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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In a commentary published in Clinical Investigation, Hennekens and David J. Bjorkman, M.D., M.S.P.H., dean and executive director of medical affairs for the Charles E. Schmidt College of Medicine consider the emerging evidence on aspirin in the prevention of colorectal and other cancers and provide advice to doctors. “All patients suffering from blockage of an artery in the heart or brain should receive 325 mg regular aspirin promptly and daily aspirin thereafter to reduce their death rate as well as subsequent heart attacks and strokes,” said Hennekens. 

In addition, he also stressed that “among long-term survivors of prior heart attacks, occlusive strokes or blockages in the arteries of the legs, aspirin should be continued long-term unless there is a specific contraindication.” Hennekens and Bjorkman advise doctors that, based on the current totality of evidence, in the primary prevention of vascular disease and cancer, any judgments about prescribing long-term aspirin therapy for apparently healthy individuals should be based on individual clinical judgments between the doctor and each of his or her patients.

General guidelines that advocate the routine use of aspirin in all apparently healthy individuals do not seem to be justified for the primary prevention of either cardiovascular disease (CVD) or cancer. The increasing burden of CVD in developed and developing countries underscores the need for more widespread therapeutic lifestyle changes as well as the adjunctive use of drug therapies of proven net benefit in the primary prevention of CVD. These should include statins to lower cholesterol, and the multiple drug therapies likely to be necessary to achieve control of high blood pressure.

 Hennekens was the first to discover that aspirin prevents a first heart attack and has lifesaving benefits when given during a heart attack or among long-term survivors of prior events. Science Watch ranked Hennekens as the third most widely cited medical researcher in the world from 1995-2005, and five of the top 20 were his former trainees and/or fellows. In 2012, Science Heroes ranked Hennekens No. 81 in the history of the world for having saved more than 1.1 million lives.

On March 2, the American Heart Association honored the Charles E. Schmidt College of Medicine as well as Hennekens, Dick and Barbara Schmidt, and Bjorkman for their past, current, and future contributions to reducing suffering and death from heart attacks and strokes. On May 1, Hennekens received the Presidential Award from his alma mater, Queens College, the highest honour bestowed upon any graduate.

The statement is published online in the association’s journal, Circulation. ‘Pet ownership, particularly dog ownership, is probably associated with a decreased risk of heart disease,’ said Glenn N. Levine, MD, professor at Baylor College of Medicine in Houston, Texas. ‘In essence, data suggest that there probably is an association between pet ownership and decreased cardiovascular risk,’ Levine said. ‘What’s less clear is whether the act of adopting or acquiring a pet could lead to a reduction in cardiovascular risk in those with pre-existing disease. Further research, including better quality studies, is needed to more definitively answer this question.’

Source: IANS

For the study, researchers tracked the health of 6,500 Danish 22-year-old men for 33 years up to the age of 55. Almost half of those classified as obese at the age of 22 were diagnosed with diabetes, high blood pressure, heart attack, stroke, blood clots in the legs or lungs, or had died before reaching the age of 55. The latest findings have prompted researchers to warn that the continuing rise in obesity may counteract the fall in deaths from heart disease. “Obesity-related morbidity and mortality will, in decades to come, place an unprecedented burden on healthcare systems worldwide,” said researchers. It may be worth remembering normal weight is classified as a body mass index (BMI) of between 18.5 and 25; obesity is classified as a BMI of 30 or more.

Source: IANS

‘We need to build awareness on cardio-vascular disease. Heart wellness programmes, with timely and effective medical and interventional management, may help us in curbing the rising menace of coronary artery disease in India,’ said Naresh Trehan, chairman and managing director, Medanta Medicity told reporters.

Medanta Medicity has started India Prevent, an NGO which will come up with a programme to eradicate heart attacks. ‘The NGO will help cardio-vascular patients adopt a healthy lifestyle, including heart friendly nutrition, exercises, tobacco abstinence, weight management, hypertension, diabetes care and stress management will enhance corporate health,’ Trehan said.

According to doctors, India holds more than 60 percent of cardio vascular disease burn of the world. Death from cardio vascular disease in India is estimated to be 15 lakh per year.

