Hypertension (High Blood Pressure) and the Story of A Patient

According to the World Health Organization, hypertension is the world’s third health killer, which could bring to other critical diseases such as coronary heart disease, stroke and kidney damage. It is another slow health killer. It was reported that one out of three Malaysians (33%) aged 30 and above suffers from hypertension. You need to learn more about this disease because only six out of every 100 Malaysians with hypertension have their blood pressure under control (New Straits Times, 7 April 2006). Some people have high blood pressure for years without knowing it. Hence, hypertension is also another ‘silent killer’.

Blood pressure is the force of blood against the wall of arteries. The heart pumps blood around our body through a network of arteries. The blood needs some pressure to carry the nutrients and oxygen to various parts of the human body and also to carry away waste. When it pumps, it forces blood through the arteries into smaller blood vessels known as capillaries. The force that the heart produces in arteries when it pumps is the blood pressure. If these vessels are narrow, it's harder for the blood to flow through them and the pressure inside them increases. When a person’s blood pressure is higher than the normal level, hypertension occurs.

High blood pressure measurement
Ideal: <120 mm Hg (lower) and <80 mmHg (higher).
Normal: <130 mm Hg (lower) and <85 mmHg (higher).
Marginal: <130–139 mm Hg (lower) and < 85–89 mmHg (higher).
1st stage hypertension: <140–159 mm Hg (lower) and < 90–99 mmHg (higher).
2nd stage hypertension: <160–179 mm Hg (lower) and < 100–109 mmHg (higher).
3rd stage hypertension: <180–209 mm Hg (lower) and < 110–119 mmHg (higher).

When high blood pressure occurs, the heart becomes strained and blood vessels may become damaged. Changes in the vessels that supply blood to the kidneys and brain may cause these organs to be affected. Hypertension damages body organs such as the heart, blood vessels, kidneys and eyes. It makes the heart work too hard and this contributes to atherosclerosis (hardening of the arteries), increases the risk of heart disease and stroke and brings about other health problems such as congestive heart failure and blindness.

Information from the websites on health shows that 90 to 95% of high blood pressure cases are of unknown cause. When the cause is unknown, it is called essential or primary hypertension. Scientists have identified some factors that contribute to high blood pressure. These are arteriosclerosis (or hardening of the arteries), thickening or hypertrophy of the artery wall and excess contraction of the arterioles (small arteries).

Even though the cause of high blood pressure is unknown, certain associations have been recognized in people with essential hypertension. For example, essential hypertension develops only in groups or societies that have a fairly high intake of salt, exceeding 5.8 grams daily. Thus, excess salt may be involved in the hypertension that is associated with advancing age, obesity, hereditary (genetic) susceptibility and kidney failure (renal insufficiency).

Factors that may lead to high blood pressure in the remaining 5–10% of cases, which are known as secondary hypertension, include (a) kidney abnormality, (b) a structural abnormality of the aorta (large blood vessel leaving the heart) existing since birth and (c) narrowing of certain arteries.

Doctors normally use medicines to control the high blood pressure. When one type of medicine does not bring the desired effect or brings side effects, another medicine is prescribed. The following case of one of my relatives (a 60-year-old married female in 2006) is an example of how high blood pressure could lead to other problems.

1970-1990s: Had headache from time to time. Practised self-medication with ‘Panadol’ and ‘Dusil’ tablets purchased from sundry shops. She liked to eat salty food. Much salt was added to fish, vegetable and soup prepared for lunch and dinner.

1999: Confirmed to have high blood pressure and began to take medicine prescribed by doctors. She sought medical treatment in hospitals and specialist centres in Kuantan and Kuala Lumpur. She also believed to have bad luck when high blood occurred and hence sought traditional religious treatment from Chinese mediums.

2000–2003: Felt physically weak and dizzy from time to time. Besides visiting the doctors, she continued to obtain traditional medicine from Chinese medium. Also took food supplements to enhance body immune system. She fainted a few times. Following my advice, she began to drink a glass of fruit juice a day. She followed the doctor’s advice that she is ‘free to eat anything she likes’ and did not want to change to health food.

2004: Stroke occurred and she was warded in the government hospital for a week. She took medicine, namely Enalapril Maleate 5 mg/tablet and Glibenclamide 5 mg/tablet to reduce hypertension and diabetes. She also took food supplements. She felt that death may be nearer than thought. She had to be careful to walk slowly.

2005: To reduce hypertension and diabetes, she is now on three treatments, namely (a) Western medication – Enalapril 5 mg/tablet and 28 Filmtabletten 80/12, 5 mg/tablet, (b) 3 types of Chinese herbal tablets and (c) Chinese acupuncture treatment from a Chinese physician in Kuala Lumpur. As her life is now threatened, she said that she did not mind spending money as long as there is a way to recover from stroke.

2006-2008: She began to reduce meat consumption. By January 2007, she can walk firmly without the care of her husband. She believes that her slight health improvement is the result of acupuncture treatment.

2009: She had another minor stroke and almost fell to the ground. Despite of this, she continues to enjoy the nice and tasty food.

Medically, the main cause of high blood pressure is not known. It is however associated with excessive salt intake. The disease is linked to eye disease, blood vessel damage, coronary artery disease, kidney failure, stroke, dementia, erectile dysfunction.

In the case of the high blood pressure patient above, the association to excessive salt intake is true. She likes to consume salted food, from vegetable, egg to fish. High blood pressure has resulted in her stroke. If she does not adjust her diet for healthy living, she may be suffering more at the last stage of her life.