McXtra Care Newsletter | September 2019

Section A


Understanding high blood pressure – Risks and consequences

Blood pressure (BP) is the pressure that blood flowing in our arteries exerts on its wall. Arteries are blood vessels which carry blood rich in oxygen from our heart to different parts of the body. This pressure is maximum when the heart contracts on the heartbeat and ejects the blood into the artery (this is called systolic BP). The pressure is lowest in between heart beats (this is called diastolic BP). Therefore, blood pressure is expressed in the units of mm of mercury (Hg) as a fraction of systolic upon diastolic BP (example – 120/80 mmHg).


The cutoffs for high BP have been lowered in 2017 by global health associations, including India to a BP target of <130/80. There is enough evidence that BP levels between 130-139/80-89 mm Hg in the Indian population can cause substantial risk of cardiovascular disease (CVD), and premature death. Lower cutoffs aim to create greater health consciousness of lifestyle and diet, help in early intervention to prevent complications, and maintain a higher level of community health.

So, <130/80 can be considered the new BP target globally but, many physicians today still rather go with the BP target of <140/90 in people aged 65 or less, and 65 years of age.

It is to be emphasized that a single BP reading is not diagnostic and is not used for decision making. If the first visit BP reading is high, it should be rechecked again (after 1-2 weeks for BP between 160/100 to 179/109 and 2-4 weeks for BP between 130/80 to 159/99). At least 3 consecutive BP readings over 3 different visits should consistently show raised readings to diagnose anyone as having Hypertension. If BP reading is 180/110 or higher at any visit, it is treated as an emergency and will need to be immediately managed medically.

Also, the cut offs mentioned so far are for in-clinic BP measurement. Sometimes self-BP measurement at your home (to prevent rise in BP and heart rate due to anxiousness/nervousness) or a continuous BP measurement over 24 hours (Ambulatory BP monitoring) maybe advised. In such cases the BP cutoffs for hypertension maybe even lower.


High Blood pressure especially when not adequately or well controlled can lead to consequent complications. Blood flowing at higher pressure has more chances of causing micro-injuries to the vessel wall. This increased the risk of formation of ‘plaques’ (made up of fats, cholesterol, calcium and platelets). These cause narrowing or obstruction of blood vessels resulting in reduction (partial obstruction) or loss (complete obstruction) of blood supply and oxygen to vital organs.

Cardiovascular Disease (CVD): This includes conditions like Angina, Heart attack, Stroke or Peripheral Arterial disease.
Angina or Heart attack (also called Myocardial Infarction MI) is caused due to partial, and complete blood flow obstruction to the heart respectively which causes reduction in oxygen and heart pain. Since the heart has to pump blood against a higher pressure and resistance, its contracting effort increases which can slowly lead to its reduced efficiency and inability to cope, causing Heart failure. Obstruction/reduction in blood flow to the brain leads to Stroke, (also called Cerebrovascular accident). High BP can also affect blood flow to our limbs (Peripheral arterial disease) which can cause intense pain on walking. Hypertension can cause ongoing damage to Kidneys and eventual Kidney failure.

Other complications like rupture or blockage of the fragile narrow vessels of the retina of the eye (Hypertensive Retinopathy) can affect vision. Hypertension can cause reduction in blood flow and damage to many other organs like bones, reproductive organs and others, hampering their functioning.

Classification (AHA/ACC)

Systolic BP (mm Hg)

Diastolic BP (mm Hg)









Lifestyle and Diet modification

Stage 1 Hypertension



If no other CVD risk factors – Lifestyle and Diet measures

If other CVD risk factors present – Add BP lowering drug/s + Lifestyle-diet measures

Stage 2 Hypertension

140 or more

90 or more

Combination of 2 or more BP lowering medicines + Lifestyle-diet measures


Increasing age (male>45; female>55 years) and being of South Asian and African race are natural risk factors. Other risk factors include:

  • • Being overweight or obese
  • • Taking too much salt (sodium) or too little potassium in your diet
  • • Sedentary lifestyle or inadequate physical activity
  • • Smoking
  • • Dyslipidemia (Increased in Cholesterol +/- Triglycerides in blood)
  • • Stress or suppressed anger
  • • Coexisting Diabetes, Kidney disease or Sleep apnea
  • • High carb, saturated-trans fats in diet
  • • High alcohol consumption
  • • Family history of high BP or Cardiovascular disease (CVD)

Overall more the number of coexisting risk factors present in an individual, greater the risk of developing complications of high BP. Sometimes a 10 year risk of CVD is calculated, and if it is > 10%, BP lowering medicines are started immediately along with Lifestyle-diet measures

Section B


Health Solutions for High BP

People in the stage of elevated BP are managed with Lifestyle and Diet modifications. These measures can reduce systolic BP by 4-10mmHg, usually in the range of around 5mmHg over a few months

People in stage 1 hypertension who have coexisting cardiovascular risk factors (or a 10 year CVD risk >10%), will require a BP lowering medicine in addition to Lifestyle-Diet measures, as compared to people without additional/coexisting risk factors who can be managed with Lifestyle-Diet measures alone.

