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04.06.2023

Understanding Hypertension: A Comprehensive Guide

High blood pressure is a prevalent condition in Malaysia and affects 30% of adults over 18 years old. Surprisingly, only 50% of those afflicted are conscious of their condition. Find out more in this article.

Article contribution by Homage Malaysia

Picture: Getty Images/iStockphoto

Our blood pressure is always changing in response to our physical activity, emotions, age, environment and many other factors. Hypertension, or high blood pressure, occurs when our blood is pumped around the body at a higher-than-normal pressure over a prolonged period. The narrower our arteries and the more blood our heart pumps, the higher our blood pressure.

Blood Pressure Reading

A complete blood pressure reading is often presented like this: 120/80. This is read as “120 over 80”, and the two numbers represent the systolic and diastolic blood pressure respectively.

Systolic blood pressure refers to the amount of pressure in your arteries when your heart contracts to pump blood around your body, while diastolic blood pressure refers to the blood pressure in your arteries when your heart is between beats.

How do I measure my blood pressure?It is recommended for us to take a blood pressure reading every 3 years for those with normal blood pressure levels. If you already have or are at high risk of developing high blood pressure or other cardiovascular diseases, your doctor may recommend more frequent readings.

Blood pressure machines are portable and easy to use. You can measure your blood pressure level at home too. Here are some things to look out for when taking your blood pressure for an accurate reading:

●      Avoid caffeinated drinks, smoking or exercising half an hour before you measure blood pressure.

●      Sit with your back straight and supported, with your feet flat on the floor. Do not cross your legs.

●      Your arm should be supported on a flat surface, and the upper arm should be at heart level.

●      The middle of the cuff should be placed directly above the elbow.

●      Don’t move around while you’re measuring.

●      Measure at the same time every day, take multiple (two or three, one minute apart) readings and note them down.

If one or both of the numbers are consistently above the recommended guidelines of 130/80, you should consult a doctor and get checked for hypertension.

Stages of Hypertension

Different countries may classify the stages of hypertension differently. In Malaysia, there are 5 stages: Stage

●      Normal: A blood pressure reading lower than 130/80 mm Hg is considered to be within the normal range. At this stage, no treatment is necessary, but it is recommended for us to continue monitoring our blood pressure to ensure it stays within the healthy range.

●      High-Normal: Individuals with a blood pressure reading between 130/85 to 139/89 mm Hg are considered pre-hypertensive and are at risk of moving on to develop heart disease. While medication may not be required at this point, lifestyle measures to reduce blood pressure are recommended.

●      Grade 1: If you have a blood pressure reading of 140/90 mm Hg and above, your doctor may prescribe medication and recommend lifestyle changes to lower your blood pressure and reduce your risk of stroke and heart diseases.

●      Grade 2: If you have a blood pressure reading of 160/100 mm Hg and above, the guideline believes you should receive antihypertensive medication and recommend lifestyle changes to reduce blood pressure.

●      Grade 3: Individuals with a blood pressure reading more than 180/110 mm Hg are considered high risk or severe hypertension which requires immediate intervention to lower blood pressure.

What are the types of hypertension?

There are two types of hypertension: primary and secondary hypertension.

●      Primary hypertension, also called essential hypertension, accounts for approximately 95% of all cases and develops gradually over years. There is no clear cause of primary hypertension.

●      Secondary hypertension accounts for the remaining 5% and often develops as a result of other conditions, such as sleep apnea, kidney issues, thyroid problems, adrenal gland tumours, congenital defects in blood vessels, and certain drugs and medications.

Symptoms of High Blood Pressure

Commonly known as the silent killer, hypertension often does not give rise to any noticeable symptoms even if blood pressure is dangerously high. Sometimes, individuals with hypertension may experience headaches, shortness of breath or nosebleeds, but they don’t usually occur until blood pressure has reached a severe or life-threatening stage.

Complications of Hypertension

If left untreated, the increased pressure on our artery walls caused by hypertension can damage our blood vessels and organs. The higher the pressure and the longer it goes uncontrolled, the greater the damage.

