According to the WHO (World Health Organisation),  one in three people world over suffer from high blood pressure*. With India forming a significant part of this statistic, it is time we took notice. This year’s theme for World Hypertension day is ‘Healthy Heart Beat-Healthy Blood Pressure’. In this post, we have tried to explain what the relation between the two is.

How are heartbeats connected to blood pressure?

When the heart beats, it acts like a pump that takes in de-oxygenated blood from the body, and pushes out oxygenated blood with great pressure. The pushing out of blood leads to  pressure being exerted by the blood on the blood vessels in the body. This is known as blood pressure. Although the workings of the heart are not that simple, the explanation shows that there is a direct correlation between  the number of heartbeats and blood pressure. In some cases the heart may beat at a normal rate, but due to other factors, like blocks in the blood vessels, irregularities of the valves within the heart etc, a person could suffer from high blood pressure. According to Dr Aashish Contractor, preventive cardiologist at the Asian Heart Institute, ‘Optimal blood pressure is below 120/80. A person can be diagnosed with high blood pressure if his/her BP is above 140/90. Anything in between is considered as borderline’.

Apart from this, some people might suffer from a condition called Atrial fibrillation or AF. Although this condition is not very common, people with this condition experience extremely irregular heartbeats, which then leads to high or low blood pressure, dizziness and in some cases can lead to a heart attack or stroke. It may have no symptoms and can only be detected by either checking the pulse, or by a healthcare professional. An episode of AF can lead to formation of blood clots, which may flow out of the heart and cause blocks in other blood vessels, leading to severe consequences strokes. AF episodes first start off intermittently and may become permanent in the long run.

Hypertension or high blood pressure is the most common risk factor that leads to AF. If both AF and hypertension coexist, it puts a person at higher risk of suffering from a stroke.

What is normal and what isn’t when it comes to heartbeats? 

According to Dr Aashish Contractor, ‘a normal heart rate consists of 60-90 heart beats per minute, when a person is at rest. Anything above or below this can be considered abnormal’. According to specialists, a heart rate that is higher than 100 to 150 beats is considered extremely dangerous. Symptoms usually range from feeling faint, uneasiness usually in the chest, fainting etc.

How does one detect any kind of abnormality in the heartbeats?

If a person feels that his/her heartbeat might be above or below normal, the best way to detect it is to simply measure his/her blood pressure and pulse rate. In the case of patients who are suffering from AF, their doctor will perform some simple tests to detect it. He/she may perform tests like an EKG (Electrocardiography), Holter test, Stress test, chest X-ray, and in some cases a blood test as well. All these tests are absolutely painless and non invasive in nature. If a doctor finds it difficult to detect the extent of the AF he may prescribe an Transoesophageal echocardiography (TEE). This is a test where the doctor will use a probe to check for irregular heartbeats through the oesophagus.

What are the treatment options for  irregular heartbeats?

There are basically two ways to control irregular heartbeats, they are – the rhythm control method  and rate control method.

The aim of the rhythm control method is to regularize  a person’s heartbeat. A doctor may primarily choose to treat a patient with medication, and if that fails, the patient might be given a controlled shock over the heart to regularize his/her  heart rate. Dr Contractor says , ‘All  procedures must be  strictly monitored by a trained professional, and should never be tried without supervision’.

The rate control method employs medication to slow the heart rate of a person. In most cases these medications also help to control irregular heart beats.

Lastly, remember that prevention is always better than cure, so get some exercise, eat healthy and get regular check ups to stay in shape. 

Source: * WHO

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If it is not possible to subject an individual to PAMI due to any reasons, then giving intravenous clot busters (thrombolysis) is an alternative. The success of clot buster medicine stands at about 55 per cent and the chances become even lesser if the patient reaches the hospital late. The most ideal time for delivery of the medication is said to be within the first 30 minutes after the onset of symptoms, usually diagnosed by an ECG. Although using clot busting medication is an easier option, it is not as effective as an angioplasty.

The cardiologist will use a stent to prop open the affected artery during an angioplasty and will help replace the lost blood flow. A stent is a steel or steel-like metal wire mesh scaffold to prop open the clogged blood vessel. There are different types of stents approved for use with the cost varying between INR 35000-INR 55000 (non-medicated stents) or INR 80000-INR 125000 (medicated stents). Bio degradable stents costs INR 270000-INR 285000 per stent.

Non-medicated stents are relatively cheaper and equally effective and safe. Medicated stents have the same base of non-medicated stents over which there is a uniform coat of a drug in fixed concentration. This drug is slowly released locally over a period of 30 to 120 days at the site of implantation. This also prevents cell multiplication(common cause of re-blockade or re-stenosis over period of time) to a great extent. Those who have diabetes mellitus and small vessel diameter (caliber) should opt for drug coated stents.

What type of angioplasty is ideal?

