High Blood Pressure

HIGH BLOOD PRESSURE
WHAT THE PUBLIC NEEDS TO KNOW

Are you one of the very many adult Nigerians who have high blood pressure? How do you know if you have high blood pressure?
High blood pressure, known medically by the health profession as hypertension, is also called the “silent killer” because it usually has little or no symptoms in some individuals, strikes people dead without warning. You may not tell if you have high blood pressure because you do not feel sick. One out of every four adults has hypertension but half of them do not even know this.
Only by having your blood pressure taken by a qualified professional and treated by a medical doctor would you stop high blood pressure before it stops you.

PREFACE
HIGH BLOOD PRESSURE: WHAT YOU NEED TO KNOW
There is no doubt that many people have heard or have been told that they are suffering from high blood pressure. The incidence of high blood pressure in our society is so high that it has become the most common disease that people discuss, are afraid of, and when they are told they have it, are anxious to get rid of it. What people discuss shows that they do not understand what high blood pressure is all about. Instead, they have numerous wrong ideas and impressions. However, the circumstances and manner in which people are told about high blood pressure may confuse and frighten a lot of people. In many situations, when the diagnosis of hypertension is made, the medical doctor simply prescribes drugs and tells the patient to take life easy. There is no real explanation of the implications of uncontrolled high blood pressure, hence the need for strict and continued adherence to taking the prescribed drugs. Sometimes when it is called hypertension, some people think they are suffering from two diseases, not knowing that hypertension is the medical term for high blood pressure.
Several books have been written on high blood pressure, but, alas they are written in the medical jargon that is not for all to consume. As a result, many people are anxious to know what high blood pressure (hypertension) is, what causes it, how it affects their life and what drugs to take to reduce their blood pressure to normal.
The author has been involved elsewhere in the mass education and treatment programs developed for persons who are suffering from high blood pressure. The obligation to render this social and public service by writing this book emanated from his years of experience as to what people think high blood pressure is or is not. Therefore, to allay fears reduce confusion as to what to do when one feels that one has high blood pressure (hypertension) and how to take the drugs, it became necessary to reduce the medical literature to a readable form for public consumption. This public awareness effort is based on the fact that the more informed people are about their disease and drugs, the more they will comply with treatment. This book, therefore, will help people understand what the doctors say in the clinics an/d make people appreciated the need for the drugs given for the disease as well as help them adopt habits and lifestyles that would go a long way towards promoting longer and more useful lives.
When people understand the disease better and take their drugs as the doctor or pharmacist tells them, we hope that this will reduce the incidence of stroke, heart and kidney failure as well as sudden death that is very common in the society today.
The omission of the drugs that are used in the treatment of high blood pressure (hypertension) was done on purpose. We find it much proper to give the general information on what people should know about their drugs instead of discussing the individual or groups of drugs that are normally used. The latter may encourage poor and dangerous self-medication. The medical doctor is most qualified to decide on which drug each person gets for his disease.
Finally, a request to the reader of this book: our aim is to improve peoples’ understanding of the disease and the need for continued drug-intake in the treatment of high blood pressure (hypertension). In this manner, it has been clearly shown that the complications of the disease are greatly reduced. In this regard the authors would appreciate any constructive criticism and relevant information that would be included eventually in a revised edition.

Cletus Nze Aguma

INTRODUCTION
As a developing nation, the information explosion is reaching many corners of this country. People are becoming more aware of economic, political and social innovations. At the same time, many more people are becoming aware of their health. After malaria, one of the most serious health problems that many people seem to know something about is high blood pressure. Several years ago, high blood pressure and diabetes (high level of sugar in the blood and urine) were referred to as “big men’s disease”. But today it is becoming obvious to /many people that may one may fall a victim of high blood pressure. People have different understanding of what high blood pressure is and what is not. In writing this book, the intention of the author is to bring into sharp focus to the layman, what high blood pressure is, in order to allay fears and correct wrong beliefs so that people will seek medical care before it is too late. I have attempted to bring the information in as simple a presentation as possible to the public. With better understanding of what high blood pressure is, people should not be afraid of it anymore. They should go to hospitals and see doctors for treatment. Treatment will prolong life, create a healthier nation and provide better quality of life.


