Hypertension

         Hypertension or high blood pressure is a disease that is silent until a complication of the disease like heart attack, stroke or renal failure occurs.  That is why it is known as silent killer.  Even in developed countries only half of the people who suffer from hypertension are aware of their condition and those who are aware only a few percent are under adequate treatment.

  Blood pressure is measured generally by an apparatus – sphygmomanometer – BP apparatus, measured as systolic and diastolic BP.  Now electronic gadgets have come with which any individual can check his/her BP.  Systolic pressure is the pressure with which heart pumps the blood and diastolic is the resistance of the vessels to the flow of blood.  Various factors affect this systolic and diastolic BP. In general in any person at any given time the blood pressure should not be more than 130/80 mm.Hg. (millimeters of mercury), 130 being systolic and 80 being diastolic BP.  When the BP crosses this it is regarded as hypertension or high BP.  What ever may be the cause it needs treatment.  In fact, present studies indicate that a person whose BP is around 130/80mm.Hg should follow life style modification (LSM) to prevent any further increase in BP.  This LSM includes restriction of salt intake to less than 5gm/day, restriction of alcohol intake, reduction in weight in case of obese individuals, regular physical exercise and following some relaxing methods like meditation and yoga.

 The causes of Hypertension are known only in about 10% of the patient.  The most important cause is kidney disease and pregnancy induced hypertension.  There are other causes like vascular (blood vessel) diseases and rarely tumors of adrenal glands.  This is called secondary hypertension, the cause may sometimes be corrected or treated and high blood pressure is brought to normal levels.  In more than 90% of cases where the cause is not known it is called essential hypertension or primary hypertension. Genetic factor contributes to a great extent and environmental factors – physical and mental wellbeing will add to it.  When the systolic BP is 140 or more and diastolic is 90 or more mm.Hg definite treatment apart from LSM is needed.  After ruling out any known causes of high BP, considering other health factors of the individual, drugs are prescribed.  Until BP comes down to 130/80mm.Hg regular follow-up weekly or fortnightly (depending on severity of hypertension) is required for adjusting appropriate dosage of appropriate drug/drugs.

  Once hypertension (HTN) is diagnosed patient is evaluated not only for the cause of HTN but also for any organ damage.  As said early, HTN itself does not present any symptom unless some organ damage has occurred.  Usually it is diagnosed when an individual goes to the doctor with some fever or nonspecific complaints.  In the initial stages patients do not want to accept that they have HTN.  Though for milder forms LSM is suggested even that is ignored that they never had any ‘BP’ in the past.  They fail to accept that though they never had it previously now they have it.  The failure of compliance of the patient leads to early organ damage and life threatening complications.

 Though all organs are affected by HTN, the vital organs that are affected and causing complications are the heart, kidney and brain.  The degree of HTN is not important, even mild forms when untreated can result in complications like renal (kidney) failure, heart attack or stroke.  Severe forms definitely lead to complication some time in future.  In India stroke is more common than heart attack in patients with HTN.

  To avoid or delay organ damage and complications it is best to take physician’s advice and be adequately treated with proper drugs to maintain BP at ‘normal’ level.  Once BP is maintained at normal level medication should be continued regularly with periodic check-up by physician to note any signs of organ damage or any change required in medication.  Generally patients once declared to have normal BP, they stop medications.  This is because of lack of understanding that the medication they are using is maintaining the BP at normal level. Once medication is stopped complications are liable to occur.  Once diagnosed and treated with drugs, continuation of medication is life long for a long life.  This is to be remembered by patients under treatment for essential/primary hypertension.  To have a disease and not using medication is being diseased.  Using treatment for the disease is being eased out of disease and maintaining almost normal healthy life.

 I wanted to write this highly simplified presentation of HTN just to make people aware of the fact that HTN is a silent killer, hence though they do not have any symptoms but diagnosed to have BP at regular health check-up must strictly follow the advice of the physician and take treatment.  There should not be delay or irregular treatment which will increase complications.  It is good for individuals to have general regular health check-up once a year after the age of 30yrs even without any obvious health problems.

I wish everyone a tension free life with proper health precautions.