The pressure that blood exerts against the walls of the arteries is blood pressure. It depends upon the strength and rate of the heartís construction, the volume of blood in the circulatory system and the elasticity of the arteries. The sphygmomanometer is used to measure blood pressure. The pressure at which the flow of blood resumes is called the systolic pressure, it represents the blood pressure when the heart is contracting. This pressure is determined by reading the gauge or the scale on the mercury tubes. As more air is let out of the cuff, the sounds become muffled. The pressure at this point is called the diastolic pressure, represents the pressure when the heart is relaxing. It rises with age because arteries become less elastic and slow down the flow of blood. Normal blood pressure: systolic 120/distolic 80.
Blood is the lifestream of the human body, this red fluid performs many tasks and no part of the body can live without it. Blood supplies the cells of the body with the food and oxygen they need for work and growth. It carries waste products to special organs that remove them from the body or break them down into harmless substances. It fights disease germs that enter the body. The amount of blood depends on the size and the environment of each person. The heart pumps the blood through the body. It flows from the heart through the arteries and it returns to the heart through the veins. The large arteries that leave the heart carry blood into smaller and smaller vessels. The smallest of these vessels are the narrow thin walled capillaries. Blood flows from capillaries into large veins until it reaches the great veins that enter the heart. Other organs also work to keep the blood functioning: lungs supply it with oxygen and remove its carbon dioxide, Kidneys keep it free of poisons, they also regulate its water and salt contents, the liver and intestines supply the blood with food. The four main parts are plasma, red blood cells, white blood cells and platelets.
A palmist looks at the hand and predicts the futures. An astrologer reads the horoscope and relates all about your life. A physician is also in a good position to predict your health future by measuring blood pressure. He is able to confirm whether you are candidate for stroke or heart attack. He may be able to foretell the approximate expectancy of life if you do not wish to change the life style. To make the prediction more correct a few additional things have to be known. They are called risk factors. More risk factors you have, along with high blood pressure, greater are the chances that you will fall a prey to heart attack or stroke at an early date.
Risk factors are age, cigarette smoking, high fat levels (cholesterol and glycerides ) in the blood, diabetes, obesity and changes in X-ray and electro-cardiogram. This is why the physician gives a thorough examination, takes the cardiogram and sends the blood for different tests. He can advise the way and means to make your future safer. He will suggest reducing the risk factors and blood pressure to avoid stroke and heart attack. The future is in your own hands. It is important to take high blood pressure seriously. Most people ignore blood pressure as it, in most cases, symptomless, to their great cost. They may pay for this carelessness with stroke or death.
A few may have headaches, breathlessness on exertion and blured vision. There is a chance of giddiness or unsteadiness if blood pressure is too high or even if it has been brought down lower than desired through medication. Blood pressure is a silent killer, it does not show up as a major problem. So it becomes natural to ignore it. Even if you do not ignore it you tend to take tablets to get rid of the symptom. But blood pressure is a lifelong ailment and has to be treated as such, once the root cause is found.
Let us first understand what blood pressure is. In order to maintain supply to all parts of the body, the heart has to pump blood at certain pressure. Even in healthy person, the blood pressure varies from moment to moment to meet different demands of the body. It goes down during sleep. When you get up, it takes little time for the blood pressure to rise to a normal level. This is why you feel sluggish. If you stand up suddenly you may feel light-headed or dizzy. Normal systolic blood pressure is 120 and diastolic is 80mm. Of Hg.
