HEALTH TRIBUNE Wednesday, October 3, 2001, Chandigarh, India
 


All you need to know about
High Blood Pressure -II

Dr R.P. Sapru
I
t is essential that high blood pressure be treated. There is a great volume of evidence to show that adequate treatment of blood pressure prevents damage to various organs like the kidneys, the heart and the brain. Persons in whom blood pressure remains within the normal range are saved the ravages of high blood pressure. It is true that the benefits of treating high blood pressure are not immediately obvious; just as the damage caused by high blood pressure is a slow process, benefits of treatment are clearly expressed over a long period of time.

Diet and high BP
Madhu Arora

T
he general concept among people is that if you are hypertensive you have to cut down your salt intake. But is it only the salt that matters? There are a number of factors responsible for hypertension and there is a need to know some practical tips regarding the dietary management of the condition.

HEALTH BULLETIN
Tulsi: holy healer 
Dr R.Vatsyayan, Ayurvedacharya
T
ulsi is an important symbol of the Hindu religious tradition. Although the word ‘‘tulsi’’ gives the connotation of the incomparable one, its other name, Vishnupriya, means the one that pleases Lord Vishnu. Found in most of the Indian homes and worshipped, its legend has permeated Indian ethos down the ages. Tulsi has been adored in almost all ancient ayurvedic texts although for its extraordinary medicinal properties.

HEALTH EVENTS

Q&A
Killer clot
Q: Can we manage it?
A: yes, says Dr J.D. Wig



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All you need to know about
High Blood Pressure -II
Dr R.P. Sapru

It is essential that high blood pressure be treated. There is a great volume of evidence to show that adequate treatment of blood pressure prevents damage to various organs like the kidneys, the heart and the brain. Persons in whom blood pressure remains within the normal range are saved the ravages of high blood pressure. It is true that the benefits of treating high blood pressure are not immediately obvious; just as the damage caused by high blood pressure is a slow process, benefits of treatment are clearly expressed over a long period of time. Since the benefits are related to the prevention of damage or limiting the existing damage, the patient would remain unaware of the same. Clearly, therefore, adherence to the prescribed treatment is often related to how much faith or confidence the patient has in the treating physician! One cannot emphasise enough the need to persist with the treatment as advised even if no tangible benefits are visible to the patient.

Some complimentary strategies are advised for the treatment of high blood pressure. The first and foremost is advice for lifestyle modification. Essentially, this involves weight reduction, diet modification and regular exercise. It is well established that weight reduction to the ideal level of body weight helps to control high blood pressure. Overweight individuals who have high blood pressure are often able to adequately control the blood pressure merely by losing weight!

Of course, weight reduction is easier said than done. I like to suggest that body weight is like a bank balance which is the residue of all debits and credits. If debits exceed credits, body weight will increase and vice versa. Comparison of food intake with other persons, even in the same family, does not help because food requirements of different individuals differ. Besides the expenditure side of the balance differs amongst different persons which is not often appreciated. Further food intake should take into account all food items and not just " chapatis" as most persons are prone to do.

It is not easy to convince overweight individuals that losing weight is eminently possible provided one puts one's mind to it. Overweight persons have this psychological dependence on eating that they find diet control impossible . Yet those who have successfully lost weight recognise the consequent benefits and find themselves to be much more agile and "healthy". It is a matter of self-realisation that alone can be reinforced by sound medical advice. The most practical solution is to eat less and exercise more. In order to overcome hunger even while eating less the best solution is to drink a glass of plain water and eat a bowl of salad before partaking of the main meal. In between meals also, salads should replace the casual snacks.

It is recommended that weight loss should be a gradual process targeting at 1 to 2 kg per month. More rapid weight loss can lead to problems and is generally not sustainable.

Besides diet, equal emphasis needs to be placed on an appropriate exercise schedule tailored to suit individual requirements. Group activities can help to sustain interest in a weight reduction programme and reinforce the will to stick to the schedule. Ultimately, however, it is the individual's own effort that will help to reduce weight and keep it down.

Apart from weight reduction, restricted salt intake is important. All added salt should be avoided and as little salt added to the food preparations as possible. Salted snacks and achars should be forbidden. The idea is to reduce salt to the minimum without making food absolutely tasteless. Canned foods use extra salt as preservatives and should be avoided.

Fresh fruits and vegetables should be encouraged. Vegetarian food is superior to non-vegetarian meals. White meat is better than red meat. All oils and fats contain twice as many calories as other food ingredients. Reduction in the consumption of oils and fats will, therefore, go a long way in reducing calorie intake.

Those in love with Bacchus should realise that regular intake of alcohol promotes high blood pressure. The usual accompaniments of salted snacks only make matters worse. Patients of high blood pressure are, therefore, advised to keep off alcohol as far as possible.

