High Blood Pressure is a Silent Killer

Fishing - one way to relax. (Dr. Noorali Bharwani)
Fishing - one way to relax. (Dr. Noorali Bharwani)

A new study shows that lowering blood pressure more with a target of 120 instead of 140 mm Hg systolic can cut deaths by 25 per cent. A third of U.S. and Canadian adults have high blood pressure. So millions could be affected by the new findings. But U.S. government-funded researchers who ran the study say it’s too soon for anyone to change what they are doing just yet.

“This is huge – I mean, 25 per cent less deaths and a third – 33 percent – less heart attacks, strokes and heart failure – that’s huge,” says Dr. Julia Lewis, a kidney specialist at Vanderbilt University who took part in the new study.

Normally, systolic blood pressure should be less than 140 mm Hg (mercury) and diastolic pressure of less than 90 mm Hg. It is written as – systolic over diastolic (for example 120/80 mm Hg). Blood pressure is lowest in the early morning, rises as the day progresses, and then dips down during the night and earliest hours of the morning. Blood pressure can fluctuate under different circumstances.

World Health Organization says that hypertension (high blood pressure) causes seven million premature deaths worldwide each year. Hypertension affects 22 percent of Canadians. It is estimated that 25 percent of the 42 million people with high blood pressure in the United States are unaware that they have hypertension. These patients probably have no symptoms. That is dangerous. That is why it is called a silent killer.

The incidence of hypertension increases with age. Most elderly Canadians have high blood pressure – probably due to thickening of blood vessels. No cause is identified in 80 to 95 percent of people with hypertension. This is known as idiopathic or essential hypertension. Others have hypertension due to primary disease of kidneys or due to certain hormonal disorders.

Blood pressure also varies from minute to minute, depending on levels of stress and physical activity. “White-coat hypertension” means a person’s blood pressure is up in the doctor’s office but not elsewhere.

Hypertension can be prevented and treated with lifestyle changes – with or without medication. Eat a healthy diet, lose weight if you are overweight, do not smoke, limit alcohol intake, eat a low salt diet, minimize sugar intake, do regular exercise, relax and learn to manage stress with laughter and meditation.

If your doctor wants you to take pills to control your blood pressure then make sure you take it regularly. Research has shown that 50 per cent of the patients with high blood pressure discontinue their antihypertensive medications by the first year. This is not good.

The U.S.-funded study is not quite finished but the effects on the heart were strong and clear. Getting blood pressure to 120 or lower reduced rates of cardiovascular events, such as heart attack, stroke and heart failure by a third. It reduced the deaths from any cause by 25 percent.

The research team is still studying the effects of lower blood pressure on dementia, memory loss and kidney function. Other studies have suggested lower blood pressure can help reduce or delay dementia symptoms and boost kidney function.

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Regular Physical Exercise Makes You Smart and Healthy

One step at a time. (Dr. Noorali Bharwani)
One step at a time. (Dr. Noorali Bharwani)

Who wouldn’t like to be smart and healthy?

An article in the Scientific American Mind (July/August 2009), titled “Fit Body, Fit Mind?” says your workout makes you smarter and you stay sharp into old age.

“We are used to thinking of intelligence as largely a matter of genetic inheritance, but that is not the whole picture. What you do affects your mental wellbeing: staying physically and mentally active helps us stay sharp as we age,” says the article. Your brain and body – either use it or lose it.

A review of dozens of studies shows that maintaining a mental edge requires more. Other things you do – including participating in activities that make you think, getting regular exercise, staying socially engaged and even having a positive attitude – have a meaningful influence on how effective your cognitive functioning will be in old age, says the article.

Sometime ago, researchers from Denver presented their research at the annual meeting of the Pediatric Academic Societies. Their conclusion: being more physically fit means kids will do better in school. They found that this can be achieved by increasing school’s physical education program to 40 minutes a day, five days a week, from 40 minutes once a week. The performance improved by about 70 per cent. Amazing!

A healthy and smart child will one day become a parent and hopefully instill the same kind of healthy attitude to the future generations. A person can workout at school, at a public or private gym or at home.

To be smart and healthy one has to have enough sleep everyday. Sleep scientists say that we need one hour of sleep for every two we stay alert. This allows the brain to regenerate and repair itself. A student needs that to stay fresh and study more. A good night’s sleep also makes driving safe.

To be smart, a student has to study. Without studying you don’t get the grades. So how many hours should one study? That requires time management skills. We all have 168 hours in a week to use as we wish. Common sense says that more time you spend studying better your academic performance will be.

Most universities recommend that students study at least two hours outside of class for every hour spent in class, although some recommend even more.

Finally, boost your memory and brainpower with healthy food like fruits, vegetables and fish.

It is not difficult to be healthy, happy and smart. Mental and physical power depends on how much time and effort we put into it. Have fun.

