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Ismail Munir

اپنے بلڈ پریشر کے بارے میں جانئے

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;

Conclusion

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;

Key Points

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

Humza Khizer

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

The Nation’s Stance Against TB

Pakistan, with around 510,000 new <a href="https://www.merisehat.pk/disease/tuberculosis">Tuberculosis (TB)</a> cases reported every year and around 15,000 transitioning to drug-resistant TB cases consistently, is positioned 5th among high-burden nations overall. It represents 61% of the TB burden in the WHO Eastern Mediterranean Region. The nation is assessed to have the 4th most elevated predominance of multidrug-resistant TB (MDR-TB) worldwide.&nbsp; 
&nbsp;

Key explanations behind the development of the medication-resistant types of TB range from untimely and late diagnosis; unadministered, improper, and insufficient medication regimens; poor development and absence of a social help program for high-risk populaces<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

Understanding Pakistan's Fight Against TB

The Pakistan National Tuberculosis Program (NTP) has accomplished a momentous and consistent improvement in the staggering number of TB cases identified from 11,050 in 2000 to 248,115 in 2008. Likewise, treatment achievement rates recorded were an impressive 91% in 2007<a href="#accordion">[6]</a>.&nbsp; 
&nbsp;

This has been accomplished through robust responsibility and monetary contributions by the Government along with well-being advancement offered by supporters. 
&nbsp;

The World Health Organization (WHO) Directly Observed Treatment Short-course (DOTS) technique for TB was embraced and guided by Pakistan from 1995 onwards. However, significant advancement in TB control was accomplished after the recovery of the NTP in 2001 when TB had been proclaimed a public general health crisis through the Islamabad Declaration<a href="#accordion">[6]</a>.&nbsp; 
&nbsp;

The NTP operates under the Ministry of Health and is answerable for general coordination, strategy course, and specialized direction for TB control, while realistic execution is the obligation of the Provincial TB Programs (PTPs) and specialists within each region. The NTP focal unit connects elaborately with PTP chiefs and regional TB facilitators<a href="#accordion">[6]</a>. 
&nbsp;

The TB administrations are incorporated into the essential general medical care framework at the district level<a href="#accordion">[10]</a>.&nbsp; 
&nbsp;

A 2003 study led by the NTP and PTPs in Lahore and Rawalpindi locale saw that under 3% of general practitioners (GPs) were strictly abiding by the public rules for active contact tracing and the management of TB, while 90% of GPs were depending on chest radiography for confirmed diagnosis<a href="#accordion">[5]</a>.&nbsp; 
&nbsp;

Parastatal health administration&rsquo;s structure is one more place of entry outside the general medical care framework and NTP guidelines. In general, 32 government services and the federal bureau secretariat, with 208 independent (parastatal) bodies, give well-being administrations to 389,923 representatives and their dependents<a href="#accordion">[4]</a>. Excluding the Ministry of Defense, which has its own monetary cost for wellbeing administrations.&nbsp; 
&nbsp;

Lately, though, a high need has been given to creating practical organizations with medical care suppliers in the private domain, taking on a deliberate methodology following the WHO rules. Extra drives, like a better reconnaissance and research center organization, and improved follow-up and treatment modalities subsidized by international and public sources, have added to the huge improvement in recognition and treatment achievement rates framed previously.&nbsp; 
&nbsp;

The target of the survey was to feature the accomplishments of Pakistan&#39;s NTP throughout the last 10 years and to frame the exceptional needs and difficulties for what&#39;s to come. Moreover, the NTP has become more inclusive and has strived to work against discrimination of any sort while providing treatment and care for TB. This has been achieved by systematically drafting a communication manual through collaborative efforts to become more accessible to the people in Pakistan<a href="#accordion">[8]</a>.

&nbsp;

The PPM model was established to function through a typical and unanimous decision [memorandum of understanding, (MOU)] between the NTP (public arm) and the partaking wellbeing office proprietors (private arm) while adhering to the pertinent and important public TB rules<a href="#accordion">[13]</a>.&nbsp; 
&nbsp;

The NTP support component (material stockpile, monetary help, and specialized help) to the private supplier was, likewise, something very similar and uniformly disseminated in all TB offices working through the PPM model (PPM-1, 2, 3, and 4). It was provided by the Provincial TB control program (NTP provincial wing) via the area TB control program (NTP district wing) in all existing PPM approaches.&nbsp; 
&nbsp;

Nonetheless, the PPM enrolled cases were notified by private suppliers to the district TB control program (DTB), then to the Provincial TB control program (PTP), and lastly refreshed into the NTP data set. The four PPM approaches were following a specific arrangement of patient assessment, demonstrative diagnostics, and follow-up methods<a href="#accordion">[13]</a>. 
&nbsp;

First and foremost, the principal strength of the PPM mediation study (various methodologies of the customary PPM model) is that the data was gathered from regularly updated and revised program information, so the discoveries are theoretically going to mirror the program&#39;s real factors<a href="#accordion">[13]</a>. Second, the review and target population have an enormously appropriate sample size, which correspondingly allows the gauge to be a closer and more accurate representation of the truth. Third, the STROBE rules were adhered to for unparalleled concentration on the plan, procedure, and announcement of results which limits the gamble of systemic predispositions<a href="#accordion">[14]</a>. And fourth, the review gives proof and a graphic outline of all the TB case notifications (PPM and non-PPM) from all TB treatment offices accessible for 97% of Pakistani DOTS residents living in 4 regions in the review period<a href="#accordion">[13]</a>. 
&nbsp;

From the 4 PPM approaches (PPM-1, - 2, - 3, and&minus;4), increase in GP facilities ought to be centered more toward their PPM coverage result, as well as changing the PPM-1 procedure for consideration of GPs that are only practicing TB care in the private sector. On the other hand, NGO facilities should focus on an expansion in their PPM coverage, whereas private clinics should upgrade their PPM coverage proficiency, alongside broadening the treatment achievement rate up to 85%<a href="#accordion">[13]</a>.&nbsp; 
&nbsp;

However, changes in Parastatal offices cannot just be pointed toward redesigning the Parastatal commitment toward PPM TB case notification. They should also be working on their subsequent systems to prevent the default of Parastatal notified TB cases as well as holding the number of Parastatal offices offering TB administrations<a href="#accordion">[13]</a>. 
&nbsp;

