Measuring blood pressure
High blood pressure is often associated with few or no symptoms. Many people have it for years without knowing it. In this report by Sade Oguntola, experts say that when symptoms do occur, it’s usually only when blood pressure spikes suddenly and extremely enough to be considered a medical emergency.
Hypertension symptoms? Often there is none. High blood pressure is often called the “silent” disease, because it may have no noticeable symptoms.
Blood pressure is actually the force with which the blood pushes against the walls of arteries. When the pressure in the blood vessels is higher than the normal level, it is known as high blood pressure or hypertension.
Hypertension actually puts a lot of pressure on the heart and arteries and increases their workload. If it remains untreated, it can increase the chances of developing cardiovascular diseases like heart attack, stroke and vision loss.
But, there are times when high blood pressure is considered an emergency and requires urgent medical attention. This can occur if the blood pressure rises quickly and severely, possibly causing organ damage.
The two types of hypertensive crises—hypertensive emergency and hypertensive urgency— share a common sign: severely elevated blood pressure, usually defined as a diastolic pressure that exceeds 120 mm Hg.
In a hypertensive emergency, the high blood pressure causes target organ damage (brain, eyes, blood vessels, heart, and kidneys). Although the blood pressure is also elevated in a hypertensive urgency, there’s little or no evidence of target organ damage.
In pregnancy, preexisting poorly managed hypertension can lead to stroke on the mother, convulsions during pregnancy (eclampsia), slow growth of the baby inside the womb, placenta abruption, and stillbirth.
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However, in Nigeria, a hypertensive emergency is not rare. “Even before some people are diagnosed with hypertension, the damage to organs such as heart, kidney, blood vessels or brain may have occurred,” Professor Babatunde Salako, a nephrologist, said.
Salako, director-general, Nigerian Institute of Medical Research (NIMER), Lagos declared that unfortunately, high blood pressure is not controlled in at least 50 per cent of Nigerians with hypertension, so putting them at a higher risk of organ damage.
He added, “the heart tops the list of organs that are affected. When it occurs, it is always an emergency because it is either heart failure or a heart attack.”
Although hypertension usually has no symptoms or signs, Professor Salako said when blood pressure remains persistently high, it can cause both short and long term organ damage such as heart enlargement, kidney failure and abnormal heartbeats.
However, Dr Yemi Raji, a hypertension expert at the University College Hospital (UCH), Ibadan, Oyo State, said individuals should not wait till they start experiencing signs and symptoms of hypertension that requires treatment.
According to Dr Raji, “That is why compliance with their medications and clinic appointments is very important. By the time, there are signs and symptoms; there is already a damaged organ that will require medical attention.”
He added, “The effect of hypertension can manifest in the brain as a severe headache which does not seem to die down even with pain killers. The headache could be because the individual has developed stroke. That is enough reason to quickly seek medical attention.
“Untreated blood pressure can also cause transient vision loss, difficulty speaking, sudden wooziness, loss of balance coupled with severe confusion, abnormal heartbeats and difficulty breathing.
“Individuals with heart failure or whose heart is not working well will be breathless. They may also be coughing because their heart is not pumping well.”
Dr Raji said usually during hospital visits, individuals with hypertension are told about severe hypertension complications, need for adherence to high blood pressure medications and lifestyle choices that support a low blood pressure as well as why they most not miss their doctor’s appointments.
According to him, “that you take your blood pressure medications is not enough. There could be the need for the doctor to adjust the dosage either downward or upward or even change the medication, if need be, to ensure a good blood pressure control.”
There are a variety of medications that can be used to treat high blood pressure if lifestyle changes alone aren’t helping. Many cases will require up to two different medications.
Professor Ranti Familoni, a consultant physician, Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Ogun State, said the symptoms of severe hypertension is determined by the organ affected by the persistently high blood pressure.
Professor Familoni stated that severe hypertension could also be a reason to experience pain around the neck when it causes internal bleeding. The pain seems to originate from the upper neck and extends to the back of the head.
Also, he said abnormal heartbeats, shortness of breath and chest pains that could occur initially during exercise and which come up with rest overtime could be features of hypertensive heart failure.
Abnormal heartbeats or heart palpitations are one of the most common symptoms of high blood pressure. It may also feel like the pounding is near the ears and temples.
Professor Familoni stated that vision loss due to blurred vision and detachment in the retina inside the eye may also occur due to uncontrolled high blood pressure.
He added, “that is why we always emphasise that individuals with hypertension cannot stop their drugs just because they think that their blood pressure is down.
“Control of high bloodpressure is a big issue due to many variables, including fake drugs, economic problems and many patients’ ignorance that medications for blood pressure has to be taken for life,” he declared.
Treatment will also greatly lower the chance of heart attack, stroke, and other heart disease-related complications.
Professor Familoni added, “Taking their drugs regularly is not enough because they will not know when complications such as organ damage set it. Of course, if there is any organ damage or other complications of hypertension, the doctor might need to make changes in their treatment to also treat the problem.”
Whatever organ damage that has occurred is treated with therapies specific to the organ that is damaged.
Certain tests will be performed to monitor bloodpressure and assess organ damage, including regular monitoring of blood pressure, eye examination to look for swelling and bleeding as well as blood and urine testing to look for micro-albumin, an early indicator of kidney damage caused by high blood pressure.
Persons diagnosed with high blood pressure need to also track their blood pressure and medications. If possible during an emergency, having these logs can provide valuable information to the medical team providing treatment.
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