Figures Reveal High Blood Pressure Risk Among Young People

Gerry Gajadharsingh writes:

“Blood pressure is a measurement, which tells us about various systems in the body, including arterial resistance, the heart, the kidneys and metabolism to name a few. There are two readings, one is the systolic blood pressure which is the pressure in the arteries when the heart is contracting and the diastolic blood pressure, the pressure in the arteries when the heart is relaxed. Standard or normal blood pressure tends to be 120/80 mmHg. NICE defines hypertension as greater than or equal to 140/90 mmHg.

Hypertension or high blood pressure is something people in the middle and later stages of life are aware of. Many people with hypertension are categorised as having “essential (or primary)” hypertension which means there doesn’t appear to be an obvious medical reason why their blood pressure is high. Many patients do not experience symptoms of hypertension, although headache can be one of them when blood pressure is quite high. However, hypertension is a known risk factor for other cardiovascular and kidney related problems. There are numerous medications used to control blood pressure and they will have different actions and therefore work in different ways, and sometimes patients are given more than one drug to control their hypertension. There appear to be 4.2 million people in the UK with undiagnosed hypertension.

The latest statistics revealed that prevalence increased with age for both sexes, with 7% of males and 4% of females aged 16-24 years having hypertension, rising to 66% of males and 71% of females among those aged 75 years and older. However, the latest figures showed that 66% of males and 26% of females with hypertension who were aged 16-24 years were likely to be undiagnosed.

Obesity, caffeine, nicotine and excess salt intake, tends to increase blood pressure as do several over-the-counter medications, such as non-steroidal anti-inflammatories (NSAID’s).

One mechanism that is rarely talked about, is the effect of the autonomic nervous system in controlling blood pressure, and as regular readers of my blog will know, I am extremely passionate about this subject. Measuring heart rate variability (HRV) in particular respiratory sinus arrhythmia (RSA) or breathing heart wave (BHW), which is the heart rate variability in relation to our breathing pattern, that’s a good indication of autonomic nervous system balance. Many patients tend to be in sympathetic up regulation, which switches on the stress (sympathetic) part of the autonomic nervous system, targeting heart, lungs, muscles, and liver. Focusing on functional factors, such as slowing your breathing rate down and extending the phase of exhalation, will have a positive effect at down regulating the sympathetic or stress part of your nervous system and up regulating the parasympathetic and relaxation part of your nervous system, by decreasing arterial tone and help reduce blood pressure.

Below is an explanation of how some of this works (apologies for the medical jargon and terminology):

 Normally when blood pressure is elevated, carotid sinus baroreceptors are activated to send signals to the brain stem nuclei in which inhibitory signals are delivered to attenuate the sympathetic tone and subsequently the blood pressure after a complex signal reception and conversion process.  The carotid sinus is a neurovascular structure (in the neck) which presents as a dilation at the bifurcation of the common carotid artery and proximal aspect of the internal carotid artery. It contains numerous stretch receptors, also known as baroreceptors which are sensitive to changes in arterial blood pressure. Therefore, the carotid sinus plays a direct role in the control of blood pressure and heart rate. 

On detecting changes in blood pressure, afferent signals are transported from the carotid sinus to the cardiovascular control centre in the midbrain by the carotid sinus nerve and subsequent CN1X nerve. In response, efferent signals are emitted via parasympathetic and sympathetic nerves to the heart and blood vessels resulting in decreased cardiac output. This cardiovascular change stimulated in response to the baroreceptors of the carotid sinus is known as carotid sinus baroreflex. 

Sometimes this complex reaction doesn’t work properly. Osteopathic Manual Treatment (OMT) and breathing education can be useful interventions to help restore this complex mechanism to better balance, as well as other appropriate lifestyle interventions, such as dietary and certain exercise strategies, which help support the parasympathetic or relaxation, part of the autonomic nervous system.”

Medscape

Peter Russell

Around 4.2 million adults in England have undiagnosed hypertension, with younger people and those in otherwise good health among those most likely to be unaware they have the condition, figures showed.

Professor Bryan Williams, president of the International Society of Hypertension, described the figures as “shocking but alas, not surprising”. Prof Williams, who is a hypertension specialist at University College London Hospitals NHS Foundation Trust, said: “They highlight an ongoing challenge we face in that many people do not get their blood pressure checked and are not aware they have hypertension.”

The Office for National Statistics (ONS) estimated that 32% of adults living in private households had hypertension and that among those, 29% were undiagnosed.

The latest statistics revealed that prevalence increased with age for both sexes, with 7% of males and 4% of females aged 16-24 years having hypertension, rising to 66% of males and 71% of females among those aged 75 years and older.

Undiagnosed Younger Adults

However, the latest figures showed that 66% of males and 26% of females with hypertension who were aged 16-24 years were likely to be undiagnosed. Among those aged 25-34 years, the proportion was 55% of males and 44% of females, the ONS reported.

“Our analysis found that while the prevalence of hypertension increased with age and other known risk factors such as high BMI and poor general health, there are considerable numbers of younger, healthier people who are undiagnosed,” commented Chris Shrine from the ONS’s analytical hub.

Commenting on Twitter , Dr Pauline Swift from the charity Blood Pressure UK said: “In recent years we have seen an increase in younger patients with high blood pressure, often as a result of poor diet, consuming too much salt and lack of exercise leading to weight gain.”

When applied across private households, the ONS estimated that 140,000 males and 30,000 females aged 16-24 years had undiagnosed hypertension, compared with 220,000 males and 380,000 females aged 75 years and over.

The ONS analysis estimated that men aged 55-64 years had the highest proportion of undiagnosed cases of hypertension, with around half-a-million cases, followed by women between the ages of 65-74, with around 460,000 cases going undiagnosed.

Risk Factors

Prevalence of hypertension for men was highest in the North West of England and lowest in the South East and East of England whilst for women, prevalence was highest in the East Midlands and lowest in the South East.

Adults with hypertension were more likely to be undiagnosed if their self-reported general health was ‘very good or good’ (males 41%, females 28%) compared with ‘fair’ (males 21%, females 14%) or ‘bad or very bad’ (males 18%, females 14%).

Adults from a Black ethnic background, who had no educational qualifications, worked in semi-routine occupations, and were single were at particularly high risk of having hypertension. Other groups most likely to be undiagnosed included males living in rural areas, living in regions other than London, or who had never regularly smoked, and females who were married or in a civil partnership, had degree-level or equivalent qualifications, or who worked for small employers or were self-employed.

The estimate that 32% of the adult population living in private households had hypertension was higher than the 28% figure for 2019, but statisticians said there were differences in the way the condition was defined between the two years. Research published in January this year in the journal Nature Medicine found a decline in the number of antihypertensive medications dispensed during the COVID-19 pandemic between March 2020 and July 2021 in England, Scotland, and Wales, with 491,306 fewer individuals starting treatment than expected.

The ONS analysis, which was based on results from the Health Survey for England, was intended to inform health services, and “may also raise awareness among the general population, leading to more timely diagnoses in the future”, said Mr Shine.

Commenting on the statistical analysis, Professor Bryan Williams, president of the International Society of Hypertension, tweeted : “If I have a simple message, it is: get your blood pressure checked and don’t ignore it if it is high.”