The Integrated Health System Strengthening and Service Delivery (IHSS-SD) Activity is a United States Agency for International Development (USAID) subsidized drive in Pakistan. Integrated in 2018, it has been working intimately with the government and district well-being specialists to reform, change, and reinforce the well-being framework that has been implemented at the provincial level<a href="#accordion">[11]</a>. 
&nbsp;

The general objective of this specialized forum was to help the Provincial TB Control Programs in Sindh and Khyber Pakhtunkhwa in further developing the dynamic contact tracing of bacteriologic positive TB cases and decentralizing the administration of drug-resistant TB cases. 
&nbsp;

The definitive goals of this technical and international action were to accumulate sufficient proof for demonstrating the viability of active contact tracing and screening as a major strategy to work on the detection of bacteriologic positive instances of TB within the networks, and to improve the testing limit of the provincial TB programs. The program began on January 1, 2021, and finished on September 30, 2021<a href="#accordion">[11]</a>. 
&nbsp;

Diagnosing and proving the necessary care for TB cases in refugee camps and new settlements is a challenging task as many individuals are unregistered and undocumented. Besides, the societal stigma revolving around TB acts as a silent suppressor. Additionally, everyday environments, financial status, and restricted admittance to medical care are boundaries to TB services<a href="#accordion">[9]</a>.&nbsp; 
&nbsp;

There are a lot of instances where healthcare agents missed out TB among the refugees of Afghan populations in the three states covered by the Global Fund award.&nbsp; 
&nbsp;

Tracing TB cases and contact tracing is an effective way to stop the spread of the disease, including the epidemic of drug-resistant strains.&nbsp; 
&nbsp;

The Global Fund is a grant that functions under UNDP&#39;s attempts to reinforce joint effort and data sharing between Afghanistan, Iran, and Pakistan to guarantee quality care for patients who are relocating<a href="#accordion">[9]</a>. 
&nbsp;

UNDP introduced a cross-country computerized platform for recording and detailing TB cases among displaced people, returnees, and mobile communities. It was planned in association with public TB programs, the Global Fund, the United Nations High Commissioner for Refugees (UNHCR), International Organization for Migration (IOM), and others.&nbsp; 
&nbsp;

The online application was created by Dure Tech and uses the WHO Prevent TB Digital Platform. It depends on open-source technology and incorporates a patient-focused module, as well as interoperability with well-being data frameworks. Hence, empowering the screening of TB patients across the continuum of medical services, transcending borders and nationalities<a href="#accordion">[9]</a>. 
&nbsp;

The PMDT model of care in Pakistan comprises 3 connected systems of hierarchies<a href="#accordion">[7]</a>. At the highest point of the order is a full-scale framework that could be referred to as the macro system, which contains the majority of global wellbeing organizations. These include the WHO and the Global Fund, which give direction and monetary help to the PMDT model of care. 
&nbsp;

At the national level, the public and provincial TB programs work collaboratively with the non-legislative associations forming a mesosystem that gets the necessary assistance from global offices, and subsequently interprets and adjusts rules for nearby settings and districts. Together, the two frameworks build a microsystem &mdash; i.e., the PMDT facilities, which work as per universally accepted norms of care and are rooted in a former, more extensive wellbeing system<a href="#accordion">[7]</a>.&nbsp; 
&nbsp;

The PMDT model focuses on materials. For example, foundation, medications, and quantities of individuals tested and screened. Initially, there wasn&rsquo;t much emphasis on developing competencies of the PMDT staff; hence, they were incapable of giving responsive care. 
&nbsp;

Later the PMDT staff suggested prioritizing medical services connected to responsiveness which, when implemented, proved to be fruitful for patients<a href="#accordion">[1]</a>.

&nbsp;

Significant steps have been made to provide accessible and effective medical services and care for TB. However, more efforts are needed since ailing health, unfortunate lodging, and sterilization, for instance, intensified by other risk factors, like tobacco, liquor use and diabetes aggravate the condition which are still prevalent in the society.&nbsp; 
&nbsp;

The Minister pledged and vowed Pakistan&#39;s continuous and unwavering stance with the global community in the fight to eradicate TB and is undoubtedly dedicated to ending the TB pestilence by 2030 as visualized in the agenda 2030 for Sustainable Development and its Sustainable Development Goals, World Health Organization End TB Strategy, Stop TB Partnership Global Plan to End TB<a href="#accordion">[12]</a>. 
&nbsp;

<ul>
	<li>Pakistan has a high prevalence of TB cases; it stands 5th in the world.</li>
	<li>Pakistan has made significant contributions to reducing the global burden of TB.</li>
	<li>The National TB Control Program (NTB) works at the central level to draft and implement national policies for TB care.</li>
	<li>NTB caters to the growing TB population through models such as the Public-Private Mix (PPM) Model or the Programmatic Management of Drug-Resistant Tuberculosis (PMDT).</li>
	<li>Global organisations such as WHO and the Global Fund assist Pakistan in fighting against TB.</li>
	<li>The Integrated Health System Strengthening and Service Delivery (IHSS-SD) Activity by USAID has allowed smooth provincial administration for TB.</li>
	<li>Tuberculosis is a notification priority disease in Pakistan and any presenting cases should be notified to the concerned authorities immediately.</li>
	<li>In 2018, Federal Minister for National Health Services Saira Afzal Tarar said Pakistan&#39;s committed to eradicate TB by 2030 as visualised in the agenda 2030 for Sustainable Development and its Sustainable Development Goals, World Health Organization End TB Strategy, Stop TB Partnership Global Plan to End TB.</li>
</ul>

&nbsp;

[1] Abbas, S., Kermode, M., & Kane, S. (2020). Strengthening the response to drug-resistant TB in Pakistan: a practice theory-informed approach. Public health action, 10(4), 147–156.

[2] Federal Bureau of Statistics. (2009). National health accounts Pakistan 2005–06. Islamabad: Federal Bureau of Statistics, Statistics Division.

[3] Khan, J. A., Irfan, M., Zaki, A., Beg, M., Hussain, S. F., & Rizvi, N. (2006). Knowledge, attitude, and misconceptions regarding tuberculosis in Pakistani patients. Journal of Pakistan Medical Association, 56(5), 211–214.

