-Dr. Tapan Ghose, Director & HOD- Department of Cardiology at Fortis Flt. Lt., Rajan Dhall Hospital
According to the global burden of diseases (GBS) study, ischemic heart disease (IHD) remains the no one killer in India. 29.8% of Indian adults have high BP (urban India 33.8%, rural India 27.6%). IHD and stroke has trebled in India in recent times. INTERHEART and INTERSTROKE study show that population attributable risk for IHD is 17.9% and for stroke is 34.6% in presence of hypertension.
How is covid related to high BP?
The novel coronavirus pneumonia emergency response epidemiology team published data from China which showed a case fatality rate of 2.3% (1023 of 44,672 cases). The death risk was higher (6%) in patients with high BP. Not only that they are likely to have the severe disease (Risk 2.49 times), 50% of the people with covid over age 70years have high BP. Moreover, the death risk for covid-19 is up to 8% at age 70 to 79 years.
The reasons of higher death from covid 19 are advanced age, the depressed defense mechanism of the body (low immunity), poor BP control, associated cardiovascular diseases etc. This is not specific to Covid-19.similar high death risk was seen in SARS and MERS infection.
Can my blood pressure pills increase risk from Covid-19?
The viral spike(s) protein enters the human body cells after binding with angiotensin-converting enzymes-2 (ACE-2) receptors. The receptor no is higher in high bp, presence of diabetes and people treated with either ramipril or telmisartan-like medications. Initially, people thought, this as a cause of high death risk in these population group. However, multiple studies show that your bp pills does not effect Covid-19 death risk. In fact they are protective. The idea is to know the target bp and maintain bp in the target range of less than 130/80 mm Hg in most people.
What is the impact of Covid-19 on high BP?
After the first wave of Covid-19, many patients with known high BP presented with off target readings. This was related to many factors. Notably, lack of exercise due to lockdown. Other factors are missing BP medicines, disturbed sleep pattern, stress related to the pandemic related news, increased intake of high calorie diet, less intake of fruits and vegetables because of logistical issues and obesity & excess alcohol consumption. Mostly middle aged adults & elderly had these issues
After the 2nd wave of the pandemic many younger patients between 30-50 years are presenting with vague chest discomfort, palpitations & uneasiness and shortness of breath. Many of them have high bp. This again relates to similar factors of ongoing inflammation and blood clotting tendency. Some of them have dysfunction at small vessel level (microvascular dysfunction). Many of them have high heart rate, 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 high heart rate during fever picked up by pulse oximetry, its because of fever. Treatment of fever will lower heart rate.
For blood pressure, self-monitoring one has to take 3 readings at a 5min gap. Discard the first reading. Average of the 2nd and 3rd reading in your blood pressure. Avoid panic. BP is usually a silent killer. You can record the average bp at multiple times of the day and show it to your doctor. Another issue is off-target BP 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’s a joint contribution by both the patient & the health care professional. Without panic, one can repeat the set of bp measurements. If it’s high again, one of the bp medicines can be taken as an extra dose and bp measured again after 5 hours to 6 hours. Teleconsult is the best approach.
One should keep the stocks of medicines in advance if bp medications have been prescribed. Be regular with medications. Follow a no added salt 5 meals (3 major meals, 2 minor portion) diet. Increase fruit intake. Fruit intake should be 600-700gm per head per day. Salt should be less than 5gm (1 teaspoon full) daily. Keep fit. Regular walk (even at home environment), stretching exercise, light weight lifting should be practised regularly. Meditation is an exercise of mind.
Yoga is a lifestyle therapy for cardiovascular disease. Sleep helps to heal of the body & boosts the immune system. Sleeping 7 hours (range 6-8hours) daily lowers stroke and heart attack. One should not smoke. Obesity should be controlled. Diabetes, high cholesterol should be treated. Alcohol intake should be moderated. Listening to Indian classical vocal and instrumental music lowers blood pressure. Ultimately the mantra is “don’t worry be happy”.
We have seen that covid-19 has changed the population behavior and reaction. Average level of bp has gone higher, as seen during daily clinical practice. Blood pressure should be treated with DASH (Dietary approaches to stop hypertension) diet, lifestyle changes and added medications in selected cases. One should understand that sustained reduction to the target range saves individuals from stroke, heart attack and kidney failure.
High blood pressure remains the single most important preventable, undetected, untreated 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, Control It, Live Longer) of World Hypertension Day May 17, 2021.