Regular exercise also helps to keep the blood pressure within the normal range. Walking is very good. If supplemented with yogic relaxation exercises, the effect is even better. Benefit from yogic kriyas is still being assessed scientifically.

Since hypertension is more common in modernising urban societies, it is believed to be related to the tensions of modern living. However, "tension" is an expression that means different things to different people. A certain degree of "tension" is inevitable for progress in life. An exaggerated response to the pressures and uncertainties of life is, on the other hand, not conducive to good health. Pressures of life are inevitable. What matters is the manner in which one responds to them. To be the best in a chosen field of life is desirable, indeed commendable, but to lose one's composure in the process is not. A proper mix of "tension" and "equanimity" would appear to be the best mantra one should strive for. Of course, this is an individual effort, a balancing of outlook on life that can be suggested but must spring forth from within.

Medication is possible but much less effective than self-realisation. Hard work and due concern for the outcome are not harmful but getting distressed in the process is. Hard work and peace of mind need not be contradictory. It is within our power to reconcile the two. Pleasure some hard work is desirable; distressful hard work is not.

A large number of drugs are currently available for the treatment of high blood pressure. These are quite powerful and fairly safe with few side effects. More drugs are being discovered and introduced all the time. There are two possible approaches in the use of drugs. One is to push a single drug to its maximum tolerated dose before adding another drug. The other is to use more than one drug, each at a relatively lower dose, and then gradually work up the most appropriate dose for the person. The first has the advantage of a lesser number of tablets to be taken. Current thinking favours the use of a combination of two or more drugs rather than a single drug alone. Combining different classes of drugs has the advantage of using multiple "strategies" to achieve the goal while minimising the chances of side-effects with anyone of them.

The choice of drugs varies for different patients. Treatment has to be tailored to the individual requirement. The recommended practice is to start with a low dose of one or more drugs and gradually build up the dose, or change the mix of drugs, depending upon the response of the patient. It takes some time for the drugs to achieve the maximum effect so that there is no point in hurrying the process. This process may take several weeks and require suitable revisits by the patient. Patience is desirable.

Monitoring of the treatment with a regular check-up of blood pressure is essential. It is desirable to have a weekly check-up till the blood pressure is stabilised and fortnightly thereafter. No fixed schedule is necessary. Measurement can be made at any convenient time of the day with a reasonably flexible scheduling. The doctor is interested in the overall trend rather than in any single reading. As already explained, some fluctuation in blood pressure will be observed. That is normal. There is no need to panic if an odd reading is somewhat elevated or a little lower than otherwise. Your doctor will adjust the drug mix or dosage if there is consistent pattern suggesting inadequate control. Sometimes ambulatory monitoring of blood pressure as described above may be useful to check upon the adequacy of blood pressure control.

Concern for low blood pressure is often misplaced. There is no need to worry till the blood pressure touches 100/60 mm hg or thereabouts. If, however, the patient experiences dizziness, especially on standing, there is reason to report to the doctor irrespective of the blood pressure at which this happens. There is no doubt that some persons do not tolerate lower blood pressure even though these may be desirable. In their case, the doctor will make appropriate adjustments to achieve the most optimum blood pressure . Most patients will, however, achieve the target blood pressure without much problem.

Treatment, of course, has to be continued life long for these drugs do not cure "blood pressure". If, however, the optimum body weight is achieved, a regular exercise schedule is followed, and the salt intake is restricted, it may be possible to reduce the drug dosage in some cases. Even so this must be done under the formal supervision of a doctor and the regular monitoring of blood pressure thereafter so that any return of high blood pressure can be detected well in time and appropriate treatment instituted.

Some patients may show a better control of blood pressure in summer months as compared to the winter months requiring suitable adjustments in drug dosage. This is largely due to the salt loss in sweat during the summer months.

High blood pressure tends to run in families. If both parents have high blood pressure, the chances that the children will also have high blood pressure are considerably increased. Such persons need to be vigilant and have their blood pressure checked frequently. It is possible to prevent or delay the appearance of high blood pressure in such individuals by ensuring that they maintain the ideal body weight and do not become overweight. Further, they should reduce their salt intake as much as possible, stay away from alcohol and also take regular exercise.

Thus, given the will and perseverance, it is possible for patients of high blood pressure to maintain normal blood pressure and avoid all adverse consequences of the disease. Likewise, susceptible individuals can delay the appearance of the disease or even prevent it altogether.

( Concluded)

Dr Sapru, MD, Ph.D, a former Head of the Department of Cardiology at the PGI, is the Medical Director and Head of the Department of Cardiology at INSCOL, Sector 34, Chandigarh ( 667897). Readers of The Tribune can also contact him at his residence at Panchkula ( 598801 and 598802)
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Diet and high BP
Madhu Arora

The general concept among people is that if you are hypertensive you have to cut down your salt intake. But is it only the salt that matters? There are a number of factors responsible for hypertension and there is a need to know some practical tips regarding the dietary management of the condition. The most important aspect regarding the prevention and control of high blood pressure is maintaining a healthy lifestyle in a stress free-environment.

