The prevalence of hypertension (hipertensi) among adults aged more than 18 years old is 35.3% in the year 2015 according to the National Health and Morbidity Survey (NHMS) for NCD risk factors. This figure was smaller in the year 2011, where 33.6% of adults were having hypertension. There are several risk factors and possible causes for the incidence of hypertension.
Hypertension can be diagnosed based on clinical blood pressure taken several times in appropriate conditions and equipment. A normal healthy adult will have his or her blood pressure below 120 for systolic and 80 for diastolic. A hypertensive adult will have a reading above this cut off value and can be further classified to a few stages.
For stage 1 or mild hypertension, the systolic reading is in between 140 to 159 and/or diastolic of 90 to 99. For stage 2 or moderate hypertension, systolic reading is between 160 to 179 and diastolic of 100 to 109. Meanwhile, stage 3 hypertension being the severe stage ranges more than 180 for systolic and more than 110 for diastolic. Apart from these, there are other types of hypertension such as isolated systolic hypertension and white-coat hypertension.
Causes of hypertension
About 90% of the reason someone getting hypertension is from an unknown cause. This condition is called as essential hypertension, while the remaining 10% are from possible secondary causes discussed below;
- Parenchymal kidney disease. Kidney is an essential organ that functions to regulate the blood pressure by absorbing and secreting water from the tubules of the kidney. Chronic damages to the kidney leads to failure of these regulation, thus increasing the blood pressure,
- Drug induced. Drugs such as oral contraceptives, steroids and some painkillers from the non steroidal anti inflammatory drugs group.
- Thyroid disease. Thyroid disease such as hyperthyroidism and Grave’s disease can cause an increase in body metabolism, hence increasing the blood pressure.
- Cushing syndrome. This is a syndrome due to an increase in production of steroids in the body or can be due to overconsumption of steroids. Steroids function to increase the blood pressure in our body.
- This is usually a benign tumor that arises from the adrenal glands forcing them to release huge amounts of hormones that are responsible to raise the blood pressure.
- Coarctation of aorta. This is typically an anatomical defect diagnosed from birth that causes the blood vessel, aorta to be narrower than usual. This narrowing can lead to an increase in the pressure needed to pump the blood out from the heart.
Treatment of hypertension
After blood pressure measurements were taken, patients will be then assessed on their cardiovascular global risk based on target organ damage and target organ failure such as kidney and heart failure. For any patients who fall under the low to intermediate category, they will be advised on non pharmacologic measures for about 3 to 6 months and then reassessed again.
Some of the non pharmacologic measures are as follows;
- Weight reduction
- Reduce consumption of salt
- Reduce consumption of alcohol
- Health eating
- Regular exercise
- Smoking cessation
- Meditation and relaxation therapy
For patients with medium, high, and very high global cardiovascular risk, they will be prescribed with antihypertensives drugs from different groups according to their medical background profile and will be monitored regularly. These are some common groups of anit-hypertensives used in clinics and hospitals.
- Beta blockers
- Alpha blockers
- Calcium channel blockers
- Angiotensin receptor blockers
- Angiotensin converting enzymes inhibitors
Most of the hypertension are from an idiopathic origin or commonly called as essential hypertension, whilst the other 10% are caused by secondary causes as listed above. Do consult a doctor if you have any main risk factors of getting hypertension.