What do we mean when we say hypertension? The term is a combination of the Greek word hyper, meaning “over, beyond, over much, above measure”, and the Latin word tensionem, meaning “a stretching”. The blood pressure is the pressure or tension exerted on the walls of the arteries or blood vessels. When this tension or pressure is consistently excessive, you have high blood pressure or hypertension.

Hypertension is measured as two figures – the systolic or “top” figure and the diastolic or “bottom” figure. When the measured systolic blood pressure is consistently greater than or equal to 130 mmHg or the diastolic pressure greater than or equal to 80 mmHg, you are said to be hypertensive.

Hypertension is a very common disorder, globally. It is particularly prevalent in people of colour and in the Caribbean and Latin America. In the Jamaica Health and Lifestyle Survey (JHLS) 2016-2017, the results of which were released in 2018, 33.8 per cent of Jamaicans 15 years or older were diagnosed with hypertension, up from 20.9 per cent in the 2000-2001 survey and 25.2 per cent in the 2007-2008 survey.

The high prevalence of hypertension is particularly troubling for several reasons. Because hypertension is largely a silent disease, that is, most people with hypertension have no symptoms, many people may be hypertensive without knowing it and the very large numbers that confront us may actually be an underestimation.

Surveys in almost every region of the world consistently demonstrate that, even in those diagnosed with hypertension, only about a third are on treatment and only about a third of those are properly controlled. And very importantly, hypertension is an important risk factor for developing cardiovascular disease, which is the leading non-communicable disease (NCD) responsible for the most premature deaths globally.

Hypertension is responsible for 19 per cent of these premature deaths globally, followed by overweight and obesity and elevated blood sugar. The burden of hypertension is very high.

Hypertension causes cardiovascular disease by causing damage to blood vessel walls and leading to impaired blood flow to heart muscle (causing heart attacks and heart failure), reduced blood flow to kidneys (causing kidney disease and failure), reduced blood flow or leaky blood vessels in the eyes (impaired vision), blockages in blood vessels of the brain or bleeding into the brain (causing stroke), as well as other organ damage.

Uncontrolled or untreated hypertension can cause death and disability in people during normally productive years, physical infirmity, and loss of independence in older individuals.

Many of these complications can be avoided by careful and effective management of high blood pressure.

Hypertension is a chronic disease which is incurable, in most cases, but eminently manageable. Only about five per cent of cases of hypertension are due to another underlying condition, such as kidney disease, certain glandular or hormonal disorders, or drugs.

In these people, treatment of the underlying condition may cause resolution of the hypertension. Most people with hypertension have primary hypertension, which is usually genetic in origin, that is, they were born with the genetic predisposition to develop hypertension, which usually starts showing up in their 30s or 40s. This type of hypertension cannot be cured and must be managed lifelong. You can develop hypertension at any age, even as late as your 80s and older.

Again, for the vast majority of people with hypertension, management is with a combination of lifestyle modification and medication. Only a small proportion of patients with very mild hypertension can manage their hypertension with lifestyle modification alone. Most will require medication to control the blood pressure well. Lifestyle measures include maintaining a healthy weight, dietary restriction of salt, and regular physical exercise. These measures may allow blood pressure to be controlled with less medication and are equally as important as the medication. Paying attention to what we eat, reading food labels, and making healthy food choices will contribute to weight loss, if necessary, and healthier hearts and blood vessels.

If the burden of hypertension is to be reduced, several things need to happen. All adults should be screened on a regular basis — at least once a year — if you are not known to have high blood pressure. If you have elevated blood pressure, you must start on a programme of weight management, dietary restriction, regular physical exercise, and have your blood pressure checked at least every three months. If diagnosed with hypertension, strive to control blood pressure well. Do this consistently and lifelong in order to minimise blood vessel damage and restriction of blood flow to vital organs. This will reduce the risk of cardiovascular events which can be catastrophic and life-changing and significantly affect your quality of life.

Check your blood pressure regularly. You can live well with hypertension. No pressure!

You can check your blood pressure and see the doctor at the Heart Foundation of Jamaica’s (HFJ) weekly Hypertension Clinic on Thursdays and Fridays at 28 Beechwood Avenue, Kingston 5.

Dr Andrene Chung is a consultant cardiologist and chair of the Heart Foundation of Jamaica.