The ‘silent killer’ approaches on stealthy, quiet feet

Commonly referred to as “the silent killer”, high blood pressure (or hypertension) often has no symptoms and greatly increases the risk of heart attack and stroke.

South Africa has the highest prevalence of hypertension in southern Africa, and also has the largest number of people whose blood pressure is still not controlled, even while on treatment

National Stroke Week – marked from Sunday October 8 to Saturday November 3, and World Stroke Day, which was on Monday October 29, are considered vital to raise awareness of the link between hypertension and stroke.

The biggest risk factor for having a stroke, according to The Heart and Stroke Foundation of South Africa, is high, uncontrolled blood pressure.

“It is estimated that about 30.4%, or one in three adults in South Africa, have high blood pressure,” says Dr Martin Mpe, president of the Southern African Hypertension Society.

“According to South Africa Demographic and Health Survey (SADHS) of 2016, there may be even higher prevalence, of around 46% in females and 44% in males above the age of 15 years.”

Dr Mpe explains that there are several factors contributing to high blood pressure, which can be divided into two categories.

“Essential high blood pressure has no established cause, and accounts for more than 95% of cases of high blood pressure. Secondary high blood pressure, on the other hand, has an underlying cause. This includes kidney disease, hormonal problems and disease of the aorta.”

“South Africa has seen an exponential growth in hypertension over the last 20 years,” says Professor Brian Rayner, nephrologist and director of the Hypertension Institute at the University of Cape Town.

“It’s a national health emergency, but because the links between high BP and death, heart disease and stroke are indirect, public awareness is poor.”

In addition to strokes, heart attacks, and heart and kidney failure, hypertension is also related to dementia and sexual dysfunction.

These problems can be prevented if they are well treated and controlled. Professor Rayner stresses that all adults should have their blood pressure measured regularly.

“Getting tested is easy and painless. It’s advisable for everyone to get their blood pressure checked at least once a year,” he says.

One high blood pressure reading is not enough for a diagnosis of hypertension and additional tests may be needed. “Most people will have higher readings when under physical or emotional stress. Blood pressure should be measured when you are relaxed and rested,” according to Dr Mpe.

Professor Neil Poulter, president of the International Society of Hypertension, and a speaker at the 34th World Congress of Internal Medicine 2018 (WCIM) in Cape Town, says that lifestyle is a key factor in the prevention and management of hypertension.

“Generally, people who have high blood pressure also have some of the other risks for heart disease and stroke, such as not getting enough physical activity, having unhealthy eating habits, using too much salt, smoking, being overweight or drinking too much alcohol. Eating lots of fresh fruit and vegetables, as well as aerobic exercise, are highly recommended,” says Professor Poulter.

Adherence to treatment, which includes taking medication, following a diet, and making lifestyle changes as recommended by a healthcare provider, is extremely important.

Unfortunately, the data show that adherence to medication for chronic diseases is about 50%, which means that only half of patients who should be taking life-saving medication actually do so.

“The bad news is that less than half of patients diagnosed with high blood pressure have their condition under control,” says Professor Rayner.

“Many patients with hypertension are prescribed medication to help lower blood pressure levels, but may fail to take them properly.

“Not taking blood pressure medications as prescribed drastically increases stroke risk in patients with hypertension. Considering that high blood pressure can be diagnosed very easily and controlled with lifestyle and medication, this is a situation that needs to be addressed urgently.”

He stresses that if medication is prescribed as part of treatment, it is important to take your pills exactly as directed.

“Even if you feel well, you still need to take your medicine. It is impossible to feel the damage that could be occurring inside of your body until it is too late,” he says.

The best way to diagnose high blood pressure is to have your blood pressure checked. Your doctor, local pharmacy or clinic can all assist you with blood pressure tests.

In South Africa, more than one in three adults live with high blood pressure, and it is responsible for one in every two strokes, and two in every five heart attacks.

Blood pressure is the physical pressure of blood in the blood vessels. It is similar to the concept of air pressure in a car tyre. It goes up and down with different normal daily activities, such as exercise or having a conversation.

In adult years, weight and blood pressure are closely related. When weight goes up, blood pressure tends to go up. We can lower blood pressure by losing weight.

A common blood pressure might be 120/80 (120 over 80). The higher pressure (120) represents the pressure in the arteries when the heart beats, pumping blood into the arteries.

This pressure is called systolic pressure. The lower pressure (80) represents the pressure in the arteries when the heart is relaxed between beats. This pressure is called diastolic pressure.

Along with medication, making lifestyle changes helps to achieve the best possible results. Changes to lifestyle such as weight loss, reduced salt intake, reduced alcohol consumption or exercise are often the first line of treatment.

If these approaches don’t return blood pressure to acceptable levels, then drug treatment is usually required.

There are various definitions of high blood pressure but most doctors consider blood pressure of 140/90 and greater to be high.

High blood pressure is more common in older people, and those who are overweight. However, high blood pressure can affect young, thin people with no family history, so no one is immune.

Left unchecked, high blood pressure will over the years cause damage to the blood vessels of the heart and brain that leads to heart attacks and strokes.

It also places extra strain on the heart, causing thickening of the heart muscle and heart failure and it damages the kidneys and can lead to kidney failure.