 Good morning all friends. I'll be speaking to you about healthy heart or you know lifestyle management to prevent the heart disease. So I'll keep it simple without much of a charts and the data and this is a lecture about you know baseline and indicative of how we should go ahead for individual person, individual you know assessment and treatments or the prevention methods are applied. So you know the heart disease, common heart disease we will be speaking that you know coronary artery disease means you know the supply of the heart has got three blood supplies in which if there is a block then we call it a coronary artery disease and blocking and by a blockage of it it causes you know heart attack or angina heart pain and we need to improve that situation that we call as treatment of the coronary artery disease. So we I'll just show you a few things about how do we treat mechanically and then go ahead with telling that how these things develop or what are the risk factor for it and how we can you know reduce those risk factors and buy healthy lifestyle or properly following the directions of a doctor. So this photo shows that on the top most left they chose the blood supply when you cut open then you see the blood flow is going very well and then in the left lower panel left side you see cholesterol, fat is depositing and the blood cells are depositing and it becomes a fatty block you know the fat deposition along with the cells and that right lower most show there is a blood clot in between. So the disease starts with a fat deposition and cell deposition and reduces the lumen of the tube that is blood supply and slowly when the tube lumen is less then you get any exertion you get chest pain which we call as angina and when there is a blood clot then sudden happens you can get a heart attack and slowly happens you can get it you know again worsening of angina. So this is what the pathology again this is a moving diagram or moving picture shows that the black area is showing that there is a blood supply block there is a cholesterol fat yellow block on top of that suddenly the blood clot forms and then there is a heart attack you can see the black area expanding this area is getting damaged so sudden blockage of a supply leads to heart attack. So if you see coronary artery disease or the in common language the heart disease is a major health challenge in India we are already diabetic capital of India and hypertension and coronary artery disease also makes some in our country. It's lot of it is related to changes in lifestyle economic development apart from genetic factors decline in the west or stagnant in the west due to aggressive modification of lifestyle by entire population as well as they have you know done the you know formalization of health checkup at a periodic level so you cannot escape then you can detect the things much better. In India roughly you can say it's doubled in last 20 years and projected to increase more and more and there are no major data here in the sense that you know we don't have a nationwide data but you know few studies give you some such idea urban is you know more prevalence of this disease and rural is lesser although rural area also catching up there is no difference in north and south much it's based on the study only what's uniform all across India if you see the impressions of the doctor. For the coronary artery disease what we have the heart disease we as in you know South Asian people have a four times more risk than a white Americans of Caucasians six times more than Chinese and 20 times more risk than Japanese so as an ethnic group or a race we genetically are more prone for that and there are a lot of theories about it one is thriftogen theory where is because we had a lot of feminine and pestilence time so there will be a period of where it will be feminine and there will be a period where you'll have good food available so our body has developed genetic structure like that during time of good food availability the food the in forms of calorie and fat will be stored around the stomach and inside abdomen and during time of feminine it will be utilized but when we have round the clock around the availability of food in modern times and high calorie food this same genetic mechanism becomes deadly for us so Indians run the highest risk for heart attacks and especially the problem is we have more risk of heart disease in younger age group in 30s and 40s and the reason is that the thing is that the risk factors what are good for you know the genetic theory theory I spoke about that that comes into picture early in life and the risk factors the traditional risk factor which used to develop after 50s and 60s we are seeing them in younger population along with that this is in 30s and 40s are one of the most productive years of a person where maturity and you know is there plus you know working ability is there so our younger population is suffering more and this is one way of finding out the exactly there are so many ways to find out the exact coronary artery disease coronary angiogram is the most common one most of us know so I won't be dealing with in detail this is how we find out when there is a block be treated by angioplasty or a bypass if it is required otherwise medicines are the common treatment so in angioplasty we would put a wire and on top of that we put a balloon and open and displace and fracture the cholesterol block followed by to prevent it from collapsing you put a spring and then we give that is known as 10 we give good medicines to reduce the we blockages bypass surgery is a different option it is a surgical option where we put a small tubes taken from the body itself veins and arteries and bypass the graft so pre symptoms of a heart attack just to I showed you the treatment the disease now we just get an idea about you know many time people who are coming with heart attack many of them will show some science and symptoms in within last 24 hours up to 4 weeks so if they are you know assessed properly or understood by the