Avoid Sudden Illnesses, Monitor Blood Pressure

By Erda Khursyiah Basir

KUALA LUMPUR (Bernama) -- “When was the last time you measured your blood pressure?” the doctor asked her patient, who had a stroke.

“Thirty years ago,” answered the 52 year-old taxi driver. His blood pressure reading was 200 mmHg.

The doctor was dismayed. She later learned that the man had never felt the need to check his blood pressure because he rarely felt sick enough to go to the doctor.

The story was a personal experience shared by the President of Malaysian Society of Hypertension (MSH) Professor Dr Chia Yook Chin during a health campaign, recently.

The campaign is to educate the public on the importance of preventing and managing hypertension through regular home blood pressure monitoring. 

“This is one of the problems among Malaysians - they only see the doctor when they are sick. Unfortunately, high blood pressure, also known as hypertension, is a silent killer.

“There are no symptoms or signs that you have high blood pressure and often in cases like the taxi driver’s, people only realise that they have the condition when they are struck by illnesses like a stroke or a heart attack,” she said during the ‘HealthinUrHands’ campaign by Omron.

SILENT KILLER

Approximately two out of three adults aged 30 years and older are unaware that they have high blood pressure.

Dr Chia said that one of the main reasons why strokes and heart attacks seem to appear ‘suddenly’ was that many people were ignorant of the need to regularly monitor their blood pressure.

They could thus have hypertension without being aware of their condition and would subsequently not seek the treatment they need.

“Many do not realise that failure to monitor their blood pressure has led to a range of cardiovascular diseases such as heart attack, stroke and in some cases, death,” added Dr Chia. 

Every year, an estimated 40,000 Malaysians suffer from stroke. Sadly, such cases also include young adults.

More than 30 percent of Malaysian adults aged 18 years and above have been diagnosed with hypertension, indicating the need to monitor blood pressure regularly.

KNOW YOUR ‘NUMBERS’

Hypertension can be divided into two categories: primary and secondary.

Primary hypertension (also called essential hypertension) normally happens to adults with no identifiable cause and tends to develop gradually over many years.

Secondary hypertension may be caused by various conditions such as kidney disease as well as intake of medications that would cause a sudden spike in blood pressure.

Explaining further, Dr Chia said regularly monitoring blood pressure and taking note of any surge or persistently high readings could help alert a person of their health status.

“Normal blood pressure is between 120/80 mmHg and 140/90 (120/80-140/90). Any reading equal to or over 140/90 mmHg is considered as elevated and if it remains high, doctors will request to have more readings done over the course of a few days or weeks. 

“This is because the environmental factors can also contribute to increased blood pressure, including stress that many might feel when they see the doctors. However, if the reading is still more than 140/90 after repeated measurements, patients will be diagnosed with hypertension,” she added.

Risk factors associated with hypertension include age (the older, the higher the risk), genetics or family history and chronic conditions such as kidney disease.

Another factor that increases a person’s chances of developing hypertension is a poor lifestyle such as having an unhealthy diet, lack of exercise, obesity, smoking, excessive alcohol and salt consumption.

“While some risk factors such as family history cannot be modified, others can be managed through treatment and medication,” she said.

TREATMENT AND MEDICATION

Some patients worry about taking medicines to control their high blood pressure due to the belief that long term medication will lead to potentially serious side effects, particularly kidney damage.

A Consultant Cardiologist at Gleneagles Hospital Kuala Lumpur Dr Azani Mohamed Daud who was also present at the event stressed that taking appropriate medication to control high blood pressure would help to protect the kidneys, rather than cause damage.

“Patients are always very concerned and frequently ask ‘will my kidneys get affected by the medication?’. We have to educate them and correct the misconception that long-term medication causes kidney damage. We need to emphasise that elevated blood pressure is a known cause of kidney damage and failure which will result in the need for dialysis.

“Similarly, in patients with diabetes, uncontrolled and elevated blood sugar levels are likely to result in kidney damage. A patient with both elevated blood pressure and sugar levels will be at even higher risk of kidney damage,” he explained.

Can a patient stop the medication if their blood pressure returns to normal?

Dr Azani said that patients must understand that the medication only controls the blood pressure and does not cure the problem.

However, stopping the medication will cause the blood pressure to go up again.

“So, the answer is ‘no’. If the blood pressure is controlled by medication, please continue with the medication,” he said.

He also emphasised the need for people who have been diagnosed with hypertension to always consult their doctors and undergo regular follow-up to ensure that their blood pressure remained controlled.

“As one ages, there is a tendency for blood pressure to rise further due to stiffening of the blood vessels and there may be a need to increase medication.

“If patients just take the same medicines with no follow up with their doctors, there is a risk of their blood pressure going up over time with potentially catastrophic consequences like stroke, heart attack and kidney damage,” said Dr Azani.

HOME MONITORING

It is recommended that home blood pressure monitors used are those which have been validated by international protocols for accuracy.

Both patients and caregivers also need to be educated on how to take measurements correctly because it will ensure that the readings are meaningful and can contribute to optimal blood pressure control.

“It has been recommended that for initial diagnosis of elevated blood pressure that home blood pressure monitoring be performed over at least three days and ideally seven days. The readings should be taken at about the same time in the morning and evening.

“It has also been recommended that three readings should be taken each time and recorded in a specific logbook for discussion with the doctors,” said Dr Azani.

He said that for those on medication, the frequency of monitoring may be at longer intervals such as on a weekly basis – once their blood pressure has been regulated. 

Several do’s and don'ts also need to be taken into account such as no exercise, drinking coffee or smoking 30 minutes before the measurements as well as not to wear tight clothing as all these will affect the readings.

Patients should also be seated comfortably with their back supported and the arm resting roughly at the same level as the heart.

“Home blood pressure monitoring can also be used to assess the effectiveness of patients’ current anti-hypertensive medication, thus enabling the patients and doctors to make more informed treatment decisions resulting in better outcomes.

“Studies conducted both locally and internationally have found that patients with a home blood pressure monitor who have been taught how to use it properly can have a positive impact on their adherence to medication resulting in significantly better blood pressure control as well,” he said.

Edited by Sakina mohamed

-- BERNAMA