Gain clarity on postpartum hypertension. Discover whether it's a temporary condition with expert guidance from Meri Sehat.

Does Postpartum Hypertension Go Away?

Madeeha Syed

This article or video has been vetted and verified by Meri Sehat’s specialists. It contains citations and research from validated sources.

Your Body After Giving Birth

Overview

Post-pregnancy or postpartum is a crucial period. It&rsquo;s also known as the fourth trimester. This is when your body is <a href="https://merisehat.pk/disease/chronic-fatigue-syndrome">recovering from the fatigue</a> of pregnancy.

During pregnancy, the body goes through a lot of changes to accommodate your baby. The body eventually goes back to normal, but this can take a while.&nbsp;

Continue reading to find out more about some common changes that take place in your body, after you give birth. 
&nbsp;

Post-pregnancy or postpartum

During pregnancy, hair growth gets better and the texture of hair gets thicker. This is all thanks to the hormones that are active during that phase. However, post-delivery, this phase settles down and enters into a resting phase for about one to five months. Normal hair growth pattern usually returns six to 15 months after delivery. 
&nbsp;

Shoe surprise is pretty common after pregnancy. It is not just the midsection that gets affected. After a baby is born, your shoe size changes permanently. That is because during pregnancy women gain an average of 25-35 pounds which puts extra pressure on the feet. This pressure flattens out the arch in your feet which is the reason for extra inches in your feet. 
&nbsp;

Belly bulge is common after pregnancy. A lot of women expect that the belly will return to its normal size after birth. The upper portion of the uterus is at the level of your navel. Post-pregnancy belly returns to its normal size in about six to eight weeks. A good diet and exercise are the key to toning down your belly. Workouts focused on the core can show quick results. 
&nbsp;

A common expectation of most women is that the breast size will go up after giving birth and breastfeeding. Once you stop breastfeeding, however, the size goes back to what it was. In fact, in some cases, it goes a cup down. The main reason for the size to increase is that fat tissue in the breast is replaced by functional tissue. Once a woman stops breastfeeding, functional tissue depletes as it is no longer needed. 
&nbsp;

The first six months of the post-partum period are the recovery period. No matter how easy or smooth your pregnancy is, your body has gone through a lot of stress and trauma. It needs time to recuperate. Remember that every mom goes through a different experience and symptoms; hence, the recovery rate also changes.

Most of the symptoms, like sore nipples, backache, pain in the thigh area, etc., continue for more than a week. Other symptoms, like leaky breasts, can linger on for months.

In vaginal delivery, recovery timelines vary depending upon the kind of delivery. The soreness and perennial pain go away in three weeks. However, in the case of vaginal tear or episiotomy (incision made on the vagina to ease the delivery process), recovery can take up to six weeks.

If you have been delivered through c-section, it will take around three to four days in the hospital to recover. In about four to six weeks you can recover completely. 
&nbsp;

For the first 24 hours after birth, ice your perineum region. Sit in warm baths for 20 minutes to ease pain and avoid long periods of standing or sitting.

Ease pain and aches by taking hot showers and massages.

Do your Kegel exercises, to strengthen your pelvic muscles.

Keep up with your doctor appointments. It will help you stay on track. Your doctor can also notify you about your emotional well-being and help you with your new journey.

Ask your doctor regarding your workout plan. They can guide you about how and when can you exercise. It is a good idea to start by walking into your house and then gradually into the neighbourhood. Walking helps in recovery by improving blood circulation and toning muscles. 
&nbsp;

Bottom Line

Your diet after pregnancy shouldn&rsquo;t be very different from what you eat during pregnancy. Avoid processed foods. Focus on eating whole grains, high fibre foods, Omega-3 fatty acid-rich food, nuts, and fish.&nbsp;

<ul>
	<li>Lean Meat: Milk, cheese, and yogurt are all crucial components of a breastfeeding mother&#39;s diet. Your infant receives calcium from breastmilk for the formation of bones. Consume foods high in calcium to replenish the calcium your body has lost. Include three cups of dairy in your diet each day.</li>
	<li>Pulses: These are a good source of protein and fibre. You can cook them with different seasonings to make them tasty and easy to eat. Pulses also prevent fat from accumulating in the body.</li>
	<li>Vegetables:&nbsp;These are low-calorie healthy food. They are rich in antioxidants and aid in losing weight. Spinach and broccoli are good sources of Vitamin A which is healthy for you and your baby.</li>
</ul>

Once the baby is born, you can resume most of the food you avoided during pregnancy. Include nutrient-rich foods like legumes, proteins, fibre, citrus fruits, and vegetables. Don&rsquo;t forget to keep yourself hydrated. You may consult a dietician and your doctor in designing your diet plan.

Namwer Rao

What Happens To Your Body After Giving Birth

Giving birth is a life-changing experience. You&rsquo;ve just brought a new baby into this world, which is an incredible, miraculous feat in itself, but it also means that your body has been through quite an ordeal. You may have experienced some pain during labor and delivery, or perhaps you&rsquo;re still recovering from an episiotomy or C-section incision. No matter what kind of birth experience you had, it&rsquo;s important to take good care of yourself now so that you can heal properly. In this article, we&rsquo;ll talk about what happens to your body after giving birth and how best to care for yourself during the recovery process. 
&nbsp;

Post baby body

After giving birth, your uterus will become smaller and return to the shape it had before you became pregnant. This process can take up to six weeks, but it can happen faster if you have a cesarean section or if you have your baby naturally (vaginally). 
&nbsp;

You&rsquo;ll lose weight and muscle mass which can cause you to look different than you did before your pregnancy.

Your breasts will lose some of their volume as breast tissue shrinks. Your uterus will shrink back down to its pre-pregnant size as well.

You&rsquo;ll also notice that your stomach is flatter and less rounded than it was before delivering your baby. Your hair will likely grow back first, followed by another six months or so until any other changes are noticeable. 
&nbsp;

You may have cramping and pain. This can be uncomfortable, but it&rsquo;s a normal part of healing after delivery.

You may have a fever. This usually starts about 48 hours after birth and will go away on its own within a week or so as your body heals. It can also happen if you are breastfeeding and the baby has thrush (an infection of yeast in their mouth). If your temperature goes above 100 degrees Fahrenheit (37 degrees Celsius), <a href="https://merisehat.pk/doctor-now" target="_blank">call your doctor</a> right away!

A fever could mean that you had an infection during pregnancy or while giving birth (puerperal sepsis) and need antibiotics right away; this is highly unlikely unless you have symptoms such as chills, shaking/shivering, nausea/vomiting with diarrhea, and headaches. 
&nbsp;

This is normal and it will pass. Your body is dealing with a lot of changes, including lower blood pressure and blood sugar levels. 
&nbsp;

When you&rsquo;re ready to start exercising again, it&rsquo;s important that you consult your physician first. Many women think they can immediately resume their normal exercise routine after giving birth, but this isn&rsquo;t always the case. You need a postpartum check-up with your doctor before jumping into any rigorous workouts.

The good news is that most doctors will want to see you after just one week of rest and recovery (or sooner if there are complications). They&rsquo;ll assess how much weight you&rsquo;ve lost since giving birth, as well as take note of any pain or discomfort in your pelvic area and abdomen. If everything looks good, then they&rsquo;ll likely give the go-ahead for some light exercise like walking on flat surfaces with support from family members or friends until things feel better &mdash; and then maybe even invite some gentle stretching movements back into play! But don&rsquo;t worry too much if these tips aren&rsquo;t enough; talk with your physician about what activities would be safe for someone recovering from childbirth before getting started yourself! 
&nbsp;

The stitches will feel uncomfortable when you go to the bathroom. You can take painkillers to relieve the discomfort, but if that doesn&rsquo;t help, talk to your doctor about stronger medications.

You may also feel some discomfort from gas and bloating, which happens because of all the food your body has been absorbing in preparation for breastfeeding. In order to minimise these side effects, it&rsquo;s important not to eat anything for a few hours before feeding your baby&mdash;and make sure that whatever you do eat is high in fibre and low on fat. 
&nbsp;

Postpartum bleeding (lochia) may last for several weeks after delivery. Lochia is the normal discharge that comes from the vagina after giving birth, and it contains blood, mucus and tissue from the lining of your uterus. The amount of blood varies greatly among women, but most new mothers can expect to see some sort of discharge for six weeks or so after giving birth.

