-Dr Hemant Thacker
Across the world, high blood pressure (BP) is the most common disease requiring a medical prescription. Medically, it is called hypertension, but unfortunately it is often misread as “hyper” tension or increased mental anxiety when it is really a medical condition, not a personality issue. And while it has a definite genetic slant, hypertension is precipitated and perpetuated by bad lifestyle.
In the years since the estimation of blood pressure by the cuff started, different medical and heart associations have defined and redefined the range of normal and abnormal BP values. The most commonly accepted “normal” value is 120/80 (systolic/ diastolic), with lower values being acceptable in younger age groups.
The American College of Cardiology (ACC) has set the cutoff for the diagnosis of hypertension at 130/80, while the European Society of Cardiology (ESC) has set it at 140/90. The Cardiological Society of India has taken a practical stand, setting 130/80 as the baseline for those under 60 years of age, and 140/90 for those above.
We need to understand that these values were arrived at after collating data from clinical trials and real-world evidence. The different associations only differ in their approach to reining in the problem.
Dr Luke Laffin, director of cardiac rehabilitation at the Cleveland Clinic, says Americans chose to set the bar at 130/80, mainly to shake off the clinical inertia that exists in the minds of clinicians when a patient comes in at, say, 134/85. Laffin said, clinically, he was happy to go along with the ESC recommendations, but the stringent ACC guidelines were sacrosanct, especially for people who had comorbidities or associated heart, kidney or other conditions.
However, for young people with 134/82 and no other issues, he was happy to watch their response to lifestyle, dietary and weight modifications. He said 70% of such patients were able to control their BP with these changes. Drug intervention was indicated only when such non-phar macolo gical measures failed and patients started drifting towards 140/90.
In the Indian context, too, cardiologists were unanimous about the lower bar to not miss out the growing number of young patients advancing towards hypertension.
This made a very good compromise between the two continents where high-risk patients are definitely checked in at 130/80. The moderate to severe patients are now prescribed dual- and even triple-combination therapy.
By using different groups of anti-hypertensive agents in therapeutic doses, with no excess dose of a single agent, the aim is to deliver optimum benefit with minimal side effects. The reliance on lifestyle modification in the young is of paramount importance as hypertension happens a decade earlier in our country.
The aim of this piece is to inform you that hypertension is a function of many variables and while doctors may aim at a number, they finally treat the patient. Let your physician decide your goal and do not extrapolate from numbers a friend pulled out of thin air for you.
(Dr Hemant Thacker is a consultant physician & cardiometabolic specialist affiliated to Times Group, where he renders in-house medical help and also advocates medical education.