The Writer: Dr. Kabi Prasad Misra has more than 35 years of experience in Medicine and Cardiology in various hospitals in India and USA. Currently he is a senior cardiologist at the corporate Apollo Hospitals in Chennai, India. He has been conferred with a D.Sc. by AvinashiLingam University of Tamil Nadu and also with FRCP Fellow of the Royal College of Physicians&Surgeons of Glasgow,UK. Beyond Cardiology and Medicine, Dr. Misra writes on Jagannath Culture, humanism, humor, art, culture and philosophy. He has received “Bharat Gaurav” among other awards.

.......................................................................HYPERTENSION – MYTHS AND FACTS

Franklin D Roosevelt had a medical check up towards the end of his fourth term as President of USA in 1945 when his BP was found to be 300/190 mm Hg (normal:130-140/80-90 mm Hg). His BP had been slowly but steadily rising over the previous years, but he was declared fit each time until the fateful day of 12 April 1945 when he died of cerebral hemorrhage (bleeding into the brain), one of the common complications of uncontrolled hypertension (high BP). In those days high blood pressure for elderly people was considered ‘essential’. Even now many textbooks of medicine describe hypertension wrongly as ‘essential hypertension’; there is nothing essential about it. In fact high BP at any age is harmful. Hypertension is called the “biggest silent killer” of mankind as it kills silently but slowly and surely. Silently because 90% of high BP patients have no symptoms. However it is unfortunate that there are many wrong ideas and myths surrounding high BP among our patients and some doctors, which complicate the management of hypertension. It is important that we point out the facts against the myths about this common disease, which is going to have the highest incidence in India among all countries in the world by 2020. The article highlights briefly the myths and facts about the disease. 1. Myth – If there is high BP there should be some symptoms like headache, giddiness etc. If there is no obesity and one is a non-smoker and vegetarian high BP cannot occur. Fact – As mentioned earlier 90% of high BP patients do not have any symptoms. It is usually discovered accidentally in a routine check up or before any operation or procedure. The patient cannot feel high blood pressure, like the driver of a vehicle cannot estimate the tyre pressure. There is no single cause for high BP as it is the result of many factors including heredity, age, obesity, stressful life, disease of kidney or endocrine organs etc. This is called the mosaic theory of hypertension and doctors nowadays call essential hypertension as primary or idiopathic (meaning cause is unknown). 2. Myth – If there are no symptoms one should not take medicines. Fact – Not correct. Even if there are no symptoms one has to take treatment as the complications over a period of time (a few years) are very serious, e.g. stroke (paralysis), heart attack, retinopathy (leading to blindness), nephropathy (leading to kidney failure). 3. Myth – When the blood pressure becomes normal with medications one can stop the medications. Fact – This is not true. Stopping the medications may lead to rise in the blood pressure again. This will lead to fluctuations in the blood pressure, which is far more injurious to health than sustained high BP. It is important to maintain normal blood pressure with the use of medications on a regular basis as the disease is usually life long. High BP like diabetes “can be controlled but not cured”. 4. Myth – Once medicines are started for high BP one becomes addicted and has to take it lifetime. Fact – Only 20-30% of high BP patients (especially mild ones) can be controlled or even “cured” with life style modification only (especially quitting smoking, reducing salt in the diet, reducing body weight, regular exercise, and also by relaxation methods like yoga, meditation, pranayama etc.) The rest of high BP patients require medicines for the whole life, not because the medicines are addictive but they are required for keeping the BP under optimal control. No BP medicine is addictive, as there is no psychological dependence on these drugs. 5. Myth – If one follows life style modification medicines are not required. Fact – Not so. Only minority of patients can be controlled with life style modification alone. Most of the moderate and severe high BP patients will require life style modification as well as medicines to keep BP under control. 6. Myth– In the long run BP medicines are expensive and therefore it is not possible to take such expensive treatment lifelong. Fact – Not all BP medicines are expensive. There are a variety of BP medicines, some of which are relatively inexpensive. The doctor decides on the patient’s total assessment, which medicines are to be taken. At any rate the complications and the consequences of sustained high BP are so serious that one has to prevent them as much as possible. Otherwise lifelong disability and morbidity will occur which may be more expensive than the treatment of BP. 7. Myth – At old age high BP is usually normal and should not be treated. Fact – Not correct at all. It has been found out by studies that even in old age high BP, especially the upper reading (systolic) is as harmful or even more so than high BP in the young. Many well conducted studies found out that uncontrolled high BP at old age gives as much or more complications (because of old age) than in the young. In the interest of the public and medical profession all the above facts against the myths have to be understood in the proper perspective. We need to be very careful in understanding and managing high BP as India is going to be one of the worst affected countries in terms of heart attack, high BP and diabetes – the three major enemies of the Indians in the near future.