Source: IANS

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. 

The policies championed by Prof Boyle in the UK were instrumental in halving deaths due to heart disease over an eight-year period. Whilst acknowledging the differences in healthcare systems between India and the UK, he believes that many of the policies for which he was responsible for implementing in the UK could also be applied here to significant effect. Most importantly, medical professionals need to engage government at both a national and local level to agree on a concerted plan of action for both the prevention and treatment of heart disease.

 There should also be good quality data monitoring put in place to accurately track its success. Prevention of heart disease needs to be achieved through promoting the adoption of more healthy lifestyles (a diet involving less fat and more fibre; increased amounts of exercise; less tobacco chewing); and routine screening of everyone over 40 with suspected risk factors (a family history of heart disease; overweight; high blood pressure; high cholesterol). Treatment of established heart disease needs to include effective lowering of both blood pressure and cholesterol, which could be cost-effectively achieved with the use of relatively cheap generic drugs.

 ‘India is facing a tsunami of heart disease in the very near future unless effective action is taken to reduce both the prevention and treatment of this condition over the long term’, commented Prof Boyle. ‘Quite a apart from the human cost, this makes a lot of sense economically: in the UK, the cost of effectively promoting the concept of lifetime risk assessment has proved to be only a fifth of the resulting savings due to improved economic productivity and reduced chronic treatment plus social care costs.’ Professor Boyle has been supported on his visit to India with an educational grant from Biosensors International, a global medical device company specialising in interventional cardiology.

Here are 15 health benefits of methi (fenugreek):

Increase breast milk production

Fenugreek ranks high among the ‘must haves’ for nursing mothers. This is due to the presence of diosgenin in the spice which increases milk production in lactating mothers.

Induce and ease child birth

Fenugreek has been known to be helpful in inducing childbirth by stimulating uterine contractions. It is also known to reduce labour pain. But here’s a word of caution. Excess intake of fenugreek seeds during pregnancy could put you in risk of miscarriage or premature childbirth.

Ease women’s health problems

Fenugreek contains compounds like diosgenin and isoflavones with oestrogen-like properties which help reduce symptoms like discomfort and menstrual cramps associated with PMS. These compounds also ease menopausal symptoms like hot flashes and mood fluctuations. Women are more prone to iron deficiency during adolescence (initiation of menstrual periods), during pregnancy and breastfeeding. Including green leafy veggies like fenugreek (methi) in your diet can supply a good amount of iron. But make sure to add tomatoes or potatoes to the preparations to enhance the iron absorption.

Breast Enlargement

Want to enlarge your breasts? Include fenugreek in your regular diet. The oestrogen-like property of fenugreek can help in breast enlargement by balancing hormones in women.

Reduce cholesterol

According to studies fenugreek helps to reduce cholesterol level, especially that of the low density lipoprotein (LDL).

Reduce cardiovascular risk

Fenugreek seed has cardiovascular benefits due to the presence of galactomannan. It lowers the risk of heart attack. It is also an excellent source of potassium which counters the action of sodium to help control heart rate and blood pressure.

Control diabetes

Fenugreek is beneficial for people with diabetes.  Galactomannan, a natural soluble fibre present in fenugreek slows down the rate of sugar absorption into blood. Fenugreek also contains amino acid responsible for inducing the production of insulin.

Aid digestion

Fenugreek helps flush out harmful toxins. It relieves indigestion and helps treat constipation.

Cure acid reflux or heartburn

One teaspoon of fenugreek seeds in your food can be an effective remedy for acid reflux or heartburn. Mucilage of fenugreek seeds coat the lining of the stomach and intestine and sooth irritated gastrointestinal tissues. Before consuming, you can soak the methi seeds in water to make their outer coat mucilaginous.

Remedy for fever and sore throat

Fenugreek when taken with a teaspoon of lemon and honey can work wonders to reduce fever by nourishing the body. The soothing effect of mucilage in fenugreek also helps to relieve cough and pain from sore throat.

Prevent colon cancer

The fibre content (saponins, mucilage, etc.) of fenugreek binds to toxins in the food and flush them out. This in turn helps to protect the mucus membrane of the colon from cancers.

