Hypertension is a condition in which blood pressure in the arteries is persistently elevated. High BP is also a major risk factor for stroke heart diseases. Lifestyle changes and medications can lower blood pressure and the risk of health conditions. At Medicircle, we are representing the World Hypertension Day Awareness Series wherein we are featuring eminent Cardiologists to create awareness amongst the general population about preventive action.

Dr. Ripen Gupta is an Interventional Cardiologist and Director at Max Smart Super Speciality Hospital in New Delhi. He's an esteemed and award-winning Cardiologist in India, who has over 28 years of experience in performing Complex Coronary Angioplasty, Stenting, Pacemaker Implantations. He has several awards and recognitions for his name.

Factors affecting Blood pressure

Dr. Ripen informs, “In the majority of the patients, there is no reason, no exact cause for blood pressure. In fact, we have labeled it as Essential hypertension. Essential hypertension means there is no exact cause, though there are a number of factors that can lead to hypertension. 

Someone in the family who is having hypertension like your father, mother, brother, sister, then your chances of getting hypertension is more.

As you become older, your chances of having hypertension increase.

Males as compared to females have more chances of having high blood pressure, especially at a younger age group. Once you are 55, then the risk becomes equal.

Unhealthy lifestyle. We don't do regular exercise, we don't eat proper food, and we take more salt in our diet that can lead to high blood pressure. Even stress can lead to high blood pressure. 

In fact, certain medicines also, like taking birth control pills in females. Even this can lead to high blood pressure. 

For acidity, we generally take Eno, even though this can cause high BP. In high BP sodium content has to be reduced. So taking any form of sodium can also lead to high blood pressure.” 

Dr. Ripen says, “In around 5% of the cases there is a definite reason for blood pressure. And most commonly it is the kidneys in those patients. Either the kidneys are not working properly or the flow to the kidney has been blocked. So the patient will have a blockage in the heart arteries. The arteries that supply blood to the kidneys get blocked. 

In a few cases, there can be some Tumors or abnormalities of a gland known as Adrenal gland. This gland sits on the top of the kidney and if it is not functioning properly, this can also lead to high blood pressure. 

Even if your thyroid is not controlled, either you are hypothyroid or hyperthyroid both can cause disturbance in the blood pressure.” 

BP has to be managed, It is a silent killer

Dr. Ripen advises, “an important factor we have to remember is that the majority will have no exact cause for high BP where we can cure the patient. Hence, we have to manage blood pressure. And this is a very important aspect to understand that blood pressure cannot be cured. I have seen patients that come and say, I have been taking medicine for the last three months. And now I am okay, I don't need to take medicines. So I explain to them that once we start you on medication, most likely you will be on medicines for a lifetime. Though we don't start medicine in the beginning, first we give lifestyle management. We don't have a cause for the blood pressure, but we have risk factors. So, I try to make them understand that if someone in the family is having high blood pressure, it means they are a bit more at risk.”

Dr. Ripen voices, “Blood pressure is a silent killer. It doesn't cause any symptoms. There is a lot of misconception that blood pressure causes headaches. Headache has nothing to do with BP. 95% of the patients are with no symptoms. So, everyone who is 25 years of age should get a BP checkup done every five years. If the BP is not normal, then they should get it more frequently. And once it crosses a threshold of 140 by 90, then we generally prescribe lifestyle management followed by medications if required.” 

DASH diet – Specific BP diet

Dr. Ripen mentions, “There is a specific diet called DASH Diet which is specifically meant for patients to control their blood pressure. It has 4 - 5 components. One important component is that we should eat more vegetables, fruits and more low fat dairy means skim milk or paneer. We should take more fish, poultry and nuts. We have to cut down on the fats, saturated fats, trans fats, and decrease cholesterol in the diet. We should cut down on red meat, sugary drinks and sugars. So this diet can lower blood pressure and in fact it is equivalent to one tablet of BP. So if a patient follows this, he will be able to control BP with lifestyle management only.” 

30 – 35 % of Indians may be having BP problem

Dr. Ripen elaborates, “Indians take around 10 to 12 grams of salt and what is recommended is 4 - 5 grams. A hypertensive patient should take 2.5 grams of salt only, which is something like one teaspoon of salt in 24 hours. They have to take salt in Dal and Vegetables and no additional salt intake.

We are living in a tropical country. And before these ACs and all came in, we used to sweat a lot and along with that, we take a lot of salt. Our ancestors used salt as a defense mechanism. But now, we are living in an AC environment. We are not going out that much, we don't sweat that much, thus we don't lose salt also. And above that our plate is having more salt. Out of 140 crores people, we may be having 40 to 50 crores people who are hypertensive. I think no other diseases are that prevalent in India. This is a major issue. If we don’t stop here then India is going to be the hypertension capital of the world.”

BP medicines have no serious side effects

Dr. Ripen stresses, “We don't start blood pressure medications in each and every patient, first we give lifestyle management trials of two months in patients with mild hypertension. 

All BP medicines are meant to be taken for lifelong, they have been studied for 20 - 25 years. Maybe newer versions of medicines have come in but they are of the same group. So most of the BP medications will have no serious side effects. 

Secondly, we follow a philosophy of giving a combination of two low dose medicines rather than a higher dose of single medicine. The concept is that if you give a smaller dose of two medicines, the side effects are minimized and the benefits are magnified. Generally the doctor will prescribe a combination of two small doses of tablet. 

Few patients may have some side effects like diuretics can cause low sodium.  Calcium blocker can cause a little bit of swelling in the feet. Angiotensin receptor blocker (ARB) can cause a change in the reading levels of patients whose kidney is not working properly. If a particular medicine is not suiting the patient, the doctor will change to some other medicine. So, BP medicines are safe, meant to be taken for a lifetime,” says Dr. Ripen. 

Taking regular medicine for BP is very important

Dr. Ripen mentions, “As per the guidelines, BP medications can be taken plus minus half an hour means. For ex - a patient is taking medication every day in the morning around 9am. Next day he can take it by 08 : 30 – 09 : 30. So, this is the window he has, you cannot go beyond this. All medicines have half-life. If you delay taking medicines, the effect will go away and BP will start rising. This high BP can rupture blood vessels in the brain and rupture can cause stroke. So we have to keep the BP constantly in check. Hence you can’t skip BP medicine.” 

Dr. Ripen speaks, “What happens is that once you are on medication for many years, even if you skip for 2 - 3 days, BP may not rise. That doesn't mean you don't require the medications. You have to understand that it is the medicines which are bringing the BP to normal limits, not otherwise.” 

COVID and hypertension

Dr. Ripen adds, “Recent guidelines from American College of Cardiology, European Society of Cardiology and Indian hypertension Society says that if a person is on hypertensive medications, then he should not change his medicine even in this pandemic. The patient should keep very tight control on blood pressure because it has been seen that in COVID-19 if your blood pressure is not controlled, your chances of having complications from COVID-19 is more. So one should continue with BP medicines. If you are not able to meet the doctor, you can do teleconsultation but do not stop your medicines. Keep your BP under control to prevent complications from COVID-19.”

(Edited by Renu Gupta)