Hypertension: Healthy lifestyle is paramount

Hypertension is an ailment that affects both men and women daily, and this has been linked to various factors. Dr. Akinsanya Olusegun-Joseph, a consultant cardiologist at the Lagos University Teaching Hospital, told GERALDINE AKUTU the cause of hypertension, how to manage it and how to avoid it.

What causes Hypertension?
Hypertension, defined as sustained or persistent elevation of blood pressure, higher than that expected for the individual’s age and sex, is the most common chronic medical problem prompting visits to primary health care providers.

There are basically two types of hypertension: primary or essential hypertension, which constitutes 95 percent of all hypertensive cases, and the secondary hypertension, constituting five percent. Primary hypertension has multiple interplay of factors that predispose a person to it, while secondary hypertension is caused by other disease entities or clinical state, such as kidney, thyroid, adrenal diseases, use of drugs, like steroids and pregnancy induced hypertension, among others.

Primary hypertension is caused by the interplay of genetic and environmental factors. There are certain genetic predispositions to hypertension. However, most may not manifest, if the individual leads a healthy life. Notable risk factors for essential hypertension includes: high salt diet, smoking, ageing, family history, obesity, high cholesterol diet, physical inactivity, insulin resistance, low potassium diet (due to inadequate consumption of fruits and vegetables), type A personalities (very aggressive individuals with short temperament, who hardly take a break) and alcohol consumption.

Newer risk factors include: chronic inflammation, infections such as Chlamydia and Helicobacter pylori; low birth weight (the unborn child may be at risk), obstructive sleep apnea, consumption of sweetened sodas and energy drinks. More recently, environmental pollution, such as noise and air pollutions have also been implicated as risk factors for hypertension.

What health problems are linked with hypertension?
Hypertension is a major risk factor for cardiovascular diseases, and can affect major organs of the body. It is the leading cause of Cerebrovascular Accident (CVA) also known as stroke. This leads to loss of function of the affected part of the body. The person may lose the function of the upper and lower limb of one part of the body. Hypertension can affect the heart, resulting in heart attack, which can cause instant death or permanent disability. Hypertension is also the commonest cause of heart failure.

Furthermore, hypertension is the major cause of renal failure, which can result in death or life long morbidity. Hypertension is also a major cause of eye problem, ranging from bleeding into the eye to blindness. It is also a major cause of peripheral vascular disease, a condition that can result in loss of a limb, usually the lower limb.

What should be the optimal blood pressure (BP)?
According to the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) VII and VIII, World Health Organisation (WHO) and International Society of Hypertension (ISH) the optimal or ideal blood pressure (BP) is <120/80mmHg. However, the cut off for hypertension according to WHO, JNC is > 140/90mmHg. Prehypertension is between 120-139/80-89 mmHg. People that have this BP range are more at risk of developing hypertension around four to five years down the line, if no aggressive lifestyle modification is instituted.

How to detect hypertension and what are the treatment options?
Hypertension can only be detected objectively by having your blood pressure measured. Most times, people with hypertension may not have any symptoms, even when the BP is very high, which is why it is called a silent killer. Some others may have vague, none specific symptoms, such as tiredness, malaise, headache, and inability to sleep or poor sleep. Most people with such symptoms just take painkillers like paracetamol, get better for a while and continue their life with the elevated BP until tragedy strikes, when they may have heart attack, stroke or kidney failure.

Another trend is that people with the above symptoms may go to a laboratory or chemist, where they will be told that they have typhoid or malaria, without having their BP checked. Again, they may feel better after treatment of the so-called typhoid and malaria, living with this raised BP until tragedy strikes.

Management options include, pharmacological and non-pharmacological (lifestyle modification) approach. The pharmacological option should be instituted by a medical practitioner, and this is usually individualised. Some people erroneously start taking the medication of their spouse, neighbours, or friends. This is a very dangerous practice, which should be highly discouraged, as this may cause more harm than good.

Patients must be actively involved in their own management. Another very disheartening trend is patient not knowing the names of their drugs. In this era of information and enlightenment, no patient should take the drug he/she does not know the name. However, that does not mean he/ she should not go for his/her regular clinic visits for review.

Non-pharmacological management or lifestyle modification is a very important aspect of hypertension management. The lifestyle changes include:
Reducing salt intake. Increased salt has been implicated as a risk factor for hypertension. Reduced salt intake is not limited to table salt, but also includes salty condiments. Others include, smoking cessation, reduced intake of fat/cholesterol rich food, increased intake of fruits, vegetables, whole grains and nuts.

Other factors include, limiting intake of sugar-sweetened beverages, weight reduction programme, if obese, reduce/stop alcohol, and energy drinks, reduced exposure to pollutants as much as possible, and reduced stress.

Medications that cause hypertension
There are some medications that can cause hypertension. They include steroids, pain relieving drugs like Nonsteroidal anti-inflammatory drugs (NSAIDs), including Indomethacin, naproxen, Ibuprofen and Piroxicam (Feldene). Others include caffeine containing drugs, antidepressants like fluoxetine (Prozac, Selfemra), paroxetine (Paxil, Pexeva), sertraline (Zoloft); decongestants used to treat cold like Pseudoephedrine (Sudafed), Phenylephrine (Neo-Synephrine); bronchodilators like Salbutamol (Ventolin) and Isoprenalin.

Patients on any of these drugs must have their BP checked regularly, and if they are hypertensive, their BP must be aggressively controlled.

What kind of diet should be followed to avoid hypertension?
There are healthy diets that can positively impact on one’s BP. These include: increased intake of fruits and vegetables, which have lots of anti-oxidants that are beneficial to heart health, process, and improve the health of other organs like the brain and kidneys, reduces the risk of atherosclerosis, heart attack, as well as cancers. They also reduce ageing.

Also, increased intake of fish, especially those rich in omega 3 fatty acid like Salmon. Increased intake of nuts like groundnuts, cashew nuts and walnuts also helps. Cereals and whole grains such as oatmeal are also heart healthy and tend to improve the health of the blood vessels and by extension improve blood pressure.