The several categories of high blood pressure are listed :
- Very high blood pressure - Above 230 systolic and 130 diastolic
- High blood pressure - 170 systolic and 110 diastolic
- Moderately high blood pressure - 160 systolic and 95 diastolic
- Border line blood pressure - 150 systolic and 90 diastolic
In most people with high blood pressure, the cause cannot be easily identified. The only finding is the raised blood pressure. The cause has to be traced : cholesterol, diabetes, kidneys, defective heart etc. It is common for a person of, say, age 35 to 40 to carry on with high blood pressure without complicating symptoms. No headaches, no dizzy spells, no hot flushes. Gradually, as time goes on the body begins to show off the strain of high blood pressure, may be after 5 years, 10 years or even more. When it comes it is dramatic. It comes all of a sudden without a warning in the form of a stroke or heart attack. The heart has to work harder when you suffer from blood pressure. It is pumping blood under greater pressure. After a long term, it damages the lining of the arteries. Instead of flowing smoothly the blood in the arteries crashes, buffeting against the arterial walls just like the high tide water of the sea when it enters a cleavage of a rocky seashore. Under a prolonged strain, the arteries become hardened and thickened reducing the blood supply. At the point of maximum turbulence the lining of the arteries gets damaged over the small patchy deposits of hardened, then called plaque, and on its rough surface clumping of the platelets (responsible for blood clotting) takes place. Abruptly, it may block the artery, totally cutting off the blood supply to the heart. The heart deprived of nourishment at the time when it is overworked and fatigued is forced to work harder to push the blood through obstruction.
Unless something is done a heart attack is just around the corner. A small artery under the strain of high blood pressure can burst in the brain and cause a stroke. Under the strain of high blood pressure, the kidneys can fail in the course of time. There may be difficulty in walking, due to atherosclerosis in legs, called intermittent claudication. The blood pressure has not created the havoc suddenly. It was done in the course of many years by high blood pressure and circulating fats in the blood. Most horrible end of the story will be sudden death or crippling stroke. To prevent such a tragic end something must be done from now. We can determined, even reverse the whole course of the disease in terms of many more years of healthy, youthful and productive life. Where there is a wall there is way - and it is true.
Measure Blood Pressure
It is difficult job. Blood pressure rises with emotion and exertion. At the first visit to a consultant, it may tend to be higher than normal because you are anxious. It is high by 10 mm of Hg. Than your third visit. It is always better to take rest for 10-15 minutes before the pressure is taken. A cup of coffee or a cigarette smoked can also raise the pressure count. There are many factors affecting blood pressure.
Age: Blood pressure keeps on rising throughout life. It rises rapidly from infant to the baby stage and to teenage. The rise is slow between 25 years and 40 years. Later it rises slowly almost 1mm of Hg. Every year. Women have slightly lower blood pressure than men, but equal men after the menopause. If aged 25 years and the systolic blood pressure is 160mm of Hg. You have two and half times more chance of dying compared to a person of same age having 120 mm of Hg. This was the result of a study made by the National Institute of Health in Framingham, Massachusetts (U.S.A.).
Risk factors are important to predict the future if suffering from high blood pressure. A computer programme was constructed by feeding information about risk factors in a computer and the history of two patients was fed to know the additional gravity. Two patients were selected aged 45 years and with the same systolic blood pressure of 170 mm of Hg.
|170 m of|
|170 mm of|
|Left ventricular (heart) enlargement|
Through both patients have the same age and the same blood pressure, through the addition of other risk factors in the first case the risk of heart attack rises to 54.1%. In the second case it is only 6.33%. (Data based on Framingham Survey). In another survey, a comparison was made between a person of high blood pressure (160 mm of Hg systolic and 95mm of Hg diastolic) and a person having normal blood pressure. A person with high blood pressure has 3 times more chance a heart failure and 7 times more chance for stroke.
Cutting down on the risk factors is more important than just reducing blood pressure by drugs and not looking after the other risk factors does not reduce the danger of a heart attack. A recent study has shown that if you have lower blood pressure and are loaded with other risk factors you have a much higher risk than high blood pressure alone. It has been revealed that if you take drugs like cholestyramine to reduce the blood fats it does not reduce the risk factor because it does not reduce fat as a whole and does not discriminate between good fats for the heart (high density cholesterol) and bad fats (low density cholesterol). Trials have shown negative results or even increased mortality with certain drugs (Clofibrate).
If parents have high blood pressure you are a more suitable candidate for high blood pressure. But you may not have the same level of blood pressure as your parents. One cannot choose parents but he can change the life style, cut down on risk factors and control blood pressure to a great extent. Concern for body weight is justified. People with 20% higher body weight will have 3 times more chances of high blood pressure. Keep on reducing diet is the first step, if overweight, and with high blood pressure.
Chances of getting a stroke are high, between 40 to 49 years. If the diastolic pressure exceeds 104 the chances are 10 times more of getting a stroke than if the diastolic is less than 85 mm of Hg.
