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.

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

New year is a good time to control the silent killer.

Sunrise at Haleakala Volcano summit in Maui, Hawaii. (Dr. Noorali Bharwani)
Sunrise at Haleakala Volcano summit in Maui, Hawaii. (Dr. Noorali Bharwani)

In the new year, you can wish for many things and make many resolutions. But don’t forget to take care of the silent killer – your blood pressure.

The lifetime risk for developing hypertension (high blood pressure) among adults aged 55 to 65 years is 90 per cent. Our New Year’s resolution should be to keep our blood pressure under control.

More about that later. First, I have a question for you: when is the best time to take your blood pressure pill?

Currently, there are no guidelines on when to take your blood pressure pills – is it better to take it in the morning or at bedtime?

The answer is in an article recently published in the British Medical Journal (BMJ 23 October 2019) titled “Taking antihypertensives at bedtime nearly halves cardiovascular deaths when compared with morning dosing.”

A study of nearly 20,000 hypertensive patients in primary care has shown taking pills for high blood pressure at bedtime is associated with improved blood pressure controls. Besides, the risk of dying from cardiovascular causes is reduced by half when compared with morning dosing.

The Hygia Chronotherapy Trial randomly assigned 19,084 hypertensive patients (median age 60.5 years) to take their entire daily dose of one or more antihypertensives at bedtime or on waking in the morning. The patients were followed up with ambulatory blood pressure monitoring, for a median follow-up period of 6.3 years.

The results show these patients have better controlled blood pressure and, most importantly, a significantly decreased risk of death or illness from heart and blood vessel problems.

The researchers found there was enough evidence from this study to recommend patients consider taking their blood pressure medication at bedtime.

It should be noted that this recommendation does not apply to medicines that need to be taken more than once a day or to blood pressure medicines that are prescribed for other problems, such as angina or heart failure.

Do not change your medication schedule without consult your doctor.

What is considered to be high blood pressure?

Blood pressure that is consistently more than 140/90 mmHg is considered high, but if you have diabetes or chronic kidney disease, 130/80 mmHg is high, says Health Canada website.

High blood pressure significantly increases risk for stroke, ischemic heart disease, peripheral vascular disease and heart failure.

Some facts about high blood pressure (hypertension):

  1. Hypertension affects more than one in five people.
  2. Approximately 17 per cent of individuals with hypertension are not aware of their condition, the true prevalence of hypertension is likely higher.
  3. Hypertension is the most common reason to visit a doctor.
  4. Hypertension is the number one reason for taking medication.
  5. The lifetime risk for developing hypertension among adults aged 55 to 65 years with normal blood pressure is 90 per cent.
  6. It is estimated that almost 30 per cent of hypertension can be attributed to excess dietary sodium. Reduction in daily sodium intake to recommended levels could result in one million fewer Canadians with hypertension.
  7. Smoking, being overweight or obese, lack of physical activity, too much salt, stress, genetics and family history can induce hypertension.

That is it for this year. Let me wish you all Merry Christmas, Season’s Greetings, Happy Healthy Safe and Sober New Year! Remember what Earl Wilson (American Athlete) said, “One way to get high blood pressure is to go mountain climbing over molehills.” Talk to you next year.

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

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.

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

A Pinch of Salt – The Rest of the Story

An overweight man getting his blood pressure checked. (Digital Vision/Thinkstock)
An overweight man getting his blood pressure checked. (Digital Vision/Thinkstock)

In my column last week, I discussed the adverse effects of dietary salt on your health. The conclusion was that if you want to stay healthy and have your blood pressure under control then you need to eat less than one teaspoon table salt a day.

After that, a reader sent me a link to a Scientific American article, “It’s Time to End the War on Salt,” written by Melinda Wenner Moyer.

Moyer says, “The zealous drive by politicians to limit our salt intake has little basis in science.”

Moyer’s argument is based on a meta-analysis of seven studies involving a total of 6,250 subjects in the American Journal of Hypertension found no strong evidence that cutting salt intake reduces the risk for heart attacks, strokes or death in people with normal or high blood pressure.

Moyer goes on to quote several more studies from all over the world. She goes on to say, “These findings call into question the common wisdom that excess salt is bad for you, but the evidence linking salt to heart disease has always been tenuous.” She concludes the article by saying there is little evidence for long-term benefit from reducing salt intake.

Point well taken. However, there is evidence that shows too much or too little salt in the diet can lead to muscle cramps, dizziness, or electrolyte disturbance, which can cause neurological problems or death. Generally, more emphasis is given to the evidence showing an association between salt intake and blood pressure among adults. We also know reduced salt intake results in a small reduction in blood pressure. Evidence suggests that high salt intake causes enlargement of the heart and swelling of the legs. The evidence may be tenuous but it is there.

Like many things in science and particularly in medicine, strong evidence is lacking in many of the things doctors advise their patients about good health. Some advice is based on “tenuous” evidence as there is nothing better to suggest. When we have strong evidence that certain habits can lead to bad health and even cancer (e.g. smoking, sun worshipping) generally people ignore the advice.

The story of salt intake is a just a small pinch in the overall story of healthy eating and exercise in maintaining good cardiovascular system and good health. The message is, eat in moderation, it is not what you do and eat, it is how much you do and eat to stay healthy and happy.

Less salt won’t hurt you. Too much salt is not good for you.

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