Traditionally, someone who suffered from hypertension – or high blood pressure – would only receive treatment when his or her blood pressure was measured and the reading was found be higher than normal. But this meant that the condition was often picked up only when the person had a stroke or a heart attack – and in many instances this was too late.
As a result of this, the thinking on when to treat hypertension has changed in the past few years. Research has shown that hypertension should not only be diagnosed on the basis of one blood pressure reading, as this reading could vary and be raised by other triggers such as stress.
Instead, doctors make use of a risk assessment tool that measures the overall cardiovascular risk of a patient. The tool estimates the risk that a person faces over the next ten years of having a heart attack.
They do this by looking at the risk factors patients are exposed to: what is their age and gender? Do they smoke? Are they overweight or obese and do they have high cholesterol levels or diabetes? The tool determines a patient’s risk of developing cardiovascular disease in the next ten years and guides doctors on whether or not they should prescribe high blood pressure treatment to reduce the patient’s risk.
This is because hypertension rates and associated risky lifestyle behaviours are on the rise – especially in the developing world.
Globally about 22% of adults over the age of 18 suffer from hypertension, according to statistics from the World Health Organisation in 2014. But in Africa, this figure is higher and sits at 30%.
In South Africa, 28% of the adult population suffers from hypertension compared with 23% in Brazil and 25% in China. And among adults older than 50 the rate of hypertension is as high as 70%.
Hypertension is one of the leading causes of cardiovascular diseases such as stroke, heart attacks, heart failure, peripheral vascular disease and kidney disease.
Why treatment methods have changed
The challenge with hypertension is that there are usually no warning signs or symptoms for someone suffering from hypertension. Hypertension is often referred to as the “silent killer”, as a heart attack or a stroke may be the first warning sign.
But patients do classically have a combination of other risk factors. These include having an unhealthy diet, not exercising, and smoking and drinking too much. And it is the effects of these behavioural risk factors that may show up in patients as hypertension, raised blood glucose, raised cholesterol, and being overweight and obese.
As a result, it is estimated that in South Africa only 26% of men and 51% of women are aware that they suffer from hypertension.
The research shows that in South Africa hypertension is the leading reason that people seek help from primary care facilities such as clinics. It is also the most common diagnosis in primary care in the country.
Changing your lifestyle can help
Treating hypertension is not only about taking tablets. Someone with raised blood pressure can also reduce it by changing their behaviour. There are several guidelines that should be followed:
Reduce salt intake as it raises blood pressure. The South African government has recently legislated salt intake, ruling that salt content in common foods such as bread should be reduced. As an extra measure, people should not add extra salt to their food and avoid very salty processed foods such as packet soups, stock cubes or gravies.
Lose weight. People who are overweight or obese have a higher risk of suffering from hypertension. The key is to eat healthily, exercise and reduce meal portions. Instead of large amounts of starchy food, fruit and vegetable intake must be increased and fatty foods and sugar reduced.
Drink less. Alcohol also increases blood pressure so it is important to only drink in moderation. Men should not exceed two drinks a day and women one drink a day.
Exercise more. At least 150 minutes of exercise a week translates into 30 minutes a day, which raises the heart rate.
Smoke less. A person who smokes can reduce their cardiovascular risk further by cutting down or stopping smoking altogether.
Even when patients are on treatment for hypertension it is still important for them to try to change their behaviour as this reduces the amount of medication they need to control their blood pressure.
But most importantly, diagnosis is important. Many people are unaware of their cardiovascular risk and raised blood pressure. People should check their blood pressure at least once every five years to ensure that it is normal. This can be done at a clinic or even a pharmacy.
Bob Mash, Division of Family Medicine and Primary Care, Stellenbosch University and Zelra Malan, Senior Lecturer, Division of Family Medicine and Primary Care, Faculty of Medicine and Health Sciences, Stellenbosch University