17 May: World Hypertension Day Interview with Professor René Baragou, Head of Cardiology at the CHU Sylvanus Olympio

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Extract from the article: Maladie chronique, l’hypertension artérielle est une hyperpression du sang sur la paroi des artères. On compte ainsi 1.28 milliard de personnes atteintes d’hypertension artérielle dans le monde, dont 700 millions qui ne sont pas traitées. Elle touche

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« To prevent arterial hypertension, lifestyle modification is not only the first step before initiating curative therapy, it is also the most important preventive measure »

Hypertension is a chronic disease in which the blood pressure on the artery walls is too high. Worldwide, 1.28 billion people suffer from hypertension, 700 million of whom are untreated. According to the WHO, it affects more than one adult in three. How can hypertension be prevented? What treatments are available for this cardiovascular condition? How do you monitor your blood pressure? Professor René Baragou, Head of Cardiology at the CHU Sylvanus Olympio in Lomé and President of the Togolese Cardiology Society (SOCRT), explains in this interview.

Health-Education: What is hypertension?

Professor Réné Baragou: Hypertension, also known as arterial hypertension, refers to a chronic increase in blood pressure. It begins with systolic values of 140 mmHg or more, and diastolic values of 90 mmHg or more.Optimal blood pressure is considered to be below 120/80 mmHg.More than a billion people worldwide are affected by high blood pressure.Hypertension causes millions of deaths every year. 

When should you start actively looking after your high blood pressure?

In principle, people with optimal blood pressure (120/80 mmHg) should have their blood pressure measured at least every 5 years, as part of routine diagnostics.People with normal but high blood pressure (130/80 mmHg and above) should have their blood pressure checked every year. In the meantime, we know just how important an individual home measurement is. Ideally, this should be done on the upper arm.

Which people are particularly at risk?

Hypertension is a substantial risk factor for cardiovascular disease.Risk calculators can help assess these risks over a 10-year period.Additional risks include smoking, disturbances in lipid metabolism, increased fasting blood sugar levels, age and family predisposition.People who already have diseases of the coronary circulatory system should pay particular attention to their blood pressure values.

How can I spot high blood pressure?

Are there any warning signs?Routine measurement of blood pressure is particularly important, because a long period without symptoms, which is frequently observed, can delay the initial diagnosis, often by several years.In all cases, headaches (especially at the back of the head), sleep disturbances, dizziness, blurred vision, ringing in the ears, nervousness, tachycardia or nosebleeds are common.If you feel a tightness in the chest or shortness of breath, you should contact the emergency services or an ambulance immediately.

What are the unavoidable risk factors?

There's the family history: if your parents or grandparents are hypertensive, the risk is increased for you and your children.Age: systolic (upper) blood pressure tends to increase with age (the risk generally increases from the age of 55; in men, it is from the age of 45 and in women, from the age of 55).Certain diseases: kidney disease, diabetes, sleep apnoea, etc. Apart from these non-modifiable factors, behaviours that put people at risk of hypertension can be corrected.Certain dietary hygiene measures can prevent the risks.

Does heredity play a role in high blood pressure?

Yes, we are talking about familial hypertension, which is currently well defined. It is not uncommon to find several hypertensives in the same family.But discovering the genes responsible for hypertension remains difficult.Nonetheless, having parents with high blood pressure is a good reason to have your blood pressure checked even more regularly, at least once a year after the age of 30, and to encourage your children to adopt healthy eating habits, avoiding excess salt and being overweight.

What are the consequences of high blood pressure? What makes it so dangerous?

Hypertension is often only recognised by the damage it causes.These include strokes, heart attacks, heart failure, or "big heart", kidney failure that can lead to dialysis.Acute attacks of blood pressure (>180/120 mmHg) can lead to brain bleeds, heart attacks and damage to the aorta, all potentially fatal.

What can I do to lower my blood pressure?

The key word is lifestyle change, but this has a formidable internal enemy: our own evil demons!It is recommended to reduce the salt content of food, to drink alcohol only in moderate quantities, to reduce body mass and to adopt a Mediterranean-style diet (vegetables, fruit, fish, nuts, olive oil).It is also important to exercise regularly (at least 3 or 4 times a week for 30 to 45 minutes).We also recommend relaxation methods such as stretching to reduce stress. As far as possible, you should avoid taking medicines that increase blood pressure.

When should I turn to medication?

The need for medication depends on individual risk levels, the damage already sustained by the various organs and, not least, the success of blood pressure control measures based on lifestyle changes. Depending on the stage of the condition, therapy is nowadays started with a combination of two different types of pressure-reducing medication.

Do pressure-reducing drugs have to be taken for life?

In the vast majority of cases, the answer is yes. The most important aim is to achieve continuous, long-term regulation of blood pressure, so as to prevent organ damage. This requires the patient to take medication for a long time, or even for the rest of his or her life.Sudden discontinuation of the medication, at the patient's own discretion, can also lead to a rise in blood pressure, which can be dangerous or even fatal.

What are the most important preventive measures?

When it comes to preventing high blood pressure, lifestyle modification is not only the first step before starting curative therapy, it is also the most important preventive measure.What's more, it is also beneficial in preventing other diseases and conditions such as heart attacks, strokes and other potentially dangerous conditions. Avoid: smoking, a sedentary lifestyle, excess weight and obesity. Eat salt and alcohol in moderation. Eat 5 fruit and vegetables and 3 low-fat dairy products every day.Adopt a physical activity that allows you to talk during exercise.Take self-measurement readings in a calm environment in the days leading up to a medical appointment.

Take care of your blood pressure: after a few years, untreated hypertension can lead to serious illness. Take your blood pressure regularly every year from the age of 40. So if you change your lifestyle, you kill several birds with one stone.

Once blood pressure has returned to normal, is treatment still necessary?

As with most chronic diseases, treatment will be instituted for life, except in a few specific cases (renal origin, damage to the adrenal glands or even over-consumption of liquorice, etc.).In over 90% of patients, stopping treatment is synonymous with a return to hypertension.This is because, although these products bring blood pressure back to normal, they do not act directly on the causes: hypertension cannot be cured.

Do treatments for hypertension have side effects?

Yes, some patients report side-effects that they find annoying or very annoying (tiredness, cold hands and feet, heavy and swollen legs, insomnia, nightmares, dry mouth, dizziness, digestive problems, sexual problems, etc.).But the mistake is to stop or change your treatment yourself. If you experience any troubles, talk to your doctor.Prescriptions need to be adapted before the right solution can be found.

Interview by Abel OZIH