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Hypertension is one of the leading causes of a lot of diseases such as Cardiovascular Disease (CVD), renal disease and other complications. This essay will be critically discussing the symptoms and causes of hypertension. This will be followed by dietary modifications and the importance of aerobic exercises in management of the condition.
Every individual has a particular blood pressure (BP) determined by the blood flow through arteries necessary to supply oxygen and nutrients to different body tissues and organs (Nhs.uk, 2019). Hypertension is referred to as the condition when there is a persistently higher blood pressure than the normal range which is 120/80 mm-hg/dl. The Systolic blood pressure (SBP) higher than 120 mm-hg and Diastolic Blood Pressure (DBP) higher than 80 mm-hg for 100 ml is stated as hypertension (Who.int, 2021). However, there are different stages of this condition where SBP<129 and DBP<84 mmHg/dl is a pre-hypertensive conditions. BP>140/90 mm-hg/100 ml is a hypertensive condition (Heart.org, 2022).
Frequent headache, dizziness, lack of clarity in the vision, fatigue, pulmonary discomfort such as difficulty in breathing, nose bleeding is some of the major symptoms for patients having a blood pressure higher than 180/110 mm-hg/dl. The patients need proper medications, along with other interventions to reduce further complications associated with this condition. Other than that, there are mainly two types of hypertension, which are“Primary or Essentialhypertension” and “Secondary” hypertension. Primary hypertension is found in those who are not necessarily suffering from any other diseases. The reason can be genetic or prolonged consumption of food high in salt. Hence, the name is primary or essential and in medical terms, it is referred to as “Idiopathic” as well (Sandberg et al. 2015). Diabetes and obesity are some of the lifestyle disorders which further proceed to hypertension like conditions if not controlled properly. The probability of retinopathy, stroke, gangrenes, Coronary Heart Diseases (CHDs), and kidney diseases is significantly enhanced. Secondary hypertension is seen in people already having serious CVDs and renal diseases or any condition due to an imbalance of hormones (Charles et al. 2017). Therefore, this type of hypertension is present as an underlying symptom of these diseases and thus named secondary hypertension.
The World Health Organisation (WHO) takes note of all incidents related to hypertension and they call this condition the “Silent killer”. The main matter of concern is around half of the global population (46%) are unaware that they are suffering from this condition. Hence, these people do not get treatment and remain like this without even diagnosis. WHO estimated that 1.28 billion people aged between 30 to 79 years’ old who live in low to middle-income countries are suffering from hypertension and among this total, less than half (42%) receives treatments following diagnosis. It is one of the leading causes of deaths that are too premature worldwide (WHO, 2021). According to a case study, 28.5% of people of high-income countries are having this condition during the same time people became more aware of hypertension and opted for treatments to control the high BP (Mills et al. 2015). WHO has been taking several steps to control hypertension and effectively manage the increased burden on people’s lives.
The global epidemiology indicates that there is a significantly higher rate of hypertension in lower and middle-income groups than higher-income people and the reason is higher intake of sodium which is present in junk food, frequent consumption of alcohol, lower intakes of potassium, are causes of essential hypertension (Gupta-Malhotra et al. 2015).The incidence of hypertension is higher in those who are suffering from obesity due to the consumption of high-calorie food rich in saturated fat and trans fat (Aronow, 2017). Obesity is a leading cause of diabetes as it increases insulin resistance by inactivating insulin up taking receptors. Therefore, obesity indirectly causes diabetes as the body is unable to manage higher glucose levels due to its unutilised “Insulin” (Bhupathiraju and Hu, 2016). In the preliminary stage, the beta cells of the pancreas produce normal levels of insulin but as it does not get utilised the body slowly decreases or even stops producing this hormone and the latter makes a person completely dependent on external insulin to regulate the normal blood sugar. Therefore, as a part of further complications of obesity CHDs can come too.
