What do you do when you can’t hear something that is quietly but steadily wearing out your body? You try and listen more closely. High blood pressure (BP), or hypertension, has reached epidemic proportions among Indians today.
Sanofi’s 2009-10 Screening India’s Twin Epidemic (SITE) study on hypertension and diabetes found that 46% of 15,662 adults tested across urban areas in seven states (Maharashtra, Tamil Nadu, West Bengal, Karnataka, Andhra Pradesh, Madhya Pradesh and Gujarat) and Delhi had hypertension; 20.6% had both diabetes and hypertension, and 34.7% had diabetes. The study was funded by pharmaceutical firm Sanofi-Aventis.
The SITE study results reflect the number of Indian adults suffering from hypertension alone, and not as a consequence of any underlying diseases.
The study was carried out by Shashank Joshi and his colleagues at Mumbai’s Lilavati Hospital and Research Centre, Bhatia Hospital and Grant Medical College, and the results were published in the Diabetes Technology and Therapeutics journal in January.
While many of us are aware of the diabetes epidemic waiting to explode, not many of us know that cases of hypertension too are on the rise.
The SITE study corroborates what other, sometimes smaller, Indian studies and doctors have observed in their clinics for the past couple of years. Atul Biniwale, a cardiologist in private practice in Pune, says that 20 years ago he saw maybe one patient a month with hypertension, now he sees three patients every week. Dr Biniwale doesn’t attribute the rise in the number of patients to increased awareness alone, but also to greater prevalence.
He says that BP—whether slightly high or moderately over the limit—doesn’t show any symptoms. It is the damage it causes to the body that produces symptoms.
Hidden from view
You won’t hear it coming. Hypertension is a serious but silent medical condition. You will typically experience no symptoms unless your BP escalates considerably, in which case you may experience headaches and dizziness. In most cases you may feel fine even when your BP is high, but if it is not controlled, it can play havoc with your organs and put you at increased risk of heart disease, heart attack, kidney failure, eye damage and stroke. Take the case of Pramod Panwalkar, 58. A few years ago, he went for a routine medical check-up and his BP was was found to be at a heart-unhealthy 210/150. He was immediately put on medication and asked to make lifestyle modifications—reducing salt intake, quitting smoking and starting regular exercise. Two years later, Panwalkar was able to stop the medication to check his BP levels.
Dr Joshi says 95% of strokes can be prevented if BP is monitored. “Research shows that a third of the people with hypertension will eventually develop diabetes,” he explains, underscoring the importance of getting BP checked regularly (see “Blood pressure decoded”).
Dr Biniwale says his typical patient is an executive just over 40 years who gets diagnosed with pre-hypertension or hypertension stage 1 while getting his annual physical check-up and has no underlying medical condition, no family history of hypertension or diabetes and no organ damage. Nothing seems wrong, really, except immediate stress. “In such cases,” he says, “lifestyle changes alone can bring the BP back to normal.”
Spike in hypertension
Why are so many urban Indians suffering from hypertension in the first place? Dr Joshi attributes this to four factors: reduced physical exercise, urban work-related stress, increased consumption of fast food and the relatively salty Indian diet. He attributes the higher salt intake to regular consumption of snacks, papads and pickles.
Anoop Misra, director and head, department of diabetes and metabolic diseases, Fortis Hospital, Vasant Kunj, says Indian adults eat about 8-10g of salt a day when they should be eating no more than 5g daily. “Salt restriction is a habit everyone should follow, irrespective of whether they have hypertension or not.”
If hypertension is indeed diagnosed, then the doctor needs to determine if any underlying medical conditions are causing it, like polycystic kidney disease, glomerular disease, thyroid problems or Cushing’s syndrome, among others. BP may rise during pregnancy too. If there are no underlying medical conditions, the doctor can treat the person for hypertension alone.
Treatment for hypertension depends on the degree of hypertension; for example, if there is any organ damage, if hypertension coexists with diabetes, and if you have a family history of hypertension and/or diabetes.
Finding a solution
Research has shown that losing as little as 4.5kg can reduce BP and prevent hypertension, even if you’re overweight. The DASH (Dietary Approaches to Stop Hypertension) diet, a low-fat, low-cholesterol diet rich in fresh fruits and vegetables, and high in potassium and calcium, has a positive impact, according to Dr Misra. In addition to reduced salt in diet (less than 5g a day), experts prescribe exercise for 30 minutes on most days a week. Yoga is very effective as a stress-management tool and can help reduce hypertension, but it should be done in addition to, not instead of, moderate aerobic exercise. Finally, alcohol needs to be limited to no more than two alcoholic drinks per day for men and not more than one alcoholic drink per day for women as well as men who are underweight.
Dr Misra adds a caveat, “Sometimes lifestyle changes are not enough.” He cites the case of a patient, a 45-year-old executive who had been putting in long hours in office and had a strong family history of hypertension and diabetes. When he went for a check-up to Dr Misra’s clinic, he complained of insomnia and mild headaches—he thought these were fairly mild symptoms. Medical investigation revealed that he had stage 2 hypertension and left ventricular hypertrophy, in which the left lower chamber of his heart had enlarged because of hypertension. “In a situation like this,” Dr Misra says, “medication is necessary, along with lifestyle-related changes...to bring the BP down as soon as possible.”
Prevention over cure any day, of course. “Since hypertension has such a high prevalence among Indian adults and is a disease that manifests in silence, everyone over the age of 40 should get their BP accurately checked annually,” he says.
Dr Biniwale’s recommendation is that under the age of 40, it should be checked annually, and those over 40 should get it checked twice a year. A simple rule of thumb is to have your BP checked every time you visit a doctor for any reason, even a common cold. Since people of even the most robust constitution visit a doctor at least a couple of times a year, BP can be monitored easily.
Listening to your doctor is the best way to hear what your body is saying to you—after listening to it yourself.
*** Blood pressure decoded
Blood pressure (BP) is the force exerted by blood on the arterial walls as it courses through the body. BP has two components, systolic and diastolic, and is written medically as systolic/diastolic, or as 118/80. The systolic pressure is the pressure of the blood when the heart is beating, and diastolic is the pressure between beats when the heart is at rest. Normal BP is anything less than 120/80 mm hg (millimetres of mercury). BP levels in adults are defined as either normal, pre-hypertension, hypertension stage 1 or hypertension stage 2 (see “Listen to your heart”). It is important that BP be measured accurately, says Atul Biniwale. It should be taken twice at each of three separate doctor visits, ideally with a rest period of 5 minutes between the pressure measurements. BP fluctuates—it is less when you sleep and increases when you are active, anxious, excited or stressed. But someone with high BP will show consistently high reading, regardless of their activity level on that day.
Lifestyle changes that can help prevent hypertension
• Reduce body weight
Maintain normal body weight for your height, as prescribed by a physician
• Eat the DASH diet
It is rich in fresh fruits and vegetables, low in both total fat and saturated fat, and high in calcium and potassium
• Reduce salt intake
No more than 5g a day
• Brisk walk
Do 30 minutes of moderate aerobic activity, like a brisk walk, at least five days a week
• Reduce alcohol intake
Two drinks a day for men and one for women
• Quit smoking
Source: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7).
Sujata Kelkar Shetty, PhD, writes on public health issues and is a research scientist trained at the National Institutes of Health in Bethesda, US.
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