patient or by the general public because of the education or the referring doctor who refers to the tertiary care then we can reduce the chances of heart attack worsening or coming up before major heart attack happens in small minor attack situation and stable angina situation only we can detect it and because you know sudden cardiac death is the worst manifestation of heart attack and many time people don't get the time to reach hospital that's one of the major reason we should you know diagnose the heart disease earlier reduce sudden death and reduce damage to the heart also so heart attack prevention or healthy heart is a myth or a reality as usual the truth is somewhere in between it's neither a myth but it's more close to reality where you can reduce the incidence and prevalence and severity of heart attack and heart disease you may not be able to prevent it all together so let's see what are the things which are causing the heart attack most of you will know what I'm talking about because in the newspaper, magazines, TV, it comes you I'll just present doctor's perspective on that as a cardiologist perspective so there are risk factors for heart attack your heart disease it falls into two categories one is non-modifiable and one is modifiable non-modifiable means you cannot change it like age sex families you cannot change it your age the sex you cannot change in a broader sense family history if you have severe family history of heart disease early you will not be able to change it there are modified risk factor which is a bad cholesterol and triglycerides if they are high smoking or tobacco in any form diabetes whether mild or severe same only long-standing diabetes has got more trouble high blood pressure obesity and lifestyle which is a stressful lifestyle these are common risk factors which we deal with that which we can prevent from causing its worsening so the lipid or cholesterol abnormality you don't need to remember all these things but what do you say when you do a check up you should make sure that your cholesterol by the either treatment of prevention remains in proper range just taking medicine and having a precaution is not good enough your values also should come down because these values are silent values they won't cause any symptom they will cause the disease and disease will cause a symptom so total cholesterol more than 200 not good LDL is a bad cholesterol if it is high otherwise it is required in the body more than 100 for most of the heart patient or there is high risk heart patient should not be more than 100 HDL good cholesterol less than 45 in general for it is not good and triglycerides more than 150 so you see that it's very well you know documented that what should be done now there is one lipoprotein A that is the one type of cholesterol this is genetically determined by birth and because of that your diet and all has got no change no effect on that and lipoprotein A more than 30 milligram percent increases the risk of heart disease by three times even if your other activities or other parameters are normal and if total cholesterol is high means normal cholesterol is also high than it 14 times it's a multiplicative risk you cannot change it and you can only you know there are few medicines which can reduce it but they are not the first line of medicine to treat that so you have if you have this is also high then it makes more sense to control your other factors so tobacco in any form especially smoking you know it accelerate heart disease by decreasing the good cholesterol that is HDL increasing the bad cholesterol that is LDL and triglycerides it increases blood pressure like people who smoke and come or take tobacco come you will invariably find BP sites well known that it promotes significant clot formation in the blood system because it causes the vascular the blood supply lining damage and it and reduces the response to hypertension medication you know BP medication if you take any keep on smoking the medicine effect also comes down this is apart from causing damage to the lungs and in smoking either you are a smoker or non-smoker there is nothing as such that you know less smoker more smoker it's a smoking years you should see and less smoker more smoker more comes out with a you know lung damage how much is it can cause so diabetes is bad in the sense that it chews up the whole body from top to bottom brain eyes heart kidneys legs apply it causes everything in the body apart from and you know you can say what not it causes so it causes increase cholesterol deposition in the blood supply lining even if your cholesterol is not very high because it makes it very sticky it's a general term I'm telling it also increases clotting in the body and the vascular supply and it causes increased hypertension by affecting kidneys also so it affects the cholesterol it affects the blood supply it affects blood pressure it affects the clotting or you know blood thinning in the body so now if you if you see the sorry if you see in smoking passive smoking is also hazardous and vaping that you know non-tobacco smoke is also not good it's bad for lungs and it still can cause heart trouble so whenever a person is not a smoker we pay attention that a patient is a passive smoker because that is at least 50% of the risk you inherit of a smoker because you are in between the smokes. Hypertension is a usually is a combination of genetic and lifestyle so if your parents are hypertensive your higher chance of being hypertensive despite of the best of the prevention but lifestyle is also equally important because you know overweight smoking excess salt intake these things will cause high bb and a combination of you have risk factor like high blood pressure and cholesterol it multiplies the risk it doesn't like 2 plus 2 doesn't become 4 it becomes 22. Obesity let's see its simplest thing is more than 20% of over ideal body weight is obesity. Obesity it increases bad cholesterol decreases good cholesterol it causes high blood pressure because weight increases blood