IMA and HCFI propose the Rule of 20 in identifying factors associated with hypertension

IMA and HCFI propose the Rule of 20 in identifying factors associated with hypertension On World Hypertension Day, IMA and HCFI call for understanding the numbers, and also taking a step forward in identifying and managing the symptoms New Delhi, 17 May 2017: About one-third of India's urban population and one-fourth of the rural population are hypertensive, according to a recent study published in the Journal of Hypertension. It has been found that high blood pressure is responsible for almost half the ischemic strokes that are also called brain attacks, akin to a heart attack. It also increases the chances of hemorrhagic strokes. Hypertension often goes unnoticed as it attacks the body without showing any symptoms at all. The 17th of May every year marks the World Hypertension Day, with the theme this year being 'Know your numbers'. Experts opine that early detection of blood pressure and its management may reduce the complications of hypertension as also the risk of death. Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, "High blood pressure is one of the leading causes for stroke contributing to over 50% in blockages (ischemic stroke) and leads to bleeding in the brain. This condition can damage arteries throughout the body, creating conditions where they can burst or clog more easily. Weakened arteries in the brain, resulting from high blood pressure, put people at a much higher risk of stroke. There are many factors and conditions which can lead to high blood pressure, for example, smoking, lack of physical activity, excess salt in the diet, consumption of alcohol, stress, and genetic history of high blood pressure." The IMA recently conducted a national study on ambulatory blood pressure measurement amongst doctors in partnership with HCFI and Eris Lifesciences. The study revealed that 21% of the doctors surveyed had masked hypertension or isolated ambulatory hypertension. In simple terms, their BP readings were normal when evaluated through the conventional clinic measurement technique but high when checked through the ABPM technique. Masked hypertension is associated with an increased long-term risk of sustained hypertension and cardiovascular morbidity. "Ambulatory Blood Pressure Monitoring is globally accepted as the gold-standard method towards detecting hypertension. It evaluates a patient's BP continuously over a period of 24 hours and helps diagnose masked or white coat hypertension, conditions in which a patient's BP readings are inaccurate due to certain environments. It is important to increase your intake of fresh fruits, vegetables, olive oil, and omega-3 foods to help lower high BP levels. Apart from this, it is a good idea to consume sprouted or 100% whole grains as also reduce your sodium intake. The real culprits behind increased sodium intake include processed and ultra-processed foods," opined Dr Aggarwal. Understanding the Rule of 20 in Hypertension can go a long way in identifying and managing the causes and symptoms of hypertension. • Prevalence of hypertension is 20% in the society • Only 20% of people are aware about Hypertension at any given time. • The morbidity and mortality due to hypertension is 20%. • Only 20% people get treated for hypertension and at any given time. • Only 20% of hypertensives are well controlled at any given time. • The risk of CAD and heart attack in hypertension is 20% • Risk of peripheral vascular disease in hypertension is 20% • Risk of paralysis in hypertension is 20%. • The severity of hypertension is decided by increments of 20 mm Hg each • In white coat hypertension, a person can have rise of more than 20 mm systolic blood pressure. • 20 mm Hg systolic blood pressure can be reduced by life style management alone. • 20 mm Hg systolic blood pressure can be reduced by one drug intervention. • Up to 20 ML of 80 proof 40% whisky is safe in hypertension. • 10 KG weight reduction can reduce systolic blood pressure by 20 mm Hg • Reduction of salt to 6 grams and intake of DASH diet can reduce systolic blood pressure by 20 Mm Hg • Look for a cause of hypertension, if blood pressure first time appears before the age of 20 • Each and every IMA member should monitor BP of at least 20 patients per day. • 20 Cores people are seen by IMA member every year • In last 20 years, the community systolic blood pressure has gone up by 20 mm hg. • IMA has more than 20,000 office bearers.

