Hypertension as a Risk Factor
In this series we have concentrated on supporting the prevention and management of cardiovascular disease (CVD) through lifestyle changes. The term cardiovascular disease refers to a number of diseases of the heart and blood vessels, including:
- Coronary heart disease (CHD)
- Cerebrovascular disease (stroke)
- Peripheral arterial disease
- Myocardial infarction
- Congenital heart disease
- Heart failure
Hypertension (high blood pressure) is a risk factor for CV disease. Risk factors are regarded as either non-modifiable (e.g. age, gender, ethnic origin, family history), or modifiable (e.g. hypertension, diabetes, smoking, obesity and lifestyle). Around 80 per cent of coronary heart disease cases can be attributed to behavioural risk factors, such as smoking, physical inactivity and an unhealthy dietii.These are all controllable factors that can be reduced through lifestyle changes.
For this reason we have brought together the glamorous and fun world of ballroom dance with the serious nature of disease management. The programme shows that regardless of your age and fitness levels, dance can encourage you to take better care of your heart health.
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You are said to have high blood pressure (medically known as hypertension) if readings on separate occasions consistently show your blood pressure to be 140/90mmHg or higher.
There are three different kinds of hypertension:
- Arterial hypertension
- Pulmonary hypertension
- Portal hypertension
A blood pressure reading below 130/80mmHg is considered to be normal.
In general, the term ‘hypertension’ is used to refer to essential arterial hypertension, typically defined as blood pressure above 140/90 mmHg.
For more than 90 percent of people with high blood pressure, the cause is unknown – this is called primary or essential hypertension. However, your chances of having high blood pressure increase as you get older. Even though there is often no clear cause of high blood pressure you may have an increased risk if you:
- are overweight
- have a relative with high blood pressure
- are of African or Caribbean descent
- eat too much salt
- don’t eat enough fruit and vegetables
- don’t do enough exercise
- drink too much coffee (or other caffeine-based drinks)
- drink too much alcohol
- are aged over 65
In the remaining 10 percent, there is an underlying cause – this is called secondary hypertension. The main causes for secondary hypertension are:
- chronic kidney disease
- diseases in the arteries supplying the kidneys
- chronic alcohol abuse
- hormonal disturbances
- endocrine tumours
High blood pressure usually does not cause any symptoms. This means that it may go unnoticed until it causes secondary organ damage, such as a stroke or heart attack.
However, severe hypertension can cause symptoms such as:
An unhealthy diet is estimated to be related to about half of hypertension (About 30% related to increased salt consumption, and about 20% related to low dietary potassium (low fruit and vegetables). Physical inactivity is related to about 20% of hypertension and obesity is related to about 30% of hypertension. Excess alcohol and fat consumption also causes hypertension. Being tobacco free is especially important for people with hypertension.
- Lifestyle changes can be made to help prevent high blood pressure by:
- losing weight if you need to
- reducing the amount of salt you eat
- exercising regularly
- eating a healthy diet
- cutting back if you drink too much alcohol
- stopping smoking
- cutting down on caffeine
Just a 2 mmHg drop in systolic blood pressure in middle aged patients can:
- Reduce the risk of death due to ischaemic heart disease and other cardiovascular causes by 7 per cent
- Reduce the risk of stroke mortality by 10 per cent
Medical treatment pathways include:
- Angiotensin-II-converting enzyme inhibitors (ACEIs)
- Angiotensin-II receptor blockers (ARBs)
- Calcium channel blockers
The prevention and treatment of hypertension are a high priority in medicine and public health. It is well documented that blood pressure reduction with medication significantly reduces cardiovascular risk. Exercise remains a cornerstone therapy for the primary prevention, treatment, and control of hypertension.
Ongoing investigation around lifestyle interventions proven to be beneficial in the prevention and treatment of hypertension resulted in updated guidelines from the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC) advise thatx:
- Epidemiological studies suggested that regular aerobic physical activity may be beneficial for both prevention and treatment of hypertension and to lower CV risk and mortality
- Hypertensive patients should be advised to participate in at least 30 min of moderate-intensity dynamic aerobic exercise on 5–7 days per week
If left uncontrolled, hypertension may lead to serious cardiovascular health complications such as heart attack or stroke. Patients with a history of hypertension have at least six times greater risk of heart failure than those who do not have such a history.
Uncontrolled hypertension is therefore a significant contributor to healthcare spending across Europe, as overall cardiovascular disease is estimated to cost the EU economy €196 billion a year.3 Better control of hypertension is imperative not only from a patient and public health perspective, but also to reduce the overall financial burden of cardiovascular disease.
Supporting programmes for healthcare professionals and patients can play an important role, by providing education on hypertension and the motivational skills for lifestyle changes.
Know Your Blood Pressure
Your blood pressure is one of the most important indicators for your personal well-being.
Clinical trials show that lowering blood pressure significantly reduces the likelihood of having a heart attack, severe kidney damage, or a stroke.
Here are some recommendations for taking your blood pressure:
- Sit and relax for 3-5 minutes before starting your blood pressure measurements.
- Take at least two measurements, in sitting position, spaced 1-2 minutes apart, and additional measurements if the first two are quite different.
- Measure blood pressure initially in both arms to detect any differences. For future measurements, take the arm with the higher value.
- Please also track the resting heart rate registered during the blood pressure measurement.
- The normal value is between 60 and 100 beats a minute.
iiMancia G et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension. Available HERE
iiiHealthCentral. High Blood Pressure (Hypertension). Available HERE
ivNHS UK. High blood pressure (hypertension) – Symptoms. Available HERE
vHigh Blood Pressure: Why Prevention and Control Are Urgent and Important—A 2014 Fact Sheet From the World Hypertension League and the International Society of Hypertension Available HERE
viiLewington S et al. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002; 360: 1903-1913.
viiiEffect of Aerobic Exercises in Blood Pressure, Abu Shaphe et al. Available HERE
ixCHEP 2015 One Page Summary Available HERE
x2013 ESH/ESC Guidelines for the management of arterial hypertension Available HERE
xiChalmers J et al. World Health Organization-International Society of Hypertension Guidelines for the management of hypertension. Guidelines sub-committee of the World Health Organization. Clin Exp Hypertens 1999; 21: 1009-1060.
xiiAllender S et al. European cardiovascular disease statistics, European Heart Network, 2008. Available HERE
xiiiWorld Health Organization (WHO). Cardiovascular disease factsheet no. 317. Jan 2011. Available HERE