My Experience Managing Hypertension

Let me begin by explaining the reason why I chose this topic. A good friend of mine, Mr. Singh, told me that my last article was very robotic in nature—very factual, but it didn't engage the audience because it lacked heart. Hence, I decided to write this article in a manner that reflects how I would speak to someone to explain the condition of hypertension and its management.

First of all, let's begin with the classification of hypertension. Hypertension has two types: primary or essential hypertension, and secondary hypertension. Primary or essential hypertension has no specific cause; it could be due to genetic conditions, lifestyle factors, or something as simple as the amount of table salt intake, which can influence blood pressure. Meanwhile, secondary hypertension occurs as a symptom caused by another pre-existing condition, such as diabetes, hormonal disorders, or heart-related diseases.

Now, let's discuss blood pressure in the human body, which is closely related to the vessels in our body. There are two types of vessels in our body: arteries and veins. Arteries carry oxygenated blood throughout the body, while veins carry deoxygenated blood back to the heart. One of the most important differences between an artery and a vein is that arteries have smooth muscles within their walls, giving them the ability to regulate blood pressure, whereas veins only have valves to prevent the backflow of blood. When we speak of blood pressure in the human body, it is solely related to the pressure within the arterial walls.

Blood pressure is measured during the systole and diastole phases of the heartbeat cycle. Simply put, systole occurs during the contraction of the heart, while diastole occurs during the relaxation of the heart, corresponding directly to the contraction and relaxation of the smooth muscles within the arterial walls. Measuring this reading using a sphygmomanometer, or simply known as a blood pressure machine, gives us an idea of how efficiently the heart is working in an individual.

Understanding the etiology of blood pressure is important for effective treatment. For example, if it is secondary hypertension caused by another disease, it's vital that the underlying cause is treated alongside managing the hypertension itself. For instance, a woman in the pre-menopausal stage may experience fluctuations in blood pressure due to hormonal imbalances during her monthly cycle. In such cases, addressing the hormonal disorder is crucial to balancing her blood pressure condition.

Now, let's discuss the ideal levels for blood pressure. The optimum blood pressure is considered to be 120 over 80, or 90 over 60. The reason for two different ranges is historical, influenced by medical literature from Western countries where individuals generally have larger builds compared to countries such as Asia. Originally, the golden number for a healthy person's blood pressure was considered to be 120 over 80, with a deviation of approximately 15 points on either side as the borderline. For instance, a systolic pressure of 135 is considered pre-hypertension, while a systolic pressure of 105 is considered hypotension. If we were to use 120 over 80 as the golden standard, many people in Asia with smaller statures would be considered pathological, even if their blood pressure deviates only slightly from these numbers. It's crucial to consider the range between systolic and diastolic pressure, as well as the heart rate, to determine optimal blood pressure.

Regarding blood pressure measurement, there are traditional devices such as the sphygmomanometer, which requires a stethoscope to listen to the pulse and determine blood pressure. Modern devices utilize tactile sensors, and there are even smartwatches capable of measuring blood pressure and pulse rate. However, not all of these devices are considered suitable for medical management. As a doctor, I always recommend using devices with cuffs placed on the arm, as they compress the brachial artery to obtain a uniform sound or tactile sense ensuring accuracy.

Now, let's discuss when and how blood pressure should be measured. Physical activities can increase blood pressure, so it's important to be in a relaxed state for an accurate reading. It's also best to avoid measuring blood pressure immediately after eating, as metabolic processes like digestion can influence pressure. In my experience, the best time for a blood pressure reading, or what I call "resting blood pressure," is usually after eight hours of restful sleep. During sleep, the body is in a horizontal position, which puts less strain on the heart, allowing for a relaxed state for the balance of bodily functions. Active blood pressure monitoring, on the other hand, is done after daily activities and before dinner to assess the influence of lifestyle factors on blood pressure.

Let me share a personal story about managing a patient's blood pressure. It's crucial to know when to take blood pressure medication. I once had a patient who was instructed to take his medication every morning, but his blood pressure remained high. Upon further inquiry, I discovered that he was a night shift security guard who took his medication before going to sleep in the morning. Since the body naturally balances blood pressure during rest, there was no need for him to take medication at that time. Instead, he should have taken it before his strenuous physical activity in the night.

Lifestyle management plays a significant role in reducing blood pressure naturally. As a doctor, I strongly advise against smoking, as it poses numerous health risks, including hypertension. If hypertension is related to factors like body mass index or cholesterol levels, a holistic approach to management is necessary. My objective for most patients with hypertension is to manage it with medication to prevent serious conditions like stroke or heart attack, while also emphasizing the importance of physical activity, diet, and stress management for optimal results.

I will come back soon with my another experience. Stay tuned and join the community. Also please leave your comment so I can share more about what you are looking for.

Thank you.