First of its kind national study by IMA, HCFI & Eris Lifesciences through the ABPM method reveals high incidence of hypertension amongst the medical fraternity

First of its kind national study by IMA, HCFI & Eris Lifesciences through the ABPM method reveals high incidence of hypertension amongst the medical fraternity Record attempt of collecting 20,000 ambulatory blood pressure readings of over 500 doctors in 1 day Over 50% physicians found to be suffering from uncontrolled hypertension despite taking hypertensive medicines; 56% from irregular BP at night and 21% from masked hypertension New Delhi, May 16, 2017: In what can be called as a massive feat, the Indian Medical Association, in partnership with the Heart Care Foundation of India(HCFI) and Eris Lifesciences in the form of an unconditional educational grant attempted to record the maximum number of ambulatory blood pressure readings amongst the medical fraternity in a single day. About 20,000 readings were taken of 533 doctors including those of the IMA leadership spanning 33 Indian cities. The aim being to raise awareness about the benefits of ambulatory blood pressure monitoring (ABPM) in the timely and correct diagnosis of hypertension on the occasion of the World Hypertension Day 2017. Hypertension is one of the most common lifestyle diseases prevalent today with one in three Indian adults suffering from it. The incidence of hypertension is equally high amongst the medical fraternity owing to high-stress levels. Often hypertension is misdiagnosed given the difference in blood pressure readings at home and in a clinic. Ambulatory Blood Pressure Monitoring (ABPM) can help in getting a more accurate picture of a person's BP pattern in a span of 24 hour. “The IMA National study on ambulatory blood pressure measurement amongst doctors conducted in partnership with HCFI and Eris Lifesciences revealed that 21% of the doctors surveyed had masked hypertension or isolated ambulatory hypertension. In simple terms, their BP readings were normal when evaluated through the conventional clinic measurement technique but high through the ABPM technique. Masked hypertension is associated with an increased long-term risk of sustained hypertension and cardiovascular morbidity. In addition to this, 56% of the doctors evaluated suffered from irregular BP pattern at night making them prone to future adverse cardiac events. 37% doctors had nocturnal hypertension, which can never be diagnosed through in clinic BP measurement. Over 50% physicians had uncontrolled hypertension despite taking hypertensive medicines,” said Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA. Evaluating both daytime and nighttime blood pressure is crucial for predicting all cardiovascular events. It is a fact that a blood pressure reading obtained during one’s sleep is more accurate in helping predict all causes of mortality when compared to those obtained during waking hours. Ambulatory Blood Pressure Monitoring is globally accepted as the gold-standard method towards detecting hypertension. It evaluates the patient's BP continuously over a period of 24 hours and helps diagnose masked or white coat hypertension, conditions in which a patient's BP readings are inaccurate due to certain environments. Dr Shashank Joshi, President Hypertension Society of India opined, "Your doctor may suggest ABPM for the following reasons: to find out if your blood pressure readings are higher in the clinic than at home; to see the efficacy of your medicines in controlling blood pressure throughout the day, or to note whether your blood pressure increases at night. Since there are no visible signs of masked hypertension, it is always good to let your doctor know if you have a family history of high blood pressure. I congratulate IMA, HCFI and Eris on this initiative and believe that a collaborative effort towards raising mass level awareness on the prevention of hypertension, it's timely diagnosis and management is crucial in our country where every third person has high BP”. ABPM involves attaching a small digital blood pressure machine to a belt around your body. This is in turn is connected to a cuff around the upper arm. It does not cause any inconvenience, as it is small enough for you to carry on with your routine. This machine notes blood pressure readings at regular intervals during a 24 hour period: typically, every 15 to 30 minutes during the day and 30 to 60 minutes at night. Increasing your intake of fresh fruits, vegetables, olive oil, and omega-3 foods can help lower your high blood pressure levels. It is also a good idea to consume sprouted or 100% whole grains. Try to reduce your sodium intake, which does not necessarily come only from table salt or salt added while cooking. Processed and ultra-processed foods are the real culprits behind increased sodium intake. Disclaimer: This project is undertaken by the IMA under an unconditional education grant from Eris Lifesciences Ltd. Contents of this program are a copyright of IMA and are not influenced by any third party.

May Measurement Month

May Measurement Month As you are well aware, hypertension has been long recognized as one of the major risk factors for cardiovascular disease and premature deaths worldwide. It is estimated to cause 9.4 million deaths and 7.0% of disability-adjusted life years (DALYs). In India, it exerts substantial public health burden on cardiovascular health status and the health care system. It is estimated to account for 10.8% of all the deaths and 4.6% of DALYs in the country. Indian Medical Association is collaborating with Indian Council of Medical Research (ICMR), who in turn, is collaborating with Centre for Chronic Disease Control – WHO Collaborating Centre and Public Health Foundation of India to observe May 2017 as “May Measurement Month”, which is a joint initiative between the International Society of Hypertension and World Hypertension league. As a part of this international project, it has been decided to monitor the blood pressure of over 25 million people around the globe with India getting a target of 2.5 million in this month. Indian Medical Association has been assigned, as a participant of this initiative, to ensure that each and every member of the Association monitors the blood pressure of at least 20 patients per day for the whole month starting from 1st May 2017. Under this project, all patients between 18-65 years of age are to undergo blood pressure monitoring 3 times in one go with a gap of one minute each through mid-left arm sitting position. A link to download the data collection tool for Android phones is appended below. We call for the participation of one and all in IMA to achieve the set target for the project as above and raise the IMA flag higher in the international arena. (Dr KK Aggarwal) (Dr RN Tandon) National President, IMA Hony Secy Gen, IMA For Study material, click to download:- 1. Patient_Information_sheet 2. FAQs 3. 10 Tips 4. Project Flyer 5. Matter for Standee 6. Patient Informed Consent format 7. Information sheet for volunteers to use when advising members of the public found to be hypertensive with blood pressure readings of 140/90 or above 8. Measurement card format 9. Printable Excel sheet format for records of persons checked

New ACP/AAFP guidelines on treatment of hypertension in adults older than 60 years

New ACP/AAFP guidelines on treatment of hypertension in adults older than 60 years New clinical practice guidelines developed jointly by the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP) for the pharmacologic treatment of hypertension in adults aged 60 years or older have been released. Published January 17, 2017 in the Annals of Internal Medicine, the guideline includes clinical recommendations based on the benefits and harms of higher versus lower blood pressure targets for the treatment of hypertension in adults aged 60 years or older. The treatment goals should be individualized. The three recommendations are: • Treatment should be started if the systolic blood pressure continues to be 150 mm Hg or higher to achieve a target systolic blood pressure of less than 150 mm Hg to reduce the risk for mortality, stroke, and cardiac events. • Start or intensify pharmacologic treatment if these patients have a history of stroke or transient ischemic attack to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk for recurrent stroke. • Clinicians should consider initiating or intensifying pharmacologic treatment in some adults aged 60 years or older at high cardiovascular risk, based on individualized assessment, to achieve a target systolic blood pressure of less than 140 mm Hg to reduce the risk for stroke or cardiac events. (Source: Annals of Internal Medicine)

Clinic BP measurements may miss many patients with masked hypertension

Clinic BP measurements may miss many patients with masked hypertension

Dr K K Aggarwal, National President IMA

According to a new research published in the journal Circulation, around the clock monitoring during daily activity revealed masked, or undetected, high blood pressure among otherwise healthy adults who had normal readings in the clinic.

In this study, researchers compared clinic blood pressure measurements to ambulatory blood pressure monitoring in 888 healthy, middle-aged participants enrolled in the Masked Hypertension Study at Stony Brook University and Columbia University in New York between 2005 and 2012. And 24-hour ambulatory BP monitoring during daily activities revealed undetected high BP among otherwise healthy adults who had normal readings in the clinic.

·         15.7% of study participants with normal clinic BP had masked hypertension based on ambulatory monitoring, regardless of sex, race, or ethnicity.

·         Younger, normal-weight participants were more likely than older, overweight participants to have ambulatory blood pressure readings higher than their clinic readings.

