Hypertension

January 1, 2021

6 min read

Hypertension is a silent killer and if not regulated properly leads to various cardiovascular diseases and eventually death. Hypertension is a more prevalent chronic condition than diabetes and it is surprisingly more common even among young adults in India according to a nationally representative study of 1.3 Million individuals¹.

The hypertension prevalence estimates were higher in younger Indians compared to those of Central and Eastern Europe. This unexpected high prevalence of hypertension in India which if ineffectively treated leads to higher rates of cardiovascular diseases in the future².

There are many risk factors for the development of hypertension which are modifiable such as

consumption of food containing too much salt and fat, and not eating enough fruit and vegetables
harmful levels of alcohol use
physical inactivity and lack of exercise
poor stress management.
being overweight or obese.

Non-modifiable risk factors include a family history of hypertension, age over 65 years, and co-existing diseases such as diabetes or kidney disease.

Lifestyle modifications have shown a significant impact on lowering blood pressure, thereby improving the effectiveness of antihypertensive drugs and reducing the risk of developing cardiovascular diseases³.

A healthy lifestyle for patients with hypertension includes eating healthy, being physically active, avoiding the harmful use of alcohol, quitting smoking, and managing stress. Apart from this, a balanced diet with low salt intake is highly recommended for hypertensive individuals⁴. In most countries, the average intake of salt per person is between 9 to 12 grams per day which is too high for a normal⁵.

WHO recommends that adults should consume less than 2 grams of sodium or 5 grams of salt per day⁶.

Severe hypertension can cause fatigue, nausea, vomiting, confusion, anxiety, chest pain, and muscle tremors whereas uncontrolled hypertension leads to complications such as

Chest pain (also called angina)
Heart attack, which occurs when the blood supply to the heart is blocked and heart muscle cells die due to lack of oxygen. The longer the blood flow is blocked, the greater the damage to the heart.
Heart failure, which occurs when the heart cannot pump enough blood and oxygen to other vital body organs.
An irregular heartbeat (can lead to sudden death).

Hypertension can also burst or block arteries that supply blood and oxygen to the brain, causing a stroke. Besides over a period of time hypertension can cause kidney damage, leading to kidney failure⁷.

Modest salt reduction leads to a decrease in blood pressure levels. A meta-analysis conducted by He and Mac Gregor assessed the effect of modest salt reduction on blood pressure reduction with a duration of more than 4 weeks. A total of 17 trials in hypertensive subjects and 11 trials in non-hypertensive subjects were done. After assessing the blood pressure it was found that in hypertensive subjects there was a decrease in systolic pressure by 5.0 mm Hg and diastolic pressure by 2.7 mm Hg. Whereas, in non-hypertensive subjects, the systolic blood pressure was decreased by 2.0 mm Hg and diastolic pressure decreased by 0.3 mm Hg⁸.

In a randomized controlled study conducted by Edgar et al 44 patients with hypertension and obesity were subjected to a low calorie, low sodium diet for 9 weeks and followed. The result was a decrease in mean body weight by 4.5kgs and an overall reduction in the blood pressure levels⁹.

The Dietary Approaches to Stop Hypertension (DASH) study evaluated the effects on blood pressure of three dietary patterns a control diet that was similar to a traditional American diet, a diet high in fruit and vegetables, the DASH diet, which was higher in fruits, vegetables, and low-fat dairy products and lower in total fat, saturated fat, and cholesterol. However, there was no change in sodium intake, physical activity, and body weight. After a review, it was found that both test diets lowered blood pressure compared to that of the control diet and the DASH diet reduced the systolic and diastolic pressure by 8 and 6 mm Hg respectively¹⁰.

In two randomized controlled trials conducted to evaluate the efficacy of multiple lifestyle modifications such as sodium reduction, weight loss, the DASH diet, and regular physical activity it was found that at the end of 9 weeks there is a net reduction in 24-hour ambulatory systolic and diastolic blood pressure by 9.5 and 5.3 mm Hg and changes in daytime systolic and diastolic blood pressure by 12.1 and 6.6 mm Hg, respectively¹¹.

Normal ranges for blood pressure as per WHO¹².

Category	SYSTOLIC mm Hg	DIASTOLIC mm Hg
Normal	120-129	80-84
Elevated	130-139	85-89
High Blood Pressure (Stage 1)	140-159	90-99
High Blood Pressure (Stage 2)	160-179	100-109
High Blood Pressure (Stage 3)	>180	>110