Understanding High Blood Pressure #Hypertension: A Comprehensive Guide by Dr Satish Niraula

High blood pressure (hypertension) is a condition where the pressure in your blood vessels is consistently higher than normal. Often called the “silent killer,” it can damage your heart, brain, kidneys, and eyes without showing any symptoms. May is observed globally as “Hypertension Awareness Month,” aiming to spread awareness about this condition. With the increasing burden of hypertension in Nepal, raising awareness has become essential.

The Impact of Hypertension Worldwide and in Nepal

Global Scenario: According to the World Health Organization (WHO), approximately 1.13 billion people worldwide suffer from hypertension. This number has nearly doubled from 594 million in 1975, with the increase particularly notable in low and middle-income countries. About 27% of people in African regions and 18% in the Americas are affected by hypertension.

Nepal’s Situation: The 2016 Nepal Demographic and Health Survey (NDHS) reported that 20% of adults over 18 years in Nepal have hypertension. It’s more prevalent in men (34.25%) than women (25.99%), and more common in urban areas (28.4%) than rural areas (24.4%). According to the 2022 NDHS, 50.4% of people with hypertension remain undiagnosed.

Economic and Social Burden

Economic Impact: Hypertension and its complications account for a significant portion of healthcare costs. In South Asia, the estimated cost of hypertension over 10 years is 30,657 million USD. In Nepal, the lack of affordable medication and treatment increases long-term healthcare expenses.

Social Impact: Hypertension creates family and community stress, work disability, and social inequality. Particularly among lower-income groups, limited access to healthcare increases the disease burden.

Complications of Hypertension

Uncontrolled high blood pressure can lead to:

• Heart and Blood Vessels: Heart attack, heart failure, aneurysm
• Brain: Stroke, cognitive decline, dementia
• Kidneys: Kidney disease, kidney failure
• Eyes: Retinopathy, vision loss
• Other: Pulmonary hypertension, sexual dysfunction

Importance of Awareness

Early detection and control of hypertension can reduce complications. Hypertension Awareness Month in May emphasizes:

• Regular blood pressure checks
• Adopting a healthy lifestyle
• Community health camps and educational programs

In Nepal, where over 50% of people with hypertension remain undiagnosed, awareness campaigns can help reduce the burden on the healthcare system and decrease mortality rates.

Classification of Hypertension (JNC 7)

The JNC 7 (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure) classifies blood pressure as:

• Normal: Systolic <120 mmHg and Diastolic <80 mmHg
• Pre-hypertension: Systolic 120-139 mmHg or Diastolic 80-89 mmHg
• Stage 1 Hypertension: Systolic 140-159 mmHg or Diastolic 90-99 mmHg
• Stage 2 Hypertension: Systolic ≥160 mmHg or Diastolic ≥100 mmHg

If systolic and diastolic pressures fall into different categories, the higher category applies.

Types of Hypertension

Primary (Essential) Hypertension:

• Accounts for 90-95% of cases
• No specific identifiable cause, but influenced by genetic, lifestyle, and environmental factors

Secondary Hypertension:

• Accounts for 5-10% of cases
• Caused by other diseases or conditions, such as:
  • Kidney disease
  • Adrenal gland problems (pheochromocytoma, primary aldosteronism)
  • Thyroid disorders
  • Use of birth control pills or steroid medications

Simplified Pathophysiology of Hypertension

High blood pressure develops over time through:

• Vascular Resistance: Narrowing or stiffening of blood vessels obstructs blood flow, increasing pressure
• Cardiac Function: When the heart pumps with greater force, blood pressure rises
• Renin-Angiotensin System: The kidneys produce renin hormone, which narrows blood vessels and increases pressure
• Salt Sensitivity: Excessive salt consumption leads to water retention, raising blood pressure
• Genetic and Environmental Influences: Genes and lifestyle factors (like stress, obesity) cause long-term changes in vascular and cardiac function

These factors create continuous pressure on blood vessels and the heart, resulting in hypertension.

