Research shows that for a man in his 40s:
This all sounds rather frightening, but the good news is that early diagnosis and treatment can control your blood pressure and keep you healthy. It is vitally important that your hypertension is well controlled, by taking your tablets exactly as prescribed. A number of relatively simple dietary and lifestyle changes can also help to reduce the risk of high blood pressure, lower a BP that is already raised and reduce the risk of complications such as coronary heart disease. If these changes were to reduce your diastolic BP by as little as 5 mmHg, they would decrease your risk of coronary heart disease by 16 per cent, and if they succeeded in reducing your average blood pressure by 10 mmHg, this would reduce your risk of premature death by as much as a third. You really can eat to beat the unwanted effects of high blood pressure.
UNDIAGNOSED HYPERTENSION
Ideally, all adults should have their blood pressure measured regularly, at least once every three years, or more often as your doctor recommends. If your blood pressure is found to be high, you will have it measured several times before your doctor decides whether or not to prescribe any anti-hypertensive drugs. This is to make sure your blood pressure remains consistently high and is not just going up as a result of visiting the surgery. Once you start taking blood pressure treatment, you may be on it for life – but you will probably live longer as a result.
Unfortunately, an estimated one in two people with high blood pressure are undiagnosed, and of those that are picked up and treated, at least another half do not have acceptable blood pressure control. This is mostly because the condition rarely makes you feel ill, and having to take one, two or even three tablets per day to treat something that is not an illness, but a risk factor for other diseases, is understandably frustrating. However, early diagnosis and successful treatment of high blood pressure is vital for continued long-term health.
Types of High Blood Pressure
Ninety per cent of people with high blood pressure, have no obvious single cause and are said to have primary, or essential, hypertension. The remaining one in ten people with high blood pressure have an identifiable underlying factor, such as kidney problems, a hormone imbalance or drug side-effects, and are said to have secondary hypertension.
Malignant hypertension refers to the most dangerous type of high blood pressure in which pressures go very high, often very quickly. This can damage internal organs over a short period of time and is sometimes also referred to as accelerated hypertension. It is treated as a medical emergency because if diastolic pressure remains above 120 mmHg for a prolonged period of time, the linings of small blood vessels (arterioles) are damaged and start to leak. When looked at under the microscope, the blood vessel walls have literally started to crumble (fibrinoid necrosis). This lets protein-rich fluid, and sometimes whole blood, seep out of the blood stream to build up in the tissues. As well as interfering with blood supply to that part of the body, the leakages cause damage, inflammation and scarring – commonly to the kidneys, backs of the eyes and in the brain. This is known as target organ damage. Damage to the kidneys also results in the release of hormones that put the blood pressure up even more, so a vicious cycle builds up. Treatment aims to bring BP down slowly over several days so that the body can adjust to lower pressures again.
To differentiate it from malignant hypertension, primary high blood pressure is often referred to as benign essential hypertension.
Refractory hypertension refers to high blood pressure that does not respond to standard first-line anti-hypertensive drug treatments. Although this is uncommon, referral to a specialist is needed so that investigations and treatment with other drugs can be started.
CHAPTER 2 Causes, Diagnosis and Treatment of High Blood Pressure
Blood pressure naturally tends to rise with age, so that high blood pressure is more common in middle life and beyond. Some people, especially males, may develop it in their 20s or even earlier, however. Blood pressure is also known to vary with race – those of African origin tend to have higher blood pressures than Caucasians, for example.
Causes of Essential Hypertension
Several factors are thought to be involved in the development of primary, or benign essential hypertension. These include inherited factors (high blood pressure runs in some families), developmental factors (occurring during embryonic life in the womb) and environmental factors such as diet and lifestyle, which you can address to help lower a high blood pressure.
INHERITED FACTORS
Essential hypertension is thought to result from inherited genes that may trigger high blood pressure as a result of one or more abnormalities involving:
Researchers have already identified a gene that may be able to predict your future risk of hypertension. People who have inherited the angiotensinogen gene (T235) from both parents have double the risk of developing high blood pressure and coronary heart disease compared to those who do not have the gene variant, or who inherit it only from one parent.
DEVELOPMENTAL FACTORS
Fascinating research has suggests the way you develop during the first few weeks of life as an embryo may affect your future risk of high blood pressure and other cardiovascular diseases in adult life. This is probably linked with lack of micronutrients (vitamin and minerals) in the mother’s diet, which affects the way your arteries are laid down. Researchers have found, for example, that: