Al­most half of the UAE’s pop­u­la­tion has the si­lent killer, hy­per­ten­sion – and wor­ry­ingly, most don’t even know they have it.

Have you been checked for hy­per­ten­sion? As 45 per cent of the UAE’s pop­u­la­tion bat­tles the si­lent killer that is hy­per­ten­sion, Mri­nal Shekar finds out preven­tion re­ally is bet­ter than cure

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Af­ter an ex­tremely busy day, Dubai res­i­dent Pradeep Kr­ish­nan was driv­ing back home late one night three years ago, won­der­ing why the slight headache he’d had the whole day had still not gone. It could be be­cause he’d skipped lunch, he thought to him­self. With in­nu­mer­able re­ports to be sub­mit­ted, meet­ings to be at­tended and calls to be an­swered, Pradeep had barely time for a cou­ple of lat­tes and muffins to take him through the day. Sud­denly, the headache turned into a throb and by the time he got home, he could feel small beads of sweat de­vel­op­ing on his fore­head. Pradeep im­me­di­ately called out to his wife. He does not re­mem­ber very clearly what hap­pened next as he kept ex­pe­ri­enc­ing spells of dizzi­ness. ‘What I will not for­get is the chat I had with a doc­tor the fol­low­ing day,’ he says.

‘Quite of­ten hy­per­ten­sion goes un­der the radar as it is not usu­ally as­so­ci­ated with any spe­cific symp­toms. Many peo­ple have it but are to­tally obliv­i­ous to it,’ says Dr Adam Mather, con­sul­tant in­ter­ven­tional car­di­ol­o­gist at Mediclinic City Hos­pi­tal in Dubai’s Health­care City. In Pradeep’s case, it was a prob­lem he was hop­ing would go away with­out him hav­ing to deal with it.

Pradeep was 42 years old, weighed 135kg and had al­ready been di­ag­nosed with hy­per­ten­sion and type 2 di­a­betes. ‘I just don’t have the time,’ was Pradeep’s reg­u­lar ex­cuse for not ex­er­cis­ing or eat­ing right. ‘The doc­tor told me that my poor eat­ing habits and stress­ful life had got the bet­ter of me and my blood pres­sure had sky-rock­eted. He also made it clear that if I wanted to live long enough to see my kids grad­u­ate and get mar­ried, then I had to ac­cept the grav­ity of the prob­lem and make some vi­tal life­style changes,’ he says. That warn­ing was a re­al­ity check for Pradeep. ‘Also, he told me that un­like most peo­ple, I was for­tu­nate that I al­ready knew I had hy­per­ten­sion.’

The fact that the con­di­tion goes largely un­de­tected is the rea­son for hy­per­ten­sion’s moniker: the si­lent killer.

So what is hy­per­ten­sion? Dr Mather ex­plains, ‘Blood pres­sure is in­di­cated by two num­bers, for ex­am­ple 124/76 mmHg. The first num­ber is known as sys­tolic pres­sure – the blood pres­sure when the heart beats. The se­cond num­ber, di­as­tolic pres­sure, is the pres­sure when the heart rests be­tween beats.’ The Amer­i­can Heart Foun­da­tion de­fines hy­per­ten­sion as hav­ing a sys­tolic read­ing above 140 mmHg and/or a di­as­tolic read­ing above 90 mmHg.

Re­search pub­lished in last Novem­ber’s is­sue of Lancet said, ‘1.13 bil­lion peo­ple across the world suf­fer from high blood pres­sure’. Even more shock­ing are the statis­tics re­leased by World Health Or­gan­i­sa­tion that show blood pres­sure is­sues are es­ti­mated to cause 7.5 mil­lion deaths glob­ally; al­most 13 per cent of all deaths.

