Living under pressure: Hidden hypertension risk in your daily life

Hypertension is predominantly a disease of the elderly and does not usually present any noticeable signs or symptoms, apart from high blood pressure.

Whether treated or untreated, hypertension tends to worsen with age. Medical professionals emphasise that multiple examinations are essential to identify the condition. Over the years, hypertension can lead to target organ damage. Structural, functional and pathological changes, such as left ventricular enlargement, congestive heart failure, nephrosclerosis or arteriosclerosis may occur.

Whenever target organ damage is present, the therapeutic goal becomes not only to reduce blood pressure, but also to prevent or reverse such damage.

“The therapeutic goals for the treatment of hypertension are to reverse or prevent any target organ damage to the heart, kidneys and vascular system, and to reduce blood pressure while causing minimal side effects. It is also vital to address other treatable cardiovascular risk factors, such as smoking, obesity, lipid abnormalities and lack of physical activity,” says Dr Joseph Aluoch, a cardiologist and chest specialist at The Nairobi Hospital.

It has long been known that physical or mental stress can trigger cardiovascular episodes, such as stroke or heart attack. “The danger of physical stress is obvious, since it overloads the system,” explains Dr Aluoch, who is also a medical consultant and chairman of the HIV Clinicians Society of Kenya.

He adds that the emotional stress of the modern world, such as work deadlines, traffic jams, arguments with superiors, economic worries, depression, overthinking and excessive anxiety, can lead to recurrent high blood pressure, the precursor to hypertension, which is a primary factor in heart disease.

One of the most revealing studies of stress-induced hypertension monitored air traffic controllers. The three-year study of 16 air traffic controllers, and similar research involving prisoners who slept in group cells rather than single cells, identified what experts and scientists describe as “sustained vigilance under threatening conditions”.

In the study, investigators also identified low socio-economic status as another precursor of high blood pressure. Dr Aluoch notes that poorer individuals are more susceptible to high blood pressure and hypertensive heart disease. The connection between poverty and hypertension helps explain why impoverished Africans face an almost 70 per cent greater risk of developing the condition.

Dr Aluoch says the living conditions of many poor people, especially in Kenya, are to blame for the rising cases of hypertension. Reducing stress is strongly advisable, as it is one of the most pervasive risk factors in circulatory diseases and often prevents people from changing harmful habits such as smoking and alcohol consumption.

Dr Susan Aete, a nutrition and diet consultant, advises that everyone, young or old, should exercise at least twice a week, as it is one of the most effective ways to relieve stress and tension. “Every medical condition requires the right diet and regular exercise,” she notes.

She explains that exercise lowers stress hormones, reduces heart rate and blood pressure, controls body weight and improves the body’s ability to dissolve blood clots.

“Exercise is beneficial only when done extensively, using large muscle groups for at least 30 minutes with enough effort to induce sweating, and repeated regularly,” she adds.

“For people with hypertension, however, it is not enough to lose weight, stop smoking, cut salt, exercise or relax—treatment is also essential. These patients require active medical treatment, including antihypertensive drugs,” says Dr Peter Meredith of the Gardiner Institute, Glasgow.

He warns that some drugs can cause side effects such as weakness, drowsiness, digestive upsets, lethargy, sexual problems and sudden drops in blood pressure leading to fainting. The choice of drug, he notes, depends on the degree of hypertension and the patient’s tolerance.

According to Dr Aluoch, doctors should start with a low dose, increase it gradually if ineffective, and move to a second-line drug if necessary. Once control is achieved, treatment is usually lifelong. Patients should check their blood pressure regularly—ideally three to four times every six months—and follow medical advice faithfully.

Experts note that some older drugs have been discontinued due to poor efficacy, but newer, first-class medications are now available. These modern drugs effectively regulate blood pressure, reduce mortality, control chronic heart failure and prevent type 2 diabetes. Some are metabolically neutral and also help reverse target organ damage.

“Good drug tolerance improves compliance and outcomes by reducing cardiac hypertrophy, improving renal function and protecting blood vessels,” says Dr Meredith.

Treatment for hypertension in Kenya costs between Sh3,000 and Sh15,000 per month, including doctors’ visits and laboratory tests. Dr Aluoch cites a 2025 Kenya Medical Association (KMA) study, which found the mean annual direct cost to a hypertensive patient to be about Sh40,000 (approximately US$310).

“There is no single latest drug for hypertension. Treatment depends on different classes of medication. The newest approach is Fixed-Dose Combination pills, which combine two or three drugs to improve adherence,” says Dr Aluoch.

On diet, Dr Aete advises patients to eat vegetables, fruits, whole grains, low-fat dairy, fish, poultry, beans, nuts and seeds, and to avoid fatty meats, full-fat dairy, sugary drinks, sweets and excess salt.