High Blood Pressure

High blood pressure, also known as hypertension. It’s a condition when your blood has a higher force against the blood vessel. It’s defined as a persistent elevation of systolic blood pressure of 140mm/Hg or greater or a diastolic pressure of 90mm/Hg or greater (140/90mm/Hg), taken at least on 2 separate occasions.

Hypertension is a silent killer disorder. Imagine that you are holding a time bomb by yourself and you might not know when this bomb will blow-up. It’s dangerous and too late to cure when the bomb has blown up.

The higher the blood pressure, the greater the chance for one individual to get a heart attack, heart failure, stroke, blurry vision, and chronic kidney disease. In long term, persistent high blood pressure will strain the heart and vessel which eventually causes total end-organ damage and death.

Based on the report of the National Health and Morbidity Survey 2019, 3 in 10 Malaysian, which is around a 6.4million people in Malaysia have hypertension. Unfortunately, only half of the people with hypertension are aware of themselves hypertension, and half of it are unaware of it. Besides, hypertension is 3x common to occur in the male population compared to females.

Below Table 1 showed the classification of hypertension in adults. One should always seek medical attention urgently if their blood pressure is in a severe stage which is ≥180/110 mmHg.

Classificationsystolic (mmHg)Diastolic (mmHg)
Optimal <120<80
Normal 120-12980-84
At Risk130-13985-89
Stage 1 Hypertension
(Mild)
140-15990-99
Stage 2 Hypertension
(Moderate)
160-179100-109
Stage 3 Hypertension
(severe)
≥180≥110
Table 1: Classification of blood pressure in Adults

How do I Know I have Hypertension?

Hypertension is also known as a silent killer which is a common medical condition that can manifest from asymptomatic to a symptom that arises from its complications. One will not notice any symptoms in the early stage. Hence, early detection through blood pressure monitoring is important.

It may take few years for the symptoms to develop which arise from the complications of hypertension. One should aware of the symptoms of severe hypertension and medical attention should be sought immediately if there are any symptoms of severe hypertension. Example of symptoms of severe hypertension are:

  • Severe Headache
  • Dizziness
  • Lethargy
  • blurring of vision
  • Seizure
  • Chest pain
  • shortness of breath
  • Foamy Urine

Why do I Have Hypertension??

Hypertension can be divided into 2 categories which are primary hypertension also known as essential hypertension and secondary hypertension also known as young hypertension.

Primary Hypertension

Around 90% of hypertension that we have is primary hypertension. Primary hypertension does not have any identifiable cause. Studies from American Heart Association (AHA) suggest that there are a number of factors that increase blood pressure:

  1. Family history and genes
  2. Obesity
  3. High salt intake
  4. High alcohol intake
  5. Sedentary lifestyle
  6. Aging
  7. Stress

Secondary Hypertension

Secondary hypertension is also known as young hypertension. The prevalence of secondary hypertension is around 5-10%. It is usually suspected when someone has hypertension is less than 40 years old. Further investigation should be carried out by medical personnel to find out the cause of secondary hypertension. Examples of condition that can cause secondary hypertension are:

  1. obstructive sleep apnea
  2. Hormonal Problem – hyperthyroidism, hyperaldosteronism, Cushing disease
  3. Heart problem – coarctation of aorta
  4. kidney problem- renovascular disease, renal parenchymal disease
  5. Drugs- oral contraceptive pills, steroids

It’s important to find out the causes of secondary hypertension in order to cure the root of hypertension.

Get Move On for Lifestyle Changes!

Healthy lifestyle changes remain as one of the critical strategies from AHA and Malaysian guidelines in hypertension management. Below are some of the recommendation for healthy lifestyle changes by AHA:

1. Weight Reduction. In people with hypertension, a weight reduction diet has been shown to reduce blood pressure and body weight. Besides that, Studies have shown that reduction of 1 kg body weight in relation to the reduction of 1mmHg systolic blood pressure. Lastly, maintain a BMI of less than 25 is important in maintaining normal blood pressure.

