What is blood pressure?
While beating, heart pumps blood to give oxygen and nutrients (energy) to the tissues and organs. As blood moves, it pushes against the sides of arteries (blood vessels). The strength of this push is known as blood pressure. Cannot be seen or felt. Think of it like the air pressure in tires. If the air pressure goes too high, the tire can pop. That's why "BP" matters!
What does high and low BP mean?
BP does not stay the same always. It rises marginally when we wake up and lowers as we sleep. It rises when we are nervous, excited, or active. If we stand up quickly, it drops for some time. Then, the body adjusts it to make sure enough blood and oxygen are flowing to vital organs like brain heart, kidneys, and others. However, all these changes happen within the normal range.
How many types of BP are there?
Below are 2 main types of BP.
Systolic pressure: Force created by heart when it contracts and pushes blood through arteries to body parts.
Diastolic pressure: Force created when the heart rests between beats and the blood fills into it.
High BP or hypertension signifies too much pressure is put on the arterial walls for longer periods. As per the World Health Organization (WHO), 1 in every 3 people in the US and 1 in 4 in the UK suffer from hypertension. According to National Family Health Survey, 1 in 8 adults above age 30 in India suffer from high BP. Still lower than other countries but cannot be ignored!
High BP (Hypertension) shows no symptoms in early stages until it becomes serious! Over time at severe stages, headache, nosebleeds, dizziness, weakness, anxiety, confusion, chest pain and breathlessness may occur.
What are the long-term side effects of high blood pressure?
Damage and narrow arteries, making them less elastic with weak spots or scars, increasing plaque buildup, raising risk of heart disease (coronary artery) and blood clots formation.
Cause aneurysms (swelling of artery wall) which can rupture, causing life threatening internal bleeding.
Weaken and narrow brain's blood vessels, causing them to rupture or leak. cognitive impairment to dementia.
Damage blood vessels inside and those leading to kidneys, affecting their ability to filter waste from blood effectively. Dangerous levels of fluid and waste accumulate, cause kidney diseases, increasing risk of kidney failure.
Injure vessels supplying blood to retina, causing eye bleeding, blurred vision, or vision loss due to various diseases like retinopathy, fluid buildup, nerve damage.
Cause erectile dysfunction in men, by damaging arterial walls, limiting blood flow to penis.
Cause bone loss by excessive elimination of calcium in urine. Loss of bone density (osteoporosis) increases risk of fractures, especially in older women.
Cause sleep disorders.
What are the risk factors of high blood pressure?
- Family history and genetics
- Unhealthy eating patterns (excessive salt intake)
- Excessive alcohol consumption,smoking
- Sedentary lifestyle
- Stress and anxiety
- Other medical conditions
Obesity, sleep disorder, thyroid problems, heart problems, chronic kidney disease
Is low BP a silent killer?
Low BP usually does not cause severe health issues like high BP. But the moment BP becomes too low, blood supply to vital organs of the body is affected resulting in organ damage.
What happens when BP is low?
Lack of concentration
In case of shock (severe sudden low
Cold, pale skin
Rapid, shallow breathing
Weak and rapid pulse
Who is at highest risk for low blood pressure?
- Prolonged bed rest or standing
- Blood loss (major trauma, severe internal bleeding)
- Anemia or nutritional deficiencies ((vitamins B-12 and Folate deficiency)
- hypertension, heart diseases, depression)
- Medical conditions like heart problems, thyroiddiabetes
- Severe infection/allergy
High or Low BP can Affect Young or Old!What is the main cause of high BP in Young Adults?
Pregnant women- High BP during pregnancy (pre-eclampsia) is harmful to a carrying mother's vital organs. It can also cause preterm birth, low birth weight and fetal growth problems. Some medicines used to treat high BP are not recommended during pregnancy. High BP patients thinking of having baby must consult doctor to control BP before and during pregnancy. During pregnancy, circulatory system expands to accommodate the fetus, which can cause small drop in BP. But, this change is not significant enough to cause problems. However, severe sudden low BP requires doctor's attention if symptoms like vaginal bleeding appear.
Elderly - With age, blood vessels naturally thicken and stiffen, damaging their structure, thereby declining function. High systolic blood pressure with low diastolic blood pressure, as one ages, causes isolated systolic hypertension. Low BP too can occur in the elderly as blood flow to heart and brain declines with age.
