 to everyone. Today I'll be telling you something about the common disease that is hypertension or hypertension in common language as it is known to all of you. Hypertension is the most common cardiovascular disease affecting the human-gaze gloom. Hypertension, uncontrolled hypertension or uncontrolled blood pressure is a condition which affects each and every organ of your body starting from head to toe and it is responsible for many cardiovascular diseases namely stroke, heart failure, kidney failure and heart attacks. In India, we find that there is a huge variation in the distribution, geographical distribution of the blood pressure. We find that Jammu, Kashmir, North East regions, they are highly affected. There is high prevalence of disease in these areas and as compared to Rajasthan and Uttar Pradesh Bihar, we have more patients in South, down South. There are various reasons for that. There are genetic reasons then there are reasons related to the lifestyle, your climate conditions. It is said that one in four adults, out of the four people, one person has got high blood pressure and what is more pathetic is that only one-third of the people, only two-third of the people will know that they have high blood pressure and one-third they don't know it that there is high blood pressure affecting them. Why? I will let you know. Now first of all let me define what is high blood pressure. From time to time guidelines keep changing but in on an average for your understanding if your blood pressure is more than 130 by 80 all the adult people I am talking of, 130 by 80 if it is more than that really this means we have high blood pressure. Now depending upon the further increase in the pressure we stage them and how do we say, how do we conclude that your pressure is 130 or 80 and beyond this we tend to have to average of two readings taken at two different occasions and we follow a standardized protocol for that. What is that? I'll just give you an insight into that also. Very common notion is that people think that blood pressure is a condition which will affect which is important for the people who are middle-aged, young people. As you grow the pressure has to increase. What is the great fun about it? That is the most mishand misconception which is there in the society. It is true that as we grow old all of us are to have a high pressure so much so that it is set by 90 years of the age 99% of the people will develop high pressure which is high from the readings of 120 by 80. But then we can't ignore this pressure reading if we grow old. It has been found that the cardiovascular mobility, the death related with the associated with the high blood pressure is much more in every age group as compared to the middle age group such as the importance of treating and controlling the blood pressure. It is said that for every 2 millimeters high in systolic blood pressure we can have 7% increased risk of death due to heart attack and 10% increase in the rate of death due to stroke or the brain stroke which you know by in common language. Now once we check in blood pressure we always advise our patients to person to sit say take rest say 10 to 15 minutes before you get their preparation measurement. You should be rather comfortable sitting in the chair bladder should be empty trying to avoid taking caffeine smoking before you visit the clinic of your doctor because that tends to increase your pressure. Then once the pressure is being taken your arm should be rested on the table elbow should be at the heart level anything above or below which is going to change the reading. Similarly try not to look at your mobile phones at the time try not to talk to the system who is taking the blood pressure or to the attendance be calm, composed and get your reading checked. Cuff size metals whether we have not centered the cuff or not at all metals but that are the things which will be taken care by the medical petition is taking your pressure. Sometimes what we find is that and you must have noted yourself also that the reading in the home is different and once you reach a hospital or you go to a clinic your reading gets up. This is something we call as a white coat reaction let's see the white coat you get hypersensitivity you you go into an anxiety form and your pressure rises but then we have things to judge whether this is a some in white coat reaction some related to that anxiety only or you truly are having high pressure we have this to find it out so don't worry about that but then this is one of the phenomena which can occur when we visit a clinic or a hospital. Now when we check your blood pressure it is just not only the reading of the pressure we concentrate upon it is the in the totality we see the patient but what is your body what is your age what is your gender what is your body weight whether you're obese or not then you have other risk factors for heart developing cardiovascular disease very important among them are whether you have diabetes do you smoke are you already having a kidney problem are you already having a heart problem history of stroke or something vascular problem in the legs and we calculate a risk like what is it what is your failure risk of developing a cardiovascular disease it is not just the pressure readings what is your cholesterol levels and what is your family history of heart disease all this matters and if that risk is more than 10 percent then we categorize you into a category which needs immediate attention which needs immediate treatment which needs initiation of treatment and the control of pressure now this treatment and the control of pressure immediately with lifestyle changes lifestyle measures or maybe with the drugs or a combination of the two so we have to accept that if the pressure is this high we have to be treated then sometimes some readings are so high that we cannot ignore that and then we have to start the treatment immediately something like suppose a patient comes to me in emergency and the pressure is 180 by 110 I cannot go by other demographic readiness I have to start medicine otherwise this patient will go into a complicated stretch very important very pertinent question when the person comes to