Hypertension Through the Eyes of a Doctor

As I do almost every day, I usually see between 75 and 100 patients at my clinic. Many of them are farmers and labourers who spend long hours doing physically demanding work on estates. They come for treatment for all kinds of illnesses. However, it is very rare for someone to visit the clinic specifically to have their blood pressure checked. In fact, some of the patients who come to the clinic have never had their blood pressure measured before… Checking the blood pressure of every single patient is certainly not an easy task. However, no matter how long it takes, I check every patient’s blood pressure because, as a doctor, I understand very well how serious and dangerous hypertension can be. Some people experience no pain or discomfort at all when they develop high blood pressure, or hypertension. However, if it is not detected early and treated appropriately, the condition can end in a major tragedy.

What Happened That Night—Something I Will Never Forget…

Let me tell you a story that shows just how much destruction high blood pressure, or “pressure” as we commonly call it, can cause. Although this incident happened a long time ago, I still cannot forget it. During my internship, I worked at a very busy hospital. I had many night shifts each week. One night, a schoolteacher named Mrs Silva, who was in her early forties, was suddenly admitted to the ward. One side of her body had become paralysed, and she had collapsed inside her home. Her two children—a seven-year-old son and a fifteen-year-old daughter—stood helplessly beside her. There was overwhelming fear in both children’s eyes. After examining Mrs Silva, and before proceeding with further treatment, we performed a CT scan of her brain. What we saw on the scan was not encouraging. Years of uncontrolled hypertension had caused a haemorrhagic stroke, or bleeding within the brain, and a large amount of blood had accumulated in her brain. Although it was difficult to accept, we had to acknowledge that there was only a very small chance of saving Mrs Silva’s life. My goodness, the hardest task for me was telling those two little children the news. Mrs Silva’s son, who was too young even to understand the seriousness of the situation, looked at me and asked, “Doctor aunty, will our mother get better?” His older sister was old enough to understand a little more. I could see her tightly holding her brother’s hand and trying to remain strong. Fate can be terribly unfair. Their father had died some time earlier, and their mother was the only parent they had left. Unfortunately, despite our best efforts, we were unable to save Mrs Silva’s life. In the end, those two helpless children were left without either their father or their mother. I still remember how they stood holding hands, their hearts filled with fear and grief, unable to understand what had happened. Whenever I speak to a patient about hypertension, I can still picture the faces of those two children. I tell this story to my patients while checking their blood pressure because I hope that hearing it will encourage them to take their health more seriously.

What Exactly Is Hypertension?

Hypertension occurs when blood is pushed through the blood vessels at an abnormally high pressure over a prolonged period. There are two main types of blood vessels in our body. One type is called the arteries. Arteries carry blood pumped from the heart to the organs of the body. Veins, on the other hand, return blood from the body’s organs and tissues back to the heart. Blood is then pumped from the heart to the lungs, where it becomes oxygenated. When blood pressure is high, the increased pressure can cause the arteries to narrow, lose their elasticity, and become strained. In addition, this can contribute to the formation of blood clots and damage to the arterial walls. When the arteries become narrowed, the heart has to work harder to pump blood. If this continues over time, it can lead to serious health complications. Think of the arteries in your body as being like a hose used to water flowers. If the water pressure becomes too high, the hose may swell and begin to leak. If the problem is not identified and repaired, the hose may eventually burst. The same thing can happen to the arteries when hypertension is left untreated. This condition can contribute to numerous health problems, including heart attacks and kidney damage.

What Are the Different Blood Pressure Categories?

You may have noticed that blood pressure is written as two numbers. · Systolic pressure (the upper number): This represents the pressure exerted against the walls of the arteries when the heart contracts and pumps blood out during a heartbeat. · Diastolic pressure (the lower number): This represents the pressure within the arteries when the heart relaxes between two heartbeats. According to the American Heart Association, blood pressure can be divided into the following categories.

Blood Pressure Category	Systolic (mm Hg)	Diastolic (mm Hg)
Normal	Less than 120	Less than 80
Elevated blood pressure	120–129	Less than 80
Stage 1 hypertension	130–139	80–89
Stage 2 hypertension	140 or higher	90 or higher
Hypertensive crisis	Higher than 180	Higher than 120

Persistently elevated blood pressure is a warning sign that danger may be close at hand. Medication is not always required for stage 1 hypertension, but lifestyle changes are necessary. Stage 2 hypertension requires appropriate medical treatment. If blood pressure rises to a very high level—reaching the level of a hypertensive crisis—it is extremely important to seek medical advice immediately.

Causes of Hypertension

Hypertension can be divided into two types: primary hypertension and secondary hypertension.

Primary Hypertension

Most patients have primary hypertension. It can develop gradually over many years due to a variety of factors. Some of these factors are listed below.

• Genetic factors: If someone in your family has hypertension, you are more likely to develop it as well. Certain genetic mutations can also contribute to hypertension.
• Age: As we grow older, the arteries lose their elasticity and become stiffer. Therefore, people over the age of 65 are more likely to develop hypertension.
• Ethnicity: Researchers have shown that, because of genetic and cultural factors, people of African or Black ethnicity are more likely to develop hypertension.
• Lifestyle: A sedentary lifestyle involving prolonged sitting and little physical activity increases the risk of hypertension. In addition, consuming foods high in sodium, being overweight or obese, and drinking excessive amounts of alcohol can contribute to hypertension.