Primary angioplasty gives ideal results. Called PAMI (Primary angioplasty In Acute Myocardial Infarction) It can prevent more than 50 per cent deaths, avoid repeated heart attacks and heart pump failure. An angioplasty requires an average of two to three days hospitalization followed by lifestyle modification, diet modification and proper medications. Also one has to maintain proper blood pressure, proper sugar levels & cholesterol levels.

How do stents work?

In a blocked segment of a blood vessel, they are deployed over a balloon. After deployment at a particular pressure the balloon catheter and wires are removed out but the stent stays expanded within the blood vessel keeping it widely open at that place. So it allows free flow of blood in a previously obstructed case.

How do doctors choose a particular type of stent?

The cardiologist usually chooses drug-eluting stents (stents which release drugs) if a person has a long segment block, when the vessel diameter is relatively small or if an individual is diabetic.

He/she chooses bare metal stents in the case of short focal blocks, in elderly patients (it may be unsafe to use dual blood thinners like aspirin and clopidogrel indefinitely). It is the stent of choice for acute heart attacks and for large diameter blood vessels as well.                             

Can a stent be removed after it has been inserted like other implants?

No.  Once a stent is delivered or deployed it is not removed. Over a period of time it becomes an integral part of the vessel wall.  Months later even if a small camera (angioscope) is passed through the vessel then the stent is invisible as it gets embedded into the vessel layer and normal cells grow over it covering it completely.  This process is called as endothelisation.  This process takes about a month to a year depending upon the stent type.  It is very important to take dual blood thinners (Aspirin and Clopidogrel) until this time.

 If I have a stent, is it something I have to worried about all my life?

Unfortunately, a patient who has had a heart attack, becomes a heart patient for life. After an angioplasty, regular medication, lifestyle changes and regular follow-ups become mandatory for every patient. After a period, the doctor might reduce the number and concentration of drugs to be taken, but he/she will never advise you to stop basic drugs like aspirin and statins (cholesterol lowering drugs).  It is unsafe to stop these drugs in the first year. Clopidogrel may be stopped anywhere after one or three years.  However, depending on several factors, some doctors may prefer to continue combination of Aspirin and Clopidogrel for a long time. 

When the patient has to undergo any other major surgeries while on the blood thinner medication, there is a risk of excessive bleeding. Ideally such surgeries should be planned in advance, and in case of emergent procedures, the patient should inform the surgeon about his/her condition.  

Can a stent develop a clot or block again?

Yes, there is a 1-10 per cent risk for stents to get re-blocked. It is not because of the techniques or the material used, but the natural functioning of the body in some people.  

How can one reduce the occurrence of these blocks?

Modification of lifestyle, changing the diet, regular exercise, regular medication and meticulous follow-up with a cardiologist or a physician can help you effectively minimize the chances of recurrence of a block.

If a stent is re-blocked, what are the treatment options available? 

The only option is a repeat angioplasty procedure which may be just a balloon dilatation with either a routine angioplasty balloon or with a specialized drug eluting balloon (DEB).  Majority of times if the vessel size permits it, then another stent is deployed within  – stent within a stent.

Why are stents so expensive? Are there any cheaper options?

Stents are life-saving smart implant devices and are currently not manufactured in India on a large scale. Because they are imported, they are expensive. Government levies tax, VAT and octroi (now LBT)  which further adds to the cost.

What are the complications of angioplasty?

The major risk or complications of angioplasty include bleeding or hematoma (collection of blood) at the punctured site, sudden abrupt closure of artery with fresh clot, heart attack requiring an emergency CABG (or bypass graft procedure) and rarely death.

What are the benefits of angioplasty over bypass surgery?

Fewer chances of infection, short recovery period, short hospitalization, negligible blood loss, rare blood transfusion are the advantages of angioplasty. Patient can resume all physical & mental activity within seven days.

The WHO estimates that the tobacco industry spends billions around the year in advertising, promotion and sponsorship. In countries like ours where direct advertising is banned, the tobacco industry usually adopts a technique called ‘surrogate advertising’ in which they promote other products to drill the brand name into the consumer. The long-term goal is a total ban on direct and indirect advertising, promotion and sponsorship, as provided in guidelines to Article 13 of the WHO Framework Convention on Tobacco Control, can substantially reduce tobacco consumption and protect people, particularly the youth, from industry marketing tactics. To be effective, bans must be complete and apply to all marketing categories.

The problem is the sheer positioning linking the tobacco products to success, coolness and glamour.  The devastating results are there to see with tobacco use linked to heart disease, cancer, lung disease, hypertension, erectile dysfunction and other non-communicable diseases. In fact, it’s strange that despite its well-known ill-effects tobacco usage still remains as popular as ever.

In many countries, tobacco is promoted wherever the youth can be influenced – the movies, on the Internet, in fashion magazines and at music and sports events. These ads also help to reassure current smokers and create a climate where smoking is seen as normal social behaviour. This has created an illusion that tobacco is just an ordinary consumer product, not one that kills half its users and maims almost all of them.  There’s enough evidence to that adolescents who are exposed to tobacco use at a young age are likely to stay hooked for the rest of their lives.

