pressure can be fatal

This pressure can kill

Your Health
DR GITA MATHAI

High blood pressure sneaks up on you like a thief in the night with practically no warning. Symptoms like giddiness, headache, nose bleeds and convulsions occur very late in the disease, when the blood pressure has already spiralled out of control. The only way to ensure early detection is by getting your blood pressure checked every two years, starting when you turn 18.

Blood pressure measurements have two values, an upper or systolic and a lower or diastolic. As long as the upper value is 120 or less and the lower value is 80, you are safe. If it creeps up to 139/89 you are in the pre-hypertension stage, which requires frequent evaluation and perhaps, medication. Once you have reached 140/90 you require treatment to prevent progression and side effects. Blood pressure varies from day to day. At least three values are needed before a diagnosis is made.

Primary hypertension has no known cause. It tends to run in families. Several genes have been identified in its inheritance. A person with a genetic predisposition to hypertension is more likely to develop it if they are also obese and inactive.

Secondary hypertension occurs when there is kidney disease, congenital abnormalities in blood vessels, sometimes during pregnancy or as a side effect of certain medication. The pressure returns to normal if the precipitating factor is removed.

The risk of developing blood pressure increases with age. This is because blood vessels become rigid and less compliant as you age. Obesity increases the risk. It is also more likely to eventually occur in diabetics.

Tobacco (smoked, chewed or snorted) releases certain chemicals into the body. These cause an immediate transient elevation in blood pressure. Over a period of time, the inner lining of the blood vessels become permanently damaged and narrowed, causing a permanent elevation of the blood pressure. Passive inhalation of second hand smoke causes the same effects.

Alcohol increases the heart rate. As it is metabolised, certain chemicals are released that elevate the blood pressure. It also damages the heart, making it more vulnerable to the effects of hypertension.

Salt adds flavour to food but too much of it can cause the body to retain fluid and elevate blood pressure. The requirement is 6gm a day (1 teaspoon = 5gm). Most people take around 9gm a day. Potassium balances salt in the blood, and the requirement is 1.5gm to 2gm a day. It is present in bananas and some nuts. Most people get too little potassium, causing salt to accumulate.

Deficiency of vitamin D affects some kidney enzymes that regulate blood pressure, aggravating hypertension.

High blood pressure can affect children and teenagers too. Most often it is aggravated by obesity, lack of exercise and excessive consumption of high salt snacks.

Uncontrolled hypertension silently damages the body. It can cause the heart to work hard to pump blood against resistance. The heart can become enlarged, weakened and eventually fail. The blood vessels in the body can be damaged and weakened. They may give way, causing a bulge called an aneurysm. This can suddenly rupture. If this occurs in the eyes, it can result in blindness.

Blood supply to the brain can become compromised. Initially this can result in loss of memory, forgetfulness or confusion. It can eventually result in a stroke. Blood vessels to the kidneys can get damaged, causing them to fail.

There is no universal medication for high blood pressure. Some people do well with a single drug. Others require frequent dosing with as many as four or more drugs. The important thing is to remember to take your medication regularly and not skip doses. Fasting, rearranging schedules or switching to alternate medication should not be done without consulting a doctor. Drugs can react with one another. So it is better to stay with a single physician who will be able to monitor your medication and response. Low dose aspirin may be needed to prevent strokes and heart attacks.

Lifestyle changes are necessary to eventually reduce the dosage, number of drugs and the long-term effects of high blood pressure.

lMaintain ideal body weight. This can be calculated by multiplying height in metre squared by 23.

lTry adding more fruits, vegetables and fibre rich food to your diet. Reduce the fat content.

lReduce salt intake to 1.5gm (one-fourth tsp) a day. Remember to take into account the salt in pickles, and ready-to-eat soups and sauces.

lDo not smoke or use tobacco in any form.

lAvoid alcohol. If that is not possible, remember the allowance is 2 drinks a day for men and one for women.

lGet moving. You can reap huge benefits by walking as little as 30 minutes a day. Every step counts!

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in

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