Its 2 am on a cold winter night and a lady is rushed in the Medical ER intake on a wheel chair, with a couple of attendants who apparently and understandably are distressed. Wearing a ‘bandana’ of sorts around here forehead, compressing it. She keeps on wailing, moaning and shouting at the attending Docs that she has been having high ‘BLOOD PRESSURE’ since long and has this band like headache every now and then. Her vitals turn up normal but the patient and attendants refuse to accept this and are adamant that she has ‘HIGH BP’. When the history is probed into, it is revealed by the attendants that there have been domestic issues on and off and after every episode, she has this headache. This was labelled by local GP’s as being due to HIGH BP while on inquiring further, BP turned out normal every time. Workup was normal in the ER and she was managed for ‘stress or tension headache’ and returned home.
The above scenario emphasizes the fact that contrary to common perception, not every headache is due to HIGH BP and to the contrary HIGH BP may not necessarily have any symptoms especially when chronic. Overdiagnosis is rampant everywhere in healthcare which leads to uncalled for medication and their adverse effects.
What is blood pressure? To cut a long story short, it is a pressure wave which travels along the length of the arterial network of the body when the heart contracts and relaxes ( Hence the systolic and diastolic components). Blood pressure depends on numerous factors including those related to the pumping of the heart to the stiffness of your blood vessels. So, you can see when either of these parameters is affected the BP starts to rise. Other factors which affect BP include Age, raised cholesterol, Diabetes Mellitus, certain medicines. BP can rise with Age since the vessels become stiff and less elastic thus our thresholds for labelling someone as hypertensive are different for a 60-year-old versus a 30 year old.
The international authority on Systemic Hypertension *JNC in their Guidelines has given the following recommendations for blood pressure classification
<120 mm Hg
120-139 mm Hg
Stage 1 Hypertension
140-159 mm Hg
Stage 2 Hypertension
>100 mm Hg
Most of the Hypertension you see around you Is classified as Essential Hypertension ( >90 % of patients) in which there is no obvious cause rather only Genetic and Environmental components to it. The remaining 10 percent is secondary to underlying causes ( Hormonal and vascular disorders mostly ).
TREATMENT, WHEN AND WHY:
Patients who have repeated readings in the pre-hypertensive range are not to be recommended medication straight away unless precluded by certain conditions which make treatment initiation mandatory like Heart Disease, Diabetes Mellitus or Kidney issues. People with probable Essential Hypertension should be explained the importance of the factors which can normalize BP along with other metabolic parameters like blood sugars, Blood Cholesterol levels etc. People will BP readings in Stage 1 may do well on Dietary/lifestyle modification or may be supplemented with medication if not responding. While people with readings persistently in Stage 2 will need medication in addition to lifestyle modification.
LIFESTYLE/DIETARY INTERVENTIONS TO MAINTAIN NORMAL BLOOD PRESSURE:
- Physical Activity: Being active on a regular basis not only lowers our blood pressure but also helps in optimizing our health as a whole. Physical Activity may include aerobic ( brisk walk ) or anaerobic activity ( weight training, jogging) or just simply being active with daily chores. A mix of the above does wonders. Mild to Moderate activity of up to 150 mins/week ( walking on flat, climbing stairs, household chores ) and Vigorous activity of up to 75 mins/week ( weight training, jogging ) or a mix of the two are recommended by WHO.
- Reducing Weight in the Obese: Weight loss in the Obese can have a drastic effect in reducing BP. Reducing the caloric intake by eating less calorie-dense food like simple sugars ( sweets, carbonated drinks and other junk food) and Physical Activity can lower weight and eventually BP.
- Salt Intake: The daily salt intake has been proposed to be linked to increasing BP readings. Most of our daily salt intake is surprising though the Gravies that we chow down, it is through the processed food we eat on the day in and out. Examples being Bread and other bakery products, chips and other packaged and tinned food. American Heart Association recommends no more than 2300 mg/day for an adult. This is half a teaspoon per day of table salt/day only!!
- Fat intake: The amount of fat intake in our diets can contribute to high cholesterol levels which can deposit in the lumen of blood vessels and increase blood pressure. Most of us get fat in our diet through oils and meat in our diet. The type of oil and quantity of oil consumed, both are important. Poly and monounsaturated oils are recommended for everyday cooking which includes canola, sunflower, olive oils. While saturated fat which includes palm oil and hydrogenated oils ( both presents in large quantities in processed market food ) are not recommended beyond a small quantity on a daily basis. Ghee and Butter also contain saturated fat. The daily intake of cholesterol should not exceed 300mg/day of which only 7 percent should be of the saturated type.
- Psychosocial issues: It has been seen that Psychological stress, be it at home or work can contribute immensely to disease and can worsen all our metabolic parameters including blood glucose, cholesterol profile, blood pressure etc. Adequately handling stress cannot be overemphasized. If the need is, a Behavioral therapy or Pharmacological therapy for underlying Psychological/Psychiatric illness should be sought.
- Sleep: Adequate sleep is Mandatory to maintain a stress-free brain and eventually body. Our brain and body need rest to recuperate and start anew every other day. Normal Memory and thought processes require restful sleep. At least 6 hours of refreshing sleep is necessary to keep our stress levels in check. As we are now seeing that chronic stress in our bodies can give rise to numerous chronic diseases and worsen pre-existing ones.
DIETS FOR PREVENTION/TREATMENT OF HYPERTENSION:
There are numerous diets which when consumed lower the chances of pre-hypertensives progressing to hypertension and hypertensives having their BP readings under check. The detailed account of these diets is beyond the scope of this article but I will briefly go about a couple of them what they are all about.
- DASH ( DIETARY ADVICE TO STOP HYPERTENSION ) :
This diet focuses on fruits/vegetables making up to a quarter of the daily diet with whole grains making up another quarter. While fat including butter and oils are consumed in minimal quantity. Poultry, fish and lean meat are added to meals but in a limited amount. Dairy also makes a small proportion of daily intake. Healthy fat as in nuts is recommended. Sweets are almost restricted to a very negligible intake.
- MEDITERRANEAN DIET:
The Mediterranean diet has also proven to be very effective in lowering BP and maintaining a healthy metabolic profile. It is more or less the same as the DASH diet in terms of components and proportions. It is more liberal in terms of Unsaturated fat intake ( Good fats!), recommending regular intake of oily fish, olive oil and nuts.
Regular Physical Activity, restful sleep and a balanced diet all can help us in maintaining normal BP. Life is all about moderation and striking a balance in what we do and eat. What we invest in our health goes a long way beyond just metabolic control, it gives you that’ Feel Good’ feeling.
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