HYPERTENSION WITH HEART DISEASE

About half of individuals with untreated hypertension may die of heart disease due to poor supply of blood to different parts of body. The changes in heart may occur gradually and progressively but are not immediate.

Effects of hypertension on heart are: 

  1. Coronary and ischemic heart disease:

It is a condition that occurs due to narrowing or stiffness with decreased elasticity of arteries supplying blood to heart when hypertension is left untreated. Untreated hypertension may cause damage to the inner lining of arteries, leading to formation of clots/plaques. The complications can be heart failure, heart attack.

Symptoms can be left sided chest pain, radiating to left arm, shoulder, back, associated with nausea, dizziness, sweating, shortness of breath, fatigue, pounding heart, etc.

2. Left ventricular hypertrophy:

This is nothing but enlarged left side of heart, that actively pumps blood to all the parts of the body. The walls of left chamber of heart may thicken and stiffen due to increased workload of heart to pump blood effectively to the body, to overcome the resistance offered by the high blood pressure. It may lead to heart failure, sudden cardiac death, if left untreated.

3. Heart failure:

Untreated hypertension may cause the muscles of heart to weaken, decreasing its efficiency to pump blood effectively leading to heart failure eventually. This can lead to kidney dysfunction, leading to fluid collection in the body, including around heart.

Symptoms include difficulty in taking breaths, swelling of ankles and feet, bloated abdomen, increase frequency of urination at night, etc.

Testing needs to be done when any of the symptoms are experienced based on history and physical examination finding. The tests are Chest Xray, Electrocardiogram (ECG), Echocardiogram (ECHO), cardiac stress test, Coronary angiogram, etc.

Treatment options for hypertension include

  • Medications to control hypertension.
  • Regular exercise.
  • Healthy diet with restricted carbohydrates and fats, low sodium diet, fiber and potassium rich foods.
  • Avoiding smoking and alcohol consumption

It is also very important to go for routine medical checkups to the treating doctor, monitor BP readings regularly

References:

https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20045868

https://www.webmd.com/hypertension-high-blood-pressure/guide/hypertensive-heart-disease#2

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/LearnHowHBPHarmsYourHealth/How-High-Blood-Pressure-Can-Lead-to-Heart-Failure_UCM_490534_Article.jsp#.Wzx1bNIzbDd

https://emedicine.medscape.com/article/162449-overview

https://www.ncbi.nlm.nih.gov/pubmed/19505285
 Dr. Divya Teja Pasupuleti

Obesity and related skin conditions

Obesity is the leading disease in the western and asian countries .The number is increasing day by day. Obesity is considered as “worldwide pandemic”. The list of diseases related to obesity are increasing, some of them are diabetes, hypertension, stroke, delayed wound healing, skin issues, impotence, stroke etc.

Here in this article we are dealing with skin related infections in obese individuals.

How does obesity cause skin problems?

Obesity is a condition of excess adipose(Fat) tissue and is the result of changes in lifestyle, excessive consumption of energy-dense foods with poor nutritional value, physical inactivity. However there are other related disturbances caused by obesity. Metabolic disturbances are  equally important and can be interlinked with Diabetes (Insulin Related) which is responsible as an exacerbating factors for dermatitis.

Below we can see the stages, skin getting affected in various forms:

  • Disproportional production of oil(sebum) from the skin cells: As we know its the oily substance that keeps the skin moisturized and avoid dryness. In obesity, the sebum channels are blocked and get infected leading to formation of Acne. Acne is also caused due to other hormonal factors like rise in androgens(Male hormones), growth hormones, insulin
  • Alteration in properties of skin function:skin  barrier cells have  a set of critical defensive functions along with the function of holding body water in and keeping microbes and foreign molecules out. Alteration leads to infection formation
  • Imbalance in collagen production and structure: Adipose cells(Fat cells)     decreases the formation of collagen and leads to weakening and laxity of skin tissues
  • Delay in wound healing properties: Adiponectin(Cells seen in Adipose tissue) which is responsible for Increasing the vascularity and  wound healing is decreased in obesity and there is a delay in wound healing.