High Blood Pressure (HBP) – What is is
Everybody has blood pressure. Blood pressure is a measure of the force in the wall of the blood vessel to which the heart pumps blood against. Some degree of blood pressure is absolutely necessary in order to get/ blood and its nutrient elements to all parts of the body. When we us the words – high blood pressure (HBP) it means that the blood pressure in the arterial wall has increased above that which is usually normal for that particular person. When it becomes too high it becomes risky for the person who has it. Therefore HBP does not mean “too much tension” or “too much blood” in the body. HB as a disease comes on very gradually. It is painless but very destructive. The day your doctor tells you that your BP is high is not the day it started. It has taken some months or several years before it finally showed up. The only thing good about HBP is that it is one of the easiest of all diseases to detect in an individual who is suffering from it. In terms of treatment, it is one of the most rewarding in the sense that effective treatment could forestall long-term complications thus extending the patient’s life-span. Many people do not know that they have high blood pressure. Only a very small percentage of those who know, are receiving adequate treatment. Some people are so afraid that they do not want to be told that they have it. High blood pressure is your enemy. Being afraid of it without fighting against it, will not save you from the destructions HBP does to the body.
Facts and Fallacies About High Blood Pressure
Fallacy: Hypertension is nervous tension
Fact: Feeling tension is not a symptom. People who are calm can have HBP as well as those who are tense.
Fallacy: Hypertension (HBP) means “high blood”
Fact: It has no relation to how much blood is in your body.
Fallacy: Too much fried food, onions, pepper and other foods cause HBP
Fact: Too much salt in the food causes increase in blood pressure.
Fallacy: Those who have high blood pressure should not drink any type of alcohol.
Fact: Social drinking does not worsen high blood pressure but cigarette smoking must be avoided.
Fallacy: Only adults can have high blood pressure
Fact: Children as well as adults may suffer from high blood pressure
Fallacy: High blood pressure is hereditary
Fact: High blood pressure is not proved to be hereditary but one’s chances of getting HBP is high if both parents have died of stroke or suffered HBP.
Fallacy: Those who have HBP should always remain calm and not work hard.
Fact: Exercise is as important as drug in the lowering of one’s BP (Blood Pressure)
Fallacy: If one’s blood pressure gets back to normal after taking some drugs, one is cured and can stop taking the drugs.
Fact: Control or lowering the HBP does not mean cure. Keeping HBP under control requires daily treatment.
Fallacy: It is better that one does not measure the blood pressure for fear of discovering HBP.
Fact: High blood pressure is number one cause of stroke, sudden death and other heart diseases, being afraid will not prevent one from getting the stroke etc.
Fallacy: If my blood pressure is high, all I have to do is take drugs to bring it down.
Fact: Effective treatment requires a complete regimen of drugs, diet, rest and exercise. Taking medication at prescribed intervals, however, is the primary basis for keeping HBP under control. One may take drugs, loose weight, reduce salt intake and stop smoking – all these may help solve ones HBP problems.
We have just said that blood pressure is the amount of force needed to circulate the blood throughout the body.
What then is normal blood pressure?
Blood pressure is measured at two levels, when the heart is contracting (systolic) and when it is relaxing between contractions (diastolic). Average systolic blood pressure is about 120 milimetres or mercury, whereas average normal diastolic pressure is 80 milimetres of mercury. This is reported as 120/80 or 120 “over” 80.
When is blood pressure considered to be high?
When the diastolic pressure 90 or higher it is said to be elevated or “high”.
What causes high blood pressure?
We do not know for sure. However, it is thought to be due to narrowing of certain blood vessels (vasoconstriction) and may be related to kidney function. In a small percentage of patients it may be due to a specific cause such as a tumour (pheochromocytoma). For the most part though, the cause of high blood pressure is a complete mystery.
How common is high blood pressure?
It is estimated that between 10 – 15 percent of the adult population of this country have high blood pressure. In terms of numbers, this is about 6 million people. This disease affects both the black and white races. It affects people from all parts of the world. In the United States of America for example, it is estimated that about 10 percent of the adult population or about 20 million people have high blood pressure. Unfortunately, many people who have high blood pressure are not aware of their problems.
At what age does high blood pressure begin?
The average age range for the beginning of high blood pressure is the 30s, however, it can occur at almost any age. Whereas children and people of teenage age can have high blood pressure, the disease becomes more common as we get older.
Is high blood pressure inherited?
The risk of developing hypertension is related to family history. Most studies have indicated that high blood pressure often runs in families. Those who have a family history of this disease are more likely to be hypertensive than those who do not. High blood pressure is more likely to develop in individuals whose parents had the disease than in those whose parents did not have or do not have the disorder. This is simply by chance and it does not have to occur. The importance of family history is that if any people in one’s family have HBP one has to start early to go for yearly medical checkups. If detected early, treatment would stop further damage in the heart and other parts of the body.