[4] Metzger, P., Baloch, N., Kazi, G., & Bile, K. (2010). Tuberculosis control in Pakistan: reviewing a decade of success and challenges. Eastern Mediterranean Health Journal, Volume 16, 47-53.

[6] National TB Control Programme (NTP). (2014). National TB Control Programme Reach, treat, cure everyone: Annual report, 2014. Islamabad, Pakistan: Ministry of National Health Services Regulations & Coordination.

[6] National Tuberculosis Programme (NTP). (2008). Advocacy, communication and social mobilization: national strategy and operational guidelines. Islamabad: Ministry of Health.

[7] Ostby, K., & Burton, T. (2022, March 29). Tracking the 'missing cases' of TB as it moves across borders.

[8] Shah, S., Sadiq, H., Khalil, M., & Noor, A. (2003). Do private doctors follow national guidelines for managing pulmonary tuberculosis in Pakistan? Eastern Mediterranean Health Journal, 9(4), 776–788.

[9] Shaikh, B. T., Laghari, A. K., Durrani, S., Chaudhry, A., & Ali, N. (2022). Supporting tuberculosis program in active contact tracing: a case study from Pakistan. Infectious Diseases of Poverty volume 11, 42.

[10] The Frontier Post. (2018, March 27). All resources to be mobilized to fight against TB says Saira.

[11] Ullah, W., Ahmad, W., Haq, M. U., Yaqoob, A., Fatima, R., & Khan, G. M. (2021, August 10). Public–Private Mix Models of Tuberculosis Care in Pakistan: A High-Burden Country Perspective. Retrieved from Frontiers Public Health:

[12] Vandenbroucke, J. P., Elm, E. V., Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., . . . Initiative., S. (2007). Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Annals of internal medicine, 147(8), W-163.

[13] World Health Organization (WHO). (2006). Engaging all health care providers in TB control: guidance on implementing public-private mix approaches. Retrieved from World Health Organization (WHO):

[14] World Health Organization (WHO). (2022). Tuberculosis.

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

What Does Your Blood Type Have To Do With Your Risk Of Stroke?

Did you know that your blood type has a significant say in your susceptibility to <a href="https://www.merisehat.pk/disease/stroke">stroke</a>? Well, yes that&#39;s true, and, as surprising as it may sound, recent research has proven that individuals with type A blood group have a 16% higher risk of early-onset stroke, whereas individuals with blood type O have a 12% reduced risk of early onset stroke<a href="#accordion">[1]</a>.&nbsp; 
&nbsp;

A study was conducted and data was collected from 48 genetic studies on the incidence of ischemic stroke in the adult population (aged 18-59 years). Ischemic stroke is caused by a clot in the blood vessel supplying the brain, thus, disrupting the blood flow to the brain tissue. The study revolved around 17,000 patients who have had a stroke in the past and 600,000 healthy individuals as controls who had no previous history of stroke 
.&nbsp;

The purpose of the study was to determine the genetic causes behind stroke since it was not known earlier and the results showed a significant correlation between an individual&#39;s blood type and the risk of early-onset stroke<a href="#accordion">[1]</a>.&nbsp; 
&nbsp;

Understanding the Association Between Blood Groups and Risk of a Stroke

It is imperative to know about the different blood groups before discussing their linkage with stroke. 4 blood groups are known to exist in humans &ndash; A, B, AB, and O. The blood group O is the commonest while the blood group AB is the rarest blood type. Individuals inherit their blood group from their parents<a href="#accordion">[1]</a>.&nbsp; 
&nbsp;

These blood groups are determined based on the presence of antigen (a protein) on the surface of our red blood cells.&nbsp; 
&nbsp;

<ul>
	<li>Type A: The A antigen is present on the surface of the red blood cell while the B antigen is present in the plasma.</li>
	<li>Type B: The B antigen is present on the surface of the red blood cell while the A antigen is present in the plasma.</li>
	<li>Type AB: Both A and B antigens are present on the surface of red blood cells and no antibody is present in the plasma.</li>
	<li>Type O: No antigen is present on the surface of the red blood cell; however, both A and B antigens are present in the plasma<a href="#accordion">[2]</a>. 
	&nbsp;</li>
</ul>

Individuals with blood type O are known as universal donors because they can donate blood to anyone, while individuals with blood type AB are known as universal recipients because they can receive any and all blood types<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

According to the study, early stroke is more common in individuals with type A blood and less common in individuals with type O blood as compared to individuals who have had late onset stroke and those who had no previous history of stroke. Moreover, individuals with type B blood group are more likely to have both early and late onset of strokes<a href="#accordion">[4]</a>. 
&nbsp;

Now, you might be wondering how serious a stroke is? So, let&#39;s take a look into what stroke is and how serious it can be.&nbsp; 
&nbsp;

Stroke is referred to as a medical emergency since it can result in lifelong disability if prompt medical actions aren&#39;t taken<a href="#accordion">[5]</a>. Strokes are mostly ischemic, but they can be hemorrhagic as well.&nbsp; 
&nbsp;

In an ischemic stroke, there is blockage in a blood vessel supplying the brain. This disruption in the blood flow starves the brain tissue of oxygen and consequently results in the death of brain cells.&nbsp; 
&nbsp;

Since the brain is the control center of the body, any damage to the brain results in long-term consequences. For instance, after a stroke, people may experience blindness and problems with speech and memory. Individuals may also develop paralysis on the side of the body that is contralateral (opposite) to the site of stroke. That is, if an individual had a stroke in the right side of their brain, then the left side of their body would be paralyzed<a href="#accordion">[2]</a>. 
&nbsp;

According to the Center of Disease Control and Prevention (CDC), every 40 seconds someone in the U.S. experiences a stroke and every 3.5 minutes someone dies because of it. It is regarded as one of the leading causes of mortality (death) in the U.S<a href="#accordion">[6]</a>.&nbsp; 
&nbsp;

Stroke may present as<a href="#accordion">[7]</a>:&nbsp; 
&nbsp;

