The silent killer stalking us

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You are more at risk if you have a family history of high blood pressure, stroke or heart problems, or if you are black or south Asian. Both ethnic groups have higher rates of hypertension.

It was a constant headache – “like a huge weight on top of my head” – that took Nina de Vries, 49, off to her doctor, who found she had hypertension, commonly known as high blood pressure.

“My blood pressure has always been a bit high, but the alarmed look in the doctor’s face told me it was off the chart. He put me on pills straight away, and I’ve been on them for a month. I take two a day,” she says.

It took two days for the headache to dissipate, but Nina says she now has to battle her weight. She gained 14kg after stopping smoking in June last year, and has to reverse some poor eating habits. “I like salt, so giving that up is especially difficult,” she says.

Kgomotso Masisi, 46, was diagnosed with hypertension 10 years ago. “In a way I wasn’t surprised, because my mother had died of a stroke from high blood pressure at 45. My brother has it and so has my older sister, and she isn’t overweight like my brother and myself,” she says.

Kgomotso was prescribed anti-hypertensive tablets, initially taking half a tablet each morning then progressing to a full tablet when the doctor observed little difference.

After a year, she was also prescribed the common anti-hypertensive drug Adalat XL as well as Prexum Perindopril, and now, at 46, pops four pills daily and visits the clinic monthly for check-ups. “My blood pressure has come down but not by much. I worry about my daughters, because it’s obviously hereditary and there’s diabetes in their father’s family,” she says.

Known as the “silent killer” as there are rarely noticeable symptoms, hypertension afflicts about six million South Africans, about one in four people. It is the top chronic condition by frequency among members of Fedhealth medical scheme, with 12 percent of its members currently registered on the chronic medicine programme suffering from hypertension.

Many people unknowingly suffer hypertension for years, only getting diagnosed when serious symptoms appear. In advanced cases, symptoms might include headaches, visual disturbances, nose bleeds, nausea, vomiting, sleeplessness and even seizures, but by then serious damage has already been done to your body. Says Peter Jordaan, principal officer of Fedhealth: “Hypertension very often leads to hospitalisation where the member will require treatment for complications such as renal failure, dialysis or coronary artery disease.”

Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps out blood. Hypertension develops when the walls of the larger arteries lose their natural elasticity and become rigid and the smaller blood vessels become narrower, increasing your blood pressure.

If your blood pressure remains high, it can lead to a heart attack, stroke (brain attack), kidney failure and premature death. And unfortunately, while there are remedies, there is no known cure.

Many people, as in Kgomotso’s case, are genetically predisposed to hypertension and the black African population is particularly vulnerable. The risks increase with being overweight (especially around the abdomen), following an unhealthy diet with lots of salt, stress, smoking, drinking excessively, lack of exercise and age, 35 being the start of the risk trajectory.

Dr Kubedi Mokhobo, a cardiologist at Potchefstroom provincial hospital, says he sees marginally more women than men at his rooms, as “women tend to put on weight due to poor diet and little exercise”.

“Hypertension keeps company with diabetes, and usually rears its ugly head at around 35 to 40,” he says.

People living in South Africa’s deep rural areas were once free of this disease because they walked long distances and ate a lot of wild fruit and vegetables, explains Professor Pindile Mntla, a cardiologist at the Medical University of SA (Medunsa). “But that has changed over the decades. What were once fertile, green plantations have become barren. So even rural people are forced to buy fruit and vegetables, and consequently don’t eat enough. In the urban areas people’s diets include a lot of junk food, so the prevalence of hypertension is higher in the cities,” he says.

Cardiology professor John Milne, who runs a hypertension clinic at the Charlotte Maxeke Johannesburg Hospital every Wednesday, goes as far as to say hypertension is “exploding in all communities”.

“Traditional pap and meat is no longer the sole staple in the rural areas and people are eating far more salt,” he says.

Milne, like Mntla, usually only sees the sufferers when complications have already set in.

Complications due to hypertension vary. “In black patients with hypertension, the complications are usually severe, including strokes and renal failure, whereas in white or Indian patients, they typically present with heart disease,” Mntla observes.