With regard to hypertension, what does the expression “spiking in youth” mean?
In addition to the importance of family history in determining the risk of developing hypertension, there is also evidence that “spiking” of blood pressure early in life are significant. In other words, when a Youngman has his first blood pressure measurement, it is possible to predict, based on this reading, the risk of developing hypertension in later life. For example, if a Youngman who has a physical examination at age 19, shows a diastolic blood pressure of 90mmHg the chances of becoming hypertensive in later life is high than that of a counterpart of the same age whose initial diastolic blood pressure was less than 80mmHg.
Some other reasons why the blood pressure may be high blood pressure
In a majority of people no one knows yet for sure the cause of high blood pressure. However, it is thought to the due to narrowing of certain blood vessels (vasoconstriction) and may be related to kidney function. About 90 – 95 percent of all people suffering from HBP fall into a class we describe as “essential hypertension”. The term “essential” means I do not know. At the moment no one is sure of the cause of high blood pressure in this group of people. Since the cause of high blood pressure is not known, it cannot be prevented or removed. That is why we say that HBP can be controlled but not cured in the great majority of sufferers.
In a small percentage of patients, 10 – 15 percent, HBP is due to something specific such as a tumour (pheochromocytoma) or some disease or damage to the kidneys. In these types of hypertension, when the tumour is removed by surgery or the damaged kidney walls are repaired, the blood pressure comes back to normal. In this small group, one can say that the high blood pressure is cured because the cause has been removed.
However, in the majority of people whose HBP is not curable i.e. the cause is not known, many factors have been shown to contribute to the development of the disease. In some people, there may be a temporary rise in blood pressure. This is why a single blood pressure measurement may not always indicate whether someone has HBP or not. A discussion of these other factors which have been shown to contribute to HBP now follows. Please note that these factors should be translated as causes of HBP per se, only factors that contributes to the development of the disease.
Salt Intake
Whereas obesity and hypertension are interrelated, obesity is neither a necessary nor a sufficient cause of HBP. This is true because many fat (obese) people do not have HBP, infact the mechanism whereby these 2 factors are interrelated is not yet clearly understood. Nonetheless, I have data that show that among groups of individuals, when body weights at young adulthood are compared, people who tend to have relatively greater body weights than their mates of the same age group, tend to have a greater tendency towards developing HBP at middle age. Another important aspect of this problem is that overweighing people, who are hypertensive, often enjoy a decrease in their blood pressures when they loose weight.
Cigarette Smoking
Another hygienic measure that helps in attaining normal blood pressure in someone who has hypertension is stopping cigarette smoking. Simply speaking, the hypertensive patient who smokes is at much greater risk than one who does not. Therefore people with a positive family history for hypertension and/or “spiking” in youth as well as those with established hypertension would be better off not smoking cigarettes.


High blood levels of cholesterol and glucose
As with the situation in cigarette smoking, people who have been found, upon medical examination by a qualified doctor, to have high levels of sugar and fats in their blood stream, should cut down on their intake of high calorie sugar-containing foods, saturated fats and cholesterol. Most of our usual African diets do not contain high levels of dietary fat. However in some regions of the continent where dairy and poultry farming yield products with high fat contents, high levels of cholesterol may be obtained in their meals.
It is very likely, though not yet conclusively proven, that the constant presence of high levels of sugar in the blood also adds to the risk of developing high blood pressure. This provides yet another reason for stressing the need to prevent and correct obesity, since the bodies of fat people tend to tolerate sugar (carbohydrate) less well.

Personality Traits
People have often asked if there is a typical high blood pressure “type” of individual. Generally speaking, the answer is no. personality characteristics have not been proven to cause high blood pressure, even though it is a popular misconception that a hypertensive patient is a nervous, compulsive, never-resting perfectionist who cannot sit still. This is not necessarily the case. Some people with high blood pressure maybe of this type, whereas other is the relaxed, well-adjusted, quiet, calm type.
One single, stressful, never-wrecking experience appears most unlikely to cause a sustained high blood pressure. At the point of immediate aggravation, the blood pressure may have risen, but the rise is only transient in a normal healthy person and very soon returns back to normal. However there is a sufficient evidence to show that prolonged and sustained aggravation, frustration, stress and strain at work for several years may cause high blood pressure. Constant stress and strain will not only help to quicken the development of high blood pressure/in a person prone to getting it, but it will also worsen high blood pressure that is already present. This is why one of the general advices often given to people with high blood pressure is for them to relax more and not worry too much about things.
Psychological Factors
There is no significant difference in the blood pressure of those who live in big towns and those who live in small urban and rural areas. Considering variables like education, occupation, income, place of residence etc, these factors do not seem to affect blood pressures. Circumstances in ones life that cause acute mental stress can initiate sudden though temporary increases in the blood pressure of some people. This does not mean that they now have high blood pressure. If there is a death in a family or loss of a loved one (or property for that matter), the blood pressure of the bereaved individual may suddenly shoot up. However, it should come down to normal after some weeks or months.
If it does not decrease but stays high over a reasonable period of time after the causative incident, the individual may then need to be treated with a drug. In a situation like this, it is still difficult to prove that the death in the family or loss of property as the case may be, caused the high blood pressure. When we realize that many of us who have high blood pressure do not even know it, it should be realized that the person in question could have had the high blood pressure before the death in the family or the loss of a loved one or personal property.

Blood Pressure: When should it be labeled high?
Is it true, for instance, that normal blood pressure should be 110/80 plus a patient’s age?
Before we begin to screen any population or group of people for hypertension, several other related questions must be answered.
These are:
1) What should be the dividing line that shows when blood pressure is “high”?
2) Is it the blood pressure at the point when the heart is contracting (systolic) or the pressure when the heart is relaxing (diastolic)?
3) Should the blood pressure be considered in the light of the person’s sex and age?
4) Should we use different standards for people of different races, the blacks and whites for example?
5) Is a single blood pressure measurement enough or do we have to repeat several times?
These are all thorny problems for which unfortunately there are no short, clear-cut, answers. These types of questions should not bother you as the patient, let the doctors and other experts in the health care field worry about them. If there is any doubt in your doctor’s mind as to whether your blood pressure is high enough to merit treatment, he will suggest that you return at some other time in the future to see him again for a check-up.