Salt: Salt and the tongue have been in love with each other for centuries. The tongue is so much used to salty taste that to separate the two is to make lives saltless, a proverb commonly used to indicate that all pleasures have departed form life.
In the Roman Empire part of the salary was paid in "salt" and this is how the word "salary" took origin. Those who, as a matter of habit, consume more salt have a higher average blood pressure that those who consume less salt. Too much sodium, an unwanted ingredient in salt, is the principal cause of high blood pressure. Too much sodium also causes the body to excrete much needed potassium salts. The load on the kidneys increases when we take in more salt. Salt helps to retain water in the body. it is common to consume two to three or even more times salt than it is needed for the body. Now it is clearly acknowledge that more salt is injurious to health. Do not take more than 4 gms of salt in a day. Cutting down on salt will bring down blood pressure. Spicy food helps to consume more salt. It affects the wall of arteries and makes them more sensitive to stimulation. Generally, the palate is conditioned to salty foods. Cut down, gradually, on salt. Instead, use herbs like dhania leaves pudina leaves and curry leaves and mild spices, like onion garlic, radish or even mild masala like jeera, dhania, haladi and mustard seeds etc. Avoid processed food and pickles which are known to have too much salt.
Slow -moving rural folk, who are in close contact with nature have less problems with blood pressure. A study of Pacific Islanders showed that the group in closer contact with the modern ways of society have higher blood pressure that those found in communities from where they migrated. Even if food remains the same. Smoking: cigarette smoking not only increases blood pressure and heart rate but also affects the quality and quantity of blood reaching the heart. Nicotine in cigarette increases heart rate and blood pressure. Carbon monoxide which is inhaled along with the smoke affects blood as far as the release of oxygen, is concerned. Nicotine constricts coronary arteries. It reduces blood supply reaching the heart.
Exercise is beneficial in hypertension. It reduces heart rate and blood pressure. The collateral blood supply to the heart increases, increasing the total amount of blood reaching to the heart musculature. To help the heart, stop smoking cigarettes and start doing exercise. A good physician always checks blood pressure. If a patient is found to be suffering form high blood pressure he should be advised to check his blood pressure regularly. Unfortunately many cases are detected very late after the onset of heart attack or stroke or after death.
Treatment : To treat a patient with high blood pressure is difficult. It needs understanding, friendly inspiring and a polite physician. It is important to explain to him his disease, why one gets high blood pressure, what damage it can cause and how long it will take for blood pressure to harm the body. Most patients suffer form mild to moderately high blood pressure. These are patients who are not benefited by medication to bring down blood pressure. Most deaths which occur in such cases are due to heart attack. In none of the individual clinical trials carried so far, no significant benefits were noted after long terms proper treatment by medication. It will not be wise to assume that new drugs which have come into the market will be safe and effective till they have been tried for several years.
These drugs only lower the blood pressure, nut do not do anything to reverse the process of progressive damage being done to the body. it is important to know the significant role played by diet, exercise, relaxation and the beneficial effects of non-smoking. The aim of treatment is to reduce the risk of getting a heart attack to stroke. What should be the treatment will depend on the level of the blood pressure and the number of risk factors it carries. If blood pressure is high the immediate need is to reduce it. We can think of other measures to be taken later on. In a majority of cases where blood pressure is mild, to moderately high, giving up cigarettes and starting a proper diet can work wonders.
If you are obese, a reduction in body weight will help to bring down blood pressure. Be prepared for a long journey of diet control, less fat, less salt, less sugar, complex carbohydrates and more fibres. Take sugarcane juice, jaggery and honey, instead of sugar. Use whole wheat flour instead of white flour. Take a lot of fibres in the form of salads, green vegetables and fruits in the diet. Cut down on milk and milk products. All this is to enable you to cut down calorie intake and reduce weight.
