Part I: High Blood Pressure: Managing the ‘Silent Killer’
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Part I: High Blood Pressure: Managing the ‘Silent Killer’

High blood pressure or hypertension is regarded as one of the modern epidemics. It is perhaps one of the commonest diseases affecting mankind. It causes elevated levels of blood pressure in the human body. It is often a consequence of a sedentary lifestyl

Post by on Friday, May 21, 2021

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High blood pressure or hypertension is regarded as one of the modern epidemics. It is perhaps one of the commonest diseases affecting mankind. It causes elevated levels of blood pressure in the human body. It is often a consequence of a sedentary lifestyle, mismanaged stress, and unhealthy dietary habits. May 17 is observed as World Hypertension Day and the theme chosen for this year is "Measure Your Blood Pressure Accurately, Control It, Live Longer". This year's theme aims at raising awareness about the condition across the world and promotes its accurate measurement and management methods.

Hypertension affects about one third of the world population. It can be seen at any age groups although the prevalence more common as age increases. It is estimated that about 26% of the world's total population has hypertension and it is expected to increase to 29% by 2025. The Kidney plays a critical role in salt handling is the cause of high blood pressure in essential Hypertension. In young people under 35 years of age high blood pressure is most often due to underlying kidney disease. High blood pressure over a long period of time also causes kidney damage. The heart too gets affected by high blood pressure and is not the cause of high blood pressure. Good blood pressure control protects the kidney, heart and the brain.High blood pressure continues to play an important role even after kidney transplant. 

Hypertension and COVID are closely interlinked. During COVID times the prevalence of hypertension is believed to be increasing. The two main reasons are increased stress and lack of a regular exercise schedule leading to weight gain. This has further been worsened by the fact that patients are reluctant to go to hospitals or doctors “ clinic because of fear of COVID. The severity of the COVID infection is also more in patients who have comorbidities like hypertension. Hence there is even a greater need to 

Your blood pressure can change from minute to minute, with changes in posture, exercise or sleeping, but it should normally be less than 120/80 mm Hg for an adult. Blood pressure that stays between 120-139/80-89 is considered prehypertension and above this level (140/90 mm Hg or higher) is considered high (hypertension). Your doctor may take several readings over time before deciding whether your blood pressure is high. 


Silent Killer?

It usually causes no symptoms but can still cause serious complications. Hence it is often called the "silent killer." 

• Many people have high blood pressure and don't even know it. 

• The key complications of high blood pressure include kidney failure, heart disease, heart attack, congestive heart failure, stroke, and peripheral artery disease, especially aortic aneurysms or outpouchings of the aorta. 

• Public awareness of these dangers has increased. High blood pressure has become the second most common reason for medical visits in the United States. 

• The only way to tell if you have high blood pressure is to have your blood pressure checked. 


How common is it?

There is paucity of data from our country but data from the US suggest that as many as 1 billion people worldwide have high blood pressure.

• That's about 1 in 3 adults aged 18 years and older. Yet nearly one-third of these people don't know they have it. If this true for theland of the enlightened you can imagine the state in a country like ours.

• Studies done in US and UK suggest that the prevalence of hypertension in NRIs is much higher than native Caucasians.  

• In India too with the changing lifestyle, increasing urbanization and Fats food culture there is an increasing prevalence. 

• Uncontrolled high blood pressure is indirectly responsible for many deaths and disability resulting from heart attack, stroke, and kidney failure. 

• However, good news is that the progress of heart disease as well as the kidney disease caused by high blood pressure can be slowed down by optimal blood pressure control. 


How Do I Know If I Have High Blood Pressure?

High blood pressure usually has no symptoms. In fact, many people have this disease for years without knowing it. Having high blood pressure (hypertension) doesn't mean you're tense, nervous or hyperactive. You can be a calm, relaxed person and still have hypertension. The only way to find out if you have this disease is to have your blood pressure checked! A blood pressure test is quick and painless. It can be done in a doctor's office, hospital clinic, school, nurse's office, company clinic or at a health fair. 

A single high reading doesn't mean you have high blood pressure, but it's a sign that you need to watch it carefully. 

The mercury sphygmomanometer remains the most accurate way of measuring blood pressure. This device consists of a gauge and a rubber cuff that is placed around your arm and inflated. Having your blood pressure measured is painless and takes just a few minutes. If you are using electronic devices they need to be periodically cross calibrated with the mercury sphygmomanometer.


Causes of High Blood Pressure?

In about 10% of people, high blood pressure is caused by another disease (this is called secondary hypertension). In such cases, when the root cause is treated, blood pressure usually returns to normal. These causes include the following conditions: 

• Chronic kidney disease 

• Tumors or other diseases of the adrenal gland 

• Coarctation of the aorta - A narrowing of the aorta that you are born with that can cause high blood pressure in your arms 

• Alcohol addiction

• Thyroid dysfunction 


In the other 90% of cases, the cause of high blood pressure is not known (primary hypertension). Although the specific cause is unknown, certain factors are recognized as contributing to high blood pressure.

What can we do to prevent developing high blood pressure? 

• Overweight (obesity): is defined as being 30% or more over your healthy body weight. It is very closely related to high blood pressure. It is  strongly recommended  that all obese people with high blood pressure lose weight until they are within 15% of their healthy body weight. Your doctor can help you calculate your healthy range of body weight. 