<ul>
	<li>Sudden weakness in the face, arm, or leg&nbsp;</li>
	<li>Sudden numbness in face, arm, or leg&nbsp;</li>
	<li>Sudden blindness&nbsp;</li>
	<li>Sudden confusion&nbsp;</li>
	<li>Sudden difficulty with understanding speech</li>
	<li>Sudden trouble with speaking&nbsp;</li>
	<li>Sudden dizziness</li>
	<li>Sudden loss of balance&nbsp; 
	&nbsp;</li>
</ul>

<h5>What Is An Early And Late Onset Stroke?</h5>

Stroke that occurs in individuals younger than 60 years of age is known as early onset stroke, whereas stroke that happens after 60 years of age is late onset stroke.&nbsp; 
&nbsp;

<h5>How Does Type A Blood Increase The Risk Of Early Onset Stroke?</h5>

Type A blood group increases the risk of having early onset stroke by 16% while the risk of having a late onset stroke is estimated to be 5% in individuals with type A blood<a href="#accordion">[1]</a>.&nbsp; 
&nbsp;

Unfortunately, researchers don&#39;t have the answer as to why type A blood confers a higher risk of stroke in individuals less than 60 years of age, but it is believed that it has something to do with the clotting mechanism. There are studies that suggest that people with type A blood are slightly prone to developing blood clots in the leg &ndash; a condition known as deep vein thrombosis<a href="#accordion">[1]</a>. This signals towards the pro-clotting nature of type A blood group that paves way to the formation of other clotting-related diseases, including stroke<a href="#accordion">[1]</a>. 
&nbsp;

<h5>Should I worry If I Have Type A Blood?</h5>

Researchers emphasize that the risk associated with type A blood and early onset stroke is not that significant, hence, individuals with this blood type need not to worry about it nor do they need to engage in additional screening or medical testing. If you have Type A blood, you can simply take it as a reminder to be cautious and to take steps to manage any risk factors you might have. 
&nbsp;

Additionally, stroke risk doubles every decade after 55 years of age and CDC has warned about the risk of stroke increasing with age. Most strokes occur in individuals after 50 years of age, but it has been reported that early onset stroke incidences are increasing, too. Every 1 in 7 strokes happen in individuals aged between 15 and 49 years<a href="#accordion">[6]</a>. 
&nbsp;

Yes, strokes can be prevented. As a matter of fact, 80% of strokes are preventable<a href="#accordion">[6]</a>. 
&nbsp;

While you cannot alter your blood type or stop your age from progressing, there are certain risk factors of stroke that you can control through lifestyle modifications. To do so, you first need to know the modifiable risk factors for stroke. This include<a href="#accordion">[5]</a>:&nbsp; 
&nbsp;

<ul>
	<li><a href="https://www.merisehat.pk/disease/hypertension-57">Hypertension </a>(high blood pressure)&nbsp;</li>
	<li>High cholesterol levels</li>
	<li><a href="https://www.merisehat.pk/disease/diabetes-type-1-and-2">Diabetes mellitus</a>&nbsp;</li>
	<li>Smoking&nbsp;</li>
	<li><a href="https://www.merisehat.pk/disease/obesity">Obesity&nbsp;</a> 
	&nbsp;</li>
</ul>

Taking steps, such as quitting smoking and alcohol, incorporating exercise in your routine, managing your blood pressure and cholesterol levels, and eating a diet that is rich in fruits, vegetables and fibers can significantly reduce your stroke risk. 
&nbsp;

In a nutshell, even though blood type A is associated with increased risk of early onset stroke as proven by recent research, the risk for stroke is modest. Instead of worrying and finding ways to screen stroke, you should take it as a reason to be mindful about your health and work on other modifiable risk factors to reduce your chances of stroke.&nbsp; 
&nbsp;

<ul>
	<li>Stroke is a medical emergency that can result in life-long disability.&nbsp;</li>
	<li>Certain genetic factors, such as blood type, have been discovered through research to influence the risk of stroke.</li>
	<li>Blood type A is found to be associated with increased risk of early onset stroke, while individuals with blood type O are associated with decreased risk of early onset stroke.&nbsp;</li>
	<li>Early onset stroke occurs in individuals before the age of 60 years.&nbsp;</li>
	<li>The risk of stroke with blood type A is modest. Instead of getting involved in screening for stroke, individuals with blood type A should adopt healthier practices to manage the modifiable risk factors of stroke.&nbsp;</li>
</ul>

[1] Chang N.  Published 2022. Accessed September 23, 2022.

Norris J. Type A vs. O: Does blood type influence stroke risk?. Medicalnewstoday.com. Accessed September 23, 2022. https://www.medicalnewstoday.com/articles/is-there-a-link-between-your-blood-type-and-risk-of-stroke. Published 2022.

[2] Bailey E. Blood Type Linked to Risk of Stroke Before Age 60. Healthline.

[3] What Is A Universal Blood Type?. Redcrossblood.org.

[4] Conditions H, Risk S, Haase M. This Blood Type May Mean You’re at a Higher Risk of Early Stroke, New Study Finds. Prevention.

[5] Norris J. Type A vs. O: Does blood type influence stroke risk?. Medicalnewstoday.com.

[6] Solis-Moriera J. Your Blood Type May Influence Your Stroke Risk, Study Shows. Health.Published 2022.

[7] CDC.

Nawal Adnan

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.

Shermeen Zuberi

Iqra Mazhar

This article or video has been viewed by many visitors, and is popular.

A Short, Bloody Story About Long COVID

The first case of <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a> came forward in November of 2019. However, it wasn&rsquo;t until March 2020 that the World Health Organization (WHO) declared the outbreak a pandemic.

&nbsp;

Over the past year, several people have begun travelling to countries across Europe. Considering the recent ease in lockdown measures and international travel restrictions, this may not come as a surprise to many people. But what&rsquo;s surprising is the fact that thousands of them are spending all their life savings on these European destinations. Do they need a vacation that badly? Or are they in search of something bigger?&nbsp;

According to a BMJ study, thousands of patients with long COVID are traveling to Switzerland, Cyprus, and Germany for &lsquo;blood washing&rsquo;<a href="#accordion">[1]</a>. While this may sound like a satanic ritual, it&rsquo;s an experimental treatment being offered across private clinics in these countries. Patients report spending &euro;15,000 to &euro;40,000 on the treatment, just for a slight relief of their debilitating symptoms<a href="#accordion">[1]</a>. Although there is a lack of research on blood washing for treating <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a>, long COVID sufferers are desperate. After having their symptoms dismissed by several healthcare professionals, and trying every treatment in the book, they are willing to try anything.&nbsp;

This makes us wonder: how bad could long COVID possibly be that people are willing to travel to far-off locations for an unproven &lsquo;blood washing&rsquo; treatment?