me sitting opposite my chair in the OPD we tell them that your pressure is high the first reaction is denial doctor how is it possible I am not having any symptoms let me tell you here and clarify you all that if you talk to me about the symptom of high blood pressure literally there are no symptoms of high blood pressure you have to accept it that and I don't want to scare you by this term but blood pressure of the hypertension is known as a silent killer it is said that 99% of the time don't feel any symptoms and the pressure is high it is damaging your organs it is damaging your body and you get to know only when you check it if you don't check your readings you can't tell that you are having high blood pressure now so don't be surprised if you visit the clinic for anything and you find your pressure high accept that reading and start hitting on it then if the symptoms and very important is if the symptoms have started usually the stage is a complicated stage not always but most of the time it's a complicated stage that you presented suppose the patient may be having nose bleed he may be having headache and headache may turn out to be some brain stroke he may be having nausea he may be feeling short of breath and nausea short of death vomiting he may be having inside either fluid in the lungs or because of the high pressure or there may be some cardiac problem which has started like he may present the day unstable and then a acute heart attack situation also in certain conditions so this is just a way to tell you that our guidelines say that we have to target the blood pressure below 1-80 for almost everyone whether you are in the age group of these 50s or you are in the age group of 80s or something depends and how much is your cardiovascular risk as I already described and also what are your other comorbid conditions whether you are having any diabetes also your bees you smoke you take an alcohol you have family history all this and what is your cholesterol levels all this has to be taken now as far as the drug that is concerned we have full battery of drugs which can help you out in controlling the blood pressure which drug will be used for which patient depends upon we select the drugs according to certain behaviors suppose what is your age what is your gender how active you are in the in your job what type what is the nature of your job then what are your cholesterol levels are you having any other coexisting problem that diabetes renal problem then are you an old age group patient with a prostate hyper photography so there are few things which we take into consideration before you starting on your medicines if you are dealing with one demography it's fine otherwise telegraphically also people tend to differ Americans differ they respond to different type of drugs black Africans they tend to respond better to some group of drugs and not to the others so all this is known to your clinician you have to just believe him and if there are any side effects you have to report to them back and the medicines will be adjusted accordingly for you to understand and what you can institute is the lifestyle changes because it is it is the one thing which only you can do and this goes a long way in preventing this condition and also controlling this condition mainly lifestyle changes mainly are basically how much physical activity you are doing what is your diet how much salt you are whether you are habitual to smoke or alcohol and all these things I take bundle most important in the foremost thing I consider for your well-being is the physical activity I think it is second to none if your physical activity active right from the your childhood adolescent days you are very unlikely to see a doctor in a clinic that is my statement for all age groups all and all both general all age groups the reason is that exercise and the physical activity is one thing which keeps you away from all these lifestyle changes blood pressure diabetes people ask her what is the cause I tell them it is a lifestyle lipid disorder it is a lifestyle it is how you conduct yourself starting from the childhood no age is there which will not benefit from the physical activity you can you have information on the google's also but people can get better can have physical activity which can drastically change even in the age group of 70s if we are 25 we are 30 we are 40 that is the best age to start the exercise if we have not been doing previously it is said that the aerobic endurance exercises they can reduce the blood pressure even in normal individuals patients with normal blood pressure and of course they are very beneficial in patients who have high blood pressure aerobic activity we consider like this for jogging running you doing you playing some sports badminton cycling all these coming to swimming all they come into aerobic activity where you are not using weights but you are using your body and putting into motion so it places demands on the cardiovascular system now the immediate effects a long-term effects are tremendous the it said that the reduction of the blood pressure with exercise can till can last 22 hours means when you next time go to the exercise that is after 24 hours later you are breathing the benefit of the previous days exercise and it is not always that if you lose weight then only blood pressure will come now blood pressure can come down without you losing weight also with exercise so we have it is said that usually with regular physical activity you can have a reduction in systolic and diastolic blood pressure between of 2.5 to 5 to 11 just by doing exercise we recommend that you should be preferably you should be doing it all the days if not then at least five days a week intensity we recommend as a moderate it should be 30 minutes of continuous activity sometimes but it is not that if you can't do 30 minutes of continuous activity you can't have the benefit of the physical activity it can it is still there you this even this statement is important that if you are sedentary and if you start walking you start doing simple things like not taking a lift and the elevators and taking stairs you are doing good to yourself even you are standing for some