How to manage high BP?
The only way to manage high BP risk is by regular health checkups. Blood pressure is measured via blood pressure machines (sphygmomanometer) or 24-hour BP monitoring. Final diagnosis is made based on medical history, risk factors, and symptoms (if any). Other tests include,
What tests are done if you have high blood pressure?
Blood Tests - Complete blood count (anemia), HbA1c (diabetes detection), thyroid panel, kidney profile, lipid profile (cholesterol levels) and vitamins profile.
Urine Tests - Detect kidney problems, pre-eclampsia, diabetes.
Eye Tests - Detect thickened, narrowed/burst capillaries.
Electrocardiogram (ECG) - Detects damage to heart by recording its electrical activity.
Echocardiogram - Checks the heart function, detects poor blood flow areas or heart abnormalities
In severe cases, when lifestyle changes are not effective, medications (antihypertensive drugs) are prescribed to reduce high BP. Emergency cases of malignant hypertension (rapid high BP causing organ damage) or resistant hypertension (uncontrolled BP after treatment with 3 anti- hypertensives) require immediate medical supervision. For low BP, medications and compression stockings are prescribed.
Most high BP patients find out the criticality of situation after a heart attack or stroke, or when diagnosed with heart or kidney disease. Early diagnosis, lifestyle modifications with timely medications and right treatment can prevent severe complications, improving quality of life and increasing life expectancy.
Humans are creatures of habits. To eat, drink, interact, move and survive in society, we form habits. They define our behaviour and help to meet our needs. It is easy to form unhealthy habits, because they come with a sense of reward or 'feel good' sensation which gives pleasure and comfort, like avoiding exercise, sugar rush (after eating sweets), temporary relaxation (smoking or drinking alcohol), etc. Healthy habits of balanced diet (home cooked meals) or exercises appear boring, taxing and difficult to maintain for many.
The ways in which we adapt to conduct our lifestyle directly impact health. These habits can make or break your health. It may sound astonishing to many but as small as a daily habit can slowly have a huge impact on the way blood flows in the body! Yes, unhealthy habits can make the force of blood on the arterial walls too high. If unhealthy routine of bad habits continue, one can develop high Blood Pressure (BP) for continuous periods, called hypertension. Let's find out which habits bring this illness!
What unhealthy habits are associated with hypertension?
Food Habits Going Wrong Untimely eating patterns and overeating fatty, sugary foods cause unwanted weight gain. It increases bad cholesterol levels, triglycerides and lowers good cholesterol levels. If such habits continue, one becomes prone to the build up of plaque in the arteries, making it difficult for blood to freely flow through them. When the fatty deposits accumulation narrow down and block arteries, it leads to increase in BP. Extra weight also stresses heart to pump more blood faster, narrowing and weakening arteries. Obesity can cause insulin resistance and raise blood glucose giving invitation to diabetes, which in turn triggers hypertension and heart diseases.
Take it with a Pinch of Salt! A diet too high in Sodium (salt) and low in potassium may cause high BP. Most of the sodium we eat comes from table salt, processed and restaurant food items. Potassium, an important mineral that helps to lower BP and balance out harmful effects of high salt intake. Normal balance between sodium and potassium helps kidneys to remove extra water, to maintain BP. High salt levels make kidneys to hold onto more water. This extra stored water raises BP and puts strain on arteries, kidneys, heart and brain. Raised BP in a long term can make arterial walls thick and narrow, which again causes hypertension.
Smoking and Tobacco - Dooms the Heart! Nicotine present in cigarettes damages heart and blood vessels by increasing sympathetic nervous system activity. It raises BP and heart rate by narrowing arteries and hardening their walls. It increases risk of clot as it stresses heart causing heart attack and brain leading to stroke. Also, carbon monoxide produced during smoking reduces the amount of oxygen in blood. Long term cigarette smoking can cause hypertension and heart diseases.
Alcohol-Drowns Your Health! Alcohol contains calories which causes unwanted weight gain (obesity) - a risk factor of high BP. Also, alcohol can interfere with effectiveness of BP medications and can increase side effects as well. It can narrow down arteries and reduce blood flow. Low to moderate alcohol consumption temporarily increases BP. But, repeated binge drinking can cause long term increase in BP, causing hypertension and increasing risk of heart diseases, liver damage and stroke.
