Uncontrolled high blood pressure is a serious risk factor for COVID-19 complications

Life is a journey, not a destination! (Dr. Noorali Bharwani)
Life is a journey, not a destination! (Dr. Noorali Bharwani)

We know high blood pressure is a serious condition. If not treated, it can lead to many complications like heart failure, stroke and dementia. There is evidence to show hypertensive patients are more at risk of complications from COVID-19 than those whose high blood pressure is managed with medication.

A combination of medications and lifestyle changes can bring your blood pressure under control and reduce the risk of heart failure, stroke, dementia and COVID-19.

You should buy a blood pressure monitor and learn to take your own blood pressure at home.

An article in the Canadian Medical Association Journal (Monitoring blood pressure at home: guidance for Canadian Patients – CMAJ July 12, 2021) says it is important to buy home blood pressure monitor approved by Hypertension Canada.

The article says, “Most home blood pressure monitors sold commercially (> 85 per cent worldwide) do not measure blood pressure accurately. Hypertension Canada has a list of recommended devices that have been tested, are known to give valid readings and can be recognized in stores by their Recommended by Hypertension Canada logo (https://hypertension.ca/bpdevices).”

The article recommends measuring blood pressure twice in the morning and twice in the evening for seven consecutive days (28 readings total). If your blood pressure is stable then you can monitor your blood pressure every three months. Best thing would be to check with your doctor and follow the recommendations.

What would be considered high blood pressure?

If your blood pressure readings at home average 135/85 or over then you have high blood pressure. You should discuss this with your doctor.

If you have symptoms of a heart attack or stroke then you should call 911.

What can you do to get your blood pressure under control?

First step is to make lifestyle changes. Eat a healthy diet and exercise 30 to 60 minutes daily. If this does not reduce your blood pressure then you need medications. Medications are needed for systolic blood pressure of 160 or higher and diastolic readings of 100 or higher. If this is not taken care of then your risk of heart attack and stoke are high.

This risk is reduced with medications prescribed by your family doctor, combined with home monitoring and lifestyle changes.

What is meant by lifestyle changes?

  1. Eat heart-healthy foods: fruits, vegetables, whole grains, poultry, fish and low-fat dairy foods.
  2. Eat low salt diet: Aim to limit sodium in your diet.
  3. Lose weight: Losing even a little weight can reduce your blood pressure.
  4. Increase physical activity: This reduces blood pressure and helps with stress and weight loss.
  5. Manage stress: Try deep breathing and meditation.
  6. Avoid or limit alcohol: Alcohol can raise blood pressure.
  7. Do not smoke: Tobacco causes blood pressure to rise and plaque to build up quickly in your arteries.

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We shouldn’t take the Delta threat lightly.

Cruise to Alaska. (Dr. Noorali Bharwani)
Cruise to Alaska. (Dr. Noorali Bharwani)

When we are in a crisis situation our thinking tends to go in high gear. We tend to become innovative and look for growth opportunities. We recognise our strengths and weaknesses. We try to find solutions in a hurry. Look at COVID-19 pandemic. It has changed how we think and it has changed the future of health care.

Now that we seem to be getting control of COVID-19, the virus is trying to outsmart us.

When first cases of the SARS-CoV-2 Delta variant were detected in the United Kingdom in mid-April, the nation was getting ready to open up. This had to be delayed. The fear of Delta variant virus has spread all over the world.

These variants seem to spread more easily and quickly than other variants, which may lead to more cases of COVID-19. These variants may be associated with different symptoms. An increase in the number of cases will put more strain on healthcare resources, lead to more hospitalizations, and potentially more deaths.

According to Alberta Health Care website, anyone who has been infected with a variant strain will test positive for COVID-19. Positive tests are screened again for all variants to determine the exact strain. To date, four variants of concern have been identified in Alberta.

B.1.1.7 (Alpha): This variant was first detected in the United States in December 2020. It was initially detected in the United Kingdom. It’s estimated to be around 50 percent more transmissible than the version of the pandemic coronavirus. According to fresh data, two variants now threaten Alpha’s reign: Delta and Gamma. Delta is considered the most concerning variant seen yet.

