5 Steps to Control High Blood Pressure Is high blood pressure affecting your health? g@~ Understand High Blood Pressure . Overcome the disease Measure Your Risk Take control of your life Dr. ANJALI ARORAB lood pressure is the force created as the heart pumps blood through the blood vessels. When the blood pressure goes beyond the prescribed normal range, an individual is diagnosed as having high blood pressure. High blood pressure (Hypertension) usually shows no symptoms and can affect people of all ages and backgrounds. 25% of the population these days suffer from high blood pressure. You too might be having high blood pressure, and not even know about it!7 Test Yourself for Possible ; Yes No Personal and Family History ! High Blood Pressure | You smoke. —————_— ——— | You are between ‘ 35-50 years of age. You have a close Yes No Lifestyle Yeu have irregular blood relative who working hours. suffers from high || [) You are constantly a blood pressure, under a lot of stress. heart disease or You do not have stroke. much physical ; 2 activity at work or at Yes No Medical History home. Your cholesterol level is over Yes No Eating Habits 200 mg/dl. r] [). You are fond of salty, fried or sweet LI You are more than ten percent of your ideal weight. food. You have more than two alcoholic drinks each day. It has been more You usually have more than Iwo cups than one year of coffee or other caffeinated since you had beverages each day. your blood pressure checked. The more times you answer “yes” to the above statements, the greater is your risk of developing high blood pressure.2 Understand High Blood Pressure Everyone needs blood pressure (BP) to live. However, high blood pressure is a silent killer. Learn about it and fight this silent threat. The Heart: A Silent Pump The heartis a fist-sized muscle which pumps blood, three hundred and sixty-five days a year, twenty- four hours a day. Your heart pumps away constantly, sending oxygen and nutrient-rich blood through your body. left atrium: right atrium right lat ventricle ventricle Human Heart Blood Vessels: Pipelines for Blood Your blood vessels are a network of elastic, smoothly lined ‘pipes’ surrounded by muscles and nerves: Arteries are vessels that carry fresh blood from your heart to your body. Veins return used blood from your body and heart to your lungs. Used blood depleted of oxygen and nutrients, arrives , from the upper and lower \s parts of your body through the blood vessels to the right chamber of your heart. Your heart pumps the used blood through the pulmonary artery to the lungs, where the blood receives fresh oxygen supply (which you breathe in) and gives out carbon dioxide (which you breathe out). Fresh blood, rich in oxygen, returns to the left chamber of your heart from your lungs. This blood gets circulated through the aorta and the other blood vessels to the rest of your body. Arteries supply your heart (coronary arteries) with oxygen rich blood. This makes the heart muscle in the body with its own supply of oxygen and energy. tos 2Normal Blood Pressure Blood pressure is the pressure that blood exerts on the walls of the arteries. Measurement of blood pressure consists of two numbers such as 120/80. The first number refers to the systolic pressure and the second to the diastolic. These numbers measure your heart in its pumping and resting stages. Systolic blood pressure: The first number above measures the force while your heart is at the pumping stage. A normal, healthy systolic blood pressure is 120 mmHg or below. Diastolic blood pressure: The second number measures the force at rest — that is, in between the heart pumps. A normal, healthy diastolic blood pressure is 80 mmHg or below. While your diastolic blood pressure stays at about the same level all the time, your systolic blood pressure changes frequently. These variations can be due to your daily activities and the body's response to physical and mental stress. For example, if your BP is normally 122/80 mmHg at work, it can increase to 160/80 mmHg due to stress. At play, it may also vary from 110/80 mmHg to 150/ 80 mmHg. Regulation of Blood Pressure Regulation of blood pressure through mechanisms which have been well understood are: = Baroreceptor reflex: Baroreceptors in various organs can detect changes in blood pressure, and adjust the mean arterial pressure by altering both the force and speed of the heart's contractions. The total peripheral resistance is also regulated by them.