December 3, 2022

Alexander Okere

Family physician and Principal Medical Officer at the University of Lagos, Medical Centre, Akoka, Dr. Olatokunbo Oseni, discusses the triggers and management of hypertension in this interview with ALEXANDER OKERE

How best can hypertension be defined?

Hypertension is a medical diagnosis made when the force or pressure by which the heart pumps blood through the arteries to all parts of the body is persistently or consistently high over time. The blood pressure is measured as two readings. The upper value is known as the systolic blood pressure, and it is obtained during the period when the heart muscles contract, while the lower value is known as the diastolic blood pressure, and it is obtained when the heart is resting in between contractions.

Hypertension is defined as a systolic blood pressure reading of 140mmHg or more on two or more occasions or a diastolic blood pressure reading of 90mmHg or more on two or more occasions.

Do hypertension and high blood pressure mean the same thing?

Though hypertension and high blood pressure are frequently used interchangeably, they do not mean the same thing. Hypertension is a diagnosis of a medical condition that is chronic in nature and results from consistently high or elevated blood pressure readings over time, while high blood pressure is just a sign that the blood pressure reading is higher than the normal value and needs to be observed over time to ascertain whether it was caused by an acute stressor or whether it is consistently high over time for the diagnosis of hypertension to be made.

Dr Olatokunbo Oseni

Is hypertension a serious condition?

Hypertension is a very serious condition and when left untreated becomes a major risk factor for other health conditions such as heart disease, myocardial infarction, cardiac arrest, vascular disease, chronic kidney disease, and stroke, which could all lead to death.

Can you clearly describe how it occurs?

Hypertension develops gradually over time, and it is determined by the amount of blood the heart pumps and how hard it is for the blood to be pumped through the arteries to other parts of the body. Once there is more blood pumping through the heart in the presence of narrowed arteries, there would be a resultant elevation in blood pressure.

Can you explain in simple terms how blood pressure can be read?

The blood pressure reading is obtained by using a blood pressure apparatus called the sphygmomanometer. It is represented as two values in millimeter of mercury (mmHg). The upper value represents the amount of pressure generated with the contraction of the heart, and it is called the systolic blood pressure, while the lower value represents the amount of pressure generated when the heart is resting in between contractions, and it is called the diastolic blood pressure. In general, the normal blood pressure reading is between 90/60mmHg and 120/80mHg.

What are the different blood pressure categories?

There is pre-hypertension, which means before hypertension is classified as systolic blood pressure in the range of 120 and 139mmHg, and/or diastolic blood pressure in the range of 80 and 89mmHg. This blood pressure puts the individual at increased risk of developing hypertension. Others are Stage One hypertension, Stage Two hypertension, hypertensive crisis, hypertensive urgency, and hypertensive emergency.

Stage One hypertension is classified as systolic blood pressure in the range of 140 to 159mmHg and/or diastolic blood pressure in the range of 90 and 99mmHg. Stage Two hypertension is classified as systolic blood pressure equal to or greater than 160mmHg and/or diastolic blood pressure equal to or greater than 100mmHg. A hypertensive crisis is a situation where the blood pressure is severely elevated and is classified into hypertensive urgency and hypertensive emergency.

Hypertensive urgency is where the systolic blood pressure is greater than 180mmHg and/or the diastolic blood pressure is greater than 120mmHg with minimal or no symptoms indicating acute organ damage. A hypertensive emergency, on the other hand, is a situation where the systolic blood pressure is greater than 180mmHg and/or diastolic blood pressure is greater than 120mmHg with evidence of progressive organ damage or system damage.

Why is hypertension considered a silent killer?

Hypertension is referred to as a silent killer because it often shows no symptoms till it is severely elevated and puts the individual at risk for heart disease, heart failure, and stroke. There are no obvious symptoms of hypertension and that is why it is called a silent killer or condition. However, in situations where the blood pressure is severely elevated (hypertensive crisis), the affected individual might experience headaches, nosebleeds, and shortness of breath, but bear in mind that these symptoms are non-specific to the illness.

Apart from the different categories, are there types of hypertension?

Hypertension can be classified into two types: essential hypertension and secondary hypertension. Essential hypertension, which is also known as primary or idiopathic hypertension, is defined as persistently elevated blood pressure in which no identifiable secondary cause of hypertension is present. Secondary hypertension is defined as persistently elevated blood pressure that is caused by another medical condition. It can be caused by pregnancy or conditions that affect the kidneys, arteries, heart, or endocrine system.

What are the major causes of high blood pressure?

In most cases, it is not clear what exactly causes high blood pressure, but there are factors that increase the risk of high blood pressure and hypertension.

Can you explain the risk factors of the condition?

The risk factors for hypertension are generally classified into two: non-modifiable and modifiable risk factors. The non-modifiable risk factors are factors that we cannot change and they include age, family history, coexisting diseases, unhealthy diets, physical inactivity, smoking or consumption of tobacco, more than daily allowance of alcohol, and being overweight or obese.

As an individual grows older, the risk for hypertension increases. The risk increases if you have a relative, especially a parent or parents who developed health-related conditions and co-existing diseases such as diabetes mellitus, kidney disease, and atherosclerosis. Modifiable risk factors are factors that we can correct or change, and they include unhealthy diets like excessive salt consumption, a diet high in saturated and trans fats, a low intake of fruit and vegetables, and physical inactivity.