All people in stage 2 hypertension should be managed with a combination of BP lowering drugs, and Lifestyle-Diet modifications.

The target BP of all patients in stage 1 and 2 hypertension is <130/80. However there maybe variability among physicians and cardiologists in setting target BP in different patients. DASH- Dietary Approaches to Stop Hypertension is aimed at lowering BP, reducing risk of cardiovascular sequelae and also helping in BMI and weight reduction. Read upcoming detailed full article on understanding and incorporating the DASH diet as part of your lifestyle:

Further Lifestyle-diet measures for Blood sugar and Lipids (Cholesterol and Triglycerides) will also be advised if these 2 risk factors are coexisting with Hypertension.


Lifestyle Measures



Weight reduction

Aim for a BMI <25 kg/m2




Rich in fruits, vegetables, whole grains, and low-fat dairy products, with reduced fat


Salt reduction

Aim for reducing daily salt intake. Limit to 1 teaspoon (2.3 g sodium) or less (ideal 1.5g sodium/day)


Potassium intake

Aim for a range of 3.5-5 g/day


Alcohol use

Aim to reduce to not more than a glass per day; not more than 4 times/week



90-150 minutes/week (aim for 30 minutes/ 6 days a week) Include exercises like brisk walking, cycling, swimming, jogging


Smoking/Tobacco use

Stop completely


Stress Management

Relaxation techniques, mindfulness, Breathing exercises and wellness programs

BP lowering Medicines

BP lowering medicines are given singly or in combinations (separately or combined in a single pill). Usually one medicine is added for every 10mm systolic BP above target. Sometimes two medicines at lower doses maybe preferred to one medicine at higher dose, to improve response and reduce side effects.

There are 4 classes of BP lowering medicines which are considered as first line (ACEI-pril group, ARB- sartan group, CCB-dipine group and Diuretics-thiazide group). One of these, or a combination of these are used to bring and maintain the BP at target values. The second line drugs are used when the combination of 3 first line agents of different classes do not manage to control high BP or in certain special situations or patients with associated cardiac, kidney or other conditions.

Important points to remember

  • • All medicines should be taken only by prescription and recommendation of a qualified medical practitioner in the dose, schedule and time of day prescribed along with incorporating all the lifestyle/diet measures suggested.
  • • Separate medicines will also be needed for coexisting risk factors (like diabetes and high lipids) if present.
  • • Irregularity of taking these pills can lead to uncontrolled BP
  • • There are certain situations where some class of drug may not be appropriate or suitable, while some may cause side effects in certain patients, so one should never start or change any drug without consulting a qualified physician.
  • • The blood pressure, and parameters for other risk factors when present, should be measured and monitored periodically under the guidance of the treating physician.
  • • Usually suggested follow up visit is at 3 months after starting on lifestyle-diet measures, and at 1 month after starting a BP lowering medicine.

Section C


DASH diet for controlling BP and weight

DASH (Dietary Approaches to Stop Hypertension) is a diet rich in fruits, vegetables, and low-fat dairy products, with moderate amounts of whole grains, legumes, nuts, fish and poultry, and reduced fat and sugar content. The DASH diet is a scientifically validated diet mainly meant for reducing blood pressure and cardiovascular risk. Up to 5-6mm Hg drop can be achieved in blood pressure with regular incorporation of the DASH diet.

This diet aims to supply 2000 Kcal /day (55-60% from carbohydrates; 25-30% from fats and 15-20% from proteins). The DASH diet helps to maintain weight (and even lose weight in the range of 1-5 kg or so). If larger amount of weight loss is required to reach the recommended BMI of <25 kg/m2, a further reduction in calorie intake and a structured weight loss program is recommended.

Below is a practical guide to incorporate and achieve the DASH diet.
(Note ‘cup’ refers to any utensil which accommodates around 240-250ml of water; 1 tablespoon =15ml=3 teaspoons).


  • • Move to whole grain cereals which has higher nutrition and fiber, with less fat like brown rice, whole wheat bread/pasta. Do not add butter, ghee, oil, cream or sauces.
  • • 6- 8 servings/day are recommended. 1 serving = 1 bread piece, 30 g (approx 1 cup of dry cereal) or ½ cup for cooked cereal/rice.


  • • Include plenty of fresh vegetables in diet –Green vegetables, carrots, tomato and sweet potatoes, as these offer a range of vitamins and minerals including potassium.
  • • 4-5 servings/day are recommended. 1 serving = 1 cup raw/leafy green vegetables or ½ cup for cut/cooked vegetables.
  • • If using canned vegetables go for ‘low salt’ preparations or 1-2 rounds of rinsing.


  • • Most fruits are low in fat (exceptions like coconut) and high on fiber, vitamins and minerals like potassium. Fruits can be consumed with meals and as inter-meal snacks.
  • • 4-5 servings/day are recommended. 1 serving = 1 full medium sized fruit, ½ cup of cut fresh, frozen or canned (no added sugar) fruits or 120ml (half cup) fruit juice.