If you experience heavy bleeding more than two weeks after giving birth, contact your doctor immediately. 
&nbsp;

To avoid infection, you&rsquo;ll want to:

<ul>
	<li>Take a shower or bath</li>
	<li>Change your pads frequently, especially if they&rsquo;re not waterproof</li>
	<li>Wash and dry yourself well in the genital area after using the bathroom. If you have stitches, use medicine that has been prescribed by your doctor for cleansing stitches 
	&nbsp;</li>
</ul>

Eat healthy food that is high in protein and low in fat (a few small meals throughout the day), such as peas, beans, and fish (not red meat). Avoid junk foods like chips or chocolate bars; they won&rsquo;t give you much nutritional value.&nbsp;

Get plenty of rest so your body can repair itself from all those intense contractions during labor; don&rsquo;t worry about taking naps &mdash; it&rsquo;s okay to sleep whenever it&rsquo;s easy for you. If you feel tired during the day, try lying down on a couch instead of sitting up straight at a desk or table. 
&nbsp;

We hope you feel more prepared for what is to come. It can be overwhelming, but the best thing to remember is that your body knows what it&rsquo;s doing and will get back to normal soon enough. If you have any concerns about your health or recovery, don&rsquo;t hesitate to talk with your doctor!

Umna Salah

Humza Khizer

Baby Blues (Postpartum Depression): Is There A New Treatment?

The entire process of pregnancy is very rewarding, but what happens after you have delivered the baby? Your body that has gone through so many constant changes over the 9 months, reverses them all to get you back to normal. This process often leads to postpartum <a href="https://www.merisehat.pk/disease/depression">depression</a>.

About 11% of women in the United States suffer from postpartum depression (PPD).<a href="#accordion">[4]</a>&nbsp;PPD affects not just the life of the mother but also the infant. If left untreated, it can get worse and affect your spouse or other people close to you. So far, the treatment used for PPD has been very generic; similar to that of major depressive episode (MDE) consisting of conventional antidepressants like SSRIs, benzodiazepines, and tricyclic antidepressants. FDA has recently approved the first-ever drug targeted toward treating postpartum depression. 
&nbsp;

Understanding The Latest Treatment For Postpartum Depression

Postpartum depression is best explained as a worsened form of postpartum blues or baby blues. Baby blues are experienced a few days after delivery. Some new moms, however, experience a much more severe case of baby blues that can be classified as postpartum depression and it can go on for over a year.<a href="#accordion">[8]</a>&nbsp;PPD is characterized by:

<ul>
	<li>Feeling depressed and low</li>
	<li>Sleeping too little or too much</li>
	<li>Feeling tired all the time</li>
	<li>Doubting yourself as a mother</li>
	<li>Thinking that you do not want the baby</li>
	<li>Excessive crying</li>
	<li>Loss of appetite</li>
	<li>Anxiety and panic attacks&nbsp;</li>
	<li>Thoughts of harming yourself or the baby</li>
	<li>Unable to think clearly or make the right decisions</li>
	<li>Increased anger and irritability</li>
	<li>Overall reduced interest in everything</li>
</ul>

If you or anyone that you know are facing any of these symptoms, immediately contact your physician and get yourself screened through the Edinburg Postnatal Depression Scale (EPDS). It is one of the most common and quickest screening tools with high accuracy and allows your physician to assess the situation better through the score.&nbsp; 
&nbsp;

A lot of factors contribute to postpartum depression.The biggest factor that is not only responsible for PPD but also for the baby blues is the drastic change in hormones. During pregnancy, your estrogen and progesterone levels are very high. As soon as the baby is delivered, these levels are dropped drastically.

Since estrogen is directly linked to increasing serotonin levels in our brain&nbsp;and progesterone is known for stimulating dopamine release, the decrease in the production of these hormones coupled with some underlying mental issues or previous history of depression or anxiety becomes the most common and the biggest cause of PPD.<a href="#accordion">[2][3][7]</a> 
&nbsp;

While screening of postpartum depression can be done by several tools that are used for Major Depressive Episodes (MDE), the most universally acceptable tool targeted especially for PPD is Edinburgh Postnatal Depression Scale or EDPS. EDPS is a 10-item questionnaire with a response score of 0 to 3. If the total score is over 12, then there is a need for further in-depth assessment of the situation and severity of the condition.&nbsp;

PPD is best diagnosed by your medical practitioner through regular visits. Your doctor asks a series of questions every few days to assess your mental health and well-being. Another way to differentiate PPD from baby blues is to ensure that the patient has at least 3-5 of the symptoms that make up PPD. The generalized diagnostic criteria used for PPD are similar to the one used for Major Depressive Episode (MDE). Immediate attention is recommended to avoid any worsening of the symptoms and from transitioning of PPD to postpartum psychosis. 
&nbsp;

So far, the treatment of postpartum depression is similar to that of conventional major depressive disorder. Special attention is paid to the excretion of the drug and the concentration of the drug removed from the body through breast milk.

The following antidepressants are commonly used to treat postpartum depression due to their low levels of excretion in breast milk, making it safe for use if you are a breastfeeding mother:

<ul>
</ul>

<ul>
	<li>Fluoxetine</li>
	<li>Paroxetine</li>
	<li>Sertraline</li>
	<li>Bupropion</li>
	<li>Amitriptyline</li>
	<li>Doxepin</li>
	<li>Desipramine</li>
	<li>Tranylcypromine</li>
	<li>Trimipramine</li>
	<li>Desipramine</li>
	<li>Paroxetine</li>
	<li>Escitalopram</li>
</ul>

These antidepressants come with some common side effects that include nausea, vomiting, dizziness, sexual issues, diarrhea, blurry vision, weight gain, increased perspiration, etc.<a href="#accordion">[6]</a> 
&nbsp;

Brexanolone (under the brand name of Zulresso) got approved by the FDA as the first drug targeted toward PPD. Brexanolone is approved with a Risk Evaluation and Mitigation Strategy (REMS) which means that it is currently a controlled medicine available through a restricted distribution channel to carefully assess the conditions of the patients throughout the treatment. The program is currently known as Zulresso REMS Program.<a href="#accordion">[5]</a>&nbsp;Currently, to get Brexanolone administered to you for treating your PPD, you are required to enroll in the Zulresso REMS program.&nbsp; 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>Mechanism Of Action</h5>
	</li>
</ul>

Brexanolone is a synthetic form of allopregnanolone. Allopregnanolone is a neurosteroid. Neuroactive steroids are a group of substances that change a receptor&rsquo;s response to a stimulus by binding to them.<a href="#accordion">[4]</a>&nbsp;Allopregnanolone is best understood as a metabolite of progesterone, which is a GABA-A receptor agonist. This means that progesterone is responsible for increasing GABA functions.

The exact mechanism of the drug and of allopregnanolone is still unknown. Their enhancement of the functions of GABA (Gamma-aminobutyric acid) means that it will inhibit neuronal excitability by blocking messages that are sent to our nervous system with the help of certain stimuli. This not only aids in dealing with depressive triggers but also helps with anxiety.<a href="#accordion">[1]</a> 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>Dosage And Administration</h5>
	</li>
</ul>

Zulresso is administered intravenously. The dosage is determined by your doctor based on your weight and other factors. The drug is administered over a period of 2.5 days or 60 hours and requires constant monitoring due to the risk of unconsciousness.<a href="#accordion">[5]</a> 
&nbsp;

<ul dir="ltr">
	<li>
	<h5 dir="ltr">Adverse Effects</h5>
	</li>
</ul>

Since the drug is relatively new, there are a limited number of side effects reported so far. They include:

<ul>
	<li>Dry mouth</li>
	<li>Dizziness</li>
	<li>Flushed skin</li>
	<li>Losing consciousness</li>
</ul>

<h5 dir="ltr">Important!</h5>

FDA has advised to stop the treatment of Zulresso if more serious side effects occur that may include the worsening of PPD and suicidal thoughts especially in women under the age of 25. 
&nbsp;

Current research suggests that brexanolone may interact with other CNS depressants like opioids and benzodiazepines and increase the severity of the adverse effects with regard to sedation. Alcohol consumption is also not advised due to similar reasons.