= Renin Angiotensin System (RAS): This system is generally known for its long-term adjustment of blood pressure. This system allows the kidney to compensate for the loss in blood volume, in case of surgery or injury. = Aldosterone release: This steroid hormone is released from the adrenal cortex in response to angiotensin II or high sodium potassium levels. Aldosterone stimulates sodium retention and potassium excretion by the kidneys. Sodium is the main ion determining the amount of fluid in the blood vessels by osmosis, therefore aldosterone increases the fluid retention, and indirectly the blood pressure. Factors Influencing Blood Pressure There are many physical factors that influence blood pressure. Each of these may be influenced by physiological factors, such as diet, exercise, disease, drugs, etc. Physical Factors = Pumping rate of heart: In the circulatory system, this rate is called heart rate, the rate at which blood (the fluid) is pumped by the heart. The higher the heart rate, the higher is the blood pressure. = Fluid volume: The more the Cin blood present in the body, the r= higher the rate of blood return io the heart and the resulting a cardiac output. There is some | relationship between dietary Z salt intake and increased blood oe peat 1 pe volume. High salt intake Can sey. Most af us eat far more than 1-2 teaspoons. result in higher blood pressure. = Resistance: In the circulatory system, this is the resistance of the blood vessels. The higher the resistance, the higher the blood pressure. Resistance is related to size (the larger the blood vessel, the lower the resistance). It is also related to the smoothness of the blood vessel walls. The build-up of fatty deposits on the arterial walls reduces the smooth arterial lining roughening up the arteries. artery fatly deposits on arterial walls= Renin Angiotensin System (RAS): This system is generally known for its long-term adjustment of blood pressure. This system allows the kidney to compensate for the loss in blood volume, in case of surgery or injury. = Aldosterone release: This steroid hormone is released from the adrenal cortex in response to angiotensin II or high sodium potassium levels. Aldosterone stimulates sodium retention and potassium excretion by the kidneys. Sodium is the main ion determining the amount of fluid in the blood vessels by osmosis, therefore aldosterone increases the fluid retention, and indirectly the blood pressure. Factors Influencing Blood Pressure There are many physical factors that influence blood pressure. Each of these may be influenced by physiological factors, such as diet, exercise, disease, drugs, ec. Physical Factors Pumping rate of heart: In the circulatory system, this rate is called heart rate, the rate at which blood (the fluid) is pumped by the heart. The higher the heart rate, the higher is the blood pressure. Fluid volume: The more the blood present in the body, the higher the rate of blood return to the heart and the resulting | cardiac output. There is some relationship between dietary — salt intake and increased blood —_ Yeu ness just. pinch . {bout 500 may of salt exer volume. High salt intake can ay. Most of us eat far result in higher blood pressure. Sennen ee Resistance: In the circulatory system, this is the resistance of the blood vessels. The higher the resistance, the higher the blood pressure. Resistance is related to size (the larger the blood vessel, ihe lower the resistance). It is also related to the smoothness of the blood vessel walls. The build-up of fatty deposits on the arterial walls reduces the smooth arterial lining roughening up the arteries. artery fatty deposits on anterial walls blood flowVasoconstrictors, released by the body (e.g. due to stress) can reduce the size of the blood vessels, thereby increasing the blood pressure. Vasodilator medication (e.g. Nitroglycerin) helps to increase the size of blood vessels, thereby decreasing high blood pressure. = Viscosity, or thickness of the fluid: If the blood gets thicker, the result is an increase in blood pressure. Certain conditions can change the viscosity of the blood. Low red blood cell concentration (anaemia) reduces blood viscosity, whereas increased red blood cell concentration increases blood viscosity. Viscosity also increases with blood sugar concentration. Each individual's autonomic nervous system in the body, responds to and regulates all these interacting factors. The Blood Pressure — Minerals Calcium Recent studies indicate that low levels of calcium (besides being linked to osteoporosis) are linked to blood pressure. Trials are showing that calcium intake helps decrease blood pressure in hypertensive patients. A diet including leafy greens, broccoli and dairy products helps raise calcium levels. Most vitamins and minerals should be obtained from natural foods. Supplements help provide the balance of your daily intake. Four types of supplements usually present are — gluoconate, carbonate, citrate, lactate. To Help Increase Absorption of Calcium Take Your Supplement = With meals = Or one to one and a half hour after your meals with a glass of water. = Calcium is absorbed better when taken with vitamin D. = Do not take more than 500 mg of calcium at a time. Small doses are processed more efficiently by the body.To Calculate Calcium Dose in a Supplement 500 mg of calcium supplement