Every person needs blood pressure. Without it, blood can’t circulate through the body, giving vital organs much-needed oxygen and food. Under normal conditions, your heart beats about 60 to 80 times a minute. Blood pressure—or BP, as it is commonly known—rises with each heartbeat and falls when the heart relaxes between beats.
Like the air pressure in tires, blood pressure can change from minute to minute. The pressure in the tires depends on the temperature and whether the car is driven. Blood pressure changes with posture, exercise, sleep or even the level of the arm when blood pressure is measured.
A BP measurement has two numbers: The higher number (called systolic) represents the pressure when the heart contracts to start a heartbeat, while the lower number (known as diastolic) corresponds to the pressure when the heart relaxes between beats.
In the numbers game of hypertension, as it is known in medical profession, 120 over 80 is the goal. Anything above those figures can be unhealthy. As the numbers climb, so do the risks. Of the two numbers, the first one is more likely to predict trouble. When it reaches 140, doctors start prescribing medication.
“High blood pressure is not an illness in itself,” explained Dr. Robert Buckman, author of What You Really Need to Know About High Blood Pressure. Low blood pressure, or hypotension as it is called, is also not a medical problem. “By and large if your blood pressure is low, you are more likely to live a long, healthy life,” he said.
As stated earlier, BP changes through the day. It is lower at night when you are relaxing, when you are asleep and when listening to quiet music. BP goes up during the day, with exercise or exertion, smoking a cigarette when anxious, stressed or excited and in cold weather.
“Most people with hypertension feel perfectly well and do not experience any symptoms,” Dr. Buckman wrote. “However, it is important that it is treated, because if it stays raised for any length of time, it can damage the blood vessels and lead to serious health problems.”
Currently, 28 percent of Filipino adults have hypertension. Aside from middle-aged and elderly people, hypertension is also prevalent among obese people, heavy drinkers and women who are taking birth-control pills. People who have diabetes, gout or kidney disease are more likely to have hypertension than those who don’t, studies show.
Hypertension is also hereditary in nature. “High blood pressure runs in my family, so I was not surprised at all when my doctors put me on medication,” said Generoso Mortejo, a 35-year-old teacher. “I did, however, find it surprising that because of my age, even though the numbers showed that I had high blood pressure, they were reluctant to say I had it.”
Because of his family history, Generoso knew the dangers of hypertension. “I decided to take charge of my condition. I bought a monitor so I could check my blood pressure at home,” he said. “I had been told that my blood pressure was high because of the tension from my work, so I shouldn’t worry, but it was high at home, too. I knew that my condition was more serious than the diagnosis said it was.”
At Generoso’s next appointment, he discussed his condition in detail with his doctor. As they looked back over his chart and talked about the readings he had gotten at home, it became clear that he needed to go on medication.
“I was almost relieved,” he said. “I didn’t really want to be put on medication at such a young age, but I also didn’t want to suffer the consequences of not treating my condition.”
Generoso is just one of those 9 percent who know their condition. Studies have shown that 19 percent of those with hypertension are actually not aware that they have it, and these are the people that are most likely to suffer serious health problems.
Several doctors call hypertension “the silent killer” because it stealthily damages the heart, blood vessels, eyes and kidneys. Occasionally, if BP is high, people may experience headaches, dizziness and blurred eyesight.
“Hypertension is the leading risk factor for heart attack, or myocardial infarction,” wrote Dr. Julian Whitaker, author of Reversing Hypertension: A Vital New Program to Prevent, Treat, and Reduce High Blood Pressure. “A heart attack occurs when part of the heart’s blood supply is suddenly reduced or cut off; usually, due to a blockage in one of the coronary arteries supplying blood to the heart. The portions of the heart muscle that cannot get adequate oxygen and nutrients die. The more extensive the damage, the more serious the heart attack.”
Hypertension is the primary factor underlying strokes and stroke-related deaths. “Too much pressure can cause the bursting of a vessel—especially if that vessel has been weakened by age and the excess pressure of hypertension,” explained Dr. Whitaker.
“Hypertension also contributes to atherosclerosis and arteriosclerosis, the narrowing and stiffening of the arteries that increases the likelihood of blood clots cutting off blood supply,” Dr. Whitaker continued. “When either of these scenarios occur in an artery in the brain, the result is a stroke. There is a reduction in oxygen supply to that area of the brain, followed by cell degeneration and death.”
Hypertension also accelerates the aging of the kidneys. High blood pressure damages the arteries and arterioles that supply blood and nutrients to the kidneys. As these arteries become stiff and less elastic, blood supply to the kidneys is reduced or, in some cases, cut off, causing damage to the kidneys themselves.
