High blood pressure (BP), also called hypertension, is the commonest vascular problem seen globally. It is the most common cause of death and exceeds smoking, diabetes and even high cholesterol levels. According to conservative estimates there are an estimated 234 million adults with hypertension in India and more than 3.5 million persons suffering from hypertension in Kashmir. The theme of this year’s world Hypertension day is: Measure your BP correctly, Control it and Live longer. The importance of controlling it effectively becomes even more important in the current Pandemic. The adverse events including mortality is significantly higher in COVID patients with hypertension.
An important issue with hypertension is that it is usually not associated with symptoms that is why it is called “A Silent Killer”. One of the cardinal messages to be spread should be that every adult should know his/ her usual BP. Measuring BP is easy and no special training is needed. Preference is given to well calibrated instruments made by a number of reliable companies. The digital instruments using an oscillometer method are the preferred ones over the dial type or manometric instruments. Mercury manometers which are still used in many places have been completely banned all over the world because of the toxicity of mercury. Lowering the BP even modestly helps one in living longer. A 10 mms reduction in BP can lead to a 13% reduction in all-cause mortality. The goal of BP reduction is to attain levels less than 140/90 and as close to 130/80 as possible at all ages as early as possible , except in very old and frail persons where attempts of lowering the BP need to be gradual because of a tendency of falls and injuries.
It has also been recognized that self-measured home recording is the best way to record the BP. This should be the method of choice these days when lock downs and restrictions to move out are enforced very often to contain the pandemic. Besides this, it obviates the problem of white coat hypertension (High BP in clinic and normal at home) seen in about 25% of our population. This was an important finding of the large “India Heart Study” conducted under the supervision of the author in 19,000 subjects. The other finding from this study was that the evening BP in our population was higher than the morning recordings contrary to the prevailing belief. In addition, the pulse rates were higher than 70 in majority even in home measurements. These findings can have important bearings on the time of drug administration and choice of drugs. It has been shown in a few studies that administering BP lowering medications during the evenings leads to lower incidence of strokes, heart attacks and heart failure admissions. Like-wise it has been suggested that BP drugs which do not increase pulse rate and preferably lower are to be preferred. This is because it is a well-known epidemiological fact that communities with lower heart rate live longer.
Patients with high BP, if they develop moderate to severe forms of COVID have to be extra careful. Many of them are on high doses of steroids (methyl prednisolone etc) and on anti-coagulants (blood thinners). Steroids can increase the BP and also induce increase in blood sugar levels making diabetes out of control in diabetics. Anti-coagulant use which is essential in patients with significant lung involvement can make the person with uncontrolled BP prone to bleeding in the brain leading to a stroke. For this reason, having a home BP measurement and sugar monitoring is very important.
One of the important missions of the Gauri Healthy Heart program is to optimally control the BP, which goes a long way in preventing heart attacks. In our district camps in the valley and across the Pir Panchal, uncontrolled BP was a major issue seen in around half of the patients despite being on drugs. Compliance to treatment is an important issue. For this reason, most National and International Guidelines insist on single tablet combinations containing up to even 3 drugs. In addition, non-drug measures like regular exercise, weight reduction and low salt diets with plenty of fruits and vegetables are very important adjuncts. These measures have the efficacy of 2 drugs are cost effective with good side effects.
Take Home Message:
Hypertension is a major and very common public health problem. Its recognition and early diagnosis is very important. It is amenable to adopting good life style and easily available medicines. Reducing BP and bringing it to normal levels minimizes strokes, heart attacks, chronic kidney disease and heart failure, thereby prolonging purposeful life. Advancing age increases its incidence and complications. The rules of controlling it remain the same at all ages.
Prof Upendra Kaul is Founder director Gauri Kaul Foundation, A recipient of Padma Shri and Dr B C Roy Award