“Hypertension, or high blood pressure, is a key risk factor for circulatory disease including heart disease, stroke, eye disease, kidney and heart failure,” says Dr Diane Bennis, GP with webdoctor.ie.
With 64 per cent of adults over the age of 50 in Ireland presenting with high blood pressure, it’s vital we are aware of not only the environmental and lifestyle factors that play a part in the condition, but also our additional risk due to our family health history.
“Family and twin studies estimate that the heritability (fraction of the trait explained by genes) of hypertension is 30-50 per cent,” says Dr Bennis. “Strong empirical evidence of the importance of genes in hypertension shows that it is 2.4 times more likely in patients who have two hypertensive parents.”
Angie Rodrigué is aware of her family history with high blood pressure as her grandfather and great-grandfather both died around the age of 40 due to stroke. Both of her parents are doctors, and her father also manages his own high blood pressure. With their understanding that high blood pressure runs in the family, they actively encourage a healthy lifestyle.
“When I lived in Malta,” says Angie who now lives in Dublin, “I was going through a difficult and stressful period of my life. I started having high blood pressure and I was diagnosed there and given medication as a treatment. I did that for two years.”
After this, Angie moved to Ireland and felt medication was not supporting her system as her blood pressure was dropping very low. “I needed to reassess if I needed the medication or not,” she says. “I talked to my GP, and she took me off the meds and kept me under control.”
After an in-depth discussion with her GP, Angie altered her lifestyle significantly and now monitors her blood pressure at home in consultation with her doctor.
“The lifestyle changes I have made here like living a more relaxed life, eating very healthily and not drinking alcohol has had a big impact on my blood pressure. I keep track of my blood pressure and data on a health app and share the information with my GP. Lifestyle changes have had a huge influence and maybe it’s just delaying the inevitable and I will eventually be on medication full-time, but for now, I can see my before and after and it is truly a big difference.”
“Despite the importance and high prevalence of hypertension, its aetiology is still not fully understood,” says Dr Bennis. “It most likely results from a complex interplay of genetic, epigenetic (reversible genetic changes) and environmental factors. There has been extensive interest and studies into the genetics of hypertension. It is now understood that there are at least 1,000 common genetic hypertensive risk variants (and probably a lot more) that are each associated with very small changes in blood pressure (1mmHg or even less).
“The probability of hypertension occurring in an individual grows larger with the number of risk genes present and is modulated by environmental factors such as age, BMI, sex, salt consumption and others. Therefore, unlike some diseases with only one or a few genes as risk factors, there is no such thing as a primary hypertensive gene or a gene that can be targeted to identify risk or be targeted for treatment. It is much more complex.”
The difficulty with abnormal blood pressure is that it can exist for a long time without presenting any obvious symptoms. It is important to understand and therefore be aware of the factors that can put us at risk of hypertension which Dr Bennis informs us include:
- Family history of hypertension.
- Advancing age is associated with increased blood pressure.
- Obesity and weight gain are major risk factors for hypertension.
- Hypertension tends to be more common, more severe, occur earlier in life, and is associated with greater complications in Black people.
- Excess sodium intake increases the risk of hypertension.
- Excess alcohol intake is associated with the development of hypertension.
- Physical inactivity increases the risk of high blood pressure.
- About 6 out of 10 people who have diabetes have high blood pressure.
- Sleep apnoea increases the risk of high blood pressure.
“If you have any of these risk factors, especially in association with a family history, you should recognise that you could be at risk of developing high blood pressure,” says Dr Bennis.
“You can easily get your blood pressure checked intermittently at your local GP clinic or through a home blood pressure testing kit which we provide at webdoctor.ie, alternatively you can check with your pharmacist or nurse.”
Dr Bennis tells us that there are several proven, highly effective, and well-tolerated lifestyle and treatment strategies that can reduce our risk of hypertension and reduce blood pressure if it is high.
“Despite this,” she reiterates, “blood pressure control rates remain poor and high blood pressure often remains undetected. Consequently, hypertension remains a major preventable cause of cardiovascular disease globally and in Europe.
“Our risk for high blood pressure can increase when heredity risk is combined with an unhealthy lifestyle. So, if you have a family history of hypertension, start taking steps to lower your risk through a healthy lifestyle. Even if you don’t have a family history of high blood pressure, it is still important to be aware of other risk factors that you may have. It is important to remember that you can develop high blood pressure even if you don’t have a family history.”
To reduce our risk, we can look at managing our lifestyle and the choices we make.
- A healthy diet, low in saturated fat with a focus on whole grain products, vegetables, fruit, and fish.
- Maintaining a BMI between 18.5-25kg/m2 and waist circumference <94cm for men and <80cm for women.
- Managing good blood sugar control if diabetic. HBA1c <53mmol/ml.
- Lipids - Targets can be calculated by your GP so that you will know your lipid targets.
- 150 minutes of moderate activity per week (30 min 5 days a week) or 75 minutes a week of vigorous activity (15 min for 5 days) or a combination of both. However, any increase in physical activity level is beneficial even if you are not reaching these targets.
- No exposure to tobacco of any form.
- Maintain a moderate alcohol intake.
- Limit salt intake to 2-3 grams per day.
- Manage your stress.