Hypertension requires a reduction in the consumption of calories. Besides, the cutting down on fats and sugar and a regular walk or exercise schedule are a must. The aim is to bring about a weight reduction of 2 to 3 kg per month if a person is obese.

Fibre: A high-fibre diet is important as it gives satiety value and decreases the endogenous synthesis of cholesterol and hypercholesterolemia.

Fats: A high intake of animal fats and hydrogenated oils (vegetable oil, vanaspati, and margarine) should be avoided. Buffalo milk is high in fat. So, instead of low fat milk like double-toned milk should be used. As far as possible, butter or cream, mayonnaise and other sources of fats should be avoided. In a non-vegetarian diet, chicken can be used instead of mutton.

Salt: Most of the sodium in the diet is in the form of inorganic salt, principally sodium chloride (Nacl). The major source of sodium is the salt added during cooking. The average intake of sodium is salt added during cooking. It is 3 to 4 gm per day equivalent to 7.5 to 10 gm sodium chloride.

While buying commercial products the hypertensive patient should always check the label for any high sodium ingredients like monosodium glutamate, sodium citrate, sodium propionate or baking soda.

Potassium: An increase in potassium intake reportedly reduces blood pressure.

Beverages: Tea and coffee should also be consumed in moderation.

Alcohol: Three or more alcoholic drinks in a day is a definite risk factor in high blood pressure cases.

Smoking: Smoking has an injurious effect in patients with high blood pressure. The cessation of smoking brings about a series of beneficial changes.

Madhu Arora is a dietician at the GMCH, Sector 32, Chandigarh (Ph 574465)

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HEALTH BULLETIN
Tulsi: holy healer 

Dr R.Vatsyayan, Ayurvedacharya

Tulsi is an important symbol of the Hindu religious tradition. Although the word ‘‘tulsi’’ gives the connotation of the incomparable one, its other name, Vishnupriya, means the one that pleases Lord Vishnu. Found in most of the Indian homes and worshipped, its legend has permeated Indian ethos down the ages. Tulsi has been adored in almost all ancient ayurvedic texts although for its extraordinary medicinal properties.

Known in English as Holy Basil and botanically called Ocimum sactum, Tulsi is pungent and bitter in taste and hot, light and dry in effect. Its seeds are considered to be cold in effect. It has been described as of two types — vanya (wild) and gramya (grown in homes). Although having identical usage, the former has darker leaves. Seeds, roots and leaves of the plant are medicinal.

Ayurvedic texts categorise Tulsi as stimulant, aromatic and antipyretic. While alleviating kapha and vata, it aggravates pitta. It has a wide range of action on the human body mainly as a cough alleviator, a sweat-inducer and a mitigator of indigestion and anorexia.

Tulsi also has antibacterial, anti-inflammatory, anthelmentic and blood-purifying properties. Extensive research has found it to be an anabolic, adaptogenic and immuno-modulator drug. Its anti-tubercular activity is one-tenth of the potency of streptomycin and one-fourth of that of isonizid.

Tulsi is a popular home remedy for a number of ailments. Here are a few tips:

Fever — Tulsi leaves are specific for many fevers. In the case of malaria and of other tropical infections, a decoction of Tulsi leaves boiled with powdered cardamom in a cup of water and strengthened with sugar and milk brings down the temperature. Tea prepared with a little of ginger and leaves of Tulsi, while allaying bodyache, also gives a freshening feeling.

Respiratory disorders — In bronchitis and asthma, Tulsi juice is used as a medium of the intake of the medicine (anupana). In acute cough and cold, taking half a teaspoonful of dried leaves of Tulsi and black pepper, added with a little of honey, works well. Tulsi is also an important ingredient of many ayurvedic cough syrups.

Stress management — Taking the lead from the recent studies that Tulsi has stress-busting and antioxidant properties, more and more pharmaceutical companies are coming up with its preparations. However, a healthy person can take up to 10 leaves of Tulsi in a day.

Skin diseases and headache — Applied locally, Tulsi juice is beneficial in the treatment of ringworm and other minor skin diseases. Its pounded leaves, mixed with sandalwood paste, is a famous home remedy for headache. Tulsi seeds are used in anti-leucoderma preparations.

Other diseases — A decoction of 10 to 20 leaves taken along with a pinch of rock salt abates digestive problems like flatulence and anorexia. Its seeds are given in chronic urinary infections and with their mucilagenous action they are also helpful in treating diarrhoea, habitual constipation and piles.