pressure increases it causes increased glucose levels impaired glucose tolerance and finally leads to clear cut high sugar levels and central obesity is much more dangerous that is you know obesity around the waist and it is measured by waist hip ratio which in Asians is much better indicator than bmi so waist is ratio is more important body mass index is another major to think to measure the obesity it's not truly indicator because even muscular patients can have high bmi and ideal keeps on changing in you know 20 to 25 was the earlier definition it keeps on changing to you know 18.5 to 24.9 but above 25 standard your overweight obesity above 30 and above 40 extreme obesity there are formulae to calculate it there are apps you can calculate your body mass index so now if you go for the you know how to prevent your risk factors are developing or how to reduce your risk factors from creating trouble become going out of control so lifestyle is the last thing we see and then we'll go on that so lifestyles it doesn't cause the disease on its own but it increases chance of having disease if you are already having risk factors so stress at work increases the blood pressure mental stress leads to more bad hormone production and causes you know stress on the heart and it can precipitate unstable situations like you know angina rhythm disturbances and stroke and heart attack so alcohol another this thing alcohol is another risk factor if it is not in moderation mild alcohol use is safe but heavy drinking frequent drinking can cause increase in hypertension impaired clotting ability leading ability of the body and it can cause fatty liver and it can lead to you know trouble so in moderation it's fine so risk factor modification let's see quickly smoking or tobacco in any form is absolute no no you should cause stop complete sedition there is no half smoker or half tobacco use this is a you know misconception that if you reduce your smoking the risk comes on no if you completely stop smoking or tobacco it takes two to three years to reduce the risk to a level of non-smoker provided you already have not developed heart disease which may be silent or not silent blood pressure simplest is below 140 90 preferably keep below 130 80 because simply taking the medication is of no use you need to keep on checking it so that your medicines are working to bring it down below the target so most now the most of the patients it's easy to have a home vp instrument which is in electronic which is very simple it gives a good value and it gives a correct value in most of the situation you should need not worry about that over to obesity you should maintain ideal body weight or within plus minus 5 kg of that this is what is the required everybody cannot maintain ideal body weight so let's see how do we do these things cholesterol is not always drugs you know drugs come into picture when diet and exercise fail in some situation like acute heart attack and all we need to keep the cholesterol level artificially low so that's why we reduce the this thing by medicine only because the only by diet and exercise you cannot reduce to a very low levels so all three are important just because you are taking the diet for the cholesterol medicine sorry medicine for the cholesterol doesn't mean you can stop diet and exercise that should not happen so now we go to just simply guideline for exercise exercise means people think oh some great thing no any form of activity is an exercise the simplest one is walking a brisk walking people can jog they can cycle they can do aerobic activity by seeing youtube videos which are for 15-20 minutes is more than enough if you do high intensity interval training to do medium intensity 30 minutes is fine so it should have five to seven sessions per week five is ideal total 150 minute per week of moderate intensity activity is good enough if you are doing a heavy activity like you know HIIT and then running in very heavy sports single like tennis then 75 minutes per week is also enough duration average if you divide it it comes 20 to 30 minutes per session but if you don't have time people have complained that I don't have time 30 minutes so you can do 10 10 minutes of three session in a day if if you don't get time at one point of time you know in one session or 15 minutes of two sessions in a day whenever you get time now what how do you know now that nowadays you know you have lot of apps which guide you there are a lot of youtube videos if you don't have apps but if you don't have anything and you just want to know what should be your target level so usually 70 to 80 percent of target heart rate you should have when you are exercising and you can just check by pulse also you don't need a smartwatch and all so how do you calculate your target heart rate it is 80 85 percent of maximum heart rate for your age so if you use you reduce your or subtract your age from 220 that comes you know maximum heart rate 85 percent of that is that your target so is very simple if you have if you are confused you should make if you are not very old and frail then around 120 to 130 is a very good option for most of us or 140 to 150 is very reasonable option for us now what is the like I chose three sessions training each also now weight training also should be done intermittently because only aerobic exercise with will not strengthen your muscles that much and muscles are very good fat and sugar burner so they act like insulin so if you do weight training your muscles come into picture and then you burn more glucose and fat and also you don't get injury because unless you do muscle and weight training you will get a lot of injury if you are doing only aerobic activity so twice a week average or twice a week you should do unless you are a professional trainer and you should do rotate all muscles and joint groups like one day you are doing upper upper limb or you know hand and chest then other time you should do legs then third time you should do back and abdomen it's like that you know body upper middle and