• Sodium (salt) sensitivity: Some people have high sensitivity to sodium (salt), and their blood pressure goes up if they use salt. Reducing sodium intake tends to lower their blood pressure. The typical Indian doiet  contains very high sodium. Fast foods and processed foods contain particularly high amounts of sodium. Many over-the-counter medicines, such as painkillers, also contain large amounts of sodium. Read labels to find out how much sodium is contained in food items. Avoid those with high sodium levels. 

• Alcohol use: Drinking more than 1-2 drinks of alcohol per day tends to raise blood pressure in those who are sensitive to alcohol. 

• Birth control pills (oral contraceptive use): Some women who take birth control pills develop high blood pressure. 

• Lack of exercise (physical inactivity): A sedentary lifestyle contributes to the development of obesity and high blood pressure. This is one of the most important reasons for an increasing incidence of hypertension.

• Drugs: Certain drugs, such as amphetamines (stimulants), diet pills, and some pills used for cold and allergy symptoms, tend to raise blood pressure. 


As body weight increases, the blood pressure rises. 

• Obese people are 2-6 times more likely to develop high blood pressure than people whose weight is within a healthy range. 

• Not only the degree of obesity is important, but also the manner in which the body accumulates extra fat. Some people gain weight around their belly (central obesity or "apple-shaped" people), while others store fat around their hips and thighs ("pear-shaped" people). "Apple-shaped" people tend to have greater health risks than "pear-shaped" people and this pattern is gain more common in the Indian population. 


Sometimes people with high blood pressure have the following symptoms:

• Headache 

• Dizziness 

• Blurred vision 

• Nausea 

People often do not seek medical care until they have symptoms arising from the organ damage caused by chronic (ongoing, long-term) high blood pressure. The following types of organ damage are commonly seen in chronic high blood pressure:

• Heart attack

• Stroke or "mini stroke" (transient ischemic attack, TIA) 

• Kidney failure 

• Eye damage with loss of vision 

• Peripheral arterial disease, including outpouchings of the aorta called aneurysms 


About 1% of people with high blood pressure do not seek medical care until the high blood pressure is very severe, also called malignant hypertension.

• In malignant hypertension, the diastolic blood pressure (the lower number) often exceeds 140 mm Hg. 

• Malignant hypertension may be associated with headache, light-headedness, or nausea. 

• This degree of high blood pressure requires emergency hospitalization and lowering of blood pressure to prevent brain hemorrhage or stroke. 

It is of utmost importance to realize that high blood pressure can be unrecognized for years, causing no symptoms but causing progressive damage to the heart,kidney  other organs, and blood vessels

When to Seek Medical Care? 


Call your physician if a routine blood pressure measurement (during health screening) reveals systolic blood pressure higher than 140 mm Hg, diastolic blood pressure higher than 90 mm Hg, or both. 

You also need an urgent consultation if you have any of the following symptoms:

• Unexplained severe headache 

• Sudden or gradual changes in vision 

• Light-headedness or dizziness 

• Nausea associated with severe headache 

• Chest pain or shortness of breath upon exertion 

You need to let your doctor know if any family member has or has had high blood pressure, heart attack, stroke, or kidney failure.

Go to a hospital emergency department if your blood pressure is high when measured (for example, if your diastolic pressure is greater than 100 mm Hg).

Go to a hospital emergency department if you have any of the following symptoms:

• Severe headache 

• Unexplained dizziness of faintness 

• Unexplained blurred vision or loss of vision (partial or complete) 

• Chest pain or breathlessness that is severe or occurs at rest 

• Unexplained sudden weakness or other symptoms of stroke 


The only way to tell whether you have high blood pressure is to have it measured with a blood pressure cuff .


Blood pressure (BP) is classified as follows:

• Normal BP - Systolic less than 120 mm Hg; diastolic less than 80 mm Hg 

• High Normal - Systolic 120-139 or diastolic 80-89 mm Hg 

• High BP 

• Stage 1 - Systolic 140-159; diastolic 90-99 mm Hg 

• Stage 2 - Systolic more than 160; diastolic more than 100 mm Hg 


What investigations are a must?

Tests will be ordered to check for causes of high blood pressure and to assess any organ damage from high blood pressure or its treatment. These tests may include the following:

• Blood tests including measurement of electrolytes, blood urea, and creatinine levels (to assess kidney involvement) 

• Lipid profile for levels of various kinds of cholesterol 

• Special tests for hormones of the adrenal gland or thyroid gland 

• Urine tests for electrolytes and hormones 

A noninvasive, painless eye examination with an ophthalmoscope will look for ocular damage.

Ultrasound of the kidneys, CT scan of the abdomen, or both may be done to assess damage or enlargement of the kidneys and adrenal glands.

Any of the following may be performed to detect damage to the heart or blood vessels :

(1) Electrocardiogram (ECG) is a noninvasive test that detects the electrical activity of the heart . 

• Echocardiogram is an ultrasound examination of the heart taken through the chest. Sound waves take a picture of the heart as it beats and relaxes and then transmits these images to a video monitor. The echo can detect problems with the heart such as enlargement, abnormalities in motion of the heart wall, blood clots, and heart valve abnormalities. It also gives a good measurement of the strength of the heart muscle (ejection fraction). The echo is more accurate than an ECG, but also more expensive. 

• A plain chest x-ray primarily provides an estimate of the size of the heart, but it is much less specific than echocardiography, which looks inside the heart.

For more information on this subject please see my YouTube channel TheKidney Klinic or visit my website www.kidneyklinic.com


Dr Sanjeev Gulati 

DNB,DM, FIPN (Aust),FISN, FIAP, FRCPC (Canada)

Chairman Fortis Institute of Renal Sciences & Transplantation 

New Delhi





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