Throughout the pandemic, researchers have discovered significant information on the virulence, transmission, and mechanism of the novel coronavirus (SARS-CoV-2). Thus, with time, COVID-19 has evolved from a respiratory illness to one with multi-system effects. While many of our questions regarding the novel coronavirus and COVID-19 have been answered, several things remain a mystery. One such mystery is long COVID.&nbsp;

&nbsp;

Understanding Long COVID

The first case of COVID-19 came forward in November of 2019. However, it wasn&rsquo;t until March 2020 that the World Health Organization (WHO) declared the outbreak a pandemic<a href="#accordion">[2]</a>. As of 29th July &lsquo;22, the world has recorded more than 57 million COVID-19 infections and 6.3 million deaths<a href="#accordion">[3]</a>.

Typically, a mild or moderate coronavirus infection lasts two weeks. However, in some individuals, the symptoms can persist for months after, or return after recovery. This is called long COVID.&nbsp;

Over the years, researchers have referred to the condition by several names: long-haul COVID, chronic COVID, post-acute COVID-19, long-term effects of COVID-19, and post-acute sequelae of SARS CoV-2 infection (PASC). According to WHO, long COVID develops in people with a history of probable or confirmed coronavirus infection, typically 3 months from the onset of COVID-19<a href="#accordion">[4]</a>. The symptoms last for at least 2 months and cannot be explained by some other illness.&nbsp;

Approximately 10-20% of COVID-19 patients go on to develop long COVID<a href="#accordion">[4]</a>. As per a Lancet study, 1.5% of the UK&rsquo;s population had self-reported long COVID in July 2021<a href="#accordion">[5]</a>. Moreover, the greatest prevalence was reported among people aged 35-69 years. In contrast, the prevalence of long COVID in South-East Asia largely remains unknown; likely due to a limited number of studies. One study in India reported long COVID in 29.2% of patients; another from Pakistan found residual symptoms in 83.7% of patients, even a month after COVID<a href="#accordion">[6]</a>.&nbsp;

&nbsp;

These symptoms are often debilitating and affect one&rsquo;s overall quality of life. The WHO has issued a list of 33 symptoms of long COVID<a href="#accordion">[4]</a>. The most common symptoms are:

<ul>
	<li>Fatigue</li>
	<li>Shortness of breath</li>
	<li>Brain fog&nbsp;or difficulty concentrating</li>
	<li>Headache</li>
	<li>Altered smell or taste</li>
	<li>Sleep disturbances</li>
	<li>Heart palpitations</li>
	<li>Joint or muscle pain</li>
	<li>Menstrual irregularities</li>
	<li>Abdominal pain</li>
	<li>Diarrhea</li>
</ul>

&nbsp;

According to a survey conducted in Pakistan, body aches, low mood, and cough were the most common residual symptom among COVID-19 survivors<a href="#accordion">[7]</a>. Recently, researchers at the University of Birmingham analyzed health records of COVID-positive people in the UK<a href="#accordion">[8]</a>. The study aimed to determine symptoms most commonly present in non-hospitalized patients, 12 weeks after infection. As per the results, loss of smell, hair loss, sneezing, ejaculation difficulties, and reduced libido were the most common long COVID symptoms among the study participants<a href="#accordion">[8]</a>.&nbsp;

But that&rsquo;s not all. Long COVID is also associated with long-term psychological manifestations. A preprint study, analyzing long-term trajectories of psychological symptoms over 22 months of follow-up, reported heightened depressive symptoms and anxiety levels among long COVID patients<a href="#accordion">[9]</a>. Thus, highlighting the importance of mental health monitoring and support for such patients.&nbsp;

&nbsp;

Regardless of whether you have a mild or severe infection, you may be at risk of long COVID. The exact cause behind why the condition develops in some and spares others remains unknown. Moreover, the symptoms and their severity also vary from person to person.&nbsp;

Researchers have proposed various theories regarding the cause of long COVID. While multiple studies are currently underway, the following factors may increase one&rsquo;s risk[10]:

<ul>
	<li>Severe COVID-19 infection</li>
	<li>Underlying health conditions</li>
	<li>Unvaccinated individuals</li>
	<li>COVID-19 re-infection</li>
	<li>Presence of neurological symptoms during acute COVID infection</li>
	<li>Hospitalization or ICU admission during infection</li>
</ul>

However, several cases of long COVID have emerged among healthy individuals without any of the above factors. Therefore, further research is required to gain a deeper understanding of the condition.

&nbsp;

<h4>"COVID infections can lower oxygen saturation. Check out your oxygen levels with our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a>!"</h4>

Researchers hypothesize that the presence of neurological symptoms in long COVID patients points to nerve fiber damage. Therefore, assessing for small nerve fiber damage in the cornea can likely help identify patients with the conditions<a href="#accordion">[11]</a>. However, currently, there is no test to diagnose long COVID in suspected individuals. Moreover, the varying symptoms make it difficult for doctors to correctly diagnose patients.&nbsp;

&nbsp;

&lsquo;Blood washing&rsquo;, also called apheresis, is the process of filtering out individual components of the blood with the help of a machine. It has been used to treat diseases such as sickle cell anemia and leukemia. The procedure involves removing blood through a needle from one arm, passing it through a filtration system, and then returning the filtered blood through a needle into another arm.&nbsp;

In long COVID, doctors use apheresis to remove lipids and inflammatory proteins from the person&rsquo;s blood. Researchers hypothesize that microscopic blood clots, also called micro clots, are to blame for the clogging of capillaries, which then reduces the oxygen supply and leads to long COVID symptoms<a href="#accordion">[1]</a>. Therefore, they propose the removal of inflammatory proteins from the person&rsquo;s blood. Moreover, patients are prescribed blood thinners or anticoagulants along with blood washing. However, the procedure is yet to be proven effective for the condition.&nbsp;

While some people have reported an improvement in symptoms, many have seen no difference. Nevertheless, without any clinical trials, one cannot properly evaluate the procedure&rsquo;s risks and benefits.&nbsp;

