HIGH BLOOD PRESSURE: SERIES I
About High blood pressure
Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure. When your heart is at rest, between beats, your blood pressure falls. This is called diastolic pressure. Your blood pressure reading uses these two numbers. Usually the systolic number comes before or above the diastolic number. A reading of119/79 or lower is normal blood pressure140/90 or higher is high blood pressure Between 120 and 139 for the top number, or between 80 and 89 for the bottom number is called prehypertension.
Prehypertension means you may end up with high blood pressure, unless you take steps to prevent it.High blood pressure usually has no symptoms, but it can cause serious problems such as stroke, heart failure, heart attack and kidney failure.You can control high blood pressure through healthy lifestyle habits and taking medicines, if needed. NIH: National Heart, Lung, and Blood Institute
Are there other issues with high blood pressure medication?
It can be hard to predict which drugs will work for you, but we know some are less effective in older people or those of African Caribbean background. Most people will need more than one drug to control their blood pressure.
It is estimated that more than half of patients do not take their medications as prescribed. This contributes to poor blood pressure control and increased risk of stroke and heart attack.
Part of the problem is that with hypertension, the condition itself usually does not cause symptoms that remind you to take medications. Asking your doctor for once-a-day tablets and building it into your daily routine can help. A dosette box (pill box with compartments for each day, and times of the day if necessary) may help. You can get them at most pharmacies
African Caribbean background and High Blood Pressure: [SABRE study ]
How African Caribbean background can affect your ❤️ heart and circulatory health
If you’re of African Caribbean heritage, you may have a higher risk of some heart and circulatory diseases.
Explanations for this are unclear. A strong contender is that African Caribbean communities ( UK/USA/Canada etc.) tend to be in more deprived areas and deprivation can make it harder for a person to have a healthy lifestyle. Genetic differences may also be having an effect, and evidence for this is still being researched.
It’s never too early or too late to make lifestyle changes, such as losing weight and being more physically active.
Even changes made in older age can reduce your risk.
How is your heart health risk different if you have an African Caribbean background?
African Caribbean people have a much higher risk of high blood pressure, type 2 diabetes, and stroke, but a lower risk of coronary heart disease (CHD). This is very unusual – normally, high blood pressure and diabetes increase your risk of CHD. This disassociation isn’t yet understood, but we know that on average, cholesterol levels are much better for those of African Caribbean heritage than they are for white Europeans, and this seems to offer some protection against CHD.
If we can understand this mechanism, we could then apply it to other populations. There is evidence that African Caribbean children have some insulin resistance (an early diabetes warning sign) and healthier cholesterol levels, but no difference in blood pressure from the white European population. Higher blood pressure tends to emerge in their teenage years.
There are gender differences, too. African Caribbean men have about a 50 per cent lower risk of CHD than white European men, but for women, the risk is only about 25 per cent lower. This is partly because obesity rates are higher in African Caribbean women than men.
Do some medications affect African Caribbean people differently?
There’s strong evidence that African Caribbean people respond differently to blood pressure medications. Usually, one of the first drugs considered for high blood pressure would be an ACE inhibitor, but African Caribbean people have been shown to respond less well to this. Health providers suggests calcium channel blockers, as these have been shown to be more effective in lowering blood pressure in those of African Caribbean heritage.
Early data from the SABRE study [see box below] suggests that blood pressure control is worse in ethnic minorities, but it’s not clear why that is. It may be that the right medication, or a sufficient dose, isn’t being prescribed, or that medications are not always taken, but we need more research to find this out. When someone doesn’t have symptoms and doesn’t feel unwell, it is difficult for them to accept that they have to take medications, possibly for the rest of their life. It’s a very hard message to get across, especially when medications can cause side effects.
Much of what we know about ethnic origin and disease risk comes from the Southall and Brent Revisited (SABRE) study. This covered white European, South Asian and African-Caribbean people aged 40–69 in 1988–91. They’ve been followed for 25 years, funded by the BHF, Wellcome Trust, Medical Research Council and Diabetes UK. The focus of investigation, led by Professor Nishi Chaturvedi, is now health in older age.
What about attitudes to body shape and exercise?
In African Caribbean communities larger female body shapes are more likely to be seen as something to aspire to. There is therefore less pressure for women to lose weight. Statistics also suggest that women and older people are less likely to exercise. Due to a large number of people in African Caribbean communities being overweight, the issue is normalised.
This is also the case with type 2 diabetes. Because many people are living with the condition and seem fine, it’s seen as inevitable and not taken seriously.
Access to physical activity options is also an issue for those living in deprived areas, where there may be few facilities to exercise safely in a comfortable environment.
Are there other differences in lifestyle risk factors?
There is evidence to suggest African Caribbean people may be more sensitive to the effects of salt on blood pressure. The biology of high blood pressure appears to be different; it’s not that African Caribbean people consume more salt – we all eat too much. On the positive side, people of African Caribbean origin tend to smoke less than the overall population and drink less alcohol.