time in the kitchen you are doing good to yourself even small amount of activity is helpful such is the tremendous benefit of doing a physical activity daily but if you can do it in a consistent way you can do it 30 minutes or more of a continuous activity then you are doing the maximum benefits if you can't do that continuous you can break it up for the enduring the day like 10-15 minutes I've done this thing 10-15 minutes in the afternoon I've done something in the evening I've done something so aerobic exercise we usually use your large muscles but for the blood pressure patients we have a cautions also if your pressure is too uncontrolled it is more than 160 by 110 don't go for exercise immediately first get your pressures controlled by the drugs and no salt and everything as as per your doctor's advice and once it is in the coming down and it's in the normal range you start your activity this will help you in reducing your number of drugs and also it will help in other ways like reducing your cholesterol levels taking control of your diabetes it will take control of your weight next important thing is alcohol now people are so so much formed of alcohol especially our main patients there's so much into this that they feel that the statement should be that you are allowed alcohol living that is a complete no we have that you must be searching in the google and you must be asking your colleagues that one or two per se they will help you that statement comes with inverted commas because if we say that some amount of alcohol is helping you in your coronary artery blockages but this is not helping you in your blood pressure control it is not helping you in controlling your weight it is not helping in you in controlling your lipid profiles it is not helping you as for your muscle strength is concerned heart muscle gets weakened with chronic alcohol use then you have liver also if you have no heart blockages but you have liver disease what are we gaining so there are so many side effects of alcohol and as far as the blood pressure contest is there we we say if you can avoid it it is it is it is very very good thing but if somebody is taking a call should actually there should be at least two few days per week when you're not taking a call and you should limit it to one unit a day and these days we say the binge drinking is if you do it take more than three units a day and believe me there are no safe limits for alcohol important another important vice which is there in the society is the smoke smoke I tell you if all your risk factors if if I compare two people with the similar age group male people no uh similar lipid profiles everything is okay but only difference between these two individuals these two patients is one is smoker other is a non-smoker we tell the cardiovascular risk goes by more than double any person who is a smoker as compared to who does not smoke such is the tremendous effect of smoke on their cardiovascular disease actually acutely increases the blood pressure and it has other significant effects on your blood vessels it damages the inner lining of the blood vessels when it damages the inner lining there is a plaque formation on those in those vessels plaque is a scientific term in common language we can say that there is a deposition of fat cholesterol and the inflammatory tissue coming out the inflammatory cells coming out sitting on that fat and globules which causes a thick waist structure inside the lumen of the vessel and slowly it gets increasing in size and what it does is it reduces your blood flow to the organ suppose it is suffering in the vessel supplying the heart the heart vessels will get narrowed down your blood supply to the heart muscle will go down and what you will land up in is which we commonly known as angina or a heart attack similar reduction in the brain supply can cause you a stroke uh brain stroke similar reduction in the kidney can cause kidney problems so if we refrain from having it we can cut down our risk of heart diseases and brain strokes while salt is an important component when we discuss the blood pressure our recommendation is you limit your salt to five grams a day but what happens is that most of the people they don't know that there are invisible ways of you getting salt being absorbed in your body so and most of the time we find that what we are taking is almost double of the recommendations so avoid it go for low salt rights and prevent the intake of high salt substitutes high salt things are when you go for canned things you go for processed meat you take a lot of bread then you lose sauce achar pickles all these things in your diet more often on the other hand when you have a lot of fresh foods variables in your diet pulses in in the short the nature found things like the things which nature has offered to us if you rely more on them in your food in your diet then you're doing their justice to yourself as well as this controlling this condition is concern if we say that there is 1.25 gram of salt per 100 gram of the food which you're eating we label it as a heavily salted and here I want to tell for our younger patients that once we snack outside the person who is preparing food for him who is not a homemade food he's just concentrating on his benefit he has to earn something from you he's giving you something which is very palatable very tasty to your appealing to your tongue but he's not taking care of your diet he's not there to take care of your health who is there who is a person who is really thinking about your health is the person who is sitting in the house and cooking for you it may be your mother maybe your sister maybe your life so trust them instead of the people who are out to just make money out of what you are eating because it is said that one meal outside the house will you will prepare you what will you do you will undo your 15 days of precautions which you have already taken in your diet so we advocate the dash plate what is a dash plate dash plate is a very you see how colorful diet it is on your plate you have all the types of colors this yellow there is red there is green inch in short you have to include fruits and green vegetables in your diet three