Sunil Kapoor (54), a Delhi-based office superintendent, had a toothache. During the check-up, it turned out that he had a blood pressure of 160/95 mm Hg as well. Kapoor had no other medical problem. His mother also had high BP. The doctor advised him to start taking medicines immediately, which threw him in a dilemma because he had no symptoms and felt BP was not something he should be worried about.He hated medication and it did not help that this friends told him that this particular medication had to be continued for life. WHAT IS HIGH BLOOD PRESSUREHigh blood pressure is one of the most common cardiovascular problems. As per studies carried out among urban, semi-urban and rural population, its prevalence is as at least as high as 20 per cent if the cut-off 150/90 mm is kept as its definition. In India alone, 15 crore patients need medical treatment. Untreated high BP is a common cause of brain stroke, heart attack and kidney failure.Most clinicians practicing medicine feel that the incidence of hypertension is steadily increasing. One of the most obvious reasons is the increasing level of stress in the community: the prevailing hostilities, anxieties related to work atmosphere, strain in family work being some examples. The high salt intake in the Indian diet is another important reason. So is genetic influence. Those with a family history of blood pressure are more prone to it and at a younger age.What is normal Blood PressureOptimal BP is a pressure less than 120/80 mm Hg. Any rise in BP above 110/75 mm is associated with a linear increase in stroke and heart attack rates. This has been proven by several epidemiologic studies and life insurance statistics. An increase of 10 mm in systolic or diastolic pressure is associated with a doubling of the risk of a vascular event. Unfortunately, high BP is invariably not accompanied by symptoms and therefore its detection and management is a challenge. This is in fact, why, it has been described as a “Silent Killer”.Some myths about blood pressure:Blood pressure increases with age and is a normal phenomenon: Truth: According to this theory, normal BP of a 60-year-old is 160 and at 80 years it is 180 (Age+100). This is not true. Normal BP at all ages should be less than 120/80 mm.Low Blood Pressure is a disease:People with BP lower than 100 to 110 mm systolic in good health often seek medical attention.Truth: Individuals with pressures on the lower side (90 to 100 mm systolic) without any other disease are very fortunate in having natures blessing to have a long healthy life. They should not waste their resources on taking tonics and BP increasing measures. Stay healthy first Everyone who has high blood pressure should adopt measures to stay healthy (see box). The lifestyle changes advised will bring down the dosage of drugs and number of medicines that need to be taken.All healthy individuals too, should adopt these non-drug measures, so their pressure remains below 120/80 mm Hg. IF YOU STILL NEED MEDICINEBefore starting drugs make sure that you minimise the consumption of following: Painkillers, nasal drops, cough syrups, anti-depressants and mood elevating drugs.POINTS TO CONSIDER BEFORE BEING LABELLED A BP PATIENT• Get the BP measurement done after sitting for several minutes in a quiet room• Take at least 2 measurements spaced by one to two minutes and additional readings if the two are quite different• An appropriate BP apparatus • If the BP in two arms is different, take the higher value as the reference Drug treatment for high BP is a very long term treatment. Once it has been recommended that medicines (very often 2 drugs if the BP is more than 160/100 mm) are needed, they are not to be stopped even after BP comes down to target levels. This is a common mistake committed even by very educated people. The aim of medication is to keep you free of the risk of complications like heart attacks, stroke etc. It is to ensure that you remain free of catastrophic problems as years go by.The currently used drugs are very safe and need very little monitoring for side-effects. Most are well-tolerated. For every patient, the treatment has to be individualised. No one should try self-medication. THE LATEST STUDYThe agents used and dosage of medicines depend on several variables. Broadly, the agents used are ACE inhibitors and angiotensin receptor blockers, calcium blockers, beta-blockers and diuretics or water pills in various combinations. A recent study presented at the European Cardiology Society meeting held in Vienna showed that adding a combination of perindopri l (ACE inhibitor) and indapemide (a diuretic) in diabetics, reduces the BP by 6 mm systolic and 3 mm diastolic. It reduces the cause deaths by 14 per cent. If this benefit is applied to even half of the worlds diabetic population, approximately 1.5 million deaths can be avoided in 5 years.The aim is to not only keep your BP in normal range but also to take care of all the risk factors, which lead to heart attacks and strokes. “Observing the Rule of 100” goes a long way. Keep your blood sugar and cholesterol and triglyceride levels close to 100 mgs. The emphasis is on keeping all round risk very low instead of concentrating on one risk factor. Patients needing BP lowering drugs are also often in need of agents to keep cholesterol and triglycerides very low. The management should be holistic and not just treating numbers.ADVICE FOR MR KAPOORSKapoor was recommended to have his BP checked again and to see it is more than 140/ 85. He needed to have his blood tests for sugar, cholesterol and triglycerides done. All the lifestyle measures, limiting salt intake, regular exercise, losing weight, eating heart healthy diet, was to be started straightaway. If his BP still stayed more than 140/85 mm Hg, he was told to start long-term medicines under medical supervision. Periodic BP checks are essential and discontinuing medicine without medical advice is dangerous.— The author is Director Cardiology , Fortis HospitalIndications for taking BP lowering drugsIdeal blood pressure at all ages should be below 120 In general, medicines are recommended when BP is more than 140/85 mm Hg. In some situations, medicines are recommended even at levels of 130/80 mm Hg. These situations are:• Patients with diabetes• Patients with kidney disease and high levels of blood urea and creatinine • Patients with pre-existing heart disease or stroke. Non-drug methods to reduce BPNon-drug methods can reduce BP by 10 to 15 mm Hg: These measures are:• Regular exercise• Salt intake of not more than 4 to 5 grams per day• Fresh fruits and leafy vegetables (4 to 5 servings/day)• Avoidance of alcohol or drinking in moderation• Losing weight
