High blood pressure, especially in early stages, doesn’t have any symptoms. It is only diagnosed incidentally, on routine health check up. The question then arises: Do we need to treat it?
We Indians hate taking medicines. Superstition, irrational fear due to illiteracy and the cost of daily tablets have ensured that Indians take medicines only when there is no alternative. Since high BP has no symptoms, more than 90% of those are undiagnosed, and 90% of those diagnosed are untreated. Even amongst those treated, 90% are improperly treated! (This incidentally is imaginatively named as “The Iceberg Phenomenon”: from the fact that 90% of the iceberg remains hidden submerged under water!
So, does this “untreated” or “undertreated” Hypertension extract a toll? Does uncontrolled high Blood Pressure have permanent, irreversible effects on the Cardiovascular System? If so, what are they, and how can they be prevented?
Consequences of uncontrolled high blood pressure
One of the main organs to suffer because of uncontrolled Blood Pressure is the heart. High blood pressure causes tears in the arteries of the heart. This can trigger a massive heart attack. This can be fatal unless immediately treated.
The high pressure against which the heart muscle has to pump causes the heart to fail, causing “heart failure”. This can cause fatigue, breathlessness and even death.
High Blood pressure can cause tears in Aorta, the largest blood vessel which carries blood to all the organs. This is called “Aortic Dissection” and is a very serious condition and has a high mortality rate despite best treatment.
Apart from this, high blood pressure can cause the heart to beat irregularly. This condition, called Atrial Fibrillation, can cause large clots to form in the heart. These can then travel to the brain, or other organs causing Stroke or serious damage to the body organs.
Another major organ bearing the brunt of high blood pressure is the brain. Stopping of blood supply to the brain: Called “Stroke” can occur due to Hypertension. Equally, bleeding in the brain, called “hemorrhage” can also occur due to uncontrolled Hypertension. Severe damage to the brain cells often lands a person in a coma or a vegetative state. Both these conditions can also cause death and needs to be treated expeditiously to minimise aforementioned damage.
High blood pressure over a long period can also cause memory loss, referred to as “Dementia”. Early control of blood pressure can stave off intellectual deterioration; however, dementia is irreversible when a critical mass of brain cells are injured by high blood pressure.
The third organ to be devastated by high blood pressure is the kidney. Kidney failure is one of the feared consequences of uncontrolled Blood Pressure. Once Renal Failure sets in, its progress is inexorable, and bi-weekly or tri-weekly dialysis is the only recourse.
Let me pepper this with a real-life anecdote. A young 27-year-old boy-let’s call him Raju for the purpose of this discussion-came to me with high blood pressure in early 2019. I treated him with two medicines, and in a couple of weeks, his pressure was under complete control. However, then came 2020, and along with it the Covid Lockdown. The guy went to his village, and upon the advice of his ill-informed friends, he gave up the medicines (I was not privy to their conversation, but usual suspects go like this:
“You are too young for daily medicines!”
“These medicines are habit forming.” “Discontinue them as soon as your pressure is controlled.”
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“Now you are in the village. The clean pollution free air and unadulterated food will cure you of Hypertension. You need not take those “harmful chemicals” any longer! “)
I don’t know which of these arguments were used, nor which was most persuasive for my patient, but long story short: he stopped all blood pressure medications during the entire duration of lockdown and then some more.
I saw Raju again in November 2020. This time, he came with breathlessness, loss of appetite and vomiting. His blood pressure was a staggering 210 mm Hg systolic. I feared the worst and sent the appropriate tests. My worst fears came true, and Raju was diagnosed with Kidney failure. Just imagine: Six months of uncontrolled Blood Pressure can irreparably damage the kidneys.
For the next few years, he suffered the agonies of bi-weekly dialysis. A Kidney Transplant was done on him subsequently, thanks to his sister who was a perfect match, but Raju is now on expensive immunosuppressive therapy and his life is far more restrained now than if he had just taken the blood pressure tablets as prescribed!!!
Eyes are our windows to the world. Retinal hemorrhages and damage may ensue due to uncontrolled high Blood Pressure. Vision loss is one of the most devastating effects of uncontrolled Blood Pressure on the eyes, and hence, they need to be treated by a retinal specialist at the earliest to minimise permanent blindness.
Especially when combined with smoking, high blood pressure induced atherosclerosis can often cause male sexual dysfunction. Inadequate erection, and inability to have penetrative sex are common consequences of long neglected high blood pressure. The effects of this are manifold: psychological (depression, lack of self-worth); social (marital discord), and medical. Several studies have correlated that men having erectile dysfunction have more severe blockages in heart arteries and are much more likely to suffer from heart attacks and sudden deaths than those men with robust sexual health and strong erections.
High blood pressure must be treated
As is abundantly clear from the above examples, blood pressure control is a must, even when it is asymptomatic. There is clear evidence to show that the incidence of all the aforementioned complications is directly related to high blood pressure, and the beneficials effects are often exponential, in that small reduction in BP causes a large reduction in the incidence of complications. Although early treatment of blood pressure is ideal, significant benefits can be derived even after the complications have occurred by controlling blood pressure.
So let us rise above our superstitions and illiteracy. High blood pressure must be treated, and treatment is generally life-long. But remember this: It is the only way to ensure that your life IS long!!!!
Lastly, I will leave you with this argument. A small blood pressure tablet, merely a couple of millimeters in diameter, has a capacity to forestall potentially lethal complications. Is it not worth it?
Truly: An ounce of prevention is worth a pound of cure.
The article is authored by Dr Kaushal Chhatrapati, MD DM, FACC FSCAI FESC, Interventional Cardiologist.
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