Commonly associated skin conditions seen in obesity and their management:

1)Acanthosis Nigricans and Skin tags: This is a common skin problem in obesity. Acanthosis nigricans appears as velvety, symmetrical dark patches. It is most commonly observed in the armpits, groin, back of the neck, elbows, knuckles, and face. This condition can be controlled with the help of decreasing the increased Insulin levels. Skin tags can be removed by a doctor.

2)Hyperandrogenism and hirsutism: This is caused by high levels of male hormones. Development of male sexual characters is seen like increase in facial hair. Acne may occur. Treatment of hyperandrogenism consists of controlling insulin levels, weight loss, oral contraceptive and antiandrogenic therapies.

3)Striae due to over extension: Striae are commonly seen on the skin due to stretching of skin and increased adipose tissue. Striae are seen more often in the areas like breasts, buttocks, abdomen and thigh regions. They appear as red marks turning violet, then finally becoming white depressed plaques. There are no treatment options.

4)Varicose veins: Appear as bulged veins and/or black itchy skin on the lower extremities. Treatment is with elastic stocking other life style intweventions, weight loss, reducing the standing time, elevation of the legs for few minutes and surgically by stripping and ligation.

Other skin related issues seen in Obesity:

  • lymphedema
  • psoriasis
  • insulin resistance syndrome
  • skin infections including fungal infections, mainly in the skin folds
  • plantar hyperkeratosis

-Dr.Surampally Bhavani Sagar

 

 

OBESITY AND RESPIRATORY PROBLEMS

Respiratory problems include breathing difficulties such as asthma, obstructive sleep apnea, emphysema, heart disease and anxiety. One of the health condition leading to breathing difficulties is obesity or being overweight

Large Waist Size

Men and women with abdominal obesity are at risk of difficulty in breathing. The excess belly fat pushes the diaphragm and chest wall making it hard for lungs to fill with air leading to breathing difficulties

Normal range of waist circumference should be less than or equal to 80 cm for women and less than or equal to 90 cm for men of Indian origin.

Obesity & Sleep Apnea

Obstructive sleep apnea is a condition where in during night times while sleeping there is difficulty in breathing which lasts for few seconds at a time, multiple times. Many of the times it may go unnoticed as u mostly don’t wake up fully to notice it. One of the risk factors for shortness of breath is being obese or having abdominal fat.

A commons sign of obstructive sleep apnea is snoring.

symptoms :

  • excessive day time sleep
  • loud snoring
  • morning headache
  • nighttime sweating
  • difficulty in concentrating

Home remedies :

  • lose weight
  • exercise daily
  • quit smoking
  • sleep on your side instead on your back.

Prevention

A healthy lifestyle and proper dietary plans may reduce the risk of developing breathing difficulties. Make efforts to reduce weight if you’re obese. A reasonable goal for weight loss is to try to lose 1 to 2 lbs. per week by reducing the number of calories that you eat and by increasing the number of calories that you burn through exercise. Make sure you consult your dietician before going on weight loss plan.

Obstructive sleep Apnoea can pose long term health consequences, like Hypertension, Headaches, heart failure, Depression and poor life satisfaction. Consult a doctor so that the problem can be looked in to, with appropriate tests which include sleep studies.

References

https://www.webmd.com/diet/obesity/obesity-health-risks#1

https://www.webmd.com/sleep-disorders/sleep-apnea/obstructive-sleep-apnea-causes#1

-Dr.Chandrashekar

MEDICAL CONDITIONS LEADING TO OBESITY

Obesity is usually caused by lifestyle habits and underlying medical conditions or risk factors leading to overweight.  

Medical causes of obesity can include:

Hypothyroidism- Condition associated with thyroid gland, located in the neck, produces too little thyroid hormone. This hormone regulates our metabolism. The decrease in levels of these hormones effects the metabolism, leading to weight gain.

