Friday, September 6, 2013

Hypertension: A Lifestyle Disease

 The Pentecostal Fellowship of Nigeria, Gwarimpa Zone Abuja recently asked me to do an article for the National Newsletter of the PFN on Hypertension. I have reproduced the article on my blog. As I'm aware my Seniors will read this, any errors herein are greatly regretted. But if the write up is good enough credit goes to all Residents and Consultants who made an input into my training in medical school. I hope the Pentecostal Fellowship of Nigeria will find this useful.


The term Lifestyle Disease has been invented to describe Obesity, Diabetes Mellitus as well as Hypertension. The list of Lifestyle diseases isn't limited to these but we shall discuss Hypertension.

In his few years of Medical Practice, this writer has found that every aspect of daily life can be related to disease and this includes diet, sleep, exercise, emotions, habits etc. Blood Pressure in particular responds to an individuals lifestyle choices quite sensitively in much the same way as weight and blood glucose levels. This implies that for many sufferers of hypertension, a simple change in lifestyle can be a good way to prevent complications of high blood pressure. However since prevention is better than cure, these lifestyle changes must be kept up for a lifetime. For millions of people in their senior years though, the arrival of High Blood Pressure comes at a stage when a radical lifestyle change may be too little and a little too late.

Healthy Lifestyle changes are actually non-drug managements for high blood pressure. They include:

1. Exercise at least 30 minutes a day
2. Maintain a normal weight (BMI <25)
3. Reduce salt intake
4. Increase potassium intake
5. Limit alcohol consumption to a bottle/day
6. Quit smoking completely
7. Consume a diet rich in fruits & vegetables

Dietary Approach to Stop Hypertension (DASH)

Apart from the aforementioned lifestyle changes, the under listed dietary approaches to lower Blood Pressure have been proven to have additional benefits in preventing heart disease and stroke - two of the several complications of hypertension.

1. Limit Sodium intake: it is recommended that individuals take a daily sodium intake of <2,300 mg. This means that only a pinch of salt should be added to meals whether the taste is enhanced or not. Furthermore Sodium Monoglutamate should be replaced with naturally occurring spices and food additives.

2. Reduce Saturated fats to no more than 6% of daily calories: This can be achieved by boiling foods rather than frying them.

3. When choosing fats select mono unsaturated oils such as soy bean oil: This is because the body needs High Density Lipoprotein which is good cholesterol. We can do without the Low Density Lipoprotein which is bad cholesterol. Cholesterol isn't all bad. It’s an essential fat that provides support in the membranes of our bodies' cells. Some cholesterol comes from diet and some is made by the liver. Cholesterol can't dissolve in blood, so transport proteins carry it where it needs to go. These carriers, acting like a microscopic bus fleet are called lipoproteins, and LDL (low-density lipoprotein) is one member of the lipoprotein family.

4. Choose whole grains instead of flour meals. For instance whole Maize grains are preferable to Maize mealies. Avoid processed foods as much as possible.

5. Include nuts, seeds or legumes in your daily meals.

6. Fish, skinless chicken, soy bean milk are the best protein source.

7. Fruits like banana are rich in potassium and are highly recommended.

8. Fish oil and Omega 3 fatty acids (docosahexanoic and eicosapentanoic acids) are packaged for sale in the food supplement Max Omega. However, they are naturally occurring in oily fish like Sardines and studies show that they make blood vessels more flexible.

What is Hypertension?

Every time the human heart beats, it pumps blood to the whole body through conduits/channels called arteries. These blood vessels therefore have to be flexible enough to accommodate varying volumes and pressures of blood. Blood Pressure is the force of blood pushing against the blood vessel walls. The higher the pressure, the harder the heart has to pump. Hypertension, also known as High Blood Pressure therefore is a condition in which these arteries have persistently elevated pressure. Hypertension can lead to rupture of these arteries in the brain due to the high pressure, it can lead to rupture of blood vessels in the heart, it can cause the heart to be overworked so much that blood and blood components begin to accumulate in the lungs. These are referred to as end organ damage.

According to Medilexicons medical dictionary, hypertension is a transitory or sustained elevation of systemic arterial blood pressure to a level likely to cause Cardioovascular damage or other adverse consequences.

Normal Blood Pressure: 120/80 mmHg
Pre-hypertension: 120/80 - 139/89 mmHg
Hypertension: >140/90 mmHg

The numerator signifies the systolic measurement which simply put means the highest possible pressure in the arteries. The denominator signifies the diastolic measurement (lowest possible pressure in the arteries).

Hypertension may be classified as Essential or Secondary. It is said to be essential when there is no known cause. The term essential doesn't convey this meaning but its simply used here because this accounts for 95% of cases. Secondary hypertension is used for High Blood Pressure with a known direct primary cause like Renal Artery Stenosis, coarctations of the aorta, arteriosclerosis (in which LDL are deposited as plaques on the intima of blood vessels).

What causes hypertension?

The exact cause of hypertension remains largely unknown. There are several factors that increase the risk of developing this lifestyle disease.

1. Smoking
2. Alcohol consumption
3. Overweight
4. Diabetes
5. Sedentary Lifestyle
6. Lack of physical activity
7. High level of salt intake
8. Insufficient calcium, potassium & magnesium
9. Stress
10. Ageing
11. Family History of Similar illness
12. Chronic Kidney disease
13. Adrenal and Thyroid problems

What do I feel in my body if I have hypertension?

There is no guarantee that a person with hypertension will feel anything in his body. About 33% of people actually do not know they have high blood pressure and this ignorance can last for years. It is now becoming increasingly common to find hypertension in people between 20 - 35 years of age. Infact there are documented evidence of a 19 year old having a well established case of hypertension. For this reason it is advisable to undergo periodic blood pressure screening even when no symptoms are present.

By the time a person with hypertension starts feeling the following symptoms, irreversible damage would have begun:

1. Dizziness
2. Fatigue
3. Headache
4. Awareness of heartbeat
5. Seeing flashes of light

Why is hypertension so dangerous?

The arteries are normally supposed to be flexible and they ought to have a continuous internal wall devoid of cholesterol deposits or plaques. LDL cholesterol can block these blood channels partially or totally occlude them thus increasing the pressure required to transmit blood through that region. This increases the after load on the heart. The increased work load on the heart is what manifests as symptoms of hypertension. Complications may arise when these deposits are dislodged and carried in the current of blood flow to a distant region. On arrival at a narrow channel which these debris cannot pass, they may lodge there and prevent blood supply to the affected organ. This results in Stroke if the affected region is the brain or renal failure if the affected region is the Kidneys.

What drugs will my Physician give me?

A hypertensive patient will be on tablets for life whether he or she feels any symptoms or not. That is why a Medical Doctor doesn't place any patient on medication until the blood pressure has been taken on three separate occasions over 1-2 weeks. All clients on high blood pressure drugs are advised to return to their Medical Doctors if there are unacceptable side effects. Don't listen to a pharmacist or a laboratory scientist or nurse or any other health worker other than your medical doctor. They may advice you to stop your drugs for any reason at all and that is as risky as it is unwise.

When taking any of the underlisted medication you may feel the following. Remember to see your Medical Doctor and complain.

1. Methyl Dopa: is a good drug for women but has been shown t cause decreased sexual performance in men

2. Lisinopril: can cause a prolonged dry cough that isnt relieved by cough syrups

3. Moduretic: may cause excessive urination

4. Propanolol: may cause nightmares

Visit your Physician for check up today.

Dr. Obasi Ndubisi

Medical Officer at Faith Mediplex, Abuja
NMA Medinews Deputy Editor

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