Increase in blood pressure (BP) beyond what is considered normal is called Hypertension. Hypertension is one of the most common diseases, and can affect almost every organ of the human body. Hypertension is increasingly being diagnosed at a much younger age now, and far more people report poorly controlled blood pressure even on being multiple medications. Here I outline a few basic aspects related to BP/Hypertension that everyone should be familiar with.
1. Hypertension typically stays for life. Its possible to control BP just by lifestyle and behavioral modifications in some cases, but that shouldn't make someone believe that they don't have 'Hypertension' anymore. Few patients stop their medications or fail to keep up with healthy habits once their blood pressure gets under control. This can be a risky practice since BP will likely rise in almost all such cases, and to dangerous levels in certain people.
2. BP is intricately related to daily salt intake. A low-salt diet is a key to Hypertension management, and high salt intake remains one of the most common causes of sub-optimal BP control. Healthy subjects who don't have Hypertension should avoid excess salt consumption, and people with diagnosed Hypertension should avoid it altogether. Scientific recommendation of fewer than 2 grams of salt per day is effective but can be difficult to achieve. It's important to note that salt alternatives have a similar effect on BP and should be avoided as well.
3. Medicines for Hypertension don't cause addiction. There is a widespread concern that BP medicines themselves cause addiction and once you get on, it's difficult to get off. BP medicines don't cause addiction. The reason why someone can't get off medicines is because the moment medication effect wears off, BP starts rising. It's not because medicines made it so, its because the body had a tendency to increase the blood pressure, the reason why BP medicines were started in the first place. Having said that, medicines are safe only if used appropriately. This means the choice of a particular drug may be optimal for one patient while sub-optimal for someone else. This is why self-medication for Hypertension can be harmful. Also, few Hypertension medicines require regular follow up with basic blood tests, doctor's visit etc.
4. BP medicines are very safe. Commonly used treatment options for Hypertension had been extensively studied in humans and are found very safe. In an otherwise healthy individual, these medicines rarely cause a major side effect. The benefit to risk ratio of such medicines exceedingly favors its long-term clinical use.
5. People may have Hypertension for years and may not know about it. Basics of blood pressure can be found here. While extremely high blood pressure (sBP >180-200) can cause acute heart attack, stroke (paralysis), kidney injury, eye injury etc., moderately elevated blood pressure may not produce any overt symptoms. Most people lead a normal life while elevated BP continues to injure a body's organs in the background. Its only after years when organs are injured to a threshold that symptoms start showing up. Lucky people report to the hospital/doctors before a permanent injury. In such cases, intricate BP control may reverse organ dysfunction. If not addressed in time, permanent multi-organ damage may occur.
6. Hypertension is a dynamic condition. Blood pressure fluctuations occur even among people who have been taking medicines for Hypertension religiously. Such fluctuations can be due to change in the body's homeostasis mechanisms or progression of the disease itself. It is paramount for people with Hypertension to check their BP regularly, and follow up with their doctors periodically to address any change from previous.
7. Yoga is very helpful. In fact, any form of meditation or calming exercise helps to reduce the blood pressure. One has to understand though that such modalities are complementary, not supplementary.
8. Management approach to Hypertension needs to be comprehensive. Simply doing one thing and ignoring others is destined to give a sub-optimal result. Listed below are components of 'comprehensive' care:
(a) Low salt diet
(b) Regular exercise
(c) Stress management: Yoga, meditation, recreational activities, socialize etc.
(d) Good sleep hygiene
(e) Active weight management: Aim for BMI of 18-25.
(f) Medicines aimed at bringing down the blood pressure to its goal
(g) Address medical conditions that aggravate blood pressure: Obstructive Sleep Apnea, Thyroid issues etc.
(h) Evaluate for secondary causes of high BP: There is a long list for this. A professional opinion of a cardiologist or an Internal Medicine physician is advisable.
(i) Avoid medicines that precipitate high blood pressure: Common ones are painkillers, nasal drops/sprays etc.
9. Blood pressure reading at home often is more reliable than that of a doctor's visit. This has to do with the human body's physiology. Our body is programmed to increase the blood pressure or heart rate at times of stress or anxiety. White Coat Hypertension refers to a condition where a person's BP is elevated only during a doctor's visit. While physiologically, blood pressure taken at home is more reliable, often the technique may not be optimal, giving rise to faulty readings.
Best practices on how to ensure optimal home blood pressure recording are listed here.
Please ask any related questions on this topic and I will be glad to add those to this list.