Cushing’s syndrome- Condition wherein the adrenal glands secrete an excess amount of cortisol hormone, leading to a build-up of fat in certain sites such as the face, upper back, and abdomen.

Polycystic ovary disease:  This condition leads to increase in levels of androgen levels leading to males like characteristics such as body hair growth, irregular periods and weight gain.   

Depression- People with depression overeat or binge eating ultimately leading to obesity.

Pregnancy- During the pregnancy period women tend to attain weight significantly and most of them find it difficult to lose after the pregnancy. This could lead to obesity.

Other causes

Inactivity. Sedentary lifestyle or work which includes less physical activity will lead to accumulation of fat in the body due to excess intake or improper use of those calories leading to obesity.

Genetics. Some people are genetically predisposed to the condition.

Family lifestyle. Obesity runs in family, if one or either of your parents are obese then you are a risk of attaining the same. Family members share same lifestyle or eating habits leading to obesity

Unhealthy diet. A diet high in calories and frequent habit of eating the junk food or unprocessed food is one of the causes for increased levels of cholesterol, which is a risk factor for obesity.

Certain medications. Medications such as antidepressants, anti-seizure, and steroids intake will lead to weight gain.

Age. It affects every age group including young children. As you grow up hormonal changes and less active or sedentary lifestyle may increase your risk of obesity.

Quitting smoking- quitting smoking can lead to a temporary gain of weight, but long-term quitting of smoking will benefit you from ill health.

Lack of sleep- improper sleeping habits may cause in imbalance of the appetite hormones which may lead to weight gain due to excess craving for food.

Though obesity may be caused by different conditions or risk factors, proper diet, and physical activity can prevent you from gaining weight and help u stay healthy.

 

Reference

https://blog.ekincare.com/2018/06/18/obesity-as-a-result-of-sedentary-lifestyle/

http://www.idealshape.com/blog/conditions-that-cause-obesity/

https://www.medicinenet.com/obesity_weight_loss/article.htm.

-Dr.Chandrashekar

 

Long Term complications of Hypertension

High blood pressure is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, affecting almost every organ systems.

You can have high blood pressure (hypertension) for years without any symptoms. Even without symptoms, damage to blood vessels and your heart continues and can be detected. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.

Complications of Hypertension

The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.

Uncontrolled high blood pressure can lead to complications including:

  • Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications. Keeping the blood pressure at check ensures further delaying and prevention of these complications.
  • Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening. Avoiding spikes in blood pressure over the years is protective for these complications.
  • Heart failure. To pump blood against the higher pressure in your vessels, the heart has to work harder. This causes the walls of the heart’s pumping chamber to thicken (left ventricular hypertrophy). Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body’s needs, which can lead to heart failure.
  • Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally. Kidney complications are preventable if measures to keep blood pressure at check are adopted from the start.
  • Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.This also is a preventable complication,if the spikes in blood pressure over the years is avoided.
  • Metabolic syndrome. This syndrome is a cluster of disorders of your body’s metabolism, including increased waist circumference; high triglycerides; low high-density lipoprotein (HDL) cholesterol, the “good” cholesterol; high blood pressure and insulin resistence. These conditions make you more likely to develop diabetes, heart disease and stroke. Maintaining the blood pressure at check during the years prevents these complications in later years.
  • Trouble with memory or understanding. Uncontrolled high blood pressure may also affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people with high blood pressure. Repeated damage to the brain cells by high blood pressures can be prevented by managing blood pressure from the start by various lifestyle changes.
  • Neurological complications like dementia (Memory loss),can also be prevented by avoiding undue surge in BP over the years.

