Hypertension Diagnosis, Causes, Prevention, and Effective Management Strategies

Diagnosis of Hypertension

Hypertension, often known as the "silent killer," is usually diagnosed by monitoring regular blood pressure, as many people are unaware, it causes due to the lack of noticeable symptoms. When symptoms do occur, these may include:

• Early morning headache,
• Nosebleed,
• Arrythmia,
• Eyesight changes,
• Buzzing in the ears.

In cases of severe hypertension, symptoms can escalate to fatigue, nausea, vomiting, confusion, anxiety, chest pain, and muscle tremors.

Causes of Hypertension:

• Stress
• Unhealthy diet
• Excessive use of salt in daily routine
• Obesity
• Narcotics consumption
• Chronic conditions

Reducing the Burden of Hypertension helps in:

?Managing hypertension helps prevent serious complications such as heart attacks, strokes, kidney damage caused by damage of arteries and other organs linked to other chronic health conditions if left untreated.

Prevention:

Hypertension is chronic health condition almost affecting half of young adults’ day another day. Self-monitoring at home or through visiting your physician on regular basis are the best ways of recognizing masked hypertension. Additionally, following are few key points to be taken care for prevention of Hypertension:

• ?Reduce salt intake to less than 5g per day.
• Engage in regular physical activity.
• Increase fruit and vegetable consumption.
• Limit intake of foods high in saturated fats.
• Reduce alcohol consumption.
• Avoid tobacco use.
• Eliminate or reduce trans fats from the diet.

?Management:

• By reducing and managing stress.
• Take treatment of high blood pressure when necessary.
• Manage other medical conditions.
• Regular monitoring of blood pressure.

?For severe cases of Hypertension medication should be started if blood pressure remains uncontrolled, particularly for those over 50, or in patients with grade 2 hypertension. However, lifestyle changes are the foundation of hypertension management. These include dietary adjustments like reducing salt and alcohol.

DASH (Dietary Approaches to Stop Hypertension) eating plan, which emphasizes:

For patients with uncontrolled blood pressure, Pharmacological treatment is recommended if lifestyle changes are insufficient, aiming to lower blood pressure to below 140/90 mm Hg within the first three months of treatment.

?WHO’s Response:

The World Health Organization (WHO) supports global efforts to control the burden of hypertension. In 2021, WHO released updated guidelines on the pharmacological treatment of hypertension, providing evidence-based recommendations to initiate treatment, follow-up intervals, target blood pressure, and who within the healthcare system can start treatment.

WHO also launched the Global Hearts Initiative in 2016 in collaboration with the U.S. CDC, which features the HEART’S technical package.

?Package generally focuses on:

• Counselling for Healthy lifestyle,
• Treatment protocols which are evidence-based,
• Access to essential medicines and technology,
• Risk-based management,
• Team-based care,
• Monitoring systems.

?The Government of India also implemented several programs and initiatives to control the burden of hypertension, recognizing it as a major public health concern. These efforts are aimed at reducing the risk factors associated with hypertension which includes improving early detection and providing affordable treatment.

?Some Programs are as below:

?1. National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS)

• Launch: Launched in 2010 focuses on hypertension as part of its larger agenda to combat non-communicable diseases (NCDs) like cardiovascular diseases, diabetes, cancer, and stroke.
• Objectives:

• Early detection at the primary healthcare level through screening.

• Promotion of healthy lifestyles and awareness campaigns to reduce risk factors (e.g., unhealthy diets, lack of physical activity, tobacco and alcohol use).

• Strengthening healthcare infrastructure to treat NCDs, including hypertension.

?2. Ayushman Bharat – Health and Wellness Centres (HWCs)

• Launch: It was launched in 2018. All the centres under this focuses on primary healthcare, including hypertension screening as a part of the services offered to the public. The aim is to detect hypertension at an early stage and provide necessary management to prevent complications.
• Initiatives includes:

• Free health check-ups, including blood pressure monitoring.

• Counselling for lifestyle changes to prevent hypertension.

• Referral for secondary care and tertiary care as per need.

?3. India Hypertension Control Initiative (IHCI)

• Launch: Launched in 2018, in collaboration with WHO, the Indian Council of Medical Research (ICMR), and the Ministry of Health and Family Welfare. It focuses on better hypertension management by improving access to standardized treatment protocols.

• Ongoing Actions:

• Training of healthcare workers in primary healthcare centers on standardized treatment protocols.

• Ensuring the availability of essential medicines for hypertension at government healthcare facilities.

• Monitoring of patients with hypertension regularly to ensure they adhere to treatment.

?4. Jan Aushadhi Scheme (Pradhan Mantri Bhartiya Janaushadhi Pariyojana - PMBJP)

• Launch: launched in 2008 and established by Beauro of Pharma Public Sector undertakings of India (BPPSU), aiming to provide quality generic medicines, which includes anti-hypertensive drugs too, at an affordable price through a large network of government run pharmacies. This ensures that patients suffering from hypertension, especially low-income groups, can access treatment without any financial strain.

?5. National Health Mission (NHM)

• Launch: This program was launched in 2013 that focuses to integrate hypertension screening into the broader healthcare system, particularly in rural and underserved areas. This is part of India’s broader strategy to enhance healthcare access and coverage for NCDs.

6. Telemedicine and Digital Health Initiatives:

Telemedicine platforms, specifically at the time of the COVID-19 pandemic, have been very helpful in providing consultations for hypertension management. This allows patients to access advice on controlling hypertension remotely, ensuring continuity of care. All these programs collectively aim to increase awareness to diagnose and cure the hypertension.

