Understanding and Managing Hypertension for Better Health ❤️‍🩹

Welcome to my blog toward better health!

As a Nutritionist and future Registered Dietitian, I aim to empower you to take ownership of your well-being.

Today, we delve into a topic of immense relevance, particularly for individuals grappling with diabetes and excess body weight - hypertension (high blood pressure).

Hypertension is a common thread among many people. Hypertension earns its ominous nickname, the "silent killer," because it often operates stealthily without noticeable symptoms. This silent nature can make it challenging to detect and address, underscoring the importance of monitoring and proactive health management.

In this blog post, we will embark on a comprehensive exploration of hypertension: what it is and how it's diagnosed and treated.

Together, we'll equip ourselves with knowledge and practical strategies to navigate the challenges of hypertension, and in doing so, we'll be taking a significant step towards our best health.

Are you ready to take control of your health? Let's get started!

What is Hypertension?

The World Health Organization (WHO) defines hypertension as a medical condition in which the pressure within a person's blood vessels becomes excessively high, typically registering 140/90 millimeters of mercury (mmHg) or higher during blood pressure measurements. If your blood exerts an excessive force against your blood vessel walls, it places strain on your heart and circulatory system.

To capture its importance, let's delve into the mechanics: with each heartbeat, your heart pumps blood throughout your body, supplying it with energy and oxygen. As this blood circulates, it exerts pressure against the walls of your blood vessels, and the intensity of this pressure is what we refer to as blood pressure.

Why Does High Blood Pressure Matter?

High blood pressure can have a profound impact on your health. It places added stress on your heart and blood vessels, which, over time, can lead to various health complications, including heart attacks, strokes, kidney disease, and certain forms of dementia. The good news is that there are numerous strategies you can adopt to lower and manage high blood pressure effectively.

Certain risk factors increase the likelihood of developing high blood pressure, including older age, genetics, obesity, physical inactivity, a high-salt diet, and excessive alcohol consumption (ESC/ESH 2018). Lifestyle changes such as adopting a healthier diet, quitting smoking, increasing physical activity, and reducing salt intake can help lower blood pressure. However, some individuals may require medication in addition to lifestyle changes.

Blood pressure is represented as two numbers: systolic (when the heart beats) and diastolic (when the heart rests between beats). Hypertension is typically diagnosed when systolic readings are ≥140 mmHg and/or diastolic readings are ≥90 mmHg on two different days (WHO; 2023).

Risk factors for hypertension can be categorized as modifiable and non-modifiable. Modifiable risk factors include unhealthy diets, physical inactivity, tobacco and alcohol use, and obesity. Non-modifiable risk factors include a family history of hypertension, age over 65, and co-existing conditions like diabetes or kidney disease.

While most people with hypertension don't experience noticeable symptoms, very high blood pressure can lead to headaches, blurred vision, chest pain, and other symptoms. Regular blood pressure checks are crucial for diagnosis and early intervention, as untreated hypertension can lead to kidney disease, heart disease, and stroke.

In severe cases, when blood pressure reaches levels like 180/120 or higher, individuals may experience symptoms such as severe headaches, chest pain, dizziness, difficulty breathing, nausea, vomiting, blurred vision, anxiety, confusion, ear buzzing, nosebleeds, and abnormal heart rhythms. If you or someone you know experiences these symptoms along with high blood pressure, seek immediate medical attention.

Understanding Hypertension Types

When it comes to hypertension, there are two primary categories. In about 95 percent of cases, high blood pressure strikes without a clear cause, and this is known as essential or primary hypertension. On the other hand, when a specific cause can be identified, it falls under the category of secondary hypertension (Oparil, Suzanne et al.; 2018) .

Essential Hypertension

This form of hypertension is diagnosed when a healthcare provider observes consistently high blood pressure readings over multiple visits and rules out other identifiable causes. Typically, individuals with essential hypertension don't exhibit noticeable symptoms, although some may occasionally experience issues like frequent headaches, fatigue, dizziness, or nosebleeds. While the precise cause remains a mystery, research points to factors such as obesity, smoking, alcohol consumption, dietary choices, and family history playing roles in essential hypertension.

Secondary Hypertension

In cases of secondary hypertension, there is an underlying, identifiable factor or condition at play. The most frequent triggers include abnormalities in the arteries that supply blood to the kidneys, sleep-related airway obstructions, diseases and tumours of the adrenal glands, hormone imbalances, thyroid disorders, excessive salt or alcohol intake, and certain medications, including common over-the-counter options like ibuprofen and pseudoephedrine. The encouraging news is that, if the root cause is pinpointed, hypertension can often be effectively managed.

