UNDER PRESSURE
Hypertension is another silent health assassin. We investigate.
Cardiovascular disease is the leading cause of premature death and disability – and hypertension is behind one in every two strokes and two in every five heart attacks, reports the Heart and Stroke Foundation of South Africa. Yet simple steps can help keep you safe.
Astudy by Wits scientists shows South Africa has the highest prevalence
of hypertension, or high blood pressure (BP), in southern Africa. An alarming one in three of us is living with it – and it’s on the rise, says nephrologist Professor Brian Rayner, director of the Hypertension Clinic at the University of Cape Town. ‘In a sense we’re facing a national health emergency, but because the links between high BP and heart disease, stroke, kidney failure, dementia and death are indirect, public awareness is poor.’
Essentially, we need enough pressure in
our arteries for blood to flow from our heart to the different parts of our body. It’s normal for this to fluctuate, but when it’s persistently too high, putting too much pressure on vessel walls, it can cause hardening and thickening of our arteries (atherosclerosis), which can lead to heart attacks, stroke, kidney failure, blindness and brain damage.
But alarmingly, more than half of us who have high BP are unaware of it. ‘This is because it tends to creep up without symptoms, or with symptoms we attribute to other causes and don’t take too seriously,’ says Professor Pamela Naidoo, CEO of the Heart and Stroke Foundation of South Africa (HSFSA). And it can affect us whatever our age, gender, fitness level or lifestyle, even striking down schoolchildren, marathon runners and enviably healthy-looking stars (Whitney Houston’s autopsy revealed her coronary problems were linked to undiagnosed hypertension, reported MedPage Today).
‘Even if you lead a healthy lifestyle you can still have high BP; it doesn’t exempt you,’ says Rayner. ‘But a bad lifestyle makes everything worse. I have many tragedies where people trust in lifestyle solely, do everything correctly and end up with a life-changing stroke. The reason is that about 5% of hypertension is related to secondary or genetic causes that are independent of lifestyle.’
For most of us, however, taking some simple steps and making a couple of sensible lifestyle changes can greatly reduce our odds of developing hypertension.1 KNOW YOUR RISKThis rises as you age – high BP affects nearly eight in 10 South Africans over the age of 55, notes the HSFSA. It’s also higher if you have a personal history or family history of hypertension, diabetes or stroke; if you’re obese or overweight; of African origin; are physically inactive; have high BP in pregnancy; smoke or use tobacco; and have a poor diet, high in sugar, salt and alcohol. Tick one or more of these, and it’s essential to have your BP checked at least once a year with your healthcare professional or at a pharmacy clinic. ‘Even if you don’t tick any, still check your BP,’ urges Rayner.2 SPOT THE SYMPTOMSDon’t wait for these to appear, but if they do, see your doctor immediately to have your BP measured and be checked out: headaches (especially on waking, says Rayner), light-headedness, vertigo, visual disturbances, nose bleeds, nausea, vomiting, chest pain and shortness of breath.3 KNOW YOUR NUMBERSA BP measurement records two numbers: your systolic blood pressure (SBP) – the pressure when your heart contracts and is higher – represented over your diastolic blood pressure (DBP), the pressure when your heart rests between beats. High blood pressure is diagnosed when either or both SBP and DBP are persistently raised on more than one occasion, says the HSFSA.
• A NORMAL READING IS officially SBP below 130 (mmHg) and DBP below 85. However, according to a major international analysis by the University of Washington’s Institute for Health Metrics and Evaluation in 2017, ‘there is very strong evidence that the risk of having elevated BP begins above 115 mmHg (SBP),’ and steps should be taken at that stage to control your blood pressure by making healthy lifestyle choices and maintaining a healthy weight.
• A HIGH NORMAL READING IS an SBP of 130–139 or DBP of 85–89, and it’s a wake-up call to make lifestyle changes if you haven’t yet, and to go for regular BP checks, says Naidoo.
• MILD HYPERTENSION IS 140–159 SBP or 90–99 DBP, and signals you should see your health professional as soon as you can. You may be put on medication as well as told to make lifestyle changes.
• MODERATE HYPERTENSION IS 160–179 SBP or 100–109 DBP. See your healthcare professional straight away.
• A HYPERTENSIVE EMERGENCY IS anything above 180 SBP or 110 DBP. ‘Go to your nearest hospital,’ says Naidoo.