During the clinical trials, patients who were taking antidepressants also showed a more severe case of sedation as compared to the ones who did not or were a part of the placebo studies. 
&nbsp;

Conclusion

Considering the rapid onset of action with brexanolone especially when compared to the long-term treatments offered by conventional antidepressants, it is believed that brexanolone can take over the go-to therapy for PPD. However, a much more convenient way of administration would be through oral pills instead of I/V. There are still many concerns left that can only be answered through long-term data in a lesser restricted environment as opposed to a clinical trial setting.&nbsp; 
&nbsp;

Key Points

<ul>
</ul>

<ul>
	<li>Current antidepressant therapies employed for PPD are based on&nbsp;long-term treatment.</li>
	<li>Brexanolone&rsquo;s onset of action is fast and has shown significant improvement in women of all ages suffering from PPD.</li>
	<li>Some women under the age of 25 were observed to experience severe side effects that even led to the worsening of their PPD.</li>
	<li>The drug is still under strict observation with the help of the REMS program.</li>
	<li>Administration coupled with the duration over which it has to be administered can make it difficult to commercialize as compared to drugs that are available in the form of oral pills.&nbsp;</li>
</ul>

[1] Allen B, Vespa PM. Antiseizure medications in critical care: An update. Curr Opin Crit Care. 2019;25(2):117-125

[2] ATP Science, 2021. HOW DOES PROGESTERONE CREATE A DOPAMINERGIC RESPONSE?. [Online] .

[3] Debra Fulghum Bruce, P., 2020. Postpartum Depression. [Online].

[4] Fala, L., 2019. Approved by the FDA Specifically for Postpartum Depression in Adults. [Online]

[5] Federal Drug Administration, 2019. FDA approves first treatment for post-partum depression. [Online]

[6] Fields, L., 2021. Which Antidepressants Treat Postpartum Depression?. [Online]

[7] Matthew Hoffman, M., 2021. Estrogen and Women's Emotions. [Online]

[8] Mayo Clinic, 2022. Postpartum depression. [Online]

Getting Back To Working Out After Giving Birth

The weeks after one&rsquo;s delivery can be as stressful as they are joyous. Newborn babies need constant attention and it&rsquo;s difficult to take out time to care for oneself. When the baby is down for a nap, it&rsquo;s our chance to get some sleep too or catch up on chores. Naturally, there&rsquo;s very little time or mental space for fitness and physical activity. Plus, there&rsquo;s the physical exhaustion that comes with long nights and breastfeeding. 
However, taking care of our bodies is essential to recovering quickly from pregnancy and childbirth. Taking time out for fitness enables us to better manage the stressors that come with a newborn baby, both physically and emotionally. This, in turn, ensures that we are able to enjoy the joys of new motherhood as well.

<div>&nbsp;</div>

time to recover body

As a new mother, it&rsquo;s important to ensure that you are consuming all of the nutrients that are essential to your health and recovery. If you are breastfeeding, it is even more important that you consume a nutritious diet.&nbsp;

Try to include a good amount of protein in your diet, as well as good fats and essential fatty acids. Eating a sufficient amount of carbs will give you the energy you need to keep up with your baby. Make sure to include fruits and nutrients in your diet as they are an important source of <a href="https://merisehat.pk/article/a-guide-to-essential-vitamins-and-micronutrients-and-should-you-be-taking-them">micronutrients and fibre</a>.&nbsp;

If you have a straightforward vaginal delivery, you can start with gentle movement in the form of short walks as soon as the day you deliver; however, you will have to wait till your epidural has been taken out. If you delivered via a caesarean or faced postpartum complications, you may have to wait a few extra days to give your body time to recover.&nbsp; 
&nbsp;

<h5>Moderate Walking</h5>

Easy to moderate walking is the best way to start moving after childbirth. You can start with just 20 minutes a day and gently build up to half an hour over the course of four to six weeks. Consider breaking up your walks into several walks a day to avoid tiring yourself out and being able to fit them in more easily into your newborn&rsquo;s routine. You could start with two 10-minute walks a day, build that up to two 12-minute walks after a few days and so on. Walking burns calories, while also strengthening muscles and joints, and improving blood circulation. 
&nbsp;

<h5>Postpartum Exercises</h5>

Incorporate gentle postpartum exercises and stretches into your routine in the first few weeks after a delivery. There is a lot of information online about safe postpartum exercises. You can look some up and aim to do them for five minutes a day. YouTube videos focused on postpartum exercises can also be easy to follow along, and if you&rsquo;d like the opportunity to get out of the house, a postpartum exercise or yoga class might just be the thing for you. As with walking, start with just a few minutes a day and slowly build up as your body adjusts.

Your pelvic floor and core tend to be particularly weak after childbirth. Before you move onto high-impact exercises, it is important to build some strength in these parts of the body. You can start doing gentle pelvic exercises, like kegels and pelvic tilts in the first week after your delivery. Aim to do them for about five minutes at a time, up to three times a day. Again, there&rsquo;s no need to do long sessions and tire yourself out. Fitting in smaller movement sessions throughout the day will ensure that you are able to be consistent and don&rsquo;t end up pushing yourself too much.

About a month after childbirth, you can start exercising core exercises into your routine. Again, this also depends on what kind of delivery you&rsquo;ve had and whether you faced any complications during or after. Once again, incorporate a few minutes of core work into your daily movement sessions and break it up into two to three sessions a day.&nbsp; 
&nbsp;

<h5>As A Rule Of Thumb</h5>

You should wait at least six weeks after childbirth to get into high-impact exercises. It&rsquo;s important to prepare your body in the preceding weeks and to also take it slow when you do start with higher impact movement. Make sure to consult your doctor and get their okay beforehand. Even at this stage, start slowly and listen to your body. There&rsquo;s no need to push forward from the get go. What&rsquo;s important is that you maintain consistency and build up in a manner that is doable for you. 
&nbsp;

It&rsquo;s easy to forget to take care of ourselves in the first few months after childbirth. But we need to remember that we need as much love and care as our newborn babies do. Being kind to yourself and patient with your body is especially important after a delivery. Remember, the healthier you feel, the better you&rsquo;ll be able to enjoy the time you get with your newborn!

Ayesha Binte Rashid

Online Consultation

Ismail Munir

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

Know Your Blood Pressure Numbers

Introduction

Blood pressure refers to the force applied by the flowing blood against the walls of the body&#39;s arteries<a href="#accordion">[1]</a>.&nbsp;Not only does this force help supply organs with oxygen and nutrients but also white blood cells and antibodies for immunity, and hormones like insulin<a href="#accordion">[2]</a>. Moreover, along with transporting oxygen and nutrients, blood pressure also plays a role in removing harmful metabolic end products, including carbon dioxide and other toxins cleared from the liver and kidneys.&nbsp; 
&nbsp;

Understanding blood pressure readings

When blood pressure exceeds the normal range, it is called <a href="https://www.merisehat.pk/disease/hypertension-57">hypertension</a>. Blood pressure is composed of a pair of numbers. The first (systolic) number represents the blood vessels&#39; pressure when the heart contracts. The second (diastolic) number is associated with the pressure in the vessels when the heart rests in between the beats<a href="#accordion">[1]</a>.&nbsp;The combination of the two allows doctors and health professionals to gauge the overall well-being of an individual. 
&nbsp;

Mild and temporary fluctuations in blood pressure are normal and can be triggered due to a myriad of reasons. However, if an individual deviates from the normal range for a chronic period, then that may indicate a deeper and more complex medical condition, and should be further explored by a licensed practitioner. To analyze quantitively, blood pressure has been categorized into five categories<a href="#accordion">[3]</a>. 
&nbsp;

<h5>Normal Range</h5>

The first range of blood pressure is defined as the normal range and is expected from every healthy individual. Numbers under 120/80mmHg are viewed as normal<a href="#accordion">[4].</a>&nbsp;Activities that encourage and support the heart&rsquo;s rhythmic motions, such as a well-balanced healthy diet and physical activity can help maintain the blood pressure in the normal range<a href="#accordion">[4]</a>. 
&nbsp;

At birth, the blood pressure stays at 64/40mmHg and then rises to 120/80mmHg as one reaches adulthood<a href="#accordion">[3]</a>. Several factors, both natural and human-induced, can then cause the blood pressure to fluctuate. For example, checking the blood pressure after delivering a fervent speech or running a marathon will likely give a high reading. This is perfectly normal as the increased adrenaline levels cause the body to increase the blood pressure, and supply the heart with more oxygen for fight or flight events<a href="#accordion">[3]</a>.&nbsp;

&nbsp;

<h5>Elevated Levels</h5>

This is a warning stage to alarm patients and usher them into hypertension treatment before it is exacerbated. Elevated levels are denoted by persistent high blood pressure readings. A doctor is likely to investigate for differential diagnosis if the systolic blood pressure is in the range of 120-129mmHg and the diastolic is less than 80mmHg<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

