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, 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.

Alternative medicine

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

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 are seen in practice?

1. High systolic and normal diastolic – vata-pitta imbalance

2. Normal systolic and high diastolic – vata-kapha 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.

Is there a cure for hypertension?

There are several Ayurveda medicines indicated in hypertension. However, treatment varies according to the dosha involvement. 180/110 is a reading Ayurveda can treat; above that level, a complementary approach is more useful. Diuretics are useful in vata-pitta and vata-pitta-kapha hypertension; cholesterol-lowering medicines and home remedies like garlic are useful in the vata-kapha type of hypertension.
There are several herbs as well as Ayurvedic preparations that are helpful in treating hypertension. Treatments like Sirodhara, abhyangam help in high systolic cases.

What can we do to prevent hypertension?

The right food, good sleep and proper exercise are key. Also, follow your biological clock with regard to your daily routines.

At what stage should we see a doctor?

Consult a doctor if your systolic pressure is above 140mmHg or diastolic pressure is above 90mmHg. That said, a reading of 140/90, for instance, may not mean the patient needs to start medication. A personalised evaluation is required.

We’ve come across hypertension cases caused by several underlying conditions; this is called secondary hypertension. Sleep issues, kidney problems, thyroid problems and medications are common causes. There have been several cases of hypertension (both primary and secondary) where BP is controlled with continued use of Ayurveda herbs. I remember the case of a young healthy adult who was found hypertensive without any obvious underlying cause. Eventually, we found that he was taking lozenges and cough syrup. Once he stopped, his BP showed remarkable improvement.

We also see the ‘white coat effect’ influencing some patients’ blood pressure. If they are very anxious the systolic blood pressure can rise by as much as 30mmHg.

True or false?

Dr Adam Mather busts myths about hypertension…

Hypertension is genetic. If somebody in your family has it, you’re bound to get it and there’s nothing you can do about it.

True and false! Yes, there is a genetic component to hypertension, but just because somebody in your family has it, does not mean you will inevitably suffer from hypertension. Also, it definitely does not mean that you cannot prevent it with appropriate lifestyle modifications.

The causes of hypertension are different in women.

False. In general, the causes of hypertension are the same for both women and men, although the prevalence of each cause may vary between the sexes. 
aving said that, there are certain causes that may relate to female reproductive organs, such as the association between polycystic ovarian syndrome and hypertension. But this is relatively rare.

The lower the blood pressure, the healthier the person.

True, in general. The risk associated with increasing blood pressure is continuous. With every 2 mmHg rise in systolic blood pressure, the risk of mortality from heart disease increases by 7 per cent and the risk of mortality from stroke increases by 10 per cent.

High blood pressure among the elderly is nothing to be worried about.

False. While it is true that blood pressure increases with age and that we accept higher ‘normal’ ranges of blood pressure in patients over the age of 80 years, higher than normal blood pressure is always a concern.

There is no cure for hypertension.

True, at least at present.

How big a role do dietary habits and lifestyle factors play?

According to Ayurveda, diet and lifestyle play a major role in maintaining a balanced blood pressure.

■ Eating healthy in Ayurveda means eating according to one’s body type and digestion. What’s best for one might not
be so for another.

■ Reduce intake of salt and drink plenty of water and fluids.

■ Maintain weight according to the body type. A kapha body type tends to have a higher BMI, while a vata type tends have a lower BMI by nature.

■ Be physically active; but don’t overdo it. Exercise in the daytime and rest after sunset.

■ Avoid unhealthy choices like smoking.

■ Be happy and contented.

■ In general, diet and exercise, particularly yoga and pranayama, are the best ways to lower high blood pressure. Eat fruits, vegetables, whole grains and low-fat dairy foods. Eat less saturated fat and total fat. Consider supplements like cod liver oil, calcium, garlic, cocoa. If the patient is overweight, losing even 2-3kg can lower his/her blood pressure. Do physical activity for at least 30 minutes a day.