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A study published in 2014 in the Journal Of Hypertension found that about 33% of urban and 25% of rural Indian adults are hypertensive. “The increased incidence of hypertension, or high blood pressure (BP), over the years can be attributed to a lack of exercise, a diet rich in fat and salt, obesity, increased level of stress and increased smoking and alcohol consumption," says Santosh Kumar Dora, senior cardiologist at the Asian Heart Institute in Mumbai.

High BP is the result of abnormally high pressure of blood in the arteries. BP should normally be around 120/80 mm Hg. High BP, in most cases, is asymptomatic and silent, so unless it’s monitored actively, it stays hidden. The symptoms are usually vague—dizziness, headache, nosebleeds, flushing, tension and fatigue—so it can be missed easily.

“High BP, along with smoking and high cholesterol, is one of the biggest risk factors for coronary artery disease," says Dr Dora. “High BP damages the heart and other organs, accelerates hardening of the arteries and build-up of cholesterol-laden plaque on arterial walls. It is also a risk factor for stroke, and is associated with sexual dysfunction in both men and women," he adds. Yet it’s not difficult to prevent—or control. Changes in lifestyle are always possible, even if we can’t control factors like age.

The white poison

Excess consumption of salt and sugar can contribute to hypertension. Research presented at the Experimental Biology 2016 meeting in San Diego, US, in April shows that high levels of fructose may predispose individuals to hypertension. Experimental Biology is a multidisciplinary annual meeting comprising over 14,000 scientists and exhibitors.

“Actually, high BP and insulin resistance (which can be caused by a sugar-rich diet) tend to go hand in hand, so one needs to control the sugar intake to nip high BP in the bud," says Vanita Arora, associate director and head, cardiac electrophysiology, at the Max Super Speciality Hospital in Saket, New Delhi.

One of the primary underlying causes of high BP is the body’s production of excessive insulin and leptin in response to a diet high in carbohydrates and processed food. “Multiple studies are establishing that a high amount of added sugar in the diet, as well as sweetened beverages, pose a major health risk, especially in hypertension. The 2015 American dietary guidelines revised their dietary recommendation to cut down added sugar level in the diet to less than 10% of the calorie requirement per day," says Dr Dora.

Sweetened beverages and other sweetened food items often contain fructose as a sweetening element. This, if taken in excess, has been linked to high uric acid (hyperuricemia). “This can lead to depletion of endothelial nitric oxide, an important molecule in preventing hypertension," explains Dr Dora.

Remember also that an increase in salt intake leads to increased sodium in the blood. Sodium retains water and this increases the blood volume, leading to extra stress on the blood vessels in the heart. “Increased sodium content in blood also prevents the kidneys from removing extra water in the blood, contributing to high BP," he says.

Potassium neutralizes the effect of sodium and can thus prevent high BP, says Dr Dora. Good sources of potassium include banana, coconut water, sweet potato, spinach, lentils, kidney beans and watermelon.

Cut trans fats

“Consumption of trans fats leads to increased LDL (bad cholesterol), decreased HDL (good cholesterol) and increased triglycerides (a type of fat found in blood that increases the risk of heart disease). All these factors lead to fat deposit and hardening of arteries—resulting in hypertension," says Dr Dora.

Avoid all trans fats or hydrogenated fats that have been modified to extend their shelf life. “This includes margarine, vegetable oils and butter-like spreads," says Dr Arora.

Keep a check on your weight

“People with a high body mass index (BMI) are prone to early onset of high BP," says Pranjit Bhowmik, head of internal medicine at the Asian Institute of Medical Sciences in Faridabad, adjoining Delhi. BMI in the range of 18.5-24.9 is considered normal; a BMI of 25-29.9 is overweight and BMI of 30 or greater is obese.

A study published online in the JAMA Internal Medicine in January also shows the relation between excess weight and long-term risk of hypertension.

Your waist size may be an effective measure to assess obesity-related hypertension risk. “If you have a high waist-to-hip ratio, that is, you carry more fat around your waist than on your hips, you may be at an increased risk of obesity-related hypertension," says Dr Arora.

To calculate your waist-to-hip ratio, measure the circumference of your hips at the widest part, across your buttocks, and your waist at the smallest circumference, just above your belly button. Then divide your waist measurement by your hip measurement to get the ratio. “Abdominal obesity is defined by a waist circumference greater that 102cm (40 inches) for men and 88cm (35 inches) for women," says Dr Arora.

Don’t take insomnia lightly

Those who take longer than 14 minutes to fall asleep face a greater risk of hypertension, according to research published last year in Hypertension, the American Heart Association’s journal. In a study conducted at Sichuan University’s West China Hospital in Chengdu, researchers studied 219 chronic insomniacs (they defined chronic insomnia as difficulty in sleeping for more than six months) and 96 normal sleepers and found that the insomniacs were at a higher risk of hypertension.

“Insomnia is defined as difficulty initiating or maintaining sleep or waking up too early, or sleep that is chronically non-restorative or poor in quality, causing fatigue, irritability, sleepiness and so on despite having enough opportunities to sleep. And chronic insomnia (lasting more than a few months) has an effect on various body functions and can be responsible for an increase in blood pressure too," says Manvir Bhatia, director (sleep medicine) at the Max hospital in Saket.

If you suffer from such sleep disturbances, it may be advisable to get screened for hypertension.

Cut stress

There is a special category called stress-related hypertension. “Our body produces a surge of hormones when we are stressed. These hormones temporarily increase our BP by causing the heart to beat faster and the blood vessels to become narrow," says Dr Bhowmik. Other behaviours linked to stress, such as overeating, alcohol consumption and poor sleeping habits, may also cause high BP. “Short-term stress-related spikes in your blood pressure, added up over time, may put you at risk of developing long-term high BP," says Dr Arora.

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