Hypertension – A Silent Killer
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Hello friends,
We at Ayushman are all geared up to keep our promise of continuing to keep you healthy with of Ayush Patrika. In this issue we are going to tell you about Hypertension since it has become very common even in the young.

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HYPERTENSION – A SILENT KILLER

The title has been purposely chosen, as many people have no complaints when they have high blood pressure, and it remains ‘silent’ as it quietly goes about its job of destroying the body from within, if left uncontrolled.

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What is hypertension?

The pressure exerted by the heart to pump blood into our blood vessels, is called blood pressure. Let us take the example of a cycle tube – the pressure in the tube can go up more than normal if there is a narrowing or choking up of the tube or some obstruction at the end, or if more air is pumped in, than the tube’s capacity.

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The story is the same in our arteries. Hypertension can occur because of increased volume of blood, narrowing of arteries or increase in the peripheral resistance. Due to narrowing of arteries of limbs especially in the legs, the heart has to pump harder for the blood to reach the furthest parts, and because of this, over a period of time, its size enlarges although pumping capacity reduces. As a consequence less blood goes to various organs especially kidneys, brain, heart, limbs and eyes, leading to a slow damage of all these organs and causing paralysis, heart attack, blindness, kidney failure and gangrene of limbs which may even require amputation. Sometimes these blood vessels in eyes, aorta (major artery) or brain may burst (because they cannot bear so much pressure and get thinned out after sometime) – causing brain haemorrhage (bleeding), bleeding inside the eyes  (retinal haemorrhage), etc. Imagine all the changes due to blood pressure may be silently taking place in the body, and we may remain blissfully unaware, or more tragically, knowingly careless, since we know that we have blood pressure but choose to keep it untreated. ‘Why should I get my blood pressure treated?  I have no complaints,’ is a common query from patients, and hopefully after reading this, a few of them will start taking regular medication.

What is atherosclerosis?
Atheros means artery and sclerosis means hardening- so atherosclerosis means hardening of the blood vessels due to deposition of fats, followed by cells, sticky substances and finally calcium.

What is systolic and diastolic blood pressure?

When the force of the pressure exerted by the heart is the greatest, it is called systolic blood pressure, and when the heart is relaxed, or exerting least pressure, what we measure is called diastolic blood pressure.

Normal blood pressure

 There is no single level of pressure, which is “normal”. But on an average anything from 100-140mm of mercury systolic or 60-90mm of mercury diastolic is considered normal. Blood pressure also increases with age.  We have a formula, (for systolic blood pressure)

AGE +100 = Normal blood pressure, for your age.  For example if you are forty years old, your systolic blood pressure, should not exceed 40+100, =140mm of mercury. But lately the tendency is to maintain a tighter control at any age.  For example even in an eighty year old, we would not like to maintain 180 mm of mercury systolic blood for long.

Complaints
Patients of hypertension may present with any of the following complaints -headache, palpitations (being conscious of one’s heart beats), dizziness, flushed face, nose-bleed, breathlessness, blurred sight etc.

Secondary blood pressure – Normally blood pressure is called primary or essential blood pressure, which is not curable, but can only be kept under control. But there are certain diseases that can cause curable blood pressure.

These are called secondary blood pressures. They may be due to, -

1) Kidney diseases – A diseased kidney or a narrowing in a kidney blood vessel can cause hypertension, as kidneys are responsible for maintaining salt balance and they also secrete a chemical, which increases blood pressure.

2) Certain tumours – of glands in our abdomen (stomach) called “phaeochromocytoma” -can cause very high and fluctuating blood pressure.

3) Increase in activity of another gland called adrenal gland can cause “Cushings disease” which can also cause high blood pressure.

4) Drugs- steroids, anti- inflammatory drugs, and contraceptive pills (birth control pills) can cause reversible high blood pressure.

Precipitating causes – Now what can increase our chances of getting high blood pressure? These may be-

1) Obesity
2) Smoking
3) Coffee
4) Stress
5) Alcohol
6) Family history of blood pressure
7) Lipid abnormality
8) Some drugs
9) Hyperinsulinemia

Now let us consider these one by one. -

1) Obesity – when we are over-weight, our heart has to pump blood to a greater body mass obviously increasing the “pressure” on our blood vessels.

