Hypertension The Silent Killer
■ Sagorika Mitra*, a lecturer in Kolkata, started suffering from frequent headaches and irritation in the eyes. She had been busy with several cultural activities in college post-normal work hours, so she dismissed it as signs of tiredness and popped a pain-killer whenever needed. But when the problem persisted over a few weeks, the 35-year-old visited her physician. Her BP was found to be quite high. She was advised tests again after a week. When the results appeared similar, she started on medication. No one in her immediate family has high BP.
■ 45-year-old Dr Hari Singh* suffered a sudden cardiac arrest and was rushed to ICU. Fortunately, timely cardio-pulmonary massage revived him. A non-smoker and non-diabetic, Singh’s cholesterol levels were normal. The only risk factor that he had was high BP -- a result of occupational stress.
■ R Sathish*, a 27-year-old IT professional approached his doctor with a complaint of progressive weight gain – he had put on 6kg in the last year, mainly around the middle. He also complained of shortness of breath while climbing stairs. Sathish led a sedentary life and ate out frequently. Both his parents have diabetes mellitus and his father also has hypertension. Sathish’s BP was found to be high. His blood reports also showed elevated LDL (bad cholesterol) and Triglycerides and low HDL (good cholesterol). His ECG already had evidence of left ventricular hypertrophy (enlarged heart), which is a marker of high BP. He was advised lifestyle changes and also started on medications.
Three different cases, but a common diagnosis—high BP or hypertension. In fact, experts say it’s so common that every fourth or fifth Indian suffers from it. New Delhi-based Dr Sailesh Mohan, Senior Research Scientist and Associate Professor, Public Health Foundation of India, puts the prevalence at one-third of the adult Indian population. “According to WHO, the estimated prevalence of high blood pressure amongst Indians aged 25 years and older is 33 per cent,” he says, adding, “Applying these figures to the census of India’s population for 2013 (in this age group), I’ve estimated that there are about 199 million hypertensives currently—103 million men and 96 million women, in our country.”
Over the years, many regional studies on hypertension prevalence have also been done across India. Referring to them, Dr Rajeev Gupta, Senior Consultant and Head of Medicine & Director, Research & Academics, Fortis Escorts Hospital, Jaipur, says, “A review of these studies has suggested that prevalence of hypertension varies from 25-30 per cent adults in urban locations to 15-18 per cent in rural adults. The prevalence is lower among younger subjects, and varies from less than 10 per cent in subjects under 30 years to more than 50 per cent in subjects older than 60 years of age.”
One aspect of hypertension that’s striking is how the number (of affected people) has increased over the decades, and continues to grow rapidly. “Epidemiological studies in the 1960s and ’70s reported presence of hypertension in about 5 per cent of rural population and 15 per cent of urban adults. Recent studies have reported a three-time increase in rural areas and double in urban locations. Studies have reported that prevalence of hypertension has increased by 10-15 per cent over a 15-20 year period,” says Dr Gupta.
BACK TO BASICS
To understand hypertension, it’s essential to start at the beginning—with arteries. These blood vessels carry blood from the heart to various organs. Blood pressure refers to the pressure that blood applies to the inner walls of the arteries. Explains Dr Sonia Gyamlani, Senior Consultant, Internal Medicine & Coordinator, Preventive Health Checks, Fortis Memorial Research Institute, Gurgaon, “A person’s blood pressure is defined by two measurements—systolic pressure (the pressure in the arteries produced when the heart contracts, at the time of a heart beat) and diastolic pressure (the pressure in the arteries during relaxation of the heart between heart beats). Blood pressure is reported as the systolic pressure over diastolic pressure. For example: 120/70 (mm Hg) or 120 over 70. A normal blood pressure reading should be less than 120/80.” If the readings are between 121 and 139 for systolic pressure and between 81 and 89 for diastolic pressure, it’s called pre-hypertension. “Other than those suffering from hypertension, another 20-30 per cent of the population (amounting to millions) is pre-hypertensive. These cases will convert to full-fledged hypertension if risk factors are not controlled,” cautions Dr Mohan.
In case of hypertension, there are two levels—stage 1: readings of 140-159 over 90-99 and stage 2: > 160 over > 100. A single high reading does not indicate hypertension. The doctor will almost always ask the patient to get the test repeated after a week or so before confirming.
Mumbai-based Dr Siddharth N Shah, Consulting Physician and Diabetologist and Editor, Journal of The Association of Physicians of India, says, “There are two main types of hypertension—Primary (also called Essential) and Secondary. Primary hypertension is much more common.” In this, the cause of high BP is not known. In case of secondary hypertension, there’s an underlying cause, such as kidney disease or hormonal disorder, which is generally treatable. Dr Gyamlani also mentions that some people suffer from White Coat Hypertension, which is an anxiety-induced hypertension on seeing a doctor. “In such cases, we ask the patients to measure their BP at home and maintain a record for us,” she says.
What is Hypertension?
Arteries carry blood from the heart to various organs in the body. Blood pressure refers to the pressure that blood applies to the inner walls of the arteries. Read more
The Silent Killer
So, why are so many people suffering from hypertension? Doctors say that hypertension generally exhibits no symptoms, earning it the sinister sobriquet of Silent Killer. Read more