Low to No Physical Activity Sedentary Future Binge watching favorite shows glued to TV or sitcoms whole day or maximum hours of day is a trend in young and old. Couch potatoes consume loads of calories by sitting and snacking on sodas, processed or junk foods like chips, crackers, noodles, cheese rolls, etc. Lack of exercises or physical activity also increases storage of salt and water, raising body fluid content, thus, causing high BP. These conditions also increase bad cholesterol levels and cause insulin resistance. Over time, it causes weight gain and makes the overweight, obese, and increases the risks of hypertension to diabetes, thyroid problems, heart diseases, etc.
Stress and No Sleep - Terrible Combo! Stress due to anxiety and depression can cause overeating, social isolation, obesity and poor mental health. A good sleep rejuvenates and repairs wear and tear of the body. It regulates stress hormones keeping nervous system healthy. Over time, sleeplessness, continuous lack of sleep, sleep disorders, alter body's ability to regulate these hormones, leading to hypertension.
Underlying Health Conditions Hidden Factors! Health conditions like diabetes, kidney diseases, genetic defects in the blood vessels, thyroid disorders, tumors of adrenal gland, sleep disorders, pregnancy, certain medications, drug abuse, etc., can also cause hypertension.
What are the Factors Increasing Hypertension Risk?
Age: As one gets older, arteries weaken and get thickened, raising BP.
Gender: Both men and women can have high BP issues. Women are more likely to have it post menopause.
Family History: Genetic factors inherited from family.
Ethnicity: Asian Indians and South Asians are more prone.
How to Keep High Blood Pressure at Bay?
- Leading an active lifestyle-Walking more with less sedentary hours.
- Consuming a balanced, low-fat diet rich in fruits, vegetables, nuts and fiber.
- If obese, adapting healthy eating patterns for losing weight and not skipping meals would help.
- Avoiding junk or processed foods.
- Managing stress and exercising daily.
- Reducing alcohol consumption and smoking.
- Sleeping for at least 6-8 hours.
- Regular checkups and timely medications becomes essential if diagnosed with BP.
What's stronger than unhealthy habits? It's a resolution to change them, if one knows how dangerous hypertension can be. Will power and discipline to stick to healthy ways of living can spare some stress on heart and blood vessels, preventing the unwanted that come with hypertension. Let's take a step towards health today!
Dual Dilemma Hypertension and Diabetes
Living with diabetes is an every day struggle. The sugar malady brings in a lot of changes in diet and lifestyle of an individual. Insulin, the hormone required to maintain normal blood glucose levels, plays a main part in causing diabetes. Insulin is the key to open up the cell receptors to utilize glucose. Its deficiency or ineffective utilization raises the amount of glucose present in blood as the body cannot use it to produce energy.
With alarmingly high blood glucose levels, diabetes brings deadly changes inside the body, if not managed well! One such danger being 'hypertension' wherein Blood Pressure (BP) in the arteries is continuously high, for prolonged periods. This deadly duo then kick starts the processes that not only shake up the overall metabolism but over a period of time, damage vital body organs.
How is Hypertension and Diabetes linked?
Type 1 Diabetes -Body is unable to produce insulin from pancreas Type 2 Diabetes - Body does not produce enough insulin or cannot use it effectively due to insulin resistance (body cells insensitive to insulin) Diabetics patients are more prone to hypertension than general population. It is seen more in individual with type 2 diabetes than type 1. In both the cases, development of hypertension starts with insulin deficiency at cellular level.
Diabetes and hypertension co-exist usually as they share similar risk factors like
- Unhealthy diet
- Sedentary/Inactive lifestyle
- Genetic factors
- Family history
- Chronic diseases of kidney, heart, etc.
- Sleep disorders
Insulin Resistance and Hypertension Inactive lifestyle and excessive calorie intake (sugary/fatty/junk food, caffeinated drinks) makes one prone to develop insulin resistance, which leads to raised blood glucose levels diabetes. Plaque buildup in arteries (atherosclerosis) due to high cholesterol levels and fat deposits in diabetics, which can damage the arteries in long run. Arteries weaken and get narrowed, restricting smooth blood flow, causing high BP.
