

Even if you’re having a higher range of blood pressure in your first visit, your doctor will take more readings for consistent results before diagnosing you as a patient of high blood pressure and starting treatment. This is because your blood pressure can be high due to anxiety or fear during your first visit, a condition known as white coat hypertension. Hence, several readings are needed.

Contrary to white coat hypertension, masked hypertension is a condition in which otherwise hypertensive patients show normal blood pressure readings at the doctor's clinic. There is no known cause for masked hypertension though a stressed lifestyle, alcoholism, smoking and being a male increases the chances of this type of high blood pressure.

So, your doctor may take more than one blood pressure reading to confirm the diagnosis. If you are diagnosed with high blood pressure, your doctor will ask you for frequent visits to monitor the response of blood pressure to the treatment he/she has started and to modify the treatment accordingly.

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High blood pressure cannot be treated completely but can be controlled with proper care and anti-hypertensive drugs to avoid further complications. Treatment of high blood pressure depends upon the blood pressure readings taken by your doctor. An average of two or more readings has to be taken before starting any treatment.

• If you have a normal blood pressure of 120/80 mm Hg or below, your doctor will advise you to follow a healthy lifestyle such as healthy diet and exercise to avoid development of increased blood pressure.
   
• If your systolic BP (Blood pressure) is 120-129 mm Hg but diastolic BP is less than 80 mm Hg, your doctor will diagnose you as an elevated blood pressure patient that falls in the category of PREHYPERTENSION. At this stage, you may not require drugs, but, may require diet and exercise inclusion in your daily routine. Your doctor may ask you to monitor BP once in every  15 days by electronic machines at home or by visiting a clinic. 
   
• If your systolic BP is 130-139 mm Hg and diastolic BP is less than 80 – 89 mm Hg, this means you have stage 1 hypertension.  In this case, your doctor may advise you one or more anti-hypertensive drugs, along with, diet modification, exercise, and strict BP monitoring.
   
• If your systolic BP is 140 mm Hg or more and diastolic BP is less than 90 mm Hg or more, it means you have stage 2 hypertension or high blood pressure. In this case, your doctor will advise you more than one anti-hypertensive drug and strict diet modification and exercise routine, along with, strict BP monitoring.
   
• Drugs like calcium channel blockers, ACE inhibitors, beta-blockers, and diuretics are used as antihypertensive drugs. One of these drugs or a combination of two or more drugs is used to control high blood pressure. The choice of drug for your treatment is decided by your doctors depending upon severity, blood pressure readings, age, and availability of medicines.
   
• Anti-hypertensive drugs (when taken regularly without fail), along with, salt restriction, avoiding stress and following daily routine exercises as advised by your doctor will help you to control your blood pressure effectively.  These measures will also avoid further complications due to high blood pressure. 

Healthy lifestyle changes include

• Eating healthy 
  Stop eating fried, junk food and start including green vegetables, fresh fruits, and whole grains in your diet.
   
• Limiting intake of alcohol 
  limiting the intake of alcohol and tobacco or if possible avoiding it completely can help in regulating your blood pressure.
   
• Use of less salt or avoiding canned foods because they contain high sodium.
   
• Staying fit
  Including simple exercises like walking and jogging in your daily routine can keep you fit and also keep a check on your blood pressure. You may include exercises like swimming, High-intensity workout, but only, with permission of your doctor and under the guidance of an expert.
   
• Managing stress
  Stress could also be an important contributor to high blood pressure. Taking up activities that manage stress such as yoga, meditation, deep breathing exercises can help in coping with stress and in managing your blood pressure.

LIFESTYLE MANAGEMENT
Lifestyle changes will be very helpful if you are diagnosed with high blood pressure. Modifications in your daily routine life are important to control high blood pressure. Healthy measures to ensure a healthy lifestyle may lead to a reduction of the dose of your medication and control the blood pressure to avoid further complications. Such changes include:

• Watch your weight 
  It is the most effective way to control your blood pressure as an increase in weight will lead to an increase in blood pressure and vice versa. Obesity can be a risk factor for developing increased blood pressure. You must aim to reach the appropriate weight for your height and age. An ideal body mass index should be between 18 and 24.5 kg/m2. 
   
