World Hypertension Day: Why young Indians need to be cautious about high BP levels

Having elevated blood pressure levels, or hypertension, is considered to be common among Indians, but not many are aware of the risks associated with the condition, which affects over 40 percent of adults. According to the National Family and Health Survey's (NFHS) latest report, 21 percent of women and 24 percent of men of age 15 years and over have hypertension and around 40 percent of adults of age 15 years and over are pre-hypertensive. The NFHS data further reveals, among the diagnosed hypertensives only 7 percent of women and 6 percent of men took medicines to lower their blood pressure.

Hypertension occurs when the systolic blood pressure - the pressure exerted on the arteries when the heart beats - is more than the normal 120 mmHg (millimetres of mercury) and diastolic pressure - the pressure on the arteries when the heart rests between the beat - is more than 80 mmHg. A serious medical condition, experts point out, if not diagnosed at an earlier stage, hypertension can pose threats to the individual's heart, kidney, brain and eyes.

On World Hypertension Day, Mid-Day Digital reached out to Dr Sushil T Jain, pulmonary consultant at Masina Hospital and Dr Santosh Kumar Dora, senior cardiologist at Asian Heart Institute, Mumbai to understand how hypertension symptoms set in at a younger age and the ways in which people can prevent or manage the symptoms at an earlier stage.

What are the major causes of hypertension among the youth (18-35 years) in India? Please elaborate.

Jain: The top three risk factors for hypertension in young people in India were perceived to be smoking, mental stress and obesity. The other risk factors were high salt intake, increased alcohol intake, sedentary lifestyle, and lack of adequate sleep (less than 7 hours).

Overweight and obesity: The more you weigh the more blood you need to supply oxygen and nutrients to your tissues. As the amount of blood flow through your blood vessels increases, so does the pressure on your artery walls.

Not being physically active: People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.

Stress: High levels of stress can lead to a temporary increase in blood pressure. Stress-related habits such as eating more, using tobacco or drinking alcohol can lead to further increases in blood pressure.

Tobacco and alcohol intake: Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow and increase your risk of heart disease. Secondhand smoke also can increase your heart disease risk. Over time, heavy drinking can affect blood pressure levels and can cause damage to the heart.

More sodium and less potassium in the diet: Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure. Potassium helps balance the amount of sodium in your cells. A proper balance of potassium is critical for good heart health. If you don't get enough potassium in your diet, or you lose too much potassium due to dehydration or other health conditions, sodium can build up in your blood.

How can one assess if they are hypertensive? Is fluctuation in blood pressure the only major indicator?

Dora: Statistics show that blood pressure is quite prevalent in society. According to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure, the prevalence of hypertension in adults is around 26 percent and increases with age. The prevalence is 50 percent in people 60-69 years of age and approximately 75 percent in those 70 years of age and older. The lifetime risk of developing hypertension is approximately 90 percent for men and women who were non-hypertensive at 55 or 65 years respectively. Most of the people having high blood pressure do not have any symptoms. Only a few may have a headache, giddiness, uneasiness, etc. So it is important to have a yearly check-up of blood pressure even if it is found to be normal.

If not diagnosed and treated in time, what health dangers can one possibly be exposed to?

Jain: Excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels as well as your organs. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage. Uncontrolled high blood pressure can lead to complications including:

Heart attack or stroke: High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.

Aneurysm: Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.

Heart failure: To pump blood against the higher pressure in your vessels, the heart has to work harder. This causes the walls of the heart's pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body's needs, which can lead to heart failure.

Weakened and narrowed blood vessels in your kidneys: This can prevent these organs from functioning normally.

Thickened, narrowed or torn blood vessels in the eyes: This can result in gradual vision loss.

Dementia: Narrowed or blocked arteries can limit blood flow to the brain, leading to a certain type of dementia. This can also cause trouble with memory or understanding.

What is the general attitude of Indian youth towards hypertension and its treatment?

Dora: People panic only when they develop symptoms. The general attitude towards hypertension is very callous as hypertension does not give rise to any symptoms in most cases. But when symptoms start coming, it is usually very late. So it is very important to have a periodic checkup. Also it is important to treat hypertension properly. Under-treatment of hypertension is as dangerous as no treatment. Statistics suggest that hypertension is under control in only 20 percent of patients who take drugs for it.

In what ways is hypertension associated with diet and sleep routine?

Jain: Reduction in dietary sodium intake will reduce the mean population blood pressure, as well as the prevalence of hypertension. Dietary intake of potassium lowers blood pressure and is protective against stroke and cardiac arrhythmia.

Adapting the DASH (Dietary Approaches to Stopping Hypertension) eating plan can reduce blood pressure by 8-14 mmHg. The DASH diet consists mainly of fruits, vegetables and low-fat dairy products and includes whole grains, poultry, fish and nuts while limiting the amount of red meat, sweets and sugar-containing beverages.

Intake of saturated fatty acids should be reduced to less than 10 percent of total energy consumption, and trans fatty acids to less than 1 percent. Intake of trans fatty acids can be reduced by replacing them with polyunsaturated fatty acids.

When it comes to the sleep cycle, the less you sleep, the higher your blood pressure may be affected. People who sleep six hours or less may have steeper increases in blood pressure. Sleep helps your body control hormones needed to regulate stress and metabolism. Over time, a lack of sleep could cause hormonal changes, leading to high blood pressure and other risk factors for heart disease.

What changes can one inculcate in their lifestyle to prevent symptoms of hypertension?

Experts Jain and Dora suggest lifestyle changes can go a long way in prevention and controlling symptoms of high blood pressure and hypertension:

1. Eating a heart-healthy diet with less salt

2. Indulging in dynamic exercises or physical activities

3. Maintaining a healthy weight or losing weight if you're overweight or obese

4. Limiting the amount of alcohol you drink

5. Limiting the intake of foods high in saturated fats

6. Eliminating/reducing trans fats in diet

7. Eating more fruits and vegetables

8. A good sleep for 7 to 8 hours is very helpful in keeping blood pressure normal

But sometimes lifestyle changes aren't enough. If diet and exercise don't help, your doctor may recommend medication to lower your blood pressure.

(Disclaimer: This article is not intended as a substitute for professional medical advice, diagnosis or treatment. Mid-day Online does not in any way endorse the accuracy, completeness, efficacy or timeliness of any advice or line of treatment mentioned in this article. Readers must always seek the advice of a certified medical practitioner and/or a mental health professional before deciding on or starting any course of treatment.)