Hypertension also called high blood pressure is the most common chronic condition in Anguilla and is among the 10 most common causes of death. Complications from hypertension, like stroke, kidney failure and heart failure are common in our society and require urgent attention. The management of hypertension is a constant challenge for health professions working on the island and requires much greater community participation.

What is hypertension?
Blood pressure is simply the pressure on the walls of the blood vessels as the heart pumps blood through them. In some people their blood pressure goes up higher than the normal range of blood pressure and stays that way. These people are then described as having hypertension or high blood pressure. The accepted cut off point for high blood pressure is greater than 140 mmHg systolic and greater than 90 mmHg diastolic.

What causes hypertension?
Hypertension is a multifactorial disease. Hereditary factors, environment and the intrauterine period all play a role in the etiology of hypertension. Impaired maternal nutrition and poor weight gain during pregnancy have been shown to be related to higher childhood blood pressures. There are clear ethnic differences in the pattern of hypertension, both in terms of incidence and complication. Hypertension is more common in blacks compared to white populations.

Who can get high blood pressure?
A person can develop high blood pressure at any age. It can develop in children, but is more common in adults. If someone in your family has hypertension your chances of developing hypertension is markedly increased.

What are the symptoms of hypertension?
High blood pressure is asymptomatic. This means there are no signs or symptoms that tell you that you have this disease. That is why it is called the silent killer. Headaches and pain behind the neck do not indicate that you have hypertension. Accurate and repeated blood pressure measurement is needed to diagnose hypertension.

Management of hypertension
There are four areas of lifestyle in which change has been shown to be clearly associated with a reduction in blood pressure. These are weight reduction, exercise, diet and social drugs.
Weight reduction-As many, as 50% of hypertensive patients are overweight. A weight drop of 4-5kg in overweight patients can reduce both systolic as well as diastolic blood pressure by 2-3 mmHg. Loss of as little as 5-10% of body weight in the obese patient can lower blood pressure as much as single drug therapy.
Exercise - Regular exercise is associated with improved cardiovascular fitness, which leads to reduction in blood pressures. Exercise will also lead to weight reduction and other health benefits.
Diet - A number of dietary manipulations has been shown to reduce blood pressure. Diets low in saturated fat and high in fruit and vegetables can, in the short-term, lower blood pressure. Sodium restricted diets (less than 6 g NaCl) have been effective in lowering blood pressure by as much as 5-10 mmHg. The role of potassium and calcium supplementation in not established.
Social drugs - reduction of alcohol intake from moderate and high levels to low or modest levels (not more than 1 or 2 drinks per day) reduces hypertension and the stopping of smoking decreases cardiovascular risk.
There is evidence that medication, prayer and humour can lower blood pressure as well.

Pharmacological treatment
Patients who have not responded adequately to lifestyle modification will require some form of drug medication. Drug treatment is not an easy matter as many patients are asymptomatic and are reluctant to take medications as prescribed and many have side effects such as impotence! Most doctors have agreed that the cut-off point for treatment for hypertension is 140/90. Target organ damage should also be considered when deciding when to use drugs and the type of drugs to be used. Race is an important factor in determining the anti-hypertensive to be used. Some medications are not as effective as others are in the Afro-Caribbean population.
All patients with high blood pressure should be fully evaluated by a qualified doctor and end organ damage must be determined. Close follow up is needed to determine the progression of the disease and to prevent complications developing.

What are some of the complications of high blood pressure?
The main organs damaged by uncontrolled and untreated high blood pressure are the brain, the kidneys and the heart.
In blacks, strokes are common in severe hypertensive patients. The eyes are also affected leading to retinal damage and blindness.
Kidney damage occurs early in the natural history of high blood pressure. Many patients develop kidney failure which can be life threatening if dialysis or renal transplantation is not available.
Hypertension is a leading factor in coronary artery disease. Heart failure is common in the Caribbean and is a leading cause of death. Uncontrolled high blood pressure can lead to enlargement of the heart resulting in many heart complications.
It has been shown by several large clinical studies that good control of a patient’s high blood pressure can prevent many of the complications associated with high blood pressure
Patient education
There are certain cultural beliefs that make compliance and treatment of hypertension difficult in the Caribbean including Anguilla. Some people believe that high blood pressure is associated with stress and will resolve once the stressful situation is over. This is not the case. Very few cases of high blood pressure are related to stress. Many people continue to believe that headaches and dizziness are associated with hypertension, therefore if you do not have headaches and dizziness you do not have high blood pressure. Many people fail to associate stroke and kidney failure with high blood pressure. Many people will not continue their medication on the advice of ill-informed individuals who have little knowledge about the management of hypertension. The exact role of the various bush teas used by some individuals has not been fully studied to determine their potency and their side effects. The interaction of these bush teas and other medications is not well documented.

Conclusion
High blood pressure is a very serious condition that affects many Anguillans. Very often individuals with this condition ignore it and go on to develop many complications that can result in death. Uncontrolled high blood pressure can cause kidney failure, stroke and heart attacks. The combination of high blood pressure and diabetes is found in many Anguillans and together these two conditions if not properly treated can result in early death. There is need for more patient education about high blood pressure here in Anguilla. Non pharmacological treatment of high blood pressure is important and should be reinforced by health care professionals at all times. All individuals should have their blood pressure taken regularly by qualified persons and should seek medical care if they are hypertensive. Hypertension is a silent killer right here in Anguilla.

Dr Brett Hodge is a Family Physician and Specialist Obstetrician/Gynaecologist with a Medical Practice in the JOHNSON BUILDING in THE VALLEY.

Dr. Brett Hodge

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