Nikash's sharp thinking leads to early diagnosis of high blood pressure

On World Hypertension Day - 17 May - Nikash is encouraging all of us to get our blood pressure checked out. "The screening test is very simple, non-invasive, takes less than a minute and can literally save your life," he says.

"Keep in mind that hypertension, or elevated blood pressure, is called a 'silent killer'. That's because it usually shows no symptoms until someone has a stroke or heart attack or is diagnosed with a serious illness. That's why regular health checks are important."

Screening for hypertension gives you the luxury of time

Hypertension is a common condition. If it's not treated, it increases the risk of heart attacks, strokes, kidney failure and other serious health conditions.

For these reasons, Nikash encourages everyone to "address the elephant in the room" and go for regular health check-ups to screen for hypertension and other 'invisible' conditions.

"A fit, athletic friend of mine recently had a surprise stroke," he says. "When he was hospitalised, they found that he had been living with hypertension. When I heard about this, I thought, 'That could've been me.' And that's not a nice way to get your hypertension diagnosis."

As Nikash explains: "if you get screened and get a red flag, at least you have the luxury of time to get it under control before it causes other, more serious health problems."

"I put my symptoms down to work stress."

Being in tune with his body paid off for Nikash. He was diagnosed with hypertension after he refused to stop looking for answers to his health niggles.

Nikash studied biochemistry and health economics and works in the healthcare industry. He says he was lucky to have experienced some worrying symptoms a year before his diagnosis.

In 2020, soon after he returned to South Africa from the United States to start a new job, he noticed that something wasn't right. "My heart would race and I'd get headaches. I'd feel a tightness in my chest, and that made me feel anxious," he says.

"I put my symptoms down to work stress and living through the pandemic. I don't think I was ready to address the elephant in the room: my suspicions that something was actually wrong." Also, like most people, during the first year of the COVID-19 pandemic Nikash avoided visiting healthcare facilities, unless absolutely necessary, to prevent exposure to COVID-19. He therefore missed out on his health checks.

In 2021 Nikash decided it was time to return to his yearly Discovery Vitality Health Checks - and his blood-pressure reading rang the alarm bells.

Nikash hires a blood-pressure monitor after experiencing the 'white-coat effect'

"I was worried that the reading was caused by the 'white-coat effect'. This happens when you get anxious in a clinical setting and your blood pressure goes up in that moment only," he explains. "I needed to be sure. Having worked in healthcare, I had a good understanding of how serious unchecked hypertension can be. I'd also had those worrying symptoms when I got back from the US."

Nikash had every reason to suspect the 'white-coat effect'. In 2016, he had a high blood-pressure reading during a health check-up. A cardiologist colleague at the company he was working for at the time gave him a battery-powered blood-pressure monitor to use for 24 hours to make sure he wouldn't be misdiagnosed with hypertension. Thankfully, Nikash's blood pressure readings came back normal.

To make sure this was not the case again, Nikash asked his local Dis-Chem clinic if he could hire a 24-hour ambulatory blood pressure monitor (ABPM). He wore the monitor for a day. The clinic then printed the measurements for him to take to his GP, Dr Lize-Maré Steenkamp.

Star patient Nikash is diagnosed with hypertension

Dr Steenkamp describes Nikash as a "star patient" because she's never had a patient monitor their own blood pressure and bring her the results.

After reading the report, Dr Steenkamp found that Nikash suffered from high blood pressure, mostly during the day. He was diagnosed with hypertension and prescribed medicine to control his blood pressure.

Dr Steenkamp used Discovery HealthID, an electronic health record for doctors, to register his chronic condition under the Discovery Health Cardio Care Programme. She also registered his chronic medicine on HealthID, which meant that Nikash could collect his medicine from a pharmacy. It was fully paid for through his medical scheme cover.

"I love Discovery HealthID," says Dr Steenkamp. "Once I've registered a patient's chronic condition I can quickly tell them that the medical aid will indeed pay for their medicine and their blood tests."