Dairy products

  • • These include milk, yogurt, and cheese which are good sources of Proteins, Vitamin D, and minerals like calcium and potassium.
  • • For milk 4 options are available: whole milk (3.25% milk fat), reduced-fat milk (2% milk fat), low fat milk (1% milk fat) and fat free/skimmed milk (0.1-0.2% milk fat). Choose low fat or fat free/skimmed options for milk, yogurt and cheese.
  • • 2-3 servings recommended per day. 1 serving = 1 cup milk; 1 cup yogurt or 40-50g cheese
  • • If lactose intolerant- go for lactose free milk, yogurt or cheese options which are now available
  • • Cheese should be checked for salt content (should be in the range or less than 300-330mg sodium/g of cheese)


  • • Out of the daily recommended intake of 2000 calories, about 30% should come from fats.
    • • Good fats (include in diet) – mono and poly unsaturated fats (oils like sesame, sunflower, soyabean, olive, canola, rice bran, linseed/flaxseed and peanut oils, fish/fish oils, margarine, and nuts like cashews, almonds, walnuts, peanuts, avocados, and pine nuts)
    • • Bad fats (avoid in diet – keep to 5% or less) – saturated fat (found in butter, cheese, coconut and palm oil, lard, cream, whole milk, red meats) and trans fat (processed and fried foods).
  • • 2-3 servings/day are recommended.
    1 serving = 1 teaspoon oil/margarine or, 1-2 tablespoons salad dressing/mayonnaise or ¼ cup nuts. Nuts should be eaten in moderation (3-4 times/week)

Non-vegetarian food

  • • Meats are not only a rich source of protein but also of vital minerals and vitamins.
  • • While choosing meats go more with lean meat (low fat) instead of red meats, use poultry with skin/fat removed, consume as grilled/boiled form instead of fried, and substitute fish (salmon, tuna, herring) and shrimp for meats on some days.
  • • 1 serving/day is recommended. 1 serving = 150-200g for meats/fish/poultry or 1 egg


  • • They are good sources of protein for vegetarians and non-vegetarians
  • • Soyabean is a very good option for meat in vegetarians in the same measure.
  • • 1 serving/day is recommended. 1 serving = ½ cup cooked lentils/peas/beans per day (limit peas/beans to not more than 4 times/week.


  • • Try as much to go for low fat/low sugar options with sweet.
  • • Artificial sweeteners such as aspartame or sucralose can be substituted but not overused.
  • • 1 serving/day (not more than 3-4 servings/week) is recommended. 1 serving = 3 teaspoons sugar/jam. (Diabetics require separate restrictions)


  • • 1-2 cups of tea or coffee are fine in a day (200ml/cup).
  • • Make sure the added sugar remains within daily limits of 3 teaspoons of sugar.


  • • Total salt intake should be kept less 1 teaspoon (1 serving) of table salt (2.3g sodium) and aim to push it to 1/2 to 2/3 teaspoon over a period of time. This may sound like a tough task for the taste buds but with time and other seasoning options, the adjustment of the taste buds can be achieved.
  • • Non salt seasoning and spicing options include – garlic, onion, celery, mustard, cilantro, ginger, lemon and vinegar
  • • Explore low salt/low sodium options in foods, as well as read the salt content mentioned on the pack of food items before buying. Canned foods and pickles are high in salt. 1-2 rounds of rinsing can help cut the salt down.
  • • In addition to lowering sodium, the amount of potassium should be stepped up in diet to 3.5-5g/day. This is automatically achieved with high amount of fruits, vegetables, low fat dairy items and food items like fish part of the DASH diet. Roasted options instead of boiling, yields more potassium.


  • • Drinking in moderation is permitted and may contribute to relaxing the mind, and also raising good cholesterol (HDL) but some do’s and don’ts need to be observed.
  • • Limit to a glass/day or 5 glasses/week. On a single day do not go beyond 2 glasses.
  • • Do not gulp drinks, or binge drink, or drink on an empty stomach.
    • • 1 serving=1 glass
      Vodka, Whiskey, Brandy, Rum (contain around 40% alcohol). 1 glass=45 ml (If alcohol content is 50% or more, make it 30ml)
    • • Wine (contains around 10-20% alcohol). 1 glass =120-140ml depending on alcohol content mentioned on bottle
    • • Beer (contains around 5% alcohol). 1 glass=350ml

DASH Diet Summary

Food Item


Whole grains






Low fat dairy






Lean meats

1 (3-4 times/week)


1 (3-4 times/week)


1 (3-4 times/week)




1 (≤5 time/week)

Mind Tickle

Solve the crossword below with the clues given


1 – Diet for High BP and BMI

2 – Another name for high BP

3 – Heart pain when oxygen supply to it falls

4 – Reduce this with relaxation and breathing



1 – When blood vessels supplying brain get blocked

2 – Kick this habit to reduce BP and health risk

3 – This is what creates blockages in the arteries

4 – Reduce this in your diet to keep BP in check

On the Lighter Side

– Medical content courtesy – Dr Varsha’s Health Solutions


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