A pregnant woman with hypertension has much more chances of developing severe health complications if she becomes Covid-positive. A hypertensive pregnant woman infected with Covid can suffer from complications like premature birth, eclampsia (seizures), premature separation of placenta leading to fetal death, and fetal growth retardation. In severe cases, she may even face loss of vision or brain hemorrhage.

Hypertension is a significant co-morbidity in Covid patients. Pregnant women carrying twins or triplets have higher risk of pregnancy induced hypertension and face higher morbidity that those carrying single pregnancies. Complications for them can include elevated liver enzymes and altered coagulation profile. When women facing pregnancy induced hypertension get infected with Covid, they need to control their blood pressure, be under proper care of an obstetrician and physician and seek admission in a tertiary hospital which hasa newborn intensive care unit (NICU).

It is totally safe for pregnant women with hypertension to get vaccinated against Covid. About 5 to 10 percent of pregnant women suffer from hypertension. Age is a major risk factor, with women below 19 years or more than 35 years being more susceptible to hypertension during pregnancy.The incidence is more common in rural areas because of lack of medical facilities for early diagnosis. Also, women with pregnancy induced hypertension are more prone to getting hypertension later in life.

Dr. Vidya V Bhat
Fertility Specialist & Medical Director
Radha Krishna Multispecialty Hospital
Bengaluru.

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As the Covid-19 pandemic sweeps the globe, reports are pouring in from several countries that patients with hypertension, diabetes and heart disease are among the hardest hit by the SARS-CoV2 virus. It is just about the right time for us to know a little about hypertension and it’s prevention in the light of the pandemic.

Hypertension, or high blood pressure runs deep in the veins of India. A chronic condition and one of the most common lifestyle diseases,hypertension is characterised as blood pressure (BP) recording of 140 over 90 mmHg on several occasions over a period of time. It was earlier thought to be a disease of the elderly, however that narrative has now changed. More and more younger people are developing hypertension in the recent times. It is estimated that one out of every 5 young Indians and 1 out of every 3 adults in India suffer from this condition.

Incidentally, India also has among the highest burden of diabetes in the world; diabetics are also at a higher risk of developing hypertension compared to non-diabetics; it appears that 2 out of every 3 diabetics eventually develop high BP as well. It is very common for high BP to go unnoticed until a complication develops, such as a stroke, heart failure or kidney disease, earning this dread disease the epithet, the silent killer.

Early detection and management of your hypertension:

Identifying hypertension early is important because at this stage, it is possible to control it or even completely reverse it, thereby preventing any further damage. As alluded to, high BP can be entirely asymptomatic. However, certain symptoms do suggest a person could be having high BP. These are recurrent headaches, especially in the back of the head, blurred vision, nausea, heart palpitations, breathing difficulty, nosebleed etc. If there is a history of high blood pressure in your family or you experience any of the above symptoms, it is important to seek a doctor’s advice.. More often, hypertension is detected on routine check or during an unrelated medical examination. Therefore, it is suggested that everyone above 25 years of age should check BP at least once a year.

Remedial Measures:

Lifestyle factors play a major role in the development of hypertension. An increase in unhealthy food habits, physical inactivity, high levels of stress, increased use of tobacco and alcohol, all of these contribute towards it. All these lifestyle factors are potentially correctable. During these uncertain times during the Covid-19 pandemic, it is advisable to adhere to a healthy lifestyle and to inculcate these for the times beyond the pandemic. Pay attention to the following –

1. Diet dilemma: Refined carbohydrates are associated with obesity and diabetes mellitus. There is sufficient evidence that avoiding highly processed foods that contain refined carbohydrates and/or excessive salt can prevent early onset of hypertension. IN the times of Covid-19 people have been found to stock up on processed, easy to cook foods as well as snacks. Consumption of these in excess amounts will lead to worsening of diabetes, add to weight gain and unmask hypertension in those who are prone for it. Increased intake of natural food items rich in fibre, potassium and calcium such as vegetables, some fruits and dairy products is also associated with prevention of hypertension

2. Avoid falling into the inactivity trap: Quite often, we postpone exercise and physical activity for tomorrow which never comes! Make exercise a routine. During the time of Covid pandemic, going out due to restrictions or the need for social distancing further reduces the opportunity to exercise. Take the stairs often. Online streaming services are providing free aerobic exercise classes such as aerobics, yoga, dancing and Zumba. Take advantage of these and find fun ways to exercise and feel its positive physical and mental benefits. Again, these healthy habits can be continued beyond the time of the pandemic.