Obesity along with diabetes make the condition even worse and enhances the probability of this condition as well. An unhealthy lifestyle is reflected in the dietary pattern of any person. Hence, eating junk food every day high in calories and unhealthy fat get stored every day in the body particularly in the adipose tissues. Excessive fat in favourable conditions slowly start to accumulate in the inner walls of blood vessels and steadily give rise to atherosclerosis. The diameter of vessels gets narrowed down and when the blood flows with a higher force it gives higher partial pressure that gets reflected when the BP of that person is measured. Therefore, obesity is one of the reasons for essential hypertension (Molica et al. 2015). Therefore, it can be certainly said that an unhealthy lifestyle along with no physical activities or exercise certainly causes positive energy balance in the body and which with time cause diabetes or sometimes directly hypertension. Moreover, as a consequence of uncontrolled diabetes hypertension or even in the worst conditions lead to CHDs. Dietary patterns are environmental factors responsible for hypertension. Other than that genetic predisposition can be one of the major causes of hypertension as well (Waken et al. 2017). Even if the person is normal weighed, there is a higher tendency he or she may develop hypertension later on in life and further develop CHDs or renal diseases in future. Therefore, the interaction between environmental factors and genetic factors causes hypertension among individuals.
Presence of CHDs or renal diseases can cause another type of hypertension named secondary hypertension among individuals. Chronic Renal Failure or CRF is a major cause of secondary hypertension (Vadakedath and Kandi, 2017). The kidneys are unable to regulate the normal BP in this condition because excess amounts of water and sodium are absorbed due to disturbances in the RAAS system (Renin-angiotensin-aldosterone system)(Yuan et al. 2015). Excess fluid accumulates in extracellular parts and gives rise to high BP. Disturbances in endocrine glands can cause excess secretion of aldosterone hormone that retains more sodium, potassium, and other ions in the blood along with water and cause high BP, a major cause of hypertension (Hall et al. 2015). It puts higher pressure on kidneys as well and leads to severe renal disorders.
In 2018, Public Health England had taken initiatives to prevent as well reduce the risk associated with high BP, detecting people suffering from this condition, its treatment to improve management. Moreover, the campaign was started because 1 in 4 adults have been suffering from this condition and it was the third biggest risk factor and it was estimated more than 1.5 billion people will be affected by 2025, worldwide (Service.gov.uk, 2018). There is no latest update available since the campaign was started. A guideline by NICE is available for hypertensive people for diagnosis and treatment of hypertension, annual measurement of BP for patients with T2DM, specialist investigation to understand the cause of hypertension along with selection of anti-hypertensive drugs (Nice.org.uk, 2019).
Along with medical treatments, dietary modifications along with regular exercise or some amount of physical activities are useful ways to control high BP in hypertensive patients. “Dietary Approach to Stop Hypertension” or DASH suggests a diet popularly known as the DASH diet can help to bring about a healthy reduction in blood pressure for people suffering from hypertension. Consumption of high amounts of fruits and vegetables, the inclusion of fish in a regular diet, the inclusion of low-fat milk, reduction of total fat intake, and reduction in sodium intake are the principles of this diet (Siervo et al. 2015). This helps any person suffering from hypertension to reduce a significant amount of weight and effectively manage the complications of hypertension. In order to maintain IBW or Ideal Body Weight, a reduction in total calorie consumption is very necessary.
[Refer to Appendix 2]
A reduction of at least 3500kcal/week or 500kcal daily can help a person to reduce a significant amount of weight. Total calorie consumption must not exceed 1600 kcal/day and for that incorporation of fruits and vegetables as a primary source of energy instead of fat is very necessary. Fruits are the richest sources of potassium that help to reduce the probability of other CHDs and stroke in patients and at the same time gives only a little amount of energy as well as fulfils a person (Wakerley et al. 2015).