Lifestyle changes can help you control and prevent high blood pressure along with the blood pressure medications advised by your doctor. Here’s what you can do:

  • Eat healthy foods. Eat a heart-healthy diet. Avoid saturated fats and trans fats.
  • Decrease the salt in your diet.
  • Maintain a healthy weight. Keeping a healthy weight, or losing weight if you’re overweight or obese, can help you control your high blood pressure and lower your risk of related health problems.
  • Increase physical activity. Regular physical activity can help lower your blood pressure, manage stress, reduce your risk of several health problems and keep your weight under control.
  • Limit alcohol. Even if you’re healthy, alcohol can raise your blood pressure. If you choose to drink alcohol, do so in moderation.
  • Don’t smoke. Quitting smoking is the only way to prevent complications.
  • Manage stress. Reduce stress as much as possible.
  • Monitor your blood pressure at home.
  • Control blood pressure during pregnancy. If you’re a woman with high blood pressure, discuss with your doctor how to control your blood pressure during pregnancy.

Regular visits to your doctor and getting the right tests done is important. They can detect irregularities in your blood pressure early on.

It’s vital to pay attention. This is especially true when it starts to show up with problems in other parts of your body.

Pay attention to your body and take care of yourself.

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/LearnHowHBPHarmsYourHealth/Health-Threats-From-High-Blood-Pressure_UCM_002051_Article.jsp#.Wx37VUiFPIU

https://www.healthline.com/health/high-blood-pressure-hypertension

https://www.nhlbi.nih.gov/health-topics/high-blood-pressure

-Dr Prerna Gaur

 

HOME BP MONITORING – DOs AND DON’Ts

Why is Blood pressure monitoring at home is important?

  1. To make sure blood pressure is maintained normal and to keep an eye on the blood pressure in individuals whose medications or dose of medications for hypertension are changed, lifestyle changes are made, recently.
  2. It is important to make a note of all the BP readings in an app/a book, as a single reading of blood pressure doesn’t warrant diagnosis of hypertension or a need of medication unless, it is consistantly high.
  3. To avoid biased blood pressure readings as many people may get anxious, stressed at the doctor’s clinic leading to false high blood pressure called white coat hypertension.
  4. To avoid frequent visits to the doctor for checking blood pressure.
  5. If one feels dizzy, lightheaded after waking up from bed/ on standing from sitting position, it is best to check blood pressure on standing and sitting position as well to check if there is a decrease in BP on standing.

Pre-requisites for blood pressure recording:

  1. Avoid smoking, food, alcohol intake, exercises, caffeinated drinks such as coffee, tea, aerated drinks, etc. at least 30 minutes before measuring blood pressure.
  2. Empty bladder before taking the blood pressure reading as full bladder may rise blood pressure.
  3. Sitting in a comfortable position, staying calm and relaxed for at least 5 minutes before measuring the blood pressure is important to get an accurate reading.
  4. Sitting straight with a back rest, with feet flat on the surface of floor (without cross-legged) and resting the elbow and forearm flat on a cushion/a pillow with upper arm at the heart level is also important.
  5. The cuff of the BP apparatus should cover at least 80% of the upper arm with its lower part placed just above the elbow crease.
  6. Do not tie the cuff too tight or too loose to get accurate reading.
  7. The cuff should be tied over arm but not over sleeve/clothing to avoid false readings of BP. If the sleeve is too tight when folded up, it may be best to remove the sleeve off arm.
  8. The readings should be taken only at the same time every day, ideally in the morning (not immediately after waking up) before breakfast and in the evening.
  9. At least two readings of blood pressure should be taken about 2-3 minutes apart to get accurate measurement.
  10. BP from both arms should be measured at least once in a while
  11. Do not talk, do not make a fist but keep the hand and arms relaxed while BP is being measured.
  12. Make sure the cuff is of right size of the arm while buying the BP apparatus.
  13. Make sure the BP apparatus that is going to be used at home and the procedure of measuring BP by self is correct by practicing once before the treating doctor.
  14. Start measuring blood pressure every day at least after 2 weeks of starting a new dose or a new medication for hypertension and at least 1 week before next appointment with the doctor.