Degree of severity of high blood pressure
Because we do not often know the cause of high blood pressure and people often have it without being aware of this, this silent killer may be doing damages to some organs of the body, undetected. To make things easier for people who have to treat hypertension/, we classify high blood pressure, depending on certain measurements and observations, into mild, moderate and severe high blood pressure. This classification is based on not just how high the blood pressure reading is, but also on such things as the effects of this raised blood pressure, if any, on such parts of the body as the heart, kidneys, eyes and the brain. This classification is also important in determining the nature of the drug treatment, general management and ultimate follow-up of the patient.
People with the same illness, high blood pressure, who come to a hospital, are often given different drugs. This has something to do with this classification I mentioned a little while ago. Some patients maybe placed on a single drug, others two or three or even more drugs. The doctor may decide, for example to hospitalize some people for some days to lower their blood pressure being more rapidly or in a more controlled atmosphere. When you begin to bee constantly aware of your blood pressure being high, for instance, frequent headaches, blurred vision, nose bleeds etc., it is likely that the high blood pressure has begun to damage certain body organs. Based on some of these symptoms, the doctor decides to put the particular patient on the drugs he prescribes for the patient. This means that the patient should pay close attention to the directions given by the doctor. We have heard people say that they feel they have high blood pressure and would therefore like to take some of the Brinerdin given to their relatives who have the same problem. This practice is dangerous. No matter how mild or moderate the blood pressure is, the only rightful thing to do is to take the drugs as directed only by the doctor to control blood pressure.

Who suffers from high blood pressure?
HBP is not a disease of any particular race, class or people. It affects both blacks and whites, peoples from all over the world. It has no discrimination for age but it is generally thought to be more common among the older than the younger age groups. On the average, most cases of high blood pressure begin about the age of 30 or within the third decade of life. Many of these cases unfortunately go undetected until the patient reaches the ages of 50 or 60, hence the general false belief that it is normal for a person/ to have high blood pressure as he becomes older. This long time between the onset of the disease and the time it is actually detected, also often means that by the time it is confirmed, the raised blood pressure has caused damage to important body organs like the heart and kidneys or brain (stroke) or led to considerable loss of vision.

More facts on the incidence of high blood pressure
A survey carried out among the adult population of the United States of America aged 18 – 79 years, between the years 1960 – 1962, showed that about 15% of the whites and 27% of the blacks have high blood pressure. A similar survey in 1974 showed that 24 million Americans, both blacks and whites have high blood pressure. Of these peoples, only about half of this number knows that they have the disease. Of the number who knows that they have the disease, only 50% are receiving drug treatment, and of this last number, again only about 50% are effectively controlled. As a result of these findings, the US government declared hypertension, a national health problem and correspondingly took steps to create a stronger public awareness of this problem. As a result of this effect, today, many more hypertensive Americans are receiving treatment.
In Nigeria, we are not aware of any national programme against high blood pressure. There are a few reports here and there on the prevalence of the disease. Based on our experience for the past 2 years here, we are close to estimating that perhaps one out of every 4 Nigerians has some of raised blood pressure that deserves treatment. We should all be concerned about this. What we need at this point is a nationwide survey, involving every nook and corner of this nation in order to obtain proper incidence figures for this country. As you read this book, pause for a minute and think of how many people in your village have died suddenly of unknown causes or suffered strokes within the past year.
Many of these people were usually thought to have been well until they died in their sleep or soon after a heavy meal. Some of these deaths may have been due to high blood pressure, a disease that often strikes without any previous notice.
As a general rule, high blood pressure is more common in women than in men. However, women can tolerate it better than men. Studies using the racially-mixed population of the United States have shown that it is more common and dos more damage in young black males when compared to their white counterparts. It has also been shown that people who have the disease called diabetes have a greater chance of having high blood pressure. A child from a family where both parents have high blood pressure has a higher chance of having the disease when he grows up than his age counterparts. Nonetheless, it must be emphasized that anyone from any race or any part of this world can suffer from high blood pressure.


