At 30, he was 90 kg, smoking 10 cigarettes a day, had weekly date with alcohol and had a silent threat lurking: High blood pressure

Kerkar is representative of the many asymptomatic Indians, who may not feel any discomfort despite elevated levels of blood pressure. Without proper screening and awareness, they can unknowingly develop heart disease, suffer from heart attacks, strokes, or kidney dysfunction. This issue is highlighted in the latest WHO report on the global impact of hypertension, which reveals that only 37 percent of Indians with hypertension are diagnosed, and only 30 percent receive treatment.

IDENTIFYING THE PROBLEM

Kerkar attributed his elevated BP to work stress and deadline pressures and was convinced it was a temporary spike. “Most patients refuse to accept that they have hypertension, thinking it is an old age issue. Also patients have anxiety issues when their BP is recorded in front of a doctor, known as the white coat syndrome. That’s why we attached a 24-hour ambulatory BP monitoring device to his body, which tracks blood pressure throughout the day, including during various activities, periods of stress, and restful phases. “This helps us diagnose conditions like Kerkar’s, who have stage 1 hypertension with systolic readings ranging from 142 to 146 mmHg. His was high even during the restful stage at home,” says Dr Chaurasia.

STAGES OF DIAGNOSIS AND REHABILITATION

According to both European and American guidelines on hypertension, Stage 1 blood pressure ranges between 140-159/80-89 mmHg, Stage 2 is 160-179/90-99 mmHg and Stage 3 at 180/100 mmHg. For stage 1 of hypertension, doctors advise lifestyle tweaks and better dietary choices. “We advised Kerkar to adopt a DASH (Dietary Approach to Stop Hypertension) diet, rich in fruits, vegetables, legumes and lean meats, zero trans fats, reduce salt intake and give up smoking and alcohol. We advised him normal walking or jogging for 30 minutes five days a week. He did yoga to manage stress,” says Dr Chaurasia.

Kerkar didn’t try very hard at first and the results, predictably, weren’t great. He had trouble quitting smoking and drinking. The doctor told him he needed to do more. “The patient started eating better, sleeping for eight hours, and exercising regularly. His blood pressure went down, but it would sometimes go up because of his genetic history. He also got out of breath quickly. So, I gave him a small pill once a day. After a while, Kerkar’s blood pressure was much better, at 132/72 mmHg,” Dr Chaurasia says.

However, Dr Chaurasia highlights that BP medication has to be correlated with other parameters like lipid profile, thyroid and kidney function tests. “The same BP drug cannot be administered to all and has to be calibrated on a case-specific basis, We begin with a single dose and move to two doses of a single pill, then add a second pill, again with two doses and subsequently follow processes as mandated, ” Dr Chaurasia says.

He emphasises on another key issue: When it comes to controlling blood pressure, medications alone are only half the solution. “No matter what the combination, drugs are 50 per cent effective. The other 50 per cent has to come from lifestyle changes and individual effort. Without this 50 per cent, no combination of high power control drugs can save you. What’s crucial is monitoring BP levels and following up with your doctor,” he says.

(Designed by Abhishek Mitra)

Dr Chaurasia points out that Kerkar did really well because he kept going to the doctor and stuck to both his medication and healthy lifestyle. “That’s why his figures are stable. Most do not, and even give up BP drugs midway, fearing they damage the kidneys. Fact is uncontrolled BP damages the kidneys. Get it into your heads, BP drugs are to be had life-long. And go for screening, it saves you from complicated issues in the emergency room,” Dr Chaurasia says.