2. Eating a Healthy Diet. A healthy diet consists of foods that are rich in vegetables and fruits. Dairy products that are high in saturated and total fat should be reduced.

3. Exercise. Regular physical activities have been shown to effectively reduce blood pressure. It’s recommended to perform a moderate-intensity aerobic exercise of at least 150minutes/ week. Examples of aerobic exercises are brisk walking, jogging, cycling, and swimming.

4. Stop smoking. Smoking has been shown to increase cardiovascular risk and mortality in patient with hypertension

5. Reduce alcohol consumption. A study has shown that alcohol consumption elevates BP. It’s advised that people who drink alcohol should limit their alcohol consumption to ≤ two drinks per day.

Dietary recommendations for people with Hypertension

Reduce salt intake. High salt intake is associated with an increased risk of stroke and heart attack. Reducing salt intake is associated with the reduction of blood pressure. World Health Organization (WHO) has recommended a reduction of salt to <5g/day, which is around one teaspoon of salts in adults.

Eating more fruits and vegetables. Eating more fruits and vegetables able to reduce your blood pressure. it’s also a good protective factor in the prevention of high blood pressure.

Eat whole grains or more fiber food. Eating an increased amount of fiber may decrease your blood pressure. It’s recommended to take at least 20-35g of fiber per day. Examples of whole grains and more fiber foods are brown rice, oats, wheat, legume (beans), fruits, and vegetables.

Eat more fish. American Heart Association has recommended people eat oily fish at least twice per week. Eating more fish may help to lower blood pressure especially combined with weight loss.

Increase dietary potassium. studies have shown that increase dietary intake of potassium will reduce the blood pressure and risk of stroke in adults. However, this should be cautious and should not practice in people with kidney problems as high potassium intake in this group of people will cause a medical emergency. Examples of foods that high in potassium are bananas, spinach, apricots, broccoli and etc.

Reduce your sugar intake. High sugar intake will increase the risk of getting cardiovascular disorder and mortality.

Lastly, hypertension is a silent disease. Always check and monitor your blood pressure regularly. Consult your doctor if you found out you have high blood pressure so that your doctor could formulate a suitable plan for you. Remember to Check, Change and Control your blood pressure.

References

Aburto NJ, Hanson S, Gutierrez H, et al. Effect of increased potassium intake on cardiovascular risk factors and disease: systematic review and meta-analyses. BMJ 2013;346:f1378.

Aburto NJ, Ziolkovska A, Hooper L, et al. Effect of lower sodium intake on health: systematic review and meta-analyses. BMJ 2013; 346:f1326.

Carretero, O. A., & Oparil, S. (2000). Essential hypertension: part I: definition and etiology. Circulation101(3), 329-335.

Lichtenstein, A. H., Appel, L. J., Brands, M., Carnethon, M., Daniels, S., Franch, H. A., … & Wylie-Rosett, J. (2006). Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation114(1), 82-96.

Ministry of Health Malaysia (2018). Clinical Practice Guidelines on Management of Hypertension 2018 (5th ed.).

Ministry of Health Malaysia (2020). National Health and Morbidity Survey 2019: Non-communicable diseases, healthcare demand, and health literacy. Retrived from http://iptk.moh.gov.my/images/technical_report/2020/4_Infographic_Booklet_NHMS_2019_-_English.pdf

Roerecke M, Kaczorowski J, Tobe SW, et al. The effect of a reduction in alcohol consumption on blood pressure: a systematic review and meta-analysis. Lancet Public Health 2017;2: e108–20.

Sever PS, Poulter NR. A hypothesis for the pathogenesis of essential hypertension: the initiating factors. J Hypertens. 1989;7(suppl 1):S9–S12.

World Health Organization. Reducing sodium intake to reduce blood pressure and risk of cardiovascular diseases in adults. Geneva, Switzerland: WHO 2017. Available at http://www.who.int/elena/titles/sodium_cvd_adults/en/

Xin X, He J, Frontini MG, et al. Effects of alcohol reduction on blood pressure: a metaanalysis of randomized controlled trials. Hypertension 2001; 38(5):1112-7.

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