Blood pressure is often termed as a ‘silent killer’ because it does not have specific symptoms, and detection may often happen too late. This lifestyle disease afflicts one in eight Indians (source: National Family Health Survey), which makes it a cause for concern. But like most lifestyle diseases, it just needs a few tweaks in your lifestyle to prevent and protect you from the disease.
Adding to the confusion, experts say that in 95% of patients, there are no identifiable causes for high blood pressure (the condition is called Essential Hypertension). It can be associated with a family history of hypertension and other metabolic diseases like obesity and diabetes mellitus. “In the remaining 5% of patients, there could be a treatable cause like sleep apnea, blockages in the kidney arteries, or small tumours in the abdomen (the condition is called Secondary Hypertension),” says Dr Nihar Mehta, Consultant Cardiologist, Jaslok Hospital & Research Centre.
Other common secondary causes are diabetes, obesity, smoking, alcohol consumption, high salt intake, physical inactivity, stress, endocrine/thyroid disorders, or pregnancy.
Having high blood pressure puts you at risk of various diseases. “The possible complications of hypertension are heart failure, coronary artery disease, stroke, kidney failure, blindness and peripheral arterial disease (PAD),” says Dr Paritosh Bagel, Internal Medicine, SL Raheja Hospital.
There are certain common signs that you can watch out for, such as a heaviness in the head or throbbing headaches, palpitations on exertion, dizziness, breathlessness, chest discomfort, swelling in the feet, visual difficulties and impotence.
To protect yourself, certain simple steps can go a long way. “Weight loss and reduction of dietary salt can prevent the development of hypertension. Regular exercise and regular intake of medicines as prescribed by the doctor can also prevent complications arising from hypertension,” says Dr Bagel.
Dr Mehta suggests regular blood pressure monitoring at a physician’s clinic, at a hospital or at home with a home blood pressure apparatus to detect the disease early.
Once you have been diagnosed with the disease, it is best to make some changes to your routine and incorporate some healthy habits. “Lifestyle changes form the cornerstone of blood pressure management. A low-salt diet (avoid pickles, papad, fried food, biscuits) and regular aerobic exercise of moderate intensity (30 minutes a day at least for 5 days a week) are essential for all patients with high blood pressure. Meditation and pranayam are also good ways to reduce blood pressure,” says Dr Mehta. In addition, several patients need medications to keep their blood pressure in the target range of less than 140 mmHg systolic and less than 90 mmHg diastolic, he says.
Some of the modern-day treatments for the disease include Renal Denervation Therapy where the nerves around the kidney artery are subjected to radiofrequency to reduce blood pressure. Another promising therapy is Baroreceptor Activation Therapy where a pacemaker sends continuous stimuli to the carotid artery in the neck. “These therapies are still in the experimental phase and might become available in the near future,” says Dr Mehta.
Beware of the silent killer
By Dr Sudhir Koganti
One may wonder what all this fuss about high blood pressure is. Hypertension causes many cardiovascular diseases that include stroke, heart attack, kidney failure and dementia, thus putting a huge burden on healthcare globally due to morbidity, mortality and associated costs. Last but not least, the public need to be aware of the correct treatment for high blood pressure.
Every year, the World Hypertension Day is celebrated on the 17th of May to increase awareness about this silent killer among general public. International Society of Hypertension along with World Hypertension League has designated the month of May as “May Measurement Month.”
The aim of this initiative is to screen as many people as possible that are over the age of 18 years for suspected hypertension. This strategy would greatly enhance in identifying silent or undiagnosed hypertensives so that they can be targeted with guideline directed lifestyle, dietary advice and treatment.
Awareness on the lower threshold of blood pressure reading required to label an individual as hypertensive is also required. American Heart Association guidelines released in 2017 clearly stipulate that a blood pressure reading of over 130/80 is now considered as stage 1 hypertension. However, the job of a cardiologist doesn’t stop with diagnosis but actually starts there. Once someone is labelled as hypertensive, it needs to be established if it is true or an entity called white coat hypertension.
Furthermore, investigations may have to be carried out to see if hypertension is secondary to a cause. Once diagnosed, a decision needs to be taken if lifestyle modification can be adopted or treatment needs to be initiated early.
