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Hypertension: a silent killer

LiveMint logoLiveMint 15-05-2017 Kavita Devgan

High blood pressure causes 7.5 million deaths worldwide, about 12.8% of the total deaths in a year, according to recent estimates by the World Health Organization (WHO). Hypertension is a condition in which the blood pressure in the arteries remains elevated, making the heart work harder to pump out blood and contributing to the hardening of arteries, strokes, and heart failure. Hypertension is one of the most common non-communicable diseases in India, says Kenneth Thorpe, chair of the Partnership to Fight Chronic Disease (PFCD), an internationally recognized organization of patients, providers and health policy experts committed to increasing awareness about non-communicable diseases.

Hypertension is called the “silent killer” because, very often, it doesn’t come with warning signs or symptoms. This year, the Indian Medical Association (IMA) is collaborating with the Delhi-based non-profit Centre for Chronic Disease Control-WHO collaborating centre and Public Health Foundation of India to observe the May Measurement Month. “As part of it, India aims to measure the blood pressure of 2.5 million people of the 25 million targeted globally. Each member of the IMA has been assigned to monitor the blood pressure of at least 20 patients a day,” says IMA national president K.K. Aggarwal. “Information is the key,” says Thorpe; building awareness about the condition, particularly the risks and causative factors, can help tackle the growing disease burden. The risk of hypertension is greater if you’re above the age of 35, overweight, have a family history, mild kidney disease, or are a smoker, he says.

Usually, the cause is a sedentary lifestyle and a high intake of processed food. But there can be some hidden reasons too. Research presented at the Experimental Biology 2016 meeting in San Diego, US, reported that high levels of fructose (present in sweetened beverages and processed foods) may predispose individuals to hypertension. Another study published in June in the American Journal Of Physiology—Regulatory, Integrative And Comparative Physiology reported that excess consumption of phosphate, used in foods as a preservative and flavour enhancer, overactivates nerves, raising blood pressure.

Unhealthy gut microbes

Over the years, studies have shown that supplementing the diet with probiotics can have a positive effect on blood pressure. In February, for instance, a study published in the Physiological Genomics journal demonstrated that the microorganisms in the intestines (microbiota) play a role in keeping blood pressure in check. Good bacteria in the gut, especially certain probiotic strains such as lactobacilli and bifidobacteria, have proven to be helpful. Regular intake of fermented foods like curd and purple carrots helps keep the gut healthy, and, in turn, keeps hypertension in check, says Rommel Tickoo, principal consultant (internal medicine) at Max Super Speciality Hospital, Delhi.

The medicine box

Many common over-the-counter pills can also be an underlying cause of hypertension. A study published in 2012 in the American Journal Of Medicine says common pain relievers like ibuprofen are often at fault; they make the body retain fluid and decrease kidney function, causing blood pressure to rise.

Some antidepressants could be at fault too, since they work by changing the body’s response to brain chemicals, including serotonin and dopamine. “So if you take antidepressants, it is important to have your blood pressure checked on a regular basis,” says Dr Tickoo.

Regular users of birth control pills need to be careful too. “This is because these contain hormones that may increase your blood pressure by narrowing smaller blood vessels,” says Dr Tickoo, adding: “Don’t assume that just because a medication can be obtained without a prescription, it’s relatively harmless. Also, don’t abuse prescription medicines by taking them beyond the advised time.”

Hormonal abnormalities

Anup Taksande, interventional cardiologist at Wockhardt Hospital in Mumbai, says endocrine irregularities can also lead to hypertension. RAS (renin angiotensin system), he says, is a hormone system involved in the regulation of plasma sodium concentration (sodium levels in blood) and arterial blood pressure. If RAS is abnormally active, blood pressure can shoot up.

His watch-list of hormonal issues includes increased secretion of the cortisol hormone, excess growth hormone (increases the basal metabolic rate), certain tumours of the adrenal gland that lead to secretion of adrenalin and noradrenaline, and renal artery blockage. Dr Taksande adds that menopause, which leads to various hormonal changes, may result in hypertension too.

Sleep apnoea

Obstructive sleep apnoea (OSA), a disorder that interrupts normal breathing, is among the most common causes of hypertension. “There’s a strong relationship between the two. About 30-60% of patients with hypertension have OSA, and 30-40% of people who come with OSA symptoms, like chronic fatigue and snoring, are found to have hypertension,” says Manvir Bhatia, director of sleep medicine at the Fortis Heart Research Institute in Delhi.

Generally, hypertension has no obvious symptoms; you might not realize it’s stalking you. That is why it is important to keep a tab periodically, and lead a lifestyle that can help keep it in check. “Lack of timely diagnosis is contributing to spiralling numbers. It is important to ensure that we put a lid on this dangerous condition,” says Thorpe.

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