Junk Food Also, hypertension further alters the delivery of insulin and glucose to muscle cells. This triggers insulin resistance and impaires glucose uptake, worsening diabetes.
Renin-Angiotensin System (RAS) Renin, an enzyme released by kidney, helps produce the hormone, angiotensin in lungs, which increases BP during stress response by narrowing blood vessels.
Uncontrolled high blood glucose can trigger abnormal RAS activation. This causes inflammation and production of excessive free radicals (oxidative stress) that destroy cells in pancreas producing insulin. It induces insulin resistance that decreases glucose transport to the cells.
Abnormal activation of RAS and insulin resistance promotes excessive sodium reabsorption via kidneys and water retention. This increases blood volume in arteries and veins and overall body fluid volume. Arteries narrow down, blocking the blood flow. Workload of heart increases and BP rises, causing hypertension in the long run.
Sympathetic Nervous System It controls glucose and fat metabolism, and regulates BP. Fat cells release a hormone, leptin that inhibits hunger (to control weight). An increased abnormal activity of sympathetic nervous system due to insulin resistance and high blood sugar disrupts leptin signaling, causing overeating. Energy expenditure reduces and fat stores increase. Eventually, this in patients with obesity, metabolic syndrome, and sleep disorder, can over stimulate RAS, which increases the risk of hypertension, diabetes and heart diseases.
Mental Stress Stress hormones (cortisol) due to depression, extreme anxiety and diabetes burden can directly raise blood glucose levels via insulin resistance and fat cell activation. Stress can cause frequent, temporary spikes in BP which damages blood vessels of heart and kidneys. Stressed patients may not take a good care of themselves, may further fall prey to unhealthy habits and physical inactivity.
Diabetes and Hypertension - A Lethal combo!
Uncontrolled diabetes and hypertension, together can lead to development of complications like - Heart diseases
- Brain stroke
- Kidney failure
- Eye problems
- Poor blood flow to different organs/parts
How to diagnose diabetes?
A diabetic individual regularly undergoes diagnostic and monitoring tests like fasting and post meal blood sugar, HbA1c, fructosamine to keep in check the blood sugar levels. BP is measured via sphygmomanometer. If hypertension and diabetes are detected, tests done to check overall health include
- Blood Tests: kidney function tests- creatinine and Blood Urea Nitrogen
(BUN), thyroid function tests, lipid profile, cardiac risk markers, electrolyte levels. - Eye exam
- Ultrasound (kidney health)
- Electrocardiogram (measures heart's electrical activity),
- Echocardiography (checks heart and blood vessels damage)
Medicines to control diabetes and BP are prescribed by medical practitioners. Maintaining good blood glucose levels and limited salt, with a healthy and active lifestyle will keep both diabetes and hypertension in control. A balanced diet, healthy weight, ample sleep, habit to remain stress-free, exercises while avoiding excessive salt intake, unhealthy habits help to escape the perils of these illnesses!
Can Obesity Influence Blood Pressure?
Do you think our modern lifestyle is making us fat? Storing food was the means of survival in ancient times. But today, with energy dense fatty food, labour-saving devices, sedentary behavior and motorised transport, we end up storing 'excess fat' unnecessarily instead!
Be it a child, adult or elderly, obesity does not spare anyone in the current scenario. At an age of actively playing and learning, young kids become 'couch-potatoes'. Long working hours and social media glues our tech-savvy generation to laptops and smartphones. Forget exercising or jogging, even a thought of short evening walk seems tiring to us these days, and we keep postponing it to the next day. No one has time to shed calories or eat healthy. This ignorance of health manifests with a stark outcome of 21" century leisure lifestyle-Obesity.
Obesity is a condition of body fat being excessive. It is diagnosed by measuring the Body Mass Index (BMI), which is the ratio of height to weight as per age. BMI of 25 or higher is considered obese. It is a serious condition as more than 65 crore adults worldwide and 13.5 crore in India are obese.' Obesity may also occur due to medical conditions like hypothyroidism, polycystic ovarian syndrome and inherited conditions.
