Friday, August 18, 2006

High blood pressure: investigation & treatment

High blood pressure: investigation & treatmentDr H.S. Wasir
Anybody who is found to have high blood pressure must get the following investigations done which help (a) to find a possible cause or causes and thereby give a specific treatment for the disease in the form of ballooning (angioplasty) or surgery, and (b) to know the extent of damage done by high blood pressure to vital organs such as brain, eyes, heart and kidneys.

The investigations include: (1) Blood tests for haemorgram, urea, sugar, uric acid, electrolytes (Na+ k+) and lipid profile, i.e. cholesterol, triglycerides and lipoproteins like LDL, HDL and VLDL. (ii) Urine analysis for albumin and microscopy (iii) X-rays of chest and abdomen (iv) ECG. (v) Ultrasound of abdomen for kidneys and adrenal glands (vi) Eye check-up (fundoscopy). (7) CT scan or MRI is advised in a few cases suspecting a tumour as a cause of high blood pressure or vascular complications due to high blood pressure.

Treatment of high blood pressure comprises of (1) non-drug measures, (2) drugs for high blood pressure, (3) angioplasty with stents (ballooning), and (4) surgery.

Non-drug measures
Weight reduction in those who are overweight. Doing regular physical exercise specially brisk walks, swimming and other dynamic exercises. Avoiding excess salt and spirits (alcohol). Avoiding smoking. Practice of mental relaxation through meditation, music and yoga, study of religious scriptures and attending to religious congregations.

Drugs
There are excellent drugs available at present for the control of high blood pressure. It is not possible to describe these in detail here, but it will suffice to state that the doctor should use such drugs or drug combinations as do not cause any disturbances in blood glucose, cholesterol and electrolytes.

One common side-effect of some of the blood pressure lowering drugs is impotence or adverse effects on male erectile function. In case the patient experiences such a side-effect it should be brought to the notice of the treating doctor so that alternative medicines can be prescribed as there is a large list available to choose from.

While treating high blood pressure in elderly patients, we must start with the smaller doses of any drug and preferably give one drug. The elderly cannot tolerate sudden falls in blood pressure and may get symptoms due to a sudden decrease in blood supply to the brain if their blood pressure is brought down suddenly.

The elderly are also more prone to postural hypotensions, i.e. sudden fall in blood pressure on standing. They should, therefore, be instructed to gradually adopt the standing posture from the lying down supine position, preferably sitting in the bed with legs hanging down for a few seconds before standing up and walking.

Stepdown therapy
Unlike the old concept that once blood pressure drugs are started one had to take them life long, this is not always so. If the drug treatment is started early, it is possible to reduce drugs and at times even stop these while continuing the life-style modifications enlisted above under non-drug measures. Any reduction in drug therapy or its stopping should be done under medical supervision.

Balloon and stenting
Some patients whose high blood pressure is due to narrowing or blocked arteries, especially the renal (kidney) arteries, can be successfully treated by angioplasty procedures, i.e. ballooning and using metallic coils called stents to prevent a recurrence of the narrowing. This procedure can be done at any age, including the adults and even elderly where the narrowing of the renal arteries is due to the process of atherosclerosis.

Surgery
It is rare that high blood pressure is due to some tumours in the kidneys or in the neighbouring organs called adrenal glands. Such patients can be cured of their high blood pressure by operations. The earlier the treatment is given, the better are the results.

Prevention
Precise prevention of a disease is possible when its exact cause is known, which in the case of high blood pressure we do not know. We, therefore, do not have any vaccination against high blood pressure as the causative agent is not known. The various preventive measures for the disease are targeted against the risk factors which either initiate or aggravate high blood pressure.

These are:
1. Avoid obesity and lose weight if overweight.
2. Regular physical exercise not only keeps the weight down but is also the best means for mental relaxation and keeps the blood pressure and blood cholesterol down. Regular physical exercise adds not only years to life but also life to years.
3. Not to consume too much salt. Diet should contain enough citrus fruits to keep the blood potassium up and sodium low. Banana is a rich source of potassium.
4. Alcohol consumption more than two ounces of whisky or two glasses of beer or wine in a day should be strongly discouraged.
5. Regular practice of meditation and yoga asanas, including padamasana and shavasana, are proven ways to give mental relaxation and to prevent high blood pressure.

Shavasana (corpse pose)
Lying flat on the ground with the face upwards, in the manner of a dead body, is shavasana. It removes tiredness and enables the mind and whole body to relax. Shavasana practised for 15 to 20 minutes daily is helpful in prevention and treatment of high blood pressure.
The writer is the Chief Cardiologist and Medical Adviser, Batra Hospital & Medical Research Centre, New Delhi.

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