Why is it important to know if I have high blood pressure?
Earlier in this book, I said that everybody has blood pressure. This pressure is needed to transport blood and nutrient elements to all parts of the body.
When blood pressure becomes abnormally high, it imposes an extra burden on your heart and blood vessels. Pumping against an abnormally high blood pressure causes your heart to over-work. An abnormal strain on your heart can case the walls of your heart to thicken and the heart itself to become enlarged. It is important to treat high blood pressure before the heart is damaged.
Apart from damaging the heart directly, high blood pressure can damage other important pats of the body. Normal blood pressure is needed to transport blood and nourishment to all parts of the body. This blood is carried through large blood vessels called arteries. When blood pressure is high, the pressure in the walls of these arteries also increases. As we naturally get older, the walls of these arteries tend to become less elastic, much thicker, harder and narrower and so less able to tolerate increase in pressure. This hardening of the arteries may progress to the point where no more passage of blood is possible at that point. This may cause death or considerable damage of that artery such that blood supply to tat part of the body is cut off completely or is drastically reduced. Blood vessels in the brain may burst when their walls are sufficiently weakened and the pressure in them is yet so high. This is the type of situation I describe as stroke or cerebrovascular accident. A stroke can cause various degrees of paralysis or even instant death.

What are the typical symptoms of high blood pressure?
As has been mentioned in previous chapters, one of the big problems of high blood pressure is its lack of symptoms. Typically, a person in the initial stages of the disease feels good. Although headache, easy fatigue, shortness of breath and dizziness can occur with high blood pressure, there are many other disorders in which similar symptoms are present. Some people may experience nose bleeds, blood in the urine, poor vision, and increase in heart beat or even chest pain. Since you can have some of these symptoms with or without having high blood pressure, it is wise therefore to have a doctor or another health professional examine you and determine whether your blood pressure requires treatment. Avoid self-treatment, always.


What effect does high blood pressure have on the kidneys?
The kidneys begin to suffer as the tiny arteries in these organs are damaged by the pressure. Eventually the kidneys fail to filter out the waste products of the body. This, of course, leads to sickness and most often, death can follow especially where this situation is allowed to exist unchecked for a long time.

Measurement of blood pressure
The measurement of blood pressure requires a sphygmomanometer, a stethoscope and a trained health professional – medical doctor, nurse and pharmacist. The measurement is simple and fast. In developed countries of the world like the United States of America, patients suffering form high blood pressure may be taught to measure their blood pressure by themselves. The doctors taking care of them usually see them for several months to reduce and stabilize their blood pressure, then send them home with instructions on when to come back based on the blood pressure readings they record. Whenever they notice nay changes in their normal range of blood pressure, they come back to the doctor in order that their drugs will be re-evaluated and adjusted if necessary.
Here in our country, blood pressures only get measure when one goes to see his doctor, while you are a patient in a hospital or if you request a nurse to do so. Some pharmacists who have learnt to take blood pressures can also do so. Most people with an average intelligence can be taught within a short period of time to take blood pressures. The problem is not who can take blood pressures: the crucial matter is who is in a position to determine what is normal and what is not and above all, what should be done next, if, infact the blood pressure reading is high. The key point that is being made is that once you suspect, either through measurement, or in some other way, that your blood pressure is high, see a qualified medical doctor.
Recording of blood pressures, unfortunately, is not a routine aspect of patient examination in most of our hospital clinics or primary health care delivery areas in Nigeria. This is one area among several others, of our health service, that needs improvement. In some hospitals, blood pressures many not only be unmeasured, but sometimes,. May not even be recognized as abnormal by someone paramedical personnel. Patients may not be alerted that their pressures are high. Sometimes when they are told, it may be said in such a casual manner that the patient may not appreciate the usefulness or seriousness of the information. Stating that the recording of blood pressures should perhaps be routine for any adult that visits a doctor’s clinic or hospital clinic may sound as though I, the author is trying to say how doctors should practice in Nigeria. No, I have no such intention. However, since it can be reasonably said that perhaps, high blood pressure as a component in many disease, is probably second to motor car accidents as the number one cause of all Nigerian adult deaths, concerned medical professionals in our country should take another good, strong look on how to fight this great national enemy.
For non-medical personnel who indulge in recording people’s blood pressures, please note that the readings you get may not always be correct. Above all, even when you do get the correct readings, you may not always be in a position to advise the patients properly. Inaccuracy in your readings or judgment may be due to faulty technique, failure to consider the patient in total perspective or faulty apparatus. Some people’s blood pressure may rise, for example, as soon as they see that recording apparatus. The problem may arise from the recorder itself. The inflating system, the cuff or the pressure registering system, all have to be air tight.
In summary, there are many antihypertensive drugs with varying degrees of potency that are effective in controlling blood pressure in the vast majority of people with high blood pressure. Your doctor will attempt to identify the exact drug or combination of drugs that are needed to control your high blood pressure. These medications may produce side effects which are usually mild and easily treated but which should be reported to your doctor and pharmacist should they occur. Have your physician and pharmacist tell you which medications you are taking and feel free to discuss any questions or problems you have that may be related to your medications. Remember, good blood pressure control depends on you and will provide you with fewer high blood pressure complications if you take your medicines regularly. There should be no leaks at the exhaust valves and rubber connections. The cuff must be intact without torn seams or holes, thus making it possible for the pressure to be evenly distributed; the cuff should neither be too tight nor too loose. The mercury manometer that records the pressure should be checked so as to be sure that it is at zero before the cuff is inflated; if not, inaccurate readings are obtained.
Like most equipments, there are different kinds and designs of blood pressure recording instruments made by a large number of different companies. All these work on the same basic principles and are strictly, not that different from one another. The important thing is for the person using them to have been trained on how to use the instrument and also to make sure that the equipment in use is sound.
In addition to faulty apparatus, poor technique may be responsible for more errors. For example, the posture of the patient with respect to his arm level to the heart is important. It should be neither too high nor too low. The patient should sit with arm stretched out and relaxed, resting on a flat surface. The observer should also take a comfortable position. The environment should be noiseless so that it will be possible to hear the first laudable sound, the reading at which point is recorded as the systolic blood pressure, and the last laudable sound or the diastolic blood pressure. These two readings will then determine whether the pressure is high or low.
It is important to realize that, generally, people who come to see a doctor in his clinic or patients newly admitted into hospitals are anxious and apprehensive. Some people are afraid to find out what their blood pressure readings are like. They do not want to be told that their blood pressure is high. To them it is a sign of doom! As a result of these feelings, they get overtly anxious when they see that instrument. For these kinds of people, words of encouragement in appreciation of their natural anxiety and humorous statements or remarks may be all that is necessary to get them to relax and loosen up. This will make it possible for their true blood pressure reading to be determined. It is important to realize that cigarette smoking, exercise, cold air, cold water, warm baths, a full bladder and heart disease, among other things, may affect the blood pressure readings. This is why it usually takes several years experience for so0meone to measure blood pressures, properly and accurately, in a consistent manner, for a different variety of people, under a wide variety of situations. In conclusion then, you can see that taking blood pressures is not that simple after all.