&nbsp;

While there is no treatment for long COVID, several prevention strategies can help prevent infections and ultimately post-COVID symptoms. The following is the best way to protect yourself:<ul><li>Wear a mask in crowded areas, especially in indoor settings</li><li>Wash your hands with soap and water</li><li>Cough or sneeze in your elbow</li><li>Get vaccinated against COVID-19</li><li>Avoid close contact with someone experiencing symptoms of COVID-19</li></ul>

Although the novel coronavirus is given a bad name for causing long-term complications, it is not alone. Several other infectious diseases can also have post-infectious sequelae e.g. Epstein-Barr virus (EBV), Lyme disease, Giardia lamblia, and several viral infections. The post-infection sequel in these diseases can result in fatigue, cognitive dysfunction, muscle pain, mood disorders, and neurological symptoms. Furthermore, chronic fatigue syndrome commonly follows viral infections.&nbsp;It is important to acknowledge any new symptoms that may occur after an acute COVID infection, and not dismiss them as a ‘thing in our head’. Moreover, since long COVID can affect anyone irrespective of their health status, it is important to remain cautious of catching the infection. Thus, continue practicing social distancing, wearing a mask, washing your hands, and staying up to date with your COVID-19 vaccines.&nbsp;

<ul>
	<li>Long COVID is defined as the persistence of symptoms in a person with a history of COVID-19, usually 3 months from the onset of the infection. Moreover, the symptoms last for at least 2 months and cannot be explained by any other diagnosis.&nbsp;</li>
	<li>The WHO has a list of 33 symptoms of long COVID. Fatigue, shortness of breath, joint or muscle pain, sleep disturbances, brain fog, hair loss, altered taste or smell, and mental health disorders are the common symptoms of long COVID.&nbsp;</li>
	<li>Researchers hypothesize that certain factors may increase the risk of long COVID. These include severe acute COVID infection, underlying health conditions, unvaccinated status, ICU admission, and repeated COVID infections. However, these factors do not explain why long COVID continues to affect people with mild infections or without any of the mentioned factors.</li>
	<li>Due to a lack of available treatments, many long COVID patients have turned to various unproven treatment procedures such as &lsquo;blood washing&rsquo;, or apheresis.&nbsp;</li>
</ul>

&nbsp;

[1] Davies M. Long covid patients travel abroad for expensive and experimental “blood washing” BMJ 2022; 378 :o1671 doi:10.1136/bmj.o1671

[2] Cucinotta, D., & Vanelli, M. (2020). WHO Declares COVID-19 a Pandemic. Acta bio-medica : Atenei Parmensis, 91(1), 157–160.

[3] World Health Organization. (n.d.). WHO Coronavirus (COVID-19) Dashboard. WHO Health Emergency Dashboard.

[4] World Health Organization. (2021, October 6). A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021. WHO | World Health Organization.

[5] The Lancet. (2021). Understanding long covid: A Modern Medical Challenge. The Lancet, 398(10302), 725.

[6] BMJ 2022;377:e069676

[7] Qamar, M. A., Martins, R. S., Dhillon, R. A., Tharwani, A., Irfan, O., Suriya, Q. F., Rizwan, W., Khan, J. A., & Zubairi, A. (2022). Residual symptoms and the quality of life in individuals recovered from COVID-19 infection: A survey from Pakistan. Annals of medicine and surgery (2012), 75, 103361.

[8] Subramanian, A., Nirantharakumar, K., Hughes, S. et al. Symptoms and risk factors for long COVID in non-hospitalized adults. Nat Med (2022).

[9] Fancourt, D., Steptoe, A., & Bu, F. (2022). Long-term psychological consequences of Long Covid: A propensity score matching analysis comparing trajectories of depression and anxiety symptoms before and after contracting long covid vs short covid.

[10] CDC. (2022, July 11). Long COVID or Post-COVID Conditions - Long COVID or Post-COVID Conditions. CDC.

[11] Bitirgen G, Korkmaz C, Zamani A, et al. Corneal confocal microscopy identifies corneal nerve fibre loss and increased dendritic cells in patients with long COVID. British Journal of Ophthalmology Published Online First: 26 July 2021.

Nimrah H. Sattar

Medilink Consultant clinic

Saad Ullah Siddiqui

Nocturnal Hypertension Explained

You&rsquo;re probably familiar with the term &lsquo;hypertension,&rsquo; which refers to blood pressure that is consistently higher than normal. However, this high blood pressure lowers when the patient is asleep. 
&nbsp;

Now, let&rsquo;s talk about the other condition which reverses this situation. In this scenario, you have normal blood pressure throughout the day, but it shoots up as soon as you fall asleep. It is known as &lsquo;nocturnal hypertension&rsquo;.&nbsp; 
&nbsp;

Understanding Nocturnal Hypertension

It is believed to be a complication of essential and secondary hypertension<a href="#accordion">[1]</a>. The increased blood pressure during sleep has been identified as an elevated risk factor for several cardiovascular issues, including heart failure and cerebrovascular diseases<a href="#accordion">[2]</a>. Several studies have revealed that nocturnal hypertension may be an initial symptom of later target organ damage.&nbsp; 
&nbsp;

There are 2 types of blood pressure patterns in nocturnal hypertension: 
&nbsp;

<h5>1. Non-Dipping Blood Pressure</h5>

During sleep, the body is not doing a lot of work; it is at rest and the person feels calm. It&rsquo;s why the blood pressure is also lower than what it is during the day time. This phenomenon is called dipping. Normally, there is at least a 10-20% dip expected from daytime to nighttime while sleeping. 
&nbsp;

However, when the dip in blood pressure at night time is less than 10%, it is then considered as non-dipping blood pressure. People with essential hypertension are more exposed to it and it is highly associated with target organ damage<a href="#accordion">[5]</a>. 
&nbsp;

<h5>2. Reverse Dipping Blood Pressure</h5>

Also known as inverted dipping, this phenomenon refers to blood pressure that is higher during the night time as compared to the daytime. People with hypertension, diabetes type 2, sleep apnea, and chronic kidney disease usually suffer from reverse dipping blood pressure<a href="#accordion">[3]</a>. This pattern of nocturnal hypertension is most common among old people and smokers.&nbsp; 
&nbsp;

