/ 24 May 2019

Avoid the silent killer

(John McCann/M&G)
(John McCann/M&G)


High blood pressure is described as a silent killer by the medical profession because the disease can exist without showing a single symptom for a very long time. The only time people are made aware of their hypertension is when they have a stroke or heart attack, by which time, it is too late to do anything to save the patient, or when a doctor picks it up during an examination.

If blood pressure is not regularly monitored and controlled with proper medication, it can result in severe irreversible complications such as heart attack, stroke and kidney failure.

The ideal blood pressure is 120/80. Treatment starts when a person has a blood pressure of 140/90 on more than two occasions.

Much of patients’ ignorance about high blood pressure is largely because health practitioners have not stressed the importance of regular blood pressure checks.

One man innocently told me that he skips his blood pressure medication for months and only uses it when he does not feel well. It came as a shock to him that high blood pressure may not have any symptoms.

His blood pressure was 180/120. It also turned out that he was grieving a son, who died at a young age from a stroke after he learnt that his wife wanted to leave him.

Of late, many people in their mid-20s are being diagnosed with hypertension. Stress, the lack of exercise, insufficient sleep, poor eating habits and high salt intake play a role in contributing to the high incidence of hypertension.

I have come across patients who have been on several antihypertensive agents and whose jobs were very stressful. Shortly after they changed work, their blood pressures came down considerably and they required very little medication, showing that perpetual stress can have an adverse effect on one’s health and well-being.

In the man’s case, he needed counselling and treatment for his depression to control his blood pressure, apart from his usual antihypertension medication.

I have also noticed that patients’ blood pressures can change within a period of six months. That is why it is so important for a medical practitioner to check the patient’s blood pressure during every visit.

Quite often blood pressure medications are prescribed routinely, without reviewing whether a patient needs them. If the blood pressure is fairly low on treatment, 110/70 for example, it might be an idea to cut one of the medications and review the response. This approach cuts costs and minimises side-effects.

I have come across patients, who stopped using medications for more than three months of their own accord. On checking their blood pressure, I discovered that it was perfectly normal, so l stopped their medication with the advice for them to have their blood pressure checked every six months to be on the safe side.

My worst experiences were two women who ignored their blood pressure for years in spite of being warned of the dangers of skipping treatment. The one woman, in her mid-40s, was rushed into my rooms, after a three-year absence, in a coma with a blood pressure of 300/200. She had a major haemorrhage in the brain and died on her way to hospital.

The second woman had severe heart failure, with a blood pressure of 240/160. Her blood pressure was never well controlled because she did not regularly take her medicines or have her blood pressure checked.

She was admitted and successfully treated, but she now has chronic kidney disease. She will need renal dialysis in the not-too-distant future but she still does not adhere to her treatment regime.

Many blood pressure medications have intolerable side-effects, which results in patients not taking them. Some tablets can cause severe coughing, swelling of feet, erectile dysfunction and, rarely, severe mood swings and anxiety. Patients should inform their doctor if they experience side effects so the right medication can be prescribed.

People with hypertension must be careful never to use flu preparations with ephedrine or pseudo ephedrine in them because they can push up one’s blood pressure. Energy drinks with high caffeine content must also be avoided.

The digital home blood pressure machines are not always accurate, so be careful not to rely on them too much.

Patients often make the mistake of requesting repeat medication without wanting to be examined. A doctor has to check the blood pressure reading to make sure that the medications are achieving the desired level. Once in six months is usually adequate.

People with diabetes and pregnant women with hypertension must monitor their blood pressure.

Treating hypertension every day with one tablet is a lot easier than living with the side-effects of a stroke.

Dr Ellapen Rapiti is a family physician, specialising in child and mental health and addiction counselling