High blood pressure that’s not well-managed can lead to health complications, including:

Picture: Homage Malaysia

Heart Attack or Stroke

High blood pressure can lead to atherosclerosis, a condition where our arteries thicken, putting us at a higher risk for heart attack, stroke or other complications.

Heart Failure

A higher pressure means our heart has to work harder to pump blood around our body. This can cause our heart muscles to thicken in a condition known as left ventricular hypertrophy, making it harder for our heart to pump enough blood.

Aneurysm

Our blood vessels may weaken and bulge in response to the increased blood pressure, forming an aneurysm, which can be deadly if ruptured.

Kidney Failure

Hypertension is the second leading cause of kidney failure. Over time, the increase in blood pressure can narrow, weaken or harden the arteries around our kidney and limit blood flow to tissues. This can lead to kidney damage or failure.

Loss of vision

Our vision may be impaired if the blood vessels in the retina are damaged. This condition is known as hypertensive retinopathy and can cause serious damage if not treated promptly.

Trouble with Memory or Understanding

Hypertension can affect our ability to think and learn. If blood vessels supplying oxygen and nutrients to the brain cells responsible for memory are damaged as a result of increased blood pressure, we may experience short-term memory loss.

Vascular Dementia

Vascular dementia is a type of dementia caused by impaired blood flow to the brain. Increased blood pressure can lead to narrowed or blocked arteries that limit blood flow to our brain, resulting in the development of vascular dementia.

Metabolic Syndrome

Metabolic syndrome is a cluster of conditions that include high blood pressure, high blood sugar, large waist circumference and abnormal cholesterol or triglyceride levels. Having one of these conditions does not mean we have metabolic syndrome. However, if we develop more of these conditions, our risk of complications such as type 2 diabetes and heart disease increases.

What causes high blood pressure?

While the exact cause of most hypertension cases is unknown, there are a number of factors associated with an increased risk of developing hypertension.

Picture: Homage Malaysia

Non-Modifiable Risk Factors

Age

As we get older, our arteries may stiffen and narrow due to the buildup of plaque over the years. This can cause our blood pressure to increase and lead to hypertension.

Family History of Hypertension

Having a family member with hypertension before the age of 60 makes it twice as likely for you to develop the condition due to genetics. In fact, the more family members you have with high blood pressure before the age of 60, the higher your chance of developing hypertension.

Existing Health Conditions

Conditions such as diabetes, high blood cholesterol, chronic kidney disease, adrenal and thyroid disorders and sleep apnea can increase our risk of hypertension. For example, kidney disease reduces our body’s ability to filter out excess fluid, leading to high volume of blood and subsequently high blood pressure.

Modifiable Risk Factors

Smoking

Smoking has a direct impact on our blood pressure and immediately raises our blood pressure temporarily. However, the chemicals in tobacco also damages our artery walls, causing our arteries to narrow and stiffen, increasing blood pressure over the long term.

Diet

A diet high in fat, sugar or sodium can increase our risk of developing hypertension. Many with hypertension are also “salt-sensitive”, meaning that if they consume more than the minimally required amount of salt, their blood pressure increases.

Physical Activity

Individuals who lead sedentary lifestyles tend to have a higher heart rate than those who are physically active. This means that the heart has to work harder with each contraction and the force on our arteries are higher as well. A lack of physical activity also increases the likelihood of us being overweight.

Weight

The heavier we are, the more blood is required to supply oxygen and nutrients around our body. With the increased volume of blood, the pressure on our blood vessels increases as well.

Alcohol

You may have read that drinking red wine benefits our heart. While it does contain antioxidants, the evidence backing the claim that red wine is good for our heart is pretty weak. In fact, having more than one alcoholic drink a day for women or two for men can raise our risk of hypertension and other health conditions.

Stress

High levels of stress can increase our blood pressure and may also encourage lifestyle habits that further contribute to the development of the condition, such as drinking, smoking, physical inactivity and poor diet.

How to lower blood pressure?

Whether you are trying to keep your hypertension in check or prevent its development, there are lifestyle habits you can adopt to lower your blood pressure.