In the UAE, too, the con­di­tion has seen a rapid rise. Re­fer­ring to 2015 statis­tics, a re­cent UAE Min­istry of Health and Preven­tion press re­lease said that 30 per cent of to­tal deaths caused by non-com­mu­ni­ca­ble dis­ease are due to car­dio­vas­cu­lar dis­ease, mak­ing it the num­ber one cause of death in the coun­try. Five per cent of all deaths are due to high blood pres­sure or hy­per­ten­sion. (The four main types of non-com­mu­ni­ca­ble dis­eases are can­cer, di­a­betes, car­dio­vas­cu­lar dis­eases such as heart at­tacks and stroke, and chronic res­pi­ra­tory dis­eases, such as chronic ob­struc­tive pul­monary dis­ease and asthma.) ‘In the UAE, it is es­ti­mated that 40 to 45 per cent of adults be­tween the ages of 35 and 70 have hy­per­ten­sion,’ says Dr Mather.

These mind-bog­gling num­bers prove that hy­per­ten­sion is of ex­treme con­cern, par­tic­u­larly in the UAE ‘be­cause the rates of obe­sity and type 2 di­a­betes mel­li­tus are ris­ing faster in this re­gion than other parts of the world,’ says the doc­tor. ‘Also, we have no­ticed that the av­er­age age of pa­tients pre­sent­ing with car­dio­vas­cu­lar dis­ease in the UAE is much lower than in Europe and North Amer­ica.’

The doc­tor be­lieves the rea­son for the steep rise in hy­per­ten­sion in the re­gion ‘is mainly be­cause of poor life­style choices such as smok­ing, un­healthy diet and lack of ex­er­cise.’ But what makes it a vi­cious cir­cle, ac­cord­ing to Dr Mather, is the fact that the rate of obe­sity, di­a­betes and high choles­terol has also seen a sharp in­crease. All of these fac­tors come to­gether to make a lethal cock­tail that in­creases the risk for strokes, heart at­tacks, heart fail­ure, chronic kid­ney dis­ease and,

A few rea­sons HY­PER­TEN­SION has seen a STEEP RISE in the re­gion is mainly be­cause of poor LIFE­STYLE choices such as SMOK­ING, fol­low­ing an UN­HEALTHY DIET and lack of EX­ER­CISE

even­tu­ally, pre­ma­ture death. ‘If left un­treated, the pro­gres­sive rise in blood pres­sure will dam­age the blood ves­sels and the kid­neys and may cul­mi­nate in a treat­ment-re­sis­tant state,’ says the doc­tor.

Pradeep was tread­ing that deadly path, but the doc­tor’s warn­ing worked and Pradeep de­cided to make dras­tic life­style changes. Over the past two years, Dr Mather re­veals, Pradeep lost 50kg by eat­ing healthily and ex­er­cis­ing reg­u­larly. ‘Ear­lier, he used to take five tablets for hy­per­ten­sion; now he is down to one. He has also been able to con­trol his blood-sugar level through diet alone.’

Pradeep’s tes­ti­mo­nial proves that life­style changes and reg­u­lar screen­ing

are key to keep­ing hy­per­ten­sion at bay. ‘We need to pro­mote reg­u­lar ex­er­cise. The Euro­pean So­ci­ety of Car­di­ol­ogy and the Amer­i­can Heart As­so­ci­a­tion rec­om­mend that we should do mod­er­ate in­ten­sity ex­er­cise at least five days a week for at least 30 min­utes each day,’ says Dr Mather.

He also ad­vises re­duc­ing salt in­take to 5g to 6g a day, fol­low­ing a low-fat diet and keep­ing a check on sugar in­take. ‘But most im­por­tantly, we need to get our blood pres­sure checked at least once a year if we are over the age of 35 and if a per­son has other risk fac­tors for heart dis­ease such as di­a­betes, obe­sity, high choles­terol, or smokes. In such in­stances, he or she needs to go for check-ups more of­ten. In short, you will not know your blood pres­sure con­di­tion un­less you get it checked,’ he adds.

Reg­u­lar check-ups and health aware­ness pro­grammes are in fact go­ing to be an in­te­gral part of UAE gov­ern­ment’s strat­egy to com­bat this grave con­di­tion. Dr Hus­sain Ab­dul Rah­man Al Rand, as­sis­tant un­der­sec­re­tary of the Health Cen­ters and Clin­ics Sec­tor at the UAE Min­istry of Health and Preven­tion, re­cently said, ‘Our goal is to work out ways to pre­vent the on­set of hy­per­ten­sion as well as guide mem­bers of the com­mu­nity in di­ag­nos­ing the dis­ease and the as­so­ci­ated risk fac­tors through early screen­ing.’