Individuals who constantly have elevated levels of blood pressure are more vulnerable and at risk of developing various coronary diseases early in their life<a href="#accordion">[5]</a>. An aneurysm is an abnormal bulge in the blood vessel wall that can result from prolonged and unattended elevated levels of blood pressure. Elevated blood pressure levels also increase the risk of cardiovascular failure. Moreover, damage to the renal vessels can affect healthy kidney functioning. Since little veins in the eyes are particularly defenseless against harm, hypertension can also prompt vision issues and even visual impairment<a href="#accordion">[4]</a>.&nbsp; 
&nbsp;

<h5>Hypertension Stage I</h5>

If not addressed, then elevated levels can deteriorate to advanced stages of hypertension. Stage 1 is defined by consistently high blood pressure levels of systolic 130-139mmHg and diastolic 80-89mmHg<a href="#accordion">[3]</a>. At this phase of hypertension, specialists endorse and stress a reconsideration of routine activities and life changes. They may also prescribe blood pressure medications based on the individual&#39;s risk of developing an atherosclerotic cardiovascular disease (ASCVD), such as a heart attack or a stroke<a href="#accordion">[3]</a>.&nbsp;&nbsp; 
&nbsp;

<h5>Hypertension Stage II</h5>

If treatment for hypertension stage 1 does not prove to be successful, then the individual is likely to progress to hypertension stage 2. Hypertension stage 2 is defined as blood pressure readings of 140/90mmHg or higher<a href="#accordion">[3]</a>. At this stage, specialists will probably recommend lifestyle changes and alternatives to the previously prescribed blood pressure prescriptions While treating a patient with stage 2 hypertension, the clinician should decide on the proper blood pressure (BP) objective, select the underlying anti-hypertensive routine, and change that routine, as required, to accomplish the objective BP. Likewise, the clinician ought to think about the effect of the treatment routine on both the patient&#39;s consistency with treatment and long-term risk for cardiovascular disease (CVD)<a href="#accordion">[6]</a>.&nbsp;

&nbsp;

If an individual has a history of high blood pressure, then they may be more likely to develop a hypertensive crisis. This phase of hypertension necessitates immediate and proper medical assistance. Therefore, it is important not to delay treatment. If during a routine blood pressure check, the readings out of nowhere surpass 180/120mmHg, try not to panic. Take a deep breath, wait for five minutes, and afterwards test the blood pressure once more. However, if the readings are bizarrely high twice in a row, immediately contact a hospital or a doctor<a href="#accordion">[3]</a>. Such high levels could indicate that the person is going through a hypertensive crisis.&nbsp; 
&nbsp;

Moreover, with the blood pressure reading being higher than 180/120mmHg the individual might witness other alarming and distressing symptoms. These suggest signs of conceivable organ harm<a href="#accordion">[7]</a>. They may range from chest pain to difficulty in breathing, body numbness and pain (especially in the back), visible change in vision, and communication problems. If these accompany the blood pressure readings, then an individual should not hesitate or wait for the shortness of breath to pass away, and immediately call for medical help<a href="#accordion">[7]</a>.

&nbsp;

<h4>"Stay on top of your blood pressure reading with our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a>!"</h4>

To maintain the blood pressure (BP) goal according to the individual&rsquo;s age, health, and stage, the patient must regularly monitor their readings for comparison and to confirm if the advised treatment is leading to any progress or not. Realistically, it is neither economical nor feasible to expect an individual to travel great lengths, and pay hefty consultation fees for a quotidian blood pressure reading. Therefore, a doctor may suggest investing in a home blood pressure monitor. 
&nbsp;

A home blood pressure apparatus is a more accessible and economical alternative than rushing to the hospital each day. Moreover, a patient does not require a doctor&#39;s prescription to purchase one. Thus, increasing its prevalence in every home. However, it should be stated that home blood pressure observation is not a substitute for visits to the primary care physician for more serious concerns and complications that might arise due to hypertension. Additionally, home blood pressure apparatuses might have a few shortcomings of their own<a href="#accordion">[7].</a> However, these can be avoided if the individual makes an informed purchase.&nbsp; 
&nbsp;

Don&#39;t hesitate to venture onto the world wide web and gather all necessary specifications before buying a home blood pressure monitor. You can even bother a doctor for suggestions for a reliable and approved gadget. Make sure to be diligent with the yearly check-ups of the apparatus. For the inauguration, bring it to the doctor&#39;s office and request a doctor or nursing staff to teach you the proper method of checking blood pressure at home. This will help guarantee correct readings<a href="#accordion">[7]</a>.&nbsp;

&nbsp;

Hypertension is a gateway to permanent damage and life-long complications. Therefore, it is important to understand the different stages of high blood pressure and the method to monitor it. The predominance of hypertension with increasing age is a result of the gradual rise in systolic blood pressure. 
&nbsp;

Systolic hypertension is the most common type of hypertension in people older than 50 years and reflects the pathologic decline in the blood vessel and arterial compliance<a href="#accordion">[6]</a>. The increase in systolic blood pressure is a more significant risk factor for cardiovascular disease than diastolic blood pressure rise. However, both should be regulated through prescribed treatments and lifestyle changes.

&nbsp;

While hypertension covers a range of sub-topics, it is important to remember that: 
&nbsp;

<ul>
	<li>Hypertension results from the normal blood pressure rising consistently. Blood pressure is measured through a pair of readings: systolic and diastolic.</li>
	<li>Systolic blood pressure results from the heart contracting, while diastolic pressure develops when the heart relaxes.</li>
	<li>The normal range of blood pressure is less than 120mmHg for systolic, and less than 80mmHg for diastolic.</li>
	<li>Elevated levels are defined as a systolic reading of 120-129mmHg and diastolic pressures of less than 80mmHg.</li>
	<li>Hypertension Stage 1 has blood pressure readings of 130-139mmHg and 80-89mmHg for systolic and diastolic respectively.&nbsp;</li>
	<li>Hypertension Stage 2 has blood pressure readings of 140mmHg or higher for systolic and 90mmHg or higher for diastolic.&nbsp;</li>
	<li>During a hypertensive crisis, systolic readings soar above 180mmHg while diastolic readings are higher than 120mmHg. This requires immediate medical attention.</li>
</ul>

&nbsp;

[1].World Health Organization (WHO). (2021, August 25). Hypertension. Retrieved from World Health Organization (WHO)

[2].Weatherspoon, D. (2022, March 20). What is a normal blood pressure reading? Retrieved from Medical News Today:

[3].American Heart Association. (2022). Understanding Blood Pressure Readings. Retrieved from American Heart Association:

[4].Jaret, P. (2021, September 17). High Blood Pressure. Retrieved from WebMD:

[5].Chobani, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., IzzoJr, J. L., . . . Rocella, E. J. (2003). Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension, Vol. 42, No. 6, 1206-1252

[6].Giles, T. D., & Materson, B. J. (2005). Treating stage 2 hypertension. Journal of clinical hypertension (Greenwich, Conn.), 7(8), 464–470.

[7].Mayo Clinic. (2021, July 1). High blood pressure (hypertension). Retrieved from Mayo Clinic:

Zarlish Kazmi

Iqra Mazhar

Insulin And Postpartum

The postpartum period refers to the time after you give birth. Your hormonal levels will be fluctuating as your body recovers from the physical and emotional toll of the pregnancy. You&rsquo;ll probably be overwhelmed by all sorts of emotions during this period.

Besides mood, these changes can affect your blood sugar regulation, particularly if you had <a href="https://merisehat.pk/disease/diabetes-gestational">gestational diabetes</a>. However, you can have postpartum diabetes even if you did not have gestational diabetes. 
&nbsp;

Around 2-10% of all pregnant women in the US have gestational diabetes<a href="#accordion">[1]</a>. The condition often shows up during the middle of pregnancy when the placenta produces hormones that prevent the body from efficiently using insulin. Consequently, glucose concentrates in the blood rather than being absorbed by the cells.

The best thing to do after the diagnosis of gestational diabetes is to look after yourself as much as possible. It&rsquo;s crucial to monitor blood glucose during labor and birth. While eating healthy and staying active during pregnancy can help control blood sugar levels, you may need to take insulin as well to control your blood sugar levels and avoid complications, like preeclampsia and birth defects, for you and your baby. 
&nbsp;

Insulin can be injected via pen or syringe and it&rsquo;s generally safe to use as prescribed by your doctor. Using too much insulin or skipping a meal, however, may cause hypoglycemia which can be dangerous for both you and your baby.