Therefore, it is important that enforceable measures be put into place to ban all forms of advertising including television, radio, print publications and billboards. There is also a need to ensure that indirect forms of advertising, such as brand stretching, point of sale display of product and tobacco industry-sponsored CSR (corporate social responsibility) programmes, are also addressed. The battle against tobacco is one we can’t afford to lose; the lives of millions of people depend on it.

Silent heart attacks are the same as any other attack, but the person just doesn’t feel it. This is usually because  of  possible nerve damage or neuropathy around the heart due to long term diseases or narrowing of the coronary arteries (the main arteries of the heart) which impedes blood flow to the heart. Ironically, people who are at high risk for heart attack are most susceptible to suffer from a silent heart attack.

Risk factors include:

• Diabetes
• High blood pressure
• Smoking
• Family history of heart trouble
• High cholesterol

Symptoms:

A silent heart attack is when the person does not experience the usual chest pain, chest discomfort or shortness of breath, etc. and the person who experiences it may not realise he’s suffering from a heart attack. 

Some of the most common tell-tale signs are — feeling increased fatigue after normal activities, shortness of breath and sleep disturbances, persistent feeling of indigestion, burping, bloating of  the stomach with no history of gastric disorders.

Because a patient may not be able to identify the exact reason for the discomfort, most doctors cannot treat the patient within the ‘golden hour’ or golden 90 minutes’ (a term used to describe the crucial 90 minutes after the attack during which the patient is most likely to make a full recover), leading to a lower heart pumping rate. Another risk these patients face is the fact that they are susceptible to recurrent episodes which could lead to heart failure, pump failure and congestive heart failure.

Diagnosis:

In most cases a silent heart attack is not diagnosed until after it happens. Here are the tests that a doctor would use to diagnose this condition:

• An electrocardiogram (ECG),
•  2 -D ECHO-color Doppler ,
• The presence of cardiac enzymes (proteins which are released by the dead heart muscle) which are usually elevated in case of a heart attack.

Treatment:

• Medications that thin the blood and make it easier for blood to travel through the arteries.
• Anti-arrhythmics (medicines that keep a check on heart rhythm) help to decrease the formation of blood clots.
• Managing high blood pressure helps to reduce the risk of further damage to the heart and other major organs.
• Modifying lifestyle
• Control of diabetes
• Controlling  high cholesterol and triglyceride levels
• Eating a heart healthy diet of fruits, vegetables, nuts and lean meats
• Getting the proper rest and exercise

While most people don’t think they are likely to have a serious condition like a heart attack, there are a few who have a  higher risk than other people. People who have a family history of the disease, are overweight, have diabetes or  have high blood pressure tend to suffer from silent heart attacks. Doctors advice that people with heart disease should go in for early definitive test like a coronary angiography and if required an angioplasty or by-pass surgery. Multiple aggressive counselling sessions are required for a person to get convinced for definitive management. In addition to this the fear of surgery pushes people to try out short-cuts which in turn can be more dangerous.

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What drugs are used?

Several antihypertensive drugs are available and which one your doctor prescribes will depend on several factors. Diuretics, direct-acting vasodilators, anti-adrenergics, angiotensin converting enzyme (ACE) inhibitors, calcium-channel blockers, direct renin inhibitors and angiotensin receptor blockers are some of the categories of drugs commonly prescribed in hyptertensive patients.

How do they act?

Antihypertensive drugs act by different mechanisms to achieve the same result – to reduce high blood pressure to normal levels. To be able to understand how these drugs act, let us understand how the body usually regulates blood pressure. Blood pressure depends on three important factors – how fast the heart beats, the amount of blood the heart pumps out at each beat and the width of the arteries through which the blood travels.

Each of these factors can be affected by how your nervous system is functioning and the levels of particular hormones in blood. Blood pressure generally increases if

• The brain produces excess of catecholamine hormones or
• The kidneys produce too much of angiotensin hormone or
• There is an excess of sodium in the blood

Each category of antihypertensive drugs acts by regulating one of these processes to control the increase in blood pressure.

Diuretics: Drain out excess sodium and water from your body.

Anti-adrenergics: Act on either the alpha or beta type of receptors and are accordingly called alpha blockers or beta blockers. Alpha blockers block the action of the nervous system on the blood vessels and this prevents the arteries from growing narrow. Beta blockers reduce the heart rate, slow down the strength of each heart contraction and also inhibit production of angiotensin, leading to a drop in blood pressure.

ACE inhibitors: Prevent formation of angiotensin by inhibiting an important enzyme in the kidney.

Calcium channel blockers: Prevent calcium from entering the muscles in the heart and blood vessels; the heart rate drops and blood vessels stay wide open, so the blood pressure does not rise.

