Blood pressure is the force in the blood vessel that transports blood to every part of our body. Blood pressure is described by two numbers: the systolic and the diastolic.
The systolic pressure is the upper number and it measures the pressure in our blood vessel when the heart is pumping out blood. The diastolic is the lower number and it measures the pressure in our blood vessel when it is at its most relaxed stage which is in between heart beats.
So, if your doctor says your pressure is 120/60, it means your systolic pressure is 120mmHg (millimetre mercury) and diastolic 60mmHg. Both measurements are important as either one can pose serious health problems if high.
According to the latest British Hypertension Society (BHS) definition, hypertension is defined as systolic blood pressure equal or greater than 140mmHg, diastolic pressure equal or greater than 90mmHg, or both.
In many people with hypertension, both the systolic and diastolic pressure readings are high. However, in selected elderly people, they suffer only isolated systolic hypertension. In both condition, the risk and complications are the same.
Generally, people should start monitoring their blood pressure from the age of 20. Those with high or moderately high readings should monitor their pressure once every few weeks.
Causes of hypertension
In more than 90% of adults with hypertension, there is no identifiable cause. This type of hypertension is normally known as primary hypertension or essential hypertension.
Even though no cause is linked to this type of hypertension, studies have shown that certain factors can lead to its development. They include high salt intake, lack of exercise, being overweight, excessive alcohol consumption, smoking, family history of hypertension and environmental stress.
In the remaining 5% to 10%, the hypertension can be related to underlying conditions such as kidney disease, heart problem, hormonal disease or selected medications.
This type of hypertension is known as secondary hypertension because a cause is identifiable. Some young people have this type of hypertension and treating the underlying cause may cure the condition.
Symptoms and complications
Hypertension is a silent killer. Most people with hypertension have no symptoms at all. High pressure is only discovered when complications such as stroke or heart attack set in. Some may complain of headache and giddiness. But these symptoms are not specific to hypertension.
In the long run, uncontrolled or unnoticed high blood pressure can lead to severe complications such as stroke, heart attack, heart failure, heart enlargement, kidney failure, bleeding in the retina of eye, damage to peripheral blood vessel, etc.
Most of these complications are preventable if high blood pressure is treated early.
The BHS advocates medication if the systolic pressure is 160mmHg or higher, and the diastolic pressure is 100mmHg or higher, or both. For those with lower readings but above normal (that is, 140/90mmHg) but experience no complications, the society advises lifestyle changes and close monitoring of pressure.
There are many types of medication to treat hypertension and each has its own specific usage. Certain medications are more suitable for hypertensive patients with diabetes while some are suitable for young people. Your doctor will decide which one is the most suitable for you.
If one medication is not sufficient to control your pressure, your doctor may combine it with another type. Sometimes, doctors may use up to three or four different types of medication.
Be compliant with medication – this is very important. One recent local clinical study has shown that Malaysians are not compliant with anti-hypertensive medication. If you have any doubts about the medication, talk to your doctor or get counseling.
Go to your doctor for follow-up treatment. Do not assume that a normal reading during one of the follow-up sessions warrants you to stop taking medication. Hypertension is a lifelong condition. Vigilant treatment and follow-ups can reduce risk of getting severe complications.
• Exercise regularly (aerobic exercise) and maintain an ideal weight.
• Reduce salt and saturated fat intake.
• Stop smoking and reduce alcohol intake.
• Consume at least five portions of fresh fruits and vegetables every day.
(By Dr. Gan Ing Earn, a consultant gastroenterologist and internal medicine physician)