Heart attack, cardiac arrest and stroke have one thing in common: hypertension or high blood pressure. But hypertension is not a disease but a long-term medical condition in which the blood pressure in the arteries is persistently elevated.
A national survey shows that one in four Filipinos has hypertension, the medical parlance for high blood pressure. Unknowingly, most of those with hypertension are unaware of their condition, according to the Department of Health.
Blood pressure – or BP as it is commonly known – is needed so the blood can circulate through the body, giving vital organs the much-needed oxygen and food. Under normal conditions, your heart beats about 60 to 80 times a minute.
The blood pressure rises with each heartbeat and falls when the heart relaxes between beats. Like the air pressure in tires, blood pressure can change from minute to minute. The pressure in the tires depends on the temperature and whether the car is driven. Blood pressure changes with posture, exercise, sleeping or even the level of the arm when the blood pressure is measured.
A BP measurement has two numbers: The higher number (called systolic) represents the pressure when the heart contracts to start a heartbeat while the lower number (known as diastolic) corresponds to the pressure when the heart relaxes between beats.
In the numbers game of hypertension, as it is known in medical profession, 120 over 80 is the goal. Anything above those figures can be unhealthy. As the numbers climb, so do the risks. Of the two numbers, the first one is more likely to predict trouble. When it reaches 140, doctors start prescribing medication.
“High blood pressure is not an illness in itself,” explains Dr. Robert Buckman, author of “What You Really Need to Know About High Blood Pressure.” Low blood pressure, or hypotension as it is called, is also not a medical problem. “By and large if your blood pressure is low, you are more likely to live a long, healthy life,” he says.
As stated earlier, BP changes throughout a day. It is lower at night, when you are relaxing, when you are asleep, and when listening to quiet music. BP goes up during the day, with exercise or exertion, while smoking a cigarette, if anxious, stressed or excited and in cold weather.
“In 95% of patients, the cause of high blood pressure is unknown,” says Dr. Willie T. Ong, an active consultant in cardiology at the Manila Doctors Hospital and Makati Medical Center. “We call this primary or essential hypertension. In these patients, we can still treat and control the hypertension by addressing some of the risk factors involved.”
In the remaining 5%, the high blood pressure can be traced to a specific disease, such as kidney disease, illegal drug use, hyperactive thyroid or a tumor. “We call these cases as secondary hypertension,” Dr. Ong says.
Most of those who are most likely to have hypertension are adult. Currently, 28% of Filipino adults have high blood pressure, studies show. “Our blood pressure rises fairly steadily between the ages 20 and 40,” Dr. Buckman notes. “After this, it tends to increase more rapidly.”
Hypertension is also prevalent among obese people, heavy drinkers and smokers, and women who are taking birth control pills. People who have diabetes, gout or kidney disease are more likely to have hypertension than those who don’t, according to some studies. It is also hereditary in nature.
In some cases, hypertension have no symptoms at all. That is why it is oftentimes regarded as a silent killer. “Most people with hypertension feel perfectly well and do not experience any symptoms,” Dr. Buckman writes.
However, there are patients who develop symptoms such as headache, nape pain, dizziness, flushing of the face, palpitation, and nose bleeding.
“It is important that high blood pressure is treated, because if it isn’t lowered down to normal levels, then over time, the excessive pressure can damage and stiffen the arteries. In addition, the heart will slowly thicken, enlarge and eventually weaken.
“Hypertension is the leading risk factor for heart attack, or myocardial infarction,” writes Dr. Julian Whitaker, author of “Reversing Hypertension: A Vital New Program to Prevent, Treat, and Reduce High Blood Pressure.” “A heart attack occurs when part of the heart’s blood supply is suddenly reduced or cut off; usually do to a blockage in one of the coronary arteries supplying blood to the heart. The portions of the heart muscle that cannot get adequate oxygen and nutrients die. The more extensive the damage, the more serious the heart attack.”
Hypertension is the primary factor underlying strokes and stroke-related deaths. “Too much pressure can cause the bursting of a vessel – especially if that vessel has been weakened by age and the excess pressure of hypertension,” explains Dr. Whitaker.
“Hypertension also contributes to atherosclerosis and arteriosclerosis, the narrowing and stiffening of the arteries that increases the likelihood of blood clots cutting off blood supply,” Dr. Whitaker continues. “When either of these scenarios occurs in an artery in the brain, the result is a stroke. There is a reduction in oxygen supply to that area of the brain, followed by cell degeneration and death.”
Hypertension also accelerates the aging of the kidneys. High blood pressure damages the arteries and arterioles that supply blood and nutrients to the kidneys. As these arteries become stiff and less elastic, blood supply to the kidneys is reduced or, in some cases, cut off, causing damage to the kidneys themselves.
“Severe high blood pressure causes kidney malfunction over a relatively short period of time; however, even milder forms of uncontrolled hypertension can damage kidneys over several years, with no evident symptoms until severe damage has already occurred,” Dr. Whitaker claims. “Poorly controlled high blood pressure is responsible for approximately 25% of all cases of chronic kidney failure.”
What about the eyes? “High blood pressure does not seriously damage vision unless it is very high,” says Dr. Buckman. “However, abnormalities in the small blood vessels of the retina can be clearly seen, even in cases of mildly raised blood pressure. Extremely high blood pressure can cause hypertensive retinopathy, which can lead to blurred vision and blindness.”
A lesser-known outcome of hypertension is memory loss and an increased risk of dementia and Alzheimer’s disease. “It is believed that hypertension’s adverse effects on the brain are caused by the relentless pounding on the small vessels in the brain,” Dr. Whitaker writes. The brains of patients with hypertension actually shrink – by as much as 20%, according to some studies.
The good thing is that hypertension can be treated. “There is a wide range of drugs that your doctor can prescribe to bring your blood pressure down,” Dr. Buckman writes. “The aim is to find the particular drug or combination of drugs that will lower your blood pressure to a safe level and prevent problems. The doctor will tailor treatment to you as individual, so do not be surprised if you find that you are taking completely different drugs from someone else with the same condition.”
Hypertension is considered as the biggest single risk factor for deaths worldwide. “Hypertension is truly a serious problem that requires more serious attention,” points out Dr. Esperanza Cabral, past president of the Philippine Society of Hypertension. “It’s no longer acceptable that just any doctor can treat any patient with hypertension. Many cases of hypertension are more complicated than they seem.” — ###