Lifestyle modifications include six key steps and they are:
• Get expert advice from your doctor to help you understand your results;
• Lower salt/sodium to prevent excess fluid in the blood, which strains blood vessels;
• Eat more fruits and veggies – particularly potassium-rich ones – to balance out sodium in the blood;
• Exercise – it makes the heart stronger, putting less strain on blood vessels;
• Quit smoking – constituents of tobacco smoke damages blood vessel linings; and
• Monitor your blood pressure at home
As per studies and data, thousands of people are on wrong treatment for hypertension with a class of drugs called Betablockers (Atenolol, Metoprolol etc) being prescribed as first line or second line agent.
Betablockers have been phased out as first line or second line drugs to treat hypertension a while ago, unless there is concomitant coronary artery disease or heart failure. In fact, the same holds for other concomitant conditions too such as kidney disease, stroke etc.
Essentially, the key message is one prescription does not fit all and it need to be tailored to the individual in a dedicated specialist clinic. People need to actively undergo blood pressure screening of themselves.
They need to nudge their relatives and friends in the month of May and seek expert advice on how to manage and monitor this silent killer over the long run to lead an active and healthy life. (Writer is Consultant Cardiologist, Citizens Hospitals, Nallagandla, Serilingampally)
Dr Sudhir Koganti
Jawless fish may hold key to effective brain cancer treatment
A chemical found in jawless parasitic fish can be used to deliver anti-cancer drugs directly to brain tumours, as well as lead to more effective treatments for trauma and stroke, a study has found.
The research, published in the journal Science Advances, found that molecules from the immune system of the parasitic sea lamprey may also be combined with a wide array of other therapies, offering hope to treat disorders like multiple sclerosis, Alzheimer’s disease or even traumatic injuries.
“We believe it could be applied as a platform technology across multiple conditions,” said Eric Shusta, a professor at the University of Wisconsin-Madison in the US.
When injected into the bloodstream, many drugs cannot reach targets in the brain as the blood-brain barrier prevents large molecules from leaving the blood vessels in the brain, researchers said.
In conditions such as brain cancer, stroke, trauma and multiple sclerosis, however, the barrier becomes leaky in and around the disease locations, researchers said.
The study found that leaky barrier offers a unique point of entry, allowing molecules to access the brain and deliver drugs precisely on target.
“Molecules like this normally couldn’t ferry cargo into the brain, but anywhere there’s a blood-brain barrier disruption, they can deliver drugs right to the site of pathology,” Shusta said in a statement.
Researchers said that the technology takes advantage of the fact that many diseases disrupt body’s natural defense mechanism – the blood-brain barrier, which lines the blood vessels of the central nervous system, protecting the brain from circulating toxins or pathogens.
They also linked the molecules to a chemotherapy called doxorubicin. The treatment prolonged survival in mouse models of glioblastoma, an incurable cancer.
“This could be a way to hold therapies in place that don’t otherwise accumulate well in the brain so they can be more effective,” said Ben Umlauf from the University of Wisconsin-Madison.
“There are several disease processes that disrupt the blood-brain barrier and we could conceive of delivering a variety of different therapies with these molecules,” said John Kuo from the University of Texas in the US.
Life expectancy linked to a person’s walking speed
People who walk slowly have a lower life expectancy than those who walk fast, a recent study has claimed. According to the study published in the Journal of Mayo Clinic Proceedings, those with a habitually fast walking pace have a long life expectancy across all levels of weight status – from underweight to morbidly obese.
Underweight individuals with a slow walking pace had the lowest life expectancy (an average of 64.8 years for men, 72.4 years for women). The same pattern of results was found for waist circumference measurements.
Professor Tom Yates, the lead author of the study, said, “Our findings could help clarify the relative importance of physical fitness compared to body weight on the life expectancy of individuals. In other words, the findings suggest that perhaps physical fitness is a better indicator of life expectancy than body mass index (BMI) and that encouraging the population to engage in brisk walking may add years to their lives.”
Dr Francesco Zaccardi, co-author of the study, said, “Studies published so far have mainly shown the impact of body weight and physical fitness on mortality in terms of relative risk, for example, a 20 per cent relative increase of risk of death for every 5 kilograms per metres squared increase, compared to a reference value of a BMI of 25 kilograms per metres squared (the threshold BMI between normal weight and overweight).”
Last year, Professor Yates and his team showed that middle-aged people who reported that they are slow walkers were at higher risk of heart-related disease compared to the general population.
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