Durban - Today, Thursday, is World Hypertension Day, and doctors around South Africa are urging people to test regularly for this the ‘silent killer’ that can show no signs or symptoms, but can lead to serious cardiovascular disease. 

Last year an estimated 42% to 54% of South Africans were suffering from hypertension and this figure is expected to increase. Hypertension is the leading risk factor for heart disease and stroke. Other complications can include heart failure, peripheral vascular disease, renal impairment, retinal haemorrhage and visual impairment. It is the leading cause of mortality, with an estimated 1.2 billion sufferers globally. In South Africa, more than 1 in 3 adults live with high blood pressure and it is responsible for 1 in every 2 strokes and 2 in every 5 heart attacks.

South Africa has seen an exponential growth in hypertension or high blood pressure over the last 20 years,” says Professor Bryan Rayner, nephrologist and director of the Hypertension Institute at the University of Cape Town. “In a sense we are facing a national health emergency, but because the links between high blood pressure and death, heart disease and stroke are indirect, public awareness is poor.”

“Risk factors for hypertension are a family history of hypertension, diabetes or stroke, obesity, sedentary lifestyle, diabetes, high blood pressure in pregnancy, and a poor diet with excess alcohol, sugar and salt,” says Rayner. 

A study by Wits University scientists revealed that South Africa  has the highest prevalence of hypertension in southern Africa, as well as the largest number of people whose blood pressure is still not controlled, even while on treatment.

“No one is immune to hypertension – black or white, male or female, rich or poor, old or young, overweight or thin, fit or unfit – and it is essential that everyone has their blood pressure screened regularly especially if you have risk factors for hypertension,” says Rayner. 

The theme of the day is ‘Know Your Numbers’ with the goal of increasing high blood pressure awareness in all populations around the world. In addition, May Measurement Month (MMM) is a global awareness campaign to highlight the importance of screening for raised blood pressure.

Durban pulmonologist Dr Moosa Suleman describes the effect of hypertension on the body. "Blood that is rich in oxygen arrives from the lungs to the left side of the heart, and has to be pumped to the rest of the body through vessels which are called arteries. Hypertension is defined as high pressure (tension) in the arteries that carry blood from the heart to the rest of the body. This increased pressure in the vessels cause a strain on the heart muscles which have to pump harder against the pressure, and damages other organs of the body as well."

He also tells how blood pressure readings work: "Blood pressure readings are given as two numbers: The systolic blood pressure (the top number) equals the pressure in the arteries as the heart contracts. The diastolic pressure (the bottom number) is the pressure in the arteries as the heart relaxes. Normal blood pressure is below 120/80."

The American Academy of Cardiology defines blood pressure ranges as follows: Hypertension stage 1 is 130-139 or 80-89, and hypertension stage 2 is 140 or higher, or 90 or higher.

He also says that blood pressure readings can vary in a single person throughout the day depending on the situation. "Factors such as stress, anxiety, foods eaten (caffeine or salt intake), smoking, or exercise can cause pressure to rise. 

"High blood pressure may not have any symptoms, or some people may manifest with symptoms such as headache, dizziness, shortness of breath, blurred vision, feeling of pulsations in the neck or head, or nausea. Very high blood pressure (for example, 180/110 or higher) indicates an emergency situation and may be associated with chest pain, shortness of breath, headache, dizziness, or back or abdominal pain. In such situations you should seek medical care immediately," he advises.

Blood pressure is caused by many different factors, so there are many different treatments. "The goal of treating high blood pressure is to keep the blood pressure below 134/80," says Dr Suleman. "Treatments include lifestyle modifications such as quitting smoking, losing weight, exercise, avoiding alcohol, eating a low-sodium and low-fat diet. There are many different categories of blood pressure medications. Your doctor will work with you to find the right one," he said.

Dr Suleman also said  are some complementary and alternative medicine strategies could help especially when it comes to relaxation methods that help reduce stress such as deep breathing, yoga, meditation, and biofeedback. He also advocates that keeping a daily blood pressure chart can be useful, and that you get adequate sleep. 

He says some home remedies such as garlic, coenzyme Q-10 (CoQ10), calcium, magnesium, fish oil, and flaxseed have been shown in studies to lower blood pressure, but he advised patients to consult their doctor before taking any supplements.

Having a blood pressure check is quick, simple and non-invasive. Usually, the healthcare professional will use an electronic device that is strapped to the upper arm. The cuff or band squeezes the arm for several seconds, cutting off blood flow, and then releases. 

A Patient's testimonial

Age: 45

Occupation: Public Health Medicine Specialist and PhD student

Last November, I had just trained at the gym and I decided to have my blood pressure checked as there was a nurse on site. It turned out that my blood pressure was higher than normal. My trainer suggested that it may be because I had been exercising hard and I should not be too concerned. A few weeks later, I had another check, and it was even higher; when I went to have a third test, it was an astonishingly high 190/120.

Readings above 180 systolic pressure or above 110 diastolic pressure indicate that you are in a hypertensive crisis, which meant that my health was at risk. To make matters worse, I was about to leave for London on a work trip. 

I went to the emergency room at the hospital where it was confirmed again that my BP was dangerously high. The doctor on duty advised me to see a specialist in order to obtain a comprehensive diagnosis. My husband was seriously concerned, and he suggested I see his physician before I board the plane.

I am 45 years old, I go to gym twice a week, run twice a week, I had just completed a half marathon, changed my lifestyle and had just lost 10kg when I got the diagnosis. Like many people with hypertension, I had no signs or symptoms of the disease, which is why it was such a surprise to me.

I was started on a specific treatment which I started taking on the same day as my flight to the UK. On my return, I went to my physician who over a few weeks changed my treatment to two types of medication and was relieved after a few months to discover that my blood pressure had returned to a normal, healthy level. I haven’t experienced any side effects which is great as I will have to take the medication for the rest of my life.

As a family, we have made a few changes to our diet, avoiding too many carbs and cutting out sugar. The thing I am struggling with most is giving up salt, but I’m working on it. It’s important to talk to your children and educate them about what it means to be conscious about your lifestyle and what you eat. My two children are now far more aware of the importance of a healthy diet.

The higher your blood pressure, the stronger the likelihood of serious consequences for your heart, brain or kidneys. I recommend that everyone over the age of 40 has regular blood pressure checks – for me, it was a lifesaver as hypertension is a silent killer and I was nearly a statistic.

The Independent on Saturday