All you need to know about High Blood Pressure
Dr R. P. Sapru
BLOOD circulates in the body through a network of tube-like blood vessels. Those that carry blood from the heart to various organs in the body are called arteries while those that return the blood from the very same organs to the heart are called veins. Together, the arteries and veins, along with the heart, form a closed loop of blood vessels through which blood keeps flowing constantly. In this way blood keeps going round and round in the body.

HEALTH BULLETIN
Vacha: brain tonic
Dr R. Vatsyayan, Ayurvedacharya
VACHA is one of the most renowned herbs used for mental disorders and diseases of the nervous system. In Sanskrit vacha literally means speaking. It is a strongly aromatic, semi-aquatic perennial herb with a ginger-like stem which spreads into the ground. This rhizome part of the plant is of medicinal use.

Q&A
What’s right diet in pregnancy?
Radhika Oberoi
PREGNANCY is a time to pay special attention to the health, diet and fitness of the mother-to-be. Women who eat well suffer fewer complications like anaemia, hypertension and gestational (pregnancy-induced) diabetes mellitus. One doesn’t need to “eat for two" but to have nutritionally balanced diet to have enough of all the necessary nutrients. Most women need to add only 200-300 calories a day to the 1500-2000 calories which are normal for a non-pregnant woman.

All you need to know about High Blood Pressure
Dr R. P. Sapru

BLOOD circulates in the body through a network of tube-like blood vessels. Those that carry blood from the heart to various organs in the body are called arteries while those that return the blood from the very same organs to the heart are called veins. Together, the arteries and veins, along with the heart, form a closed loop of blood vessels through which blood keeps flowing constantly. In this way blood keeps going round and round in the body. Of course, the nutrients taken up by various organs are regularly replaced as also the cells that constitute about half of the blood, thus helping to maintain a dynamic equilibrium. Whereas blood as such does not leave the blood vessels, various components of it do exchange continuously with the organs, bringing nutrients to them and taking away waste products as well as other products that may be produced by individual organs. The latter are transported to other areas where they may be required. Thus blood keeps circulating round and round in a closed loop beginning at the heart and returning to it all the time. At the same time, there is a continuous to and fro exchange of various materials between the blood and the cells of the organs it passes through. This is nature's own transport system that helps to integrate the functions of all organs of the body. It is the most efficient delivery service, pick-up service and scavenging service for the community of organs, all rolled into one and that too at the doorstep!

In order that blood may ceaselessly circulate within the body, it requires a driving force which is generated by the pumping action of the heart. This driving force imparts pressure to the column of blood that is pumped by the heart. The pressure head ensures that blood flows downstream in keeping with the physical laws of hydrodynamics that govern the movement of all liquids in nature. The only unique feature of the biological system is that blood flow is not uniform but pulsatile. Each heart beat imparts a fresh impetus to the flow of blood which is what causes the beating of the pulse at the wrist or other parts of the body. Thus the pressure in the column of blood fluctuates with each heart beat, reaching a peak as more blood is pumped by the heart, and a nadir as the pressure drops during the period that the heart is not pumping blood into the arteries. The peak pressure is called systolic pressure whereas the pressure at the nadir is called diastolic pressure.

Blood pressure is the same in all the major arteries, which include all those that are accessible to touch from the outside. It declines progressively beyond a certain size of the blood vessels and is the lowest in the collecting vessels or the veins which bring blood back to the heart.

It should, therefore, be clear that a certain blood pressure in the arteries is essential for the normal functioning of the body. It is only when this pressure becomes excessive, high blood pressure, or very low, low blood pressure, that a certain concern arises.

Blood pressure is usually measured by one of the two ways. The most commonly used is the traditional method using a sphygmomanometer. In this a rubber cuff encased in cloth is wrapped round the upper arm. The cuff is inflated with air till the pressure in the cuff rises above the pressure in the arteries over which it is placed. This stops blood flow in these arteries. A stethoscope placed over the artery at the elbow enables the doctor to listen to the appearance of first sounds as the pressure in the cuff is slowly deflated. The pressure at which the earliest sound appears is the systolic pressure. As the cuff is slowly deflated the character of the sounds changes till the sounds disappear completely, which is the level of diastolic pressure. All pressures are measured against a mercury column and therefore expressed as mm of Hg.

