By Dr. Tapan Ghose

India is home to 354 million hypertensives and one in three individuals in the country has high blood pressure. According to a Global Burden of Diseases (GBS) study, 29.8% of Indian adults have high blood pressure (urban India 33.8%, rural India 27.6%). Interheart and Interstroke studies show that population attributable risk for IHD is 17.9% and for stroke is 34.6% in presence of hypertension. High blood pressure remains the single-most-important preventable, undetected, untreated, and inadequately treated clinical condition which needs to be addressed with priority. We should join hands with World Hypertension League and promote the message “Measure your blood pressure accurately, control it, live longer” on World Hypertension Day (May 17, 2022).

What is the impact of Covid-19 on high BP?

After the first wave of COVID-19, many patients with known high blood pressure presented with off-target readings. This was related to many factors like lack of exercise due to lockdown. Other factors are missing blood pressure medicines, disturbed sleep patterns, stress related to pandemic-related news, increased intake of high-calorie diet, less intake of fruits and vegetables because of logistical issues, and obesity and excess alcohol consumption. Mostly middle-aged adults and the elderly had these issues.

After the second and third waves of the COVID-19 pandemic, many younger patients between 30-50 years of age are presenting with vague chest discomfort, palpitations, uneasiness, and shortness of breath and many of them have high blood pressure. This again relates to similar factors of ongoing inflammation and blood clotting tendency. Some of them have dysfunction at the small vessel level (microvascular dysfunction). Many of them have high heart rates, largely due to autonomic imbalance which relates to high sympathetic done and low vagal tone. Inappropriate sinus tachycardia is quite common post-COVID-19 in younger patients. Sometimes these are related to panic attacks.

What is the general medical advice for these patients?

If one has chest pain, breathing difficulty, palpitation, undue fatigue, or loss of consciousness, one should seek immediate medical help. If one has a high heart rate during fever picked up by pulse oximetry, it’s because of fever. Treatment of fever will lower heart rate.

For blood pressure self-monitoring one has to take three readings at 5-minute gap. The average of the second and third readings is your blood pressure. Another issue is off-target blood pressure recording in a known patient with high blood pressure. Mostly they panic and start calling their doctors’. We should have a planned strategy beforehand. It is a joint contribution by both the patient and the health care professional. Without panic, one can repeat the set of blood pressure measurements. If it’s high again, one of the blood pressure medicines can be taken as an extra dose and blood pressure can be measured again after 5-6 hours. Teleconsultation is the best approach. 

One should keep the stocks of medicines in advance if blood pressure medications have been prescribed. Be regular with medications.

Which dietary pattern can treat high BP?

Diet is an important determinant of blood pressure. Follow a “no added table salt” 5 meals (3 major meals, 2 minor portions) diet. Increase fruit intake. Fruit intake should be 600-700gm per head per day. Salt intake should be less than 5gm (1 teaspoon full) daily.

One may follow either of the two dietary approaches. Both of them lower blood pressure, increase good(HDL), lower bad(LDL) cholesterol, and reduce ugly(TG) cholesterol. The first approach is the DASH diet. The Dietary approach to stop Hypertension (DASH) diet is high in vegetables, fruits, low-fat dairy products, whole grains, poultry, fish, and nuts; low in sweets, sugar-sweetened beverages, and red meats. This diet is low in saturated fats, total fat, and cholesterol while rich in potassium, magnesium, calcium as well as protein, and fiber. In a recent meta-analysis on cardiovascular outcomes of the DASH diet, there was a relative risk reduction of 21% in coronary artery disease (CAD) and a 19% risk reduction in stroke.

DASH diet plan is eating several portions of protective foods daily, limiting sodium intake to 2300 mg daily, limiting high saturated fat, and limiting sugar and sweets. The recommended daily portions (servings per day) are vegetables – 4-5, fruits 5-6, whole grains-6-8, meats, poultry and fish-6 or less, eating low-fat dairy products-2-3, nuts, seeds, dry beans, and peas -1, avoidance of tropical oils such as coconut, palm kernel, and palm oil limiting sugar-sweetened beverages and sweets.
The second approach is the Mediterranean diet (MD). First pointed out by Dr. Ancel Keys in “Seven countries study”, the Mediterranean diet (MD) is derived from prevalent traditional food practices of the population inhabiting the Mediterranean basin. The diet consists of a higher intake of fruits, vegetables, whole-grain cereals, and fatty fish; lower intake of red meat; substituted lower-fat or fat-free dairy products for higher-fat dairy foods; and use of oils (olive or canola), nuts, or margarine blended with rapeseed or flaxseed oils in place of butter and other fats. MD contains moderate quantities of total fat (32-35% of total calories), relatively low in saturated fat (9-10% of total calories), high in fiber (27-37 gms/day), and high in PUFA. This diet also lowers BP and bad cholesterol and reduces death from heart and brain attacks.

Foods to be avoided

One should avoid all the food which contains high salt and also fried foods, smoking and non-smoking forms of tobacco, diet containing a high amount of visible fat and trans fats.

Activity, exercise, and other life factors and blood pressure control

Regular walks (even in a home environment), stretching exercises, and light weightlifting should be practiced regularly. Yoga is a complete lifestyle therapy for cardiovascular disease. It has eight parts. Asanas are one part only. One should attempt the eight parts under the supervision of a guide. Sleep helps to heal the body and boosts the immune system. Sleeping 7 hours (range 6-8 hours) daily lowers stroke and heart attack. One should not smoke or use chewing tobacco or use tobacco products. Obesity should be controlled. Diabetes and high cholesterol should be treated. Alcohol intake should be moderated. Listening to Indian classical vocal and instrumental music lowers blood pressure levels. Ultimately the mantra is “don’t worry be happy”.

(The author is the Director and Head, Department of Cardiology and Head, Clinical Research and Academics Fortis Flt. Lt. Rajan Dhall Hospital, New Delhi, India. Views expressed are personal and do not reflect the official position or policy of

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