Cardiovascular diseases (CVD) are often linked with hypertension, and routine diagnostic tests help monitor cardiovascular health, detect early signs of heart problems, and manage comorbidities associated with high blood pressure.

Below are some common diagnostic tests for CVD, along with comorbid factors that should be watched for in patients with hypertension:

1. Blood Pressure Measurement

• Purpose: Essential for diagnosing and monitoring hypertension, which is a major risk factor for CVD.
• How it helps: Tracks blood pressure trends to assess heart health and the effectiveness of hypertension management.

?2. Lipid Profile

• Tests: Measures total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides.
• Purpose: Evaluates the risk of atherosclerosis (narrowing of arteries due to plaque buildup), which can lead to heart attacks or strokes.
• Comorbid Factors: Patients with hypertension often have dyslipidemia (abnormal lipid levels), increasing the risk of coronary artery disease.

?3. Electrocardiogram (ECG or EKG)

• Purpose: Records the electrical activity of the heart to detect arrhythmias, ischemia (reduced blood flow), or signs of a previous heart attack.
• Comorbid Factors: Long-standing hypertension can lead to left ventricular hypertrophy (enlargement of the heart’s left ventricle), detectable through ECG.

?4. Echocardiogram

• Purpose: Uses ultrasound waves to create images of the heart’s structure and function. Helps assess heart size, pumping strength, and valve function.
• Comorbid Factors: Hypertension can cause hypertensive heart disease, leading to heart failure, which can be evaluated through an echocardiogram.

?5. Stress Test (Treadmill Test or Exercise ECG)

• Purpose: Assesses how the heart responds to physical stress, typically through exercise. It can detect ischemia or other heart problems not apparent when at rest.
• Comorbid Factors: Hypertensive patients may have underlying coronary artery disease, which can be detected when the heart is stressed.

?6. Ambulatory Blood Pressure Monitoring (ABPM)

• Purpose: Measures blood pressure continuously over 24 hours to assess fluctuations throughout the day and night.
• Comorbid Factors: Nocturnal hypertension (high blood pressure during sleep) is common in patients with CVD and can increase the risk of stroke and heart attack.

?7. Coronary Angiography (Cardiac Catheterization)

• Purpose: A specialized test that uses contrast dye and X-rays to visualize blockages or narrowing in the coronary arteries.
• Comorbid Factors: Hypertension is a leading cause of atherosclerosis, and angiography helps detect coronary artery blockages caused by plaque buildup.

?8. Carotid Ultrasound

• Purpose: Uses sound waves to examine the carotid arteries in the neck, looking for narrowing or blockages that could lead to stroke.
• Comorbid Factors: Hypertension can contribute to carotid artery disease, raising the risk of ischemic strokes.

?9. Ankle-Brachial Index (ABI)

• Purpose: Compares blood pressure in the ankle with blood pressure in the arm to assess for peripheral artery disease (PAD), which is a narrowing of arteries in the limbs.
• Comorbid Factors: Hypertension increases the risk of PAD, which is associated with poor circulation and can lead to heart attacks or strokes.

?10. Fasting Blood Glucose and HbA1c

• Purpose: Measures blood sugar levels and long-term glucose control to detect diabetes, a major comorbid factor in CVD.
• Comorbid Factors: Hypertension frequently coexists with diabetes, exacerbating cardiovascular risks. Poorly controlled diabetes increases the risk of heart attacks, strokes, and kidney disease.

?11. Kidney Function Tests (Serum Creatinine, eGFR, and Urinalysis)

• Purpose: Assesses how well the kidneys are functioning. Chronic hypertension can damage the kidneys over time.
• Comorbid Factors: Hypertension can lead to chronic kidney disease (CKD), which further increases cardiovascular risks. Elevated creatinine and decreased glomerular filtration rate (eGFR) can indicate kidney damage.

?12. Chest X-Ray

• Purpose: Provides images of the heart and lungs to look for signs of heart enlargement, pulmonary congestion, or fluid buildup (indicating heart failure).
• Comorbid Factors: Hypertension-related heart failure may present as fluid buildup in the lungs, detectable on a chest X-ray.

?13. Holter Monitoring

• Purpose: A continuous ECG recording, typically over 24-48 hours, to detect irregular heart rhythms or ischemic episodes.
• Comorbid Factors: Hypertensive patients are at risk for atrial fibrillation (AFib) and other arrhythmias, which can increase stroke risk.

?Comorbid Factors to Watch for Due to Hypertension:

1. Diabetes: Increases the risk of cardiovascular complications.
2. Chronic Kidney Disease (CKD): Common in hypertensive patients and increases the risk of heart failure.
3. Dyslipidaemia: High cholesterol levels elevate the risk of atherosclerosis and coronary artery disease.
4. Obesity: Excess body weight increases the strain on the heart, exacerbating hypertension and cardiovascular risks.
5. Atrial Fibrillation (AFib): Hypertension increases the risk of this irregular heart rhythm, which can lead to stroke.
6. Sleep Apnea: Common in people with hypertension and associated with higher cardiovascular risk.
7. Peripheral Artery Disease (PAD): Linked to hypertension, affecting blood circulation in the limbs, increasing the risk of heart attacks.

?Monitoring these comorbid factors and using the appropriate diagnostic tests are critical for managing cardiovascular health, especially in hypertensive patients.

Nainika Chaudhary , SCM – Hexamed Diagnostics