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About Hypertension, You Need to Know These

Daniel MENG, Supervisor of Cardiology Services, Consultant Cardiologist

Hypertension,also commonly known as high blood pressure,is a potentially life threatening medical condition that demands everyone’s attention. This is due to the deleterious effect it places on the blood vessels everywhere in the body, including the target end organs such as the heart, brain, and kidneys. This problem has reached an epidemic level all over the world and especially here in China.

According a recent survey, the prevalence of hypertension in China’s general population has increased from 5.11% in 1958 to 7.73% in 1978. In the modern era, it has further increased from 13.58% in 1991 to 17.56% in 2002 (see Figure 1). Currently it is estimated that 20 to 25% of the population above age 15 have hypertension. Multiple causes have been implicated to contribute to this alarmingly rapid rise of hypertension to its current level; most importantly the unhealthy lifestyle—for instance, improper diet, lack of exercise, substance abuse and stress—which invariably accompanies the rapid modernization and the socioeconomic development in China for the last 35 years.

Hypertension is strongly linked to stroke, coronary artery disease and renal failure. While in the western world, the ratio of stroke and heart attack may be 1:1; that changes to 5:1 in China, mainly due to the relatively lower incidence of heart attack when compared with the western world. Stroke has a devastating effect and remains a major public health issue. This certainly underscores the importance of mobilization of health resources and heightening public awareness to bring this health threat under control.


                           Figure 1

Causes for hypertension:


There are many causes for hypertension.

1.      Age

As we age, our blood pressure increases naturally. However, smoking or drinking excessively, or eating a poor diet rich in fatty and sugary foods, can exacerbate the rise of high blood pressure with age.

2.      Excess Sodium

According to the American Heart Association, excessive levels of salt (or sodium intake of more than 1,500 milligrams per day) can lead to high blood pressure, diabetes, and cardiovascular diseases—regardless of age, current health condition, and family history. It is estimated that a typical Chinese diet contains twice the amount of daily recommended salt level.

3.      Poor Diet

Sugar and fat-laden diets, in addition to being linked to obesity and diabetes, alters the regulatory mechanism of the blood vessel wall and reduces its response to dilation and constriction stimuli, thereby increases hypertension.

4.      Drugs and Alcohol

Drinking excessive amounts of alcohol (particularly binge drinking) or using recreational drugs—for instance, stimulants like cocaine, amphetamines and crystal methamphetamine—will put stress on the heart and arteries and cause damage.

5.      Obesity

Being overweight is linked to sedentary lifestyle, poor diet, increased sodium levels, and raised insulin levels, all of which cause thickening of the arteries, and prompt conditions like diabetes, heart attack, and stroke.

6.      Sedentary Lifestyle

Hypertension is often caused by a long-term sedentary lifestyle (lack of exercise), which leads to weight gain and undue pressure on the heart.

7.      Smoking

Smoking causes the arteries to shrink in size and promotes blockage and is strongly linked to heart disease. Smoking just one cigarette can raise your blood pressure by 10 mm Hg. High blood pressure occurs as the arteries, the largest blood vessels that carry blood to the kidneys, narrow and become constricted, resulting in more effort from the heart.

8.      Sleep Apnea

Sleep Apnea is a condition that causes oxygen levels to decrease during sleep when apnea (stop breathing transiently) occurs, resulting in increased blood pressure and stress on the cardiovascular system. Those with obstructive sleep apnea are linked to amplified risk of hypertension.

9.      Hormonal Conditions

Certain hormonal diseases or conditions—for instance, Cushing’s syndrome, caused your body to produce a greater amount of steroid hormones than needed—will put pressure on the body and result in hypertension.

10. Kidney Disease

One primary cause of hypertension is kidney disease. This occurs when the adrenal glands (small pea-shaped glands that lie on top of the kidneys) are triggered to secrete too much cortisol hormone, which elevates the “flight response” and increases blood pressure.

Symptoms for hypertension:

One of the most frightening aspects of hypertension is the lack of symptoms in the majority of cases so that, despite its high prevalence, many people who have this condition may be totally unaware of its presence; therefore, hypertension is sometimes labelled “the silent killer.”   However, in more severe cases, some people do present with symptoms that are shared by many other unrelated conditions. These symptoms may include headaches, shortness of breath, pains in the chest, exhaustion, nausea, changes in skin color, a ringing sound in the ear, becoming confused, nose bleeds, bloody spots in the eye. Whenever, one or more of these conditions appear, it is always a good practice to have blood pressure checked. However, even without any symptoms or prior knowledge of high blood pressure, you should always have blood pressure checked at least once every five years.