Understanding these distinctions is essential, as they guide the approach to diagnosis and treatment. While essential hypertension may require lifestyle modifications and awareness of contributing factors, secondary hypertension necessitates a thorough evaluation to uncover and address the underlying issue, ultimately leading to improved blood pressure control and overall well-being.

Diagnosing Hypertension:

The last update from 18 March 2022 of the National Institute for Health and Care Excellence (NICE) guideline [NG136] provides a comprehensive guide for diagnosing. Here's a summary of their key recommendations:

1. Measure blood pressure in both arms. If there's a significant difference (more than 15 mmHg) between the arms, repeat the measurements.

2. If clinic blood pressure is 140/90 mmHg or higher, take a second measurement during the consultation. Record the lower of the last two measurements as the clinic blood pressure.

3. Ambulatory Blood Pressure Monitoring (ABPM) or Home Blood Pressure Monitoring (HBPM): Offer ABPM if clinic blood pressure is between 140/90 mmHg and 180/120 mmHg. If ABPM is unsuitable, offer HBPM.

4. While awaiting a hypertension diagnosis, conduct investigations for target organ damage and assess cardiovascular risk using a risk assessment tool such as QRISK3 (link).

5. When using ABPM, take at least 2 measurements per hour during the person's usual waking hours and use the average of at least 14 measurements to confirm the diagnosis. For HBPM, take 2 consecutive measurements at least 1 minute apart, twice daily (morning and evening) for at least 4-7 days. Use the average value of the remaining measurements for diagnosis.

6. Confirm the diagnosis when clinic blood pressure is 140/90 mmHg or higher and ABPM daytime average or HBPM average is 135/85 mmHg or higher.

Managing Hypertension: What You Need to Know

Well, managing hypertension, or high blood pressure, is pretty crucial because if left unchecked, it can lead to some serious health problems.

Now, I am not saying you need to panic, but it's good to be informed. I am sharing some valuable insights straight from the experts at the National Institute for Health and Care Excellence (NICE) and the Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease 2014 (JBS3) on how to tackle this issue.

First things first, lifestyle matters: Turns out, your daily habits play a huge role in managing hypertension. Think about your diet, exercise, and even how much coffee you drink – it all matters.

NICE recommends getting professional advice and educational materials to help you make the right lifestyle changes. Well, stay tuned because my next post will focus on nutrition and all the new behaviours you can plan and change to reduce and manage your blood pressure. I'll explore the exciting world of food and its role in keeping your blood pressure in check.

When lifestyle isn't enough: Sometimes, lifestyle changes alone don't cut it. That's when medications come into play. NICE suggests that people with more severe hypertension or specific risk factors might need medication in addition to lifestyle changes. Medications like ACE inhibitors or ARBs are preferred for those under 55 years old, while those aged 55 and above should consider calcium channel blockers (CCBs) as the initial therapy. There are various options when it comes to medications, and it depends on factors like your age, and other health conditions but also how well you respond to the initial tramtnet.

Keep an eye on it: Regular monitoring of your blood pressure is key. Your healthcare provider will work with you to set the right targets and make sure your treatment is on track.

Managing hypertension often involves taking steps, from starting treatment to adjusting it as needed. It's a process tailored to your unique health profile.

And guess what? We're not done here. In our next post, I am going to dive deep into the fascinating world of nutrition and how it can help manage hypertension effectively. So, stay tuned for some mouth-watering insights into the power of food in controlling blood pressure.

By William Stivaletta AfN RD2Be

References:

Kulkarni, Spoorthy, et al. "Management of hypertensive crisis: British and Irish Hypertension Society Position document." Journal of Human Hypertension (2022): 1-17.

Oparil, Suzanne et al. “Hypertension.” Nature reviews. Disease primers vol. 4 18014. 22 Mar. 2018, doi:10.1038/nrdp.2018.14

guideline NG136, N.I.C.E., 2019. Hypertension in adults: diagnosis and management. Methods.

Board, J.B.S., 2014. Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease (JBS3). Heart, 100(Suppl 2), pp.ii1-ii67.

Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., Burnier, M., Clement, D.L., Coca, A., De Simone, G., Dominiczak, A. and Kahan, T., 2018. 2018 ESC/ESH Guidelines for the management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). European heart journal, 39(33), pp.3021-3104

WHO., 2023 Hypertension available from https://www.who.int/news-room/fact-sheets/detail/hypertension