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2) Stress – mental tension causes release of certain chemicals in the body, which leads to narrowing of blood vessels and hence rise in blood pressure.

3) Alcohol – alcohol intake in moderation can cause rise in blood pressure. Additionally, snacking and feasting leading to obesity usually accompany alcohol intake.

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4) Family history of blood pressure -If there is family history of blood pressure, tendency towards hypertension is more.

5) Coffee – excessive intake of coffee can also increase blood pressure probably by causing narrowing of vessels.

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6) Dyslipidemia – increase in bad fats and decrease in good fats hastens atherosclerosis and thus blood pressure.

7) Drugs - long-term intake of certain drugs, like steroids and anti- arthritic drugs can increase blood pressure.

8) Hyperinsulinemia - increased levels of insulin in the blood, can lead to obesity, hypertension & atherosclerosis.

9) Smoking- causes narrowing of vessels due to release of certain chemicals.

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‘DASH’ away your hypertension

DIET IN HYPERTENSION

Salt

Our body actually requires only 2000 milligrams of salt in a day from food, which can increase in summer, but most of us consume several times that amount. Try to avoid highly salted and preserved foods like pickles and salted snacks. Normal salt contains 40% sodium.
You can use low sodium salts, which contain only 18 % sodium. But this should be avoided if you have kidney failure since they contain high potassium levels which are harmful in this condition. On the other hand calcium, magnesium and potassium keep the blood pressure low.

Potassium

Best source of potassium are fruits.

Calcium

Greens and dairy products supply enough calcium.

Magnesium

Magnesium is present in nuts sprouts Soya beans and bananas.

Diet for hypertension should therefore be vegetarian (plus fish), high in fibre, a lot of fruits (fibre and potassium), plenty of vegetables (fibre and calcium), avoidance of solid fats (ghee, butter, margarine, cheese), and less of refined foods (maida, potatoes, sabudana, sugar).

The DASH diet ( Dietary Approaches to Stop Hypertension)

This is a dietary pattern promoted by the U.S.-based National Heart, Lung, and Blood Institute to prevent and control hypertension.
The DASH diet is rich in fruits, vegetables, whole grains, and low-fat dairy foods; includes fish, poultry, nuts and beans; and is limited in sugar-sweetened foods and beverages, red meat, and added fats. In addition to its effect on blood pressure, it is considered a well-balanced approach to eating for the general public. It is now recommended by the US Department of Agriculture (USDA) as an ideal eating plan for all Americans

It recommends eating a diet of 2300 mg of sodium a day or lower, with a recommendation of 1500 mg/day in adults who have elevated blood pressure; the 1500 mg/day is the low sodium level tested in the DASH-Sodium study.

At sodium intake level of 1,500 mg/day, plus the other recommendations of DASH diet, there was an average blood pressure reduction of 8.9/4.5 mm Hg (systolic/diastolic).  Hypertensive subjects experienced an average reduction of 11.5/5.7 mm Hg. This reduction in blood pressure is in fact equal to that achieved by a single antihypertensive drug.

Other measures-

In all except the severe cases of newly diagnosed hypertension, a trial of lifestyle modification — exercise, yoga, meditation and weight reduction can be made before resorting to medication

· Maintain ideal body weight

· Keep lipids under control

· Indulge in an hour of moderate exercise daily

· Stop smoking

· Avoid drugs that can cause hypertension(check with your doctor)

· Reduce stress and ensure sound sleep

With DASH diet and lifestyle changes outlined above, mild to moderate hypertension can be controlled without medication.

 

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Hope you found this issue useful and interesting. We welcome your feedback and suggestions for future interactions.
Before signing off, we at Ayushman wish you a healthy month—Ayushman bhava!

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Dr. Geeta Sundar, MD

Chief Health Counsel,IndiaOnlineHealth

5-6/A, Ramyanagari, Bibwewadi, Pune – 411037
www.indiaonlinehealth.com|info@indiaonlinehealth.com