Analysis: Why is hypertension called the "silent killer" and why is it so relevant to Ireland?
People living in Ireland have one of the highest rates of hypertension (that is, consistently high blood pressure) internationally and some of the worst rates of hypertension awareness, treatment and control of hypertension. More than one in every two men (56%) aged 40 to 79 years in Ireland have hypertension, while 43% of women in Ireland in the same age range have hypertension. Only 46% of men and 56% of women had any awareness they had hypertension.
Raised blood pressure has been related to 54.5% of deaths from ischaemic heart disease, 58% of deaths from haemorrhagic stroke and 50% of deaths from ischaemic stroke. These are not the only organs of the body seriously damaged by hypertension.
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From Irish Heart Foundation, what is blood pressure?
Why is hypertension called a 'silent killer'?
Hypertension is normally symptomless so people may look and feel well and not be aware they have hypertension. If they remain unaware, the damage to vital organs continues until it is at an advanced stage or complications arise and it is brought to the attention of medical professionals.
Organs that can be significantly damaged are:
The heart: the ischaemic heart disease that develops can lead to a myocardial infarction (heart attack) or heart failure.
The brain: as outlined above, which can cause different types of strokes (haemorrhagic / ischaemic) or it can led to dementia.
The kidneys: hypertension can lead to chronic kidney disease which may require dialysis or a kidney transplant.
The eyes: the optic nerve damage (neuropathy) causes temporary or permanent vision loss and the occlusion of the retinal blood vessel causes vision loss or blurring (retinopathy).
As hypertension is a common risk factor for such organ damage, it is considered to be the most important risk factor that should be modified, in order to avoid organ damage as well as other illnesses such as vascular disease of the peripheries (legs) and the mortality associated with the above.
How will I know if I have hypertension?
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From RTÉ Radio 1's Today with Claire Byrne, GP Dr Máire Finn answers listeners' questions about blood pressure
High blood pressure is one of the easiest conditions to detect and can be checked for free at community or primary health-care level. Many pharmacies will check it for free or the Irish Heart Foundation mobile health unit offers free heart health checks around Ireland. Many workplace health events often offer free heart health checks. It can also be checked by a practice nurse at a GP medical centre or by the GP.
How to correctly identify high blood pressure
The measurement of blood pressure is critical for the diagnosis of hypertension but continues to be poorly done. When checking for hypertension, blood pressure should be measured on at least two completely separate occasions. On each occasion, it should involve the recording of an average of the last two, of three separate, blood pressure measurements using a correctly sized blood pressure cuff positioned at the level of the heart.
There are differences between high blood pressure and hypertension, so it is important to differentiate between a once-off high recording and hypertension. Blood pressure naturally changes to accommodate environmental (e.g. temperature or noise) or physiological (exercise/ anxiety) factors which can raise rates. This includes anxiety felt by some, when entering a medical clinic or having their blood pressure measured (also called the white coat syndrome). Their blood pressure returns to normal once the appointment ends.
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From Irish Heart Foundation, get your blood pressure checked before the damage is done
Conversely, over time a person’s normal blood pressure may rise and not lower due to pathophysiological changes, age, genetics, family history or ethnicity. There is a relatively low prevalence of hypertension before 30 years of age.
Every blood pressure measurement identifies two numbers: the systolic blood pressure (upper figure) and diastolic blood pressure (lower). Systolic should be below 140 mmHg and diastolic below 90 mmHg, although, a systolic blood pressure reading of 145 mmHg is acceptable for those over 80.
What happens if I'm diagnosed with hypertension?
Once a consistently high blood pressure is identified, a diagnostic assessment should commence. This includes a physical examination, during which questions may be asked, to try and detect any organ damage and identify secondary causes. These may include kidney/thyroid problems, diabetes, high dietary salt /fat or alcohol intake, obesity/overweight or smoking. Blood tests will also assist in the identification of secondary causes, risk factors and organ damage. Anti-hypertensive drugs are a low-cost effective treatment to control blood pressure.
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From RTÉ Radio 1's Today with Claire Byrne, preventative cardiologist Dr. Paddy Barrett on lifestyle changes to prevent or reduce high blood pressure
With or without prescribed drugs, lifestyle changes will be advised to further assist and some can lower blood pressure within a matter of weeks. This can be achieved through person-centred education and support, using a multidisciplinary and community approach. The main goals are the restoration or establishment of suitable physical activity, a healthy weight with a diet high in fruit and vegetables and low in dietary salt (see salt alternatives)/ saturated (animal) fat or processed foods, with reduced alcohol intake (to within recommendations) and support to stop smoking.
If your blood pressure is borderline high, you should read and follow the professional expert advice on small steps and lifestyle changes to make in some the following areas to help reduce it:
- Balanced (DASH) diet
- Reduce salt
- Healthy weight
- Quit smoking (help /support)
- Be active
- Reduce alcohol
- Reduce cholesterol
The views expressed here are those of the author and do not represent or reflect the views of RTÉ