Consumption of low-fat milk can help to reduce the total calorie content of the diet as well. Full fat milk is rich in saturated fats that can enhance the chances of CHDs over time and so, DASH suggests replacing whole milk with skim milk or double toned milk (Chiu et al. 2016). An important element of this diet is to incorporate fish the diet. Fish is one of the richest sources of MUFA or “Monounsaturated Fatty acids” and Omega-3 and Omega-6fatty acids, also known as PUFAs or “Polyunsaturated Fatty Acids”. Fish oil, salmon, mackerel, herring etc. are rich in “Palmitoleic acid” and DHA (Docosahexaenoic acid) and EPA (Eicosapentaenoic acid) which are the examples of MUFA and Omega-3 fatty acids respectively (Lee et al. 2019). Other than fish, walnuts, peanuts, sunflower oil, olive oil, canola oil, flax seeds, chia seeds, soybean oil, sesame oil, etc. are some of the richest sources of all these essential fatty acids. They are essential fatty acids because they help in the reduction of LDL (Low-Density Lipoprotein), VLDL (Very Low-Density Lipoprotein), triglycerides and cholesterol from blood and other organs and directly help in prevention of atherosclerosis like conditions (Molinar-Toribio et al. 2015). These help to prevent further complications and strokes as well in hypertensive patients. Therefore, it is recommended to incorporate all these foods in the diet to reduce at least 2-5 mm-hg/dl SBP. Other than reduction of LDL, VLDL, it is very important to maintain 40-45 mg HDL (High-Density Lipoprotein) that helps in fat transportation from other parts of the body to the liver. MUFA and omega-3 rich food significantly help to raise this good cholesterol and thus must be incorporated into diet. However, due to socio-economic discrepancy, and cultural norms people do not eat fish or lean meat and it becomes difficult for them to manage hypertension. Moreover, unhealthy lifestyles like drinking and smoking habits among young boys and girls worsens the condition (Long et al. 2017).
DASH suggests reducing the intake of saturated fat and thus consumption of red meat such as beef, pork, egg yolk, chicken, and turkey with skin on to reduce the chances of CHDs. Saturated fats are not essential fatty acids and thus only add extra calories which are not desirable for those who want to achieve their IBWs. Hence, consumption of saturated fat must be limited and as a substitute, lean meat like skinless chicken, duck, etc. can be incorporated into the diet. Fish, lean meat, egg whites, legumes, nuts are high in protein as well which help to fulfil the daily protein requirements for hypertensive patients without adding many calories. The total protein intake must be 1g/kg IBW and the sources should be carefully chosen. Fish, lean meat, egg white, and other leguminous food are rich in protein and low in saturated fat and at the same time high in essential fatty acids necessary for hypertensive patients (Kharazmi-Khorassani et al. 2021). Pickles, sauces, cheese, salted butter, chips, and some snacks are high in sodium and add extra calories as well to the diet. Therefore, they must be eliminated from the diet. Walter Kempner suggested a diet that is low in sodium, high in potassium, moderate in calories specifically prepared for patients suffering from hypertension (Lee et al. 2018). This “Kempner’s diet” provides 2000 kcal energy, 20g protein, 150 mg sodium as well fulfils the daily requirement of vitamins and so, it is suggested for hypertensive patients as well (Alexander et al. 2018). However, some people find it monotonous and choose a DASH diet instead to reduce weight and reduce high pressure at the same time. Moreover, several studies have indicated Black Hispanic people are more prone to develop hypertension, CHD like diseases and one of the major reason is lack of awareness (Rashid et al. 2017)
The role of aerobic exercise is very crucial in the management of high BP. Brisk walking is a well-known aerobic exercise that is suggested to hypertensive patients for at least 30 minutes on alternative days to reduce 5-9 mm-hg SBP. Exercise and physical activities help to improve the heart rate and also improve blood volume. It helps to improve the endothelial functions and enhance the flexibility of blood vessels that prevents the accumulation of fat inside them (Ghadieh and Saab, 2015). Hence, it prevents hypertension and other CVDs and thus aerobic exercise must be incorporated as a part of daily routine along with medicines and a modified diet. Studies say it helps in the release of melatonin hormone that has many benefits against CVDs and control of hypertension. A significant vasorelaxation was seen in mesenteric arteries with the exercise-induced acetylcholine synthesis. Melatonin plays a crucial role following attachment with melatonin receptors (MT2) and a significant reduction in high pressure (Qiu et al. 2018). Other than that, aerobic exercise reduces oxidative stress and helps in improving endothelial dysfunctions and improves SBP and DBP in hypertensive patients. Apart from controlling high BP, exercise and physical activities lower blood glucose levels improve left ventricular diastolic functions and reduce total fat and abdominal fat as well (Larsen and Matchkov, 2016).Therefore, despite of ethnicity, socio-economic class, and cultural beliefs people suffering from hypertension needs to modify their lifestyle and practice regular physical activities to manage high BP.
The essay has incorporated an overview of hypertension, along with its prevalence and physiological and biochemical mechanisms for the development of hypertension. Other than that, the roles of dietary modifications and exercise have been mentioned too.
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