[TDMC]-HYPERTENSION

Introduction

Hypertension is commonly nicknamed the “Silent Killer”. This is because it reportedly kills around 7.5 million people worldwide and it is not easy to detect this disease. The only well-known method is to check a person’s blood pressure. The common symptoms are normally not detectable by the common people and only a professional doctor is able to detect them from an early onset. According to the World Health Organization, an average of 1.13 billion people worldwide suffer from hypertension all the time.

Abdul-Razak et al., (2016) have also stated that Malaysia in 2011 ranks first in the prevalence of hypertension with 32.7% which is in comparison with Singapore which is 26.6%, Indonesia 20%, and Thailand which has 20.5%. Another study was done in 2019 by Mohd Isa also stated that according to the latest National Health and Morbidity Survey, the percentage of hypertension among adults in Malaysia was 30% which is equivalent to around 6.1 million citizens with 17.2% of the previously undiagnosed before. This indicates that more than half of the hypertension patients were unaware of this disease.

As a result, reducing the prevalence of hypertension by 25% by 2025 (baseline 2010) has become one of the global targets in the world for non-communicable diseases. This article will attempt to simplify the definition of hypertension, the recurring symptoms, various factors that cause hypertension, the myriad types of medicinal and non-medicinal treatments, and will also recommend several lifestyle changes to the global issue of hypertension in the population.

Firstly, Hypertension is defined as a serious elevated blood pressure which is a major medical condition that significantly increases the risks to the heart, brain, kidney, and others (WHO, 2020). Hypertension is when the systolic blood pressure (SBP) is detected to be 140 mmHg or greater or it’s when the diastolic blood pressure (DBP) is detected of 90 mmHg or more (Md Isa, 2021).

Placement of Systolic and Diastolic in the blood pressure meter

Other Symptoms of hypertension includes:

• Severe headaches
• Nosebleed
• Fatigue or confusion
• Vision problems
• Chest pain
• Difficulty breathing
• Irregular heartbeat
• Blood in the urine
• Pounding in your chest, neck, or ears
• Leads to scarring of the kidneys because of extra pressure on the kidney’s filtering units. (Web MD, 2020)

Causes

1) Sodium Intake

Dietary sodium and its association with hypertension have been explored extensively in the past. The relationship between sodium intake and blood pressure has been recorded in numerous cross-sectional studies and experimental studies have studied the effects of changes in sodium intake. The result is that when sodium absorbs too much water.

In Malaysia, this is a huge problem as Malaysian food from the rural side tends to contain high levels of salt in a variety of food forms, such as salted egg, salted fish and pickled fruits, and condiments, such as pickled fish (pekasam), shrimp paste (belacan), pickled anchovies (budu), fermented shrimps (cencalok) and fermented durian (tempoyak) (Md Isa, 2019).

2) Dietary Intake

According to Md Isa 2019, more than 25% (27% to 35%) of the respondents least once a week consume tempoyak, soy sauce, chili sauce, and oyster sauce as part of their diet. In addition, salt per se is not only used for cooking food but is often applied directly to food as a condiment. In comparison to these findings, according to another INTERSALT study, urban rather than rural populations were reported as having higher salt intake and tend to have the highest percentage of hypertension.

3) Stress

As the human body perceives stress, the adrenal glands in the body make and release the hormone cortisol into the bloodstream. Cortisol is known as the stress hormone because it causes an increase in heart rate and blood pressure. It does this by releasing a large amount of glucose into the body’s muscles for immediate use. It causes the “flight or fights” human response that has kept humanity alive for thousands of years It does this by inhibiting insulin production so the glucose is not stored. Cortisol also narrows the arteries and another hormone epinephrine increases the heart rate. They work together to confront and resolve the immediate threat. And in the long term, it leads to hypertension because of the constant high blood pressure.

Taken from Premier Health, 2017

4) Lifestyle

Despite having better awareness and treatment rates compared to young adult men, BP control rates of young adult women who were on treatment (whether lifestyle advice or medication) were slightly lower than their counterparts, contrasting with results from other studies ( Zhang Y & Moran AE, 2017). There could be several reasons for this disparity in results. First, with lifestyle modification alone, there is evidence that BP control is worse in women than in men (Wenger NK, Arnold A, Bairey Merz CN, Cooper-DeHoff RM, Ferdinand KC & Fleg JL, 2018). Next, with regard to medication use, the female gender may be a risk factor for adverse effects or diminished clinical responses to antihypertensive drugs (Ueno K & Sato H, 2012), which may in turn lead to poorer treatment compliance and hence poorer BP control in the long term.

5) Being more than 40 years old

Those who are more than 40 years of age and had only primary education were significantly at 3.32 times and 12.3 times greater the risk of contracting hypertension, respectively.

6) Other causes

According to World Health Organisation 2020, a diet high in saturated fat and trans fats, low intake of fruits and vegetables, physical inactivity or a sedentary lifestyle, consumption of tobacco and alcohol, and being overweight or obese also leads to hypertension.

