Don’t neglect High Blood Pressure; It kills without making any noise
High blood pressure is one of the most common cardiovascular problems. As per studies carried out among urban, semi- urban and rural population, its prevalence is as at least as high as 20 per cent if the cut- off 150/ 90 mm is kept as its definition. In a recent study conducted by the author the prevalence of hypertension was seen in 46% of the population in 6 metropolitan cities of India.
In India alone more than 15 crore patients need medical treatment. Untreated high BP is a common cause of brain stroke, heart attack and kidney failure. High BP is a major cardiovascular problem in our state with all the regions of the valley, Jammu and Ladakh being victims of this major problem. It is an important risk factor for the genesis of heart attacks, strokes and kidney failure. High salt intake, bad life style and genetic factors are important predisposing issues. Mental Stress is another important factor which perpetuates it.
What is normal Blood Pressure? Optimal BP is a pressure less than 120/ 80 mm Hg. Any rise in BP above 110/ 75 mm is associated with a linear increase in stroke and heart attack rates. This has been proven by several epidemiologic studies and life insurance statistics. An increase of 10 mm in systolic or diastolic pressure is associated with a doubling of the risk of a vascular event. Unfortunately, high BP is invariably not accompanied by symptoms and therefore its detection and management is a challenge. This is in fact, why, it has been described as a “ Silent Killer”. Some myths about blood pressure: Blood pressure increases with age and is a normal phenomenon: Truth: According to this theory, normal BP of a 60- year- old is 160 and at 80 years it is 180 ( Age+ 100). This is not true. Normal BP at all ages should be less than 120/ 80 mm. However medicines for bringing down the BP are only recommended to be started if BP is more than 140/ 90 mms Hg.
Low Blood Pressure is a disease: People with BP lower than 100 to 110 mm systolic in good health often seek medical attention.
Truth : Individuals with pressures on the lower side ( 90 to 100 mm systolic) without any other disease are very fortunate in having natures blessing to have a long healthy life. They should not waste their resources on taking tonics and BP increasing measures.
Stay healthy first Everyone who has high blood pressure should adopt measures to stay healthy. The lifestyle changes advised will bring down the dosage of drugs and number of medicines that need to be taken.
All healthy individuals too, should adopt these non- drug measures, so their pressure remains below 120/ 80 mm Hg.
IF YOU STILL NEED MEDICINE Before starting drugs make sure that you minimize the consumption of following: Painkillers, nasal drops, cough syrups, anti- depressants and mood elevating drugs.
POINTS TO CONSIDER BEFORE BEING LABELLED A BP PATIENT • Get the BP measurement done after sitting for several minutes in a quiet room • Take at least 2 measurements spaced by one to two minutes and additional readings if the two are quite different • An appropriate BP apparatus • If the BP in two arms is different, take the higher value as the reference Drug treatment for high BP is a very long term treatment. Once it has been recommended that medicines ( very often 2 drugs if the BP is more than 160/ 100 mm) are needed, they are not to be stopped even after BP comes down to target levels. This is a common mistake committed even by very educated people. The aim of medication is to keep you free of the risk of complications like heart attacks, stroke etc. It is to ensure that you remain free of catastrophic problems as years go by.
The currently used drugs are very safe and need very little monitoring for side- effects. Most are well- tolerated. For every patient, the treatment has to be individualized. No one should try self- medication.
The agents used and dosage of medicines depend on several variables.
Broadly, the agents used are ACE inhibitors and angiotensin receptor blockers, calcium blockers, beta- blockers and diuretics or water pills in various combinations.
Several studies have shown that a combination of amlodipine and an ACE inhibitor/ Receptor blocker combination is a very well tolerated and efficacious combination for most persons requiring drug treatment. This combination can result in reduction of death by more than 15%. The combination of diabetes and high blood pressure is a very frequently seen association in our milieu. This is also called the twin epidemic which is an important cause of a very high cardiovascular disease in South Asia.
The aim is to not only keep your BP in normal range but also to take care of all the risk factors, which lead to heart attacks and strokes.
“ Observing the Rule of 100” goes a long way. Keep your blood sugar and cholesterol and triglyceride levels close to 100 mgs. The emphasis is on keeping all round risk very low instead of concentrating on one risk factor. Patients needing BP lowering drugs are also often in need of agents to keep cholesterol and triglycerides very low. The management should be holistic and not just treating numbers.
Indications for taking BP lowering drugs Ideal blood pressure at all ages should be below 120/ 80. In general, medicines are recommended when BP is more than 140/ 90 mm Hg, this includes patients with diabetes, and chronic kidney disease also.
Previously it was believed that in certain situations like diabetes and chronic kidney disease BP target should have been below 130/ 80 but recent studies indicated that going below 130/ 85 mms Hg does not add any value but could be deleterious.
Non- drug methods to reduce BP Non- drug methods can reduce BP by 10 to 15 mm Hg: These measures are: • Regular exercise • Salt intake of not more than 4 to 5 grams per day • Fresh fruits and leafy vegetables ( 4 to 5 servings/ day) • Avoidance of alcohol or drinking in moderation • Losing weight Hypertension is a very common problem seen all over the world. We are seeing its increase much more than other industrialized countries. Early recognition and its management is extremely important.
Despite a large number of safe medicines with low side effects being available the number of patients with uncontrolled BP is steadily increasing. Adverse life style is the most important cause for this and we need to recognize it and take corrective measures.
Prof Upendra Kaul is Executive Director and Dean, Fortis Escorts Heart Institute and Fortis Hospital Vasant kunj, New Delhi TAKE CARE PROF UPENDRA KAUL kaul. upendra@ gmail. com Despite a large number of safe medicines with low side effects being available the number of patients with uncontrolled BP is steadily increasing. Adverse life style is the most important cause for this and we need to recognize it and take corrective measures.
