Garth Rattray
SANOFI-AVENTIS MEDICAL representative, Mrs. Janet McConnell, informed me that Saturday, May 13 is World Hypertension Day. It is the brainchild of the World Hypertension League, WHL (formed in 1984, now with 92 supporting members). The WHL emphasises ';treatment to goal' and methods of maintaining compliance. For their part, Sanofi-Aventis plans to 'sensitise the general public on the importance of early detection, prevention and control of hypertension' through the distribution of printed material and the sponsoring of a radio interview on matters of hypertension.
Twenty-five-and-a-half per cent of Jamaican adults (35 to 64 years-old) is hypertensive. It is estimated that of that number, at least thirty per cent do not know that they have this dangerous disease and 30 per cent of those being treated are poorly controlled. Hypertension is a major contributor to cardio-vascular disease, which remains our number one killer.
Blood pressure is the pressure that the blood exerts on the walls of the arteries as the heart beats, and, barring any other medical condition(s), the lower your blood pressure, the healthier and longer you will live. Blood pressure is expressed as the systolic (the top reading) over the diastolic (the bottom reading).
The seventh report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure (JNC 7) states the optimal adult blood pressure as a systolic below 120 millimetres of mercury (mm/Hg) and a diastolic below 80. A systolic of 120 to 139 mm/Hg and a diastolic of 80 to 90 mm/Hg is considered pre-hypertensive and signals a need for lifestyle changes. Readings above those are indicative of frank hypertension.
NO CAUSE FOUND
In over 90 per cent of hypertensive patients, no cause can be found. This is called 'primary' or 'essential' hypertension. Secondary causes of hypertension (some of which are treatable) are renal, endocrine, vascular, respiratory, chemical and psychological (stress). In hypertension, from whatever cause, the excessive pressure exerted against the walls of the arteries causes pathological (harmful) changes that lead to atherosclerosis (hardening). Since blood vessels go everywhere, the list of serious morbid conditions that emanate from untreated or uncontrolled high blood pressure is frightening. Hypertension increases your risk of getting a stroke four-fold and the risk of cardiovascular disease rises with higher levels of blood pressure. High blood pressure is the number one cause of kidney failure in Jamaica (61 per cent). Additionally, hypertension can lead to an enlarged heart and eventual heart failure, serious eye damage, arterial aneurisms, peripheral vascular disease and impotence in men.
Most people wait for a headache or some other symptom that they attribute to high blood pressure (like fatigue, confusion, nausea, dizziness, visual problems, palpitations, nosebleeds or ringing in the ears) before seeking medical help or before taking prescribed medications. But by that time, a lot of damage has probably already been done.
The trouble with hypertension is not the disease, it is that patients often do not get themselves checked, investigated, adhere to lifestyle changes or take their medications every day. Loathing pills or living in denial of a hypertensive state is suicidal. It is tantamount to throwing caution to the wind and running out into a busy roadway without looking.
Treatment for hypertension includes lifestyle changes (quitting smoking and weight reduction - if needed, relaxation, reduction in salt and fat intake, high-fibre diet and regular exercise). Medications used to control hypertension include diuretics (to flush out excess fluids and sodium), alpha-blockers, beta-blockers, angiotensin converting enzyme inhibitors, angiotensin II receptor blockers and calcium channel blockers.
It's dangerous to ignore hypertension because it may not ignore you. This easily identifiable and treatable disease should not remain such a significant cause of mortality and morbidity.
Dr Garth A. Rattray is a medical doctor with a family practice.