Note: If you have type 1 or type 2 diabetes, refer to a professional doctor before getting pregnant as uncontrolled gestational diabetes is not safe for your baby. Moreover, several diabetes tablets are not safe to be taken during pregnancy so your doctor can guide you regarding insulin injections<a href="#accordion">[2]</a>. 
&nbsp;

Understanding the importance of insulin in pregnancy

If you were diagnosed with gestational diabetes, it&rsquo;s important that you get tested for diabetes after delivery. Your doctor will order regular glucose checking for a few days after delivery, usually before breakfast and two hours after meals, to ensure your glucose levels are within the normal range. An oral glucose tolerance test is recommended 6-12 weeks after birth<a href="#accordion">[2]</a>. 
&nbsp;

If your blood glucose level is:

<ul>
	<li>Normal &ndash; Get checked every three years</li>
	<li>Pre-Diabetes &ndash; Get checked every year; talk to your doctor about minimizing your risk of diabetes</li>
	<li>Diabetes &ndash; Consult your doctor and set up a treatment plan 
	&nbsp;</li>
</ul>

The symptoms of gestational diabetes usually disappear in the postpartum period as blood sugar levels return to normal after labor and any medications, including insulin, will be stopped after your baby is born. But it&rsquo;s also possible that it progresses to type 2 diabetes. Around 50% of women with gestational diabetes develop type 2 diabetes<a href="#accordion">[1]</a>. 
&nbsp;

Getting checked helps because type 2 diabetes presents few symptoms during the early stages of the disease. With a timely diagnosis, you can prevent or delay the development of type 2 diabetes by continuing with your treatment, eating healthily, and avoiding a sedentary lifestyle.

Note: For future pregnancies, make sure to inform your healthcare team about your history of gestational diabetes. 
&nbsp;

According to the American Diabetes Association, breastfeeding can help you manage your diabetes<a href="#accordion">[3]</a>.

For the baby, breastfeeding for the first six months at least means a reduced risk of developing type 1 diabetes, obesity leading to type 2 diabetes, and other health issues like eczema and respiratory disease. For the mother, benefits include a lower risk of developing health conditions like breast and ovarian cancers and type 2 diabetes in addition to a quicker recovery after birth. 
&nbsp;

That said, is it safe to take insulin while breastfeeding your newborn? Yes, it is<a href="#accordion">[3]</a>. This is because insulin molecules are large enough to not pass through the breast milk to the baby.

However, the dose needs to be adjusted accordingly after the pregnancy and, again, during breastfeeding. Ideally, the blood sugar level while breastfeeding should be between 90 and 180 mg/dL.

These levels may drop during breastfeeding, a condition known as hypoglycemia, so you should eat before each session to keep the glucose levels stable. And check your blood glucose levels every time before and after nursing. 
&nbsp;

<ul>
	<li>Gestational diabetes goes away soon after birth in the majority of cases. This is because of a drop in pregnancy hormones and the insulin resistance associated with them.</li>
	<li>If you have had gestational diabetes or are at risk of postpartum diabetes, you should monitor your blood sugar regularly during the postpartum period.</li>
	<li>Breastfeeding may help reduce insulin and blood sugar levels after birth.</li>
	<li>If you started taking insulin during pregnancy, it may be stopped after childbirth. But, depending on your blood glucose levels, you may have to restart insulin again.</li>
	<li>If you were taking insulin before pregnancy, you will most probably continue to do so. However, the dosage and the type of insulin may be reviewed by your doctor.</li>
	<li>Lifestyle recommendations may further help prevent developing type 2 diabetes. 
	&nbsp;</li>
</ul>

[1] Gestational diabetes. Centers for Disease Control and Prevention.

[2] Department of Health &amp; Human Services. Diabetes - gestational. Better Health Channel.

[3] Diabetes and breastfeeding. Diabetes and Breastfeeding | ADA

Shermeen Zuberi

Hypertension And Heart Attack

Your heart is responsible for pumping blood around your body. The pressure with which your blood pushes against the walls of the blood vessels continually changes. When your heart is relaxed, this pressure will be low. When your heart is squeezing the blood into arteries, this pressure will increase.

Your blood pressure reading is a measurement of the highest (systolic) and lowest (diastolic) recorded pressure. Normal blood pressure is less than 120/80 mmHg<a href="#accordion">[1]</a>. 
&nbsp;

High blood pressure or hypertension occurs when:

<ul>
	<li>Either the first number (systolic pressure) is above 140 mmHg</li>
	<li>Or the second number (diastolic pressure) is above 90 mmHg</li>
	<li>Or both 
	&nbsp;</li>
</ul>

Your blood pressure may vary at different times of the day depending on your activity and general health. Generally, high blood pressure is diagnosed if your readings on two separate days are higher than 140/90 mmHg.

It&rsquo;s important to monitor your blood pressure on a regular basis as high blood pressure can affect your blood flow to the organs. The higher the pressure, the greater the risk of complications. Often, it continues to damage the body quietly, without any symptoms. 
&nbsp;

Note: This limit (140/90 mmHg or higher) is based on 2003 guidelines. Some doctors diagnose high blood pressure when a patient consistently presents a reading of 130/80 mmHg or higher, as per the 2017 Guideline For The Prevention, Detection, Evaluation, And Management Of High Blood Pressure In Adults by the American College of Cardiology/American Heart Association<a href="#accordion">[1]</a>. 
&nbsp;

Understanding Hypertension and its risks

A heart attack occurs when the blood supply to your heart is blocked. The lack of oxygen causes the heart muscle to die. The longer the blood flow is blocked, the more damage it causes to your heart.

And where does hypertension fit in the picture? 
&nbsp;

A heart attack is basically a medical emergency due to high blood pressure. If your blood pressure is consistently high, you&rsquo;re at a higher risk of developing cardiovascular problems than those who don&rsquo;t.

<ul>
	<li>Additional Strain: Hypertension forces your heart to work harder to pump blood throughout your body. It weakens the heart muscle, contributing to the development of multiple heart-related conditions, including heart attack. 
	&nbsp;</li>
	<li>Atherosclerosis: Hypertension also causes the thickening of the walls of your blood vessels. The damage makes them more susceptible to blockages. A buildup of plaque (composed of cholesterol, fat, and other substances) in the artery causes the hardening or thickening of the arteries. This puts you at a higher risk of developing conditions like vascular dementia, kidney failure, heart attack, and stroke. 
	&nbsp;</li>
	<li><a href="https://merisehat.pk/disease/aortic-aneurysm">Aneurysm</a>: The increased pressure of the blood causes a section of the artery wall to enlarge and bulge out. While aneurysms can develop in any artery, they usually develop in the aorta. 
	&nbsp;</li>
	<li>Coronary Thrombosis: When the plaque ruptures, it can cause blood clots to form and block the blood flow. If it blocks the coronary arteries, it can trigger a heart attack. 
	&nbsp;</li>
</ul>

A heart attack is a life-threatening emergency. While symptoms vary from person to person, common warning signs include:

<ul>
	<li>Unexplained shortness of breath, with or without chest discomfort</li>
	<li>Chest discomfort (angina)</li>
	<li>Pain and discomfort extending beyond the chest to one or both arms, neck, jaw, teeth, stomach, and back</li>
	<li>Nausea or vomiting</li>
	<li>Anxiety</li>
	<li>Lightheadedness</li>
	<li>Cold sweats</li>
	<li>Indigestion</li>
	<li>Unexplained fatigue</li>
	<li>Coughing or wheezing</li>
	<li>Swelling in hands or feet 
	&nbsp;</li>
</ul>

Note: Seek medical attention immediately if you or a loved one has any of these symptoms. 
&nbsp;

Not all people who have a heart attack will experience intense pressure or pain to think they&rsquo;re having an episode and show due concern. In fact, some people have no symptoms at all. According to the American Heart Association, silent heart attacks make up about 20% of all heart attacks<a href="#accordion">[5]</a>.

They&rsquo;re pretty much the same as a heart attack, i.e., the heart muscle is deprived of oxygen and nutrients due to blockage, causing the person to feel pressure or pain, except that this time the problem goes unnoticed. 
&nbsp;

A general feeling of unease, for instance, that causes sleep disturbance at night should not be overlooked. Similarly, pain in the arm or shoulder should not be mistaken for simply an orthopedic issue. Sometimes, a pacemaker can disguise a heart attack as chest pain as well.

