05 Oct 2020  |   04:05am IST

Hypertension, COVID and lifestyle

Hypertension, COVID and lifestyle

Francisco Colaço

Hypertension, also known as High Blood Pressure (HBP), is a long-term medical condition in which the Blood Pressure (BP) is persistently elevated. Despite the fact that it is a serious medical condition, HBP may not have obvious symptoms to indicate that something is wrong. Often described as “the silent killer”, HBP, if left untreated, can lead to many health issues including heart disease, stroke and dementia. 

And what of hypertension and its linkage with COVID 19, “the not-so-silent killer”? 

The latest evidence shows that people with uncontrolled or untreated HBP may be at risk of getting severely ill with COVID-19. Some studies indicate an overrepresentation of hypertension among hospitalised and critically-ill COVID-19 patients. The International Society of Hypertension (ISH) is aware of concerns raised by speculation (amplified by the media) which suggest that hypertension increases susceptibility to infection with COVID-19. It goes ahead to counter this with the statement that “ … the opposite is true given that most such cases occur in those over 60 years in whom hypertension is common.”

Further speculation also suggests that two commonly used classes of blood pressure lowering agents (ACE-Inhibitors and Angiotensin Receptor Blockers (ARBs) may worsen the outcome for those who are infected with COVID-19 but this is the subject of an ongoing controversy. The ISH completely endorses the content of two recent statements made by the Council on Hypertension of the European Society of Cardiology and the European Society of Hypertension both of which make clear that there is no good evidence to change the use of ACE-inhibitors or ARBs for the management of raised blood pressure in the context of avoiding or treating COVID-19 infection.

It is therefore uncertain whether this relationship between COVID-19 and HBP is causal or confounded by age (nearly two-thirds of people over 60 have HBP) and other co-morbidities associated with hypertension including obesity, diabetes mellitus, and chronic kidney disease. What observational studies demonstrate therefore, is an association between COVID-19 and HBP (risk of getting the infection as well as complications), not causation. 

While studies are underway to explore whether hypertension is an independent risk factor for COVID-19, there is no doubt that if you have HBP, the most important step, especially in these times, is to manage it.

There is plenty you can do every day to control HBP. 

Eating healthier, exercising more, sleeping better: You can lower your blood pressure by eating lots of whole grains, fruits, vegetables, low-fat dairy and lean meats, poultry, fish, and nuts. Shedding even a few extra pounds can lower your blood pressure. It’s also important to watch your waist. Too much bulk around your “midsection” can affect your BP. For women, a waist of more than 35 inches is high. For men, it's more than 40 inches.

Too much sodium can raise blood pressure. Aim for no more than 1,500 milligrams a day and remember that salt can also lurk in soups, sandwiches, and pizza.

Exercise also can help lower your blood pressure and lose weight. While the goal is to get at least 150 minutes of physical activity each week, don’t over-do it at once. Look for aerobic workouts that make your lungs and heart work a little harder. Maybe brisk walking, biking, swimming or dancing. 

Most folks need 6-8 hours of good quality sleep each night. Claims about sleep are often exaggerated though and sleep patterns are very much related to age, so find what’s right for you.

Stress busters: Find ways to cope with stress, like meditation, yoga, or deep breathing. Take time to relax and do things you enjoy, whether it’s listening to music, gardening, or spending time with family and friends.

Manage your vices: Drinking too much alcohol can raise your blood pressure. Women should try to have no more than one drink a day. For men, it's two. 

Smoking raises your blood pressure and makes a heart attack or stroke more likely. What's more, smoking can make some medicines you take for your blood pressure less effective. 

Watch out for caffeine that can cause a short, but dramatic increase in your blood pressure, even if you don't have hypertension.

Finally, don’t lose sight of all other medical conditions with the fear of COVID-19. Check your BP regularly to make sure it doesn’t get too high either with a reliable home monitor, or a visit to your doctor, with your mask and gloves! Today we have on sale a number of drugs. If one medicine does not do the job even 3 or 4 drugs simultaneously are considered in what is called “resistant hypertension”.

Work with your doctor to make sure any other health issues you have are under control. Many people with diabetes also have high blood pressure. Other conditions like high cholesterol, sleep apnea, and thyroid disorders are also often linked with it. When you manage your overall health, you’ll help keep your BP in check.

Finally, follow the treatment plan you've created with your doctor. Protecting yourself against the serious health issues that high blood pressure can cause is especially important with COVID-19.


(Dr Francisco Colaço is a seniormost consulting physician, pioneer of Echocardiography in Goa) 


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