Hypertension - tale of a silent ticking bomb
I recently diagnosed a young, 32 years old male patient with high blood pressure or hypertension. He has been told that he has hypertension for the past 2 years but he refused to start on any medication. He often tried to convince the doctors that he would change his lifestyle including quit smoking and start exercising. Both his parents have hypertension and all his older siblings are already on medication for hypertension. His mother had passed away from complications of stroke a year ago but this has not convinced him to start on medication.
More and more younger patient are now being diagnosed with hypertension and often has evidence of end organ damage at the time of diagnosis. I met patient with essential hypertension as young as 17 years old. His main risk factors are obesity and very sedentary lifestyle. In clinical practice, younger patients with new diagnosis of hypertension, will require extensive young hypertension work-up to exclude causes of secondary hypertension from underlying organ disease or hormonal cause. If no organic causes were found, the patient is diagnose as essential or primary hypertension. It is the most common type of hypertension, affecting 95% of patients with hypertension and is likely the consequences of interaction between underlying genetic and environmental factors.
The silence nature of hypertension means that the onset of hypertension predated much earlier than when first detected. It’s one of the chronic illnesses that can go undetected for years before patient ends up with evidence of organ damage. Difficulties in diagnosing hypertension in clinical practice due to its insidious and often elusive nature. At initial stage, hypertension often preceded by a period of lability, individual variability and often significant differences in reading throughout the day
Blood pressure readings are influenced by many factors such as pain level, emotional stress, physical activity, sleep deprivation, smoking, alcohol and salt intake. There are also group of patient with a phenomenon called white coat hypertension, whom blood pressure are usually elevated in the clinic likely from anxiety but normal at home settings. Patients are advise to do home blood pressure monitoring and repeat visits are often needed to confirm diagnosis of hypertension rather than single blood pressure reading in one setting. Because of rising prevalence of obesity, sedentary lifestyle and higher consumption of processed foods, more and more patients are diagnosed with hypertension earlier and thus high index of suspicion is needed to diagnose it before the damage started regardless of patient’s age
Hypertension is a systemic illness. It affects many organs as our blood vessel travel everywhere in our body. It can affect the eye causing blindness, the heart leading to heart attack and heart failure, ruptured of blood vessel often with deadly outcome in the case of stroke and damage to the kidney leading to end stage kidney disease requiring dialysis support. Yet many patients are resistant with initiation of medication believing that it can be reversed easily with change of lifestyle. Hypertension often coexist with other blood vessel diseases such as diabetes and high cholesterol leading to development of narrowing and hardening of blood vessels called atherosclerosis.
The prospect of having to live with chronic illness, especially for young patient and the need to take medication everyday for the rest of their life has swayed many patients away from medical therapy despite extensive evidence of damaging effect of hypertension. Attentive listening and empathy are needed to help patients understand the seriousness of their illness and guiding them to start making healthy lifestyle changes
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