3. Deal with stress and anxiety: The current epidemic has generally heightened stress levels. Uncertainty regarding the coronavirus disease, economic shutdown leading to financial difficulties, job loss, stress of dear ones being elsewhere during the pandemic and increased negativity on social and mainstream media about the pandemic are responsible for the increased stress. Identify signs of stress or depression in yourself or those around you. Find methods to deal with stress. If need be, speak to a therapist. Understand that there are coping strategies to help you stay calm, level-headed and give your best even in difficult situations. Make use of this time to address these concerns. Try meditation and breathing exercises.

4. Dealing with unhealthy habits: Increased stress as well as being idle due to the lockdown has led to an increase in tobacco consumption. Once the restriction on alcohol sales was removed a rebound increase in consumption of alcohol has also been noted. Both these habits are detrimental to hypertension in particular and a healthy life in general. Avoid these habits.

Why this is all so important?

Longstanding hypertension narrows walls of the arteries making it difficult for blood to flow freely. This not only affects the heart, but also the brain, eyes and kidneys. Heart attacks, heart failure, brain haemorrhage, stroke, kidney failure can all result from poorly controlled hypertension.

A genuine effort to bring in lifestyle changes, regular monitoring of BP and strict adherence to medicine will result in immense long-term benefits, not only to beat hypertension but to keep several lifestyle illnesses at bay and improving the overall quality of life. This time of the pandemic is an ideal one for us to can re-examine our lives and make a commitment to ourselves to healthy living!

Dr .S. Venkatesh

Lead Consultant, Interventional Cardiology

Aster RV Hospital,Bengaluru

https://www.asterbangalore.com/aster-rv-jp-nagar/

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Do diet plays a major role in protecting the arterial system? Yes, junk food and poor diet intake leads to high cholesterol and are marked as prime reasons for arterial dysfunction leading to heart attacks and strokes.

Cardiovascular events being on the rise among young Indians is a serious matter of concern. The prevailing incidences of stroke & cardiovascular events, are quite evident that epidemic like situation is bound to prevail in India, as more and more young Indians (20-40 years of age) are under its radar. When almost 80% of such incidences are avoidable or preventable, what is the prime reason that is deteriorating the health of the youngsters?

Factors related to stress include hypertension, smoking, binging on alcohol and lack of physical activity, lifestyle related habits like binging on junk food and poor diet intake that leads to high cholesterol are marked as prime reasons for arterial dysfunction leading to heart attacks and strokes. Cumulatively all these factors expose the arteries to get clogged leading to interruption in the normal flow of blood in the body. This in turn results in the hardening of the arteries thereby affecting the complete arterial system.

Myocardial infarction with a mortality rate of 2 lives per minute, WHO estimates that over 40 % of the deaths, will be attributed to cardiovascular events by 2020. The younger generation also needs to adopt certain lifestyle changes to prevent stroke and cardiovascular diseases from becoming an epidemic.

Role of a healthy diet in prevention of stroke

1. Hypertension –More than 60% of all the cases of strokes and heart attacks are attributed to high blood pressure. By preventing or controlling hypertension alone, the possibilities to prevent a stroke or heart attack increases by 10 folds.

DASH (Dietary Approaches to Stop Hypertension) – The diet plan emphasizes on lowering the blood pressure by getting right amount of nutrients through portion size food. Basically the diet encourages reducing sodium intake and consuming other required nutrients like calcium, magnesium and potassium, helpful in lowering the blood pressure. Following this diet on a regular basis not only reduces hypertension thereby reducing risk of stroke but other related ailments like osteoporosis, cardiac ailments, and even cancer can be prevented.

The effectiveness of the diet has already been published in many journals. Several studies also show that the systolic blood pressure drops from 160 mm Hg to 140 mm Hg within 3 weeks after following the diet and helps in maintaining the same throughout lifetime. The following items need to be incorporated in the diet – Flax seeds, Sunflower seeds, Watermelon, Beetroot, Spinach, Whole grains (brown rice / whole wheat flour / Oats)

2. High Cholesterol levels – For our body to function healthy, certain amount of cholesterol is required, but when it exceeds the limits, it leads to plaque formation resulting in clogged arteries that hinders blood flow affecting heart, brain and all other vital organs.

As coronary arteries narrow, it’s harder for blood to flow and if an area of plaque breaks, it can result in a blood clot, which can block blood flow altogether. This puts you at great risk of having a heart attack. Blood flow has to be restored fast, or there’s a risk of permanent heart damage or death.

