160/ 99

They should have known better. Many many men and women around Vinod’s age are falling into the potentially fell embrace of high blood pressure in India. Not that older people aren’t. It is a sickness soaring high: a late 1990s Indian Heart Journal study found one among every four urban Indian adults suffering from hypertension (the medical term for high BP). That sounds tame compared to a recently released study by the Indian Council of Medical Research and the Institute of Home Economics on how high blood pressure is afflicting our young people like never before: 35 per cent of 800 Delhi-based teenage schoolchildren, monitored over three years, were found to be suffering from high BP.

But do we really need statistics to measure this ailment’s astounding ascent? Just ask your friends, acquaintances, colleagues: many of them will tell you they have high blood pressure. Or, take a walk down to your local GP, and you’ll possibly find your own blood pressure on a calamitous climb. That’s probably why the World Health Organisation (WHO) warns: "Control of hypertension is one of the biggest challenges facing public health authorities worldwide, both in individual patients and at the population level." It further detects that of all amongst us who have high blood pressure, "only half have been diagnosed, only half of those diagnosed have been treated, and only half of those treated are adequately controlled".

And here is why this condition can’t be fully grasped. To begin with, mild to moderately high blood pressure usually has no symptoms, and is thus called ‘The Silent Killer’. Recurrent headaches, blurred vision, lack of sleep, dizzy spells could be indicators, but not always. The only way to find out whether your blood pressure is higher than it should be is to have it measured (see box: Are You Hypertensive?). And even such measurement can be tricky: to be fully sure, an average of three readings has to be taken, which not many medics do; even the presence of a nurse, a physician can cause a rise in blood pressure (it’s called ‘white coat hypertension’); and factors like height and weight, previous health history and medication, plus variations in the recording machine need to be taken into consideration. Most of the time, they aren’t.

If difficulties in diagnoses are overcome, however, how easy is the cure? "High blood pressure cannot be cured," answers Dr Alka Bhasin, consultant, nephrology and hypertension at Max Healthcare. "It can only be effectively controlled so that the risks of consequent health complications—like heart and kidney failure, brain stroke, eye damage—are minimised. But such control needs early diagnosis. And sticking to a treatment plan, a plan that’s not just about taking medication but also about taking a lot of care with personal habits."

What do the BP pills—called anti-hypertensives—do? How do they slow the pace of blood in our bodies? Depends really on the category of drug the good doctor prescribes (see box). We can only hope that the medic makes an appropriate selection.

"Inappropriate drug prescriptions, though, for high blood pressure are common. For instance, young sexually active males have known to be assigned beta-blockers by doctors, the side-effect being erectile dysfunction," says Dr Chandra M. Gulhati, editor, Monthly Index of Medical Specialities. Also, prescribers pay inadequate attention to choosing cost-effective medicines. Says Gulhati, "Considering there is no significant difference in efficacy of various medicines belonging to, say, the ACE-inhibitor group of drugs, prices are miles apart. A strip of 10 tablets of Enalapril 10 mg is under Rs 40, an equivalent Ramipril costs Rs 90 and Perindopril is priced at Rs 98. And since for many high BP patients, anti-hypertensive drugs are for life, needlessly expensive medicines could cost a fortune over time."

Raise the right questions then to lower your blood pressure. Ask the doctor what category of drug you’re being prescribed, when it should be taken, what to eat and drink with it, how long before and after a meal it should be taken, what other drugs can or can’t be taken with it. Also find out what must be done if you run out of your BP medicine, or if you forget to take a dose.

But even the most regular drug doses won’t lower blood pressure if your lifestyle remains tension-ridden. Lose that flab: being overweight increases the risk of hypertension two to five times. Exercise: walk at least 30 to 45 minutes every day. Trim the fat in your diet; eat foods with high fibre like green leafy vegetables, and those rich in sources of antioxidants like citrus fruits, wheat germ, seafood. Reduce intake of salt immediately—no more than six grams of salt a day. Quit smoking, a significant rise in BP accompanies the smoking of each cigarette. If you are male, don’t drink more than 30 ml of alcohol a day. For women, it is 15 ml.

These are non-negotiables in the management of hypertension, no matter what treatment regime you choose.