References:

https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20047889

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/KnowYourNumbers/Monitoring-Your-Blood-Pressure-at-Home_UCM_301874_Article.jsp#.Wx-hoYozbDd

https://www.health.harvard.edu/heart-health/tips-to-measure-your-blood-pressure-correctly

https://doctor.ndtv.com/living-healthy/world-hypertension-day-2017-dos-and-donts-of-checking-blood-pressure-at-home-1698016

https://www.aafp.org/afp/2005/1001/p1391.html

-Dr. Divya Teja Pasupuleti

Importance of Regular Consultation for Hypertension

Importance of maintaining doctors’ follow ups and taking medications for control of Hypertension.

Persistently elevated blood pressure (BP) is a leading risk factor for cardiovascular disease   development.

-Making effective hypertension management strategy is the most important step in controlling hypertension and preventing its complications.

Regular visits to your doctor(Follow up)  and compliance to medication are an important part of keeping your  blood pressure under control.

Here are a few important benefits that regular follow up will provide.

  1. You will be educated by your doctor as to what your blood pressure numbers mean to you and your health.
  2. Your doctor, will advise you to maintain your blood pressure in a range which is suitable to you. If it is not, your treatment plan will be adjusted by your doctor.
  3. Follow-up visits are a good time to let your health care provider know about any side-effects  you are having from your medication. He or she will have suggestions for coping with side effects or may change your treatment.
  4. Follow-up visits provide an opportunity for you to be screened for damage to the heart, eyes, brain, kidney, and peripheral arteries that may be related to high blood pressure.
  5. If you have diabetes or have had a prior heart attack or stroke, your blood pressure control will need to be more stringent to prevent recurrent events. Regular visit to your doctor will help you to maintain safe blood pressure levels on a constant basis.
  6. Follow-up visits are a great opportunity for monitoring other associated risk factors, such as high cholesterol and obesity.
  7. With aging and progression of the process of hardening of the arteries, your systolic blood pressure may creep up with time. A treatment that once worked well may no longer work and regular follow up visits are an excellent way to figure it out and change the dosage or the medication.

Importance of taking hypertension medicine as advised by your doctor

Blood pressure medications are one of the best weapons against hypertension and when taken properly, can help control blood pressure levels and reduce risk of heart attack and stroke.

-However, medications can only do their job when taken correctly, which means taking the proper dose of medication at the right time and in the right way for as long as you’re supposed to. Failing to adhere to medication can not only render the drug ineffective, it can be dangerous and pose a threat to your health

  1. Take the medication as advised by your doctor-There are many blood pressure medications that work in different ways to lower your blood pressure. Your doctor chooses 1 medicine or a combination based on your health status. It is very important to take the medicine as and when advised by your doctor.
  2.  If you feel the side effects or costs pose problems, don’t stop taking your medications. Ask your doctor about other options.
  3. Unless advised by your physician, you should never stop taking your blood pressure medicines even when your blood pressure has reached its goal. Doing so can cause dangerous rebound hypertension that complications.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4687379/

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/MakeChangesThatMatter/Partnering-With-Your-Doctor-to-Treat-High-Blood-Pressure_UCM_460131_Article.jsp#.WxYxu0iFPIU

https://www.webmd.com/hypertension-high-blood-pressure/guide/high-blood-pressure-follow-up-care

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998775/

https://www.jwatch.org/jc200403190000006/2004/03/19/how-often-should-we-see-patients-with

http://www.healthcommunities.com/high-blood-pressure/follow-up-doctor-visits-blood-pressure_jhmwp.shtml

https://www.webmd.com/hypertension-high-blood-pressure/how-take-blood-pressure-medicine-properly-why-you-should#1

https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/diagnosis-treatment/drc-20373417

https://www.sharecare.com/health/high-blood-pressure-treatment/to-take-my-high-blood-pressure-medication

-Dr.Afroze Fatima