In recent years new devices that measure blood pressure automatically have been introduced. Most of these use a different principle but arrive at the same result. However, the devices currently available in the market are not entirely reliable. It is advisable to get these periodically checked by an expert against the more traditional technique of sphygmomanometry mentioned above.

The second method is by accessing the blood vessel through a needle puncture and recording the blood pressure directly from inside the blood vessel. This method is used in a hospital setting where accurate and constant monitoring of blood pressure is required as after a heart surgery or in seriously sick patients in intensive care.

There are a number of everyday events that affect blood pressure such as exertion, emotion, sleep, even posture etc. As far as exertion is concerned static work, as in lifting weight or pushing or pulling heavy objects, causes a much greater rise in blood pressure as compared to dynamic work, as during walking or bicycling. Thus the blood pressure is not a fixed value in any individual; it varies through a normal day, sometimes by as much as 40 mm Hg!

The blood pressure in a new born infant is much lower than in an adult. It increases gradually to adult levels by the teens and should remain more or less constant thereafter. There is a popular misconception that, in adults, blood pressure normally increases with growing years; it does not, or rather should not. The normal blood pressure in an adult at rest, including the elderly, should be less than 130/85 mm Hg. Blood pressure beyond 140/90mm Hg is a cause for concern. During pregnancy it tends to be lower so that the upper limit of the normal during that period is lower.

High blood pressure, also known as hypertension, is a very common disease. It is estimated that around 15% of the adult population beyond the age of 30 years and 20% beyond the age of 50 have high blood pressure. It is perhaps the most common single disease of mankind. It is slightly more common amongst the urban population as compared to the rural populations. In some tribal populations it is much less common. To that extent, the disease may be considered to be a product of the complexities of modern life-styles.

It is important to recognise that high blood pressure, except in extreme instances, does not produce any symptoms. Most people are unaware of the disease and it comes to notice only when a person goes to the doctor for a check up for whatever reason, related or unrelated. Some individuals claim that they know when their blood pressure is high. But whenever this claim has been put to test, it has invariably failed. When a person feels out of sorts it is likely that the blood pressure will rise as a result of the unwell feeling itself. Measurements at such times lead one to believe that they can predict blood pressure. In actual fact the monitoring of the blood pressure of such patients has shown periods when the pressure is actually elevated even when the patient is unaware of the same and vice versa. This has led to the concept that it is the out-of-sorts feeling which pushes up the blood pressure and not the other way round. Thus it is not the high blood pressure that gave rise to the out of sorts feeling but the unwell feeling that caused the blood pressure to rise! That is not to say that high blood pressure never produces any symptoms, but that the symptoms are so vague and ill defined that it needs a doctor to tell you whether an individual's symptoms are related to the high blood pressure or not. When the rise in blood pressure is marked, as in severe hypertension, definite symptoms like headache, breathing difficulty or palpitations may occur.

In view of the fact that blood pressure varies through the 24 hours and that patients are usually unable to predict the same, it is useful to get a 24-hour recording of blood pressure by a technique called Ambulatory Monitoring of blood pressure. With this technique blood pressure is recorded periodically by an automatic device at preset intervals of 15 or 30 minutes and the results stored in a recording device. At the end of the 24 hours, the recordings are analysed on a computer and a complete pattern of blood pressure changes through the 24 hours can be discerned. This is a useful investigation, especially when the diagnosis of high blood pressure is in some doubt.

