What causes hypertension? (2)
High blood pressure usually causes no symptoms underscoring why it’s been labelled "the silent killer." People who have high blood pressure typically don't know it until their blood pressure is measured.
Sometimes markedly elevated blood pressure may present with headaches, dizziness, nausea and vomiting and blurred vision.
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Most of the times though, this disease comes to the fore with symptoms arising from the organ damage caused by chronic (long-term) high blood pressure. These include heart attack, heart failure, kidney failure, visual impairment, stroke and others.
A small percentage of people with high blood pressure present with a condition known as malignant hypertension where the diastolic blood pressure (the lower number) often exceeds 140 mm Hg. Malignant hypertension may be associated with headache, light headedness, nausea, vomiting, and stroke-like symptoms. This condition requires emergency intervention and lowering of blood pressure to prevent bleeding into the brain or stroke.
Blood tests may be considered to assess risk factors for heart disease and stroke as well as looking for complications of hypertension. These include full blood count, blood urea and electrolytes and glomerular filtration rate both of which measure kidney function.
A fasting lipid profile will measure cholesterol and other fat profile which are risk factors for hypertension. Other important tests in evaluating other organs include an ultrasound scan of the kidneys, an electrocardiogram, and an echocardiogram which also checks on the state of the heart.
It is important to note that there is no cure for blood pressure unless the rise in the pressure is secondary to a treatable condition such as certain tumours and blood vessel aberrations called renal artery stenosis. Please ignore the numerous claims of medicines that can cure hypertension. Treatment otherwise is aimed at controlling the blood pressure. Blood pressure control is a lifelong challenge.
Hypertension can progress through the years and treatments that worked earlier in life may need to be adjusted over time. In addition, BP control may involve a stepwise approach beginning with diet, weight loss, and lifestyle changes and eventually adding medications as required.
Weight control is an important step in BP control. Even a small amount of weight loss can make a major difference in lowering or preventing high blood pressure.
It is important that caution is exercised in using medications that help decrease weight. Some weight loss medications carry major risks and may even elevate blood pressure.
Exercise and increased physical activity reduces total cholesterol particularly the bad cholesterol (low density lipoprotein or LDL) and raises the good cholesterol (high density lipoprotein or HDL). Physical activity does not mean exotic things such as joining a gym or a keep fit clubs but includes many mundane activities as cleaning the house, raking the lawn, and walking.
Other possible sources of activity include using the stairs instead of an elevator. Perhaps, the most effective of all is to park our cars and walk for errands.
Early morning or late evening walks or jog is also very effective in reducing weight and by extension blood pressure. Also, very effective is participating in social activity such as dancing. Here again, you don’t have to look for a salsa group to join but you can do it in the comfort of your own home.
You only need a video to help you do so. Recently though there are so many videos that one can follow along and dance the weight away. Whatever and however it is done, weight reduction is an integral part in reducing the blood pressure.
Note here that when we were considering the causes of hypertension, we enumerated certain modifiable factors, which when modified can lead to normalization or control of blood pressure.
Excessive alcohol consumption, has been associated with hypertension. Reducing the overindulgence in alcohol can lead to its control. In the same vein, if the hypertension is caused by oral contraceptive, pill ingestion or the injectables, then alternative method of contraception should be sought to control the blood pressure.
There are certain medical conditions that can secondarily lead to the development of hypertension. There is a type of tumour involving the adrenal glands which can lead to hypertension. Excision of this tumour leads to normalization of blood pressure.
There are also certain conditions such as renal artery stenosis or even certain problems affecting the kidneys that can lead to high pressure development. If these conditions are treated, the blood pressure is controlled.
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Certain medications like steroids, used over a long period, can cause hypertension. Going off these medications, as directed by a physician, will lead to the control of blood pressure.
Certain people also develop hypertension during pregnancy. Most of them get the BP to be normalized after delivery of the baby.
In about half of people with high blood pressure, limiting sodium intake by eliminating table salt, cooking salt, and salty and processed foods can reduce blood pressure. Losing weight and participating in regular physical activity can reduce BP further.
However, as you might have noticed by now, most of the hypertension is classified as the essential - where no causative factor is identified. In this type, almost lifestyle modifications are not that helpful.
This notwithstanding, the first line management is by lifestyle modifications. If these lifestyle changes and choices don't work, medications should be added.
It may take trial and error to find the proper medication or combination of medications that will help control hypertension in each case. It is important to take the medications as prescribed and only discontinue them on the advice of the regular physician.
As already indicated above, it may take more than one drug to control the blood pressure. This brings about a problem in the control of blood pressure particularly in males.
This is because most of the medications affect the libido and for most men that is a problem. Thus some men would prefer to die from stroke with their libido intact than to have it suppressed by medications. It is therefore important to look at other alternate therapies to control the blood pressure.
These include;
• Acupuncture and biofeedback which are well-accepted alternative techniques that may help some people with high blood pressure.
• Techniques that induce relaxation and reduce stress are recommended. These include meditation, yoga, and relaxation training.
It is worth noting that these techniques alone may not control high blood pressure for many people. They should not be used as a substitute for medical therapy without first consulting a physician.
Dietary supplements and alternative medications and therapies are sometimes recommended for high blood pressure.
The most important element in the management of high blood pressure is follow-up care. Routine blood pressure check-ups are important to monitor readings and decide upon a treatment plan. With age and the natural progression of hardening of the arteries, systolic blood pressure may elevate over time.
Routine physical exams and screening blood tests may be suggested to help monitor the success of blood pressure management. Follow-up visits are a good time to discuss any medication side effects.
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