Who can measure blood pressure?
Anyone can take blood pressure. Anyone here, means anyone who has been properly trained to measure blood pressure. In some countries like the United States of America, some patients are trained and educated to take their own blood pressure at home. This, not only acts as a tool to modify their drug-taking behaviour but it also helps them to keep an alert eye on this aspect of their health. The primary objective in advising patients to take their own blood pressure at home is to help remind them to take their prescribed drugs regularly. There has been research supporting this fact that people tend to be more compliant with their doctors’ instruction when they have to take their blood pressure. Since high blood pressure is a life-long problem, it has also been felt that perhaps teaching the patient to watch his own blood pressure makes it easier for both the doctor and patient to know when a change in medications or schedules becomes necessary. Essentially, the medical doctor, the nurse, clinical pharmacist or any other trained medical professional still holds the major responsibility for making the initial diagnosis of hypertension or determining when a patient needs to see a doctor in order to have his drugs changed or adjusted.
Some studies have shown that the community pharmacist in co-operation with the physician is the ideal individual to detect hypertension, motivate the patient to seek medical care, and maintain that patient successfully on a prescribed regimen. One important fact is that the patient must become conditioned to long-term therapy. Many physicians are too busy to spend time to explain the nature of the disease, its long-term effects on the body and the other essential things the patient has to know. The pharmacist is the ideal professional to supplement the physician in patient education for any obvious reasons. He is a health professional who is very knowledgeable about drugs and diseases. He is very easily accessible, usually without appointment. If he is there and not busy with any other patient, you can simply walk in and see him. There is a minimum of anxiety on the part of the patient in relating to the pharmacist. People are more inclined to speak to the pharmacist regarding side or adverse effects that they may be experiencing with drugs they are taking, to discuss the cost of drugs and any other reasons that they may have for not taking their drugs as prescribed by the medical doctor.

Management of HBP
The primary aims or goals in the management of HBP are to prevent sudden death and other damages that are done to body organs. Some experiments have shown that having BP down to normal levels all the time is the only successful way of achieving the above objectives.

Complications if not treated
A study in the United States of America shows that of a group of people whose blood pressures were not treated – 10 percent suffered stroke. 10 percent suffered severe chest pain. 30 percent suffered renal (kidney) damage. Others suffered seri0ous and fatal complications. Treatment does not mean only drugs. Let us consider some other factors before discussing the drug treatment.

Diet and weight control
People who are too fat and have HBP should seek help to have their weight reduced to normal. They may need to modify their diet especially with respect to the amount of carbohydrate they eat daily. Weight reduction has been associated with decrease in blood pressure. However a true consideration of ideal weight, usually also takes into account, age, height and bone size.
Salt intake
Before the discovery of some drugs called diuretics, people were advised not to cook with salt. This restriction has been lessened as these drugs would remove any excess salt in the body. Yet it is advisable that food should not be heavily salted for hypertensive patients or in those who have the chance of developing HBP.
Exercise
This plays an important part in the treatment of high blood pressure. Walking is safe. An evening walk of 30 minutes should be carried out if one cannot do swimming, tennis, running and handball. If one intends to start any rigorous type of exercise it is advisable to seek the advice of the medical doctor. There are some patients who heart conditions should preclude them from rigorous activities, consult your doctor before rigorous exercising.



