World Hypertension Day 17 May 2023

World Hypertension Day is observed globally on May 17th every year, with the current theme being “Measure your blood pressure accurately and control it for a longer life.” This initiative aims to increase awareness about the significance of regular blood pressure monitoring and understanding the normal range.

Key facts

• An estimated 1.28 billion adults aged 30–79 years worldwide have hypertension, most (two-thirds) living in low- and middle-income countries
• An estimated 46% of adults with hypertension are unaware that they have the condition.
• Less than half of adults (42%) with hypertension are diagnosed and treated.
• Approximately 1 in 5 adults (21%) with hypertension have it under control.
• Hypertension is a major cause of premature death worldwide.
• One of the global targets for non-communicable diseases is to reduce the prevalence of hypertension by 33% between 2010 and 2030.

What is Blood Pressure?

Blood pressure is the pressure of blood pushing against the walls of your arteries. Arteries carry blood from your heart to other parts of your body.

Narrow arteries(Blood vessels), create more resistance for blood flow. The narrower your arteries are, the more resistance there is, and the higher your blood pressure will be. Over the long term, the increased pressure can cause health issues, including heart disease.

Causes of High Blood Pressure

Although the exact cause is unknown, certain conditions, traits, or habits may raise your risk for the condition. These are known as risk factors. The more of these risk factors you have, the greater your chance of developing HBP

• Non-modifiable risk factors: Age, family history/genetics, and ethnicity (African Americans and non-white Hispanic Americans have a higher risk).
• Modifiable risk factors: Excessive alcohol consumption, sedentary lifestyle, high sodium intake, smoking/drug abuse, and emotional stress.
• Other conditions contributing to hypertension: Aldosteronism, end-stage renal disease, thyroid disease, obstructive sleep apnea, and certain medications.

Diagnosis of High Blood Pressure

The best way to diagnose HBP is to have it measured. A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers.

• Systolic blood pressure (the top number) indicates how much pressure your blood is exerting against your artery walls during heartbeats.
• Diastolic blood pressure (the bottom number) indicates how much pressure your blood is exerting against your artery walls while the heart is resting between beats.

Blood pressure measurements fall into four general categories. The American Heart Association’s guidelines are as follows:

• Normal blood pressure: A reading of less than 120 (systolic) and 80 (diastolic)
• Elevated blood pressure: A reading ranging from 120 to 129 (systolic) and below 80 (diastolic)
• Stage 1 hypertension: A reading ranging from 130 to 139 (systolic) or 80 to 89 (diastolic)
• Stage 2 hypertension: A reading ranging from 140 or higher (systolic) or 90 (diastolic)
• Hypertensive crisis (consult your doctor immediately): A reading higher than 180 (systolic) and/or 120 (diastolic)

Requirements for Obtaining an Accurate Blood Pressure Reading

1. Use validated automated monitors or, if not available, calibrated aneroid devices.

2. Measure blood pressure in a quiet place.

3. Follow the protocol below:

— Don´t have a conversation. Talking or active listening adds up to 10 mmHg

— Support arm at heart level. Unsupported arm adds up to 10 mmHg

— Put the cuff on bare arm. Thick clothing adds up to 5-50 mmHg

— Use correct cuff size. Cuff too small adds up to 2-10 mmHg

— Support feet. Unsupported feet adds up to 6 mmHg

— Keep legs uncrossed. Crossed legs adds up to 2-8 mmHg

— Have empty bladder. Full bladder adds up to 10 mmHg

— Support back. Unsupported back adds to mmHg

Symptoms of High Blood Pressure

1. Headaches: Frequent or persistent headaches, particularly in the morning, can be a symptom of hypertension.
2. Dizziness or lightheadedness: Feeling dizzy or lightheaded, especially when standing up quickly, maybe a symptom of high blood pressure.
3. Blurred vision: Hypertension can sometimes cause vision problems or blurred vision.
4. Chest pain: Chest pain or discomfort may occur in some individuals with high blood pressure, particularly during physical exertion.
5. Shortness of breath: Difficulty breathing or shortness of breath can be a symptom of hypertension, especially during physical activity.
6. Fatigue or weakness: Feeling excessively tired, weak, or lacking energy can be associated with high blood pressure.
7. Irregular heartbeat: Hypertension can sometimes lead to an irregular heartbeat or palpitations.
8. Nosebleeds: While not a common symptom, some people with hypertension may experience frequent nosebleeds.
9. Flushing or facial redness: Episodes of facial flushing or redness can be a sign of elevated blood pressure.
10. Swelling: Swelling, particularly in the ankles or feet, can occur due to hypertension-related complications, such as fluid retention.

It’s important to note that hypertension is often referred to as the “silent killer” because it typically doesn’t cause noticeable symptoms until it reaches severe or life-threatening levels.

Therefore, regular blood pressure screenings are crucial, especially for individuals with risk factors such as a family history of hypertension, obesity, a sedentary lifestyle, or certain medical conditions.