The abdominal fat does not just stay quietly, but activates various processes that open up Pandora's Box of illnesses. One such condition seen in obese individuals is hypertension. It is a condition wherein the Blood Pressure (BP) exerted on the walls of the arteries is higher than normal. If this continues for longer periods, it puts additional strain on the heart. One may wonder how fat which just lies deposited in the body can affect blood flow! Well, it does.
Can fats affect blood pressure?
Abdominal fat is not an inactive mass. It contains active fat cells (adipocytes). It secretes a hormone, leptin which inhibits hunger by acting on Sympathetic Nervous System (SNS). Excess fat produces high levels of leptin. Excessive fat cells and leptin levels can make it lose its functions (leptin resistance). This causes overeating and decreased energy expenditure.
High leptin levels abnormally activate hormone systems- SNS and Renin-Angiotensin System (RAS). Hormones released by these systems maintain blood pressure and fluid balance in body. Abnormal activation of both systems causes higher release of those hormones.
This causes body to hold excessive salt and water via kidneys, which increases blood volume in arteries and veins. In parallel, it also produces excessive free radicals (oxidative stress) that destroy cells in pancreas producing insulin, causing insulin resistance
Extra fat tissues require oxygen and nutrients in order to live in the body. This is supplied by blood vessels which end up circulating more blood to fat tissues. Extra weight raises heart rate and reduces body's ability to transport blood through blood vessels
Above changes collectively affect arteries and heart's function. Arteries weaken and narrow down, reducing blood flow. More circulating blood and body fluid volume adds an extra pressure on arterial walls. This increases heart's workload as it pumps more blood through blood vessels. BP rises, causing hypertension in the long run.
Obesity-Hypertension- Long-term Complications?
- Heart diseases
- High cholesterol levels
- Metabolic syndrome
- Chronic kidney disease
- Joint pain and arthritis
- Breathing problems
- Sleep disorders
- Anxiety and depression
- Risk of cancer
How to diagnose obesity?
To detect and confirm obesity, a doctor evaluates:
Waist circumference (checks excess fatin abdominal region)
Blood tests are done to check if there is any underlying reason behind the weight gain and to assess the overall health, including; Lipid profile (cholesterol levels- heart diseases), HbAlc and fasting glucose (diabetes), Thyroid panel, Steroid hormone levels, Liver function tests, Kidney profile, Electrolyte panel. BP is checked using air-filled cuff of a blood pressure monitor-sphygmomanometer Organ damage is detected by
Physical exam: Checks abdominal tenderness, enlarged thyroid.
Electrocardiogram: Checks heart's functioning.
Echocardiography: Checks blood flow through heart and heart damage.
Eye exam: Detects changes in the blood vessels of eyes.
Control Fat, Secure Health! Anti-hypertensive drugs are prescribed to manage severe hypertension. Medical conditions causing obesity are treated with specific medicines, to help control weight. Lifestyle changes help manage both obesity and high BP, aiding to lead a disease-free life!
Hypertension in Children and Teens
Mankind enjoys comfort and yes, comfort matters, but not at the cost of health! Sedentary lifestyle with little to no exercise, unhealthy habits practiced and busy work schedule followed by adults in a way also impacts the kids. With ease of availability of resources to learn and play, kids stay indoors more. Peer competition from young age, virtual world of games and social media, lack of healthy social circle, unhealthy lifestyle habits, eating unhealthy food, lesser physical activity slowly makes growing kids weak, inactive and obese. Today, even before their body gets fully developed, kids are falling prey to diseases which usually affect adults!
One such condition which brings in myriad of other illnesses is Hypertension also called Blood Pressure (BP). In children, hypertension is presumed to be rare,unless caused by an existing severe disease. That's why it is often detected only when it is serious, or in adulthood. High BP results due to an excessive force of blood flow against the walls of arteries. When this persists for longer periods, it causes hypertension. Hypertension in kids and teenagers, called pediatric hypertension, means BP greater than the 95 percentile for age, weight and height.
Standard BP readings for Children Differ from Adults! BP increases in childhood and teenage throughtout the phases of growth and maturation. Puberty and adolescence is a faster growth period wherein hormonal alterations cause rapid changes in the body mass and BP. That is why standard BP values in kids vary with gender, age, weight and height till the age of 18 years. Post that, normal adult blood pressure measurements are maintained.