Dr Steenkamp explains what happens after she's diagnosed patients like Nikash with hypertension. "I do a full set of blood tests to check everything and get baseline results for their kidney function before starting them on medicine. I have a follow-up appointment with them after a month to check how they're doing on the medicine. After that, I see them every three to six months to make sure that their blood pressure is still controlled."

At Nikash's one-month follow-up appointment, Dr Steenkamp found that the medicine she had prescribed was working - his blood pressure and heart rate had gone down and were now in normal ranges.

Nikash says: "The meds have made me feel better. I have a sense of relief that I was diagnosed early. Having my blood pressure under control helps protect my kidneys, brain and heart. There's only so much I can do to manage my condition, so I'm happy to take this single tablet every day."

Lifestyle choices: A little can go a long way

Dr Steenkamp discusses the importance of healthier lifestyle choices, such as a good diet and exercise, with her hypertensive patients.

She says: "Lifestyle changes can be difficult because your patients really have to buy in to healthy habits. I try to encourage my patients to do so, because a little bit of change can go a long way."

• Read more: You may have high blood pressure. Here's how healthy eating can help

Nikash says he hasn't had to make changes to his diet, as he mostly lives very healthily, but he does try to exercise at least three times a week. He's also started practising mindfulness to identify what triggers his anxiety, which in turn raises his blood pressure.

"I've bought into the idea of time-out. When the day is over, I put on a playlist of music and have a glass of wine to prepare for rest and relaxation. By ending the day in this way, I become more appreciative of whatever the day's experience was, whether happy or sad, and find a greater sense of peace within the present moment."

He plans to visit Dr Steenkamp for check-ups at least twice a year to make sure that his hypertension continues to be managed properly.

• Read more: How much is too much? Exercising with hypertension

"Many people have chronic conditions and they are fine."

Nikash admits that he was shocked when he was first diagnosed. "I immediately thought, 'Oh no, this is what my grandfather had. Is this a sign of getting old? What did I do to get hypertension?' But then I told myself that I've got the right doctor and the right medicine. Many people have chronic conditions that are well managed, and they are fine."

He started sharing his diagnosis with other people and was surprised by their reactions. "It's amazing how many people asked me how I monitored my blood pressure, because they also thought that they may have hypertension," he says.

Devices for monitoring blood pressure at home

These are the devices that Nikash used to monitor his blood pressure over 24 hours in 2016 and in 2021:

• Bluetooth-enabled blood-pressure-monitoring machine: This is a bedside-table device, normally used on people who are already living with hypertension.
• 24-hour ambulatory blood pressure monitor (ABPM): This device is worn on the arm for a day, and during normal daily activities such as driving, working and sleeping. It is programmed to check your blood pressure at set intervals over 24 hours. This device is preferred for people who may suffer from the 'white-coat effect' or to confirm that a diagnosis is correct. Based on the reading from the 24-hour ABPM, medicine can be prescribed based on your specific blood-pressure profile.

You can hire a 24-hour ABPM from your local Dis-Chem clinic without needing a prescripton. Here's how:

1. Contact the clinic's call centre on 086 111 7427 or email clinicqueries@dischem.co.za.
2. Ask to hire a 24-hour ABPM.
3. They will book two appointments for you and confirm them by SMS:
   • At the first appointment, they will put the ABPM cuff on your arm. There is a little computer device that you can put in your pocket. The nurse will explain how the device works.
   • At the second appointment, the nurse will take the BP cuff off, download the data and print a report for you.

At the time of publishing, the clinic charged R446.90 for this service.

How to claim for the ambulatory blood pressure monitor

If you are diagnosed with hypertension, you can claim for using a 24-hour ABPM under the procedure code 1237. The procedure description is '24-hour ambulatory blood pressure'. The 2022 Discovery Health Rate for this is R459.10.

Dis-Chem is a Discovery Health Medical Scheme and Discovery Vitality rewards partner.

• Read more: Getting the jump on high blood pressure