Beware of the silent killer

One may wonder what all this fuss about high blood pressure is. Hypertension causes many cardiovascular diseases that include stroke, heart attack, kidney failure and dementia, thus putting a huge burden on healthcare globally due to morbidity, mortality and associated costs. Last but not least, the public need to be aware of the correct treatment for high blood pressure.

Every year, the World Hypertension Day is celebrated on the 17th of May to increase awareness about this silent killer among general public. International Society of Hypertension along with World Hypertension League has designated the month of May as "May Measurement Month."

The aim of this initiative is to screen as many people as possible that are over the age of 18 years for suspected hypertension. This strategy would greatly enhance in identifying silent or undiagnosed hypertensives so that they can be targeted with guideline directed lifestyle, dietary advice and treatment.

Awareness on the lower threshold of blood pressure reading required to label an individual as hypertensive is also required. American Heart Association guidelines released in 2017 clearly stipulate that a blood pressure reading of over 130/80 is now considered as stage 1 hypertension. However, the job of a cardiologist doesn't stop with diagnosis but actually starts there. Once someone is labelled as hypertensive, it needs to be established if it is true or an entity called white coat hypertension.

Furthermore, investigations may have to be carried out to see if hypertension is secondary to a cause. Once diagnosed, a decision needs to be taken if lifestyle modification can be adopted or treatment needs to be initiated early.

Lifestyle modifications include six key steps and they are:

• Get expert advice from your doctor to help you understand your results;

• Lower salt/sodium to prevent excess fluid in the blood, which strains blood vessels;

• Eat more fruits and veggies – particularly potassium-rich ones – to balance out sodium in the blood;

• Exercise – it makes the heart stronger, putting less strain on blood vessels;

• Quit smoking – constituents of tobacco smoke damages blood vessel linings; and

• Monitor your blood pressure at home

As per studies and data, thousands of people are on wrong treatment for hypertension with a class of drugs called Betablockers (Atenolol, Metoprolol etc) being prescribed as first line or second line agent.

Betablockers have been phased out as first line or second line drugs to treat hypertension a while ago, unless there is concomitant coronary artery disease or heart failure. In fact, the same holds for other concomitant conditions too such as kidney disease, stroke etc.

Essentially, the key message is one prescription does not fit all and it need to be tailored to the individual in a dedicated specialist clinic. People need to actively undergo blood pressure screening of themselves.

They need to nudge their relatives and friends in the month of May and seek expert advice on how to manage and monitor this silent killer over the long run to lead an active and healthy life. (Writer is Consultant Cardiologist, Citizens Hospitals, Nallagandla, Serilingampally)

By Dr Sudhir Koganti