Direct renin inhibitors: Prevent the enzyme renin from catalyzing the reactions that result in formation of angiotensin; lesser angiotensin production means blood pressure stays low.

Angiotensin receptor blockers: Prevent angiotensin from combining with its receptors and so blood pressure stays normal.

How does the doctor decide which drug to give you?

Which drug your doctor prescribes depends on the specific factor that is causing hypertension and it is difficult to state that any one class of drugs is superior to the others.

When you are first diagnosed with mild hypertension, the first line of treatment is to use a diuretic. If this does not give the desired results, the doctor may add a second drug for better results. Combination therapy is sometimes used for hypertension and some drug combinations are available as a single pill. For example, a beta blocker with a diuretic or an ACE inhibitor with a diuretic may be used. Which particular combination your doctor advises depends on whether you have some other health condition.

If you have gout, a diuretic is ruled out because it can aggravate your gout; if you have kidney disease, you may do well with ACE inhibitors, but the doctor will advise you to regularly test levels of potassium that may accumulate and worsen your kidney problems. Diabetic patients are generally prescribed ACE inhibitors or angiotensin receptor blockers. Diuretics are avoided because they may cause a rise in blood sugar levels; beta blockers are also not good because they can hide the condition of blood sugar levels dropping to an unhealthy level.

Quite a few people with hypertension also suffer from high cholesterol levels; in such cases, beta blockers are out of question because they tend to increase levels of triglycerides as well as decrease the ‘good’ HDL cholesterol. Alpha blockers are a better option because they tend to raise HDL cholesterol and also reduce total cholesterol levels. Or a doctor may choose to give you a calcium channel blocker because it does not affect blood lipid levels at all. If you have asthma or chronic bronchitis, your doctor will prescribe any anti-hypertensive other than beta blockers because these can aggravate your existing disease. Patients with coronary artery disease may be given a combination of calcium channel blockers and beta blockers.

Side-effects of anti-hypertensive drugs

Each class of antihypertensive drugs has its own unique drawbacks. Diuretics can cause loss of potassium, frequent urination, fatigue, increased blood sugar levels, gout, muscle cramps and erectile dysfunction in men. Beta blockers can cause respiratory problems to worsen and mask the dangerous decrease of blood sugar in diabetic patients. They may also lead to insomnia and depression. Alpha blockers can cause heart palpitations, headache, nasal congestion, dizziness, dry mouth and a sudden drop in blood pressure when you stand up. Calcium channel blockers are known to cause headaches, edema, constipation and dizziness.

ACE inhibitors cause some people to develop a dry cough or reduce their taste sensations; in some cases, they may also cause potassium levels to go up and therefore, should be used with caution in patients who have kidney problems. The most recent category of angiotensin receptor blocker drugs are free from most of these side effects and this had made them a popular choice in treating patients with hypertension.

When you are on anti-hypertensive drugs, it is important to remember that the drug you take may interact with other medication you take. Even a simple over the counter painkiller or cough and cold medicine can react with your anti-hypertensive medicine to cause undesirable effects that may or may not be dangerous. Therefore, before you take any other medicine make it a point to ask your doctor about whether it is safe to do so.

With the right medication taken as recommended, it is possible to control your blood pressure. However, make sure you do not miss out on a healthy diet and regular exercise – these are important in deciding how well your body copes with hypertension and can even help you get by with lowest doses of anti-hypertensive medication.

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Coronary artery disease (CAD) is one of the biggest killers in the world today and most common cause of heart attacks. It’s caused by plaque build-up along the inner walls of the arteries and it can be caused due to numerous reasons. The most common ones are lifestyle habits like an unhealthy diet, lack of exercise, alcohol consumption and smoking. The more urgent cases require an angioplasty or bypass surgery. 

The treatment of CAD depends on many factors – patient’s age, heart function and overall health. Often it can be something as simple as focussing on lifestyle changes like quitting smoking, eating a heart healthy diet and engaging in physical activity. Medical management includes prescribing aspirin, medicines to reduce the workload of the heart or medicines to reduce high blood cholesterol levels or high blood pressure are also given. If none of these treatments prove effective, a patient has to undergo either of the two procedures – a balloon angioplasty or a bypass surgery.  While a bypass surgery involves grafting arteries or veins from other parts of the body area to the coronary arteries, a balloon angioplasty involves threading a tube into the artery which will expand and allow more blood flow. Dr Vijay Surase, an interventional cardiologist at Jupiter Hospital, Mumbai tells us about the latest in angioplasty – biodegradable stents!

Balloon angioplasty stenting is a procedure which involves threading a thin tube into the artery and then expanding the balloon-like apparatus as a way to increase the size of the artery to increase blood flow. The first angioplasty was performed in 1977 and the only drawback was the effect of the stents left behind in the patient’s arteries. Being a foreign object, the stent could cause an adverse response from the immune system. This can lead to problems like scar tissue over the stent and also clot formation. Since the early days, cardiologists have been dreaming of a scaffold that would disappear after the job was done. They finally saw that materialise in 2012 with the advent of biodegradable stents.

