Hypertentsion
In recent times, high blood pressure has become so common that almost every third/fourth person is likely to suffer from it. Unfortunately the only way to tell if one has high blood pressure is to have blood pressure checked, as there are practically no specific symptoms associated with it. Take the case of Mrs. Shweta, a trainer in the gymkhana club, a club for the elite in a metropolitan city. She considered herself fit as a fiddle until suddenly one fine day, at the gym as she held her breath; a cerebral vessel blew out, resulting in a massive bleed. She could not believe it, but yes, she had suffered a stroke! The stroke affected her right side and she had difficulty in walking. Slowly she recovered but she vowed that she would never take BP lightly anymore. Yes, High Blood Pressure is a risky proposition and so many people do not know that they are at risk as they have high blood pressure for years without knowing it. Uncontrolled high blood pressure can lead not only to stroke or heart attack but can cause kidney failure as well. Let us gain an insight into this silent killer……………… 

What is High BP? 
A BP reading of 120/80 mm of Hg is considered normal in adults, while above 140/90 is considered as high BP and below 90/60 as low BP (hypotension). Finding sustained blood pressure of 140/90 mm Hg or above, measured on both arms is usually the criteria considered as diagnostic. However, the diagnosis of hypertension should be made only after noting a mean elevation on two occasions. 
Another new category that is now used is called pre-hypertension where the BP readings are in the range of 120-139/80-89. Such individuals are not advised medicines but asked to make lifestyle changes such as weight reduction, diet control and exercise, reduced salt intake and quitting smoking. 

What is the incidence of BP?
It is estimated that roughly 25-30% of the population in urban areas and 10-12% in rural areas in India suffer from high BP. High BP usually has other complications such as renal failure, atherosclerosis (blocked arteries) which leads to heart attacks and death. It is reported that 10 % of the urban and half that of the rural population suffer from atherosclerosis and 140 per lakh die due to heart attacks. In India the prevalence of blocked arteries of the heart is roughly 2-4 times higher than with other population group’s world wide, and this is just not confined to Indians in India but also to Indians in western countries. The chance of blockages of the arteries of the heart and heart attacks in United States of America is four times higher in Indians than the local white population and six times higher in Indians as compared to the local Chinese population. Therefore it is not wrong to say that there is virtually an epidemic of heart and blood vessel diseases in this country and one really needs to take measures to prevent the spread of this epidemic. One of the simplest ways of keeping away from these problems is to keep the BP under control. 
While high BP is common in men above 30-35 yrs of age it is much less prevalent in women of the same age group, the female hormones are supposed to protect against high BP and prevent heart related illness. It is also reported that above the age of 55 years that is after menopause when this hormonal protection no longer exists women are as prone to BP and related heart diseases as men. 
The worst part about   this disease whether in India, US or elsewhere is that more than 30% of the patients do not  know they have the disease and in another 35% it is not properly controlled. 

  
What are the causes of BP? 
Although the exact cause of primary hypertension is not yet understood a number of genes that contribute to the disease have been identified. This indicates that this can be inherited disease although the ground realities are not as simple as that. It is observed by researchers that in nearly 30% patients it can be genetic and that it runs in families, although no single gene disorder or test is yet identified to indicate it as a risk factor.
One other cause has been identified and this relates diabetes and BP. One of the causes of diabetes is insulin resistance where the body does not use the insulin present properly that results in type II diabetes. Recently researchers have enough evidence to suggest that high BP is associated with insulin resistance. 

What are the signs and symptoms of high blood pressure?  
A majority of individuals with high BP do not know they have the disease. Symptoms are vague and not always indicative of the disease. It is usually the diagnostic and clinical acumen of the doctor that helps in diagnosis. Nearly 35%of the patients have no symptoms at all while some may experience some of the following symptoms but may not be able to relate the same to high BP. 

	Fatigue
	Confusion
	Nausea or upset stomach
	Vision changes or problems
	Excessive sweating
	Paleness or redness of skin
	Nosebleeds
	Anxiety or nervousness
	Strong, fast or obviously irregular heartbeat
	Ringing or buzzing ears
	Impotence
	Headache
	Dizziness

  
  How is BP Diagnosed? 

The diagnosis of BP is very simple. The doctor uses an instrument called ‘Sphygmomanometer’ and a stethoscope. A cuff is wrapped around the arm tightly and air pumped fully until circulation is briefly cut off. The doctor then holds the stethoscope below the cuff and slowly releases air while observing the mercury coming down on the meter. When he first hears the heart beat, it is recorded as the systolic pressure and the reading at which he stops hearing the beat is recorded as the diastolic pressure. 
A doctor will not diagnose high BP on the basis of a single reading. There is a situation called “white coat syndrome” where a patient shows transient high BP because of anxiety of being in a doctor’s office. To rule this out a doctor may advise a patient to monitor his own BP at home using digital meters and keep a record. Alternatively he may take a reading on a second or third visit after ensuring that the patient is sufficiently relaxed. Patients should remember while buying and using digital meters to ensure that the meters are of good established quality and that the readings they obtain are only indicative and just help maintaining a record and therefore they should also regularly get a check up done from a doctor using the Sphygmomanometer. 
In addition to the above the doctor may advise blood tests, ECG, echocardiograms, chest X-ray etc. if further complications of the heart are suspected. 

  
  What are the Complications or Risks associated with high BP?
  Hypertensive patients are at risk of the following:  

	Heart attack and heart failure
	Stroke
	Accelerated Coronary artery disease
	Aortic aneurysm
	Kidney failure
	Retinopathy

To help doctors and patients alike to understand the severity of the illness and the risk associated with high BP the following rankings are given. 
Reading below 90/60 is however considered as low BP and has its own  complications.

Stage	Systolic Pressure		Diastolic Pressure
Normal*	Under 120	AND	Under 80
Prehypertensive	120 - 139	OR	80 - 89
	140-159	OR	90-99
	160-179	OR	100-109
	180 or over		110 or over

 

 

 

 

 

 

  

Treatment Options:

Patients with pre-hypertension those with BP readings 120-139 / 80-89 are initially advised lifestyle changes and not medication. These include quitting smoking as this has a major impact on BP and associated heart diseases, exercises and reduction in weight particularly around the waist, and intake of reduced salt. In addition proper diet, reduced stress and vitamins and minerals go a long way in controlling BP. The above advice also applies to those with frank hypertension as they also benefit from them. In addition there are different types of medicines given which are classified as diuretics, alpha & beta blockers, calcium channel blockers ace inhibitors and angiotensin II blockers. The doctor decides which medicine to give. Depending on the onset and severity of the disease the doctor may prescribe more than one medicine to control the BP. Please remember that high BP can only be controlled and not cured and hence regular intake of medicines lifelong is a must.

Heart Attack

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High Cholesterols

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Stroke

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