Why people get High Blood pressure?

There are multiple factors, which can cause high blood pressure, however sometimes you may not have any reason to get High Blood Pressure.

The contributory factors include:

1. Smoking
2. Obesity (excessive weight)
3. Lack of exercise or physical activity
4. Excessive use of Salt
5. Alcohol consumption (more than 1 to 2 drinks per day)
6. Stress
7. Older age
8. Family history of high blood pressure

Types of High Blood Pressure

There are two types of high blood pressure.

1. Essential (Primary) Hypertension
2. Secondary Hypertension

1. Essential (Primary) Hypertension
1. This is the commonest type (95% of patients)
2. This develops gradually over many years.
3. There is no identifiable cause of high blood pressure.
2. Secondary Hypertension
1. This is less common and mostly in young people.
2. Caused by an underlying medical condition or drugs: These include:
1. Obstructive sleep apnoea (patients with excessive weight + snoring)
2. Kidney problems
3. Adrenal gland tumours (Conns syndrome or Pheochromocytoma)
4. Thyroid problems (Hyperthyroidism or Hypothyroidism)
5. Congenital (birth) problem with blood vessels (Coarctation of Aorta)
6. Certain medications, such as birth control pills, flu decongestants- medications, over-the-counter medications, steroids tablets.
7. Recreational drugs, such as cocaine and amphetamines

How to Diagnose High Blood Pressure?

1. It is extremely important to monitor and diagnose high blood pressure, as it is a major risk factor for heart disease and Stroke.
2. To measure your blood pressure, your doctor or a specialist will usually place an inflatable arm cuff around your arm and measure your blood pressure using a special pressure-measuring gauge.
3. The blood pressure reading is measure in millimeters of mercury (mm Hg)
4. The first/ top figure is Systolic pressure – generated by the pressure in your arteries when your heart beats (pumping action of heart).
5. The second/bottom figure is Diastolic pressure- generated by the resistance of arteries when heart relaxes OR pressure between beats.

How to check?

1. Firstly, you need to relax before the blood pressure is taken.
2. A pressure cuff (sphygmomanometer) is then attached to your upper arm.
3. The pressure cuff is inflated either manually or electronically.
4. For a manual pressure measurement, the stethoscope is put on the front of your forearm and the person performing the measurement listens with a stethoscope or monitors an electronic readout

How to read the readings

Treatment of High Blood Pressure

1. It is extremely important to treat high blood pressure as per your doctor instruction.
2. It is considered a “silent Killer” and if not treated can effect multiple organs
3. The treatment could be long term ( see below) or emergency ( if uncontrolled)

Aim of Treatment

1. This is to achieve a target blood pressure of:
1. < 130/80 mmHg
2. < 120/80 mmHg in high-risk patients ( diabetics, renal failure)
3. < 150 mmHg in very elderly (age 80 years or greater)

Life Style Modification

1. This is the most important step in the management of blood pressure. The recommended changes includes:
1. Restricting salt in diet
2. Healthy diet with more use of vegetables and fruits.
3. Regular walk and other regular physical activities ( avoid sedentary life)
4. Must lose weight ( if overweight) and Maintain a balance healthy weight
5. Limiting the amount of alcohol you drink

Medications

Your doctor will prescribe various medications based on your individual needs and your underlying other conditions and risk factors. The drugs used in high blood pressure are as follows:

1. Thiazide Diuretics (Water Pills)
1. These medications act on your kidneys to help your body eliminate sodium and water, therefore reducing blood volume.
2. Thiazide diuretics are often the first line therapy, but not in all patients.
3. Thiazide diuretics include chlorthalidone, hydrochlorothiazide and others.
4. A common side effect of diuretics is increased urination.
2. Angiotensin-Converting Enzyme (ACE) Inhibitors
1. These drugs help relax your arteries, lowers the blood pressure and decrease the workload on the heart
2. Examples include enalapril, Lisinopril, Ramipril and captopril.
3. Angiotensin II Receptor Blockers
1. o These drugs help relax your arteries, lowers the blood pressure and decrease the workload on the heart similar to Angiotensin-Converting Enzyme (ACE) Inhibitors.
2. o Examples include losartan and valsartan
4. Calcium Channel Blockers
1. Calcium channel blockers relax and relaxes blood vessels by affecting the muscle cells in the arterial walls.
2. These medications — including amlodipine (Norvasc), diltiazem (Cardizem, Tiazac, others).
3. Grapefruit juice interacts with some of the calcium channel blockers, increasing blood levels of the medication and therefore may increase the risk of side effects.

Additional Medications If Above not Fully Effective

1. Beta-Blockers
1. Beta-blockers reduces the heartbeats and reduces blood pressure.
2. Beta-blockers also help blood vessels relax and improve blood flow to heart muscle.
3. This drug may help in limiting or reverses some of the damage to your heat.
4. Examples include atenolol, metoprolol and bisoprolol.
2. Aldosterone Antagonists
1. This is also a different type of water pill. This has a beneficial effect on the longevity of your heart
2. This drug has an important effect in the body by increasing Potassium levels. . The doctor may request for regular blood tests.
3. Examples are spironolactone and eplerenone.
3. Alpha Blockers
1. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels.
2. Examples include doxazosin (Cardura), prazosin (Minipress) and others.
4. Vasodilators
1. These medications, including hydralazine and minoxidil, work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.
2. Effective in renal impaired patients.
5. Renin Inhibitors
1. These slows down the production of renin, a chemical produced by your kidneys that increases blood pressure.
2. Example is Aliskiren (Tekturna)
6. Central-Acting Agents
1. These medications works on your brain signals reduce heart rate and reduce blood pressure.
2. Examples include clonidine (Catapres, Kapvay), guanfacine (Intuniv, Tenex) and methyldopa.

How to Live with High Blood Pressure?

1. Diet and Life Style Changes
1. This is the most important step in the management of blood pressure. The recommended changes includes:
1. Restricting salt in diet
2. Healthy diet with more use of vegetables and fruits.
3. Regular walk and other regular physical activities ( avoid sedentary life)
4. Must lose weight ( if overweight) and Maintain a balance healthy weight
5. Limiting the amount of alcohol you drink
2. Driving and High Blood Pressure
1. If your blood pressure is control, then you can keep driving.
2. If your blood pressure remains high despite treatment, you should avoid diving. Poorly controlled BP are associated with an elevated risk for stroke and coronary heart disease.
3. You should not drive if your medicines cause symptoms which affect your driving ability
4. You must inform your licensing authority and get advice if hold heavy vehicles license.
3. Work and High blood Pressure
1. • You can continue your routine activities
2. • Avoid working in excessive cold (may increase BP) and excessive Hot environment may cause sudden drop in pressure due to dehydration.
3. • Work stress may contribute to rise in Blood pressure. If your job involves heavy lifting or manual labour, excessive work related stress, discuss with your employer.

Sexual Life High Blood Pressure

1. If blood pressure is control, sexual activities can be continued.
2. High blood pressure can lead to erectile dysfunction
3. Some drugs for treating high blood pressure, such as Diuretics or Beta-blockers can cause sexual problems.
4. Please discuss with your doctor to prescribe alternative medications.

Exercise and sports High Blood Pressure

1. It is important to stay active and you should do routine exercises.
2. Regular aerobic activities such as swimming, cycling and brisk walking will help to lower your blood pressure over time.
3. Aim for 150 minutes of moderate activity each week. Plus, it's recommended that you get 10 minutes of strength training twice a week and to stretch three times a week for 5 to 10 minutes each time.
4. Speak to your doctor if you are not sure about the safety of your exercise or sports

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