It is a common belief that people suffer high blood pressure when they think too much about their challenges. Can excessive brooding cause high blood pressure?

Brooding or worrying occurs when an individual is under a form of stress about a situation or challenge. Stress, in turn, can cause a surge in the production of certain hormones such as cortisol, which could then lead to a ‘temporary’ increase in blood pressure by causing the heart to beat faster and the blood vessels to narrow. Stress is not known to cause long-term high blood pressure or hypertension.

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Is hypertension limited to adults or can also children have it?

No, hypertension is not limited to adults. It can occur in children who are obese or those with other health conditions, such as kidney disease, heart defects, genetic conditions, or hormonal disorders. In recent times, there has been an increase in the number of children presenting with hypertension who have high exposure to some food types as seen at fast-food restaurants and those with high amounts of salt and condiments.

Why are obese people prone to hypertension?

Obese people are prone to hypertension because they bear a weight that is at least 20 per cent more than their ideal weight on their bodies. This excess weight is typically stored as fat and creates an imbalance in the body system by causing narrowing and damage to blood vessels, decreasing the sensitivity of the body cells to insulin, which should move glucose from the blood into the cells of the body, increasing salt retention which in turn leads to excessive water reabsorption at the kidneys and the body, leading to fluid overload and increased work output of the heart.

What other diseases put people at a higher risk?

Other diseases that put people at higher risk of hypertension include diabetes mellitus, long-term kidney infections, obstructive sleep apnoea, hormonal disorders, such as thyroid diseases and Cushing’s disease, and connective tissue disorders, such as scleroderma and lupus, to mention a few.

Are all types of hypertension treated the same way?

The goal of anti-hypertensive medication is to lower the blood pressure to a normal range. The medications work in different ways and target different organs to achieve the lowering of blood pressure. Some types of hypertension, such as hypertensive crises, need the blood pressure to be lowered gradually rather than rapidly. This is because the brain has become used to high blood pressure and if reduced suddenly or rapidly, it could lead to decreased flow of blood and nutrients to some parts of the brain, and eventually cause a stroke.

When do medications in the treatment of hypertension become necessary?

Medications are necessary for hypertension treatment and management when lifestyle modification or changes fail to lower persistently elevated blood pressure to normal range over time or where secondary causes of hypertension have been identified.

How can lifestyle reduce the risk of coming down with hypertension?

Healthy lifestyle choices, such as eating a healthy diet, keeping oneself at a healthy weight, being physically active and exercising regularly, getting enough sleep, abstaining from smoking,

limiting alcohol intake to small amounts or not taking any at all, and management of stress, will lead to improved heart and metabolic status, thereby, reducing and preventing the risk of hypertension.

Are there specific foods that increase blood pressure?

Yes, there are foods that potentially can increase blood pressure and lead to hypertension when eaten regularly and in high amounts. They include but are not limited to table salt, certain condiments, sauces and spices which have a lot of salt added to them, and foods rich in saturated and trans fat, such as palm oil, cow meat, milk, and other dairy products.

Others are fried food, fast food, canned, frozen, and processed foods, salted snacks, caffeine, alcohol, and soda (drinks with high amounts of added sugar).

What are the complications that can result from untreated or poorly managed hypertension?

There are numerous complications that can occur because of untreated or poorly managed hypertension, and this is because every part of the body needs blood. Hypertension exposes all parts of the body to blood at higher than normal pressure, which eventually causes damaged and narrowed arteries, aneurysms, which are bulges in the arteries because of weakened and enlarged arterial walls; coronary artery disease, which occurs because of not enough blood getting to the muscles of the heart and manifests as chest pain, irregular heart rhythms or a cardiac arrest; heart failure, heart enlargement, and thickening, which increases the risk of heart attack, heart failure, and sudden cardiac death.

Also included are transient ischaemic attacks, which are sometimes called mini-stroke because the injury to the brain and the manifestation resolve within a 24-hour period; stroke, which occurs when brain cells die because of a persistent disruption of blood flow, and nutrients to different parts of the brain; vascular dementia, kidney failure, visual impairment, and blindness because of damage to the blood vessels at the back of the eye; and sexual dysfunction in both men and women.

Why is too much consumption of salt something to worry about?

Yes, excessive consumption of salt which is the primary source of the mineral called sodium (and defined by the World Health Organisation as greater than five grams of sodium per day) has been shown to produce a significant increase in blood pressure and has been linked to the onset of hypertension and its complications.

The relationship between excessive consumption of salt and hypertension is because high salt in the blood leads to water retention in the body, which in turn leads to a volume overload in the body and on the heart and an increase in the systemic peripheral resistance, which all lead to an increased work of the heart and more force or pressure needed to pump out the blood to other parts of the body.

What about coffee? How does it trigger hypertension?

Yes, habitual consumption of large amounts of coffee can lead to transient elevation of blood pressure beyond normal levels.

Is hypertension curable?

No, it is not curable. Hypertension is a chronic disease and can only be controlled with lifestyle modifications and medications. It is, therefore, very important that people diagnosed with hypertension maintain lifestyle changes, such as decreased salt intake, reduction of dietary fats; eat meals rich in fresh vegetables and fruit, decrease alcohol intake to the barest minimum, stop smoking, lose weight, if they are overweight, exercise regularly while taking medications as prescribed by their doctors and going for regular checkups at clinics, usually for the rest of their lives.

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