Rule of the thumb here is to see if this pain can be manipulated in some way. For instance, do you feel better if you change your position? If you experienced discomfort while you were sitting in a chair, does getting up and walking around improve or aggravate it? 
&nbsp;

The earlier this condition is identified and targeted, the better. According to a study, a silent heart attack is connected to a greater risk of heart failure<a href="#accordion">[5]</a>. 
&nbsp;

<ul>
	<li>Gender &ndash; Women have a greater risk because of high blood pressure during pregnancy, birth control pills containing estrogen, and depression. Women are thrice at risk of heart failure due to high blood pressure while men are twice as likely to get it<a href="#accordion">[3]</a>.</li>
	<li>Age &ndash; Men aged 45 or above and women aged 55 or above are at risk of having a high attack.</li>
	<li>Ethnicity &ndash; At least 3 out of 5 African American women have high blood pressure (&ge; 130/80 mmHg).</li>
	<li>Diet &ndash; Consuming more than the recommended amounts of salt and unhealthy fat raises blood pressure.</li>
	<li>Lifestyle &ndash; An unhealthy lifestyle choice, like not getting enough physical activity every day or smoking, also increases the risk of developing high blood pressure.</li>
	<li>Health &ndash; Certain health conditions, like obesity, sleep apnea, and diabetes, are major risk factors. A family history of heart disease may cause it, too. 
	&nbsp;</li>
</ul>

To reduce your risk of heart attack, you need to prevent and/or manage hypertension. This includes lifestyle changes mainly:

<ul>
	<li>Not smoking</li>
	<li>Relieve stress through meditation or yoga</li>
	<li>Quitting alcohol and smoking</li>
	<li>Maintaining a healthy weight</li>
	<li>Getting at least 30 minutes of physical activity every day</li>
	<li>Eating a healthy diet</li>
	<li>Monitoring cholesterol and diabetes closely and keeping their levels under control 
	&nbsp;</li>
</ul>

Your doctor may prescribe some medication (e.g., diuretics, vasodilators, beta-blockers, and calcium channel blockers) depending on your condition to help you control your blood pressure<a href="#accordion">[3]</a>. Do not change or stop medications without talking to your doctor. 
&nbsp;

Important!

All adults aged 18 and above should get their blood pressure checked every year. In case of the presence of risk factors, more frequent checkups may be needed<a href="#accordion">[2]</a>. 
&nbsp;

The global prevalence of hypertension is 26.4%. In particular, 1 in 3 US adults have hypertension with only 54% of these patients having adequate blood pressure control<a href="#accordion">[4]</a>. It requires constant surveillance to identify and slow the development of complications.

Always consult a healthcare professional if you think you have high blood pressure or a heart-related condition. They can recommend the appropriate preventive measures and treatment options to reduce your risk of heart attack. 
&nbsp;

[1] High blood pressure symptoms and causes. Centers for Disease Control and Prevention. May 18, 2021

[2] Hypertensive Heart Disease. Pennmedicine.

[3] Hypertensive heart disease: Symptoms, causes &amp; treatment. Cleveland Clinic.

[4] Tackling G, Borhade MB. Hypertensive Heart Disease.

[5] Nania R. How to recognize the signs of a silent heart attack. AARP.

Link Between Diabetes And Hypertension

According to the World Health Organization (WHO), diabetes and <a href="https://merisehat.pk/disease/hypertension-57">hypertension</a> are major public health concerns worldwide. The prevalence of both conditions has been increasing over the past few decades.

Data from the International Diabetes Federation (IDF) indicates that around 547 million adults have diabetes, which translates to 10.5% of the adult population<a href="#accordion">[1]</a>. The number is expected to rise to 783 million by 2045; this would be an increase of 46%<a href="#accordion">[1]</a>. Type 2 diabetes continues to be the predominant type of diabetes affecting people worldwide. The increasing prevalence of obesity, a sedentary lifestyle, and an aging population are all believed to be contributing factors to the rise in the prevalence of type 2 diabetes. 
&nbsp;

Approximately 3 in 4 adults with diabetes reside in middle- and low-income countries, such as Pakistan. As per estimates, 26.7% of Pakistani adults suffer from diabetes<a href="#accordion">[2]</a>. The country currently ranks third in the world in terms of diabetes prevalence.

Hypertension, on the other hand, affects an estimated 1.28 billion people globally, as reported by the WHO[3]. More than two-thirds of these people reside in middle- and low-income countries. 
&nbsp;

In Pakistan, the prevalence is 18%<a href="#accordion">[4]</a>. However, 70% of patients are unaware of their disease and only less than 3% have controlled hypertension<a href="#accordion">[4]</a>. This is quite alarming considering hypertension is a leading cause of mortality worldwide and accounts for 45% of deaths due to heart attacks<a href="#accordion">[5]</a>.

With the prevalence of both diabetes and hypertension increasing worldwide, the question arises - is there a link between the two chronic conditions? Is one leading to the other? Let&rsquo;s find out! 
&nbsp;

Understanding the link of Diabetes and Hypertension

Both diabetes and hypertension are common chronic diseases that often coexist in individuals, and their interaction can significantly increase the risk of cardiovascular complications and other health issues. Hypertension is twice as common in diabetics as in people who do not have diabetes<a href="#accordion">[6]</a>. Moreover, hypertension exacerbates the occurrence of cardiovascular disease in people with diabetes, which is a major cause of mortality and morbidity. 
&nbsp;

However, the two chronic conditions are interlinked in several ways<a href="#accordion">[6][7]</a>.

<ul>
	<li>Shared Risk Factors - Several risk factors contribute to the development of both diabetes and hypertension. Lifestyle factors such as unhealthy diet, physical inactivity, and obesity play a significant role in the development of these conditions. The &quot;Diabesity&quot; concept, which combines diabetes and obesity, emphasizes the strong connection between the two conditions and their mutual association with hypertension. Studies have shown that overweight and obesity increase the risk of developing both diabetes and hypertension. 
	&nbsp;</li>
	<li>Insulin Resistance And Hypertension - Insulin resistance is a key feature of type 2 diabetes, where the body&#39;s cells do not respond properly to insulin, leading to high blood sugar levels. Insulin resistance also has implications for blood pressure regulation. Research demonstrates that insulin resistance is linked to increased sympathetic nervous system activity, sodium retention, and altered vasodilation, all of which can contribute to hypertension. 
	&nbsp;</li>
	<li>Endothelial Dysfunction - Endothelial cells line the inner surface of blood vessels and play a crucial role in vascular health. In both diabetes and hypertension, there is evidence of endothelial dysfunction, which can lead to impaired blood flow regulation and promote the development of atherosclerosis. 
	&nbsp;</li>
	<li>Renin-Angiotensin-Aldosterone System (RAAS) - The RAAS is a hormonal system that regulates blood pressure and fluid balance. It has been implicated in the pathogenesis of both diabetes and hypertension. Hyperactivation of the RAAS can lead to vasoconstriction and sodium retention, contributing to increased blood pressure. Studies have demonstrated that components of the RAAS are dysregulated in both diabetes and hypertension. 
	&nbsp;</li>
	<li>Cardiovascular Complications - The combination of diabetes and hypertension significantly increases the risk of developing cardiovascular complications, such as coronary artery disease, stroke, and heart failure. Individuals with diabetes and hypertension had a substantially higher risk of cardiovascular events compared to those with either condition alone. 
	&nbsp;</li>
</ul>

Managing both diabetes and hypertension together requires careful consideration of treatment strategies. Some antihypertensive medications, such as thiazide diuretics and beta-blockers, may adversely affect glucose metabolism and insulin sensitivity. Therefore, individualized treatment plans that address both conditions while minimizing potential side effects are essential. 
&nbsp;

In conclusion, diabetes and hypertension share common risk factors and pathophysiological mechanisms, which contribute to their frequent coexistence in individuals. Their interaction significantly increases the risk of cardiovascular complications and underscores the importance of comprehensive management for individuals with both conditions. Regular medical check-ups, lifestyle modifications, and appropriate medications are crucial in effectively managing these two chronic diseases together. 
&nbsp;

[1] Facts & Figures. International Diabetes Federation.

[2] Azeem S, Khan U, Liaquat A. The increasing rate of diabetes in Pakistan: A silent killer. Ann Med Surg (Lond). 2022;79:103901. Published 2022 Jun 3. doi:10.1016/j.amsu.2022.103901

[3] Hypertension. World Health Organization.

[4] Akram M, et al. (2023). Prevalence of Hypertension and Associated Co-Morbidities in Pakistan. Mathews J Nurs. 5(1):11.

