World Hypertension Day 2022: Dr Naresh Trehan gives tips on dealing with BP

World Hypertension Day 2022: Dr Naresh Trehan, CMD of Medanta, speaks to Business Standard on the spike in hypertension cases in India, the early signs, how to deal with the ailment

One in four adults suffers from hypertension. Of this lot, only 10 per cent have their blood pressure under control, according to a recent report by Indian Council of Medical Research (ICMR). May 17 is observed as World Hypertension Day to raise awareness about the condition in people. Often taken lightly, high blood pressure can be the reason for many other major diseases.

Dr Naresh Trehan, Chairman and Managing Director of Medanta-The Medicity, Gurugram speaks to Business Standard’s Anjana Kumari Mahato on the spike in hypertension cases in India, the early signs, how to deal with the ailment. Excerpts:

WHO reports that nearly 63 per cent of the deaths in India are caused by non-communicable diseases. Of these 27% are due to cardiovascular disease, which affects 45 per cent of people in the 40-69-year age group. High blood pressure is one of the key risk factors for cardiovascular diseases (CVDs). What are the reasons for such staggering numbers?
          

Rural parts of India have lower literacy rates and lower access to quality health services than urban areas. Recent studies in India have shown that Hypertension (HTN) is significantly more prevalent in lower educated group. The high prevalence of HTN in urban areas may have arisen as cardiovascular disease risk factors among the urban poor and the middle class. The surge in HTN cases in India is due to lifestyle changes brought on by rapid urbanisation and economic progress in cities. Higher consumption of salty food in eastern India due to humidity, and the presence of cardiometabolic risk factors in the south may have led to a spike in HTN cases in these regions.

 

What are the early signs of hypertension?

Headaches of all kinds are often the only symptom of hypertension in a majority of patients and are often overlooked.

Some patients also suffer from nosebleeds. In others, fatigue or confusion can be caused by pulmonary artery hypertension, in which the vessels responsible for carrying blood from the heart to the lungs undergo excessive pressure, causing fatigue. Such a condition also causes shortness of breath, chest pain, and light-headedness.

Another sign of high BP is disturbed vision caused by damaged blood vessels. Pressure exerted on the optic nerve and limits the functioning of the retina, causing vision problems.

Sudden high blood pressure causes symptoms like chest pain because it can decrease oxygen and blood flow to the heart. It damages arteries, making them less elastic, and can also lead to heart diseases.

High BP can also cause shortness of breath, a symptom of pulmonary hypertension. It happens especially when you are climbing stairs or walking for a long time.

Another cause of sudden high blood pressure is irregular heartbeat caused by temporary conditions such as anxiety, stress reactions, panic attack, excessive caffeine use, etc.

Then, you have blood in the urine, which is common in high blood pressure. High BP can also cause less urine formation and even kidney stones.

In some patients, there can be a pounding feeling in the neck, chest, or ears. Because of that, they might feel dizzy or lightheaded.
 

Facial flushing happens due to exposure to hot water or heat, alcohol consumption, exercise, etc. This might be caused by temporary high blood pressure.

Dizziness can happen because of some drugs which cause BP levels to increase. It is one of the symptoms that sudden high blood pressure causes, which indicates you must get treatment.

Why is high blood pressure also called a silent killer?

Twenty-six per cent of patients visiting our executive health check-up service had high BP which they were unaware of. So if high blood pressure is left undiagnosed and untreated it can lead to complications such as:

Heart attack: One of the most common complications of high blood pressure, heart attacks can occur as a result of thickening and hardening of the arteries.

Heart failure: If the symptoms and signs of high BP are left undiagnosed or untreated, it can lead to heart failure. Here, the walls of the heart’s pumping chamber thicken making it difficult for the organ to pump blood normally.

Kidney disease or failure: There can be kidney failure because of high BP as the blood vessels of the kidneys can be damaged.

Vision loss: If one doesn’t follow a proper diet to lower blood pressure and leave high blood pressure untreated, there is a high chance of developing eye-related complications or the risk of losing vision permanently.

Sexual dysfunction: High BP has been shown to cause erectile dysfunction in males and low sex drive, arousal, and vaginal dryness in females.

Metabolic syndrome: It is a group of risk factors that can increase the chances of developing heart disease, stroke, and type 2 diabetes. The risk factors include high blood pressure, high blood sugar levels, low HDL or good cholesterol levels, high triglyceride levels, and excess fat around the waist.

Memory problems or trouble understanding: It affects the ability to think, learn and remember. There is trouble in understanding concepts.

Dementia: This is a condition characterised by loss of memory, problem-solving, attention, language, and other thinking abilities to the extent that it affects the patient’s everyday activities. Blocked or narrowed arteries can limit the blood flow to the brain, giving rise to dement can prevent high blood pressure and its complications:

What is your advice to people suffering from hypertension?