B.1.351 (Beta): This variant was first detected in the United States at the end of January 2021. It was initially detected in South Africa in December 2020.

P.1 (Gamma): This variant was first detected in the United States in January 2021. P.1 was initially identified in travellers from Brazil, who were tested during routine screening at an airport in Japan, in early January.

B.1.617.2 (Delta): This variant was first detected in the United States in March 2021. It was initially identified in India in December 2020.

There are several reasons why Delta variant is highly dangerous. Mutations in the Delta variant make it replicate faster and evade the body’s immune mechanism. According to WHO, it is the fastest and fittest variant yet. The Delta variant is 50 – 60 per cent more transmissible than Alpha variant which was 50 – 60 per cent more transmissable than the original strain of COVID-19.

One vaccine dose is not enough to protect you. Two doses of vaccine are strongly protective. Two weeks after receiving a second dose, the Pfizer-BioNTech vaccine appeared to provide 79 per cent protection against infection with the Delta variant, compared with 92 per cent protection against the Alpha variant.

Scientists are debating whether we should take a booster dose against Delta variant. This is currently unknown. So far, studies suggest that the current authorized vaccines work on the circulating variants.

The Pfizer, Moderna and AstraZeneca vaccines currently available in Alberta offer protection against infection and may offer protection against severe outcomes with variants. However, the level of protection may vary depending on the variant and the number of doses received.

Viruses constantly change through mutation, and new variants of a virus are expected to occur. Do not lower your guard. Be vigilant. Get vaccinated. Wear a mask. Maintain social distancing and wash your hands frequently.

Take care. It is not over until it is over!

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

COVID-19 has contributed significantly to decline in physical and mental health.

River Walk in Lisbon, Portugal. (Dr. Noorali Bharwani)
River Walk in Lisbon, Portugal. (Dr. Noorali Bharwani)

Alberta Medical Association (AMA), as part of advocacy and engagement with the public has a website (albertapatients.ca) which is Canada’s largest online community for patients to share their thoughts.

AMA engages in dialogue with approximately 13,500 Albertans about health care issues. AMA’s latest survey, fielded May 19 to 27, 2021 asked about people’s worries and priorities regarding their health care. AMA received more than 4,700 responses.

AMA recently shared their findings with the members of the association. AMA says, “The results are sobering: lifestyle and livelihoods (for many) have shifted dramatically, contributing to a significant decline in physical and mental health.”

Here are the important points:

  • More than half of respondents (52 per cent) report that their physical health has declined since the start of the pandemic (15 per cent say their health is now much worse). This is up eight per cent since November 2020 and tends to be more prominent in those under the age of 54 years, and those who have a chronic medical condition. The top reasons cited for the decline in physical health are: harder to exercise, fear of going to a health care provider, and not socializing.
  • The impact COVID-19 has had on the mental health of Albertans is troubling. Sixty-four per cent of respondents report a decline in their own mental health since the start of the pandemic.
  • Twenty-three per cent say their mental health is much worse now. This is more common response among women than men, those under the age of 55, and those with a chronic medical condition.
  • Forty-seven per cent struggle with social isolation, while others cite concerns about finances and the security of their jobs, along with concerns for their own or their family’s health.
  • Only seven per cent of respondents say their mental health has improved since the pandemic began.
  • There is anxiety and depression due to care deficit on individuals who are waiting for treatment. Especially patients who are waiting for cancer surgery, chemotherapy, and radiotherapy.

The deterioration in mental and physical wellness that Albertans are reporting may be a prelude of what is to come. With significant financial deficit the government will have to find more money to play catch-up. As COVID-19 retreats, there will be no automatic reset to what was before the pandemic.

An article in the Canadian Medical Association Journal (CMAJ June 7, 2021 – Postpartum mental illness during the COVID-19 pandemic) highlights the difficulties faced by women after child birth. In Ontario, visits for mental health conditions in the postpartum period increased markedly from March 2020.

