Are You Living With The Silent Killer?

I would like to start this podcast by telling you a story about a friend of mine who recently had a health scare –I’ll call him AJ. AJ has always believed that his blood pressure was normal but a few weeks ago he suffered a mild stroke and the doctor who examined him, after he was admitted to hospital, told him that his blood pressure was very high. Fortunately, it does not sound as if any lasting damage was done and I’m happy to report that AJ is on the mend. Importantly, he is now committed to modifying his lifestyle and getting his blood pressure under control.

I share this story because it illustrates the ‘silent’ nature of hypertension or high blood pressure. High blood pressure has been termed ‘a silent killer’ because it often does not have easily detected symptoms, and yet it is a very serious condition associated with heart attack, stroke, heart failure and end-stage kidney disease. It is one of the major diseases associated with a cluster of conditions known as the metabolic syndrome.

Know Your Numbers

The 17th of May has been designated as World Hypertension Day in an effort to create awareness about this very serious health risk factor. The is what the International Society for Hypertension have to say about the 17th of May: “The purpose of the WHD is to promote public awareness of hypertension and to encourage citizens of all countries to prevent and control this silent killer, the modern epidemic. The theme for World Hypertension Day is Know Your Numbers with a goal of increasing high blood pressure awareness in all populations around the world.” High blood pressure is defined as any blood pressure measurement exceeding 140/90 mm Hg. The cut-off for people with other chronic diseases such as diabetes, will be much lower with most guidelines suggesting a target of not more than 130/80 mm Hg

About 40% of South African adults aged between 35 and 65 years old are believed to have high blood pressure and about 130 people, most of whom are women, die each day from high blood pressure associated causes. Black South Africans are particularly at risk.Of those South Africans with high blood pressure, only about 21% of males and 36% of females are on treatment using medication. Of these, only 10% of males and 18% of females have their blood pressure controlled. In other words, although 40% of a large portion of the population has high blood pressure, very few have it under control.

Children Are Not Immune to High Blood Pressure

Sadly our children are not immune from having high blood pressure. In a recent South African study conducted in children aged between 13–17 living in Mthatha in the Eastern Cape, the researchers found that 21.2% of the children in this age group had high blood pressure and 12.3% had what they termed ‘pre-hypertension’. In other words, while they did not meet the mark for classical high blood pressure, they were well on their way to developing the condition.

Research show that 95% of high blood pressure is idiopathic, i.e. the primary cause of the condition is unknown. Oxidative stress resulting from high levels of blood sugar, which in turn fuels insulin resistance, appears to be a major contributor to the condition.

Getting blood pressure under control is almost entirely dependent on self-care and not medical care. Most of the global disease burden is associated with aberrant health behaviours. Added to this are emotional factors, including anxiety, stress and fear, the severity of symptoms, personal beliefs and the beliefs of significant others. Research reveals that the successful management of most chronic conditions, including hypertension, is dependent on patient-centred self-management, or self-care, rather than on provider-centred care. Evidence shows that between 80–95% of chronic disease-related health outcomes are determined by patients’ health-related behaviours. The key role of healthcare providers in managing blood pressure is to help people acquire tools and skills to care for themselves. People with high blood pressure should not be passive recipients of care, but rather be empowered to actively engage with all aspects of their care, including identifying needs, setting goals and discussing strategy.

Lifestyle Modification Is Key

While there are a number of very effective medications available to treat high blood pressure, medication should never be the first port of all for this chronic disease of lifestyle. Lifestyle modification is key in normalising blood pressure. And we can start with our diet .Eliminating fructose, sugar and other refined carbohydrates from the diet goes a long way in the fight against this ‘silent killer.’ The popular low fat Dietary Approaches to Stop Hypertension or DASH diet has been shown to improve blood pressure control. A 2015 study that compared the low fat DASH diet with a higher fat version showed that the higher fat version was as effective in lowering blood pressure but better in reducing blood fats and improving cholesterol particle size.

After diet comes exercise. This what the world famous Mayo Clinic have to say on the subject of high blood pressure and exercise. “Regular physical activity makes your heart stronger. A stronger heart can pump more blood with less effort. If your heart can work less to pump, the force on your arteries decreases, lowering your blood pressure. Becoming more active can lower your systolic blood pressure — the top number in a blood pressure reading — by an average of 4 to 9 millimeters of mercury (mm Hg). That’s as good as some blood pressure medications. But to keep your blood pressure low, you need to keep exercising on a regular basis. It takes about one to three months for regular exercise to have an impact on your blood pressure.

The benefits last only as long as you continue to exercise. Aim for at least 30 minutes of aerobic activity most days of the week. Also, if you sit for several hours a day, try to reduce the amount of time you spend sitting. Research has found that too much sedentary time can contribute to many health conditions. Aim for five to 10 minutes of low-intensity physical activity — such as getting up to get a drink of water or going on a short walk — each hour. Consider setting a reminder in your email calendar or on your smartphone.”

Prevention Is Better Than Cure

Remember the best way of dealing with this silent killer is never to let it into your life. Prevention is possible and lifestyle modification is the most cost-effective way of preventing high blood pressure. If you would like more information or some help or if you have any comments relating to this podcast, please email me at askdrhill@upforit.co.za.

Till next time, stay healthy & safe. I’m Dr Peter Hill for UpForIt.