BP/HYPERTENSION/HIGH BLOOD PRESSURE??

We usually encounter many people saying-

"I have BP!!", "I always have low BP", "My BP is always high(150/100mm of Hg) & thats normal for me!!"

What is this BP?

It is the pressure exerted by the blood when it flows through blood vessels.

Why is BP so important??

          This is the one which determines nutrients(Ex:O2) delivered & toxins (Ex:CO2) removed from target/end organs[Brain.kidney,liver]

           In simple/layman's term i can put it as "The pressure of water source(through hose pipe)determines the growth of a plant"

where the pipe can be related to blood vessels & plant to end organs.

             Hence in case of low pressures decreased nourishment might  lead to under development/decreased performance of organs.Where as high pressure may end up causing damage to organs .

What is normal BP??

Systolic of 100-140mm of Hg, Diastolic of 60-89mm of Hg is considered as normal.

Systolic-The pressure at the heart pumps blood sround the body.

Diastolic-as the heart relaxes & refills with blood

Anything <100/60 mm of Hg is low BP

>140/90mm of Hg is taken as high BP

SO,My BP was 144/92mm of Hg during my last visit to doctor!! so am I hypertensive??do i have to start on medication?

NO!!??

There are few physiological conditions/changes during which BP can be high at certain situations:

  • Acute illness-viral fever/respiratory infections/stress
  • immediately after physical activity
  • immediately after a large meal/caffine
  • immediately after smoking
  • The thought of going to a doctor for illness/any trivial reasons(White coat hypertension)
  • Ideally a person without under the influence of any of the above mentioned situation & minimum of 3BP measurements taken in calm environment at different timing & different days showing >140/90mm of H is considered/diagnosed as hypertensive.

  • How do I know I'm hypertensive/what tests can be done to detect HTN?

              HTN is purely clinical diagnosis,there are no lab tests/investigations to detect HTN.                                            Hence make sure you get your pressures checked every time you get in touch with your health care                  provider (opportunistic screening)

       What about the tests doctors advise when they notice High BP??-ECG,S.Creatinine,USG abdomen & other blood investigations??

           These tests are done to determine the

  • (a)possible effect of prolonged persistent high BP on end organ/damage to organs.
  • (b)Aid in determining possible secondary causes of HTN in suspected people(Renal artery stenosis/hyperaldosteronism etc....)

          Signs/symptoms to W/F in HTN??

  • The organ damage would set in far earlier than the first symptom/sign of high BP is noted!!
  • So,it is also called as  "SILENT KILLER".
  •  The reason why we are seeing most of known yougsters are having heart attacks, strokes leading to temporary/permanent damage to one's life.
  •  The reason why we doctors stress on regular checkup to diagnose early so that proper action can be taken at the earliest.
  • Of course some people might have few vague symptoms like: Headache, chest discomfort during stressful environment.Which have to be addressed at the earliest with regular follow ups.

       How do I manage my BP/Treatment of HTN:

         (1)Life style changes

  • Change in diet-low salt diet
  • regular physical activity (min 30-40min 4-5days a week)
  • Weight reduction
  • stress management
  • Quitting smoking,moderate alcohol
  • diet rich in fruits & vegetables,low saturated fat

     DRUGS/MEDICATION FOR HTN:

          We often confront many patients saying:

  • "Whenever i feel little better or on non stressful days I usually skip my medication!!!"
  • "I usually fast on thursdays & saturday ,so i don't take my medication on those days!!"
  • "I never skip my medication!!Whenever i remember during my busy schedule I take my medication daily!!"
  • "I was feeling dizzy/weakness I skip my medication!!"
  • Dizziness/weakness could be because of High BP also,low blood sugar level & many other causes.
  •  "I was told to have BP variation few months back, since then whenever I have headache/chest discomfort  I take my father's/mother's medication as they are also hyprtensive!!"

     NO!!That is not the right way....!!!

    Few drugs have better effects in young/middle aged people where as they have to be avoided/used cautiously in elderly people(B-blockers) who are prone for peripheral vascular disease.

  •       Treatment usually starts with lifestyle modifications in early diagnosis,&  without organ involvement/secondary causes.
  •     Slowly drugs are started as single medication ,if not much changes after lifestyle modification  & dose titration done ,also multiple drugs may be involved keeping in mind patient's co-existing conditions & response to medication to achieve target BP of <130/90mm of Hg .
  •    It is not just reaching the target BP ,it has to be maintained at it throughout the day. Which is why timing of medication is very important.
  •         Anti-hypertensive medication has no relation with food!!
  • So fix a timing & has to be taken at that particular time(few min margin is accepted-30min).
  •         Taken at different timing--->alters body's biological response--->variation in hormone/chemical response--->Less effectiveness of medication--->organ damage will set in,also may demand for inadverent addition of more combination/dose escalation to reach target BP!!
  •          To avoid these confusion ,be frank with your physician-give complete details of your signs/symptoms & daily routine so that physician is aware of loop holes of treatment!! to guide you better.Also clear any doubts & follow the advise.

        How frequently should I see physician??

  • At initial stages, once diagnosed as hypertension & started on treatment (lifestyle change/drugs) one should consult every 15days to keep a track of BP ,to see the effect of treatment & titration of drug dosage & coombination medication if requiered.
  •  Once target BP(<130/90mm of Hg)is achieved,one has to follow up every 3months for BP monitoring & once a year complete health check to keep a watch on progression/or effect of HTN on end organs,so that proper intervention can be initiated if required.

     What does recent studies show?

  • Easily stressed teens have increased risk of HTN later in life(also known as Type A personality)
  • sedentary life style, unhealthy food habits.
  • Coffee increases risk of cardiovascular events in young adults with mild HTN.
  • SNORING/SLEEP APNEA-one of the very important risk factor but often neglected cause.                 

     TAKE HOME MESSAGE:

  • -Check your BP whenever you meet your health care provider.
  • -Do follow up at regular interval if found abnormal
  • -No self diagnosis & self medication.