But to understand the how marvellous biodegradable stents are, we need to understand what stents are. Basically, they  are slotted metal tubes effectively appearing like a spring of a ball pen refill but with very fine steel metal or other metal alloy threads knitted to each other. They are usually of two types – Bare Metal Stents and Drug Eluting Stents.

The drug eluting stent is the more advanced and effective of the two and work by releasing a drug to block cell proliferation. The newest generation of drug eluting stents are the bio-absorbable stents also known as the bio-resorbable vascular scaffold system (BVSS).

The bioabsorable stents are usually made of four components:

• Bioabsorbable scaffold
• Bioabsrobable coating
• Drug – Everolimus  (an immunosuppressant to prevent rejection)
• Delivery System

Why are biodegradable stents better?

The stents are made of polylactic acid, a proven biocompatible material that is usually used in medical implants. As with a metallic stent, bio-absorbable stent is designed to restore blood flow by propping a clogged vessel open, and to provide support until the blood vessel heals. Unlike a metallic stent, however, a bio-absorbable device is designed to be slowly metabolized by the body and completely absorbed over time. This results in a zero percent rate of stent thrombosis (blood clot formation) for all patients over the next two years.

Benefits of biodegradable stents (though technically they aren’t stents and a better term would be scaffold):

• Vessel scaffolding is only needed for a while
• It leaves no residual scaffold behind
• They restore the vessel to a natural state, which makes it capable of natural vascular function
• There is no vessel irritation and inflammation
• Vessels remain free for further treatment (a metal stent would just be there and make that vessel unusable) and it can be used for further stenting or in case a bypass surgery is needed

In totality, it’s one of the greatest medical inventions in recent history because of its ability to vanish after its work is done. It’s like ice that melts and becomes water. The only by-products left in this cases are water and carbon dioxide. The water is used by local tissues and carbon dioxide is used for energy production at cellular levels. Despite being expensive, there’s reason to believe that biodegradable stents will become the norm in the future. 

April 7 is World Health day. And this year, the theme is ‘Control your hypertension’.

In this post, we bring you some myths that surround the disease and are often the cause for many untimely deaths.

Myth 1: High blood pressure is an old age disease.

Hypertension is not just an old age problem anymore. More and more young people are suffering from high blood pressure related ailments. With age blood vessels tend to weaken and hence the chances of getting high blood pressure increase as you grow older. As per the World Health Organization (WHO), high blood pressure affects every third person above the age of 18.  The proportion increases with age, from 1 in 10 people in their 20s and 30s to 5 in 10 people in their 50s.

Myth 2: Women are less likely to get hypertension than men.

Both sexes are at risk of developing hypertension affects. In India, 23.10 per cent men and 22.60 per cent women above 25 years suffer from hypertension. However, the condition is more common in men under 45 years old and in women after menopause.

Myth 3: If I had high blood pressure I would get headaches.

Hypertension is a ‘silent killer’ which has no real indicators and can strike at any moment. There are no symptoms most of the time. High blood pressure in most cases is established during a visit to the doctor. Hence, you may develop heart and kidney problems without knowing you have high blood pressure.

Myth 4: A single high blood pressure reading means I have hypertension

Normally, your blood pressure varies throughout the day. It lowers as you sleep and rises when you wake up. Blood pressure also rises when you’re nervous, excited or active. Hence, a single reading of high blood pressure is not the basis for diagnosing hypertension. In order to diagnose you with high blood pressure you should have persistently high readings over time. Likewise, one normal reading doesn’t mean you don’t have high blood pressure.

Myth 5: Hypertension can’t be prevented if I’m in high risk category

Even if hypertension runs in your family you can take certain preventive measures to keep high blood pressure at arm’s length. Make dietary and lifestyle changes – a healthy diet, decreased salt intake, regular exercise, quit smoking, reduce stress, etc. If you are obese or overweight, aim to lose those extra kilos.

Myth 6: It is okay if only one of the blood pressure parameters is high

Our heart can tolerate occasional increases in systolic blood pressure compared to diastolic pressure. Consistently high diastolic pressure can lead to health problems. However, high systolic pressure is of concern in people above the age of 50. Hence it is advisable to take action if either of your blood pressure readings is consistently high.

Myth 7: My salt intake is under control because I don’t use much salt in my cooking.

Controlling salt intake means more than not using salt in your cooking. You have to consider the hidden salt present in pickles and papads, processed foods and bakery eatables too. Processed foods often contain high concentrations of sodium; typical examples are foods whose labels list sodium chloride, sodium bicarbonate (baking soda) or monosodium glutamate (MSG). Sweet baked foods may not exhibit a salty taste. But they contain baking powder or baking soda which is a salt of sodium.