Start on morning walks, jogging and exercise. You will use up more calories by the help of exercise. Exercises helps reduce heart rate and blood pressure. Did you know that the athletes have a slower pulse rate than a normal person. Slow down the pace of life learn to relax, do savasana as advocated by the late Dr. K.K. Datey, eminent Mumbai cardiologist. Do meditation to help bring down blood pressure. Studies have shown that during meditation there is 25 percent decrease in cardiac output, compared with a 20 percent decrease during sleep. The heart rate falls by about 5 beats a minute. Researchers have found evidence of reduction of blood pressure. Meditation helps in two ways - first it induces a relaxed state of your body and mind which is useful in moments of stress. Second, although, this is less clear, it seems to have some direct physiological effects which are beneficial to those who are prone to coronary diseases.
Do not expect miracles to happen overnight. It takes years for blood pressure to develop and it takes months to control it and reverse the process to the damages caused by blood pressure to the body. work hard with a strong mind. Be prepared to hold your destiny in your hands. Things are difficult to start with, once you get started, pursue your aim with a strong mind and with the passage down, and in due course you will walk back on the path of good health and a future when the danger of imminent heart attack and stroke is not hanging over your head.
As you progress, blood pressure will come down. Blood cholesterol and glycerides will start falling, moving towards normal levels. Frelation between the physician and patient is important. A or all this, a close patient who knows well is likely to follow the advice more keenly. Many patients drop out and are not seen on the next appointment. Few will do by deliberate rejection of therapy, but in most cases is because of less proper understanding of the disease. A well run clinic should have a proper record of attendance and issue reminder, if required.
Drugs for high blood pressure
Diuretics: (chlorothiazide and related drugs) they are important as they help in the excretion of extra salt from the body. The same job can be done if we adopt a low salt diet. The disadvantage with a diuretic is that needed potassium salt are also excreted out simultaneously and must be supplemented with fruit juices or potassium supplements. Drugs normally used are chlorthalidone ( Hygroton), Furosemide (lasix), Metolazone (zaroxolyn) etc.
Side effect: May cause impotency in men, potassium depletion, rise in uric acid levels, nausea, dizziness, rashes, numbness, pins and needles, may increase diabetes. Regular check of blood for sugar and urates should be done.
Beta blockers (practolol & propranolol) : they reduce the rate and force of the contraction of heart and reduce the cardiac output.
Side effects : breathless and swelling of the ankles. May cause asthma, cold extremities. You may have vivid dreams and insomnia. Long term use may elevate tryglycerides and lower high density cholesterol which is good for heart.
Vasodilators ( Hydralazine and Minoxidil ) : Main cause of high blood pressure is constriction of peripheral blood vessels. These drugs help o dilate them and bring down blood pressure. They increase the heart rate and force the contraction of the heart, should not be given if the patient is suffering form angina pectoris or myocardial infarction.
Side effects: flushing of skin, headaches, palpitation, gastrointestinal disturbances, dizziness and fluid retention.
Centrally acting drugs (Methyldopa and Clonidine): These drugs cause drowsiness, and dry mouth, anaemia, diarrhoea, skin rash even drug induced fever after 15 days. Clonidine, in addition to above side effects, may also cause constipation, tremor, sweating and insomnia.
Adrenergic Neuron Blocking drugs: (Guanethidine and Bethanidine): they are very effective in reducing blood pressure. They may cause substantial fall on standing and after exercise.
Side effects: Ejaculation during sexual intercourse in males may be inhibited. May cause diarrhoea, slow heart rate, weakness and nasal stuffiness.
Reserpine: it is derived from a plant Raulfia Serpentina used in India for centuries. It has tranquilizing effect on the mind.
Side effects: Slow heart rate, aggravation of peptic ulcer, diarrhoea, drowsiness, depression etc. These drugs have a different mode of action and several side effects. They are quite often given in combination so that their doses can be reduced and thus the side effects. It will also depend on the age, season, profession of patient etc.
Before we start the treatment is should be well understood that it is a life long treatment. If they are stopped, blood pressure will come back to pre-treatment level or even a little more. Generally, blood pressure is treated with the hope to prevent a stroke or heart attack. Various studies have shown however that it hardly alters the course of terminal disease.
If you important to remember it may cause an abrupt rise in the blood pressure (as clonidine). Other drugs stopped suddenly may worsen angina pectoris or even cause myocardial infarction. It is important to remember that if we are on a drug for a long time it is always advisable to gradually reduce it and then stop it though it may take weeks or months. The benefit of medicinal treatment to reduce high blood pressure is still doubtful inspite of a lot of research.
