hypertension and high blood pressure: doctors warn it may have no symptoms
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high blood pressure, or hypertension, is the number one risk factor for stroke and a major risk factor for other cardiovascular diseases. getty
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welcome to doctor’s orders, healthing’s new column that helps you make the most of the time you have with your doctor. twice a month, writer karen hawthorne asks a medical professional about a health condition, getting expert insights on what you should watch for, management and prevention — information you can take with you to your next appointment.
do you have a health issue that you’d like to get some expert insights on? email info@healthing.ca.
high blood pressure, or hypertension, is known as a “silent killer” because it typically has no warning signs or symptoms. and it’s serious. uncontrolled, it can lead to a myriad of other health issues or even a deadly heart attack or stroke. hypertension happens when the blood pressure in your arteries rises and your heart has to work much harder than normal to pump blood through the blood vessels.
almost eight million adults in canada, about one in four, have high blood pressure, according to the heart and stroke foundation. the number is expected to jump with our aging population, since risk increases with age, and the worrisome fact that more people are being diagnosed at a much younger age in their 20s and 30s. as a general rule in blood pressure categories, low risk is 120/80, medium risk is 121-134/80-84 and high risk is 135+/85+.
healthing spoke with cardiologist dr. diego delgado of toronto’s university health network, who is also a professor of medicine at the university of toronto. he has treated heart patients for 25 years.
what is hypertension?
dr. delgado: it’s a medical condition that affects the body’s arteries. basically, the walls of the arteries are stiff, so the heart has to pump harder. that also creates cardiovascular problems, which is why hypertension is the number one risk factor for stroke and a major risk factor for other cardiovascular diseases.
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what are the signs of hypertension?
dr. d: most people with hypertension do not have symptoms, even if the blood pressure reaches a dangerously high level. so that’s one of the problems. and you can have hypertension for many, many years without any symptoms. one in four canadians has hypertension but is not aware of it. so it is essential to be seen by a family doctor or a nurse who can measure the blood pressure regularly with the blood pressure cuff machine. it is simple to diagnose.
how do people develop hypertension? what are the risk factors?
dr. d: definitely there are risk factors: obesity or being overweight, family history of hypertension related to a genetic condition, not being physically active, smoking, diabetes, heavy alcohol intake and, of course, age. with age, the arteries get stiff and hypertension is more common. then you have some chronic medical conditions like sleep apnea or kidney disease that can also trigger hypertension. so in all these conditions, that’s what usually happens. they trigger different processes in the body, including inflammation, that over time will generate abnormalities in the structure of the arteries in the body that will then induce hypertension.
there is also hypertension in adolescents, particularly if they have any underlying cardiovascular condition or family history. in the last 10 years in canada and north america more and more younger people are developing diabetes and obesity, so that has a significant impact. we are seeing definitely more cases of hypertension in younger ages, usually associated with poor health habits. so it’s all related, the way we eat, sedentarism, lifestyle put us at risk for disease, including hypertension.
when we talk about the impact of hypertension, we talk about stroke, heart disease, heart failure, but patients could also have dementia related to hypertension or eye problems, and then the other one that is important is erectile or sexual dysfunction.
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are there lifestyle choices that can help prevent hypertension?
dr. d: we always recommend healthy lifestyle habits, and that includes, of course, cessation of smoking, regular physical exercise, eating well, maintaining a healthy weight or losing weight, reduced alcohol intake as well. another one that is easy to say, but hard to for some patient is to have seven to nine hours of sleep. many people suffer from insomnia and there is a clear correlation between sleep deprivation, insomnia and hypertension.
how is hypertension generally treated?
dr. d: in some patients, even if they’ve followed these lifestyle recommendations, the hypertension can still be there and they need specific medications called hypertensive medications to help relax blood vessels. they can be used in isolation or in combination, and the choice of medication depends on multiple factors, including age, gender, race and any underlying medical conditions the patient may have. so based on all these factors, there are specific guidelines that provide recommendations to health care providers to determine what is the ideal drug to use.
dr. diego delgado is a cardiologist with the university health network in toronto. supplied
we start with the medication that we think is appropriate for the patient, and then we either titrate that medication or if we notice that the treatment is failing, then that’s when we can add a second drug or even a third drug.
often when patients who are taking blood pressure medications make these lifestyle modifications, it is not unusual to see that they need less medication or eventually they don’t need any medication in the long-term.
what’s one piece of advice for someone with hypertension?
dr. d: we need to be aware that this is a chronic disease that we call a silent killer, so checking the blood pressure regularly is essential. as with any chronic condition, if we don’t detect it and treat it early, it has devastating cardiovascular consequences in the long-term.
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my specialty is heart failure, so in patients who have had hypertension for many years in isolation or in combination with other risk factors, after 10 or 20 years with poorly controlled hypertension, by the time they come to me, sometimes it’s too late. they have already developed significant structural cardiac conditions that are very difficult to reverse, so early detection and treatment is essential.
for more information about high blood pressure, visit the heart and stroke foundation of canada.
karen hawthorne is a toronto-based writer.
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