lower and if you want to repeat exercise for any the part like upper body you want to repeat so wait for at least 48 hours simple now what happens that if you are walking brisk walking you don't want to do a fast jogging or any other activity so how do you decide you are walking briskly not very slowly because whenever we walk after some time you will come back to comfortable position without knowing it you know your speed will automatically come down so keep it up the definition of brisk walking is that when you walk brisk or do any activity briskly you should be aware that your breathing is become much faster but higher so you should be aware that now you are breathing more than normal but you should not be you know you should be able to complete a simple sentence like hello how do you how are you without any breathlessness if you are not able to complete a single simple sentence because of breathlessness it means you are doing very heavy activity you can do it but you know that this is going beyond control so this this is the definition of a mild to moderate aerobic activity and whenever you use a weight to lift like an amateur if you are not don't have trainer like dumbbells on other things so if you do any group exercise or any muscle group exercise usually between 8 to 12 repetitions you should be able to do without any difficulty when you do first time if you are not able to do even 8 repetition first time and you try with that weight it means too heavy and if you are able to do more than 15 repetition very easily without getting any trouble it means pretty low for you so you should be able to do 8 to 12 repetition in the beginning with the weight whenever you use a weight in the beginning or you change a weight and then you can go on and you do three sets overall for each muscle group this is a very simple one without any trainer you can do that so now when other rule of exercise is always warm up and cool down so in 30 minutes exercise in 5 minutes you take to warm up and then 5 minutes you take to cool down and 20 minutes is the medium intensity you can do avoid extremes of heat and cold like a lot of people have this notion if I don't sweat very heavy it means I have not done very good exercise no the sweating is a mechanism to cool down your body if you are perspiring very heavy and you because you think sweat is good and you are not using a fan if you are using at home or in the gym there is not proper ventilation it means your body is not maintaining its you know cold and heat balance properly so you should have either fan or you should not have excess sweating without any reason you know you should have a proper sweating that's what you should train regularly avoid excessive peaks you know you can't compensate by doing only weekend exercises for the whole it will cause it will not give that much benefit it will lead to more injuries and there are sayings that you know no no gain without pain no the pains are not good for joint and for the muscles it means you know there is something wrong is gone so you have to report all symptoms to your doctor if you have muscle pain because muscle injury can be very nasty then last thing which people forget is that stretching you know you do exercise but you don't stretch before and after stretch exercise you should do all muscle activity this group stretching there are good videos video video for two minutes and five minutes you can do that without stretching you will have more injuries and less benefit diet this is an ending topic and diet is each time things apart from the basics there are a lot of concepts keep on coming a lot of information keep on coming so I'll be talking about general thing for the specific thing people should always take the health profit dietitian you know just don't eat this don't eat that will never work properly for most of the patients you know if you want a target of the proper weight proper your blood parameters for sugar and cholesterol you will need an opinion of a dietitian at least once so that you understand what's going on so we all know that plenty of fiber rich foods whole grain vegetables are good lot of salads and seasonal fruits are important you should not take fancy foods seasonal fruits are more than enough the oil we should use one table spoon for oil for per day for each person is good enough but if you want seasoning you can use little bit of oil tea coffee you should keep in moderation if you want to take more you should you can use unsweetened fruit juices in limited quantity because they are also not you know free of calories the now if for non-veg there are so many instructions and advices but I'll keep it to the very simple usually if you take chicken lean portions are good and the skin less egg white is very good except we have you know when your proteins are restricted like kidney disease but egg whites you can take whatever how many quantity you want if you want full full egg most of the heart patient can take whole eggs per week I mean this is rough indicative about old American studies but we also can take it those who are not having cholesterol or healthy people they can take one whole egg per day that's not a problem fish usually for healthy eating twice or twice a week is good enough ideally not fried in oil but if you want to fry it it's less is much better and as far as oils are concerned always common query no oil single oil is complete you should rotate two or three oils in a year like two months one oil and then I've changed it two or three months like that so two or three oils in a year you should change there are a lot of concepts about mono unsaturated fatty acids saturated poly I think the general public may not need to go into that details good oils have bad oils earlier concept now the bad oil concept is not there the so-called bad oils are not very desirable oils were coconut palm oil and this dalda hydrogenate fat the oils which at room temperature become solid are usually full of saturated fats earlier they were strict no no and this includes ghee but now