Hypertension or high blood pressure is diagnosed when your blood pressure(BP) is more than 140/90 millimeters of mercury (mm Hg) when measured repeatedly.

High blood pressure can cause long term problems. It is a major risk factor for heart disease, arterial disease, stroke, kidney disease, heart failure, and loss of vision.

Raised blood pressure is estimated to cause 7.5 million deaths worldwide. Nearly one in three adults in Sri Lanka have high blood pressure.

Most people can have high blood pressure without any symptoms. The only way to know is to get your blood pressure checked.
Sometimes they can present with:

• Headache, nausea, vomiting
• Bleeding from nose
• Dizziness
• Blurred vision
• Buzzing in the ears

However, these symptoms are not specific. They usually do not occur until blood pressure has reached a severe stage. Therefore it can be considered as a silent killer.

• In most patients there is no identifiable cause
• The risk factors for developing high BP are
  • Advancing age
  • Family history of high BP
  • Overweight or obesity
  • Smoking
  • Drinking excessive alcohol
  • Unhealthy diets (excessive salt consumption, diets high in saturated fat and trans fats, low intake of fruits and vegetables
  • Lack of physical activity
  • Stress
  • In some patients, there can be an underlying cause such as kidney disease, diabetes or high cholesterol

When high blood pressure is found in young age, an underlying cause need to be excluded.
It is important to catch this group early.

Certain medications such as pain killers, over the counter medications like herbal preparations and recreational drugs (cocaine, amphetamine-ecstasy) can increase the blood pressure.

BP can vary with time, mental status (eg: anger) and physical activity (exercise). Therefore if the initial blood pressure reading is high your doctor will ask you to get it checked several times before diagnosing high blood pressure. It is important to note that a single BP reading
cannot confirm the diagnosis of high BP.

This could be done at clinic by a doctor or at home and while you are doing day to day activities by a portable recorder.

Some times when you see the doctor your blood pressure can falsely go up. We call it white coat high BP. In this situation, checking blood pressure leisurely at home or while ambulating would be helpful to get the exact blood pressure.

Your doctor might order necessary investigations after diagnosing high BP.

There are few things which need to be done before and during the blood pressure check. To get the correct BP readings, these things are very important.

• Do not drink coffee or any caffeine containing drinks, exercise or smoke at least 30 min before BP measurement
• Empty the bladder before BP measurement
• Sit at least for 5 minutes comfortably on a chair without talking,
• Back and arms should be supported/rested
• Keep the feet flat on the ground touching the floor. Legs should not be crossed
• The arm is at the level of the heart
• The BP measurement should be done in a quiet environment
• Remove all the clothing covering the upper arm for cuff placement. BP cuff should not be placed over clothes.
• Please wear a light jacket to facilitate exposure
• Try to relax and avoid talking during BP measurement

HBP can give rise to damage in most of the organs of the body

It include damage to the heart, brain, kidneys, arteries and eyes.

• If we start treatment early; most of the damage can be reversed
• With long- standing hypertension damage may become irreversible despite improved blood pressure control
• High BP can also be associated with other diseases such as diabetes, fatty liver disease, obesity and high cholesterol.

• Losing weight if overweight/obese
• Your waist circumference should be
  • Less than 80 cm in females
  • Less than 90 cm males
• Eat more vegetables, fruits, whole grains and protein from plant sources or fish
• Reduce intake of foods high in sugar, saturated and trans-fats (eg: deep fried foods, bakery items, fast foods)
• Limit your daily salt intake to 5g (1 teaspoon)
• DO NOT ADD SALT TO YOUR RICE
• If you are eating dry fish, make sure you wash them in hot water thoroughly to remove extra salt
• Reduce excessive salt containing foods-foods with added salts-cashew, murukku chips, bread, sauces etc.
• Quit all forms of tobacco use
• Avoid or stop/at least cut down all forms of alcohol use
• Engage in moderate intensity aerobic exercise (e.g.: brisk walking, cycling, swimming and gardening) for 30 minutes at least on 5 days every week
• Engage in muscle strengthening exercises (pushups, squats)on 2 to 3 days per week
• Take a good sleep-6-8 hours a day
• Make your stress levels are minimum-engage in yoga/ relaxation activities-music, meditation

• If your doctor has started on blood pressure lowering treatment you have to take it for life long until your doctor advices otherwise.
• If he/she says that the blood pressure is controlled that indicates medications given for the blood pressure is working and if the medications are stopped the blood pressure will rise again. Therefore it is advised to continue the usual medications.
• The type of medicine used to treat hypertension depends on your overall health and how high your blood pressure is.
• There are several medications that can be used in High BP.
• It can take some time to find the exact medication or combination of medications that work best for you.
• Always take blood pressure medicines as prescribed by your doctor.
• Don’t change your treatment without your doctor’s advice.
• Never skip a dose or abruptly stop taking blood pressure medications.
• Sudden cessation of certain medications, can cause a sharp rise in blood pressure.
• If you skipped the medications due to cost, side effects or forgetfulness, talk to your doctor about solutions.
• There is no harm in taking the same pill for a long time. It will not cause any kidney damage.

When taking blood pressure medications, it’s important to know your goal blood pressure level. Your blood pressure should be less than140/90 mm Hg.

Your doctor may define individual BP targets according to your health and co existing diseases and special situations.

• Three month follow up is adequate if your BP is under control
• If you are having very high BP or difficult to treat BP you will be asked to come for follow up more frequently
• You need to check for organ damage and arrange investigations at least once a year or as prescribed by the doctor

• High BP is a silent killer
• High BP can result damage to many organs including heart, kidneys, blood vessels brain and eyes.
• Life style interventions are recommended for all
• Reduce salt intake, cause reduction in blood pressure
• Quit all forms of tobacco use
• Avoid or stop all forms of alcohol use
• Engage in moderate intensity aerobic exercise