Lose weight by suppressing appetite

Include fenugreek in your weight loss diet by chewing soaked methi seeds in the morning on an empty stomach. The natural soluble fibre in the fenugreek can swell and fill the stomach thereby suppressing your appetite.

Cure for skin inflammation and scars

Apply a clean cloth soaked in methi seed paste for effective treatment of skin problems like burns, boils, eczema, etc. Fenugreek seeds also help in getting rid of scars.

Beauty product

Fenugreek can be an excellent ingredient for your home-made beauty product. Fenugreek can be used in face packs to help prevent blackheads, pimples, wrinkles, etc. Washing your face with water boiled with fenugreek seeds or applying a paste of fresh fenugreek leaves for twenty minutes on your face can work wonders for your skin.

Solution to hair problems

Using fenugreek as a part of your diet or as a paste to directly apply on your hair makes your hair shiny and black. Massaging your head everyday with boiled fenugreek seeds soaked overnight in coconut oil can be an excellent remedy for thinning of hair and hair fall. What more? Fenugreek is also great to keep the dandruff away.

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Dr Anitha: When you think of high blood pressure the last thing that comes to your mind is gum disease. But we do hear there is a two-way relationship between them. Please tell us more.

Dr Richard Pereira: Like any hollow tube which transports a fluid inside it, our blood vessels have a certain resistance to the flow of blood. In case of hypertension, this resistance increases and flow of blood is hampered. Blood vessels all over the body are affected and so are so those in the gums. This causes decreased blood supply, oxygen and nutrition thus affecting the health of the gums and the periodontium (supporting structure connecting the tooth and the gums). It also  impairs the healing capacity of the tissues resulting in untimely loss of tooth.

Dr Himani Gupta: That’s not all. Gum disease can worsen heart disease as well. Due to hypertension, a mass called as an atheroma is produced in the walls of the blood vessel. Untreated gum disease (periodontitis) provides a significant and persistent reservoir of bacteria and their products. These can lodge into the atheroma and when coupled with cholesterol deposition, become a source of infection. This bacteria-laden atheroma may travel to different organs (embolism) and subsequently may lead to heart attack or stroke.

Dr Anitha: The connection is amazing. Thanks for enlightening our audience about it. So, logically, if one keeps his gums healthy, it can help in preventing heart disease? Can you give us some tips to do so?

Dr Richard Pereira: It has been estimated that the risk of having a heart attack increases by 34% if the patient suffers from gum disease as well. These statistics make it imperative that light be thrown upon the prevention of periodontitis. Firstly, a timely check-up by your dentist is advisable along with scaling and root planing so as to eliminate bacterial reservoirs in dental plaque. As bacteria can travel from the gums into the circulation during routine activities like chewing and flossing, care has to be taken to destroy these disease causing bacteria by adhering to recommended brushing technique and use of a good mouthwash. These measures can prevent periodontitis related hypertensive complications provided that the other risk factors are in control as well. In short, healthy gums give you a healthy heart.

Dr Anitha: Do the drugs prescribed for hypertension have any effect on gums? If so, what can be done about it?

Dr Himani Gupta: Hypertension may be controlled with an assortment of anti-hypertensive drugs. Calcium channel blockers are one such group of drugs that may have a side effect of producing gum overgrowth or enlargement. The outgrowth of gums lead to aesthetic disfigurement, difficulty in chewing food, problems in speaking (phonetics) and hindrance in oral hygiene maintenance. These areas may also get secondarily infected resulting in bluish red discoloration of gums that bleed easily.

This problem can be counteracted by altering the type of anti-hypertensive drug by physician’s consent. If the growths persist, removal or excision (gingivectomy) can be done by a gum surgeon (periodontist). Oral hygiene measures should be reinforced. Nutrition should be taken care of such that it is well supplemented with antioxidants and potassium.

Gumcare Multispeciality Dental Clinic is managed by Dr Richard Pereira and Dr Himani Gupta. For further details, visit their site.

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.

Read: Why hypertension is more dangerous than you think

Read: How hypertension can affect your sex life

Watch: Complications of Hypertension

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