DR VIKRAM DALVI
Systemic hypertension (often known as hypertension, high blood pressure, or simply BP, by patients) is a silent killer. If untreated, it causes damage to several organs, including the heart, brain, kidneys and eyes.
A cuff wrapped around the arm is commonly used to test blood pressure. The doctor or machine inflates it, and the pressure is gradually reduced while listening to sounds on the anterior surface of the elbow (a method called auscultation) or feeling pulsations (a method called oscillometry).
Pressure is measured in millimetres of mercury. The reading has two numbers: the higher is systolic pressure (when the heart contracts and pushes blood out) and the lower is diastolic pressure (when the heart relaxes and takes blood in for the next beat).
HOW IS HIGH BLOOD PRESSURE DETERMINED?
The person being evaluated should be physically and emotionally relaxed and well-hydrated. Blood pressure should be checked while the individual is sitting. In a sitting position, normal blood pressure is less than 120/80. Prehypertension: 120-140/80-90 mmHg
Stage 1 hypertension: 140-160/90-100 mmHg: It should be confirmed on two different occasions.
Stage 2 hypertension: more than 160/100.
WHAT ARE THE DIFFERENT TYPES OF HYPERTENSION?
Primary/essential hypertension: There is no single cause for high blood pressure. It normally develops as people get older.
Secondary hypertension is caused by other diseases, such as hyperthyroidism, renal artery stenosis, pheochromocytoma, etc.
DOES ONE HAVE TO TAKE BLOOD PRESSURE MEDICATION FOR THE REST OF ONE'S LIFE?
Primary hypertension patients typically require medications for the rest of their lives. However, regular exercise and maintaining a healthy body weight and BMI (Body Mass Index) close to 23 can help reduce medication dosage.
Secondary hypertension normally resolves once the underlying cause of high blood pressure is treated, such as thyroid disease treatment or pheochromocytoma excision.
SHOULD ONE DISCONTINUED MEDICATION ONCE BLOOD PRESSURE IS NORMAL?
The reading will be normal because medicine is being administered. If you stop taking the medication, your blood pressure will rise again.
Only if your blood pressure is less than 110/70, or a side effect of the medication is identified, will your doctor reduce or discontinue it.
WHY DON'T SOME PEOPLE FEEL ANY NEGATIVE EFFECTS WHEN THEIR BLOOD PRESSURE IS HIGH?
There is a wide range of interpersonal differences. Some patients have no symptoms even when their blood pressure is 200/120, while others get headaches and dizziness even when their blood pressure is 150/90.
However, regardless of symptoms, any pressure above 140/90 slowly damages the internal walls of the arteries over time.
CAN ONE BECOME HABITUATED TO BP MEDICINES?
Your BP needs to be kept under a certain level. If you allow your blood pressure to remain high by avoiding medications for fear of becoming addicted, this will cause lasting damage.
Long-term research has shown that regulating blood pressure using medication on a long-term basis has a high benefit-risk ratio. So you are not becoming accustomed to the medication but require it to control your blood pressure. Habituation is when you desire a chemical to make you feel good even when you don't need it.
DOES BLOOD PRESSURE MEDICATION HAVE A LOT OF SIDE EFFECTS?
Like any other medicine, blood pressure medicines also have certain side effects. Most of the time, these side effects are reversible after stopping the medicine. Despite the known side effects, controlling blood pressure is far more likely to give you a longer and more active life than not controlling your blood pressure.
Your doctor is the best person to tell you which blood pressure medication is optimal for you. Many times this depends on the additional conditions that a high BP patient has (eg, diabetes, heart disease, kidney diseases, paralytic attacks, excessively rapid heart rate, thyroid disease, etc)
IS HOME MONITORING WITH ELECTRONIC MACHINES OK?
These machines are not very accurate but are adequate for monitoring. They clearly show a trend. For better accuracy, it is better to get your machine crosschecked with your physician. If you are using a monitoring machine, the one that checks BP on the arm is preferable over the wrist-based machines. Don't be concerned if you receive different readings at different times on the same day. It is a natural occurrence.
SHOULD ONE BE CONCERNED ABOUT ONE CONCERNED ABOUT FLUCTUATIONS IN BP? FOR EXAMPLE, IF THE BP WAS 120/70 AT HOME BUT THE DOCTOR MEASURED IT AS 140/90.
Blood pressure is a variable metric. It varies from time to time. So, unless checked at the same time, there is a high chance that the readings will be different.
Secondly, there is a phenomenon called white coat hypertension where BP readings are high only in the doctor’s chamber. There is a test called 24-hour ambulatory BP monitoring that helps to diagnose this condition.
(Dr Vikram Dalvi is an internal medicine consultant at Manipal Hospitals, Goa.)