The overall prevalence of hypertension (high blood pressure) in South Africa is 29%. However, the incidence rises dramatically from only 7,5% in adults under 39 years of age, to more than 60% in the 60+ age groups. South Africa has the highest prevalence of any Sub-Saharan country and it is rising rapidly, according to an article published this year by Sharma et al, in the International Journal of Environmental Research and Public Health.
Hypertension is the leading cause of cardiovascular-related deaths worldwide. If unmanaged it can cause stroke, dementia, kidney failure, blindness and fatal heart attack. Factors that are associated with the rising incidence are obesity, eating a westernised diet with high intake of salt and refined carbohydrates, low intake of fruit and vegetables, physical inactivity, smoking and excess alcohol.
According to the guidelines produced by the South African Hypertension Society, the “cornerstone of management” is lifestyle counselling.
The interventions recommended are: weight reduction; the DASH diet (which is a plant-rich diet, low in saturated and total fat); reduction of salt intake (mostly obtained from junk and fast foods); physical activity as in brisk walking up to 30 minutes per day; moderation [or avoidance] of alcohol intake and cessation of smoking.
Combined, all of these interventions without any medications may well bring your blood pressure down to normal – classified as less than 139/89 in the South African context.
Why would you want to bother with lifestyle interventions when it is so easy to pop a few pills every day? It certainly takes a lot less time and effort by your doctor to adjust your medications than it does to sit down and coach you on your diet and smoking cessation, or discuss the challenges of increasing your physical activity? There are many reasons why lifestyle interventions are foundational to managing hypertension:
* All medications have side effects, which can include chronic cough, diarrhoea or constipation, dizziness with risk of falls, erectile problems in men, anxiety, feeling tired or weak, headaches, nausea and vomiting.
* Medications cost a lot of money.
* Hypertension is often associated with diabetes and high cholesterol, and patients end up with a whole bunch of tablets every day.
* Implementing lifestyle interventions can not only correct hypertension, but may well correct obesity, diabetes, high cholesterol, arthritis, constipation, brain fog, auto-immune disease, sexual dysfunction, depression – and reduce the risk of cancer. Now that sounds like a jackpot!
Medications can be lifesaving in severe hypertension, and you need careful supervision and regular monitoring, but you can insist that your doctor discuss lifestyle interventions – or refer you to someone who can help you.
Dr Dave Glass, MBChB, FCOG(SA), DipIBLM
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