The Medical City World Hypertension Day 2012

Understanding and Controlling your High blood Pressure 

Why is blood pressure important? 

Everybody has blood pressure. Blood cannot circulate through your body without blood pressure. Your vital organs cannot get the oxygen and nutrient it needs to work without it. Therefore it is important to know about blood pressure and how to maintain in the proper range. When the heart beats, it delivers blood into your arteries and generates pressure in them. This pressure causes blood to flow in all parts of the body. If an individual is healthy, the arteries are elastic. They stretch when heart pumps blood through them. How much they stretch depends on how much force the blood exerts.  A normal heart beats 60-80 times a minute. Blood pressure rises on contractions and falls on relaxation between beats. Blood pressure may vary and change minute to minute, with changes in position, activity or sleeping.

How is blood pressure written? 

There are two numbers recorded when taking blood pressure, such as 110/70 mmHg (millimeters of mercury). The numerator (top) or larger number measures the pressure in arteries when the heart beats, termed as systolic pressure. The denominator (bottom) or smaller number measures the pressure while your heart rests between beats, termed as diastolic pressure.

What is normal blood pressure? 

Angiotensin -2 receptor antagonists produce similar effects as ace-inhibitors. They may be tolerated because they produce less cough.  Examples are candesartan,  valsartan,  olmesaratin, losartan, irbesartan, etc. Beta-blockers decrease the heart rate and cardiac output, which lowers blood pressure. Some common beta blockers include
metropolol, atenolol, bisoprolol, carvedilol, etc. Combination therapies like beta-blocker and diuretic or ace-
inhibitor and diuretic.  Calcium channel blockers interrupt the movement of calcium into the heart and blood vessel cells. Examples are felodipine, amlodipine, diltiazem, verapamil, etc.

Can high blood pressure damage your body? 

Yes it does. It can cause damage in many ways. Primarily it adds to the workload of your heart and arteries. Because your heart must work harder than normal for a long time, it tends to become larger. A slightly enlarged heart may still work efficiently but if it is too large already, it may have a difficult time meeting your body's demands.

How will I know if I have hypertension?

Your physician can check if you have hypertension by measuring your blood pressure with a sphygmomanometer. Most people with hypertension don't have symptoms, so a lot of them don't know they have it. You should have your blood pressure checked once a year, do not rely on blood pressure measurements in the drug store. These might not be good enough. As you age, your arteries become less elastic and stiff. This occurs in all people regardless of blood pressure. However, hypertension will speed up the process. Hypertension increases your risk of stroke. It can cause damage to kidneys and eyes. People with controlled high blood pressure compared  to  those  hypertensive  with  uncontrolled  blood  pressure are:

• Three times more likely to develop coronary artery disease
• Six times more likely to develop congestive heart failure.
• Seven times more likely to have a stroke
• If you are hypertensive, follow your doctor's advice. Most high blood pressure cannot be cured but can be controlled. And its harmful effects can be prevented and reduced if recognized and treated early and kept under control.

What do I do if I have hypertension?

• You are diagnosed with hypertension, your blood pressure should be lowered to less than 140/90 or to less than 130/80 if you are diabetic or have kidney disease.  
• Modify your diet; eat foods that are low in salt and fat.
• If you are overweight / obese, try to lose weight.
• Limit alcohol intake to no more than two drinks per day.
• Increase physical activities.
• Stop smoking.
• Take high blood pressure medicine your doctor gave you and follow his/her directions carefully.
• Have your blood pressure monitored regularly.

How do I modify my diet to control hypertension?

• Food’s that are low in fat, salt and calories like low fat milk, fresh vegetables and fruit, and plain rice and pasta.
• Use flavorings, spices, and herbs instead of salt.
• Avoid butter and margarine, fatty meats, regular salad dressings, whole milk, dairy products, salty snacks, and fried foods.
• Consult your doctor for more detailed dietary advise to suit your condition.

What activities can I engage in?

• Physical activity should be part of daily schedule. It helps lower blood pressure and can help lose weight or stay your ideal weight.
• Consult your doctor before increasing your physical activities.
• A minimum of 20-30 minutes activity on most days of the week is advised.
• Walking, jogging, biking, swimming, ballroom dancing

What should I know about medicines for hypertension? 

To help reduce blood pressure, some patients require medications.  There are many medicines used to treat 
hypertension. Some act by relaxing the arteries preventing constriction, some divest fluid and salt, some reduces heart rate to control blood pressure. Patients react to medications differently. A trial period at times may be needed before the doctor finds a suitable medication for a particular patient. If your doctor prescribes medicine for hypertension, be sure to follow the exact directions. Consider  these  important  points  about  prescribed  anti-hypertensive medication:

• Name of the drug
• What it is supposed to do
• How to take it
• How much to take it
• How long to take it
• How to store the drug
• What specific time it should be taken
• What are possible side effects that might be experienced
• What to do in case a dose is missed
• Is it safe for pregnant patients
• What other medications, food or drinks, activities that should be avoided when taking the drug?

What about drug treatment? 

Diuretics are often first line treatment. These drugs help control blood pressure by taking off excess salt and water from your body. Some common diuretics are  furosemide, indapamide,  hydrochlorthiazide, etc.

Angiotensin-Converting enzyme inhibitor expand blood vessels and decrease resistance allowing blood to flow more easily and makes the heart work easier and more efficient. They are used to treat failure symptoms and control blood pressure. Some common ace-inhibitors are captopril, enalapril,  fosinopril,  lisinopril, quinapril, etc.

What causes high blood pressure? 

High blood pressure or hypertension is not nervous tension. People who have elevated blood pressure do not have to be tense, compulsive or nervous. You may have high blood pressure and not be aware of it. Hypertension usually has no symptoms, hence, referred also as the “silent killer”. About 90-95% of the cases of hypertension have no known cause. But some factors increase likelihood of developing this disease. These are termed as risk factors.

Risk factors you can control

• Obesity – people with body mass index (BMI) of 30.0 or higher ?Eating too much salty food? Alcohol – heavy and regular intake ?Lack of exercise – inactive lifestyle causes overweight
• Stress – hard to measure and response to stress vary from person to person

Risk factors you cannot control

• Race – African Americans more prone  than Caucasians to develop hypertension
• Age – the older you get, the higher the chance of having hypertension; occurs more commonly over age 35; men seem to develop it between 35-50; women are more often likely to develop after menopause.

Can you tell when your blood pressure is high?