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Hypertension most common condition during pregnancy — Expert – Punch Newspapers

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Dr Stephen Olukotun is a Senior Medical Officer at Udeco Medical Centre, Lagos State. In this interview, he speaks to TOBI AWORINDE about hypertension

What is hypertension?

Hypertension is simply when blood pressure is too high. Blood pressure is the force exerted by circulating blood against the walls of the body’s arteries, the major blood vessels in the body.

What triggers increase in blood pressure, leading to hypertension?

The risk factors for hypertension can be divided into modifiable and non-modifiable risk factors.  The modifiable risk factors include unhealthy diets, such as excessive salt consumption, a diet high in saturated fat, low intake of fruits and vegetables.

Other modifiable risk factors include physical inactivity, consumption of tobacco and alcohol, and being overweight or obese.

On the other hand, non-modifiable risk factors include a family history of hypertension, age over 65 years, and co-existing diseases, such as diabetes or kidney disease.

How high will blood pressure get for a person to suffer a stroke or heart attack?

This can happen in a hypertensive crisis. This is a severe increase in blood pressure that can lead to a stroke. Extremely high blood pressure — a top number (systolic pressure) of 180 millimetres of mercury (mmHg) or higher, or a bottom number (diastolic pressure) of 120 mmHg or higher — can damage blood vessels and subsequently lead to a stroke.

Is it safe to self-monitor one’s blood pressure?

Hypertension is called a ‘silent killer.’ Most people with hypertension are unaware of the problem because it may have no warning signs or symptoms. For this reason, it is essential that blood pressure is measured regularly. Having blood pressure measured is quick and painless. Individuals can also measure their own blood pressure using automated devices. However, an evaluation by a health professional routinely is important for assessment of risk and associated conditions.

What is a normal blood pressure?

An ideal blood pressure is considered to be between 90/60 mmHg and 120/80 mmHg. High blood pressure is considered to be 140/90 mmHg or higher. Low blood pressure is considered to be 90/60mmHg or lower.

What effect does high BP have on the body?

In most cases, hypertension is asymptomatic, meaning it has mild to no symptoms. However, when symptoms do occur, they can include early morning headaches, nosebleeds, irregular heart rhythms, vision changes, and buzzing in the ears. Severe hypertension can cause fatigue, nausea, vomiting, confusion, anxiety, chest pain, and muscle tremors.

What health problems are associated with high blood pressure?

Among other complications, hypertension can cause serious damage to the heart. Excessive pressure can harden arteries, decreasing the flow of blood and oxygen to the heart. This elevated pressure and reduced blood flow can cause chest pain, also called angina. It could also cause heart attack, which occurs when the blood supply to the heart is blocked and heart muscle cells die from lack of oxygen. The longer the blood flow is blocked, the greater the damage to the heart. Other causes are heart failure, which occurs when the heart cannot pump enough blood and oxygen to other vital body organs; and irregular heartbeat, which can lead to sudden death. Hypertension can also burst or block arteries that supply blood and oxygen to the brain, causing a stroke. In addition, hypertension can cause kidney damage, leading to kidney failure.

How common is hypertension?

According to the World Health Organisation, an estimated 1.13 billion people worldwide have hypertension, most (two-thirds) living in low- and middle-income countries. In 2015, one in four men and one in five women had hypertension. Fewer than one in five people with hypertension have the problem under control. Hypertension is a major cause of premature death worldwide. One of the global targets for non-communicable diseases is to reduce the prevalence of hypertension by 25 per cent by 2025 (baseline 2010).

Is high blood pressure reversible?

Yes, it is. As a matter of fact, it can be controlled with lifestyle modification such as the modifiable risk factors earlier said.

Are there any physical signs one should look out for?

Bear in mind that a symptom is different from a sign. A sign is any objective evidence of a disease that can be observed by others or the doctor. In most cases of hypertension, there are no physical signs.

Can hypertension cause damage to the body?

Absolutely! Those are the complications I spoke of earlier.

How dangerous is hypertension in someone with diabetes?

Hypertension can lead to many complications of diabetes, including diabetic eye disease and kidney disease, or make them worse. Most people with diabetes will eventually have high blood pressure, along with other heart and circulation problems. Diabetes damages arteries and makes them targets for hardening called atherosclerosis that can cause high blood pressure, which, if not treated, can lead to trouble, including blood vessel damage, heart attack, and kidney failure.

What are the implications of hypertension in pregnant women?

Hypertension is the most common medical problem encountered during pregnancy, complicating up to 10 per cent of pregnancies. There are several possible causes of high blood pressure during pregnancy. These include being overweight or obese, not getting enough physical activity, smoking, drinking alcohol, first-time pregnancy, a family history of pregnancy-related hypertension, carrying more than one child, age (over 35), assistive reproductive technology (such as in vitro fertilisation), and having diabetes or certain autoimmune diseases.

High blood pressure during pregnancy poses various risks. One of such is decreased blood flow to the placenta. If the placenta doesn’t get enough blood, your baby might receive less oxygen and fewer nutrients. This can lead to slow growth (intrauterine growth restriction), low birth weight or premature birth. Prematurity can lead to breathing problems, increased risk of infection and other complications for the baby.

Another risk is placental abruption. Preeclampsia increases your risk of this condition in which the placenta separates from the inner wall of your uterus before delivery. Severe abruption can cause heavy bleeding, which can be life-threatening for you and your baby. There is also intrauterine growth restriction, where hypertension results in slowed or decreased growth of your baby (intrauterine growth restriction).

Injury to your other organs is also a risk. Poorly controlled hypertension can result in injury to your brain, heart, lungs, kidneys, liver and other major organs. In severe cases, it can be life-threatening. Additionally, there is the risk of premature delivery – sometimes, an early delivery is needed to prevent potentially life-threatening complications when you have high blood pressure during pregnancy.

We also see the risk of future cardiovascular disease. Having preeclampsia might increase your risk of future heart and blood vessel (cardiovascular) disease. Your risk of future cardiovascular disease is higher if you’ve had preeclampsia more than once or you’ve had a premature birth due to having high blood pressure during pregnancy.

If you have high blood pressure during pregnancy, there can be complications such as pre-eclampsia or HELLP (haemolysis, elevated liver enzymes, and low platelet count) syndrome, among others. Pre-eclampsia can cause serious damage to your organs, including your brain and kidneys. It is also known as toxaemia. Pre-eclampsia with seizures becomes eclampsia if left untreated, and can be fatal.

Symptoms of preeclampsia include abnormal swelling in hands and face, persistent headaches, seeing spots or having changes in vision, upper abdominal pain, nausea or vomiting later in pregnancy, and difficulty breathing.

How can high blood pressure be managed?

Treatment consists of self-care and anti-hypertensive medication. Eating a healthier diet with less salt, exercising regularly and taking medication can help lower blood pressure. It is also important to imbibe lifestyle changes: physical exercise, stress management, quitting smoking, home blood pressure monitors and low sodium diet. There are also medications to manage high blood pressure, including ACE inhibitor, diuretic, beta blocker, antihypertensive drug, calcium channel blocker and vasodilator.

How can one lower the risks of developing high blood pressure?

As earlier highlighted, there are risk factors associated with high blood pressure. General lifestyle modification reduces your risks of having hypertension. Some include unhealthy diets (excessive salt consumption; a diet high in saturated fat, low intake of fruits and vegetables; physical inactivity; consumption of tobacco and alcohol; being overweight or obese, and so on.

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