World Hypertension Day Special | All you must know about high blood pressure
World Hypertension Day is observed on 17th of May each year since 2006 and is endorsed by World Hypertension League. This league is a body comprising 85 hypertension societies all over the world. The purpose being to educate the people and make them aware of Hypertension (high blood pressure) and its adverse consequences. The theme of this year is “Measure your blood pressure accurately, control it and live longer”.
Hypertension is a common cause of brain strokes, heart attacks and chronic kidney disease needing dialysis and kidney transplantations. Thus, it becomes the commonest cause of death. Most often persons having high blood pressure have no symptoms and for this reason it is called a “Silent”. According to conservative estimates based upon scientific data at least one third of our adult population has high BP.
Recognition of Hypertension (Measure your BP accurately):
Peter Drucker an eminent business consultant and father of Modern Management said “if it cannot be measured it cannot be managed”. Blood Pressure (BP) measured in a clinic or a hospital is often fallacious and high. Although a measurement repeated after a week or so in the clinic may be lower but there is still a 20% chance of it to be falsely high.
How to measure BP accurately?
Of the various types of instruments used for measuring it the most recommended one these days is the oscillometer based machines which are the easiest to use and also give digitally the BP and the pulse rate very reliably. Other machines are a dial type of aneroid instruments and the good old mercury manometer. The mercury manometer though the most accurate one has been banned from use since 2009, because of mercury which is a poisonous material and often leaks out into the box.
Since high BP is seen in one out of 3 persons, it is important for every family to possess a BP measuring instrument. Every adult must know his blood pressure like the shoe or the shirt collar size. Early recognition of high BP is easily possible if you have an access to an instrument.
Checking it yourself or by anyone else once in 6 to 12 months for normal population, should become a rule. BP should be recorded by placing the cuff on the right arm while in a sitting position when the person is relaxed and not in an agitated state or immediately after a walk. It should not be measured within an hour after consuming tea or food.
India Heart Study done under the supervision of the author (UK) on more than 18,500 patients recruited from all over the country showed that the self-measured home BP using an Oscillo metric device (which recorded BP thrice in succession and displayed the average) was the most consistent method of reproducibly recording the BP. It showed clinic BP to be falsely high in around 24 % of subjects. This phenomenon is called “white coat hypertension” and can result in unnecessary use of drugs. On the other hand, 18% subjects who had normal BP in the clinic had high BP at home. This phenomenon is now well known and is called “masked hypertension” and needs medical treatment. If only clinic BP measurements were done it would have been missed.
Another method of diagnosing hypertension is by 24 hours ambulatory BP measurement (ABPM). It is a very reliable but expensive way of diagnosing the malady. In our setting in India, it is often reserved for patients with very erratic readings at home or office, and also to assess the effect of treatment in difficult to manage patients. It is, however, the method of choice in United Kingdom where the treatment cost is borne by the state. The health authorities there found it to be the most cost-effective way by saving on drug treatment because a large segment of population with high clinic BP did not need it.
Definition of Hypertension:
Office BP: More than 140/90 and above. However, US and recent European guidelines have brought it down to 130/80.
Home BP: More than 135/80
Ambulatory BP Monitoring: More than 135/80.
Control Your high BP:
Having recognized and diagnosed hypertension it is imperative on our part to control it to the levels at least below 140/90 mms Hg at all ages in adults. If at the time of first recognition the BP is < 160/100 one need not rush for drug treatment. However, persons with 160/90 or more need to go straight for drug treatment under medical supervision. Persons with previous heart related problems and kidney disease need to keep it close to 130/80 mms Hg. All patients with high BP even if taking medicines need to be on non-drug management as well.
What is “Non - Drug Treatment”?
A good life style is the key. This management consists of regular exercise (equivalent to walking more than 8,000 steps per day). Salt restriction to less than 4 to 5 grams of salt per day (reducing salted tea, foods containing high salt content like preserved foods, pickles and chutneys etc), Consuming 4 to 5 servings of seasonal fruits, vegetables and salads per day. Avoidance of alcohol intake, losing body weight and stress management by meditation and other relaxing techniques for at least an hour per day.
Drug Treatment:
A large number of persons need use of medicines to bring down the BP to levels of at least below 140/90 mms Hg, there are several groups of safe drugs available for treatment.
A= Ace inhibitor group: Telmisartan, Olmesartan, losartan, ramipril, Lisinopril etc, B= Beta receptor blockers: metoprolol, bisoprolol, nebivilol, propanol. C= Calcium channel blockers: Amlodipine, cilnidipine etc, D= diuretics, hydrochlorothiazide, chlorthalidone. Miscellaneous= alpha blockers: Prazosin, Moxonidine , Aldosterone antagonists; spironolactone, eplerenone etc
Many patients need multiple drugs. Combinations are preferred for them because it improves the compliance and also reduces the cost. Treatment is long term and very often lifelong though adjustments are needed from time to time.
Medicines must be consumed only after consulting a doctor and self-medication should be scrupulously avoided.
Live Longer by controlling BP:
A modest reduction in BP by even 10 mms Hg improves survival by 13 %, reduces strokes by 27%, heart attacks by 20%, heart failure by 28% and kidney failure by 5%. The survival percentages are even higher in patients with co-existing diabetes which is a frequent association. Remember hypertension is the commonest cause of death with a mortality much higher than diabetes, high blood cholesterol, smoking, and obesity.
Prof Upendra Kaul, Founder Director Gauri Kaul Foundation, Recipient of Padmashri and Dr B C Roy Award