It is well known that a visit to a doctor's clinic can raise one's blood pressure! This is called "white-coat hypertension". Ambulatory monitoring helps to identify this kind of pattern for which no treatment is required. Likewise, normally blood pressure declines through some parts of the night. If this does not happen the patient is more likely to face problems in the long term and needs to be put on treatment. Ambulatory monitoring, therefore, helps to identify individuals most likely to benefit from treatment as also to monitor the adequacy of the treatment.

If high blood pressure does not produce any symptoms, one may legitimately ask as to why it should be treated! The answer is given by a number of studies from all over the world. Thousands of these studies show that elevated blood pressure is an important cause for damage to the blood vessels especially those of the kidneys, heart and brain leading to kidney failure, heart attacks and strokes. It is for this reason that high blood pressure has acquired the acronym — a "silent killer." The longer it persists, the greater is the damage done without the person being, aware of it. Further, it has been shown, without a shadow of doubt, that the adequate treatment of high blood pressure helps to reduce the risk of these complications substantially. It makes good sense, therefore, to remain on the look out for this disease and to ensure that treatment is taken well in time, for once the damage is done, benefits are much less rewarding than if the damage is prevented altogether.

The only sure way of ensuring that a rise in blood pressure is detected well in time is to have regular formal periodic check-ups at least once a year and more often if some abnormality has been detected. Besides do insist on a BP check up whenever you visit a doctor for whatever reason.

The large majority of individuals, over 95% who have high blood pressure do not have an identifiable cause for it. That is why it is called "essential hypertension." There are evolving theories as to why high blood pressure occurs but as yet we do not have a definite cause for the disease.

A small number of patients, approximately 5% or less, may have any one of several causes that can give rise to high blood pressure. Many of these are diseases of the kidneys or the blood vessels feeding the kidneys, but there is a whole list of other causes. Such "secondary hypertensions", where a definite cause may be identified, are more common in the younger patients — especially children. That is why an intense search is often made in such patients to identify the cause. Once found, it may be possible to remove the cause altogether and thereby also cure the high blood pressure as in a renal artery stenosis.

Since in the large majority of the patients a cause cannot be found, the cure of the disease is not possible. All that we can hope to achieve is a normalisation of the blood pressure with the use of drugs or other measures. The catch in this, however, is that blood pressure will remain under control only so long as the treatment is followed. The blood pressure will rise again if the treatment is stopped for whatever reason. Since high blood pressure does not produce any symptoms, or at best only vague symptoms, the patient remains unaware of the rise in blood pressure and the slow process of damage that inevitably follows.

(To be concluded)

Dr Sapru, MD, Ph.D, FAMS, FIMSA, FICA, FICC, FICP, is the Medical Director and Head of the Department of Cardiology at INSCOL, Sector 34, Chandigarh. (Phones 388883, 667897, 667876, 667903.) He is a former Head of the Department of Cardiology at the PGI.

HEALTH BULLETIN
Vacha: brain tonic
Dr R. Vatsyayan, Ayurvedacharya

VACHA is one of the most renowned herbs used for mental disorders and diseases of the nervous system. In Sanskrit vacha literally means speaking. It is a strongly aromatic, semi-aquatic perennial herb with a ginger-like stem which spreads into the ground. This rhizome part of the plant is of medicinal use.

Vacha (botanically known as Acorus calamus; Hindi — Bach) is one of the rare medicines which find mention in the Vedas. Laterday acharyas worked to find more of its benefits not only to the brain and the nervous system but also to other parts of the body. It has been described as bitter and pungent in taste and hot, sharp, dry and light in effect. It alleviates kapha and vata but aggravates pitta. Dry rhizomes of vacha contain a yellow aromatic oil which is volatile. It also has a bitter substance known as acorin.

In the ayurvedic system vacha is used as a nervine tonic and an anti-stammering drug. Experimental studies have shown that it is a potent psycho-pharmacological agent having a positive effect on the memory and the learning process. Many ancient texts have described vacha as an anti epileptic and anti-hysteric herb. It is also known to possess carminative, digestive, diuretic and mildly sedative properties.