Myth 8: High blood pressure isn’t a cause for much concern

Since there are no symptoms most of the time, you may not consider high blood pressure to be a big deal. The bad news is that long standing hypertension can cause problems with your vision (hypertensive retinopathy) and decrease blood supply to your legs. Hypertension is a major risk factor for heart attacks, heart failure, stroke, bleeding from large blood vessel (aortic aneurysm), chronic kidney disease (hypertensive nephropathy), etc. What more – they can cause erectile dysfunction and affect your sex life.

Myth 9: High blood pressure can be ‘cured’ with medication.

Hypertension can be managed but not cured. It can be a lifelong disease. You will need to make dietary and lifestyle changes, and may need medication every day for the rest of your life.

Myth 10: If my blood pressure readings were fine the last time, I can skip the medication.

You are not equipped or knowledgeable enough to take decisions about your medications for hypertension. It is best that your doctor makes the changes in the dosages, drugs etc.

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What is blood pressure?

 High blood pressure is called the ‘silent killer’ because it usually has no symptoms and causes no discomfort.  You can have it and not even know it.  People with high blood pressure have a much greater risk of having heart attacks and strokes.

Blood circulates through a network of arteries, veins, and capillaries to deliver food and oxygen to all the cells of the body.  The heart provides the force to push the blood through this network of vessels.  The force or pressure of the blood against the walls of the arteries is known as blood pressure.

 The pressure of the blood against the walls of your arteries can increase because of several factors, including:

• An increase in the amount of blood pumped through the blood vessels.
• An increase in the resistance to blood flow.  Resistance may result from narrowing of the blood vessels or stiffness in the walls of the blood vessels. 

 Systolic blood pressure (top or high number) is the pressure inside your arteries when the heart contracts and pumps blood into your arteries.

 Diastolic blood pressure (bottom or low number) is the pressure inside your arteries when the heart is relaxing and filling with blood.

 The latest international guidelines for blood pressure:

 Causes of High Blood Pressure

 In over 90 percent of people with high blood pressure, the exact cause of their high blood pressure is unknown.  There are a number of factors that increase your risk of developing high blood pressure. They include:

Risk Factors You Can’t Control

• Genetics
• Age — The older you are, the more likely you are to have high blood pressure.
• Sex — Men have a greater risk than women until age 55.  After 55, women have a higher risk.

 Risk Factors You Can Control

• Being overweight
• Being physically inactive
• Eating too much salt (sodium)
• Drinking too much alcohol

 Complications of High Blood Pressure

 The medical term for high blood pressure is hypertension.  Over time, high blood pressure can damage your blood vessels and lead to serious health problems.

 Atherosclerosis, angina, and heart attack — High blood pressure speeds up the

development of atherosclerotic plaques that can clog arteries and cut off the blood flow to the heart muscle.  Limited blood flow to the heart muscle can lead to angina (chest discomfort) or even a heart attack.

 Stroke – Similar to a heart attack, a stroke is a “brain attack.” Atherosclerotic plaque that builds up in the arteries of the head and neck can limit blood flow to parts of the brain.  This is the most common cause of stroke. A stroke can also occur when high blood pressure causes weakened blood vessels in the brain to burst. 

 Peripheral vascular disease — Atherosclerotic plaque can also build up in the arteries of the legs.  This may result in severe pain during physical activity, a condition called intermittent claudication. 

 Heart failure — High blood pressure makes it harder for the heart to pump blood through the blood vessels. Like any muscle that is overworked, the heart walls may become thickened and enlarged. An enlarged heart can’t pump normally, so blood backs up in the lungs and other organs. Congestive heart failure is the result, and it is an extremely serious condition.

 Kidney damage — High blood pressure can damage the blood vessels in the kidneys.

 Eye damage — High blood pressure can damage the blood vessels of the eyes. Blindness can result.

How is High Blood Pressure diagnosed?

A single blood pressure reading that is high doesn’t necessarily mean you have high blood pressure.  Because your blood pressure can change from time to time, several readings may need to be taken to get an accurate reading.  If your blood pressure reading is high, you will need to have at least two readings taken on two or more separate occasions to confirm if you have high blood pressure.

To ensure your blood pressure readings are accurate, ideally you shouldn’t have your blood pressure taken if you have:

• Smoked within 30 minutes of the reading
• Drank caffeine or alcohol within 30 minutes
• Engaged in moderate or vigorous physical activity within an hour
• Eaten a meal within an hour
• Taken an antihistamine or cold medicine within the past six hours

Stress can also cause blood pressure to increase temporarily. In fact, some people get nervous during a visit to their doctor’s office and this causes their blood pressure to increase. They are said to have ‘white coat’ hypertension.