In pregnant women, high blood pressure can pre-empt eclampsia, seizures which untreated, can be fatal for both the mother and her unborn child. “More often the baby dies and the mother’s health is badly compromised,” says Mntla.

Pre-eclampsia is common, says Milne. “It’s the most common serious complication of pregnancy, and when it happens, the baby in particular is at risk. If you know you’re hypertensive, your blood pressure must be controlled before conceiving, and closely monitored throughout pregnancy,” he says.

Lucinda* has three healthy sons, but it was touch and go all the way because she suffered pre-eclampsia in all three pregnancies.

“On my check at the clinic at between seven and eight months in my first pregnancy, the doctor told me my condition was serious. He even suggested I should terminate as my own life was at stake.

“I went into early labour and my kidneys started to shut down. It was terrifying. Meconium (infant’s first stools, usually passed only after birth) was present so the baby was also in distress. I had an emergency Caesar under a full anaeshetic and the baby was pulled out as quickly as possible. He was a blue colour,” she recalls.

Lucinda’s blood pressure never came down after that, and she was on medication, but she soon fell pregnant again. “There was the usual swelling, but this time I was going to the clinic and sticking religiously to the meds. After my second was born I was told not to have another, but three years later I was pregnant again.”

On this occasion, high blood pressure prevented the placenta around the baby from sufficiently forming and at 7.5 months, Lucinda couldn’t feel the baby moving.

“I rushed to the clinic and the doctor ordered an immediate Caesar because there was nothing left of the placenta and the baby was getting no nutrition,” she says.

Baby number three was also premature but healthy, but Lucinda’s fallopian tubes were tied to prevent her falling pregnant a fourth time. She remains on blood pressure medication, taking one pill a day – “and that will be for the rest of my life”.

Like most people with hypertension, until her first run-in with pre-eclampsia she never suspected anything due to never having shown any symptoms. “Even now, I don’t feel any different when my blood pressure is high compared to when it’s normal,” she says.

Since her pregnancy ordeals, her cardiologist has determined that it is inherited. Both her parents had hypertension, and she was a low-weight, premature baby, which he told her often signifies hypertension as you grow into an adult.

Medical science has been her saviour, but like all hypertension sufferers, forging healthy habits has been the other essential tool in keeping this scary affliction at bay.

HOW TO KEEP YOUR BLOOD PRESSURE IN CHECK

* Eat 3-6 small meals a day, which is what dietitians recommend for a healthy lifestyle generally.

* Follow a healthy balanced diet rich in vegetables and fruit (at least 5-a-day), high in fibre (include whole grains and nuts), low in saturated and total fats and low in unrefined carbohydrates (limit food and drinks high in added sugars).

* If you’re overweight, lose weight. Losing as little as 4.5kg can lead to a meaningful drop in blood pressure. Even if you’re a healthy weight, regular exercise is among the best ways to prevent, or reverse high blood pressure.

* Limit salt to a teaspoon a day or less (6 grams). Learn to use fresh herbs and spices and to enjoy the natural flavour of the food. Some alternatives to salt are vinegar, lemon juice, fresh garlic, ground horseradish, hot pepper sauce and onion powders. And look out for the word “sodium” in product ingredients. Sodium is salt, best to be avoided.

* If you drink, do so in moderation. One or two drinks a day is enough.

* Caffeine in coffee, tea, cola drinks, chocolate, energy drinks and weight-loss products may cause blood pressure to increase temporarily.

* Include exercise as part of your daily routine. Aim for 30 to 45 minutes most days of the week.

* Keep cholesterol in check. Cholesterol leads to accumulations of fatty material and makes arteries less elastic, which narrows them and forces your blood pressure up.

* Have your blood pressure checked once a year (more often if there is a history of it in your family). If you’re prescribed pills, don’t allow them to run out.

* If you suffer high blood pressure and suspect you’re pregnant, see a gynaecologist as soon as possible. Don’t wait. - The Star

* For advice on hypertension, call the Heart and Stroke Foundation’s Heart Mark Diet Line on 086 022 3222 or visit www.heartfoundation.co.za

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