Picture: Homage Malaysia

Watch Your Diet

A balanced diet that’s low in sodium, fat and sugar, and rich in potassium, whole grains, fruits, vegetables and low-fat dairy products can lower your blood pressure. In fact, this is a diet developed and recommended for those with hypertension and is called the Dietary Approaches to Stop Hypertension (DASH) diet.

Get Moving

Exercising has many health benefits, including keeping our arteries flexible and preventing the tightening of blood vessels by reducing activity in our sympathetic nervous system. If you have hypertension, regular physical activity can help to reduce our blood pressure readings significantly. However, it is important to be consistent, as our blood pressure may rise again if we revert back to a sedentary lifestyle.

The Ministry of Health recommends that everyone aim for 150 minutes of physical activity per week. If you are unsure whether you should be doing physical activities due to health conditions, check in with your doctor before devising a suitable exercise plan that’s within your abilities and limits.

Avoid Smoking

Besides hypertension, smoking is widely known to increase our risk of many other health conditions such as cancer. If you don’t smoke, don’t start. If you do smoke, quit smoking today. Here are some resources you can use to get started on your journey to a smoke-free life.

Reduce Stress Levels

If you are constantly feeling stressed out, take some time to understand what is causing you to feel that way and try to eliminate as many stressors as possible.

However, it is usually not possible to remove all your stressors, hence it’s important to know how to manage your stress well. Find healthy ways to cope instead of drinking, smoking or eating unhealthy food. Make time to do the things you enjoy, practise gratitude and manage your expectations.

Manage Your Weight

Being overweight forces our heart to pump harder. We should always aim for our weight to be within the acceptable range to prevent health complications. If you are overweight, come up with a suitable exercise plan and make changes to your diet. Losing weight has the biggest effect on those who are overweight and have hypertension. Even shedding just a couple of kilos can have a significant impact on our blood pressure.

Reduce Alcohol Consumption

When it comes to alcohol, moderation is key. Having a single alcoholic drink can cause a temporary spike in our blood pressure, but this tends to resolve itself within 2 hours. However, regular heavy drinking can result in a sustained rise in blood pressure and may eventually lead to chronic hypertension.

Take Your Medication

To help keep hypertension under control, your doctor may prescribe certain medication. You may need to take blood pressure medication for the rest of your life, but there is a chance that you may be able to reduce or stop treatment if your blood pressure remains under control for several years.

It is important to follow your doctor’s advice and take medication as directed to ensure its effectiveness. If you experience any side effects, inform your doctor immediately.

Left untreated, high blood pressure could lead to more health complications. Learn more tips on how to reduce and keep your blood pressure in check before it's too late.

 

Living with Hypertension

Hypertension is a chronic condition. This means that it stays with us for life. While it may not be deadly if well-managed, receiving a hypertension diagnosis can still be a depressing experience.

Thankfully, our blood pressure can be managed with simple lifestyle changes and medication. Having supportive friends and family who encourage you to lead a healthy lifestyle can help you too, both physically and emotionally. If you need more support, consider joining a support group such as Pulmonary Hypertension on Facebook, where you can connect with individuals with similar conditions, provide emotional support to one another and share practical tips on coping with hypertension.

Are you looking for someone to care for your loved ones?

Homage provides caregiving services for your loved ones at every stage. Our trained care professionals can provide companionship, nursing care, night caregiving, home therapy and more, to keep your loved ones active and engaged.

 

References

●      American Heart Association News (2019). Drinking red wine for heart health? Read this before you toast. Retrieved from https://www.heart.org/en/news/2019/05/24/drinking-red-wine-for-heart-health-read-this-before-you-toast

●      Atherosclerosis. National Heart, Lung, and Blood Institute (NHLBI). Retrieved 2 July 2020, from https://www.nhlbi.nih.gov/health-topics/atherosclerosis.

●      The Star. (2017). How to measure your bp | The Star. [online] Available at: https://www.thestar.com.my/news/nation/2017/11/01/how-to-measure-your-bp.

