Hypertension is one of the most common diseases worldwide afflicting humans and is a major risk factor for stroke, myocardial infarction, heart failure, vascular diseases and chronic kidney disease. Hypertension is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease deaths in India. About 33% urban and 25% rural Indians are hypertensive which is defined as a systolic blood pressure (SBP) of 140 mm Hg or more or a diastolic blood pressure (DBP) of 90 mm Hg or more. And only one-tenth of rural and one-fifth of urban Indian hypertensive population have their BP under control.
What Causes Hypertension
Causes of Hypertension may be categorized as:
1. Primary: When there is no identifiable cause present
2. Secondary: Approximately 90-95% of adults with hypertension have primary hypertension, whereas secondary hypertension accounts for around 5-10% of the cases. It’s important to look for secondary causes because they are among the treatable causes of hypertension.
Causes of Secondary Hypertension are renal artery stenosis, chronic kidney disease, polycystic kidney disease, obstructive sleep apnoea, coarctation of aorta, primary hyperaldosteronism, pheochromocytoma, hyperthyroidism and hypothyroidism, oral contraceptives, steroids and NSAIDS.
Symptoms of Hypertension
Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels. That’s why hypertension is also called silent killer.
A few people with high blood pressure may have headaches, shortness of breath, fatigue, chest discomfort or nosebleeds, but these signs and symptoms aren’t specific and usually don’t occur until high blood pressure has reached a severe or life-threatening stage. It is being recommended that blood pressure should be checked regularly after the age of 18 years.
Basic Investigations for Hypertensive patients are:
1 Complete blood cell count
2 Blood urea, creatinine, serum sodium, potassium and uric acid
3 Fasting blood glucose, and thyroid stimulating hormone
4 Lipid profile
5 Urinary albumin-to-creatinine ratio
6 ECG with optional echocardiogram
Management of Hypertension
Management of hypertension can be broadly divided into two categories- Lifestyle modifications and Drug therapy
Lifestyle modifications are essential for the prevention of high BP, and these are generally the initial steps in managing hypertension. Lifestyle changes can reduce BP by 5-20 mmHg. Various lifestyle modifications are:
Dietary Changes: A number of studies have documented an association between salt intake and BP. The effect of sodium chloride is particularly important in individuals who are middle-aged to elderly. A moderate reduction in sodium chloride intake can lead to reduction in blood pressure. It is recommended that the average daily consumption of sodium chloride should not exceed 5g; this may lower BP by 2-8mm Hg.
The DASH (Dietary Approach to Stop Hypertension) eating plan encompasses a diet rich in fruits, vegetables, and low-fat dairy products and may lower blood pressure by 8-14 mm Hg. Dietary potassium, calcium, and magnesium consumption have an inverse association with BP.
Weight loss and exercise: Up to 60% of all individuals with hypertension are overweight (BMI>25). Weight reduction may lower blood pressure by 5-20 mm Hg per 10 kg of weight loss in a patient. Regular aerobic physical activity can facilitate weight loss, decrease BP, and reduce the overall risk of cardiovascular disease. These activities include brisk walking for 30 minutes a day at least 5 days per week. More intense workouts of 20- 30 minutes, 3-4 times a week may also lower BP and have additional health benefits.
Reducing stress, yoga, quitting smoking and limiting alcohol intake are also important life style modifications that help in lowering blood pressure.
If lifestyle modifications are insufficient to achieve the normal blood pressure (BP), there are several drug options for the treatment and management of hypertension.
According to the JNC 8 guidelines, the 4 Class of drugs are first line therapies for hypertension for most patients:
Angiotensin-converting enzyme inhibitors [ACEIs]. Angiotensin receptor blockers [ARBs]. Calcium channel blockers [CCBs]. Thiazide diuretics
The drug class recommendations for compelling indications based on various clinical trials are:
Heart failure: Diuretic, beta-blocker, ACEI/ARB, aldosterone antagonist
CAD/ Myocardial Infarction: Beta-blocker, ACEI
Chronic Kidney Disease: ACEI/ARB.
- DR GAJINDER KUMAR GOYAL
HOD & Sr Consultant - Cardiology
For Appointment call 0129-4330000/4090300