4 REDUCE STRESS
When you’re stressed your body produces a surge of hormones that temporarily increase your BP, so your heart beats faster and your blood vessels narrow. Angelina Jolie told Vanity Fair that in 2016 she suffered from hypertension and Bell’s palsy, saying she didn’t know if the cause was stress when things got ‘difficult’ with Brad Pitt, or premature menopause (from having her ovaries removed after a double mastectomy because of a high genetic predisposition to cancer).
There is as yet no conclusive proof that stress alone causes long-term high BP, but it has been linked to finding unhealthy stress releases known to increase your risk of high BP, such as smoking, drinking and eating unhealthy foods, reports the Mayo Clinic. It adds that ‘even frequent temporary spikes in blood pressure can damage your blood vessels, heart and kidneys in a way similar to long-term high blood pressure’.
‘Prolonged stress, particularly when it is unrewarded, is particularly problematical,’ says Rayner. ‘For example, a CEO may have stress, but this is often rewarded by good outcomes. On the other hand, a lower-level employee working under a difficult supervisor may experience longterm stress with no prospect of resolution or reward.’
Aim at simplifying your schedule, get regular exercise (a natural stress reliever), try deep-breathing, meditation and yoga, and get plenty of sleep. Create time for yourself daily, journal, walk the dog or follow a hobby, says former Durban-based psychologist Tim Harkness (now based in the UK), who specialises in stress management. ‘Most importantly, have something to look forward to each day, even if it’s just a sitcom.’
5 AVOID ALCOHOL
Some previous studies have associated moderate drinking with a lower risk of certain forms of heart disease, but most did not assess high blood pressure among moderate drinkers. A major study presented this year by the American College of Cardiology shows that even moderate alcohol consumption (seven to 13 drinks a week) ‘substantially raises’ the risk of high blood pressure. ‘It’s the first study showing both heavy and moderate alcohol consumption can increase hypertension,’ reported the study’s lead author, Dr Amer Aladin. The effect of alcohol on blood pressure could come from several factors, the researchers said. Alcohol increases appetite and is energy-dense, so drinking often leads to greater caloric intake overall. And alcohol’s activities in the brain and liver could also contribute to spikes in blood pressure.
6 WATCH YOUR DIET
If you’re overweight (with a BMI over 25 or waist more than 88cm for a woman, 102cm for a man), losing even 2–5kg of weight can lower your BP, says the HSFSA. Go for vegetables, fruits (potassium in bananas can help lower BP) and wholegrains, says Bianca Tromp, an HSFSA dietician. Cut back on saturated fats and products with trans fats and sugar, and especially on salt, which directly raises BP.
For flavour, use herbs, celery, onion, garlic, ginger, lemon juice and salt-free spices instead. Counter high cholesterol (which is linked to high BP) with soluble fibre from oats porridge and legumes. Get protective omega-3 fatty acids from oily fish twice a week or a tablespoon of ground flaxseeds sprinkled on food and a few raw almonds and walnuts. ‘Aim for a balanced, sustainable, enjoyable way of eating,’ says Tromp.
7 TAKE YOUR MEDS
‘With higher grades of BP, taking medication is very important as lifestyle changes improve things but seldom resolve the problem completely,’ says Rayner. Follow the directions exactly, adds Naidoo: ‘Not taking BP meds correctly is one of the most common causes of uncontrolled high BP.’
8 GET MOVING
Moderate to vigorous aerobic activity can reduce SBP by 10mmHg on average, notes the HSFSA. ‘Regular aerobic exercise improves the function of the heart and reduces cholesterol and glucose levels, high blood pressure, excess weight and stress,’ says Cape Town biokineticist Erin Martin. Start slowly and build up to 45 minutes a day, she advises. ‘Avoid saunas and hot tubs and do resistance training only when monitored if you have elevated BP.’
9 STOP SMOKING
The American Heart Association notes that while smoking ‘is a proven risk factor for heart attack and stroke, its connection to high BP is still being determined’. But both smoking and exposure to secondhand smoke increase the risk of plaque building inside arteries, a process high blood pressure is known to accelerate. After each cigarette you smoke, your BP can temporarily increase for 30 minutes, says Naidoo. ‘Chronic smoking increases the stiffness of blood vessel walls, making the damage caused by high blood pressure even worse.’