Social Habits
Social drinking will not worsen the blood pressure but too much daily drinking may be dangerous. Cigarette smoking must be avoided in any patient with HBP. There is a high incidence of heart attacks in HBP patients who smoke.
Psychotherapy
Some hypertensives are anxious, tense and restless. If your BP is high, you have to learn to relax. The only way to relax is not just to ask the doctor for sleeping pills like valium. People can learn to relax by doing certain hobbies. People should develop the lifestyle in which they “enjoy” whatever they do, including their work. It is not advisable to become dependent on “sleeping pills” for sleeping or relaxation.
Rest
Unless the hypertensive patient also has severe cardiac or renal disease, extra daily rest, more than that dictated by common sense, is not necessary in this era of effective antihypertensive therapy. It serves no useful purpose, and is objectionable to some patients for whom the daily rest period and the early-to-bed instructions are constant reminders that they are ill, and often produces more mental turmoil, not less. Once you get an adequate night sleep, daily rest periods or naps are not necessary. Instead of daily rest period, regular vacations or holidays, and fostering of hobbies and recreational activities are especially recommended for the patient with high blood pressure.

Education
It is better that one knows that he/she is suffering from HBP by finding out from the medical doctor than relaying on hearsay, rumours and guess work. Some people may argue with us that doctors do not tell them what they are suffering from, that they keep away from the patients their blood pressure readings and the names of the drugs they are taking. This is true in some cases especially with the elderly and more conservative doctors. Others argue that our society has not advanced to that of the U.S.A hence certain information may be dangerous to the public. They may have reasons to believe so. But the authors believe that it is time we taught our people about hypertension. High blood pressure requires continuous observation and management. In this day and age, patients should be told what their BP is like. Now that effective drugs are available, secrecy can no longer be justified on the grounds of not alarming a patient about a condition for which nothing can be done. Proper and full disclosure of BP readings and the implications involved and a discussion of the benefits of therapy would be one sure way that many of our patients will believe their doctors and take the drugs as directed. Some patients may take their drugs for few weeks and when next their blood pressure is measured and it is normal, they discontinue all treatment. We must educate our patients that since we cannot cure HBP, to control it, means being on the drug without stopping.

Drug Therapy
It is neither the intention of the authors nor within the scope of this book to discuss the individual drugs that are used in the treatment of hypertension. Information on specific drugs are meant for the medical doctors who select drugs for individual patient based on individual needs. Instead we would like to present general information which all hypertensive patients have or know, regardless of the particular drugs they are taking and no matter which doctor prescribes these.
Let us make one last attempt to emphasize an important point. Drug treatment for hypertension is something that continues for as long as the hypertensive patient lives. We realize that is difficult for patients who do not have any symptoms of any disease to spend money to buy drugs, take them daily and suffer some side effects. This is the main reason many HBP patients stop their treatment, but later pay heavily for it. Drugs may make you get worse at the beginning but better later. If you see a patient with stroke, who cannot move about, has to be washed and fed and taken to the toilet, you will not fail to hit yourself on the head for failing to take your drugs any day. The situation is even worse where there are no immediate family members to take are of the bed-ridden patient. Would you like to like them?

High Blood Pressure in Pregnancy
Any kind of hypertension (HBP) may have been present before or may be first noticed during pregnancy. Blood pressures in pregnant women are usually at their lowest about the third month. When hypertension occurs during a pregnancy, it is most likely to be noticed during the last three months. Usually, the rise in blood pressure is found when a routine visit shows hypertension, passage of a substance called protein in the patient’s urine or a sudden upshot of blood pressure which on previous visits was not there. Some times the patient would retain a lot of fluids and show a good degree of swelling around the ankles. If this situation is not checked, the patient may develop what is medically referred to as eclampsia and may even have convulsions or fits that resemble those of a patient with epilepsy. Naturally, when this situation arises, the life of the unborn child is endangered. With prompt and proper medical attention, the situation can usually be brought under control and the life of both the mother and child saved.
The measurement of each patient’s blood pressure should be an important part of the routine general care that the pregnant woman receives at antenatal visits whether this is being obtained in a doctor’s clinic, hospital clinic or from private maternity clinics.
When a pregnant mother has had episodes of rises in blood pressure during a pregnancy, she should make it a point of duty to report this fact to the medical personnel who takes care of her during routine antenatal visits for subsequent pregnancies. It is also advisable that she be followed after the pregnancy to be sure that the BP does not continue to remain high.