The author is the Head Of Department for Preventive and Rehabilitative Cardiology at the Asian heart institute

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High blood pressure or hypertension as of today remains inadequately controlled in India as large numbers of cases go undetected. And it is estimated that the number of patients in India with high blood pressure is likely to rise from about 140 million in 2008 to nearly 215 million by 2030. And it’s not just an old age problem anymore. More and more young people are suffering from high blood pressure related ailments. As per the World Health Organization (WHO), high blood pressure affects every third person above the age of 18.  The proportion increases with age, from 1 in 10 people in their 20s and 30s to 5 in 10 people in their 50s.

Blood pressure (BP) is one of the principal, critically important signs of life (vital signs). It is the pressure exerted by circulating blood upon the walls of blood vessels and is expressed as systolic/diastolic blood pressure. ‘Systolic’ refers to blood pressure when the heart beats while pumping blood and ‘diastolic’ refers to blood pressure when the heart is at rest between beats. The range of systolic blood pressure for most healthy adults is between 90 and 120 mm Hg. Normal diastolic blood pressure ranges between 60 and 80 mm Hg. Blood pressure doesn’t stay the same all the time. It lowers as you sleep and rises when you wake up. Blood pressure also rises when you’re nervous, excited or active.

What is hypertension or high blood pressure?

If your blood pressure is lower than 120/80 mmHg most of the time, it is considered normal blood pressure. If your systolic pressure is between 120 and 140, and your diastolic pressure is between 80 and 90, it is called pre-hypertension. A high blood pressure or hypertension is when your blood pressure is persistently above 140/90 mmHg. Hypertension is a chronic medical condition. Your heart needs to work harder than normal to circulate blood through your blood vessels.

Read: Don’t neglect that borderline hypertension

A high blood pressure with no obvious underlying medical condition is categorized as primary (essential) hypertension, which make up for about 90–95% of the cases. Secondary hypertension is caused by medical conditions that affect your kidneys, heart, arteries or hormone system. Often in older people with hypertension, the difference between systolic and diastolic blood pressure (pulse pressure) is increased. It is termed isolated systolic hypertension. When very high blood pressure comes on suddenly and quickly it is termed malignant hypertension. It is a medical emergency. The diastolic blood pressure reading is often above 130 mmHg.

What causes high blood pressure?

Blood pressure rises with aging because your blood vessels become stiffer as you age. Hence, there is considerable risk of becoming hypertensive in later life. In most of the cases (90-95%) the cause for hypertension is unknown. Primary hypertension is considered to be a result of a complex interaction of genes and environmental factors. Family history of high blood pressure, obesity, stress, smoking, excess alcohol consumption, increased salt consumption and diabetes increase your risk for high blood pressure. Some studies have associated low birth weight, maternal smoking and lack of breast feeding as risk factors for primary hypertension later on in life. The most common cause of secondary hypertension is kidney disease. Other causes are hormone conditions (hyperthyroidism, hypothyroidism, acromegaly, Cushing’s syndrome, pheochromocytoma, etc.), obesity, diabetes, pregnancy, sleep apnoea, coarctation of aorta, certain prescription medicines, etc. Malignant hypertension occurs in people with kidney problems, collagen vascular disorders, etc. Renal hypertension and kidney failure are high risk factors for malignant hypertension.

What are the signs and symptoms of high blood pressure?

There are no symptoms most of the time. High blood pressure in most cases is established during a visit to the doctor. Hence, you may develop heart and kidney problems without knowing you have high blood pressure. Malignant hypertension, a severe and dangerous form of high blood pressure, may manifest as a severe headache, nausea or vomiting, bad headache, confusion, anxiety, sleepiness, changes in your vision, chest pain, weakness or numbness of body or bleeding from the nose. Upon examination, your doctor may notice several signs such as swelling in the legs and feet, abnormal heart sounds, fluid in the lungs, changes in reflexes, etc. He/she may also look for tell-tale signs in the eye like narrowing of the eye blood vessels, bleeding of the retina, etc. There may also be signs of kidney failure.

Read: Symptoms of hypertension – could you be ignoring them?

How is hypertension diagnosed? What are the tests involved?

Normally, the blood pressure varies throughout the day. Hence, a single reading of high blood pressure is not the basis for diagnosing hypertension. If you have a persistently high blood pressure reading, you will be diagnosed as having a hypertension.

Blood pressure is measured with an apparatus called sphygmomanometer. It has an inflatable cuff to wrap around your arm and a mercury or mechanical manometer to measure the pressure. Manual sphygmomanometers are used with a stethoscope and are of two types – mercury sphygmomanometers in which blood pressure measurement is based on the height of a column of mercury and aneroid sphygmomanometers which are mechanical types with a dial to display measurement. Digital sphygmomanometers are electronic devices that measure blood pressures by oscillometric (wave) method and display the reading on a screen.

You will be examined for signs of heart disease, damage to the eyes, etc. Several tests may be done to assess your cholesterol levels and to look damages to your heart and kidneys.

