HYPERTENSION
American Heart Association says, “Hypertension is a silent invisible killer that rarely causes symptoms.”
Hypertension is high blood pressure. Normal blood pressure is around 120/80. The upper number is systolic blood pressure, and the lower number is diastolic blood pressure. When it goes above 140 systolic or above 90 diastolic, it is considered hypertension.
Hypertension is a common condition and gets worse as we get older. It is estimated that 63% of those above 70 years old and 74% of those above 80 have hypertension. It is not however a disorder of only old people but can affect people of all ages. Nearly half of all adults in USA have hypertension. It accounts for 9.4 million deaths worldwide.
The causes of hypertension in the vast majority of the cases are due to aging itself and lifestyle habits. Hypertension can also be caused by diseases of other organs, such as hormonal problems related to diseases of thyroid, adrenal gland, pituitary gland, diabetes mellitus, kidney diseases or narrowing of arteries of the kidney, atherosclerosis, medication effects and genetic issues or due to unknown reasons called essential hypertension.
As we get older, the inner lining of the arteries gets stiffer, narrower and irregular with plaque buildups. The heart must pump harder to get the blood flow to the tissues leading to chain reactions that affects the heart function, manifesting initially as high blood pressure. Our lifestyle issues such as smoking, obesity, type of diet, exercise, stress, sleeplessness, amount of salt intake, infrequent medical checkups or pure negligence lead to hypertension.
In the past, one needed a doctor or nurse to check the blood pressure by using a mercury manometer, applying tight compression around the upper arm, and listening with a stethoscope over the artery at the elbow while slowly releasing the compression. Now, automatic digital manometers are available at many non-medical facilities, enabling us to check it by ourselves. Ideally, one must check the pressure in both upper extremities, sitting and lying down position, with the arm at heart level. It is a good idea to check blood pressure periodically by yourself.
Many people do not know that they have hypertension. That is because it does not cause any symptoms in early stages. As it gets worse, they may get headaches, palpitations, shortness of breath, swelling of legs, dizziness, or general weakness. Furthermore, it causes heart failure/attacks, irregular heartbeats, stroke, kidney failure, gangrene of legs, retinopathy and various organ failures. Extreme hypertension called malignant hypertension causes coma and death. Hypertension is the most common underlying cause for heart attacks and strokes.
Routine medical checkups are important in diagnosing and managing hypertension. Blood tests are conducted to identify diabetes mellitus, heart failure, kidney failure, thyroid disorders and other hormone problems. Neurological evaluations for potential for stroke and other cognitive disorders are done. Cholesterol and lipid levels and urine tests are conducted too. Heart function is further evaluated with EKG, and echo cardiogram. Some others may need further tests such as CAT scan, MRI or angiograms.
Hypertension must be treated and controlled. Initial treatment for mild hypertension is by modifying lifestyle habits. Diet and exercise are two important items. One should reduce salt in the food. Table salt is to be kept out of sight. Many of the snacks like potato chips and salted nuts are to be curtailed. Avoid red meat. Plant-based diet with whole grain foods, fruits, legumes, beans and vegetables of all color are better. Minimize intake of ultra-processed food and trans fats. Exercising for at least 30 minutes on a regular basis should be a daily routine. Avoid smoking and alcohol and maintain proper body weight. Sleep apnea and insomnia should be treated. Excessive use of non-steroidal anti-inflammatory drugs such as ibuprofen is avoided. Stress reduction strategies such as yoga, meditation and family counseling are useful.
Medical treatment is necessary for people with moderate hypertension. Wide range of antihypertensive medications are available. They are generally grouped as diuretics, ACE inhibitors, calcium channel blockers, ARBs, Alpha 1 blockers, beta blockers and dihydropyridines. It is best to consult your doctor for proper choice of medication. Combination of drugs are used at times for best result. Make sure that you are aware of any side effects, dosages and follow-up protocols. Certain individuals may need to take anti-lipid drugs to lower cholesterol levels. Some others may need surgery to correct overactive thyroid gland or adrenal gland. Interventional radiologist can widen narrowed renal arteries.
Modern approach to treatment of hypertension is targeted personalized management taking into consideration the individual’s environment, risk factors, lifestyles along with individualized pharmacological therapy, instead of one size fits all medications. Telemedicine and home monitoring are part of ongoing control.
