Worldwide, high blood pressure (hypertension) is estimated to contribute to around 17 million deaths annually (about 12.8% of all deaths), according to the World Health Organization (WHO). It also reported that in 2008 there were around 1 billion people in the world with uncontrolled hypertension. According to figures released by the Centers for Disease Control, 33.5% of US adults over the age of 20 have measured high blood pressure and/or are taking antihypertensive medication.

Most people with high blood pressure do not experience any symptoms and this is why hypertension is known as a silent killer. It is a significant risk factor in the development of various chronic health problems which, in turn, result in reduced productivity, high medical insurance usage, and personal health care costs, as well as loss of productive work life years due to disability and death. Hypertension itself, and the risks associated with this condition, can be prevented or managed by lifestyle changes, screening and early diagnosis, and treatment where necessary. This is where employee wellness programs can make a substantial contribution.

What is hypertension?

Blood pressure is measured in millimeters of mercury (mmHG) and it represents the pressure exerted against the walls of the arteries as the heart pumps blood throughout the body. It is expressed in two values, namely:

• Systolic blood pressure (SP), which is the pressure in the arteries when the heart is contracting
• Diastolic blood pressure (DP), which is the remaining pressure when the heart is at rest

Average normal adult blood pressure is defined as a SP of 120 mmHg and a DP of 80 mmHG. Hypertension is diagnosed when the SP is at or above 140mmHG and/or the DP is at or above 90 mmHg. A person whose blood pressure measures between the normal and hypertensive ranges is regarded as pre-hypertensive, in which case lifestyle changes are recommended to reduce the readings.

A person’s blood pressure can increase due to immediate stress factors. One such stressor is having to report for a medical examination, sometimes called white coat hypertension. Because of this, the diagnosis of hypertension is usually confirmed only after two or more measurements, often at different times. The person being screened may also be asked to lie down and relax for a few minutes after an initial measurement and then a second measurement is taken.

The body controls blood pressure through the nervous system and a variety of chemical reactions using different pathways, including heart rate, widening of narrowing of blood vessels and water regulation by the kidneys.

The exact cause of hypertension is not always clear and in those cases it is referred to as essential hypertension. In some people it is a symptom of a particular illness affecting the body’s ability to control blood pressure (such as kidney disease).

The persistent stress of modern living, of which most is job related, is believed to be a significant contributor to the worldwide hypertension epidemic. Any stress triggers the primitive fight or flight reaction, which primes the body to react to a threatening situation, whether it requires the heightened physical preparation or not. This reaction causes an increased heart rate and narrowing of the arteries, leading to an increase in blood pressure. Repeated elevation of blood pressure due to stress eventually leads to hypertension. Lifestyle factors such as an unhealthy diet, sedentary behavior, and obesity, excessive use of alcohol, and lack of physical activity are also associated with the increase in hypertension in the modern world.

Most people with elevated blood pressure do not experience any symptoms at all. However, especially in cases of severe hypertension, sufferers could experience headaches, shortness of breath, palpitations, dizziness, and nose bleeds.

What are the risks of hypertension?

Hypertension puts continuous strain on the heart and blood vessels, which eventually leads to other health problems. Most significant are the increased risk of having a stroke or developing heart disease, including ischemic heart disease (heart attack) and heart failure.

“Hypertension is responsible for at least 45% of deaths due to heart disease, and 51% of deaths due to stroke,” according to a WHO report.

Over time, hypertension also damages smaller blood vessels because of the continuous heightened pressure. This can cause reduced kidney function, dementia, reduced vision, and poor circulation in the lower limbs.

The costs associated with the complications of hypertension for individuals, employers, and society are increased health care and health insurance costs, higher rates of absenteeism and needs for job accommodations, as well as reduced productive work-life years due to either death or permanent disability.

In safety sensitive jobs, severe hypertension is also a safety concern because of the possibility of minor or major cerebrovascular incidents (strokes) causing sudden blackouts. Most countries have regulatory guidelines related to drivers of heavy vehicles and heavy equipment who are diagnosed with hypertension. Other jobs where severe or uncontrolled hypertension could result in injury to the employee or co-workers, include machine operators and those working with dangerous chemicals.

Prevention and management of hypertension

Hypertension can be prevented to a large extent through the healthy lifestyle choices such as a healthy balanced diet, weight reduction if overweight, avoiding excessive use of alcohol and smoking, exercise and stress management. Early detection and treatment of hypertension through regular screening can contribute significantly to managing the condition and reducing the risk of heart disease, stroke, and other complications. Where hypertension is left untreated the condition tends to progress over time.

Everyone should have their blood pressure checked at least once a year and take steps to reduce it if the reading is elevated. The first steps recommended by physicians in managing hypertension are often to make lifestyle changes (although medication is sometimes needed). This will often be enough regain a normal blood pressure in pre-hypertensive situations and for those with mild hypertension.

Where the SP is 160 mm HG or higher and/or the DP 90 mm Hg or above, the person will probably need medication for blood pressure control and their medical practitioner will advise on the need for any prescriptions. For some, lifestyle changes could eventually eliminate the need for medication while others may need to take it for the rest of their lives. Hypertensives require regular blood pressure monitoring to establish whether the control measures are effective. This does not necessarily require time off work for a visit to a doctor or health center as self-monitoring is possible through widely available kiosks in most pharmacies and personal blood pressure cuffs are available at minimal cost.

Addressing hypertension in the workplace

Periodic screening programs will allow for early diagnosis of hypertension. Employees should be encouraged to attend the screening through education about what blood pressure is and the potentially serious health consequences of uncontrolled hypertension. Those with an elevated blood pressure can be provided with lifestyle counseling and referral for treatment where necessary. A self-testing station with a digital blood pressure monitor and a scale to measure weight can encourage hypertensive employees to take greater responsibility for managing their own blood pressure.

All employees who were required to reduce their blood pressure due to regulated safety requirements need to be monitored regularly to ensure compliance with the medication regime as well as the continued effectiveness of the medication in controlling the condition.

The WHO regards workplace health programs (Learn more in "7 Steps for Implementing a Workplace Wellness Program".) and the promotion of a wellness culture as one of the most cost-effective ways to prevent and control non-communicable diseases. The key to reducing the incidence and severity of hypertension among employees is to encourage healthy behaviors and create an enabling environment. Wellness programs should first focus on promoting employees’ health by educating them about all aspects of healthy living. Various strategies are available and the best options will be depend on the nature of the business.

An environment which enables healthy behaviors includes:

• establishing tobacco-free workplaces
• offering employee assistance programs for professional assistance with lifestyle changes, especially if drastic intervention is required
• company health fairs to educate employees and make screening convenient (Learn more in "8 Tips for a Successful Company Health Fair".)
• offering healthy food choices in staff canteens (Learn more in "Encouraging Employees to Achieve Healthy Eating and Fitness Goals in the Workplace".)
• allowing for adequate rest-breaks (Learn more in "Breaks During Work Are Necessary for Employee Well-Being and Work Performance".) and areas where staff can relax away from their work stations
• encouraging fitness through, for example, access to exercise equipment at the workplace or participation as a company in sports events

Hypertension usually starts while adults are in their productive years and employers are in the ideal position to make an important contribution to the prevention, early diagnosis, and management of this global epidemic.