BLOOD PRESSURE is the term used to describe the pressure exerted by the blood stream at a given mome...
BLOOD PRESSURE is the term used to describe the pressure exerted by the blood stream at a given moment on a given point in the circulatory system. It is a measure of the efficiency of the heart and arteries.
Hypertension (high blood pressure) is said to exist when the pressure exceeds the normal range for a person's age and sex.
There are two readings used to measure an individual's blood pressure - the systolic, the maximum force exerted by the heart as the ventricles contract and force blood into the arteries; and the diastolic, the pressure when the ventricles are relaxed.
Blood pressure is measured using a spygmanometer. This shows the pressure in terms of the height in millimetres of a column of mercury.
Types of hypertension
There are three different types of hypertension:
1. Primary/essential hypertension: This accounts for the overwhelming majority of hypertensive cases and is where no one factor has been found as being responsible for the increased levels. However, it is known to be associated with factors such as a positive family history, high salt intake, obesity, stress, smoking and high alcohol intake.
2. Secondary hypertension: This exists where the hypertension is secondary to an underlying cause. These causes can vary and may be split as follows:
l Kidney disease accounts for most cases of secondary hypertension and some of the associated conditions include pyclonephritis (inflammation of the pelvis and kidneys) and polycystic kidney disease (multiple cysts that spread and grow causing damage to the renal tissue).
l Endocrine abnormalities, including conditions such as acromegaly (excessive production of the growth hormone caused by a tumour in the pituitary gland) and Cushings disease (excessive amounts of the corticosteroids hormone in the body).
l Cardiovascular abnormalities, including coarctation (narrowing) of the aorta.
l Pregnancy - this is usually in the early stages of pregnancy, but hypertension may become more severe later on when it is referred to as pre-eclampsia or toxaemia of pregnancy.
l Drugs - there are various types of drugs that may cause hypertension, in particular steroids and certain types of oral contraceptives.
3. Malignant/accelerated hypertension: This indicates a more severe degree of raised blood pressure and is often complicated by damage to the brain, heart or kidneys which may or may not be reversible.
Treatment
There are various forms of treatment that can be used to control hypertension and studies have shown that mortality associated with raised blood pressure is related to the pressure level irrespective of the treatment prescribed.
When underwriting an application, one of the most important factors in making the decision is the current control. In cases of mild or moderate hypertension without complications, most companies would make a decision based on current levels.
However, there are some exceptions to this ruling, one of these being that the treatment should have been established for at least three to six months. If this is not the case, it may be necessary to either take into account the pre-treatment levels or postpone the case to give the individual's blood pressure time to stabilise under treatment so that underwriters can make the fairest decision possible.
Secondly, the longer the period of time that has elapsed with an individual's hypertension going untreated, the greater the risk that they may have developed complications.
If any of these problems are indicated prior to the commencement of hypertensive treatment, it will be necessary to investigate this further to ascertain the state of the cardiovascular system, irrespective of the current blood pressure level. This may include ECG or urinalysis testing and, if any complications are found, these will need to be taken into account when arriving at a final decision.
The prognosis of several diseases exhibiting hypertension as a feature of their syndrome, in particular some of the renal diseases and those with a history of stroke or heart attack, has been much improved with the introduction of more efficient anti-hypertensive drugs. In these cases, it is possible to rate the blood pressure based on the current level (as with essential hypertension) to determine whether an additional rating is necessary.
Additional factors
When assessing a hypertensive person for life protection, critical illness protection or any disability benefits, there are a number of other features that need to be taken into account before arriving at the final decision:
l Sex - Females have higher blood pressure than males and when using blood pressure tables, the majority of life offices will use three quarters of the reading to assess the level of a female's blood pressure as opposed to that of a male. In addition, the prognosis for women with hypertensionseems to be much more favourable than for men and as a result, it may be possible to view female applications with raised blood pressure with a degree of leniency.
l Age - As we get older blood pressure rises, in particularly the systolic level. Blood pressure tables used by life offices will account for this change. Also, the earlier in life that hypertension is diagnosed, the more likely it is that there is an underlying cause until proved otherwise. It, is however, fairly routine that when someone is found to have raised blood pressure various tests will have been done by the GP to rule out any sinister cause.
l Family history - The chances of a person developing hypertension in the first place are much greater if both parents are already hypertensive. But if the person already has raised blood pressure, combined with this family history, the likelihood of them eventually developing severe essential hypertension is almost certain.
When underwriting an applicant who is rateable for their blood pressure, combined with a family history of two or more deaths in parents or siblings under the age of 60 from cardiovascular-renal causes - whether these were associated with hypertension or not - the prognosis is worse and usually results in an increase in the rating imposed.
l Obesity - This has been proven to be a cause of hypertension and a more cautious approach will be used when underwriting a combination of these features. Any extra deemed necessary for obesity will be added on any ratings imposed for the raised blood pressure.
l Smoking - This is a proven cause of heart disease and an individual who smokes will attract a loading approximately 25% to 100% (depending on the amount of tobacco smoked) greater than a non-smoker with otherwise the same hypertensive features.
l Hypercholosterolaemia - This is also a known cause of heart disease. When underwriting a combination of hypercholesterolaemia or a history of smoking with blood pressure, the features have a cumulative effect and this will be reflected in the underwriting decision.
l Chest X-ray and electrocardiagram - It is also possible to make credits when assessing hypertensive cases. If they have had a normal chest X-ray or electrocardiogram during the previous six months, in certain cases it may be possible to reduce the final loading for this.
Cardiac symptoms
The ultimate effect of persistent and substantial hypertension is on the left ventricle of the heart, the kidneys and the peripheral vascular system.
The first cardiac symptoms are usually shortness of breath when exercising. Angina is common as a result of the frequent co-existence of atherosclerosis (a disease of the arteries where fatty plaques develop on their inner walls) and also because of the increased demands on the coronary system by any left ventricular hypertrophy. Severe cases may progress to hypertensive heart failure.
Hypertensives are also prone to vascular accidents, the more serious of which include cerebral haemorrhage and infarction and subarachnoid haemorrhage. However, when hypertension is combined with any other additional features as listed above, the risks may be increased even further.
Kirsten Jones is life and disability underwriter at Guardian Financial Services