“Severe high blood pressure causes kidney malfunction over a relatively short period of time; however, even milder forms of uncontrolled hypertension can damage kidneys over several years, with no evident symptoms until severe damage has already occurred,” Dr. Whitaker claimed. “Poorly controlled high blood pressure is responsible for approximately 25 percent of all cases of chronic kidney failure.”
What about the eyes? “High blood pressure does not seriously damage vision unless it is very high,” said Dr. Buckman. “However, abnormalities in the small blood vessels of the retina can be clearly seen, even in cases of mildly raised blood pressure. Extremely high blood pressure can cause hypertensive retinopathy, which can lead to blurred vision and blindness.”
A lesser-known outcome of hypertension is memory loss and an increased risk of dementia and Alzheimer’s disease. “It is believed that hypertension’s adverse effects on the brain are caused by the relentless pounding on the small vessels in the brain,” Dr. Whitaker wrote. The brains of patients with hypertension actually shrink—by as much as 20 percent, according to some studies.
There is a wide range of drugs that your doctor can prescribe to bring BP down. The aim is to find the particular drug or combination of drugs that lower BP to a safe level and prevent problems.
“The doctor tailors treatment to you as an individual, so do not be surprised if you find that you are taking completely different drugs from someone else with the same condition,” Dr. Buckman wrote.
Dr. Willie T. Ong, a medical consultant of the Makati Medical Center, said there are four classes of drugs to treat hypertension. “Once you have started treatment, you must return to your doctor for regular blood pressure checks,” he reminded.
Diuretics are the oldest, least expensive drugs available in the antihypertension arsenal. And, according to a recent study, they are the best starting point for lowering BP when a drug is needed.
“Diuretics are drugs that act on the kidney to increase urine flow,” explained Dr. Ta Kok Soon, senior consultant cardiologist at The Heart Specialist Clinic in Singapore. (Reducing the body fluid meant that there is less for the heart to pump around the body.) “Of the diuretics, the thiazides are the most commonly used. They are by themselves not very strong diuretics [promoters of urine] but are highly effective as hypertensive agents. They act, in the short term, by inducing the kidney to excrete more salt and by reducing blood vessel resistance in the longer term.”
Possible side effects of diuretics include loss of appetite, stomach upsets, dehydration, impotence, high cholesterol and calcium levels, allergic reactions, raised blood sugar and muscle weakness.
In certain cases, doctors prefer beta-blockers, which are also given to treat heart attack, angina, palpitations and migraine. Beta-blockers reduce the heart’s workload by preventing the stimulating effects of stress, slowing the heartbeat and reducing its force. This makes it easier for the heart to pump blood around the body.
The possible side effects of beta-blockers are light-headedness, cold fingers and toes, stomach upsets, depression, fatigue, nightmares, wheezing, drowsiness, weakness, visual disturbances, impotence, elevated blood sugar and insomnia.
For hypertensive patients with diabetes or heart failure, the ACE-inhibitors are a must (ACE stands for angiotensin converting enzyme). These drugs block the formation of the hormone angiotensin that causes the blood vessels to narrow.
Side effects of ACE-inhibitors include cough, skin rashes, wheezing, deterioration of kidney function, increase in blood potassium levels, loss of taste and swelling.
Calcium antagonists are the most powerful drugs at the doctor’s disposal. They reduce the amount of calcium in the muscular artery walls, relax muscles and cause arteries to widen. This leads to a drop in blood pressure. It also reduces the workload of the heart and cuts down its oxygen needs.
“All drugs which lower BP have almost similar effectiveness,” explained Dr. Abdul Rashid Abdul Rahman, a clinical consultant and associate at the Science University of Malaysia. “The main benefits of calcium antagonists are that they lower blood pressure rather more quickly than others and they also do it in a more predictable manner than some others.”
Calcium antagonists, however, are expensive drugs. Their side effects include flushing, headache, swollen ankles and wanting to urinate more frequently than usual. Rare side effects include fatigue, nausea, drowsiness, rashes, ringing in the ears, thickened gums and constipation.
According to Dr. Buckman, different people respond to drugs in different ways. “Diuretics and beta-blockers used to be the first-line treatment for high blood pressure, but are less frequently prescribed today,” he wrote. “Beta-blockers should never be stopped abruptly. The dose should be gradually reduced over several weeks.”
ACE-inhibitors and calcium antagonists, when taken in combination, seem to have a protective effect on organs such as the kidneys.
“Before leaving the doctor’s office, make sure you understand exactly what the drug has been prescribed for and what side effects can be expected,” Dr. Buckman advised. “Ask your doctor how many times a day you need to take the drug, and when and how it should be taken.”
Hypertension is now rampant in the Philippines. “Hypertension is truly a serious problem that requires more serious attention,” urged Dr. Esperanza Cabral, former president of the Philippine Society of Hypertension. “It’s no longer acceptable that just any doctor can treat any patient with hypertension. Many cases of hypertension are more complicated than they seem.”