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Heartburn is the Most Common Gastric and Intestinal Symptom Seen by Family Physicians

Looking for something deer? (Dr. Noorali Bharwani)
Looking for something deer? (Dr. Noorali Bharwani)

Heartburn is due to the reflux of stomach acid and food into the esophagus, the throat, or the lungs. It is the most common gastric and intestinal disorder seen by family physicians. The condition is also known as gastroesophageal reflux disease (GERD).

Occasionally, patients with gastric reflux may present with chest pain. It is not a good idea to tell a patient with a history of reflux that the chest pain is due to GERD. It is imperative that the patient should be first investigated for a heart condition. If that is normal then the patient should be investigated for GERD.

Some patients with GERD may present with symptoms of chronic cough, asthma and laryngitis. Other atypical symptoms include dyspepsia, upper abdominal pain, nausea, bloating and belching, though these are symptoms also seen in other conditions. So each patient should be evaluated carefully.

Most patients with GERD are in the age group 70 to 79 years. Lowest incidence of GERD is in the age group 20 to 29. As the person ages the frequency and duration of esophageal acid exposure, and severity of esophagitis (inflammation of the esophagus) increases.

There are many reasons why GERD symptoms get worse. Some medications and posture may aggravate the symptoms. Obesity is a major risk factor for acid damage to the esophagus. Patient should be immediately investigated with endoscopy (scope test) if there is a history of weight loss, difficult or painful swallowing or there is presence of anemia.

Endoscopic examine of the esophagus, stomach and duodenum is a good diagnostic test for patients with a history of reflux. Patients with uncomplicated reflux may not need a scope test unless the diagnosis is not clear. But patients with complicated reflux should be scoped.

Treatment of reflux is mostly medical. Start with lifestyle changes. Avoid food that gives you heartburn. Lose some weight. Weight loss has been shown to be beneficial in patients who are overweight.

Elevation of the head of the bed and avoidance of late evening meals, particularly with high fat content, has shown to be beneficial for individuals with nocturnal symptoms or sleep disturbance.

Avoidance of food triggers such as chocolate, caffeine, citrus foods, spicy foods, carbonated beverages, etc., has been shown to be beneficial only if an individual can identify a specific trigger.

If a patient presents with typical symptoms of GERD then a trial of medication is indicated. Most commonly used pills fall under the category of proton pump inhibitors (PPI). Some examples of PPI are pantoprazole (Tecta, Pantoloc), omeprazole (Losec), lansoprazole (Prevacid), rabeprazole (Pariet). There are no clear differences between PPIs in terms of symptom relief or healing of inflamed esophagus (erosive esophagitis).

For best effect, PPI should be taken 30-60 minutes before the first meal of the day. Symptoms more likely to respond to PPI therapy include upper abdominal pain, early sense of fullness and belching. Antacids have a relatively short duration of action and their use can be associated with significant side effects.

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Remember, 70 is the New 50! Happy Birthday, Friend!

Echo Dale Regional Park, Medicine Hat, Alberta. (Dr. Noorali Bharwani)
Echo Dale Regional Park, Medicine Hat, Alberta. (Dr. Noorali Bharwani)

Today is August 25th. It is my friend’s birthday. He turns 70. We have been friends for a long time. Like me he was born in a small town in Tanzania. In pursuit of education he traveled through many cities and countries. Eventually he settled in Canada.

Over the years he has learned many lessons. Lessons on how to be happy, healthy and comfortable. He learned the importance of raising a good family and having good friends. He learned the art of working hard and to be happy with his coworkers.

I rarely heard him whine and complain. His principle was to mind his own business but be helpful to people who needed help. He was always funny and courteous. He never brags about himself. In fact, he thrives on self-deprecating humor.

It sounds like he is a perfect man. Not really. His youth was far from perfect. He had his share of ups and downs. From time to time he did disappoint some people and hurt some feelings. He has many regrets. But life is never going to be perfect. His motto is to learn from the past and do better in the future.

Now that he is 70, he wonders how he can make the best of whatever time he has. Who knows what will happen once he goes underground. I don’t think he will find beautiful mermaids. If he is lucky he may find some angels. Nobody has been back from the grave to tell us what to expect down under.

For both sexes in Canada, life expectancy increased on an average from 77 in 1990 to 82 in 2012. Not everyone wants to retire at 65, and very few people want to slow down. Statistics show more than one-fifth of recently retired seniors return to work.

The 72-year lifestyle guru, Martha Stewart, has written about aging gracefully and staying healthy, feats which involve ‘maintaining a tiny waist’, among other factors. According to Stewart, 70 is nothing like the 70 of 20 or 40 years ago. She says, “70 is the new 50!”

Staying healthy goes along with working and keeping mentally and physically active. One way to stay healthy is to read a book written by yours truly and follow the advice given in “Dr. B’s Eight Steps to Wellness.” The book covers topics like healthy eating, no smoking, regular exercise, stress relief, good sleep, sexual empowerment, laughter and regular meditation. I wonder if my friend has the book!

So dear friend, turning 70 is a good time to look forward to life of some comfort and some hard work. That should not be too difficult as long as you can keep your head in the right place.

Happy birthday friend.

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