For ef­fec­tive preven­tion, it is vi­tal that all those who see their blood pres­sure num­bers inch­ing up­wards heed their doc­tor’s ad­vice and bring about real changes to the way they live, just so that they don’t have to depend on med­i­ca­tion for the rest of their lives to man­age their health. How do you de­fine hy­per­ten­sion? Blood pres­sure (BP) is de­ter­mined by the amount of blood pumped by the heart and the re­sis­tance to blood flow in our ar­ter­ies. The more blood our heart pumps and the nar­rower our ar­ter­ies, the higher your blood pres­sure. Many sig­nif­i­cant con­tri­bu­tions of Ayurveda physi­cians from an­cient times re­main un­recog­nised in the his­tory of medicine. For ex­am­ple, Ayurveda physi­cians Sus­rutha (700 BC) and Charaka (AD 100) had a pre­lim­i­nary un­der­stand­ing of the car­dio­vas­cu­lar sys­tem and the heart act­ing as a pump. Pulse di­ag­no­sis has al­ways been an im­por­tant as­pect of Ayurveda di­ag­no­sis. Ayurveda used terms like the ‘snake move­ment of pulse’, ‘frog leap­ing of pulse’ and ‘swan move­ment of pulse’ to dif­fer­en­ti­ate changes in blood pres­sure and pulse in those times. With the in­ven­tion of sphyg­mo­manome­ters, it has be­come eas­ier to mea­sure blood pres­sure.

The only area Ayurveda might the­o­ret­i­cally dif­fer from the mod­ern view­point is the stan­dard­i­s­a­tion of BP for ev­ery hu­man, ir­re­spec­tive of their phys­i­o­log­i­cal unique­ness. Ac­cord­ing to Ayurveda, ev­ery hu­man be­ing is unique and so is their pulse and BP. A Vata body type might have vary­ing BP ac­cord­ing to the so­lar cy­cle while a Pitta body type might show sharp rise in BP ac­cord­ing to emo­tional changes. A BP termed as pre-hy­per­ten­sion (sys­tolic be­tween 120 and 139 and/or di­as­tolic be­tween 80 and 89) may be a nor­mal BP for a vata per­son by ge­netic in­her­i­tance. What are the symp­toms of hy­per­ten­sion? Hy­per­ten­sion may not show any symp­toms un­til it reaches a se­ri­ous or life-threat­en­ing stage. Headaches, short­ness of breath or nose­bleeds are seen as symp­toms in some pa­tients. What causes hy­per­ten­sion? As per Ayurveda, Vata is the phys­i­o­log­i­cal vi­tal force that gov­erns the pump­ing of the heart and con­trols the elas­tic­ity of blood ves­sels. With age­ing, we face a nat­u­ral in­crease in vata, which re­sults in a higher BP. Mod­ern medicine tags this as pri­mary hy­per­ten­sion. What pre­sen­ta­tions of hy­per­ten­sion

Hy­per­ten­sion may not show any SYMP­TOMS un­til it reaches a se­ri­ous or life-threat­en­ing stage. HEADACHES, short­ness of breath or nose­bleeds are seen as symp­toms in some hy­per­ten­sion PA­TIENTS

are seen in prac­tice? 1. High sys­tolic and nor­mal di­as­tolic – vat­apitta im­bal­ance 2. Nor­mal sys­tolic and high di­as­tolic – vatakapha im­bal­ance 3. High sys­tolic and high di­as­tolic – im­bal­ance of vata, pitta and kapha

The causes for vata im­bal­ance are ex­ces­sive and long-term in­take of spicy, bit­ter and as­trin­gent foods; overeat­ing and un­healthy eat­ing; sup­pres­sion or pre­ma­ture ini­ti­a­tion of nat­u­ral urges like bowel move­ments, uri­na­tion, sleep, tears, hic­cups, burps, thirst, hunger, cough; overex­er­tion and over­think­ing can also cause high blood pres­sure.

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Dr VL Shyam, an Ayurvedic prac­ti­tioner, gives his view on hy­per­ten­sion and its treat­ment

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