HIGH BLOOD PRESSURE

HIGH BLOOD PRESSURE

 

An Important Problem

In 2000, more than 25% of the population in the world had high blood pressure (also called hypertension). It is estimated that this number could climb to nearly 30% in 2025.

 

Major consequences

High blood pressure is responsible for 50% of heart attacks and cerebrovascular accidents (strokes).

It is directly responsible for almost 10 million deaths every year.

It is the principal risk factor for premature deaths (below than the age of 65).

 

In Canada

In Canada, about 45% of women and 40% of men older than 60 years are treated for high blood pressure.

 

Tip of the iceberg

Keep in mind that several people are hypertensive but don’t take their medication whereas others are hypertensive and they are unaware.

This is a major problem.

 

Pressure in the pipes

The blood pressure is like the water pressure in the pipes of your house. It makes it possible to have water supply everywhere in the house on any floor. 

 

The pressure makes the blood circulate in the body

In our body, the pressure is what makes the oxygenated blood travel in the arteries.  Blood is propelled from the heart to the organs (brain, kidneys, digestive tract, muscles), then it returns by the veins to be oxygenated by the lungs again.

 

 

The two numbers of the blood pressure

The blood pressure is made up of two values, two digits commonly called the large number and the small number.

As the heart beats in a cyclic way, the large number represents the strongest pressure exerted by the blood on the arteries at the time of the heart contraction. It is the systolic pressure.

The small number represents the pressure which remains in the arteries between the contractions. It is the diastolic pressure.

 

The blood pressure varies constantly

Blood pressure constantly varies from one day to another but also from one time of the day to another.

It is higher during exercise, physical work or periods of stress. It is lower while sleeping. 

 

Circadian cycle

Our body has a biological clock located in the brain. It is responsible for the cycles of daily hormonal release. This rhythmic pattern is adjusted with landmarks from our environment. These landmarks are mainly the alternation of day and night.

By the end of the night, around 4 to 6 o'clock in the morning, the body is getting ready for the day. In other words, it is at this time that some hormones are in higher concentrations in the blood.

The secretion of cortisol, the cortisone of our body, causes an increase in our blood pressure while we still sleep peacefully.

It is believed that this rise in blood pressure would be associated with the occurrence of heart attacks in the morning.

 

The heart under the influence of hormones

The heart, influenced by hormone secretion, reacts to all our emotions. It is thus normal that blood pressure varies from one moment to another since we are alive!

 

The tensiometer

The device used to measure the blood pressure is a tensiometer. This device usually displays 3 numbers.

 

Here is an example

Your device indicates 130-80, 72. The first number is your systolic blood pressure, 130 mm Hg (millimetres of mercury). The number 80 indicates your diastolic blood pressure, which is 80 mmHg. The last number represents your heart rate, 72 beats per minute.

 

How to measure your blood pressure at home

It is preferable to take your blood pressure on a regular basis. Record your values on a piece of paper that you will bring to your doctor.

You should make your measurements during the week preceding an appointment with your physician.

 

Optimal conditions.

Sit comfortably. Make measurements after 5 minutes of rest and more than 30 minutes after a physical activity.

It is necessary to wait one hour after drinking a coffee or any drink containing caffeine (tea, soft drinks), or after ingesting a stimulating substance like chocolate.

It is necessary to wait 2 hours after a meal because the digestion process increases blood circulation.

Use the washroom if you need to before taking your blood pressure. A full bladder raises the blood pressure.

 

Measurement

Measurement must be taken twice a day.

Two measurements are made in the morning, a few minutes apart.

The morning measurement must be done before you take your medication, your coffee or your breakfast.

Two measurements are made at night before going to bed, a few minutes apart.

You must note the two measurements taken each time, even those which seem too high or too low.

Once the day is over, calculate the average of these four values.

 

The average of the week is a good estimate

The average of the measurements of the last 6 days before an appointment, gives a good estimate of what is really the values of your blood pressure.

 

A diagnosis over several weeks

The diagnosis of high blood pressure is not made on only one high value. It is usually done after a few visits, over a few weeks or a few months.

A blood pressure constantly above 135 over 85 taken at home is currently considered harmful for your health.

Among diabetic patients, a blood pressure constantly above 130 over 80 taken at the doctor’s office is currently considered harmful. It would be necessary to aim for a blood pressure of 125 over 75 and less at home among those patients.

Once the diagnosis is made, it is important to adhere to the treatment and to check the blood pressure regularly.

You are not alone with a diagnosis of high blood pressure. A quarter of the adults around you have it.

 

White Coat Syndrome

For certain patients, measuring the blood pressure at the doctor’s office is a problem. The rise in blood pressure would be secondary to the stress generated by the doctor’s office.

Even if certain patients state that they are not stressed by the simple fact of having their blood pressure measured, this syndrome affects 1 out of 5 patients.

 

Masked arterial hypertension

On the contrary, masked hypertension is an adequate blood pressure at the doctor’s office, but high in a familiar environment.

We don’t know the mechanism yet. This syndrome would be more common than the white coat, particularly among patients with diabetes and already diagnosed with high blood pressure.

