Sunday,  November 19, 2000		Keeping fit

In this article, the writer answers certain queries raised by readers.

READERS have enquired about the role of stress and psychosocial trauma and the usefulness of tranquillisers in the treatment of hypertension. Anxiety and any psychosocial stress can result in a rise in blood pressure temporarily which would come back to normal after the causative event. This is not the basic cause of high blood pressure. Tranquillisers can be used if a positive diagnosis of anxiety has been made, but they are not the treatment if blood pressure is present independent of anxiety. It is for the physician to make the final distinction. A period of observation may be needed to differentiate between the two. One has seen long-term use of anxiolytics as a treatment of hypertension. This is obviously not correct.

In general, blood pressure requires lifelong therapy. Even when it becomes normal after treatment, it does not mean that it has been cured. The use of non-pharmacological measures as described in the article can reduce the need for drugs. The patients are, therefore, advised not to stop drugs without the advice of their physicians.

A point has been raised regarding the age when hypertension starts. There was a time when we believed that primary hypertension usually occurs after the age of 35. However, this is not true and a large number of patients are below this age. Even children are not immune of this. All of them, irrespective of age, require treatment.

A lot of questions have been raised about cholesterol.

Isabgol can be useful in lowering the cholesterol to some extent because it has natural fibre and all fibres tend to do that.

Polyunsaturated and monounsaturated fatty acids should be used roughly in equal ratio of 10 per cent of the total calories. Out of various unsaturated fats mentioned, mustard oil, which is commonly used in North India, is considered good. Fears have been expressed by various quarters that high intake of polyunsaturated acids may be responsible for cardiac deaths. There is no evidence for that and there is no need to harbour any anxiety on that account.

A reader, who has undergone bypass surgery, has asked a question whether blocked arteries can be opened up without surgery or angioplasty and how recurrence after bypass surgery can be prevented or delayed. Theoretically, blocked arteries have been shown to have been opened up without any procedure by various people who have demonstrated that a combination of strict vegetarian low-fat diet, regular yoga for at least one hour daily and exercise for 40 minutes to one hour daily can open up the blocked artery.

It is very hard to consistently adopt this kind of lifestyle and, in practice, many people have not succeeded. This is involves a change in lifestyle and is worth adopting, irrespective of final success. A lot of research has gone into the problem of recurrence of coronary artery disease after bypass. It should be remembered that the cause of the coronary artery disease is the process of blocking of arteries (atherosclerosis) and opening up of an artery by angioplasty or by bypass does not cure that process. Therefore all these measures which are used to prevent this process should be used even more vigorously. These include stopping of smoking, normalisation of weight, modest intake of alcohol, regular exercise, decreasing stress, correcting blood lipids etc.

Use of Disprin is also directed towards the same goal. In the technology of angioplasty, the use of stents have increased the life of these procedures.