mentioned on the label of your bottle or the pack, may just be the weight of the calcium pill and not the actual amount of calcium. Ry of | Some labels mention the : actual amount of the mineral (calcium) present in each tablet. if your product lists only the total weight of each tablet, calculate the actual amount of calcium present in it. = Calcium gluconate (contains 9% of calcium) * Multiply the total weight by 0.09, e.g 500 mg of calcium gluconate x 0.09 equals to only 45 mg of calcium = Calcium carbonate (contains 40% of calcium) * Multiply the total weight by 0.4, e.g. 500 mg of calcium carbonate x 0.4 equals 200 mg of calcium. = Calcium citrate contains 21% of calcium. = Calcium lactate contains 13% of calcium. You can calculate these as mentioned above. 500 mg of calcium citrate contains 105 mg of calcium while calcium lactate contains 65 mg of elemental calcium. US Recommended Dietary Allowance of Calcium Age Dietary allowance (calcium) 9-18 years | 1300 mg 18-50 years 1000 mg 50 years and above 1200 mg | Not more than 2500 mg/day of calcium is recommended. Having more calcium regularly can lead to kidney stone formation. Nitric Oxide and Blood Pressure Nitric oxide levels decline in the body in the presence of high blood pressure, stress, ageing, diabetes and certain medications. Nitric oxide is produced by the endothelium (inner most layer) of the arteries. It spreads through the cell membranes to the underlying muscle cells and turns off their contracting function. This results in dilation of the arteries. Blood pressure control and maintenance is thus achieved by the release of nitric oxide. In arteriosclerosis, the endothelium has a reduced capacity to produce nitric oxide. Nitric oxide is the key molecule for the regulation of blood pressure and cardiovascular functioning. Therefore, blood pressure and the cardiovascular system along with other organs get affected.High Blood Pressure (Hypertension) Blood pressure (B.P.) exceeding normal values is called arterial hypertension. There is no single specific cause for high BP. ‘Primary hypertension’ results from a genetic defect which gets ‘switched on’ and these days increasingly at younger ages — when factors such as obesity, sedentary lifestyle, high salt intake, excessive alcohol consumption, and physical or emotional stress have become predominating factors. Approximately five to ten per cent adults have ‘secondary hypertension’. Here high blood pressure ig due to underlying factors like kidney disease, ailments of the adrenal gland or certain cardiovascular conditions. Essential Hypertension Essential hypertension if controlled does not cause problems. It has no symptoms and is compatible with long life (unless a heart attack or other complications supervene). Therefore this kind of hypertension is also called Benign Hypertension. Hypertensive Emergency It is a condition in which high blood pressure leads to target organ damage (Macrovascular complication). The organs involved can be kidney, heart or brain. Hypertensive urgency is different from emergency. In hypertensive urgency, severely elevated blood pressure is present with no target damage. On the other hand hypertensive emergency needs immediate attention. lt is important to decrease the systolic >220 mmHg or diastolic >120 mmHg within minutes or hours. This is because it can lead to cardiac, renal or cerebral damage as a result of less blood flow (hypo perfusion). This is a medical emergency. Malignant Hypertension This is a condition with hypertensive emergency along with complications (eg. of the eye). Also characteristic in this type of hypertension is the involvement of small arteries which can cause end organ damage.Though both Hypertensive and Malignant hypertension have a different basis or pathology. eventually both of them lead to “hypertensive organ damage” and an increased cardiovascular risk. Controlling malignant hypertension entails a 24-hr strict blood pressure control. High Blood Pressure in Children Formerly considered as a disease in adults, high blood pressure is getting detected more and more in children. Increased salt intake and obesity due to a bad lifestyle are leading causes of high blood pressure. The levels of blood pressure in children are different than those of adults. When the standard blood pressure levels of children are taken, their readings are measured in accordance to their height and age. A child’s temperament also affects his/ her blood pressure. It is important to determine the underlying cause of high blood pressure in the children. Overweight children with high blood pressure are much more prone to develop heart disease as adults. A child with high blood pressure must be excluded for endocrine and kidney disorders. Low Blood Pressure (Hypotension) There are no universally accepted criteria for low BP as there are for high BP. In fact, low BP is generally not a disease. Low blood