 

A family history

For the majority of people, high blood pressure is related to their genetic background. It is a family history. It is called essential or primary hypertension. There is no identifiable cause. It is often multifactorial (multiple factors involved)

 

Essential hypertension

The risk factors of essential arterial hypertension are:

- Heredity, hypertension in the family

- Male gender

- Age; Loss of elasticity in the arteries

- Salt consumption

- Alcohol consumption

- Smoking

- Stress

- Diabetes

- Obesity

- Sedentary lifestyle

 

Secondary arterial hypertension

In a few cases, we can find a cause for high blood pressure. This is called secondary hypertension. Certain kidney diseases, abnormal function of the adrenal glands or pregnancy can be associated with secondary hypertension.

A rare cause of secondary hypertension is related to a birth defect causing a narrowing in the descending portion of the aorta in the chest. It is called a coarctation of the aorta. This is a cause to search for particularly in teenagers or young adults. In those cases, the blood pressure in the upper extremities is usually much higher than the blood pressure measured in the legs. It usually requires a surgical intervention. 

Certain drugs can increase blood pressure, particularly among patients with known hypertension. It is the case of some anti-inflammatory drugs such as naprosyn and ibuprofen that are sold over the counter in drugstores.  Cortisone can also increase the blood pressure.

 

Long-term problems

If the blood pressure remains high in a prolonged period of time, it can induce damage on the arteries.

 

Major Complications

Hypertension is one of the major risk factors for the occurrence of a heart attack or a sudden death. Stroke, heart failure, renal insufficiency and atrial fibrillation also occur more often among untreated or not optimally treated people.

The impact of treatment is major since it reduces the occurrence of heart failure by 50%, the occurrence of stroke by 40% and heart attacks by15%.

 

Possible catastrophic events

Just like the presence of high pressure in the pipes of your house, this high pressure is often not felt during the first years but the consequences are often catastrophic when they occur.  High pressure in the pipes of your house could lead to water damage whereas uncontrolled hypertension can lead to a heart attack, a stroke or sudden death.

 

Silent killer

Hypertension is a silent and sneaky killer.

 

Often without symptoms

In the majority of cases, high blood pressure doesn’t cause symptoms.

Non-specific symptoms such as headaches, dizziness, fatigue and shortness of breath may be present.

It is important to keep in mind that any pain, from anywhere, can increase blood pressure.

 

Search for other risk factors

Once the diagnosis is made, a patient may expect his or her physician to screen for other risk factors such as diabetes, high cholesterol levels, sedentary lifestyle, obesity, smoking or family history of cardiac diseases.

The more risk factors present, stronger are the probabilities of suffering from a cardiac event or a stroke.

 

Complementary testing

You will likely undergo complementary tests like an electrocardiogram (ECG) which records the electrical activity of the heart and bloodwork to screen for organ damage.

 

Recording of your blood pressure

Occasionally, an ambulatory blood pressure monitoring (ABPM) will be ordered to record your blood pressure at home. This device is installed on your arm and around your waist to measure your blood pressure several times over a 24-hour period.

 

Non pharmacological treatments

Cardiovascular exercise

One of the best ways of starting this therapy is to make the habit of exercising regularly. It consists of 30 minutes of cardiovascular exercise 4 to 7 days a week. The benefits on the blood pressure are perceptible rapidly.

Walking is a good way to exercise. This activity is accessible to all and it’s free.  

 

New dietary habits

Doing regular exercise usually leads us to change our dietary habits. That enables us to achieve or preserve our ideal weight and to reduce our waist circumference.

It is recommended to eat more fruits and vegetables, cereals and fibers and to stay away from trans fat.

 

Ideal Weight and waist size

The ideal weight is equivalent to a body mass index (BMI) of less than 25. Men should aim at a waist size of less than 40 inches and women at a waist size of less than 35 inches.

 

Quitting smoking

As doing regular exercise usually leads us to change our dietary habits, it often makes us realize that smoking doesn’t fit anymore in our new lifestyle.

 

New balance between sodium and potassium

You can also help control your blood pressure by reducing your daily salt intake.  You should reduce your sodium intake to less than 2 grams of sodium per day while increasing your potassium intake.

However, you must talk to your doctor before increasing your potassium intake, to make sure you are not predisposed to hyperkaliemia (an abnormally high level of potassium in the blood).

 

Alcohol with moderation

It is recommended to drink alcohol with moderation: less than 2 drinks per day for men and one drink or slightly more for women.

A standard drink is equivalent to one beer, a glass of wine or 1.5 ounces of distilled spirits at 40%.

 

We can help you

This non pharmacological therapy is easy to tell but not easy to adopt… health professionals can help you.

 

The use of medication

If the blood pressure remains high despite the use of non pharmacological methods, it is necessary to use medication. It is not unusual to use a combination of various drugs to control the blood pressure in an adequate way.

 

Several types of medication available

There are several classes of drugs to treat hypertension and your doctor will try to find those which work best for you without having side effects.

 

Important to take your medication

You must take your medication regularly even if you feel well.

It is also important to have your prescription re-filled before you run out of medication

 

Major impacts on your health

Appropriate and effective treatment of high blood pressure can prolong the life of a person for several years and reduce the chances of developing complications such as stroke, heart attack, heart failure or angina.  

Let’s be rigorous!

 

Hypertension can and must be controlled!