to four servings of the foods per day and lots of veggies on your plate they help you in law in controlling and in this condition now the fruits and vegetables they have a good phytochemicals antioxidants they have multiple vitamins and minerals which help you in coping up with the development and prevention of this depression high depression now people say that instead of taking food if I take this vitamin medicine this capsule it helps me no my simple answer is no never rely on supplements if you are able to chew if your body is able to digest the things then go for the natural form of this supplements can never help you they are first of all they will have one or two concentrates only second they get they don't get absorbed if you don't have a deficiency of that they're just thrown out of the body sometimes their toxicity can harm you instead of giving you any benefit coffee intake usually is considered a small amount of high blood pressure in maybe there once you're taking it but most of the time there is a antioxidant effect there is engine inflammatory effect and if you're not doing too much of everything then you can treat the benefit of coffee and it is said that once you are habituated to it usually it is it is a almost a neutral effect on the depression tightly peptides they're very important in reducing the depression important product is a milk which is so freely available to us and the indians are very fond of milk and milk products let's continue without the age of habit of having milk twice a day one cup before going to sleep also children should also be inculcated this habit and here i'd like to just tell my lady listeners that don't shy about they get shy from this product this is very good for you it's a good source of calcium also for you not only in controlling the depression but it's a source of calcium in protein also so another important thing is this is stress though there is a no direct correlation we can find out from the scientific studies but personally i feel that stress goes a long way in starting this condition and then persisting with it so as far as possible we should do have our lifestyle this way that we are not unnecessarily stressed out we can plan our things we can put them into perspective that what is the most important thing for me in the house is it the household work is it the recreational activities we do is it is it the society interaction which is important or my health and my family members health and work of course is important for everybody but whether that work should be made such a human cry to you that you damage your health the the ball lies in your foot and there are ways to condemn your stress also you can have regular physical activities one of the important things which can reduce your stress levels yoga meditation these are important things which can help you in reducing your stress and controlling this condition herbal remedies is very important questions and queries from the people and especially the older fellow we agree with them we have very good natural products which can help us in providing us with the antioxidant effects and they go if consumed properly over a long time they go a long way in developing in reducing the development of lifestyle diseases which depression is the most important even diabetes is important but this has to be combined with other good things which we require it's not that we eat diet which is prepared outside lot of oils ghee and we think that we'll have some ginger or some natural product that will counter it that that is not possible and this slide just helps you in understanding that we have to understand this this we have to understand what our clinician or doctor is telling instead of going just on the births they have to invite or if you have pressure into concern initial stage many people can help you your family physician your GP internist your cardiologist everybody can help you but what are the points what are the stages where you need a cardiologist intervention is when your blood pressure is uncontrolled in spite of any medicines when you are requiring two or more than two deep medications for the control of pressure then you have some end organ damage supports you get some effect on kidneys heart or you have some retinal problems or there is a epistexy is most bleed these are the conditions that need you need to consult your cardiologist or suppose you are planning some surgery for you that is the point you will require a physiopathologist in to conclude I like to say that after the age of 30 BP check should be regular and mandatory for all and especially those who have a family history of diabetes family is your hypertension or have some other problems like coexisting real disease or there is a history of stroke there are lipid abnormalities so on and then diagnosed with hypertension don't be the demand phase that is the most important thing we see in the clinic don't be a denial accept the thing and try to try to X start acting that day only so that you don't land up into complications you have to control your depression it may be your lifestyle it may be your medicines anything but only end point is the control blood pressure should be there as I already told you it affects actually each and every organ of your body and sometimes both things are required lifestyle also medicines also depending on which stage you have reported to the doctor and another important thing is we find that once the pressures are controlled people are very hyperactive anxious to get the medicines stopped or reduced never tell your doctor to do that you are not supposed to be telling him that why he's calling you after regular intervals why he's telling you to have a check on the pressure readings and report to with the pressure readings the purpose is this only if it feels like that your pressure is controlled and now you don't need three medicines you you are going with one medicine only he will do that but don't insist that you need a reduction of the pressure readings and don't stop the medicine of your own also this can do you more damage than better than good I think with this I conclude my slides and if any questions or queries are there you're welcome