For many years, generations of Nigerian doctors, led or taught by Prof. Oladipo Akinkugbe, have been raising the alarm about the dangers of cardiovascular or heart diseases, focusing on the treatment of hypertension or high blood pressure, which is the focus of this article. It is now universally acknowledged that high blood pressure has been on the increase in the last 50 years or so, due partly to dietary changes, especially increased consumption of sodium (salt) and sugar, and partly to lifestyle changes, especially prolonged sedentary jobs and lack of physical exercise.
Blood pressure is the force of blood pushing up against the blood vessel walls. The higher the pressure, the harder the heart has to pump. When your blood pressure is persistently high, your heart falls sick. Over time, it may fail, resulting in (sudden) death. That’s why you should see your doctor as soon as possible, even when you think you do not have high blood pressure. You may well be among those people (about 33 per cent or so) who go about their lives without symptoms of high blood pressure, even when the condition is present.
Two initial steps are necessary...
(1) You need to understand what exactly is meant by high blood pressure. (2) You need to know how to recognise it when it is present. In regard to (1), high blood pressure is a condition in which the arteries have persistently elevated blood pressure. The arteries are the “pipes” through which the heart pumps blood to the whole body each time it beats. We speak of high blood pressure when the force of blood pushing against the walls of the arteries is higher than normal.
The normal level for blood pressure is below 120/80, where 120 represents the peak pressure in the arteries and 80 represents the minimum pressure in the arteries. The peak measurement is known as systolic and the minimum, diastolic. When your blood pressure is between 120/80 and 139/89, you are in the prehypertension stage, which means that you have an increased risk of high blood pressure. However, when your blood pressure is 140/90 or above, and stays that way, you are considered hypertensive. It means that your blood pressure is too high, and you must treat it as a serious disease.
However, as stated in the opening paragraph, a high blood pressure reading may sometimes be spurious. That’s why you must see a doctor, especially a cardiologist, for a determination of your heart health and courses of treatment, rather than treat yourself on the basis of a generic description or prescription. It must be remembered that individuals vary widely in the pre-existing conditions they bring to the same disease. Besides, there are many other diseases of the heart that may not manifest as high blood pressure, just as high blood pressure may sometimes reflect your level of stress, anxiety, physical exertion, or something other than an ailing heart.
As a result, your doctor will need to evaluate you properly beyond the blood pressure reading in order to determine the range of factors responsible for your condition. This will require your full medical history and a physical examination. If high blood pressure is truly suspected, tests such as electrocardiograms (EKG) andechocardiograms will be used to measure the electrical activity of the heart and assess its physical structure. Additional blood tests will also be required to identify possible causes of high blood pressure and to measure renal function, electrolyte levels, sugar levels, and cholesterol levels.
Although the exact causes of high blood pressure may be unknown, there are many factors associated with the condition. They include genetic inheritance; obesity (overweight); diabetes; chronic kidney disease; high levels of salt intake; high levels of alcohol consumption; smoking; sedentary lifestyle; lack of physical exercise; insufficient calcium, potassium, and magnesium consumption; Vitamin D deficiency; stress; aging; smoking; high cholesterol; adrenal or thyroid problems or tumours; and certain medications, such as birth control pills.
These factors must be distinguished from the symptoms or signs of high blood pressure. They include: Severe headaches; chest pain; irregular heartbeat, especially palpitations involving abnormally rapid heartbeat; breathing problems; dizziness; nausea; fatigue; confusion or loss of consciousness; blood in the urine; and sudden changes in vision, speech, sensation, coordination, or strength.
The question now is: What do you do if you are diagnosed with high blood pressure? There are two courses of treatment, depending on the severity of your condition. In many cases, both courses are recommended. First, there is the medical course of treatment, which involves medication. There are several classes of drugs available for reducing high blood pressure, namely, ACE inhibitors, ARB drugs, beta-blockers, diuretics, calcium channel blockers, alpha-blockers, and peripheral vasodilators.
Rather than provide a list of specific medications here, I will advise that you see your doctor, because, as they say, there are different courses for horses, and different horses for courses. Patients react differently to the same drug and therefore need different drugs or drug combinations. That’s why your doctor must know your medical history and the pre-existing health conditions in order to determine which of the various blood pressure medications or combinations is good for you.
The second course of treatment is a combination of dietary and lifestyle changes. Important dietary changes include reducing sodium intake, limiting alcohol consumption, and eating a healthful diet, featuring green leafy vegetables, carrots, and foods rich in calcium, potassium, and magnesium. Important lifestyle changes include losing weight, exercising regularly, reducing stress levels, and quitting smoking.
Changes in diet and lifestyle may be all that is needed for those in the prehypertension stage to avoid full blown hypertension. It is also advisable for those who currently have normal blood pressure to note this course of treatment. Adherence to it may prevent the occurrence of high blood pressure, unless other medical conditions trigger it. However, those who already have full blown hypertension will need to combine dietary and lifestyle changes with appropriate medications.
Perhaps unrecognised by many women is the fact that they have a higher risk of cardiovascular disease than men if they have high blood pressure. This is because there are significant differences in the mechanisms that cause high blood pressure in women, compared with men.This is due to physiological differences in the cardiovascular systems of the women, which include levels and types of hormones involved in regulating blood pressure.
Recent research has shown that these factors can affect the severity and frequency of heart disease in women. This has implications for pharmaceutical companies and doctors who must figure out the treatment regimes appropriate for this vulnerable population, without raising suspicions of gender discrimination in treatment.
One final note: Nigerians are notorious for abandoning treatment once they begin to feel better. If you do so with the treatment of high blood pressure, you may suddenly drop dead. That’s why it is important to follow through on both courses of treatment, especially if you have full-blown hypertension. Indeed, for many such patients, it may be necessary to take medication throughout their lives.
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