Eat a balanced diet. To reduce BP levels, one must minimize salt or sodium consumption and increase potassium levels. Eat foods that are lower in fat to lower BP.

Consume a diet rich in fruits and vegetables, whole grain, poultry, and fish and reduce red meat, sweets and sugar-containing beverages.

Maintain a healthy weight: Make sure to check your weight regularly. Association of blood pressure with weight reduction is direct, ideally attaining a body mass index (BMI) of <25kg/m2

Stay physically active: Exercise regularly to maintain a healthy weight and reduce BP. One can start with moderate-intensity aerobic exercises, brisk walk, breathing exercises pranayama and kapalbharthi and meditation  

Do not smoke: Smoking raises blood pressure and increases the risk of heart stroke and attack.

Limit alcohol consumption: Alcohol consumption can raise blood pressure levels and also add more calories.

Manage stress: Learning how to manage and decrease stress levels can boost physical and emotional health. It will help in lowering the high blood pressure levels. One can also opt for exercising, meditation, and listening to music to reduce the chances of sudden high blood pressure.

Monitor your blood pressure at regular intervals: Taking regular BP tests can help you keep tabs on your blood pressure levels. Consult your doctor if there are any abnormalities in the results and thus help prevent complications.

In today’s hectic life, it is almost impossible to live stress-free. How must one cope with this?

Stress serves an important purpose—it enables us to respond quickly to threats and avoid danger. However, lengthy exposure to stress may lead to mental health difficulties or increased physical health problems. A large body of research suggests that increased stress levels interfere with your ability to deal with physical illness. While no one can avoid all stress, one can work to handle it in healthy ways that increase your potential to recover.

Eat and drink to optimise health. Some people try to reduce stress by drinking alcohol or eating too much. These actions may seem to help at the moment but actually may add to stress in the long run. Caffeine also can compound the effects of stress. Consuming a healthy, balanced diet can help to combat stress.

Exercise regularly. In addition to having physical health benefits, exercise is a powerful stress reliever. Consider non-competitive aerobic exercise, strengthening with weights, or movement activities like yoga or Tai Chi, and set reasonable goals for yourself. Aerobic exercise has been shown to release endorphins—natural substances that help you feel better and maintain a positive attitude.

Stop using tobacco and nicotine products. People who use nicotine often refer to it as a stress reliever. However, nicotine places more stress on the body by increasing physical arousal and reducing blood flow and breathing.

Study and practice relaxation techniques. Taking the time to relax every day helps to manage stress and to protect the body from the effects of stress. You can choose from a variety of techniques, such as deep breathing, imagery, progressive muscle relaxation, and mindfulness meditation. Many online and smartphone apps guide these techniques; although some entail purchase costs, many are available free of charge.

Reduce triggers of stress. If you are like most people, your life may be filled with too many demands and too little time. For the most part, these demands are the ones we have chosen. You can free up time by practicing time-management skills like asking for help when it’s appropriate, setting priorities, pacing yourself, and reserving time to take care of yourself.

What should one do if one has trouble sleeping due to stress?

You may experience insomnia because of discomfort, stress from personal concerns, or side effects from your medications. If you cannot sleep, try these tips:
 

• Establish a regular sleep schedule – go to bed and get up at the same time every day.

• Make sure your bed and surroundings are comfortable. Arrange the pillows so you can maintain a comfortable position.

• Keep your bedroom dark and quiet.

• Use your bedroom for sleeping only. Don't work or watch TV in your bedroom.

• Avoid napping too much during the day. At the same time, remember to balance activity with periods of rest.

• If you feel nervous or anxious, talk to your spouse, partner, or a trusted friend. Get your troubles off your mind.

• Do not rely on sleeping pills. They can be harmful when taken with other medications. Use them only if recommended for a brief period by your healthcare provider if other non-medication methods don’t work.

• Take diuretics, or "water pills," earlier if possible, so you don't have to get up in the middle of the night to use the bathroom.

• If you can't sleep, get up and do something relaxing until you feel tired. Don't stay in bed worrying about when you're going to fall asleep.

• Avoid caffeine.

Has Covid -19 pandemic made it worse?

Hypertension is the most prevalent reported co-morbidity in Covid-19 patients. A study in Wuhan reported prevalence rates averaged 15-36.5 per cent of Covid-19 patients who had a previously diagnosed hypertension. Based on the recently published clinical and epidemiological characteristics of Covid-19 patients, pointed to a higher risk of Covid-19 infection, more severe disease, and augmented mortality outcomes among the affected elderly.

Moreover, since the Covid-19 pandemic led to reduced outings and lifestyle changes, resulting in weight gain and lack of exercise, all of which affect BP control in the long term, it is important to examine whether there will be any adverse effects on BP over a longer period.

Self-measurement of home BP and telemedicine through internet-based communication can improve adherence to treatment and help control BP.