Symptoms are hard to spot, but high blood pressure can kill

Like so many people, I have high blood pressure. Yet, with the exception of occasional dizziness on rising, I can safely say that even at its highest, untreated level, hypertension has never caused me a single symptom.

The morning dizziness, I should add, is the result of postural hypotension, probably brought on by blood pressure tablets, and is not a symptom of the elevated pressure itself.

For most of us, a lack of high blood pressure symptoms is undoubtedly a reason why the condition remains underdiagnosed and undertreated. It is also the biggest reason why patients stop taking their blood pressure medication after months and years, on the basis of “well, that must be sorted by now, so I won’t bother filling the repeat prescription anymore”.

The scale of underdiagnosis and undertreatment of high blood pressure was confirmed by the landmark Prospective Urban Rural Epidemiology (Pure) project, published in 2013. The multinational study of more than 150,000 adults aged 35-70 set out to establish the prevalence and awareness of hypertension.

Some 41 per cent of participants were found to have high blood pressure; of these, just 46 per cent were aware they had the condition. And among those who were already on treatment for hypertension, only 32 per cent had their blood pressure under control (with readings less than or equal to 140/90mm Hg).

Awareness campaign

In response, the annual World Hypertension Day campaign has been extended this year to become May Measurement Month (MMM). Organised by the International Society of Hypertension and the World Hypertension League, MMM intends to increase levels of awareness among the world's hypertensive population.

The goal for the month is to screen 25 million people worldwide who have not had their blood pressure measured since April 30th, 2016. In effect, this is an ambitious target to screen 1 per cent of the population of each participating country.

In the Republic, MMM is being led by Dr Eoin O'Brien, adjunct professor of molecular pharmacology at UCD's Conway institute, and Dr Eamon Dolan, a consultant geriatrician at Connolly Hospital in Dublin.

“We hope to be able to measure blood pressure in at least 50,000 Irish adults in pharmacies, hospitals, and doctor clinics,” O’Brien says. “These measurements will give us interesting information on how many of the public have undiagnosed and untreated high blood pressure [and who are therefore at risk from stroke and heart attack], and it will allow us to compare the figures with other countries.”

Global mortality

Data from the Global Burden of Disease project show that raised blood pressure continues to be the biggest single contributor to the global burden of disease and to global mortality, causing 9.4 million deaths each year.

The negative effect of untreated blood pressure is largely seen through coronary heart disease and stroke; the relative risks for coronary heart disease and stroke deaths vary extensively by geographical location, which presumably reflects the coexistence of other risk factors. And it seems the adverse effects of systolic and diastolic blood pressure on various cardiovascular diseases are age-related.

High blood pressure is eminently treatable; while most of us will require just one anti-hypertensive, combining three drugs controls 90 per cent of cases of high blood pressure.

Some people will see a difference by increasing exercise, losing weight, stopping smoking and making other lifestyle changes and will not, initially at least, require drug treatment.

I wonder: If the reasons most people develop high blood pressure in middle and old age were known, would the awareness of hypertension and its consequences be greater? The more it is perceived as just one of those things, perhaps the easier it is to dismiss with a shrug of inevitability.

Meanwhile, please grab the opportunity to have your blood pressure assessed this month. It could be a lifesaver.