pressure is considered a variant of normal BP, often seen in lightweight individuals whose BP remains between 90/60 mmHg and 100/70 mmHg without any associated sympioms. Effects of Low Blood Pressure Blood pressure that is very low is known as hypotension. Low blood pressure may be a sign of severe disease requiring urgent medical attention. When blood pressure and blood flow decrease beyond a certain point, the perfusion of the brain becomes critically decreased (i.e., the blood supply is not sufficient), causing lightheadedness, dizziness and weak- ness.It is known that, people who maintain healthy low blood pressure have lower rates of cardiovascular disease in comparison to people with normal blood pressure. Other Causes of Low Blood Pressure = Orthostatic Hypotension: Sometimes the blood pressure drops significantly when a patient stands up from the sitting position. This is known as orthostatic hypotension. In this case, gravity reduces the rate of blood return from the veins below the heart, back to the heart. This in turn reduces the stroke volume and cardiac output, therefore resulting in low blood pressure. In healthy people, veins below the heart constrict and increase the heart rate to minimise and compensate for the effect of gravity. This is carried out involuntarily by the autonomic nervous system. The system usually requires a few seconds to fully adjust If the compensations are too slow or inadequate, the individual will suffer a reduced blood flow to the brain, dizziness and may be a blackout. ® Shock: It is a complex condition which leads to critically decreased blood perfusion. The usual mechanisms are loss of blood volume, pooling of blood within the veins reducing adequate return to the heart and/or low effective pumping of the heart. Low blood pressure, especially low pulse pressure, is offen a sign of shock. If there is a significant difference in the blood pressure from one arm to the other, then the reason may be narrowing of an artery due to certain clinical conditions. = Sepsis = Haemorrhage = Toxins including toxic doses of blood pressure medicines. = Hormonal abnormalities, such as Addison's disease. Roeitageiatiey |r tataneBefore measuring your BP, try to follow these precautions: =» Avoid smoking and consuming caffeinated products (found in colas, chocolates, coffee and tea) for at least 2 hours before getting your BP checked. Avoid eating at least half an hour before your BP is taken. Physical activity should be avoided at least two to three hours before your BP is measured. Wear loose, non-restrictive clothing. The arm to be used for measurement should be bare. Try and arrive at the doctor's clinic at least 10 minutes earlier so that you can relax for a few minutes before the measurement. A full bladder or bowel can affect your BP measurement. Go to the bathroom before getting your BP checked.= Do meniion to your doctor the kind of medication you are on, even if it is off the shelf medication (cough and cold medication, painkiller, etc). = Try and get your BP checked around the same time of day, each time. Check Your Blood Pressure Regularly How can you tell if you are falling prey to the silent killer? Since high BP rarely shows symptoms, the only way to know for sure is to check it regularly. Having your BP checked is painless, inexpensive and quick. It can be done at a doctor's clinic, with the help of a stethescope and the sphygmomano- meter (blood pressure instrument). = The cuff of the sphygmo- manometer is inflated around your arm to temporarily restrict ihe blood flow. A stethoscope is placed between the cuff and your arm. ® The cuff is then slowly deflated. As your heart pumps (systole) the first sound heard through the stethoscope is the pressure created. = The cuff then continues to deflate until no further sounds are heard. This is the pressure in between the pumps (diastole).[3 iaRssere veer ae Blood Pressure Classification for Adults A healthy lifestyle is important throughout one’s life. Patients of chronic renal disease and diabetes mellitus should begin the treatment when their blood pressure is 130/80 mmHg, along with an alteration in lifestyle. It has been shown that early anti-hypertensive treatment (or lowering of BP) can reduce the chances of stroke to about 35-40%. Chances of heart attack are also reduced to 20-25% and the probability of heart failure reduces by more than 50%. A loss of weight of about 5 kg or more can help bring down your blood pressure When does high BP become a » threat to your health? It is when either systolic or diastolic measurement, or both, rise and remain above the normal range of BP. High Blood Pressure and Risk Factors = A person having even borderline high cholesterol will be roughly at twice the risk for heart problems if his systolic blood pressure is 160 rather than 120. = High blood pressure in the presence of other risk factors, becomes more dangerous when