Types of Hypertension
- Primary Hypertension:
Occurs in older children and adolescents (26 years of age). These kids develop high
BP for prolonged periods (mild or stage 1 hypertension) due to various factors like:
Prior family history
Sedentary lifestyle with no physical activity
Unhealthy habits like exposure to smoking and alcohol consumption
Excessive consumption of salt (Sodium)
High cholesterol levels
Medications/drugs (Over-thecounter drugs, nutritional supplements)
- Secondary Hypertension:
Occurs in newborns and infants (stage 2 Hypertension), it is caused by
another underlying chronic illness such as:
Chronic kidney disease
Polycystic kidney disease
Cardiovascular diseases like severe narrowing of aorta
Fetal growth retardation
Low birth weight
Endocrine disorders (thyroid, adrenal gland)
Sleep disorders, especially sleep apnea, insomnia
Rare tumors of adrenal gland
- Other Risk Factors
Low socio-economic status, family with limited basic resources.
Less health enhancing educational and residential environments.
Psychosocial factors (job strain, discrimination, racism, abuse, trauma).
What are the Hypertension Symptoms in child?
Hypertension does not produce visible symptoms until it reaches serious stages.
If a child experiences below symptoms, seek emergency medical care.
- Fast heart beat (palpitations)
- Shortness of breath
- Chest paina
- Altered mental status
Impending Dangers Later in life incase of child with Hypertension
- Learning and attention problems
- Narrowing and weakening of arteries in
- Heart: Increases risk of coronary artery (heart) disease or heart attack as workload of heart lating wastes, giving rise to kidney diseases and risk of kidney failure.
- Brain: Increases risk of stroke (bleeding/ clot / rupture/ blockage of blood vessels).
- Eyes: Affects blood supply to retina, causing problems in vision or the eyes.
- Mental health problems like anxiety, nervousness and depression.
- Weak bones, affecting growth and development
- Mood disorders, irritability and anger issues.
- Organ damage
- Blood Tests: Lipid profile (high cholesterol), HbA1c, fasting blood glucose (diabetes), creatinine and blood urea nitrogen (renal disorders), thyroid panel (thyroid disorders), electrolyte levels, cardiac marker tests aid in assessing if any further damage has occurred, as well as to screen for underlying
Urine Test: Evaluates kidney health and checks metabolic disorders. Organ damage is analysed with physical examination, ultrasound (kidney damage) and echocardiography (checks blood flow through heart and heart problems).
How to manage hypertension in child?
Achieving proper weight through diet and exercising if obese.
- Curbing addiction to indoor games, virtual games, social media.
- Leading an active lifestyle with less sedentary hours.
- Playing outside or a sport, practice yoga.
- Cutting down extra salt in diet.
- Watching for high sodium/salt foods like cereals, processed foods (noodles, chips, baked foods).
- Taking balanced diet rich in fruits, vegetables, fiber, poultry, seafood, non-fat dairy products.
- Drinking water, fruit juices than caffeinated drinks, sodas, etc.
- Consuming healthy snacks like nuts, fruits.
- Sleeping on time (8-10 hours).
- Monitoring BP using home BP machines regularly.
- Adolescents avoiding unhealthy habits like smoking, drinking alcohol and tobacco abuse.
- Getting routine health checkup done (6 months or annually).
How to treat hypertension in child?
Above lifestyle changes may help in managing primary hypertension. When lifestyle changes are not effective and high BP still persists, then anti-hypertensive medications are prescribed by doctors. BP is monitored frequently at every visit to reach target BP.
It is unlikely in children to suddenly have heart attack, stroke or kidney failure due to hypertension. But, constant high BP, if untreated/ignored, can trigger processes in childhood that can cause future life-threatening complications in adulthood.
In an age to learn, play and grow, being affected by a condition of which they have no idea about, can become overwhelming. Having a health condition, frequent visits to a doctor, comparison with other healthy kids, lifestyle changes and medications can affect their mind negatively, bringing down the quality of life. Anxiety and depression can then engulf these tiny tots gradually. Therapy and counselling supports them to come to terms with their state of health. It boosts their mental health, lifts spirits, giving hope and positivity to cope up better. Involving family for counselling on diet and physical activity to bring healthy changes for the entire household helps better. Talking and understanding about the child's likes, woes or daily struggles, help them pour out stress. It will help to instill the right habits in them