the concept is in limited quantity occasionally you can use it it gives you a saturated fat but which is required in body but not in too much of quantity it should be sparingly used the good oils are mustard sunflower safflower so having canola olive rice bran ground nut oil so olive oil one thing is there by you know we should have a most of our cooking is you know the what you call beef frying that should not be the use of olive oil olive oil is mostly for seasoning in the salat or shallow frying very less heat you should use it and one thing is there do not repeatedly use when do not use the oil again and again what you are used like morning cooking cooking oil what you left over should not be used for the evening cooking because repeated use of the same oil portion generates trans fatty acids trans fatty acids are much worse they are hydrogenated oil they're usually found in your our fast food like you know samosas pizzas burgers and all fast food cooking has a lot of trans fatty oil and so trans fats they are the one in even limited quantity can cause significant cholesterol deposition in the body and can cause trouble so that's why the fast foods you know they are not that great in terms of you know cholesterol control alcohol same again you know big topic ideally avoid alcohol it's better said than done you know it's not possible so a lot of people ask there is a wine red wine is good protective shall I take it so we say if you're not taking alcohol or wine as such nobody will give you a prescription or a advice of take red wine and then your heart will become okay no if you're already taking alcohol then stick to the limited quantity and if you're happy to take wine then red wine is has slightly protective effect overall on the heart and so many things so maximum safe daily allowance is indicative only it doesn't mean you can take daily like that if people are taking whiskey is around 60 ml per day beer 700 wine 120 ml for women half of this is safe the liver has a capacity to metabolize and this is what it can metabolize regularly and more than that will lead to more calorie intake and more damages to the an overall body system people should be very careful that okay you are taking alcohol but the heavy snacks along with that will give you a lot of calorie salt and cholesterol and sugar so the snacks should be very very careful in that and mostly salads or after meals if you take these are cold it is much better so you avoid double whammy so if I summarize very quickly that 035140530 it's just a simple mnemonics and given 0 means no tobacco 3 means walk 3 kilometer average per day or 30 minutes of moderate activity five is the portions of fruits and vegetable per day you can mix and match 1 for 140 is your upper limit of the systolic blood pressure and if you forget 530 is given for the same to remind you so these were the you know tips to reduce the chances of the heart trouble and maintain a healthy heart not only healthy heart you can maintain healthy kidney and healthy liver also an early brain along with these things so as they say in Bhagavad Gita chapter 6 you have to rise by yourself as yourself is your friend and yourself can also be your enemy so you have to choose that for your healthy heart you want to be your friend of your enemy so thank you very much thank you doctor for your wonderful talk any questions yeah so I like every exercise most of the yoga exercise in older form are very good you know flexibility and core strength and you know breathing exercises and few exercises are more calorie burning like Surya Namaskar and all so brisk walking is an aerobic activity you can combine yoga and brisk walking both are complementary to each other they are not substitute for each other in yoga you can have a lot of flexibility and core muscle strengthening and less of a calorie burning but Surya Namaskar type of exercise give more calorie burning also but brisk walking only burns calories and improves your joints that's all only one question I got so if you feel breathlessness while climbing stairs it can be either because your stamina is less or you have some problem so first of all your doctor can tell you that you know is because of the low hemoglobin or high BP or heart weakness or lung weakness so first we need to make sure that you are not having any disease who which is causing your breathlessness once it is sorted out it only requires repetitive performance of exercise to improve stamina so if your BP is not when controlled suppose and you walk your BP will increase it's a hypertensive so even people who are fitter BP increases they can't walk they get trouble so you and if those things are not there then practice and exercise will increase your stamina and you will see in 4 to 6 weeks you will be able to do that now otherwise who's already smoker wanted to quit any suggestions yeah so one of the most difficult thing alcohol addictions are real trouble and many times we are not able to do so the two things are very important one is your willpower if you if you don't decide nothing can help you and if you decide then your support system should be there that's a second point so your family should help you in that along with that you know and if you are not able to do that then there are de-addiction centers which are you know very well run they are not like shady centers a lot of our tertiary care hospitals where psychologists are running a psychiatrist and physicians are running the addiction program so that will help you you know using there are so many things you know nicotine patches nicotine gum they can help you so you need to take a professional help you should not shy away from that then one is there I've got it any advice for people with sedentary lifestyle work from home IT employees yeah it's very easy to slip into a sedentary lifestyle all of us mentally physically are tuned to that so and there is a lot of patients have come to me after lockdown weight gain that we can't go outside and do that yeah but then what you do you people will have