Treatment of High Blood Pressure

The treatment of hypertension typically involves a combination of lifestyle modifications and, in some cases, medication. The specific approach may vary depending on the individual’s blood pressure levels, overall health, and any underlying conditions. Here are some common approaches:

Lifestyle Modification-

• Dietary Changes: Adopt a balanced diet, such as the DASH (Dietary Approaches to Stop Hypertension) diet, which emphasizes fruits, vegetables, whole grains, lean proteins, and low-fat dairy products while limiting sodium intake.

• Weight Management: Achieve and maintain a healthy weight through a combination of healthy eating and regular physical activity.

• Regular Exercise: Engage in aerobic exercise (such as brisk walking, jogging, cycling) for at least 150 minutes per week, or as advised by your healthcare provider.

• Sodium Restriction: Limit sodium intake to 1,500-2,300 milligrams per day or as recommended by your doctor.

• Limit Alcohol Consumption: Moderation is key. Limit alcohol intake to moderate levels (up to one drink per day for women and up to two drinks per day for men).

• Stress Management: Find healthy ways to manage stress, such as relaxation techniques, exercise, hobbies, or counseling.

Medications:

• Thiazide Diuretics: Often prescribed as the initial medication for most people with hypertension, these diuretics help the kidneys eliminate sodium and water from the body, reducing blood volume.

• Angiotensin-Converting Enzyme (ACE) Inhibitors: These medications help relax blood vessels by blocking the production of angiotensin II, a hormone that constricts blood vessels.

• Angiotensin II Receptor Blockers (ARBs): Similar to ACE inhibitors, ARBs work by blocking the effects of angiotensin II, leading to blood vessel relaxation.

• Calcium Channel Blockers: These medications prevent calcium from entering the muscle cells of the heart and blood vessels, thereby reducing their contraction and promoting relaxation.

• Beta-Blockers: These medications reduce the heart rate and decrease the force of heart contractions, resulting in lower blood pressure.

• Other Medications: In some cases, additional medications like alpha-blockers, central agonists, renin inhibitors, or vasodilators may be prescribed.

• Regular Monitoring: Regularly monitor your blood pressure at home or during doctor’s visits to track your progress and adjust treatment if necessary.

It’s important to follow your healthcare provider’s guidance regarding medication usage, dosage, and potential side effects. Hypertension is a chronic condition, and long-term management is necessary to control blood pressure and reduce the risk of complications.

Prevention of High Blood Pressure

Preventing hypertension involves adopting a healthy lifestyle and managing risk factors. Here are some strategies to help prevent hypertension:

• Maintain a Healthy Weight: Aim for a body mass index (BMI) within the normal range (18.5-24.9). Losing weight if overweight or obese can significantly lower the risk of developing hypertension.

• Follow a Balanced Diet: Adopt a diet rich in fruits, vegetables, whole grains, lean proteins, and low-fat dairy products. Limit processed foods, saturated fats, and cholesterol. The DASH (Dietary Approaches to Stop Hypertension) diet is specifically designed to help lower blood pressure.

• Reduce Sodium Intake: Limit your daily sodium intake to no more than 2,300 milligrams (about 1 teaspoon of salt). Be mindful of hidden sources of sodium in processed foods, canned soups, condiments, and restaurant meals.

• Increase Potassium Intake: Include potassium-rich foods like bananas, oranges, spinach, sweet potatoes, and tomatoes in your diet. Potassium helps counteract the effects of sodium and lower blood pressure.

• Limit Alcohol Consumption: Stick to moderate alcohol consumption, which means up to one drink per day for women and up to two drinks per day for men. Excessive alcohol intake can raise blood pressure.

• Engage in Regular Physical Activity: Aim for at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous exercise per week. Physical activity helps lower blood pressure and improves overall cardiovascular health.

• Quit Smoking: Smoking increases blood pressure and damages blood vessels, making hypertension more likely. Quitting smoking has numerous health benefits, including lowering blood pressure.

• Reduce Stress: Chronic stress can contribute to hypertension. Practice stress management techniques such as meditation, deep breathing exercises, yoga, or engaging in hobbies and activities you enjoy.

• Limit Caffeine Intake: While the relationship between caffeine and blood pressure is still debated, it may affect some individuals. Monitor your caffeine consumption and consider reducing it if you notice a significant increase in blood pressure.

• Regular Health Check-ups: Get regular check-ups and screenings to monitor your blood pressure, cholesterol levels, and overall health. Detecting and treating any underlying health conditions promptly can help prevent or manage hypertension.

It’s important to remember that prevention is key, and adopting these healthy habits can significantly reduce the risk of developing hypertension. However, it’s always advisable to consult with healthcare professionals for personalized advice and guidance on preventive measures.

References

• World Health Organization (WHO)
• https://www.paho.org/pt/hearts-nas-americas/hearts-americas-blood-pressure-measurement
• https://www.cdc.gov/bloodpressure/about.htm#:~:text=high%20blood%20pressure%3F-,What%20is%20blood%20pressure%3F,and%20falls%20throughout%20the%20day.