Reverse dipping pattern is further considered a risk factor for <a href="https://merisehat.pk/disease/atherosclerosis">atherosclerosis </a>and is believed to promote the formation of carotid plaque<a href="#accordion">[4]</a>. 
&nbsp;

The WHO reported the number of adults suffering from hypertension in 1975 was 594 million. According to their assessment in 2015, the number has gone up to 1.13 billion<a href="#accordion">[7]</a>. The increased instance of hypertension has also led to better controlling therapies. There is new research and newer concepts being proposed every other day.&nbsp; 
&nbsp;

The latest direction in the management of high blood pressure is to target the problem earlier and aim towards lowering the blood pressure throughout the day<a href="#accordion">[8]</a>. According to the 2017 guideline by American College of Cardiology (ACC), all blood pressure readings taken during the awake period of a patient must be less than 130/80 mm Hg. It is now considered a universal blood pressure goal.&nbsp; 
&nbsp;

Despite these measures, the risk of masked nocturnal hypertension remains and poses an increased risk for cardiovascular diseases<a href="#accordion">[7]</a>. 
&nbsp;

Sleep apnea and obstructive sleep apnea in particular, has been closely related to hypertension. Nocturnal hypertension is very commonly found in patients of sleep apnea. Coexistence of these two issues tend to increase the chances of the development of other cardiovascular issues.&nbsp; 
&nbsp;

Continuous positive airway pressure, which is the main therapy for sleep apnea, has little to no effect on the elevated blood pressure experienced in nocturnal hypertension and thus goes unnoticed<a href="#accordion">[9]</a>.&nbsp; 
&nbsp;

While there is no specific treatment targeted towards nocturnal hypertension, it is believed that taking blood pressure medications even during the day keeps the pressure at bay at night.&nbsp; 
&nbsp;

Other approaches towards the treatment would mainly include lifestyle changes, like taking potassium supplements, monitoring and reducing sodium intake, and avoiding any sleep-interrupting stimulants like alcohol or caffeine. Regulating sleep and following a proper sleep hygiene routine is a crucial fix to nocturnal hypertension<a href="#accordion">[9]</a>.&nbsp; 
&nbsp;

Considering that nocturnal hypertension is closely linked to diabetes, maintaining blood sugar level and even overall sugar intake is very important to the process. Lastly, it helps to keep a check on and maintain the other underlying health conditions<a href="#accordion">[10]</a>. 
&nbsp;

<ul>
	<li>Nocturnal hypertension refers to high blood pressure of a person while they are asleep.</li>
	<li>It has been related to several health conditions and is believed to increase the chances of several cardiovascular issues, including heart failure and stroke.</li>
	<li>There are no targeted medicines that work specifically for nocturnal hypertension. The ideal way to combat it is through lifestyle changes.</li>
</ul>

[1] Vij R, Peixoto AJ. Management of nocturnal hypertension. Expert Review of Cardiovascular Therapy. 2009;7(6):607-618. doi:10.1586/erc.09.42

[2] Tadic M, Cuspidi C, Grassi G, Mancia G. isolated nocturnal hypertension: What do we know and what can we do? Integrated Blood Pressure Control. 2020;Volume 13:63-69. doi:10.2147/ibpc.s223336

[3] Cuspidi C, Sala C, Tadic M, et al. Clinical and prognostic significance of a reverse dipping pattern on ambulatory monitoring: An updated review. The Journal of Clinical Hypertension. 2017;19(7):713-721. doi:10.1111/jch.13023

[4] Yan B, Peng L, Han D, et al. Blood pressure reverse-dipping is associated with early formation of carotid plaque in senior hypertensive patients. Medicine. 2015;94(10). doi:10.1097/md.0000000000000604

[5] Routledge F, McFetridge-Durdle J. Nondipping blood pressure patterns among individuals with essential hypertension: A review of the literature. European Journal of Cardiovascular Nursing. 2007;6(1):9-26. doi:10.1016/j.ejcnurse.2006.05.001

[6] Hypertension. World Health Organization.

[7] Whelton PK, Carey RM, Aronow WS, et al.. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Hypertension. 2018; 71:e13–e115. doi: 10.1161/HYP.0000000000000065

[9] Kario K. Nocturnal hypertension. Hypertension. 2018;71(6):997-1009. doi:10.1161/hypertensionaha.118.10971

[8] Kario K, Hettrick DA, Prejbisz A, Januszewicz A. Obstructive sleep apnea–induced neurogenic nocturnal hypertension. Hypertension. 2021;77(4):1047-1060. doi:10.1161/hypertensionaha.120.16378

[10] Vij R, Peixoto AJ. Management of nocturnal hypertension. Expert Review of Cardiovascular Therapy. 2009;7(6):607-618. doi:10.1586/erc.09.42

Umna Salah

Hypertension In Women

This is because most people with high blood pressure have no symptoms at all, at least not until the condition has become severe. Even then, it may not be visible.<a href="#accordion">[1]</a>

A common misconception is that this &ldquo;silent killer&rdquo; affects men only. On the contrary, the American Heart Association states that almost half of the adult population with high blood pressure are women.

Moreover, according to the Centers for Disease Control and Prevention, the number of women dying from stroke is greater than the figure for men. Additionally, the number of women dying from heart disease every year in the US is almost the same as men<a href="#accordion">[2]</a>. 
&nbsp;

Hypertension occurs when the force with which blood pushes against the inside lining of the arteries increases and stays high for a period. High blood pressure means:

<ul>
	<li>The diastolic pressure is 80 or above</li>
	<li>The systolic pressure is 130 or above</li>
	<li>Both systolic and diastolic pressures are high 
	&nbsp;</li>
</ul>

Gender usually does not influence how the condition affects an individual. However, the onset of menopause does increase the risk of developing high blood pressure in some women. 
&nbsp;

The risk increases further with increasing age. According to a study, this is also related to estrogen-only pills that women take to manage menopause symptoms. Those who prefer estrogen-only creams or patches are less likely to be diagnosed with high blood pressure than those who take pills<a href="#accordion">[3]</a>.