it is associated with smoking. = On smoking up to 15 cigarettes/day, someone having a moderately increased blood pressure can multiply his or her risk of death from stroke or heart attack by 4 times. = A person smoking 25 cigarettes/day, having the same moderately increased blood pressure, can increase his risk of death by ten times.Causes of High Blood Pressure = Arteries may develop wide openings. If too much blood flows through the arteries, it forcefully hits the arterial wall. This is the most frequent reason for high BP in young people. A.wide arterial opening lets too Plaque accumulales Much blood ta flow inrough it inside the artery Narrowing of artery = Accumulation of plaque and fluid can also cause high blood pressure. Tissues may swell with the fluid, thus increasing BP in the arteries. Plaque (fat and cholesterol) can collect inside the artery, making it narrow, or even blocking it. = Artery walls may thicken. The vessel's muscular lining gradually becomes thicker and less elastic, causing the opening to narrow and the blood flow to become restricted or blocked. Narrowing of your arteries means that your heart must pump faster and stronger to force blood through the arteries. Due to this, BP may rise even higher. Did You Know? Dietary Salt Salt eaten in food makes tissues retain fluid, thereby putting pressure on the arteries. This leads to an increase in your blood pressure. Salt is present ina disguised form in processed foods and baking soda, ajinomoto (monosodium glutamate) and soya sauce. Salt - Potassium Ratio It is not only the amount of salt taken per day that is important, but also the right sodium potassium ratio in your diet. You should get five times more of potassium as compared to salt. In most cases it is probably the opposite. To help keep your high blood pressure under control take less of salt in your diet and consume more foods high in potassium content.Potassium = Potassium is an important mineral in the body and is considered to be an electrolyte. Most of the potassium is located Inside the muscle cells. It assists in muscle contraction and maintains appropriate levels of fluid and electrolyte balance in the body cells. It thus ensures normal blood pressure. = Potassium plays a critical role in maintaining heart beat or heart rhyihm. Potassium also helps in proper conduction of nerve impulse. = Potassium in the body is depleted by coffee, alcohol and sugar. It is also depleted by certain high blood pressure and diuretic medication. Both physical and mental stress can lead to deficiency in body potassium. Foods High in Potassium Cantaloupe (Kharbuza) Avocados Raisins (Kishmish) Beans Tomato, Potatoes e Apricots, Figs Bananas, Citrus fruits Dairy products e- Legumes Sunflower seeds Your Diet and Blood Pressure lt has been studied that breakfast eaters have lower blood pressure, are leaner and consume fewer calories throughout the day. Also according to another research, skipping breakfast increases platelet stickiness which in turn can promote clotting, eventually leading to a heart attack. Effects of High Blood Pressure Blood pressure exceeding normal values is called arterial hypertension. Persistent hypertension is one of the risk factors for stroke, heart attack, heart failure, arterial aneurysm. Persistent high blood pressure is also the second leading cause of chronic renal failure after diabetes mellitus. Earlier most attention was paid to diastolic pressure; but nowadays it is recognised that both high systolic pressure and high pulse pressure (the numerical difference between systolic and diastolic pressures) are also the risk factors. In some cases, it appears that a decrease in excessive diastolic pressure can actually increase the risk, probably due to the increased difference between systolic and diastolic pressures. = Heart Failure: It results when the aifected heart pumps too hard for too long. This leads to a decreased efficiency of the heart and can eventually lead to failure. With high BP, a six- fold increase of heart failure has been recorded. |= Stroke or a Paralytic Attack: Stroke can result due to blockage of arteries in the brain. The blockage limits the flow of blood and oxygen to the brain, leading to infarction (death of cells). Blockage of Artery It is seen that patients with high blood pressure have three times the risk of having a stroke. Many patients with hypertension have no high blood pressure symptoms till they suffer either a heart attack or stroke. “It is the silent killer’. Vital organs of the body suffer irreparable damage. Itis therefore imperative to monitor your blood pressure with your family doctor if you have hypertension. Any patient who suffers a stroke or transient ischaemic attack (TIA) should be treated aggressively for blood pressure control. Even not having high blood pressure, but having suffered from a TIA or stroke is enough reason to maintain a steady normal