On World Hypertension Day, May 17, Dr Mitosha Do Carmo Carvalho says that we can empower the younger generation to lead healthier lives to pave the way for a future with lower burden of hypertension
DR MITOSHA DO CARMO CARVALHO
Hypertension, also known as high blood pressure, is one of the leading causes of mortality and morbidity all over the world. It is estimated to cause over seven million deaths each year, about 13% of the total number of deaths worldwide.
This non-communicable disease was presumed to be that of older adults; however, in recent years; there has been a striking rise in the incidence of hypertension and its comorbidities in the younger population. In India, it is found that the prevalence in the age group between 20 and 40 years is as high as 1 in 8 people. Unfortunately, more than 80% of them are undiagnosed due to lack of awareness or repudiation of the sad truth. It frightens me to say that in the past couple of weeks, there have been about 1-2 cases of heart attacks in the age group of 30-40 years per day in Goa Medical College itself, many of whom were later diagnosed to have hypertension.
Why the shifting demographics?
Our lifestyle is rapidly changing and becoming more sedentary due to rapid urbanisation. Change in dietary habits with shift to more processed food and so called ‘fast food’, which are high in salt and unhealthy fats, is one of the major contributors to the development of hypertension. The young generation also faces tremendous mental stress, be it in education or work life, leading to persistent elevation of stress hormones, like cortisol, which is detrimental. This is further exacerbated by the abuse of addictive substances like alcohol and tobacco.
Why be wary of this ‘silent killer’?
It is called a silent killer because, like diabetes, the majority of the patients are asymptomatic for years together, unless the blood pressure is really high or leads to complications. The constant increased pressure within the vascular system causes strain and damages the inner lining of the vessels, making them narrow and stiff. Eventually blockages occur within the organs, causing ischemic heart disease, stroke and also kidney and retinal damage. It is one of the commonest causes of heart failure. Very high blood pressure can also rupture blood vessels, causing fatality in the form of intracranial bleeds.
The Ministry of Health and Family Welfare and the U.S. Preventive Services Task Force recommend that all adults above the age of 18 should undergo opportunistic screening, and follow the five R rule list prior to BP measurement. It would be advisable to get the first evaluation done by a healthcare provider. However, various machines for automated home recording are also available. High-risk individuals may be advised to get an ambulatory 24-hour BP monitoring done to detect masked cases and rule out white coat hypertension (those having high readings in the clinic but are actually normotensive). Persons with normal BP (<130/80mm Hg) should recheck every two years.
For those detected with hypertension, what’s step 2?
Tests should be done to determine complications of hypertension and the associated comorbidities, such as blood glucose, cholesterol, creatinine and cardiogram. Every hypertensive person must do the following tests at diagnosis and regular intervals thereafter.
How do we tackle and prevent hypertension?
Use ‘Comprehensive Approach’, which includes lifestyle modifications, before drug treatment and targeting other components of metabolic syndrome, such as pre-diabetes, dyslipidemia and obesity.
Lifestyle modifications: All individuals should be advised on adopting healthy habits, stopping tobacco and excessive alcohol intake and maintaining an ideal body weight. Daily brisk walking for 30 minutes and outdoor games have proven to reduce blood pressure. Simple habits like walking short distances, taking stairs, and using a cycle can help. Avoid prolonged sitting in the office, practice the norm of leaving the chair hourly and walk for five minutes. A healthy diet with fruits, vegetables, and low-fat dairy is encouraged, with salt intake limited to less than 4gm/day. Avoidance of fast food, excessive tea, coffee, and aerated drinks are key components of dietary advice. Adequate sleep, yoga, and meditation have proven to be beneficial in stress management.
Drug treatment: It is usually simple and very effective; however, I would like to emphasise that it needs to be continued for prolonged periods, even lifelong in many cases. Young adults are more likely to be hesitant in taking medication and underestimate the severity of elevated blood pressure. Hence, prior counselling is of utmost importance.
(The writer is a senior resident in the Department of General Medicine, Goa Medical College, Bambolim.)