The authors of the article observed increased use of nonacute care services for postpartum mental health in Ontario during the first few months of the pandemic, suggesting that self-reported mental distress has translated into increased help-seeking for postpartum people.

The authors of the article suggest health systems should focus proactively on patients from high-risk groups, monitor waiting lists for care, and explore creative solutions to expand system capacity, with special attention to postpartum patients who may be experiencing barriers to care. With the extensive use of virtual care, further evidence regarding the safety and effectiveness of virtual treatment for postpartum mental illness should be sought.

As we can see the health care delivery has changed dramatically in the last year and a half. I doubt whether things will return to the old ways. Doctors will have to find creative ways to assess and treat patients.

Take care. Be safe. Don’t take unnecessary chances. The highly contagious Delta COVID-19 is likely to become dominant in Alberta. So, we have to be careful.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

What are the long-term effects of COVID-19?

Capilano Suspension Bridge in Vancouver, BC. (Dr. Noorali Bharwani)
Capilano Suspension Bridge in Vancouver, BC. (Dr. Noorali Bharwani)

With mass vaccination in progress, we look forward to post-COVID days. While we look forward to post-COVID era, we should not forget people who have been sick with COVID-19. Do we know how they are doing? What are the long-term effects of COVID-19?

What about all the people who have died because of COVID-19?

Here are the Canadian statistics as of June 3, 2021: total number of cases of COVID-19 1.4 million, total number of deaths 25,000.

Good news is Alberta is steadily climbing towards its vaccination goal for lifting COVID-19 restrictions, with nearly 65 per cent of eligible Albertans having received their first dose.

The province expects to lift all COVID-19 restrictions by the end of June or early July, two weeks after 70 per cent of Albertans aged 12 and older have received one dose of the vaccine.

What about those who have been diagnosed with COVID-19?

Recommendations are that people be vaccinated regardless of whether they already had COVID-19. If you are fully vaccinated, after two weeks you can resume activities that you did prior to the pandemic keeping in mind the guidelines set by your province.

What about people that have recovered from COVID-19? Are there any long-term effects?

Although most people with COVID-19 get better within weeks of illness, some people experience post-COVID conditions, says an article in the Centre for Disease Control and Prevention (CDC) website dated April 8, 2021.

CDC continues to work to identify how common these longer-term effects are, who is most likely to get them, and whether symptoms eventually resolve. Multi-year studies are underway to further investigate post-COVID conditions. These studies will help us better understand post-COVID conditions and understand how to treat patients with these longer-term effects.

Post-COVID conditions are a wide range of new, returning, or ongoing health problems people can experience more than four weeks after first being infected with the virus.

Even people who did not have symptoms when they were infected can have post-COVID conditions. These conditions can have different types and combinations of health problems for different lengths of time.

Types of Post-COVID conditions:

1. Long COVID
Long COVID is a range of symptoms that can last weeks or months after first being infected with the virus that causes COVID-19 or can appear weeks after infection. Long COVID can happen to anyone who has had COVID-19, even if the illness was mild, or they had no symptoms.

2. Multiorgan Effects of COVID-19
Multiorgan effects can affect most, if not all, body systems including heart, lung, kidney, skin, and brain functions. It is unknown how long multiorgan system effects might last and whether the effects could lead to chronic health conditions.

3. Other effects
Effects of COVID-19 treatment and hospitalization can also include post-intensive care syndrome (PICS), which refers to health effects that remain after a critical illness. These effects can include severe weakness and post-traumatic stress disorder (PTSD). PTSD involves long-term reactions to a very stressful event.

The best way to prevent these long-term complications is to prevent COVID-19. In general, people are considered fully vaccinated two weeks after their second dose in a two-dose series. If you were diagnosed with COVID-19 and are experiencing long-term complications then you should contact post-COVID care clinics. These clinics are opening at medical centers across Alberta and Canada. Your family doctor can help you with that.

As the saying goes, prevention is better than cure: wear a mask that covers your nose and mouth, stay two meters apart, get vaccinated, avoid crowded areas, and wash your hands frequently.

Enjoy the camping and BBQ season safely.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!