blood pressure with medication. Lowering of blood pressure can reduce the chances of a stroke. ® Blindness or Impaired Vision: It can occur when tiny blood vessels in the back of the eye rupture or become blocked. Increased BP has a role in causing blindness. Heart Attack or Myocardial Infarction: Heart attack occurs 240 7 when part of the muscle [220 7 210 affected ‘starves’ of oxygenand | 200 | s , a dies. Chances of heart attack 180 Hf a increase three-fold with increased blood pressure. Peripheral Artery Disease: It is a result of the development of atherosclerosis and high blood pressure. Major arteries supplying blood to the legs harden resulting in less supply of oxygen to the surrounding tissue and muscle. This often leads to great pain on walking. This ailment if not treated in time, may require toe or feet amputation.= Kidney Disease: High blood pressure makes your heart work harder. This results in damaged biood vessels and filters in your kidneys. Thus making removal of waste products difficult from your Kidney body. Accumulation of extra fluid could raise your blood pressure even more. Detection of Kidney Disease As with hypertension, you may not realise that you have a kidney disease. Certain laboratory tests can indicate whether your kidneys are eliminating waste products properly. These tests include serum creatinine and blood urea nitrogen (BUN). Too much of either can indicate kidney damage. Excess of protein in the urine (protienurea) is also an indication of kidney disease. Excessive potassium accumulation in the body, due to impaired potassium excretion can also damage the kidneys. Hypertension and Kidney Disease Occur More in = People who have diabetes mellitus. = People with a family history of high blood pressure and kidney disease. = In certain races. To Prevent High Blood Pressure Related Kidney Damage = Keep your blood pressure below 130/80. = Blood pressure should be checked on a regular basis. = Correct your nutrition. Patients with kidney disease should take a medium protein diet, low salt, reduce high potassium intake and avoid fruit juices and bananas. = Take the medications as advised by your doctor, regularly on time. High Blood Pressure and Related Diseases = Thyroid, Parathyroid and Abdominal Aortic Aneurysm are the diseases associated with high blood pressure. = Atheroma As the level of pressure in the arterial system rises, the strain put on the arterial wall increases. Due to this pressure, weakness develops in the walls of the arteries, e.g. brain. The risk of bleeding from affected arteries in the brain can result in a stroke. iHigh blood pressure can also increase the strain on the inner lining of the arteries. This leads to an increased risk of atheroma formation (unhealthy tissue growth). right carotid artery left carotid artery aorta subclavian artery right coronary artery brachial artery left coronary artery aorta renal artery iliac arteries: fernoral arteries: Yow > Sites of Atheroma Formation Atheroma formation and high blood pressure go hand in hand. Higher the pressure on the artery, more the stress and more the atheromatous growth. It is important to view high blood pressure as one of the most important risk factors for the development of heart disease. High Blood Pressure and... Sleep Apnoea You have been feeling tired lately. You have fallen asleep during your favourite “soap opera” or have caught yourself nodding during an important meeting. You putit on overwork and feel that a good night’s sleep is all you need.Getting more sleep is not the answer! Your symptoms may be indicative of sleep apnoea. Your body goes through five sleep stages. If you have developed sleep apnoea, your body stops breathing for a few seconds during this sleep cycle. Your system signals that there is a lack of oxygen and jolts you awake in order to restart your breathing. Then your heart rate increases. This process can occur a number of times during your sleeping hours. This may leave you feeling tired the next day. You may not even remember the next morning that your sleep cycle got interrupted fora few seconds. Sleep apnoea is seen to occur more in older people. The Process of Sleep Apnoea The sudden drop in oxygen level causes the carbon dioxide level of the blood to increase. In turn, the body tries to protect itself from injury by making the heart work harder, i.e. pumping the remaining oxygenated blood through your body. Sleep apnoea can cause: = High blood pressure = Heart attack = Stroke = Irregular heart beat and heart disease = |mpotence Diabetes Diabetes and hypertension often coexist. Bath these conditions significantly increase the risk of cardiovascular (CV) morbidity and mortality. = The prevalence of hypertension in type II diabetic patients is about two times more than that in the general population. The prevalence of hypertension (blood pressure >160/90 mm) is approximately 39% in type II diabetic