HYPERTENSION – TAKE CONTROL BEFORE IT’S TOO LATE
Hypertension or raised blood pressure is one of the most important modifiable risk factors for cardiovascular diseases7. The disease of hypertension affects nearly 1 in 4 men and 1 in 5 women throughout the world in 2015.1 If not controlled it can cause cardiovascular diseases likes atherosclerosis (clogging of arteries), heart attacks, heart failure, brain related conditions like stroke, kidney diseases like kidney failure, and many other diseases.
Nearly, 10.8% of all deaths in India are attributed to hypertension9. Data from 1950 to 2014 showed that the overall prevalence of hypertension in India is 29.8%.
Hypertension is a growing problem in India and causes significant burden on the health system. According to data from the GBD (Global Burden of Disease) study of 2016, hypertension led to 1.63 million deaths in India in the year 2016 alone11. GBD data also showed that over half of the deaths due to ischaemic heart disease (54.2%), stroke (56.2%) and chronic kidney disease (54.5%) were attributable to high systolic BP12.
Hypertension prevalence is common even among younger age groups, with one out of every 10 individuals aged 18-25 yrs. suffering from it14.
The hypertension epidemic in India is further complicated by the fact that a large proportion of individuals is unaware of their hypertension status. The increasing prevalence of hypertension is attributed to population growth, ageing and behavioural risk factors, such as an unhealthy diet, harmful use of alcohol, lack of physical activity, excess weight and exposure to persistent stress. There is 1.5 – 2 times greater prevalence of hypertension in patients with diabetes than those without diabetes, nearly 33% of patients with hypertension get diabetes later in their life. And in those patients with both hypertension and diabetes it is double edged sword especially for kidney patients as kidney plays important role in regulating blood pressure15.
WHAT IS HIGH BLOOD PRESSURE OR HYPERTENSION?
High blood pressure has no symptoms. So best way to check blood pressure is first getting it done from healthcare provider like general practitioner or other doctors during visit.
Office BP measurement is when it is measured at clinic / hospital by healthcare professional.
HBPM or Home BP measurement is when patient measures their own BP by self or assisted by BP measuring devices at home.
ABPM or Ambulatory BP monitoring is 24 hrs measurement of BP by a oscillometric, validated device as attached to patient to get complete view of whole day of BP patterns.
BP WHEN MEASURED IN CLINIC / HOSPITAL (OFFICE BP)5
| Category | Systolic (mm Hg) | Diastolic (mm Hg) | |
| Normal BP | <130 | and | <85 |
| High-normal BP | 130–139 | and / or | 85–89 |
| Grade 1 hypertension | 140–159 | and / or | 90–99 |
| Grade 2 hypertension | ≥160 | and / or | ≥100 |
CRITERIA FOR HYPERTENSION BASED ON OFFICE -, AMBULATORY (ABPM)-,AND HOME BLOOD PRESSURE (HBPM) MEASUREMENT5
| Systolic BP / Diastolic BP, mm HG | |
| Office BP | ≥140 and / or ≥90 |
| ABPM | |
| 24-h average | ≥130 and / or ≥80 |
| Day time (or awake) average | ≥135 and / or ≥85 |
| Night time (or asleep) average | ≥120 and / or ≥70 |
| HBPM | ≥135 and / or ≥85 |
TYPES OF HYPERTENSION
The form of hypertension that by definition has no other identifiable secondary cause is called primary or essential hypertension. If it occurs as a result of another medical condition or use of other medicines, it is called secondary hypertension.
WHY DO WE NEED TO WORRY ABOUT HYPERTENSION?
A person with hypertension may not notice any symptoms that’s why it is often called the “silent killer.” When blood pressure stays high, there is higher effort needed by heart to pump it to other end organs.
Also the end organs receive high amount of blood leading to symptoms like: difficulty in breathing, chest pain, blood in urine, or pounding in the chest, neck, or ears.
IS HYPERTENSION DIFFICULT TO DIAGNOSE?
A reason why hypertension gets misdiagnosed or difficult to manage is that neither SBP nor DBP is static; both are affected by the activities of the entire cardiovascular system. A person with normal BP (normotensive), has a distinct pattern called “circadian” rhythm.
Continuous invasive or intra-arterial BP monitoring has shown that during a 24-hour period, normotensives experience a peak in BP in the mid-afternoon followed by a steady fall in pressure through the night. The pressure will reach its lowest point usually between midnight and begin to rise a few hours before the person wakes up.
The greatest and most volatile change in BP occurs in response to the external environment. Depending on the physical activity, psychological stress and environmental factors, BP is known to fluctuate considerably throughout the day. All these effects are under the control of various hormones likes melatonin and cortisols.
WHAT IS MASKED HYPERTENSION?
When you check your BP at the clinic it shows normal; however when you check BP at home, readings show higher. This condition is more serious and you should immediately inform your doctor about this.
WHAT IS WHITE COAT HYPERTENSION?
When you check your BP in the clinic it shows on the higher side which could be due to anxiety however when you check your BP at home reading shows normal.
REFERENCE
- https://www.who.int/news-room/fact-sheets/detail/hypertension
- https://medlineplus.gov
- R. Gupta and S. Yusuf, “Towards better hypertension management in India,” The Indian Journal of Medical Research, vol. 139, no. 139, pp. 657–660, 2014.
- Gakidou E, Afshin A, AlemuAbajobir A, Hassen Abate K, Abbafati C, Abbas KM, et al. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: A systematic analysis for the Global Burden of Disease study 2016. Lancet 2017; 390 : 1345-422.
- GBD Compare | IHME Viz Hub. Global; both series, all ages, 2017, DALYS.
- Available from: https://vizhub.healthdata.org/gbd-compare/
- Geldsetzer P, Manne-Goehler J, Theilmann M, Davies JI, Awasthi A, Vollmer S, et al. Diabetes and hypertension in India: A nationally representative study of 1.3 million adults. JAMA Intern Med 2018; 178 : 363-72
- Anchala R, Kannuri NK, Pant H, Khan H, Franco OH, Di Angelantonio E, et al. Hypertension in India: A systematic review and meta-analysis of prevalence, awareness, and control of hypertension. J Hypertens 2014; 32 : 1170-7