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            The Aga Khan University Hospital Pakistan

High Blood Pressure: A Review of Facts

<p>​<em>An Opinion Article by Dr. Hunaina Shahab</em></p><div>A 50 year old man named Aziz (not his real name) felt that his ears were burning and had dull pain at the back of his head. He thought this was because of high blood pressure (BP) so he immediately checked his reading which was 170/70 mmHg. He went to a local doctor who gave him a medication under his tongue after which he felt very dizzy. </div><div>
</div><div>It is important for everyone to know what high BP is and how to treat it. Hypertension or high BP is defined by the Pakistan Hypertension League Guidelines and the NICE Guideline for Hypertension (UK) as a systolic reading of more than 140mmHg and/ or a diastolic reading of more than 90mmHg. High BP causes organ damage like heart attack, stroke, kidney failure, vision loss and early death. It is common for people to check their BP readings when they have headache or some general discomfort, however high BP does not cause any symptoms until there is some organ damage therefore it is known as a “silent killer”. </div><div>
</div><div>High blood pressure is not diagnosed based on one reading taken at any random point of the day. The correct way to check BP is through a proper protocol. The patient has to be sitting relaxed on a chair with a back rest, in a quiet room for 5 minutes with his/ her arm supported at heart’s level. The patient should not be speaking during the time the reading is being measured and should be wearing loose sleeves. Only a validated upper arm BP apparatus with a correct cuff size must be used. Too big or too small size of the cuff causes incorrect readings. Intake of food, tea, coffee and smoking may affect BP values. Multiple readings are to be taken over the course of many clinic visits to make a correct diagnosis of high BP.</div><div>
</div><div>Blood pressure readings naturally vary throughout the day so small fluctuations in the readings are common. If home BP check is advised by the doctor, two readings are to be taken before breakfast with 1 minute gap in between and two readings to be taken before dinner for 1 week. The doctor must be informed of these home BP readings. Time of the day is important as morning readings can only be compared with morning readings whereas night readings can only be compared with night readings. The blood vessels in the body change tone throughout the day affecting BP values. It is important to check BP readings only when asked by the doctor. Checking BP very frequently causes unnecessary anxiety. </div><div>
</div><div>Due to the phenomenon called the ‘white-coat effect’, about a third of patients increase their blood pressure in the medical environment in the presence of a physician. Another entity is ‘masked hypertension’ when the patients have lower BP in the doctors clinic but higher BP at home. This makes clinic BP check unreliable. Therefore, newer BP guidelines are recommending the use of a 24 hour Ambulatory Blood Pressure Monitor to confirm the diagnosis of high BP. This is a device which is attached with the patient and takes BP readings for the entire length of the day and gives an accurate diagnosis. Over treatment of falsely high BP causes fatigue and even fainting. The use of medication under the tongue to rapidly reduce BP is harmful and should be avoided.</div><div>
</div><div>Correctly diagnosed high BP needs treatment with medications. All patients are advised diet and lifestyle changes such as use of low salt foods, increased intake of fruits and vegetables, regular exercise and weight loss. Smoking and tobacco use must be stopped. These steps can naturally reduce BP by 5 to 20mmHg. If medications are advised by the doctor, they must be taken daily as advised. </div><div>
</div><div>This World Hypertension Day, it is important to raise awareness of the importance of high blood pressure. The National Health Survey of Pakistan has reported that every third person above the age of 45 years has high blood pressure and most of the people have uncontrolled disease. The number of people with high blood pressure is increasing in Pakistan therefore early diagnosis and correct treatment is important to reduce the burden of damage caused by high BP.</div><div>