Dr George Cloatre. — Photo courtery of Hanoi French Hospital

By Dr George Cloatre*

What is Hypertension?

Generally, high arterial blood pressure or hypertension is diagnosed when the top values are above 140mmHg and lower values above 90 mmHg.

• The top (first) number is the systolic pressure that measures pressure in the arteries when the heart contracts.
• The bottom number is the diastolic pressure that measures pressure in the arteries when the heart rests between each heartbeat.

It is a common condition and affects around 25-30 per cent of the adult population in the Western World, as well as in Việt Nam. High blood pressure is uncommon under the age of 40. Between the ages of 45-54 years, about a third of men and a quarter of women have high blood pressure. Over the age of 75 years, about two thirds of men and more than three quarters of women have high blood pressure.

Hypertension, especially when values are not very high, mostly goes unnoticed. Higher values could result in unexplained headaches, vertigo or palpitations. It is a chronic condition and an important public health problem worldwide.

Why does it matter, especially if I don’t have symptoms?

With blood vessels and heart under strain due to increased pressure,the heart and arteries can thicken and stiffen, developing a condition referred to as arteriosclerosis. Consequently, you are at an increased risk of serious health problems, such as heart attacks, transient ischemic attacks (TIA), stroke, heart failure, peripheral arterial disease, kidney damage, eye damage and dementia.

As hypertension is very often asymptomatic for a long time, all these complications can occur. This is why arterial hypertension is called a “silent killer”, emphasising the importance of regular blood pressure and health checks.

Lowering blood pressure by lifestyle changes and/or medicines reduces risks of all these conditions. If diagnosed and treated at an early stage, this improves prospects of living with good health to a ripe old age.

How is it diagnosed?

Three individual blood pressure measurements by a doctor on different occasions are necessary for the diagnosis.

The current diagnostic gold standard is the Ambulatory Blood Pressure Monitoring (ABPM), a small machine measuring blood pressure as you move around. It is normally carried over 24 hours, automatically measuring the blood pressure every half hour during the day and every hour during the night. This is followed by a consultation with the cardiologist for diagnosis and treatment plan, if any.

After starting blood pressure lowering medication therapy, you can continue to daily check your blood pressure at home with simple automated systems.

What is the reason for hypertension?

In 90 per cent of cases, the reason is unknown. This is when we talk about essential hypertension. The pressure in your blood arteries depends on how much resistance there is and how hard your heart needs to pump to push blood through them. A slight narrowing of the arteries increases the resistance to blood flow, which increases the blood pressure, but the reason for this narrowing is not clear.

In 10 per cent of cases, hypertension is caused by other conditions and is known as secondary hypertension. Examples of such conditions include coarctation of the aorta, adrenal tumours, chronic kidney disease and others. In some cases, medication taken for other conditions can cause blood pressure to rise.

Are there risk factors for the development of hypertension?

The condition is more common in people:

• With type 1 and type 2 diabetes, although it is more common in those with type 2 diabetes.
• With a family history of high blood pressure.
• With certain lifestyle factors, including:
  • Overweight
  • High salt consumption;
  • Lack of exercise
  • High alcohol consumption
  • High stress level

How can it be treated?

Lifestyle changes:

• Losing some excess weight can make a big difference. Blood pressure will fall as each excess kilogram is lost;
• Doing physical activity five or more days of the week, for at least 30 minutes. For example, brisk walking, swimming, cycling, dancing, etc.
• Eating a healthy diet;
• Moderating salt and alcohol intake;
• Giving up smoking.

Medication:

Medication is usually advised for:

• People whose pressure remains at 160/100 mm Hg or above after a trial of relevant lifestyle changes.
  • People whose blood pressure remains at 140/90 mm Hg or above after a trial of relevant lifestyle changes AND who have diabetes or an existing cardiovascular disease or high risk of developing cardiovascular disease within 10 years.

Several medications are available, and your doctor will prescribe the most appropriate one, based on other conditions, age, lifestyle factors, etc.

How can hypertension complications be avoided?

As is the case with many other medical conditions, prevention is the best treatment. In order to detect hypertension at an early stage, have an annual blood pressure check if you are 40 years and above. Those with a family history of hypertension or those with the above risk factors (diabetes, overweight or smoking) should start to check their blood pressure at the age of 35. — Hanoi French Hospital

Dr George Cloatre is a clinical cardiologist, and Dr Ngo Chi Hieu is an interventional cardiologist.

Together they bring state of the art knowledge and treatment for cardiovascular conditions, diseases and interventions to our customers.

If you have any questions or want to book an appointment with our doctors, please contact us at our phone number   84 – 24.3577.1100  , access www.hfh.com.vn, or email us at contact@hfh.com.vn,  Address: 1 Phương Mai, Đống Đa, Hà Nội