Non-pharmacologic treatment for hypertension:

If you’ve unexpectedly been diagnosed with high blood pressure; it’s not the end of the world.  There are many lifestyle changes you can make that direct against the risk factors which contribute to hypertension.

1. Exercise

The best thing you can do for blood pressure control is to get physically active—at least 30 minutes per day, every day. That could include walking, running, biking, swimming, yoga or a favorite sport.  Whatever physical activity you choose; you’ll witness of drop of your blood pressure within just a few weeks, and hopefully avoiding a full-blown hypertension.

2. Healthy Eating

Eating a balanced diet that focuses around fresh fruits and vegetables, complex carbohydrates like whole grains, lean protein, and low-fat dairy products (Diet Approach to Stop Hypertension, or DASH diet) while avoiding refined sugar, excess salt, saturated fat and cholesterol will help.

3. Smoking cessation

As mentioned before, it only takes one cigarette to temporarily raise your blood pressure level by 10 mm Hg or greater. And if you smoke frequently throughout the day, you are constantly elevating your levels to dangerous levels. If you are a chronic smoker, it may take several months after stopping smoking for your lung functions to return to normal but years for your risk for heart disease to return to those who have never smoked. But it is never too late to start.

4. Reducing Salt in diet

Reducing the sodium in your diet will instantly lower your blood pressure. There is a consensus among many health organizations that we should aim for less than 1500 mg of sodium intake per day, and definitely not more than 2300 mg per day. 1500 mg of sodium amounts to 0.75 teaspoons or 3.75 grams of salt per day, while 2300 mg amounts to one teaspoon or 6 grams of salt per day. So start reading food labels, shunning processed whole foods where you can, and keeping that daily sodium intake to the recommended level.

5. Weight loss

Blood pressure raises with weight, which means you can reduce your numbers by simply losing a few excess kilograms—particularly around your waist area.

6. Relaxation

Taking a breather from stressful work, family, social obligations, or financial obligations will also help lower blood pressure. And if you cannot eliminate stress completely, learn to cope with de-stressing methods—like exercise, massage, meditation, yoga or Tai-chi.

7. Reducing Caffeine

Studies show that caffeine makes blood pressure levels spike temporarily similar to cigarette smoking. If you already suffer high blood pressure, cutting out caffeinated substances—like soda and coffee—can help you lose weight by cutting excess sugar and calories too.

8. Drink in moderation

Studies show that alcohol, red wine in small amounts, can actually help lower blood pressure. However, the adverse effect occurs if you drink too much—which is why it’s important for women to keep alcohol intake to 1 drink per day and men to stick to a maximum of 2 drinks a day.

9. Home-Monitoring

If you’ve been diagnosed with high blood pressure, it’s within your interests to learn how to self-monitor your blood pressure at home. This is done using an upper arm blood pressure monitor to keep tabs on your blood pressure to ensure it stays within healthy levels between doctor’s visits.

10. Camaraderie

Staying healthy and sticking to a new diet and exercise plan is always easier if you have the support of your family and friends. This way, if you slip off track, you’ll be encouraged by the people who love you to invest in your health and give you the physical and emotional boost to help you do so.

If these non-pharmacologic therapies remain ineffective in bring blood pressure under control, your doctors may prescribing medications.

Pharmacologic therapy for hypertension:

Please consult the doctor according to the specific conditions.


Hypertension is a rather common finding in the Chinese population and the incidence continues to rise. It has caused significant mortality and morbidity of the people and placed a tremendous burden on the community in terms of health care resources. Fortunately, hypertension is a highly modifiable risk factor. Early detection and treatment have been proven to significantly lower the damage done to the health and improve the wellbeing of the community. It takes a collaborative effort from both the healthcare profession and population in general to bring it under control. Mere increasing the resources for early detection and treatment is not sufficient. Public awareness through organized education and lifestyle modification (especially smoking cessation) are of paramount importance in the ultimate victory over this dreadful condition.