Hypertension in Argentina

The subject of this article is not about the tension arising from hyperinflation in Argentina.  Rather, this is about high blood pressure, which is medically known as hypertension for the condition in which blood pressure is consistently higher than 140/90.  Blood circulates in the human body, carrying oxygen and nutrients to the various vital organs.  When the heart beats, blood is pumped into the arteries and creates the pressure to move the blood into the other parts of the body.  Under hypertension (or high blood pressure), the arteries become constricted, the heart has an increased workload, the blood vessels may be damaged and the vital organs may not receive sufficient amounts of oxygen and nutrients to function properly, eventually leading to stroke, heart attack, congestive heart failure or kidney failure. 

The most dangerous aspect of high blood pressure is that it can exist for years without exhibiting any apparent symptom and then a serious attack occurs suddenly.  For this reason, doctors describe high blood pressure as the silent killer.  It is difficult to estimate the true incidence of high blood pressure in the population, since many people may not know that they have the condition.

Currently, the exact causes of high blood pressure are not completely understood.  Hypertension is referred to as essential, or primary, when the physician is unable to identify a specific cause, and this occurs in up to 95 percent of patients.  By contrast, secondary hypertension has recognizable causes (such as diabetes), which are usually treatable or reversible.  It is believed that the risk factors for high blood pressure include: genetic inheritance, age, sex, race, obesity, diabetes, high cholesterol, eating too much salt, alcohol, caffeine, smoking, drugs, lead toxicity, lack of exercise, insufficient sleep and stress.  

We will now cite some data from the TGI Argentina study.  This is a survey of 5,946 persons between the ages of 12 to 75 years old who were interviewed in 2001.  According to this study, 6.8% of the respondents had taken prescription drugs to treat high blood pressure in the past 12 months.  In the next table, we show the breakdown by age and sex.  In general, the older the person, the higher the incidence.  It is also noted that the incidence is higher among teenagers (12-19 years old) than people between 20 to 34 years old.

In the next chart below, we show the breakdown by socio-economic level.  One would have expected the poor to receive less healthcare services and be less able to afford prescription drugs.  If that were the case, one might expect the incidence of prescription drug usage to increase with socio-economic level.  Notwithstanding the economic barriers, the incidence is actually a direct decreasing function of socio-economic level, which is just the opposite.  We note that socio-economic level is not necessarily a causal agent of high blood pressure, but these data certainly suggest that it is a concomitant variable.

However, this article is not meant to be a medical study.  We are more interested in the correlational aspects between high blood pressure and the stresses of modern life.  The conventional wisdom is that stress is a risk factor in high blood pressure.  However, stress is difficult to define and quantify and different people react differently to the same situation with different amounts of stress.  

In the next chart, we show the incidence of high blood pressure prescription drug usage by occupation.  As one might expect, the most stressful jobs are those of business owners and upper management, who are often Type A personalities constantly worrying about their businesses.  Persons experiencing a great deal of stress are also much more likely to engage in unhealthy behaviors such as smoking, excess alcohol use, poor diets, not getting enough sleep and not exercising, all of which further predispose to the development of high blood pressure.  This association between job strain and high blood pressure would indicate that there is a price for being 'successful.'  On the side, we also found a relatively high incidence among maintenance and security workers, who are required to make the 'right' decisions without much latitude.  

In the next chart, we show the incidence of high blood pressure prescription drug usage by consumer confidence (see definition).  For both the retrospective and prospective measures of consumer confidence, the incidence increases as the economic situation deteriorates.  The experience and anticipation of job or economic loss may cause psychological distress and negative blood pressure reactivity to  increase.

The existence of stress is not limited to economic life.  Personal lives may also be stressful.  On one hand, a daily routine of constant bickering, quarreling, anger, recrimination, aggression and physical fighting obviously causes stress.  On the other hand, the inhibition and suppression of anger may produce a superficial sense of calm, but the hidden feelings of exhaustion, frustration and despondency are also elements of stress that can activate pituitary and adrenocortical hormones, resulting in high blood pressure.  

In the next table, we show the high blood pressure prescription drug usage by marital status.  This may suggest that a free, uncommitted living arrangement is less stressful than marriage and its sometimes unfortunate aftermath.  However, we should point out that marital status is strongly correlated with age (see Gender Relationships in Latin America).

For all the correlational (which we emphasize are not causal) data between stressful situations and high blood pressure, one might think that stress management would be an effective healing tool.  Undoubtedly, stress management counseling has an overall positive impact upon both physical and mental health, and patients report feeling better and often report fewer disease-related symptoms when stress is under control.  Unfortunately, stress is often induced by exogenous factors.  Telling someone to use relaxation techniques such as deep breathing or progressive relaxation when they have just lost their jobs borders on being obscene ... 

(posted by Roland Soong, 12/14/2001)