Hypertension can better be controlled by diet and special relaxation techniques rather than customary medical care. If we control blood pressure and cannot control the other risk factors like smoking, fat consumption, lack of exercise and tension the results are negative. Medical treatment will do more harm than good if we are depending on drugs only and doing nothing to change the lifestyle.
The West has very clearly understood the invalidity of medicinal treatment in prevention of a heart attack or stroke. Death due to heart attack is common in the west due to affluence and all the luxuries available to them. It has arrived in a big way in India. Every year over 3.5 million people die in India due to heart attack, according to leading Mumbai cardiologist, Dr. B.K. Goyal. The west has become more health conscious. The number of people smoking cigarettes is reducing every year. They have taken to jogging and eating a lot of fibre foods like salads, fruits and boiled vegetables and cutting down on meats. For good healthís sake, it is time we became conscious of the way of life as medicinal treatment holds little hope.
High blood Pressure : Health Farming
Cut down on sugar, oils (including ghee and butter) salt, white flour, tea and coffee. Stop alcohol and tobacco. Eat more vegetables and fruits. Start one week on fruits only. Take fruits with your breakfast, lunch and dinner, preferably one fruit at a time. Take oranges, sweet limes, papaya, apples, pears, mangoes, guava, pineapple, rose apples, raspberry, melon, plums, peaches, strawberries etc., avoid banana and jack fruit.
After a week add mild besides fruits. Cowís milk is the best. If not available, take any low fat milk (Boil the mild just once). After two weeks add cereals. Take boiled vegetables or cook them in little oil. Salad, curd and chapati made of whole wheat flour for lunch and dinner. Take more green vegetables. Cut down on salt. Cut down on condiments to reduce the requirements of salt. Do not use more than 2-4 gms. salt per day. Salt retains water in the body an increases blood pressure. Avoid overeating.
Eating less will help cut down body weight, will keep blood pressure down. Avoid taking meat and eggs. Cut down on fish and chicken. Remember, twenty percent of your food should come from cereals, milk, nuts, pulses etc. the remaining eighty percent from vegetables and fruits. Take dry fruits like dates, raisins, anjir, manuka etc. In small quantities take cashewnuts, peanuts, almond (badam) etc. Take a glass of fruits or vegetable juice (cucumber, white pumpkin, carrots, cabbage etc.) Do not smoke cigarettes or bidi and do not chew tobacco. Cut down on coffee and tea. Nicotine and caffeine increase blood pressure.
Use a minimum of oil or ghee in cooking. It is likely to get deposited in the lumen of blood vessels as cholesterol. Fat deposits reduce blood supply. Avoid frying food. Do not take sugar. It is high calorie pressure. Drink plenty of water, atleast 2 litres a day. This is to help you to urinate more and excrete waste products from the body. A luke warm water enema if you feel constipated is recommended.
Exercises increase blood pressure, this is why it is better to start with easy exercises. As the body gets used to exercise, blood pressure will be more sustained. Exercise will help increase circulation of blood. There will be less chances of artery getting blocked, causing heart attack. Avoid worry and tension. Blood pressure may go up by 15-20 mm of Hg with tension. Rest and relaxation will bring it down. When very angry or emotionally upset, blood pressure will increase. A blood vessel in the brain can give way and cause a paralytic shock.
Learn to relax. Change your lifestyle. Learn to deal with your business or job effectively if it is causing tension. Try to do the corpse pose (sava-asana) every day, try relaxation techniques. Learn to mediate. It is effective to combat tension. Have good quality sleep, atleast 8-9 hours every day. Take 1-2 hours rest in the afternoon after lunch. Whenever you feel uneasy it is always advisable to take body wash before going to bed if you have problem getting sleep.
Pranayama is good for blood pressure as it ventilates the lungs better and causes relaxation. Water treatment is of help. Take whole body pack twice a week. Steam and sauna should no be taken pressure is high. Anyway, do not take it for a long time preferably for more than 3-6 minutes twice a week. Massage is good but should be done lightly, should be done in the direction away from the heart. Take massage in the sun if it is cold.