What is High Blood Pressure ?

First, let us consider blood pressure,

The force of blood pushing against the walls of blood vessels (arteries) while it is pumped by the heart creates blood pressure. With more pressure, the heart has to pump harder, causing more damage to many parts of the body, particularly the brain, heart and kidneys.¹

Two main factors contribute to the variations of blood pressure:

• The amount of blood pumped by the heart
• The amount of resistance to blood flow in the arteries.

The more blood the heart pumps and the narrower the arteries are, the higher the blood pressure is.²

Definition of Hypertension

Blood pressure can be low, normal, or high, and there is range that is considered a healthy blood pressure; but over time and with age, blood pressure rises. Why? The walls of large arteries become more rigid and the small blood vessels become narrower. Because of these changes, the heart has to generate a greater force to keep blood flowing around the body. This leads to an increase in blood pressure.³ Hypertension is defined as blood pressure that is consistently higher than 140/90 mmHg⁴; it is common not to notice any high blood pressure symptoms

• SYSTOLIC blood pressure (mmHg) :

The highest level of blood pressure, when blood is pumped from the heart to the entire body.

• DIASTOLIC blood pressure (mmHg) :

The lowest level of blood pressure, when your heart is relaxed before it contracts again.

Optimal：

• Systolic <120
• Diastolic <80

Normal：

• Systolic <120-129
• Diastolic 80-84

High normal：

• Systolic 130-139
• Diastolic 85-8

Let us check how to interpret your blood pressure values.⁴

Hypertension : a worldwide problem⁵

• 1.3 Billion: Around the world, hypertension affects about 1.3 billion people.⁵
• 34% prevalence in men.⁵
• 32% prevalence in women ⁵.
• 60% prevalence in patients over 60 years old.²

Age-standardized prevalence of hypertension among adults aged 30–79 years, and among those with​ hypertension, diagnosis, treatment, and effective treatment coverage in 2019, by WHO region ¹

What are the causes of Hypertension?

There are two types of hypertension: primary (or essential hypertension) and secondary hypertension.

Primary hypertension

Primary hypertension describes high blood pressure that has no obvious cause. There are number of factors that increase the risk of developing high blood pressure :

• Lack of physical activity
• Stress
• Excessive weight
• Excessive alcohol intake
• Excessive salt intake or too little potassium
• Chronic heavy smoking
• Caffeine
• Sugar
• FAMILY HISTORY: Genetic factors likely play some role in high blood pressure, and sharing a common environment and other potential factors may also increase the risk.²
• RACE OR ETHNICITY: Black people develop hypertension more often than other ethnicities, and at a younger age.

Secondary hypertension

is high blood pressure produced by identifiable causes (for example, an abnormal production of hormones from the adrenal glands). Only a small number of patients suffer from this kind of hypertension. Once the cause is found and treated correctly, blood pressure should return to normal.

 “With whom should I discuss this if I want to find out more?”

Your general practitioner is the right person to ask about blood pressure.

Why get checked?

A silent disease

Hypertension is usually discovered fortuitously during a routine examination, but the first time someone finds out that they have high blood pressure is often when they are taken to hospital because it has led to a stroke or a heart problem.

Indeed, hypertension is said to be a silent disease that can be fatal, because it often has no warning signs or symptoms. Yet up half to the people with hypertension may be unaware they have it, as they do not exhibit signs or symptoms. This is why hypertension is considered as a global public health issue.

The only way to know whether a person has hypertension is by having their blood pressure checked. For that very reason, it is recommended that you get your blood pressure checked routinely at least every 5 years if you are over 40 years of age, or more often if you have high blood pressure, in accordance with your health care team.^6,7,8

• 1.3 Billion: Around the world, hypertension affects about 1.27 billion people.⁹
• 50% of men and 41% of women have hypertension but are undiagnosed .⁹
• 10 Million deaths / year ⁹.
• 1/5 deaths worldwide .¹⁰

How can hypertension affect your body?