When plaque builds up in the arteries that carry blood to your brain, your brain is deprived of oxygen. Brain cells quickly become damaged and start to die causing stroke. A stroke can cause brain damage, disability, or death.

With elevated levels of bad cholesterol, risk of development of plaque in the walls of the arteries increase. This makes them prone to losing the integrity of their lining leading to formation of clots, which in turn can prevent blood flow. A healthy diet corresponds to your Mass Body Index (should be 25 or less), and also to the fact of maintaining a healthy metabolism. Obesity, which likely leads to heath complications such as high blood pressure and diabetes, can have a devastating effect on your heart and blood vessels.  Close monitoring of diet is necessary to maintain the right levels of good and bad cholesterols.

TLC (Therapeutic Lifestyle Changes) – this approach consists of three parts – Diet, exercise, and weight management. This helps in changing the habits for a long run and is the most balanced diets.  The diet approach aims to lower the LDL (bad Cholesterol) levels and raises the levels of HDL(good cholesterol). People suffering from high cholesterol should immediately change their eating habits and switch to this diet.

• Oats and oat bran- 3 gms of oats in your diet can reduce total cholesterol by 23 percent.
• Avocados – Avocados are low-carb plant food and rich in Vitamin K, C, B5, B6, E, potassium and folate, along with a small quantity of magnesium, manganese, copper, iron, zinc, phosphorus, vitamin A, B1 (Thiamine), B2 (Riboflavin) and B3 (Niacin), protein.
• Beans – Rajma, Chana and Kabuli chana are rich in dietary fibre which help in reducing cholesterol level
• Nuts – Walnut, Almonds and Cashews helps in lowering the cholesterol by 5.4 percent and LDL cholesterol by 9.3 percent.
• Barley and other grains
• Vegetables – Eggplant, Tomatoes, Ginger, Garlic, Broccoli and other vegetables
• Fruits –  Fruits such as pear, apples, oranges, berries, grapefruit and pomegranate have the necessary nutrients and components that aid in reducing the cholesterol level in the blood
• Green Tea – Green Tea is the natural medicine to aid digestion and is the most common thing that can be found in almost every household.

1. Diabetes – Patients with diabetes and hypertension are more likely to suffer from a heart attack/stroke. Diabetes can damage blood vessels as well as your nerves leading to a high risk of transient ischemic attacks. By controlling blood glucose level, your blood lipids, and by saying no to smoking you can considerably reduce the risk of a stroke.

Vegan Diet – The potential benefit of a vegan diet is for type 2 diabetes affected people. Switching to a vegan diet could help reverse diabetes. The eating plan consists mainly of non starchy vegetables, fruits, beans, seeds and nuts. Millions of people battling this killer disease can improve their blood sugar levels by just eradicating meat from their diet. Studies say vegan diet lowered HbA1c by an average of 0.4 percentage points, and up to 0.7 points. Plant-based diet also improves blood sugar, body weight, blood sugar, blood pressure and cholesterol all at the same time which no drug can do. The following items – Cinnamon, Fenugreek Seeds, Turmeric Tea, Cumin, Garlic, Cardamom, Fennel seeds, Ginger, Amla, Spinach, Lauki, Fibre rich food, Almonds, bitter gourd.

Apart from diet the other things to keep in mind includes –

–      Regular exercise – physical inactivity also leads to plaque build-up, hence atleast half an hour of daily activity is mandatory to avoid any risk of stroke or other ailments related to the arterial system.

–      Smoking cessation – it is the smoke and not the nicotine content that is responsible for stroke. Avoid smoking as it increases the risk of stroke by three times. When you smoke, you inhale tobacco smoke, which contains over 7,000 toxic chemicals including carbon monoxide, formaldehyde and hydrogen cyanide. These chemicals are transferred from your lungs into your bloodstream, changing and damaging cells all around your body.

–      Limit alcohol consumption – Alcohol increases the risk of ischemic (lack of blood flow to the brain due to a block in the artery) and hemorrhagic (bleed into the brain tissue) stroke. Alcohol consumption elevates blood pressure. This in-turn causes damage to the inner wall of the artery. It is also known to reduce blood flow to the brain by decreasing the caliber of the brain arteries through a direct effect on the muscles of the arteries. Excess alcohol affects the heart muscles resulting in impaired function and altered rhythm. This can result in a clot developing in the heart which can then disintegrate and migrate to the arteries in the brain and obstruct the blood flow to the brain. The clotting mechanisms can be altered/ impaired and therefore can make one prone to bleeding into the brain tissue.

Dr.Chandrashekar, Saroj super speciality hospital

Near Madhuban Chowk, New Delhi-110085

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