Hypertension: Avoiding Excess Pressure on Your Heart

Hypertension is a problem for many Malaysians and must be taken seriously by people of all ages.

The heart plays a crucial role in the cardiovascular system by acting as a pump to circulate oxygenated blood throughout the body.

Dr Koh Kok Wei, a consultant cardiologist at Subang Jaya Medical Centre (SJMC), says, "Whenever the heart beats, it creates pressure that pushes blood through the arteries. This arterial blood pressure (BP) has two readings - systolic pressure which occurs when the blood is pumped out from the heart, and diastolic pressure when the heart muscle relaxes and the arteries recoil. Normal BP is recorded as less than 120mmHg systolic and 80mmHg diastolic respectively."

However, when blood pressure is consistently higher than normal, it becomes a condition called hypertension, which can cause damage to the heart and blood vessels of susceptible organs.

Dr Koh refers to the American College of Cardiology and American Heart Association, which defines hypertension as persistent measurements - high systolic BP of 130mmHg and above and diastolic BP of 80mmHg and above.

Serious problems with atherosclerosis and aneurysm

When hypertension occurs, the excess force stretches the delicate structure inside arterial walls, resulting in two forms of injuries: atherosclerosis, the abnormal thickening of the arterial walls due to accumulation of lipids and calcium, and aneurysm, an abnormal localised bulging of the weakened arterial walls.

Dr Koh explains these damaged blood vessels can cause dangerous health conditions should it occur in certain organs. These include heart attack (heart), stroke (brain), gangrene (usually affecting the legs), renal failure (kidney) and retinopathy (eyes).

In more serious cases, an aneurysm can cause the weakened arterial wall to rupture, leading to bleeding in the brain. If the heart is pumping against elevated pressure over a long period of time, the high workload will cause the heart to become weak, potentially leading to heart failure.

Healthy living, better ageing

According to a 2019 journal article, factors associated with the severity of hypertension among Malaysian adults, found the prevalence of adults at risk of elevated blood pressure to be almost 70%. Dr Koh views the main contributing factors to be a high-sodium diet, a sedentary lifestyle and obesity. The chances of having hypertension also increase as people grow older.

He says, "Malaysian cuisine is known to contain high amounts of sodium and calories. The easy accessibility to these foods leads to the surge in obesity - it is common knowledge that both obesity and a high-sodium diet lead to hypertension."

Sedentary lifestyles are also becoming more widespread among Malaysians. Dr Koh refers to data from the National Health and Morbidity Survey 2017, which revealed that less than 50% of Malaysian adolescents are physically active.

In addition, owing to better socioeconomic and healthcare status, the number of Malaysians above 65 years old has been steadily increasing over the years, leading to an increased probability of hypertension cases and chronic diseases that may contribute to high blood pressure.

Other risk factors for hypertension include excessive alcohol and tobacco use and a family history of hypertension.

Early awareness by getting blood pressure check

Because hypertension is often asymptomatic, Dr Koh asserts the importance of early diagnosis and managing the disease as soon as possible. He notes hypertension can sometimes be present earlier in life with no obvious risk factors identified. Hence, the general public should get their blood pressure checked as early as possible regardless of age.

Fortunately, local clinics, pharmacies and hospitals can perform general health screenings and tests including BP checks, making it easier and more convenient for the public to manage their health.

Digital BP monitors are also more user-friendly and widely available in clinics and pharmacies. Hence, Dr Koh encourages those who are at risk of hypertension to buy digital BP devices to monitor their BP at home but continue to go for regular health screenings for medical advice.

Responsibility in managing hypertension

While doctors and medical staff continue to raise awareness of the dangers of hypertension, it is still the patient's responsibility to ensure their own health.

Dr Koh recommends early screening and regular health check-ups for those who are at risk of developing hypertension. He reminds the public that prevention is better than cure, and thus everyone should try to avoid risk factors and lead healthy lifestyles.

For those who are already living with hypertension, he advises, "Please adhere to your blood pressure medications along with lifestyle modifications as per your doctor's advice. You also need to follow up with your doctor long-term to adjust your medications and more importantly, for early management should any additional complications arise."

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