patients (between 25 and 64 years of age). = The dual presence of diabetes and hypertension increases the risk of coronary artery disease mortality by more than threefold in younger diabetic patients and twofold in older. = Hypertension and diabetes act synergistically in the development of cardiovascular complications. = Most diabetics (up to 80%) die of cerebro- vascular complications. Hypertension in diabetics contributes to diabetic nephropathy and retinopathy—kidney and eye disease and increases the risk of macrovascular complications, e.g. myocardial infarction, congestive heart failure, and stroke. = Studies indicate that blood pressure control becomes more effective in helping reduce diabetic macrovascular complications (heart attack, heart failure and stroke) than glycaemic control. i _$§!—— ORSenility High blood pressure can lead to small “silent” strokes, which over the time, can bring on early senility. These strokes are called silent as they do not cause the classic stroke symptoms and often go undetected. While a single silent stroke may have no apparent cumulative effects, repeated episodes can lead to memory loss, mood disorders and difficulty in walking. Osteoporosis Loss of bone mass in elderly women has been linked to high blood pressure. Women with high blood pressure lose bone density about two-third faster than those with low blood pressure. Poor calcium metabolism often increases the risk of osteoporosis and fractures. Morning Heartattack Morning high blood pressure levels are om closely associated with the risk of damage = to the brain, heart, kidney as well as the tisk of all cardiovascular events. Cases of morning high blood pressure (BP) i.e. higher BP in the morning are of two types. The first- “the morning surge” type is characterised by a marked increase in the blood pressure in the early morning. The other is the “nocturnal — high blood pressure” type. This is characterised by high blood pressure that persists from night time to early morning.The Elderly Blood pressure increases with age due to stiffening of the arteries. Medically, high blood pressure is a frequent pathology involving approximately 15 to 20% of the population. The more the arteries stiffen, the more the systolic pressure increases as compared to the diastolic. Climate and Altitude The effecis of climate and altitude on blood pressure are examined with the following conditions in mind: = Initial exposure ® Acclimatisation = Long-term residency = Place of birth A hot and arid climate seems to have little effect on the blood pressure of a person. At the same time a slight reduction of blood pressure has been found in some naturally acclimatised group of people. Likewise, exposure of the body to mildly cold conditions has little effect. Local exposure of the extremities to severe cold conditions significantly increases the blood pressure during exposure but not at other times. Acclimatisation reduces but does not eliminate that response. The effects of altitude on the blood pressure are variable. Initially there is hypertension, followed by gradual normalisation. On living at high altitude, blood pressure may actually be lower than that observed among the residents at sea level. High blood pressure is observed in people living in areas of high altitude, and severe cold climatic conditions. Also tourists visiting high altitude areas often experience high blood pressure for a few days, till their bodies get acclimatised to the prevailing conditions. =Pregnancy Pregnant women with high blood pressure can have healthy babies. Sometimes, high blood pressure becomes dangerous for both the mother and the foetus. Women with pre-existing or chronic, high blood pressure are more likely to have certain complications during pregnancy as compared to those with normal blood pressure. The effects of high blood pressure ranges from mild to severe. High blood pressure can harm the mother’s kidneys and other organs, and it can cause low birth weight and early delivery. In the most serious cases, the mother develops preeclampsia or “toxemia of pregnancy” which can threaten the lives of both the mother and the foetus. Preeclampsia Preeclampsia is a condition that typically starts after the 20" week of pregnancy and is related to increased blood pressure and protein in the mother's urine (as a result of kidney problems). Preeclampsia can affect the blood supply to the growing foetus and also the mother's kidney, liver and brain. When preeclampsia causes seizures, the condition is known as eclampsia. Most women who develop signs of preeclampsia, however, are closely monitored to lessen or avoid related problems. Preeclampsia Can Develop in Women = Who have suffered from chronic hypertension (high blood pressure) before pregnancy. = Who had developed high blood pressure or preeclampsia during a previous pregnancy, especially if these conditions occurred early in the pregnancy.