Based on these findings, the study authors advise doctors to be aware of the fact that normal BP readings in the clinic may not rule out high BP among otherwise healthy patients.

(Source: AHA Press Release, December 5, 2016) 

Low income countries overtake high income countries in hypertension prevalence

Low income countries overtake high income countries in hypertension prevalence Global disparities in hypertension prevalence and control are large and increasing and the prevalence of high blood pressure is higher in low- and middle-income countries than in the high income countries, according to the first systematic analysis of global health disparities in hypertension prevalence, awareness, treatment, and control. The greatest increases in absolute burden of hypertension were observed in East Asia and Pacific, South Asia, and sub-Saharan Africa. · In 2010, 31.1% of the world’s adults had hypertension; of these, 28.5% in high-income countries, while 31.5% were in the low- and middle-income countries. · An estimated 1.39 billion people had hypertension in 2010. And 1.04 billion of these were living in the low- and middle-income countries as compared with 349 million in high-income countries. · The prevalence of hypertension decreased by 2.6% in high-income countries but increased by 7.7% in low- and middle-income countries from 2000 to 2010. The analysis also observed considerable differences in the level of awareness and treatment of hypertension. While, awareness, treatment, and control of hypertension increased considerably in high-income countries, low- and middle-income countries showed much less improvement. The study identified many barriers to effective treatment and control of hypertension in the poorer parts of the world such as lack of access to care, costly medications, overburdened healthcare providers, lack of treatment guideline adherence, low patient health literacy and adverse side effects A total of 135 population-based studies of 968,419 adults from 90 countries were included in the analysis published August 9, 2016 in the journal Circulation.

The benefits of oranges and lemons for those with high BP

The benefits of oranges and lemons for those with high BP
New Delhi, July 27, 2016: Increasing levels of potassium in the diet may lower a person's risk of developing high blood pressure and may decrease blood pressure in people who already have high blood pressure said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA. A healthy intake of potassium is one reason why vegetarians and isolated populations have a very low incidence of heart disease. In isolated societies consuming diets low in sodium and high in fruits and vegetables, and which therefore have high levels of potassium, hypertension affects only 1 percent of the population. In contrast, in industrialized societies, where people consume diets high in processed foods and large amounts of dietary sodium, 1 in 3 persons have hypertension. The typical urban Indian diet contains about double the sodium and half the potassium that is currently recommended in dietary guidelines. The American Heart Association recommends intake of 4.7 grams per day of potassium. An increase in potassium with a decrease in sodium is probably the most important dietary choice (after weight loss) that should be implemented to reduce cardiovascular disease. Diets containing at least 500 to 1,000 milligrams magnesium daily and more than 800 milligrams of calcium daily may help lower blood pressure and the risk of developing high blood pressure, reports a study in Journal of Clinical Hypertension.

All hypertensive patients should keep their sugar lower than 90 mg%

All hypertensive patients should keep their sugar lower than 90 mg% New Delhi, July 08, 2016: "Hypertension is a risk factor for Type 2 diabetes. If not properly managed, it can lead to diabetes with subsequent high risk of kidney damage," said Padma Shri Awardee Dr KK Aggarwal – President Heart Care Foundation of India (HCFI) and Honorary Secretary General IMA.
Results of the Anglo-Scandinavian Cardiac Outcomes Trial–Blood Pressure Lowering Arm (ASCOT–BPLA) study have shown that the major predictor of new-onset diabetes (NOD) in patients with hypertension is high baseline fasting plasma glucose levels of more than 90mg%. The risk increases by 5.8 times for each 18mg% rise above 90 mg%.
Other risk factors are higher weight, higher blood pressure, and higher triglyceride levels. High BP patients taking the drugs atenolol (beta blocker drug) regimen with or without a diuretic are also at risk. On the other hand, high BP patients on amlodipine (calcium blocker) ± perindopril (ACE inhibitor), with high good HDL cholesterol levels, moderate alcohol use, and age older than 55 years had protection from developing diabetes.
The clinical tip is to keep fasting sugar lower than the waist circumference.