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Hypertension has no symptoms but deadly nonetheless

13 Feb 2018

High blood pressure of hypertension is known as the silent killer simply because it exhibits no symptoms in the majority of sufferers.

The biggest misconception about hypertension is that it will manifest itself in symptoms such as dizziness, fainting and headaches; chest pain and angina; nosebleeds, blurred vision, difficulty in breathing, arrhythmia, oedema or fatigue. While one or some of these may be true, most persons with hypertension have no outwardly symptoms, said Dr Lim Bee Chian, a consultant interventional cardiologist. In fact, people can go around their daily lives blissfully unaware they have the deadly condition.

Speaking at the forum ‘Blood Pressure, Salt and Your Health’ held in Petaling Jaya recently, Lim said hypertension develops slowly over time and hence tends to ‘creep’ up on one. 

About 90 percent of hypertension is categorized as essential—there is no known cause, while the remaining 10 percent or so is considered as secondary hypertension. Essential hypertension is chronic and cannot be cured, but it can be managed. This is an important message to pass on to patients as they have a tendency to assume the normalization of their blood pressure is a sign that the disease has been resolved, said Lim.

Secondary hypertension is caused by other disease conditions and treating the primary disease will usually result in the cure of this type of hypertension. Common causes of secondary hypertension are polycystic kidney disease, glomerular disease, Cushing’s syndrome, thyroid problems and sleep apnoea, among others.

Understandably, many patients are hesitant to initiate pharmacological treatment as it needs to be taken lifelong. For those whose blood pressure is only slightly elevated, they can initiate lifestyle modifications—the typical cutting of salt from diet, exercise, proper rest, etc. However, the usual impact of each lifestyle change only results in a four-to-five mmHg systolic blood pressure drop and a two-to-four diastolic blood pressure drop. Perhaps the most effective blood pressure reduction to be gained from a lifestyle change is through the adoption of the dietary approach to stop hypertension (DASH) diet, a scientifically-proven diet plan, which can result in a 11 mmHg systolic blood pressure drop.  [N Engl J Med 2001;344:3–10]        

Know your own risk

In his talk, Lim alluded to the Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator, an app developed by the American College of Cardiology as a tool to help estimate a person’s 10-year ASCVD risk. It is intended for the primary prevention of patients with low-density lipoprotein (LDL) cholesterol levels less than 190 mg/dL. Once all the necessary fields are filled up, the calculator will generate the percentage risk a person has of developing ASCVD. According to Lim, anyone scoring more than 10 percent is at high risk.

Lim advised the public to utilize the ASCVD Risk Estimator as it was an easy-to-use tool and takes away much of the guesswork on one’s risk of developing ASCVD. Alternatively, users can access the risk estimation tool online at http://tools.acc.org/ASCVD-Risk-Estimator-Plus/#!/calculate/estimate/

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