●      Choi, H. Y., Park, H. C., & Ha, S. K. (2015). Salt Sensitivity and Hypertension: A Paradigm Shift from Kidney Malfunction to Vascular Endothelial Dysfunction. Electrolyte & blood pressure : E & BP, 13(1), 7–16. https://doi.org/10.5049/EBP.2015.13.1.7

●      DASH Eating Plan. National Heart, Lung, and Blood Institute (NHLBI). Retrieved 2 July 2020, from https://www.nhlbi.nih.gov/health-topics/dash-eating-plan.

●      E. Kim, J. (2020). Hypertensive retinopathy. EyeWiki. Retrieved 2 July 2020, from https://eyewiki.aao.org/Hypertensive_retinopathy.

●      Family History and High Blood Pressure. (2020). [Ebook]. Retrieved 2 July 2020, from https://www.cdc.gov/pcd/issues/2005/apr/pdf/04_0134_01.pdf.

●      Ministry of Health. (2010). Retrieved 17 February 2021, from https://www.moh.gov.my/moh/images/gallery/Garispanduan/diet/KM3.pdf

●      Hecht, M. (2019). Types and Stages of Hypertension. Healthline. Retrieved 2 July 2020, from https://www.healthline.com/health/types-and-stages-of-hypertension#primary-vs-secondary.

●      High blood pressure (hypertension). Mayo Clinic. (2018). Retrieved 2 July 2020, from https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/symptoms-causes/syc-20373410.

●      How High Blood Pressure Can Lead to Kidney Damage or Failure. American Heart Association. (2016). Retrieved 2 July 2020, from https://www.heart.org/en/health-topics/high-blood-pressure/health-threats-from-high-blood-pressure/how-high-blood-pressure-can-lead-to-kidney-damage-or-failure/.

●      Know Your Risk for High Blood Pressure. Centers for Disease Control and Prevention. (2020). Retrieved 2 July 2020, from https://www.cdc.gov/bloodpressure/risk_factors.htm.

●      Maheswaran, Ravi; Jaswinder, Singh Gill; Davies, Paul; David Gareth, Beevers. (2019). High Blood Pressure Due to Alcohol A Rapidly Reversible Effect. Hypertension, 17(6), 787-792.

●      Metabolic syndrome. Mayo Clinic. (2019). Retrieved 2 July 2020, from https://www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916#:~:text=Metabolic%20syndrome%20is%20a%20cluster,abnormal%20cholesterol%20or%20triglyceride%20levels.

●      National Health Survey 2010 Singapore. (2010). [Ebook]. Retrieved 2 July 2020, from https://www.moh.gov.sg/docs/librariesprovider5/resources-statistics/reports/nhs2010---low-res.pdf.

●      Smoking, High Blood Pressure and Your Health. American Heart Association. (2016). Retrieved 2 July 2020, from https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/smoking-high-blood-pressure-and-your-health.

●      Institue of Public Health. (2020). National Health & Morbidity Survey 2019. [online] Available at: http://iku.gov.my/images/IKU/Document/REPORT/NHMS2019/NHMS2019Infographic.pdf.

●      Pendidikan Pesakit (2015). Classification Of Hypertension. [online]. Available at: http://pendidikanpesakit.myhealth.gov.my/en/classification-of-hypertension/.

●      Virdis, A., Giannarelli, C., Neves, M. F., Taddei, S., & Ghiadoni, L. (2010). Cigarette smoking and hypertension. Current pharmaceutical design, 16(23), 2518–2525. https://doi.org/10.2174/138161210792062920

●      What is Left Ventricular Hypertrophy (LVH)?. American Heart Association. (2020). Retrieved 2 July 2020, from https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/what-is-left-ventricular-hypertrophy-lvh#:~:text=Left%20ventricular%20hypertrophy%2C%20or%20LVH,pressure%20overwork%20the%20heart%20muscle.

●      Your Guide to Lowering Blood Pressure. (2003). [Ebook]. Retrieved 2 July 2020, from https://www.nhlbi.nih.gov/files/docs/public/heart/hbp_low.pdf?cid=GMB#:~:text=Being%20overweight%20or%20obese%20increases,overweight%20and%20already%20have%20hypertension.

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