Feature published in Shifa News magazine February 2017 edition
HIGH BLOOD PRESSURE: When NOT to worry
52 year old Mehmooda Bibi works in a pharmaceutical company. She is a high blood pressure patient for the past two years. The resident of Islamabad identifies it as sharp, quick pain in her head, with red eyes and cheeks and shoulder cramps. She also becomes furious for no good reason. To ease this state, she drinks milk mixed in colorless carbonated drink as her colleagues have advised so. Ironically, despite working in a drug company she prefers this drink over medicine. “I become alright with this mixture so do not need medicine.” She believes high blood pressure occurs “jab khoon garha ho jata hai” (when blood thickens). And this drink helps thin the blood.
Well, like many diseases there are various misconceptions regarding blood pressure in our society as well. Dr Saeed Ullah Shah, a cardiologist at Shifa International Hospital, Islamabad, reveals there are usually no signs of high blood pressure. “Less than one percent patients experience symptoms, that also in case of associated disease.”
He adds further that it also has no connection to thinning or thickening of blood. Moreover, fizzy drinks in any form are unhealthy. “Most people only fear blood pressure unaware of the fact that it normally fluctuates all day.”
Dr Mehboob Alam, an assistant professor of medicine (general and interventional cardiology) at Baylor College of Medicine, Houston US, while talking to Shifa News says, blood flows in the human body in arteries and veins, also referred to as “the pipes”. In order for the blood to flow from heart to all the organs, heart has to push the blood into the arteries. This generates a pressure difference between the heart and the finest of the arteries in the body. “A measurement of this pressure in the body is called blood pressure and fluctuations in it depend on our daily activities.”
“Headache while assumed to be a commonest sign of hypertension does not occur unless blood pressure is elevated to dangerous levels,” explains Dr Saeed. Headaches may occur with stress, anxiety and insomnia. And these conditions however, can increase the blood pressure.
Dr Mehboob says, high blood pressure over a prolonged period without treatment may cause chest pain, shortness of breath, leg swelling because of kidney failure, headache, and stroke from bleeding in brain in patients. “This is a hypertensive crisis and can even be life threatening.”
According to the World Health Organization, 18 percent of adults, and 33 percent of adults above 45 years old in Pakistan have hypertension.
“Though a dangerous condition, there is a lot of fear and hype created about it,” says Dr Saeed, before adding that lack of awareness, incorrect examining method and fear of complications are some major reasons prevailing in the society that give rise to misconceptions.
Explaining further he adds patients need to be explained about the complete blood circulation phenomenon and counseled that rise in pressure once in a while is normal. Moreover, an exercise test can confirm the condition. The test raises an individual’s pressure above 120mmHg and sometimes even reaches 180 mmHg. “But no symptoms like headache, eye redness or shoulder cramps appear in normal individuals. It goes down itself after a few minutes,” says Dr Mehboob.
Usually, 120 mmHg (systolic)/80 mmHg (diastolic) is considered as the normal pressure in adults. It is however, only an estimated rate and according to Dr Saeed, the “ideal rate” is still unknown. Normal systolic pressure ranges from 100 – 140 mmHg, while normal range for diastolic is 70 – 80 mmHg. If the pressure falls below this range, it is called low blood pressure or “hypotension”. On the contrary when the blood pressure is above this range, it is high blood pressure or “hypertension”.
Blood pressure increases with age and can be inherited. Obesity, diabetes, heart disease, excess salt intake, smoking, alcohol, kidney problems, pregnancy, menopause and use of painkillers are some other reasons for hypertension. “Cough syrups and hakeemi medicines which usually contain steroids can also increase the pressure,” informs Dr Saeed.
If you are young and have frequent high blood pressure, you need to consult a physician immediately as there may be an underlying problem as serious as kidney failure.
Do it right
Blood pressure is usually checked on a routine visit to a doctor as it is a good tool to examine overall health of a patient. But according to Dr Saeed, one reading cannot determine it is hypertension. Moreover, there are many factors that can affect a patient’s blood pressure. “A patient who has come running or is under stress will of course show a high reading.”
Also, the right technique matters. The equipment should be fastened on the arm, not the wrist, even if it is a digital machine. Take two readings twice a day with good quality device. “Once in the morning and the other in the evening and at the same time period. Take an average of the week’s record,” elaborates Dr Saeed. Be alarmed when the pressure is high for a long time.
Can be managed
A common misconception is “hypertension is curable”. Without lifestyle modification and irregular use of medicine, the condition can persist. “Hypertension should be treated just like diabetes which is a chronic lifelong condition that requires management with medicines and lifestyle changes,” emphasizes Dr Mehboob.
Preventing the rise
Preventing hypertension can be done with aggressive modification of risk factors. Dr Mehboob informs, while we cannot change the genetic risk, we certainly can attempt to modify the acquired risk factors. For example, weight loss, regular aerobic exercise or walk for 30-40 minutes for five days a week, treatment of sleep disorders including sleep apnea and taking a minimum of six hours uninterrupted sleep and managing diabetes can control the problem. “Moreover, reduced salt intake to as low as half teaspoon is also necessary,” says Dr Mehboob.
“Avoid junk and processed foods as they have more than normal salt content in them,” adds Dr Saeed.
Nevertheless, according to Zainab Bibi, a nutritionist at Shifa International Hospital, Islamabad not all high blood pressure patients are “salt-sensitive”. Patients who need to reduce salt intake are recommended a diet rich in potassium (such as potato and banana), green leafy vegetables and fruits.
It is usually believed olive oil helps control blood pressure. Dr Nadeem Rizvi, a cardiologist at National Institute of Cardiovascular Diseases, Karachi however says there are no direct evidences to this. “But it does contain good fats that boost blood circulation. So, any food that helps with blood circulation and controls LDL (bad cholesterol) can help.”
Stage 1 Pre-hypertension: 120-130 mmHg / 80-<85 mmHg
Stage 2 Pre-hypertension: 130-140 mmHg / 85–<90 mmHg
Stage 3 Hypertension: >140 mmHg and/or >90 mmHg on at least three separate measurements