Table of Treatment

Type of Medication (ABCD)	Medications	Effects	Side Effects	Suitability
ACE inhibitors   ( ACEI/ ARBS)	(ACEI) Lisinopril (Prinivil, Zestril), Benazepril (Lotensin)     (ARBS)   Candesartan (Atacand)    Losartan (Cozaar)	-Diabetes- protects kidneys   -Congestive heart failure- improves Ejection fraction- improves survival rate   -Connection tissue disease (Scleroderma)- protects kidneys   –Post MI pericarditis (Dressler’s Symptoms)- improves survival rate	-Angioedema- tongue swelling   -Cough (ACEI)- 30% of the patient’s -Hyperkalemia   -Hyponatremia   -Bilateral renal artery stenosis that is contraindicated- Problems with the creatinine in the renal artery stenosis.	Young- whoever has uncontrolled blood pressure   Caucasian- white
Beta blockers	Dalal   Metoprolol   acebutolol, atenolol (Tenormin)	-Congestive heart failure- improve Ejection fraction- improves survival rate   -Post MI pericarditis (Dressler’s Symptoms)- improves survival rate	-Heart rate to go down   -Increase lipids and cholesterol -Increase chances of asthma if there is history in patients -Bronchospasm- COPD   Increase potassium	Young- whoever has uncontrolled blood pressure   Caucasian- white
Calcium Channel Blockers	Dihydropyridine- all medications that end with dipine. (Eg: Nifedipine, methedipine, amlodipine, felodipine,       Non Hydropyridine -Delta – Verapamil   Diltiazem (Cardizem, Tiazac)		1) Dihydropyridine these medications cause vasodilation   Heart rate becomes higher or stays the same   Exception is amlodipine which makes the heart rate become lesser and is good for ischemic heart disease.       2) Non-Hydropyridine -Cause reduction in inotrope -Reduces contractility of the heart     Other side effects: -edema in the lower extremities   -Constipation -Heart failure	African American, Elderly
Diuretics- decreases potassium	Hydrochlorothiazides     Lasex- furosemide     Chlorthalidone, hydrochlorothiazide (Microzide)	–	1)Hydrochlorothiazide   is an ascending limb diuretic- that will increase calcium levels -Increases uric acid -Increases lipids -Increase glucose   -Increases creatinine   -Cause hypotonic hyponatremia     -Reduce Sodium concentration       2) Lasex   -decreases calcium levels   -decreases potassium levels -Increases creatinine to cause renal failure   -Causes frequent urination	African American, Elderly

Non-Medicinal Treatment

Population studies have shown that those who take part in potassium-rich diets, vegetables, fruit, and low-fat dairy products (including whole grains, poultry, fish, and nuts) have lower mean arterial blood pressure.

Exercise

Regular and adequate levels of physical activity in adults are key contributors to energy expenditure and are essential for energy balance and weight control (Chan, et al., 2017). It also reduces abdominal obesity and results in favourable changes in body composition (Paley & Johnson, 2018). Abdominal obesity was also associated with a higher incidence of development of risk factors related to cardiovascular diseases (Barosso, et al., 2017). A study was done by Cornelissen, et al, (2013) showed exercise was a successful intervention in reducing the blood pressure of the hypertensive subjects (p<0.05).

Regular Sleep

Sleep is the natural body’s method to process and eliminate the stress hormones that are known to raise pressure. Without restful sleep, the hormone levels remain high which causes inflammation. This, in turn, can cause blood vessels to narrow and leads to high blood pressure. The average adult is recommended to sleep 7 to 8 hours to avoid this.

According to Martha Jefferson Hospital Sleep Medicine Center, W. Christopher Winter, sleeping on the left side reduces hypertension because it relieves pressure on the blood vessels that are found on the right when they return to the heart. This is in adverse to sleeping on the right side which increases pressure on these vessels, and slows down the individual’s blood circulation.

(By: Sensor GEL, 2018)

What is being done to cure hypertension?

Malaysia initiated its Salt Reduction Programme in 2011 with an emphasis on health promotion and education to raise awareness of salt and its health impacts on the general population. The 2012 study found that the mean salt consumption was 8.7 grams/day, or equal to 3.4 grams of sodium/day, which was higher than the WHO recommendation.  The current WHO guideline for dietary sodium intake is < 2 grams per day (equivalent to <5 grams per day of salt).

Conclusion

This high prevalence of hypertension is consistent across the world, irrespective of income status, i.e. in lower, middle, and higher-income countries (Chow CK, Teo KK, Rangarajan S, Islam S & Gupta R ,2013). Hypertension becomes progressively more common with advancing age, with a prevalence of >60% in people aged >60 years (Chow CK, Teo KK, Rangarajan S, Islam S & Gupta R ,2013) & (European Society of Hypertension-European Society of Cardiology Guidelines Committee. 2003). As populations age, adopt more sedentary lifestyles and increase their body weight, the prevalence of hypertension worldwide will continue to rise. It is estimated that the number of people with hypertension will increase by 15% or 20% by 2025, reaching close to 1.5 billion (Kearney PM, Whelton M, Reynolds K, Muntner P & Whelton PK , 2005).

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