What is the treatment for hypertension?

The main of treatment is to lower the risk of complications by keeping your blood pressure within normal range. If you have been diagnosed with pre-hypertension, you will be advised to make dietary and lifestyle changes – a healthy diet, decreased salt intake, regular exercise, quit smoking, reduce stress, etc. If you are obese or overweight, you need to lose those extra kilos. If these changes are ineffective in controlling your increased blood pressure your will be prescribed medicines to lower your blood pressure.

Read: Cut down on salt and increase exercise to keep hypertension at bay

High blood pressure can be controlled with medicine and lifestyle changes. Antihypertensive drugs like diuretics, calcium channel blockers, ACE inhibitors, vasodilators, etc. are used to treat high blood pressure. If a control over your blood pressure is not achieved with a single drug may you may be prescribed two or more drugs.

Read: Herbal remedies for hypertension

What happens if you are not treated for high blood pressure?

Long standing hypertension can cause problems with your vision (hypertensive retinopathy) and decrease blood supply to your legs. Hypertension is a major risk factor for heart attacks, heart failure, stroke, bleeding from large blood vessel (aortic aneurysm), chronic kidney disease (hypertensive nephropathy), etc.

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Watch: Complications of Hypertension

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Garlic

Garlic has been found useful in patients whose blood pressure is mildly elevated. It is believed that allicin in garlic increases the production of nitric oxide and this helps to relax the muscles of the arteries, reducing both the diastolic as well as the systolic blood pressure. To get the entire benefits of garlic, it is recommended that you peel and lightly crush the fresh garlic and consume it raw. However, garlic also has the property of thinning blood and this means the clotting ability of blood is reduced; so it is best to use garlic supplements only after you consult your doctor.

Karpuravalli

Coleus forskohlii is the Karpuravalli plant that is grown in many home gardens in South India. In research studies, it has been found to relax the smooth muscles of the arteries and this helps to lower blood pressure. It is also said to make the heartbeat stronger and slow down the pulse. Certain studies have evaluated the action of Karpuravalli tablets and chewable pills and found it helps reduce blood pressure in the elderly.

Drum Sticks

Obtained from the Moringa oleifera plant, drum sticks, called Sahjan in Hindi, are known for their high content of protein and valuable vitamins and minerals. Studies have found that extracts from the leaves of this plant help to reduce both systolic and diastolic blood pressure. The best way to harness this benefit is to cook drumsticks with lentils or dal.

Amla

Traditionally, the amla plant has been used to lower blood pressure. Recent studies have found that aqueous extracts of the leaves of the amla plant help to reduce diastolic and systolic blood pressure; amla extracts also show the ability to reduce levels of cholesterol in the blood and the liver and this could contribute to its antihypertensive action. It is believed that the vitamin C content of amla may also play a role in widening the blood vessels and this may help to reduce blood pressure. Amla is an important component of the Triphala mixture that is commercially available.  

Radish

Also called mooli in Hindi, it is a common vegetable that is used in Indian kitchens and has been shown to have antihypertensive action. This action may be a result of the high content of the mineral potassium which helps to counter the BP-increasing effects of a high-sodium diet. Radish can be cooked as a stir fry dish or even better, be eaten raw in a salad or grated and mixed with yogurt to give a tasty raita.

Sesame

In experiments, sesame or til seed has shown an ability to reduce both diastolic and systolic blood pressure. Sesame oil contains sesamin and sesaminol and these are believed to play a major role in reducing the oxidative stress in the body; this has an anti-inflammatory effect on the arterial walls, contributing towards a lowering of the blood pressure. Recent studies have found that combining sesame oil with rice bran oil helps to reduce blood pressure in hypertensive patients more effectively than taking antihypertensive medication alone.

Rauwolfia or Sarpagandha

Traditional medicine practitioners have used Rauwolfia in treating insomnia, snakebite, insanity and high blood pressure. The alkaloid reserpine extracted from this plant was one of the first potent treatments for hypertension. This helps to widen the blood vessels and lowers the heart rate; both these effects ensure the blood pressure stays low. Although both the root powder and tablets are available, it is vital Rauwolfia is taken under the supervision of a doctor because of its potent action.

Flaxseed or Alsi

Flaxseed or linseed is rich in a compound called alpha linolenic acid that is one of the important omega-3 fatty acids. Several studies have found that people with hypertension who include flaxseed in their diet have lower levels of cholesterol and also exhibit a lowering of blood pressure.

While these herbal remedies have shown promising results against hypertension, it is vital to remember that several factors can affect how well these remedies act. Therefore, if you suffer from high blood pressure and are on antihypertensive therapy, you ought to consult your doctor about using these remedies. Most importantly, never forget the other measures that can help keep your blood pressure within control – a diet rich in vegetables and fruits, cutting down on high fat dairy and meat products, eating less salt, having regular exercise and using techniques to keep the mind free of stress. 

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