High Blood Pressure in Children
Whereas the true incidence of essential hypertension among children is not clearly known, one thing is certain: it rarely occurs in children.
Most cases of high blood pressure in children are fortunately, due to causes that can be corrected, medically; often times by an operation. In many of these cases, some kind of renal disease is usually present and can be found when the necessary medical and laboratory tests are done to investigate the cause of the illness.
Inspite of this rarity expressed above with regard to the type of hypertension described as essential, blood pressure determination should still be part of the routine physical examination done in children. To make it easier for the medical personnel checking the blood pressures to confirm or rule out the abnormal rise in blood pressure, a chart of normal blood pressures for children of various ages should be consulted whenever a diastolic blood pressure of 70mmHg or more is found in a child. The blood pressure cuff used in children should be at least 20% wider than the diameter of the child’s arm because too narrow a cuff will cause falsely-high readings.
In summary then, here are some general rules to follow in order to help you enjoy a normal effective life.
Although there are many medicines to help you, you still have to do your part. Your doctor has given you specific medicines to take, but he may also want you to:
1) Get plenty of relaxation if you feel like your body needs it. Do not wait until you are exhausted to start to rest.
2) Loose weight (especially if your doctor believes you should), then maintain it at the level he suggests.
3) Avoid alcohol and tobacco. Follow your doctor’s advice on how to stop and how to continue to desist.
4) Settle your problems so that they do not worry you and interfere with your rest and peace of mind.
5) Try and have adequate sleep as a rule.

General Information on Drug Treatment for High Blood Pressure
1. High blood pressure may produce serious life-threatening complications including heart failure, heart attacks, strokes and kidney damage. These problems can be prevented with good blood pressure control. Since high blood pressures are controlled in most patients with medications, it is very important that you take the medications exactly as prescribed. Good blood pressure control depends not only on your physician and pharmacist, but most importantly on you.
2. The medications used in the treatment of high blood pressure are called antihypertensive drugs. Antihypertensive means “against high blood pressure”. Each of these medications has different actions and potencies but all reduce blood pressure. All of these medications are available from your pharmacist, ideally, only with a prescription from your physician. In developed countries usually, there are no drugs available for high blood pressure treatment without this prescription. Therefore, if someone tries to sell you a “wonder” drug which is claimed to provide great benefits for your high blood pressure, do not be fooled. You will only be wasting your money and even more important, endangering your life by not receiving proper care.
3. It should be emphasized again that the drugs presently available only control blood pressure and do not provide a cure for the disease. As long as the medications are taken, high blood pressures are lowered. When these medications are not taken on schedule and doses are missed, blood pressure will not be well controlled and the full benefit of treatment may not be achieved.
4. While it is very important to follow (very closely) the dosage schedule of the medication prescribed for you, taking more doses than prescribed may be as dangerous as taking lesser doses than prescribed. The more doses of antihypertensive drugs you take, the lower your blood pressure. If blood pressure is lowered too much, dangerous complications can occur. Never experiment with your medications. The risks are too great.
5. Some medications may interfere with the action of the antihypertensive drugs you are receiving. These drugs may make the achievement and maintenance of normal blood pressure more difficult. To avoid these problems, do not take any non-prescription medications that are not recommended for patients with high blood pressure without the advice of your medical doctor or pharmacist. Warnings on the side of the packages of these medications indicate which drugs you should not take. These warnings, for example, are found on most cough and cold preparations. If ever you have need for non-prescription medications, be sure to contact your pharmacist for advice.
6. The second thing you should do to avoid receiving drugs which interfere with your antihypertensive drugs is to inform each doctor you see that you have high blood pressure and also tell him what medications you are receiving for it. Once knows this, he will avoid prescribing drugs which may affect your blood pressure control.
7. The number of medications that you receive for your high blood pressure depends in part on the height of your blood pressure initially and your response to medications. There is no one medication that can be given in exactly the same dose to every patient. Therefore it is our practice to give you one or two medications at a low dose and, after waiting for a period of time, rechecking your blood pressure to determine your response. If at that time your blood pressure is well controlled no more medications are added. If your blood pressure is still out of control, additional medication or different medications are added to your drug regimen. This process of slowly adding drugs or increasing doses of individual drugs is called titration. It is a process that you, your doctor and pharmacist must go through in order that the exact combination of medicines that will control our elevated blood pressure may be found. This continuing re-adjustment of dosages and drugs takes time and will require that you visit your doctor and pharmacist frequently during this period. Do not get discouraged or think that you are wasting your time. Your doctor and pharmacist are simply trying to find the exact dose that will meet your individual needs.
8. Once your blood pressure is well controlled, your visit to your physician will be less frequent but are still very important. During these visits, your physician will determine how well your blood pressure is controlled, whether your disease has progressed or has been successfully arrested and determine your need for further treatment.
9. You will no doubt see other patients who take different medicines from yours or different doses of the same medicine. This does not necessarily mean that your high blood pressure is milder or more severe than that of your friend. It only reflects a different response to the same medications by different people.
10. Since your medicine will only control your blood pressure and not cure it, you should expect to take this medicine for the rest of your life. On some rare occasions, some patients will be able to discontinue their medication at a future date without an elevation of blood pressure. The vast majority of people, however, require constant daily dosages of medicine to control blood pressure. Since your treatment will no doubt be life long, please understand that your doctor and pharmacist are very much concerned about the cost of your medicine. In selecting your medicine they have not only considered the action of the drug and the severity of disease but the cost of the medication which you will take. You should anticipate the cost of this medication each month and allow for it when arranging your budget.
11. All medications, including antihypertensive drugs, cause side effects. These side effects are usually very mild and last only for a short time after you start taking your medicine.