It is estimated that over 1.4 billion people are affected by hypertension worldwide. But the condition – when your blood pressure pushes against the walls of your blood vessels is consistently too high – often comes with little to no warning signs.
In general, hypertension is diagnosed when the blood pressure is persistently elevated above 140/90mmHg.
Many people do not even know that they have it, and this is why the disease is often called the ‘silent killer’.
But the condition, if not mitigated, can lead to severe complications and increases the risk of heart failure, stroke, kidney failure, diabetes and death.
A large proportion are hypertensive but majority are undiagnosed, and the diagnosed are not adequately treated.
Consultant Cardiologist at CVSKL, Dr Choo Gim Hooi has 20 years of experience under his belt in the cardiovascular field. He previously worked at the National Heart Institute and the Subang Jaya Medical Centre.
“Our national morbidity and mortality survey over the years have shown that about three to four Malaysians are hypertensive,” says Dr. Choo.
“Mnay Malaysians are hypertensives but majority are undiagnosed, and the diagnosed are not adequately treated.”
In 2017, 13,503 Malaysians died from heart-related disease; an increase of over 54 percent from 2007. One of the more important risk factor for heart disease is hypertension.
Unfortunately, says Dr. Choo many Malaysians neglect to have their blood pressure measured and hence many hypertensives remain undiagnosed. Even when diagnosed, they fail o adhere to blood pressure medications and neglect to improve their lifestyle habits such as overeating, binge drinking and smoking.
“Lifestyle changes should be the foundation treatment for all high blood pressure patients,” says the 51-year-old doctor.
“Whether or not they are on medication, lifestyle changes must come first. That would include weight control. Just by reducing weight can actually lower the blood pressure. But there is a limit as to how much it can reduce.”
There is no such thing, says Dr. Choo. “If you have a true diagnosis of high blood pressure most of the time there is no cure, we can only control the blood pressure (barring a small group of people who can identify the causes).”
Ninety percent of the time, hypertension does not have a definite or identifiable single cause, he adds. “ We call that ‘essential hypertension’”
Essential hypertension is high blood pressure that doesn't have a known secondary cause. “It can be more likely seen if that someone has a family member that has high blood pressure. It is more likely when you grow older and it is more likely to be seen in other situations when they are overweight.”
“The 10 percent of people who have identifiable cause of high blood pressure tend to be the younger ones. There are a few system disorders that can cause high blood pressure such as hormonal and kidney issues. Kidney impairment can cause the blood pressure to rise.”
“As we grow older, the vessels in the body changes, leaving us with less resilience. Our blood pressure will tend to rise. For those who are borderline (high blood pressure is considered considered to be 140/90mmHg or higher), they will need to be on medication and monitored. This is because in the long run they are more likely to develop true high blood pressure.”
“Many patients would claim to know when their blood pressure is high. But the pressure is mainly in the vascular system located in the body; there are no real nerves or fibers to alert us of any pain,” says Dr. Choo.
For example, some claim that neck pain and headache are symptoms of high blood pressure.
“The truth is, any bodily discomfort causes a spike in the blood. So, rather than the blood pressure causing those headaches, it’s the other way around. It is the headache that is causing the rise in blood pressure.”
“The population with high salt intake tend to have a higher prevalence of hypertension cases. Salt is a big ‘no’ for patients. So, promote less salt more vegetables and fruits instead. Exercise is also another excellent way to bring down the blood pressure.”
“Unfortunately, I have to say yes. We are known as the ‘heavyweight champion’ in Southeast Asia. We have the largest obesity and overweight population and if you look at diabetes and cigarette smoking, they are on the rise. When that rises, heart disease will rise as well.”
“We are an unhealthy nation and it’s our lifestyle that is to blame. Our food is rich in fats and cholesterol.”
“Although, I see the younger generation taking up more physical, there’s still a lot of things that we can do to improve our lifestyle”.
“Some can be moderately expensive but there are also many that are very affordable. More importantly, we have shown that treating high blood pressure is more cost effective than not treating high blood pressure at all.”
“The cost of managing those complications later are going to be far greater. Not just the cost but the cost of quality of life too. Stroke and kidney failure will cost so much more.”
“High blood pressure is what we call a ‘low hanging fruit’ for risk reduction. A 2mm reduction in your upper blood pressure reduces risks by 20 to 30 percent.”
"Your blood pressure rises in about half an hour after you smoke a stick of cigarette," says Choo. "Cigarettes have so much harm that it damages the lining of the hearts' blood vessels and the brain."
"I’m seeing young people in their 20s and 30s face heart diseases from just smoking. They may not have strong family history (with high blood pressure) or their cholesterol may not be high but smoking alone is enough to cause all the harm that will lead to premature diseases."