The dose of Tulsi juice is 10 to 20 ml whereas the seed powder can be taken from one to three gm twice a day.

Dr R.Vatsyayan is an ayurvedic consultant based at Sanjivani Ayurvedic Centre, Ludhiana
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HEALTH EVENTS

Viral Hepatitis
A ‘‘ Public Forum’’ on VIRAL HEPATITIS will be organised on October 7 (Sunday) at the PGI Lecture Theatre Number I at 4 p.m., says Dr Y. Chawla, Professor and Head of the Department of Hepatology at the Institute. The series is ‘‘Current perspectives in liver diseases (2001)’’.

Mental Health Day
World Mental Health Day will be celebrated at the PGI and other health centres and hospitals of the Union Territory on October 10, says Dr N.N. Wig, the doyen of mental health specialists. Lala Lajpat Rai Bhawan in Sector 15 will also be a major venue.

Asthma and allergy
Dr Shakuntala Lavasa will offer expert advice on allergy and asthma at 226, Sector 9, Panchkula, and at SCO 80, Sector 15-D, Chandigarh, in the evening and afternoon respectively on Saturday, October 6. More information can be obtained on telephone numbers 892226, 562239 and 782766.

Give up smoking
We are told by Glaxosmithkline that now it is possible to give up smoking with medicinal aid and doctors’ advice. ZY BAN helpline gives detailed advice on Ph. No 9622005555.

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Q&A
Killer clot

Q: Can we manage it?

A: yes, says Dr J.D. Wig

Pulmonary embolism continues to be a significant cause of postoperative morbidity and mortality. It is one of the common causes of death.

What is an embolus?: An ambolus is a free-flowing blood clot that has moved away from the location where it was formed. Once it travels through the bloodstream, it can obstruct a blood vessel, causing an interruption in the supply of blood.

What is a pulmonary embolism?: A pulmonary embolism is a life-threatening complication that results when a portion of the thrombus in the deep veins of the legs breaks off and travels through great veins, eventually being lodged in the pulmonary circulation.

How does a clot form?: If a vein is damaged, the blood flow to the heart is reduced. When blood moves slowly, it becomes sticky and gathers at the vein wall. Over time, the blood forms a clot which may grow big enough to close off the vein. A deep vein thrombosis is a blood clot occurring in a deep vein, especially of the leg. If a part of the clot breaks off and travels to the lungs, it becomes a serious matter.

What are the problems resulting from am embolus?: Pulmonary embolism causes damage to the lung tissue, disrupts the proper functioning of the damaged lung and can cause death. Symptoms depend upon the location of the blockage and the size of the area affected by lack of blood supply.

What are the symptoms of a clot in the lungs?: The feeling of being short of breath that comes on suddenly, pain in the chest when you inhale, feeling faint, coughing up blood-stained sputum and rapid pulse.

What are the risk factors?: Decreased blood flow as a result of restricted movements after an operation can lead to changes in blood viscosity. Obesity, smoking, old age, oral contraceptives, pregnancy, fractures, hip or knee replacement, urological surgery, neurological trauma — all these predispose one to an increased risk of deep vein thrombosis and pulmonary embolism. Prolonged sitting ( when you take a long trip by car, plane or train) leads to a blood clot in the deep veins of the leg.

How can this be prevented?: Stand and walk or move your legs if you must sit for long periods. Active or passive leg exercises involving the calf muscles activate the calf muscle pump and can increase the venous blood flow. Patients should be taught leg exercises as a part of the leg mobilisation programme. Wiggle you toes and tighten your calves to keep blood moving. A combination of leg elevation and elastic stockings reduces the frequency of the formation of a blood clot in the deep veins. The education of the patient and those attending is essential to ensure effective prevention.

How can this life-threatening condition be managed?: Oxygen is given to restore Oxygen tension. Drugs are administered to relive pain and distress. The mainstay of the treatment is " blood thinners" ( anticoagulants). These medications control the blood's ability to clot. Anticoagulants are given by the intravenous line in the acute phase and then in pill form. Blood is tested often to monitor how well medication is controlling clotting. Surgical removal is rarely indicated. Venous interruption is only considered in the patients who have recurrent emboli in spite of anticoagulants, or in whom long-term anticoagulation is not possible

What to do once the acute state is controlled?: Anticoagulants must be taken at the same time each day. Too much medication may cause bleeding; too little may cause clots. If you have bruising or bleeding gums, have your blood tested. Return to normal activities gradually. If your leg is unusually swollen, elevate the foot of your bed five to six inches. This helps send blood back to the heart. Exercise both legs. Wear elastic stockings when you are out of your bed. These prevent ongoing leg swelling that could cause tissue damage.

Dr Wig, the eminent surgeon, teacher and writer, is based in the Department of Surgery at the PGI, Chandigarh.
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