Secondary Hypertension

There are several specific causes of secondary hypertension.

• Kidney disease
• Sleep apnoea, which simply means interruptions in breathing during sleep
• Congenital heart defects, meaning heart abnormalities present from birth
• Disorders involving the thyroid or adrenal glands
• Some medications can cause hypertension as a side effect.

Secondary hypertension may develop suddenly. In such cases, treating the underlying cause of the elevated blood pressure may allow the blood pressure to return to a normal level.

Symptoms of Hypertension

Hypertension is often called the “silent killer” because it usually causes no symptoms. Many people only discover that they have hypertension when their blood pressure is checked during a medical visit for another illness. However, symptoms may occur when blood pressure becomes extremely high. In such situations, symptoms may include:

• Severe headache
• Nausea or vomiting
• Visual disturbances
• Chest pain
• Difficulty breathing

How Hypertension Affects the Body

As I mentioned earlier, hypertension is particularly dangerous because it may not cause any symptoms at all. If it is not properly treated, serious health problems can develop over time. Let us look at how hypertension can affect the organs of the body. Arteries: Hypertension can damage the inner lining of the arteries. This reduces their elasticity, increases their stiffness, and restricts blood flow. Heart: When blood pressure rises, the heart must pump blood with greater force, increasing the risk of heart disease and heart attacks. Kidneys: Damage to the arteries can reduce the blood supply to the kidneys and may eventually lead to kidney failure. Brain: Hypertension can cause a stroke and may also impair cognitive functions such as thinking, memory, and perception. Eyes: High blood pressure can damage the blood vessels in the eyes and may lead to loss of vision.

How Is Hypertension Diagnosed?

Diagnosing hypertension is relatively straightforward. If blood pressure readings remain consistently high, this may indicate that the person has hypertension. Because blood pressure can vary depending on many factors, it is very important to measure it correctly. A single high blood pressure reading is not enough to diagnose hypertension. In such cases, doctors usually measure the blood pressure over several days or weeks and make a diagnosis based on the pattern of readings. In addition, a 24-hour ambulatory blood pressure monitor can provide a clearer picture of how the patient’s blood pressure rises and falls throughout the day and night. Mobile applications have also recently been developed to help record and monitor blood pressure. Some patients become anxious when they visit a hospital or see a doctor. This anxiety itself can cause their blood pressure to rise. This is known as white-coat hypertension. In such patients, blood pressure can be measured at home.

What Treatments Are Available for Hypertension?

When a patient has hypertension, the first recommendation a doctor usually makes is to introduce lifestyle changes. However, when blood pressure is significantly elevated, lifestyle changes alone may not be sufficient. In such situations, medication may be required to control the hypertension.

Let Us Look at the Medications Used to Treat Hypertension.

• Beta-blockers: These reduce blood pressure by slowing the heart rate and reducing the force of contraction.
• Diuretics, or water tablets: These help remove excess water and salt from the body.
• ACE inhibitors: These block the action of certain chemicals that cause blood vessels to narrow.
• Calcium channel blockers: These relax the blood vessels and make it easier for blood to flow.

What Can You Do Every Day to Lower Your Blood Pressure?

People like Mrs Silva in our story may be able to control their blood pressure by making a few small lifestyle changes. The following are some ways to reduce blood pressure without medication.

• Follow a healthy diet: Try to eat a diet rich in vegetables, fruits, whole grains, and protein. Following the DASH diet, which stands for Dietary Approaches to Stop Hypertension, is beneficial for heart health.
• Exercise regularly: Physical activity helps keep the heart healthy. Doctors generally recommend approximately 150 minutes of exercise each week.
• Maintain a healthy weight: Even a small reduction in body weight can make a significant contribution to lowering blood pressure.
• Minimise alcohol consumption and avoid smoking: Alcohol can increase blood pressure, while smoking damages the arteries.
• Reduce sodium intake: Limiting salt intake can also help control blood pressure.

Let Us Look at a Few Tips for a Healthy Life.

If you are at risk of developing hypertension, it is very important to take steps to prevent it. By changing a few small habits, it is possible to maintain a healthy heart and reduce your risk of disease. What can you do?

• Include at least four servings of fruit and five servings of vegetables in your daily diet.
• Limit sugary foods and drinks as much as possible.
• If someone in your family has hypertension, or if you have other risk factors, it is worthwhile to have your blood pressure checked regularly.
• Managing stress through practices such as meditation and yoga is also important.

So, Remember These Important Points

Hypertension does not have to become a silent killer. Regular monitoring, a balanced diet, regular exercise, and a healthy lifestyle can help control high blood pressure. I often tell my patients, “It is still not too late to take care of your heart.” If Mrs Silva had understood that blood pressure was more than just a number, she might still be with her children today. Even now, whenever I measure a patient’s blood pressure, I remember the events surrounding Mrs Silva. I can still remember how the hope disappeared from her children’s eyes when I gave them the devastating news about their mother. My only purpose in sharing Mrs Silva’s story is to help at least one more person understand that blood pressure is not something that should ever be taken lightly. That is why I continue to remind every patient that health is a journey that must be approached with vigilance, care, and understanding. By following these small steps, we can protect not only our own lives but also the lives of the people we love. written with the help of Sithmi Vihangika