[5] Riaz M, Shah G, Asif M, Shah A, Adhikari K, Abu-Shaheen A. Factors associated with hypertension in Pakistan: A systematic review and meta-analysis. PLoS One. 2021;16(1):e0246085. Published 2021 Jan 29. doi:10.1371/journal.pone.0246085

[6] Petrie JR, Guzik TJ, Touyz RM. Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms. Can J Cardiol. 2018;34(5):575-584. doi:10.1016/j.cjca.2017.12.005

[7] Berbari, A.E., Daouk, N.A., Nasr, E.M. (2023). Coexistence of Diabetes Mellitus and Hypertension. In: Berbari, A.E., Mancia, G. (eds) Blood Pressure Disorders in Diabetes Mellitus. Updates in Hypertension and Cardiovascular Protection. Springer, Cham. doi:10.1007/978-3-031-13009-0_1

Nimrah H. Sattar

Everything You Need To Know About Hypertension And Dementia

Why do some people with high blood pressure end up having memory problems later in life? High blood pressure and memory loss and thinking problems might seem like unrelated pieces, but they share a surprising connection. 
 
&nbsp;

Blood pressure refers to the pressure exerted by blood on the walls of the arteries during the heart&#39;s pumping action, circulating blood throughout the body.

Blood pressure around 120/80 mmHg is usually considered normal. When this pressure is consistently high, above 140/90 mmHg, it is known as hypertension. It is estimated that by 2025, 1.6 billion people around the world will have hypertension.<a href="#accordion">[1]</a>

Hypertension may not have distinct signs and symptoms. But it can strain the heart and blood vessels and cause various health problems. For instance, according to research, women with hypertension in their 40s are at high risk of developing dementia.<a href="#accordion">[6]</a> 
&nbsp;

Dementia is not a specific disease but rather a term used to describe a group of symptoms affecting memory, thinking, and social abilities severely enough to interfere with daily functioning. 
&nbsp;

Understanding the link between hypertension and dementia

First and foremost, hypertension can damage blood vessels throughout the body, including those in the brain. It may cause the narrowing of arteries due to fat deposits (plaques), and the arterial walls may get thicker and stiffer.

The brain needs one quart of blood every minute on average to work efficiently.<a href="#accordion">[3]</a> Not only does hypertension impair blood flow to crucial areas of the brain, depriving it of oxygen and nutrients essential for proper function, but it also causes inflammation of the brain cells. As a result, the individual experiences cognitive decline over time.

According to one study, an early onset of hypertension (diagnosed before age 35) is associated with the greatest change in brain size and a greater likelihood of developing dementia as compared to those who have normal blood pressure.<a href="#accordion">[7]</a>

According to another study, the more an individual&rsquo;s blood pressure varies over 8 years, the more they are at risk of developing dementia.<a href="#accordion">[5]</a> 
&nbsp;

The good news is that certain preventive measures for hypertension can also help reduce the risk of dementia.

<ul>
	<li>Regularly monitor the blood pressure and work with a healthcare provider to keep it within a healthy range.</li>
	<li>Adopting a healthy lifestyle e.g. exercising regularly, eating a balanced diet and avoiding smoking. can lower blood pressure and reduce the risk of dementia.</li>
	<li>In particular, DASH and Mediterranean diets have proved effective in reducing blood pressure. Similarly, overweight or obese people who lose around 11 pounds can keep their blood pressure under control.<a href="#accordion">[5]</a></li>
	<li>If lifestyle changes alone are not sufficient to control hypertension, the healthcare provider may prescribe medications to help lower the blood pressure. 
	Existing antihypertensive medications, especially those that influence the renin-angiotensin hormone system (RAS), reduce the risk of dementia as well.<a href="#accordion">[2]</a> These drugs include valsartan, losartan, amlodipine, and hydrochlorothiazide.<a href="#accordion">[4]</a> 
	&nbsp;</li>
</ul>

While more research is needed to fully understand the link between hypertension and dementia, evidence suggests that controlling high blood pressure may help reduce the risk of developing dementia later in life. By adopting a healthy lifestyle and working closely with healthcare providers, individuals can take proactive steps to protect their cognitive health.

Key Takeaways

<ul>
	<li>Hypertension, or high blood pressure, is a condition where the force of blood against artery walls is consistently high.</li>
	<li>Dementia is not a single disease but a term used to describe a decline in cognitive abilities severe enough to interfere with daily life.</li>
	<li>Studies suggest a potential link between hypertension and an increased risk of developing dementia.</li>
	<li>High blood pressure may contribute to the formation of plaques, tangles, inflammation, and damage to brain cells, contributing to cognitive decline over time.</li>
	<li>Controlling high blood pressure through lifestyle changes, such as a healthy diet, regular exercise, maintaining a healthy weight, and avoiding smoking, can help reduce the risk of developing dementia.</li>
	<li>Regular check-ups with healthcare providers are essential for monitoring blood pressure levels and assessing overall health, especially for individuals at risk of hypertension and dementia.</li>
</ul>

[1] High blood pressure and the risk of dementia. Alzheimer’s Society. Accessed March 6, 2024.

[2] Zissimopoulos J, Thunell J, Garland H. Blood pressure medication and dementia prevention: The promising link. USC Schaeffer. October 26, 2023. Accessed March 6, 2024.

[3] Untreated hypertension can lead to memory loss by cutting down ... Accessed March 6, 2024

[4] Solan M. Some blood pressure drugs may lower dementia risk. Harvard Health. April 1, 2023. Accessed March 6, 2024.

[5] Blood pressure and alzheimer’s risk: What’s the connection? Johns Hopkins Medicine. March 10, 2022. Accessed March 6, 2024.

[6] High blood pressure in women linked to increased dementia risk. Alzheimer’s Research UK. Accessed March 6, 2024.

[7] Earlier onset of high blood pressure affects brain structure, may increase dementia risk. American Heart Association. Accessed March 6, 2024.

Pediatric Hypertension: Emerging Challenges And Treatment Strategies

In recent years, pediatric <a href="https://merisehat.pk/disease/hypertension">hypertension</a> has become a growing concern among healthcare professionals and parents alike.

At least 1 in 25 kids ages 12 to 19 have hypertension, more commonly seen in boys, those older than 12 years, and Hispanic or non-Hispanic Black ethnicity.<a href="#accordion">[2]</a>

Despite its relatively low prevalence compared to adult hypertension, the implications of high blood pressure in children can be severe and long-lasting. 
&nbsp;

Understanding The Evolving Nature Of Pediatric Hypertension

While the exact causes may vary, factors such as genetics, obesity, poor diet, teen pregnancy, smoking, and a lack of physical activity play significant roles in its development.

A family or personal history of conditions like hypertension, cholesterol, kidney disease, and diabetes should be considered as well.

Certain drugs and medications, including decongestants, caffeine, NSAIDs, and steroids, may also increase blood pressure.<a href="#accordion">[4]</a> 
&nbsp;

Pediatric hypertension can be classified into primary (essential) and secondary types.<a href="#accordion">[4]</a>

<ul>
	<li>Primary Pediatric Hypertension: Also known as essential hypertension, this type occurs when a child&#39;s blood pressure is consistently elevated without an identifiable cause. It often results from a combination of genetic, lifestyle, and environmental factors.</li>
	<li>Secondary Pediatric Hypertension: Secondary hypertension in children arises due to an underlying medical condition or external factor. Conditions such as kidney disease, heart defects, hormonal disorders, and certain medications can lead to elevated blood pressure in children. 
	&nbsp;</li>
</ul>

Diagnosing pediatric hypertension can be challenging since its symptoms often go unnoticed. Symptoms may include headaches, fatigue, vision problems, and difficulty breathing.

Accurate blood pressure measurement is crucial for diagnosing pediatric hypertension. Healthcare providers use age, height, and gender-specific norms to interpret blood pressure readings in children.

In addition to blood pressure measurement, laboratory tests such as urinalysis, blood tests, ECG, and renal ultrasound may be conducted to identify underlying conditions.