• Exercise regularly 
  It is important to add exercise to your daily routine to avoid many health problems. Activities such as 30 minutes’ walk for at least 5 days a week can help you to control your blood pressure. Most importantly, you should exercise regularly for best results. Other exercises which you may include in your daily activities are swimming, dancing, jogging, running, etc. Consult your doctor or physical fitness expert before starting any exercise.
   
• Follow the DASH Diet 
  A healthy diet is a key to good health. A healthy diet includes whole grains, vegetables, fruits, and low-fat dairy products. Also, foods with saturated fats and good cholesterol. This diet is also called as Dietary Approaches to Stop Hypertension (DASH) diet. Always keep motivating yourself for a good healthy diet as it is difficult to switch eating habits which you were following for long. Don’t keep unhealthy foodstuffs in the kitchen which can make you crave and disturb your diet.
   
• Restrict salt intake 
  Reduction in dietary sodium is very important for keeping blood pressure under control. Always read the content of food labels. Your doctor may advise you salt restriction in diet. It will be beneficial to avoid sprinkling additional salt on an already prepared dish.
   
• Avoid Alcohol
  Avoid Alcohol can be beneficial for the heart but if taken in excess, it can be harmful. You can talk to your doctor about understanding the harms of alcohol.
   
• Quit smoking
  Smoking increases blood pressure. You can slowly reduce cigarette smoking and then stop smoking for avoiding the risk of developing heart disease and also for overall good health.
   
• Manage stress
  A stressful lifestyle can lead to an increase in blood pressure. Relieving stress by keeping calm and learning meditation can help control your blood pressure.
   
• Visit your doctor 
  Regular visits and checkup can help you monitor your blood pressure and your doctor will be able to notice the effect of treatment and if necessary modifications can be made. Even if you are healthy, regular blood pressure checkup can help you get diagnosed with high blood pressure if you are asymptomatic.
   
• Seek support
  To live a healthy life, family and friends support is important as they help reduce your stress.

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Prognosis

Prognosis of high blood pressure depends upon the underlying cause and the age of the patient. In case of essential hypertension, the prognosis can be poor and high blood pressure can lead to further complications if not well-controlled. In the case of secondary hypertension, if the cause is treated, the prognosis will improve gradually and blood pressure will be in control. With an increase in age, blood pressure also increases and so do the complications like heart disease and kidney failure. A slight reduction in blood pressure can prevent serious disabilities and complications. Hence, you need to monitor your High blood pressure and follow your doctor’s instructions to keep it always under control.

Complications

If high blood pressure is not well-controlled with medication and lifestyle modifications, it can lead to serious complications like:

• Stroke
  In a stroke, due to high blood pressure, there is blockage or narrowing of blood vessels which block the blood flow to the brain causing sudden death of brain cells. It can lead to paralysis or loss of speech.
   
• Coronary heart diseases
  Due to an increase in blood pressure, in coronary heart diseases, there is damage to the arteries and deposition of platelets which further cause narrowing of the arteries. As a result, the blood flow to the heart is decreased.
   
• Heart attack
  Sudden decrease in blood flow to the heart can lead to heart attack, also known as myocardial infarction.
   
• Chronic kidney failure
  Prolonged high blood pressure can damage your kidneys.
   
• Death
  If blood pressure becomes very high and leads to severe complications for which intensive care is not provided immediately, it can potentially lead to death. As per the Indian Council of Medical Research, hypertension is responsible for about 10.8 % of all deaths in India.

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Over the past several years, High blood pressure (also known as Hypertension) has emerged as a major cause of death in India. It is a very common chronic health problem. Once you develop high blood pressure, it becomes necessary to take anti-hypertensive treatment and bring lifestyle changes for the whole life. High blood pressure is a significant risk factor for the development of heart diseases, strokes, ischemic cardiac diseases, and kidney failure. Hence, if high blood pressure is not well-controlled it can lead to other health conditions. The risk of high blood pressure and its treatment outcome is related to a person’s lifestyle, dietary habits, and family history of high blood pressure. Routine health checkups after the age of 30 can surely help monitor blood pressure, as well as, other health issues. Electronic automatic blood pressure monitoring machines can be used at home. These blood pressure monitoring machines are are easy to use and the readings can be understood easily. High blood pressure cases are increasing in number every year and it is predicted to be a leading cause of disability and death by 2020.

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