One of my patients, Elsie, is 85 years old, overweight, diabetic, and has had hypertension for 44 years. She has oedema, or swelling, with fluid retention in her body and she gets breathless walking down the corridor.
Among her other symptoms, the pressure of blood within her veins is elevated. Her heart echo shows ’normal LV function,’ meaning that the left ventricle (the heart chamber that pumps blood around the body) is functioning OK, but the left atrium – one of the four chambers of the heart is very dilated and filling pressures are elevated. Essentially, she has heart failure, the type in which the heart has difficulty filling with blood.
Elsie takes ‘water pills’, which work by reducing the amount of fluid in her body, they promote the
loss of salt and water from the kidneys and therefore healthy blood pressure. Her blood pressure control may have been very good over the years she has had her condition, or it could also have been badly controlled.
Every week I see patients like Elsie come to the clinic with signs and symptoms of possible heart failure and raised B-type naturetic peptide (BNP), which is a possible indicator of heart failure. I send them for a heart echo test which uses ultrasound waves to look at the structures and functioning of the heart.
Having seen the impact it has on patients like Elsie, I’ve become more aggressive in tackling hypertension earlier. I try to help my patients maintain a healthy blood pressure by advising on simple interventions including regular exercise, eating less salt and reducing their alcohol intake.
It’s really important that we prevent and diagnose hypertension as early as possible, because decades later it’s much more difficult to pick up the pieces.
Dr Nigel Rowell, GP, Endeavour Practice and GPSI in Heart Function, James Cook University Hospital, Middlesbrough.