Risk Factors

Modifiable Factors:

• Unhealthy Diet: High salt, fat, and junk food consumption
• Physical Inactivity: Lack of exercise
• Smoking and Alcohol: Damages blood vessels
• Obesity: Higher risk in people with high BMI
• Stress: Mental stress increases blood pressure

Non-modifiable Factors:

• Age: Risk increases after 40 years
• Genetics: Family history of hypertension
• Gender: More common in men, but risk increases in women after menopause
• Other Conditions: Diabetes, high cholesterol, kidney disease

The Harm of Junk Food

Junk food (like fast food, chips, soft drinks) contains high amounts of salt, sugar, and unhealthy fats, which:

• Increase salt levels, raising blood pressure
• Lead to obesity and insulin resistance
• Deposit fat in blood vessels, narrowing them
• Interfere with heart function

How Smoking and Alcohol Worsen Hypertension

Smoking:

• Nicotine narrows blood vessels and immediately increases blood pressure
• Damages the inner lining of blood vessels, causing long-term hypertension
• Carbon monoxide reduces oxygen supply, putting pressure on the heart

Alcohol:

• Excessive alcohol activates the renin-angiotensin system, narrowing blood vessels
• Damages the liver, affecting hormones that control blood pressure
• Increases obesity and stress, further complicating hypertension

Essential Tests

The following tests are conducted for diagnosis and management of hypertension:

• Blood Pressure Measurement: Regular measurement in both arms
• Blood Tests: Blood sugar, cholesterol, kidney function (creatinine, urea), electrolytes
• Urine Tests: Checking for protein or blood to detect kidney damage
• ECG: Examining electrical activity of the heart
• Echocardiogram: Checking heart structure and function
• Eye Examination: Fundus examination to check for retinopathy
• Kidney Ultrasound: To detect secondary causes

Comprehensive Management of Hypertension

Hypertension management includes medication, lifestyle changes, and psychosocial aspects:

Lifestyle Changes (WHO and JNC 7 Recommendations):

Diet:

• Less than 5 grams of salt daily
• Green vegetables, fruits, whole grains, and potassium-rich foods (bananas, oranges)
• Reduce fatty and junk food

Exercise: 150 minutes of moderate exercise weekly (walking, yoga)

Weight Control: Maintain BMI between 18.5-23

Quit Smoking and Alcohol: Smoking damages blood vessels and alcohol increases blood pressure

Sleep: Get 7-8 hours of sleep at night

Psychosocial and Spiritual Management:

• Stress Control: Meditation, yoga, deep breathing exercises, and pranayama reduce stress
• Social Support: Connect with family and community. Participate in community health camps
• Spirituality: Prayer, meditation, or religious activities provide mental peace, helping control blood pressure

Glycemic (Sugar) Control:

• For those with diabetes, controlling blood sugar is crucial as it complicates hypertension
• Low-carbohydrate diet, regular sugar checks, and medication as prescribed
• Aim to keep HbA1c below 7%

Treatment of Dyslipidemia (High Cholesterol):

• High cholesterol causes fat deposition in blood vessels, increasing the risk of hypertension and heart disease
• Statins, low-fat diet, and exercise can control cholesterol
• Target LDL cholesterol <100 mg/dL and HDL >40 mg/dL

Medication:

• Doctor-recommended medications: Thiazide diuretics, ACE inhibitors, calcium channel blockers, beta-blockers
• Take medication regularly and don’t stop without doctor’s advice
• WHO emphasizes making affordable and effective medications available at primary health centers

Community and Policy Initiatives:

• Organize health camps
• Implement policies to reduce salt, tobacco, and alcohol consumption
• Nepal has implemented the WHO’s “Global Hearts” initiative’s HEARTS package, strengthening screening and treatment of hypertension at primary health centers

Conclusion

Hypertension is a major public health problem in Nepal. Urbanization, unhealthy diet, stress, and limited access to healthcare services are contributing to its rise. Excessive salt consumption and lack of regular check-ups add to the risk. Hypertension is a controllable condition, but it requires regular check-ups, a healthy lifestyle, and community participation. May’s “Hypertension Awareness Month” encourages us to unite against this disease. Check your and your family’s blood pressure, adopt healthy habits, and consult a doctor. Let’s fight against hypertension together!

उच्च रक्तचाप (हाइपरटेन्सन) बारे जनचेतना #Hypertension #BloodPressure