Much like in ayurveda. "This ancient Indian system of medicine recognises that the same health complications in two people may still entail different medication because people’s constitutions are different," observes Vaidya Vilas M. Nanal, president of the Vaidya M.P. Nanal Ayurveda Foundation in Pune. "More so while treating rakta vata or hypertension since it is a modern ailment caused by our deadline-driven, stressed modern lifestyles. It makes understanding the patient’s way of life, mindset and coping mechanisms even more important before an ayurvedic prescription is made." Maybe ayurveda practitioners do have their fingers on the pulse of the problem; or so it would seem considering the growing numbers of people now looking to ayurveda solutions. Nanal’s own clinical experience is indicative—most of his high BP patients earlier came to him as a last resort or for respite from the side-effects of other therapies. "But now I’ve started getting new rakta vata patients as well, some acutely ill, even emergency cases."

Well, any route that leads to remedy really. On a sweltering summer afternoon in Delhi, a crowd of people squat at Pradeep Sharma’s Su Jok Acupuncture clinic. Many of them have come specifically to have Sharma puncture their swelling BP with his needles. It’s a Korean technique of acupuncture that has 125 practitioners across the country, Sharma informs the uninitiated among his patients, and one that, broadly speaking, treats ailments by piercing needles on certain points on the fingers and toes. "For high blood pressure, I prick just one needle on the thumb, a nerve there is connected to the pituitary gland which gets stimulated, regulating the blood flow. Eight sittings of this and 75 per cent of the people I treat for high BP are completely cured." A claim that might be worth checking out, because regulars in the crowd swear they’ve benefited.

Pune-based ayurveda doctor Balaji Tambe sings praises of yet another treatment for hypertensives: music therapy. "Compositions that have beats equivalent to the human heartbeat (72 per minute) are highly soothing," he points out. "While faster rhythms galvanise the body, slower rhythms are immensely relaxing, playing tranquiliser to those who suffer from anxiety, and in turn high blood pressure." His research, says Tambe, has established that ragas Bhupali and Todi are sources of tremendous relief to hypertensives, and ragas Ahir Bhairav, Darbari Kanhara, Khamaj, Pooriya, Tilak-Kamod, Hamsadhwani, Kalavati and Durga contain patterns that defuse mental tension to lower the throng of blood on your arteries. Muzaffarpur-based Dr Nishindra Kinjalk, a music therapist, corroborates: "In many cases patients on BP drugs have got their dosage decreased after a month or two of music therapy. There have also been patients who have completely gone off medication."

But all such treatment, mainstream or alternative, needs to be supplemented by a commitment to keeping our minds and bodies healthy. For hypertensive people, exercising the body is a must, but not mindlessly. Rahul Narang of Olympia, a south Delhi gym, cautions high BP patients against working out without supervision. "You could end up even more fatigued." Narang should know: about 25 per cent of his clients have high blood pressure, and his advice to them is exercise not merely to lose weight but also to be happy. "Tension releases cortisol or the stress hormone, exercise releases endorphin or the pleasure hormone, and the latter’s so important in countering high BP." Similarly, ayurveda and yoga guru Dinesh Sharma recommends quiet asanas over vigorous vyayams for hypertensives. To begin with, shavasana, a yogic exercise that relaxes the body, and pranayam, a breathing exercise, he says.

Because tension works like an upper for blood pressure, it sets the heart palpitating, blood pacing. In fact, cardiologist Dr Bimal Chajer, who now runs SAAOL (Science And Art of Living), says that psychological stress is half the reason for hypertension today. "Adrenaline that raises blood pressure was meant to be shot into our bloodstream to fight wild animals. Today it’s pumped in with every routine problem we face. This adrenaline rush leaves us revved up and increases our BP that then takes time to lower, till the next aggravation comes along. Too much of this, and the body gives up and boosts its baseline blood pressure to permanently higher levels." In agreement, psychiatrist and clinical psychologist Dr S.S. Kulkarni, who conducts lifestyle and stress management programmes, suggests a failsafe formula to beat tension: "You would have halved your stress if you learn to accept that you can’t control everything. That you can only manage yourself."

And in turn, manage your blood pressure.

By Soma Wadhwa with Harsh Kabra in Pune