Though as a psychotropic medicine vacha is beneficial in cases of anxiety and depression, it is best used as a nervine tonic.

Ayurvedic texts suggest that it is the premium herb to be used in cases of mental retardation, stupor, syncope and epilepsy. It is helpful in many other problems like anorexia, chronic gas trouble, hypertension, sluggishness of the liver — and also in skin diseases. As a household remedy some of the common uses of vacha are as under:

Combine in equal amounts the powders of vacha, shankhpushpi and brahmi. Half a teaspoonful of this powder mixed with one teaspoonful of honey, if taken daily, is a good adjunct in the cases of epilepsy and mental retardation. Taking with warm water, half a pinch of the vacha powder works well in the loss of appetite, flatulence, distaste, dull abdominal pain and worms. It is a herb of choice to be used in the case of loud eructations.

The powder of vacha and white sandal makes a very effective face-pack in the treatment of blemishes and pimples. In many Indian homes, customarily, vacha is administered with honey in a minute quantity to infants on the 11th and 21st days of birth. It is believed that this practice helps the child to be mentally active and vocal.

Classic ayurvedic formulations like sarswatarishta and sarswata churna contain vacha as the chief ingredient and are used for the promotion of memory and also in the treatment of many psychiatric problems. As a single drug, the dose of vacha powder is 125 mg to 500 mg. Its overdose can induce vomiting and such a situation can be managed by giving the powder of saunf with lime water. Different varieties of vacha are available in the market, but the best of them is known as ghorha bach.

Dr R. Vatsyayan is an ayurvedic consultant based at Sanjivani Ayurvedic Centre, Ludhiana: (Phones: 423500 and 431500; E-mail-sanjivni@satyam.net.in)

Q&A
What’s right diet in pregnancy?
Radhika Oberoi

PREGNANCY is a time to pay special attention to the health, diet and fitness of the mother-to-be. Women who eat well suffer fewer complications like anaemia, hypertension and gestational (pregnancy-induced) diabetes mellitus.

One doesn’t need to “eat for two" but to have nutritionally balanced diet to have enough of all the necessary nutrients. Most women need to add only 200-300 calories a day to the 1500-2000 calories which are normal for a non-pregnant woman.

Proteins form the building blocks of the new body tissue. During pregnancy an additional protein intake of 25-30 gm is recommended. Good sources of protein include lean meat, poultry, fish, cheese, eggs, beans and lentils, soya and nuts. Amongst vegetarians, a daily supplement of 2-3 cups of milk and milk products with an average one or two servings of pulses and beans should supply the daily need for protein.

Fruits and vegetables are very important for the supply of vitamins and minerals. The calcium requirement increases specifically in the last three months when most of the calcium is laid down in the bones of the developing baby. Dairy products like milk, cheese and yoghurt are rich sources of calcium.

Iron is essential for the formation of haemoglobin, which is one of the main constituents of the red blood cells and carries oxygen around the body. Good sources of iron are eggs, nuts, pulses, fortified breakfast cereals, dried fruits and green leafy vegetables.

Studies indicate that folic acid, one of the most important B-group vitamins, is especially important during the first three months of pregnancy.

Good sources of folic acid include leafy green vegetables such as spinach, broccoli, green beans and cauliflower, citrus fruits and bananas, whole wheat bread, cereals and pasta, peas and lentils, milk, yoghurt and cheese.

Foods to avoid: a) All cheese made from unpasteurised milk and certain soft ripened and blue-vein cheese due to the risk of listeria. Hard cheese and cottage cheese can be taken safely.

b) Liver and its products like pate and liver sausages.

c) Raw eggs or foods with uncooked eggs.

d) All raw meat and pre-packed, chilled and frozen foods.

e) Tea, coffee and cola drinks are to be cut down.

f) Anything too rich or spicy such as hot curry should be avoided.

Radhika Oberoi is a former dietician of the Appolo Hospital, New Delhi. (2285, Phase VIII, Mohali, Punjab)

Next week: Diet in high BP