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Cracking Under Pressure

By: Marc Evans Abat, MD, FPCP, FPCGM article_10

Hypertension or high blood pressure is a very common problem in the Philippines.  Guidelines have previously defined hypertension as a properly-recorded blood pressure of 140/90 measured at least 1 week apart.  More recent publications have even lowered it to 130/80.  According to the PRESYON 3 survey, the prevalence of hypertension has increased to 28% in 2013.  What is sad is that 9% of the 28% do not know they are hypertensive.  In the same survey, hypertension among those in the adult age group (and presumably those in the workforce) ranges from 6% in the early 20s, to as high as 55% in the retiree age group.  It is prevalent regardless of occupational field or standing.  The Employees Compensation Commission of the Department of Labor and Employment lists hypertension and related complications as compensable disorders.

In what ways can work affect your blood pressure control?  The work environment (either too hot or too cold, exposure to noxious chemicals) can put stress on the body.  The pressures of your work itself (e.g. deadlines, toxic bosses or workmates, and unusual work hours) increase the stress response of the body, part of which causes the heart to work harder and blood vessels to constrict, leading to hypertension.  Unhealthy lifestyle habits, as compensation for work-related stress, adds to the worsening of blood pressure control.  To those working in night shifts, the higher intake of caffeine to maintain wakefulness also increases constriction of arteries and increased heart output. 

Oftentimes, hypertension is also accompanied by diets that are high in salt, fat, and sugar.  The high salt content causes water retention and other hormonal responses that lead to high blood pressure.  Fat intake leads to eventual artery stiffening. Smoking is a significant risk factor for hypertension and other complications.  Nicotine and other chemicals in cigarette smoke also lead to similar artery-constricting effects.  This effect is similar to those using traditional or electronic cigarettes.  These detrimental practices extend even outside the workplace as a way to ‘chill out’ after work.  Inadequate sleep also increases the stress response in the body and predisposes to more unhealthy coping mechanisms.

Due to current working situations, many have very limited or lack of time for exercise.  There are those who try to compensate by being ‘weekend warriors’ wherein they do hard exercises only at the end of the week, which again induces stress responses on an untrained body.  Obesity, due to the abovementioned practices, leads to many physiologic changes, including insulin resistance that can lead to hypertension.  Extreme vices, like drug abuse, have hypertension as one side effect.  Excess alcohol intake is also associated with hypertension by derangement of multiple mechanisms.  There are many hypertensives who do not take any medication and in the PRESYON 3 study, can be as high as 25%.  Even in those taking medications, only 73% have controlled blood pressures.  Some factors influencing these include inadequate medical follow-up, possibly resulting in curtailed access to medical care (related to their work schedules or lack of on-site medical facilities). 

How do we then ensure good control of blood pressure and prevention of hypertension?  A good work environment is a start. 

  • Have a controlled and physiologic working environment.  This ensures good work efficiency with reasonable levels of stress.  However, this may not be feasible for many workers, especially for those working outdoors, in manual labor, or those in night shifts. 
  • Have adequate rest periods during work and sleep once off work.  For those working in unusual work periods, enable a good environment for sleep and avoid or minimize activities that may further disrupt onset of sleep at home.
  • Control or limit alcohol intake.  This may help induce sleep for many after work, but take in consideration that in the long run, alcohol is harmful. 
  • Avoid coffee intake or limit it to 2 cups a day.  Although tolerance to caffeine can be developed, this does not happen to many people.  If the taste of coffee is overpowering, try decaffeinated coffee.
  • Smoking cessation is a very important and life-saving measure.  Your cigarette fix is not worth it.  Stopping smoking has a near-immediate effect on blood pressure control.  Avoid all forms of tobacco and nicotine, whether cigarettes or vaping.  For hypertensives, smoking cessation also makes medications work better. 
  • Weight reduction and a dietary intake low in salt and fat help reduce overall cardiovascular risk.  A recommended diet is the DASH (Dietary Approaches to Stop Hypertension) diet, which is an eating plan that is high on fruits, vegetables, low- or non-fat dairy, and other plant-based products like nuts and seeds. 
  • An exercise regimen of 150 minutes a week (e.g. 30 minutes, 5x a week) of at least moderate intensity to increase the heart rate helps eventually lower blood pressure.  An alternative is to do lower intensity activities (e.g. walking or climbing stairs) for about 1 hour instead on most days of the week. 
  • Having an overall healthy psychological and emotional approach to work, including the use of relaxation techniques and mindfulness, can help lower emotional stress and control blood pressure. 
  • Regular blood pressure monitoring, both at home and at work, is important. Record all measurements as these are necessary for medication adjustments.
  • Regular medical consultations are important as well.  These consultations should be done after having enough rest for proper blood pressure measurements.
  • For those already taking medications, ensure adherence to your regimen.  Stopping your medications predisposes to acute blood pressure spikes.  There are many affordable and effective medications in the market, so medication adherence is not a problem.  You can have 2-3 medications for your blood pressure for less than 20 pesos a day.  You can even get free medications from the local health center.
  • The work company should promote the health and well-being of its workers through:

o   An adequately-staffed medical clinic where all patients can seek medical consultations and have their health monitored, especially for large companies

o   Promotion of a healthy lifestyle within the company (e.g. prohibition of smoking, provision of clean and quiet break areas, inclusion of regular exercises and health activities, and promotion of psychological health)

o   Promotion of and enabling regular health check-ups and consultations

The workplace is where we make our living and hopefully fulfill dreams and desires.  It should not be a place for cracking under pressure.


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Keywords: medical consultation, blood pressure monitoring, exercise, DASH diet, low salt intake, smoking cessation, alcohol intake, stress, work environment, blood pressure control, compensable disorder, high blood pressure, hypertension   
  
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