Some doctors suggest ambulatory monitoring to check if the child has high blood pressure. This means the child wears a special device for a short time to track their blood pressure all day, even while sleeping and playing. It ensures that high blood pressure isn&#39;t just because the child feels nervous at the doctor&#39;s office. 
&nbsp;

The new Clinical Practice Guidelines (CPG) released by the American Academy of Pediatrics (2017) state:[1]

<table cellspacing="0" class="1" style="border-collapse:collapse; border:none; width:464px">
	<tbody>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:1px solid black; height:36px; vertical-align:top; width:99px">
			&nbsp;
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:36px; vertical-align:top; width:182px">
			Systolic and/or Diastolic BP
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:1px solid black; height:36px; vertical-align:top; width:182px">
			Systolic and/or Diastolic BP
			</td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:99px">
			Age category
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&lt;13 years
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&ge;13 years
			</td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:99px">
			Normal BP
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&lt;90th percentile
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&lt;120/80 mmHg
			</td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:99px">
			Elevated BP
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&ge;95th &lt;95th percentile + 12

			or

			120-130/&lt;80 mmHg
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			120-130/&lt;80 mmHg
			</td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:99px">
			Hypertension Stage 1
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&ge;95th &lt;95th percentile + 12

			or

			130-140/80-90 mmHg
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			130-140/80-90 mmHg
			</td>
		</tr>
		<tr>
			<td style="border-bottom:1px solid black; border-left:1px solid black; border-right:1px solid black; border-top:none; vertical-align:top; width:99px">
			Hypertension Stage 2
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&ge;95th + 12 or &ge;140/90 mmHg
			</td>
			<td style="border-bottom:1px solid black; border-left:none; border-right:1px solid black; border-top:none; vertical-align:top; width:182px">
			&ge;140/90 mmHg
			</td>
		</tr>
	</tbody>
</table>

The new method helped with accurate diagnosis and understanding of the impact of different criteria on estimating high blood pressure prevalence and associated health risks:

<ul>
	<li>The approach lowered the levels used to define high blood pressure by 1&ndash;3 mmHg for children and over 4 mmHg for adolescents.</li>
	<li>It led to more children being identified as at risk of high blood pressure compared to the old criteria, sparking debates among scientists, especially with European researchers involved in setting guidelines.</li>
	<li>It resulted in higher estimates of high blood pressure prevalence compared to the old criteria.</li>
	<li>It identified that the prevalence of high blood pressure varied based on factors like age, weight, and the study setting. For instance, some children may experience higher blood pressure readings initially due to stress (white coat hypertension), which could lead to overestimation of high blood pressure prevalence.</li>
	<li>Studies show that children identified as hypertensive under the new criteria had a higher risk of cardiometabolic problems compared to those classified under the old criteria. 
	&nbsp;</li>
</ul>

Early intervention helps prevent the progression of pediatric hypertension and reduces the risk of complications later in life.

Untreated pediatric hypertension can lead to heart disease, stroke, kidney damage, and cognitive impairment.

<ul>
	<li>Lifestyle Modifications &ndash; Lifestyle modifications such as adopting a healthy diet, increasing physical activity, reducing sodium intake, and managing stress are essential to pediatric hypertension treatment.</li>
	<li>Medications &ndash; In some cases, medications such as ACE inhibitors, calcium channel blockers, angiotensin II receptor blockers, and diuretics may be prescribed to help lower blood pressure levels in children and adolescents. These medications are typically used in conjunction with lifestyle changes.</li>
</ul>

Note: Regular monitoring and follow-up appointments are necessary to track the effectiveness of treatment and make adjustments as needed. 
&nbsp;

Coping with a child&#39;s diagnosis of hypertension can be challenging for parents. Seeking support from healthcare professionals and connecting with other parents facing similar challenges can be helpful.

Moreover, collaboration among healthcare providers, parents, schools, and community organizations is important to promote a supportive environment for children and adolescents to effectively manage the condition. 
&nbsp;

Preventing pediatric hypertension involves promoting healthy lifestyle habits early on, including proper nutrition, regular physical activity, and stress management techniques. Make sure that they get quality sleep and avoid vaping, smoking, or even exposure to secondhand smoke.

Other precautions include:

<ul>
	<li>Children (aged 2-3 years) &lt;1200 mg of sodium a day</li>
	<li>Older children &lt;1500 mg of sodium a day</li>
	<li>All children 60 minutes of physical activity a day</li>
</ul>

Also, children should have their blood pressure checked at least once a year as part of their routine healthcare visits, starting at age 3. 
&nbsp;

<ul>
	<li>Pediatric hypertension refers to elevated blood pressure levels in children and adolescents. Stage II hypertension is diagnosed if a child&#39;s BP is greater than the 99th percentile plus 5 mm Hg.</li>
	<li>Symptoms of pediatric hypertension include headaches, fatigue, vision problems, and difficulty breathing.</li>
	<li>Diagnosis involves measuring blood pressure and conducting laboratory tests like urinalysis and blood tests to assess kidney function and identify underlying conditions.</li>
	<li>Causes and risk factors include genetics, obesity, poor diet, lack of physical activity, family history, excess weight, sedentary lifestyle, high-sodium diet, and certain underlying medical conditions.</li>
	<li>Treatment of pediatric hypertension includes lifestyle modifications such as diet and exercise changes, and medications may be prescribed in some cases.</li>
	<li>Untreated pediatric hypertension can lead to heart disease, stroke, kidney damage, and cognitive impairment.</li>
	<li>Promoting a healthy lifestyle from an early age through proper nutrition, regular physical activity, and stress management techniques can help prevent pediatric hypertension.</li>
</ul>

[1] Di Bonito P, Di Sessa A. New Diagnostic Criteria for Hypertension in Children and Adolescents: Lights and Shadows. Children (Basel). 2020;7(11):196. Published 2020 Oct 24.

[2] High blood pressure in children. Cleveland Clinic. Accessed February 23, 2024.

[3] Ashraf M, Irshad M, Parry NA. Pediatric hypertension: an updated review. Clin Hypertens. 2020;26(1):22. Published 2020 Dec 1.

[4] High blood pressure in children. Mayo Clinic. Accessed February 23, 2024.

Bringing a new life into the world is an incredible journey, but sometimes unexpected challenges can pop up, like postpartum hypertension.

In simple words, postpartum hypertension is high <a href="merisehat.pk/disease/blood-pressure">blood pressure</a> that shows up after you give birth. 
&nbsp;

Understanding postpartum hypertension

However, it doesn&#39;t stick around forever. It&#39;s like the body&#39;s way of saying, &quot;Hang on, I need a little more time to get back to normal.&quot;

The duration and severity of postpartum hypertension varies from woman to woman. Factors such as pre-existing health conditions and the presence of risk factors may influence the resolution of postpartum hypertension.

A recent study found that the condition was more commonly present in mothers who smoked, had delivered via C-section, were aged 35 and above, and were Black Americans.<a href="#accordion">[1]</a> 
&nbsp;

Other risk factors include:<a href="#accordion">[2]</a>

<ul>
	<li>Obesity</li>
	<li>Family or individual history of preeclampsia</li>
	<li>High blood pressure during pregnancy</li>
	<li>Multiple births</li>
	<li>Diabetes</li>
	<li>Autoimmune conditions 
	&nbsp;</li>
</ul>

High blood pressure usually peaks within 48 hours after delivery, which is when most women leave the hospital.

Call your doctor immediately if you have a reading of 140/90 mm Hg or higher or postpartum hypertension symptoms, such as changes in vision, shortness of breath, persisting and severe headache, abdominal pain, nausea or vomiting, and decreased urination.

Delayed treatment can lead to serious complications, including pulmonary edema, seizures, strokes, blood clots, and even death. 
&nbsp;

For a new mom, postpartum hypertension can be scary. Will it go away on its own? Will I need medications?

Postpartum hypertension treatment often revolves around a healthy lifestyle. Eating well, staying active, and catching those precious zzz&#39;s all contribute to your body&#39;s speedy recovery.

Regular check-ups with your healthcare provider ensure that any lingering high blood pressure is noticed and managed. Sometimes, they may prescribe blood pressure medicine, antiseizure medicine, and anticoagulant medications to treat it.

It could take several days to a few weeks for the blood pressure to return to a safe or manageable level. Remember, you&rsquo;ll also be recovering from childbirth itself during this time, too. So, you may experience physical and emotional changes, such as fatigue, tender breasts, cramping or vaginal discharge, and mood swings. 
&nbsp;

Your body has this remarkable ability to self-regulate and heal, ensuring that postpartum hypertension often resolves on its own. However, regular monitoring and doctor check-ups during this period can further help with a smooth transition back to pre-pregnancy blood pressure levels. 
&nbsp;

<ul>
	<li>Postpartum hypertension, or high blood pressure after giving birth, is a rare condition that affects some women during the weeks or months following delivery.</li>
	<li>Postpartum is a healing period for the body, and as it recovers from the stress of childbirth, blood pressure levels often return to normal.</li>
	<li>However, it&#39;s important to monitor postpartum hypertension through regular check-ups with a healthcare provider to ensure that it does not persist or lead to complications.</li>
	<li>Maintaining a healthy lifestyle, including a balanced diet, regular physical activity, and sufficient rest, helps blood pressure levels return to normal.</li>
	<li>In some cases, medical intervention, such as medication, may be required to manage postpartum hypertension.</li>
</ul>

[1] Sullivan K, Rauf D, Welch A, et al. New moms at risk of developing high blood pressure 6 weeks after childbirth, study finds. EverydayHealth.com. Accessed January 26, 2024.