Certain patients are likely to require rapid reduction of blood pressure because of high blood pressure or certain medical or surgical situations. In these instances, patient is admitted to ICU, carefully monitored and given medications intravenously.
Some other patients have resistant hypertension, where the blood pressure remains high despite proper medications and treatment. These patients need thorough evaluation of underlying reasons for the hypertension and correction of such problems, re-evaluation of their medication protocols, and control of lifestyle habits. Patients must understand the seriousness of the problem and change their diet, reduce salt intake, exercise regularly, sleep well and stop smoking and drinking.
To quote American Heart association again, “Managing high blood pressure is not just about reducing certain numbers; it is about reducing risk factors. This is a lifelong disease. You can manage it with lifestyle changes, medications and regular checkups with your doctor.”
Dr. Venkit S. Iyer, MD, FACS, is a retired general and vascular surgeon. He has authored six books: “Decision making in clinical surgery” first and second editions; “Aging well and reaching beyond,” “The Clinic,” “Geriatrics Handbook” and “Iyer’s story book for children.” They are available through Amazon or from the author. His website venkitiyer.com has necessary links and contact information.
EYE CARE
Focus on Eye Health and Vision Care in August
As the summer heat peaks in August, it’s essential to consider how the season impacts our eye health. Many of us spend more time outdoors, soaking up the sun, which brings both benefits and risks for our vision. This month is an ideal time to focus on eye care, emphasizing preventive measures and awareness of common eye conditions.
Sun Protection for Eyes
One of the most significant concerns during August is exposure to ultraviolet (UV) rays. Just as our skin needs protection from the sun, our eyes do too. Prolonged exposure to UV rays can lead to cataracts, macular degeneration and even cancer of the eyelids. Wearing sunglasses that block 100 percent of UVA and UVB rays is crucial. It’s also beneficial to wear a wide-brimmed hat for additional protection.
Hydration and Eye Health
Hydration is another key factor in maintaining eye health. Dehydration can cause dry eyes, which leads to discomfort and blurred vision. Drinking plenty of water and using artificial tears, if necessary, can help keep your eyes moist and comfortable. Humidifiers can also be beneficial in maintaining optimal moisture levels in the air, especially in air-conditioned environments.
Allergy Management
August is also a time when allergies can flare up, causing itchy, red and watery eyes. Pollen, dust and other allergens are prevalent, making it important to manage allergy symptoms effectively. Over-the-counter antihistamine eye drops can provide relief, but if symptoms persist, consulting an eye care professional is advisable to prevent further irritation or infection.
Eye Exams and Check-Ups
Routine eye exams are essential, and August is an excellent time to schedule them. Regular check-ups can detect early signs of eye conditions such as glaucoma, diabetic retinopathy and age-related macular degeneration. Early detection and treatment are crucial in preventing vision loss and maintaining eye health.
Digital Eye Strain
With the rise in remote work and virtual learning, many people experience digital eye strain from prolonged screen time. August is a good month to reassess screen habits. The 20-20-20 rule is a helpful guideline: every 20 minutes, take a 20-second break and look at something 20 feet away. Adjusting screen brightness, using anti-glare screens and maintaining an appropriate distance from the screen can also help reduce eye strain.
Nutrition for Eye Health
Nutrition plays a vital role in eye health. Foods rich in vitamins C and E, zinc, lutein and Omega-3 fatty acids can help maintain good vision and prevent age-related eye conditions. August is a great time to incorporate more leafy greens, fish, nuts and citrus fruits into your diet, ensuring your eyes get the nutrients they need.
Eye Safety in Activities
August often means more outdoor activities, from swimming to sports. Protecting your eyes during these activities is crucial. Wearing goggles while swimming can prevent eye infections caused by bacteria and chemicals in the water. For sports, wearing protective eyewear can foil injuries, which are a leading cause of vision loss in children and adults.
Children’s Eye Health
With back-to-school season approaching, August is a perfect time to focus on children’s eye health. Ensuring kids have proper vision is essential for their learning and development. Scheduling comprehensive eye exams before the school year begins can identify any vision problems that might affect academic performance.
Raising Awareness
Lastly, August is a great month to raise awareness about eye health within your community. Whether through social media, community events or educational workshops, spreading information about the importance of eye care can have a significant impact. Encouraging friends and family to prioritize their eye health helps foster a culture of proactive care, leading to healthier, happier lives.