terrace they're drawing room any place you should find out 10 10 minutes to do exercise and as I said just see on youtube you will get medium intensity exercise high intensity exercises you do 5 10 minutes in two three sessions it will improve your exercise capacity and there is no excuse for it nobody will come and tell you because nowadays when you are working from home you have access to internet and youtube and other things you can always see and just do it so that's what it will be there and of course you have to take care of your right so munching in between snacks are the deadly thing so you want to take any snacks are all working from home please choose salads and fruits it will always give you better does eating white rice causes high risk of heart disease no high white rice by itself is not a risk factor for heart disease white rice is a especially polished one they are very quick source of carbohydrates so if you take white rice and most of the time and increase carbohydrate you know diet then you can have diabetes and heart disease in moderation and it is it is of no major issue if you take as a part of the balance type especially in the daytime very less chances of causing it problem although if you can shift to brown rice and unpolished rice they are better because you know when you take refined carbohydrates the peak of sugar goes very high it's a quick peak and the body has to respond by insulin creates a lot of stress on the pancreas so chance of developing diabetes is much higher so part of a balanced diet white rice is okay another question is any relationship between patients with PCOD having heart disease per se no but many of them will have impaired sugar so and overweight so those thing you have to take care PCOD is a syndrome so by itself it doesn't cause but associated overweight and impaired sugar can cause that so you follow the same advice and usually for PCOD a lot of patients are getting metformin which is very good in weight reduction and reducing the risk factor for heart disease does acidity hard one mean weak heart if it is diagnosed acidity hard one it doesn't mean weak heart simple you have something any more questions on that in that never I think some question about the one which I missed so I think these are very good questions of day to day this thing another one any vegetarian food for improving heart health the you know it is a myth that this vegetarian food for food will improve this non-veg you will be no you should have a balanced diet you can combine non-veg and veg and you can do that simple daily diet which make which contains of around 50 to 60% of carbohydrate the rest you know 10 to 15% of fat and rest is protein it's good having your vegetables dolls grains and salads and along with that you know only wheat and rice not people should live into millets also bajra ragi ragi you know limited quantity and bajra limited you keep on changing rather than just shifting to cereals like wheat and rice if you change in between and use millets also along with vegetables and the dolls then it is good in dolls also you can keep on changing to our moon you know and also you know channa lobia rajma and black channa chole so they have a lot of protein in that so so you have to have a balance and mix of that one single thing will not happen if hereditary see what happened strong family history of heart disease it means genetically people are prone to get it early small risk factor become amplified in the body so for prevention same thing works you don't have anything different from prevention so what happens if you follow the healthy lifestyle the same disease you may catch it but you may catch it later than what your parents or sibling caught it if they were not careful and the severity of the disease will be less and people with family history your health assessment should start early in mid or late 20s and it should be proper in the sense just not doing some blood test and doing you should be having a blood test risk factor assessment very very rigid so it will reduce that and it cannot prevent you know at some point of time and if not early later on people will get it but it depends upon how bad it will mild one nothing to bother occasionally if you are lucky you will it will prevent can you please elaborate how to identify silent heart disease illness general public cannot identify a silent heart disease and illness that's why it's known as silent regular health check and proper consultation with an specialist will help you out just doing a health check been a diagnostic laboratory with ecg and you know blood test and just echo as a part of health package but not taking a doctor's opinion will never identify that because you know a lot of people do ecg and the blood test and they don't see that there is already evidence of heart trouble there because they have not gone to a doctor to see that so that's what it is recording I'll have to just see our IT department if they can generate and put it on the website of the hospital then it should be the one we'll be able to do that have fun recording of this session what we will do is that we will try to put a short version of this on a on our hospital website no my excuse sorry one last question that these days blood pressure of 140 90s considered normal in this how can this vary no it's not normal in indians basically the definition of hypertension is kept on changing over a period of time so 140 and 90 above is certainly hypertension and between 80 to 90 there are a lot different classifications say high normal and all so 140 90 is surely a hypertension but in diabetics and kidney dysfunction there even the target is keeping below 130 by 80 so one is a diagnostic level that is 140 90 and another is the target of control that's what it is I think this is the last question of the session thank you so much for participating in this uh an informative event thank you so much doctor for the talk on healthy heart I hope all the questions has been thank you audience for joining I have a great day thank you