When you have hypertension, your heart has to work harder to ensure the flow of blood around your body. Over time, this high pressure can gradually weaken your heart and damage artery walls, leading to changes in blood flow. All these situations lead to an increased risk of developing cardiovascular disease (stroke, heart disease, and heart failure). Other parts of the body, including the kidneys, limbs, and eyes, may also suffer damage.¹¹

Stroke

High blood pressure can narrow or burst arteries that supply blood and oxygen to the brain, causing a stroke. Brain cells die during a stroke because they do not get enough oxygen. Stroke can cause serious disabilities in speech, movement, and other basic activities. A stroke can kill you.¹²

Heart diseases

Coronary artery disease: due to fatty deposits, the main arteries that supply your heart become clogged up.¹³

Heart attack: the blood supply to your heart is blocked and heart muscle begins to die without enough oxygen.¹²

Vision loss

Due to damage in small blood vessels in the retina.¹¹

Kidney failure

High blood pressure can damage the arteries around the kidneys and interfere with their ability to filter blood effectively.¹¹

Atherosclerosis

This condition occurs when too much cholesterol plaque builds up in your arteries, causing them to narrow. ¹³

Causes of hypertension

Sometimes other diseases can worsen or impact a primary disease. These other diseases are what we call comorbid diseases. Hypertension has its own set of “bad friends”, the main ones being:

Hypercholesterolemia

high levels of LDL-cholesterol in the blood are associated with an increased risk of CVDs, such as atherosclerosis and coronary artery disease.¹⁴

Type 2 diabetes mellitus

elevated blood sugar levels over a prolonged period of time lead to complications such as stroke, foot ulcers, and eye damage.¹⁵

Coronary artery disease

atherosclerosis (the presence of cholesterol plaques) in the coronary arteries limits the blood flow to the heart, which leads to a lack of oxygen for myocardial cells. A common symptom is chest pain, angina, which often occurs during exercise.¹⁶

Chronic kidney disease

when kidneys do not function properly over months or years, this can lead to complications such as cardiovascular disease, anemia (ie, red cells in the blood are either insufficient, or they don’t function properly), or pericarditis (ie, inflammation of the pericardium, the sac-like tissue that surrounds the heart, holds it in place and helps it to work).^17,18

Regular follow-up

Monitoring your own blood pressure at home is very important and can be part of successful hypertension management.

Regular blood pressure measurement is key to keep your blood pressure under control. Because high blood pressure is usually symptomless and can fluctuate over time, you need to check your blood pressure regularly to ensure your treatment plan is working.

How do we measure blood pressure?

Most of the time, it is your doctor or a nurse who will measure your blood pressure, for example, during a routine visit. To do so, they will use a sphygmomanometer. It is a pressure-measuring device (manometer) connected to an inflatable cuff that is wrapped around your upper arm. The doctor will inflate the cuff, and you will feel your arm being squeezed quite hard. The air in the cuff is then let out slowly, and you will feel the grip of the cuff lessen. Blood pressure can then be measured with the manometer (in millimeters of mercury [mm Hg]).

Two different sphygmomanometers exist

Manual

The doctor or nurse inflates the cuff using a hand pump and then uses a stethoscope to listen to your pulse.

Digital Interface

The cuff inflates and deflates automatically. The pulse is detected by a sensor inside the device.

To get an accurate measurement of your blood pressure when a measurement is taken, you should have rested for at least 5 minutes previously and be seated and silent, i.e., not talking.

How can you protect yourself?

Taking your antihypertensive treatment every day is crucial for controlling your blood pressure and ensuring long-term cardiovascular protection, but it is not always easy to remember to take them. Just like brushing your teeth, taking your antihypertensive treatment can become part of your daily routine. And remember, hypertension is a silent disease: not feeling a difference is not a reason to stop your treatment!

To protect yourself do not forget to take your medication every day !

Here are some tips to help you remember :

• Put an alarm on your phone
• Associate it with another habit
• Check a box after your pill is taken
• Put an alarm on your phone

Please be aware !

Having correct blood pressure values (<130/80 mm Hg) does not mean that you are cured!* It is important to keep taking your treatment as prescribed by your doctor!

*<130/80 mm Hg is normal for patients <65 yo. For patients >65 yo, normal blood pressure is 130-139/70-80 mm Hg.