The condition remains undiagnosed and untreated because of the myth that hypertension affects only men. Doctors assuming that women are healthy or immune to high blood pressure don&rsquo;t check it then while measuring other vitals during an examination, leading to delays in proper care. 
&nbsp;

Understanding the Hypertension in Women

When symptoms occur, they may include:

<ul>
	<li>Red spots in front of the eyes</li>
	<li>Flushing</li>
	<li>Dizziness 
	&nbsp;</li>
</ul>

The only way to know the person has high blood pressure is consistently high blood pressure readings, which is why regularly monitoring blood pressure helps with early diagnosis. If not treated or controlled, hypertension can lead to serious health issues, including:

<ul>
	<li>Stroke</li>
	<li>Heart attack</li>
	<li>Dementia</li>
	<li>Kidney failure</li>
	<li>Vision problems</li>
	<li>Amputation 
	&nbsp;</li>
</ul>

High blood pressure is responsible for 8.5 million deaths globally from ischemic heart disease, stroke, and renal diseases<a href="#accordion">[4]</a>. 
&nbsp;

High blood pressure during pregnancy can be dangerous for both mother and the baby. Whether it&rsquo;s a preexisting condition (chronic hypertension) or pregnancy-induced hypertension (gestational hypertension), it can cause preeclampsia, which is one of the major causes of maternal and infant mortality.

Preeclampsia, a critical blood pressure condition that develops during pregnancy, usually presents itself after the 20th week of pregnancy. However, it can occur earlier or during postpartum as well. It is characterized by headaches, nausea or vomiting, and abdominal pain. In some cases, it also causes swelling, sudden weight gain, and kidney, liver, and brain damage. 
&nbsp;

The risk of developing high blood pressure during pregnancy increases if the mother is:

<ul>
	<li>Obese</li>
	<li>Under 20 or over 40</li>
	<li>On a diet high in fat and salt</li>
	<li>Living with chronic stress</li>
	<li>Not physically active</li>
	<li>Pregnant for the first time</li>
	<li>Had preeclampsia during a previous pregnancy</li>
	<li>Pregnant via IVF</li>
	<li>Have chronic kidney disease, hypertension, diabetes/gestational diabetes, and an immune system disorder like lupus</li>
	<li>Have a history of thrombophilia</li>
	<li>Certain medications, including some pain relievers and birth control pills</li>
	<li>Having multiple pregnancies (twins, triplets, etc.)</li>
	<li>Have a family history of hypertension or preeclampsia</li>
	<li>Environmental factors 
	&nbsp;</li>
</ul>

High blood pressure during pregnancy is dangerous for the mother because it can cause complications, such as seizures, blood clotting problems, stroke, liver problems, and temporary kidney failure. It can also necessitate a c-section delivery. 
&nbsp;

Moreover, it prevents the placenta from receiving enough blood. This restricts the food and oxygen supply for the fetus, causing:

<ul>
	<li>Labor induction before the baby is full-term</li>
	<li>Premature birth</li>
	<li>Low birth weight</li>
	<li>Stillbirth 
	&nbsp;</li>
</ul>

The risk of these serious complications increases if the condition is not diagnosed in the early stage. As such, it&rsquo;s important that women are screened for hypertension during pregnancy just like any other condition. 
&nbsp;

A woman taking medicine, as advised by the doctor throughout the pregnancy, should take it during labor, too.

In the case of mild-moderate hypertension, the blood pressure is to be monitored closely every hour during labor. Blood pressure within the acceptable range increases the chances of a natural birth. 
&nbsp;

In the case of severe hypertension, the blood pressure is to be monitored every 15-30 minutes during labor. Also, doctors may suggest using forceps or opting for a cesarean section to deliver the baby.

Post-delivery, the mother&rsquo;s blood pressure will be monitored again. If they had hypertension before pregnancy, the doctor may need to review their treatment program again two weeks after delivery.

Postpartum preeclampsia is typically diagnosed within two days after delivery and treatment proceeds accordingly. 
&nbsp;

If the doctor approves it, it&rsquo;s okay to breastfeed while taking hypertension medicine. That said, some medications are not recommended for pregnant or breastfeeding women. It&rsquo;s best to always check the warnings mentioned in the manufacturer&rsquo;s information provided<a href="#accordion">[5]</a>. 
&nbsp;

Understanding the individual risk and warning signs of high blood pressure is important to prevent it. Additionally, women should:

<ul>
	<li>Eat a healthy diet and reduce the salt intake</li>
	<li>Maintain a healthy weight</li>
	<li>Quit smoking and alcohol</li>
	<li>Be active</li>
	<li>De-stress</li>
	<li>Get plenty of rest 
	&nbsp;</li>
</ul>

Excess fat, particularly abdominal fat, can raise blood pressure. Losing just 7.7 pounds can reduce this risk by 50%<a href="#accordion">[6]</a>.

Exercising and other forms of physical activity not only help shed the extra weight but also help keep the arteries flexible. According to the American Heart Association, regular exercise can lower the numbers by 8-10 points<a href="#accordion">[6]</a>. 
&nbsp;

Moreover, fat-free dairy products, dried beans, and fresh produce have a high content of calcium, potassium, and magnesium and help regulate blood pressure. However, evidence is needed to validate the effectiveness of dietary supplements (e.g., fish oils, folic acid) in preventing hypertension in women.

Besides, it pays if the individual avoids high amounts of sodium and saturated fat. Also, a 2017 report showed that a moderate intake of coffee is safe for consumption in case of high blood pressure<a href="#accordion">[7]</a>. 
&nbsp;

Meditation and other relaxation techniques, like breathing exercises, warm baths, and yoga, are also beneficial since stress hormones raise blood pressure. And while sleep alone cannot treat hypertension, poor sleep quality or sleeping less than five hours a night increases the risk of high blood pressure. 
&nbsp;

Important!

Women aged 30-60 should monitor their blood pressure even when their levels generally remain low. Compared to men, women have lower blood pressure but it increases earlier and also progresses faster. One reason could be that their blood vessels age faster than men&rsquo;s, making them more susceptible to developing hypertension and related problems<a href="#accordion">[8]</a>. 
&nbsp;

It&rsquo;s normal for blood pressure to fluctuate throughout the day. For instance, blood pressure is different while sleeping or relaxing compared to when a person is under stress or excited. However, when the resting blood pressure level is too high, it can stiffen, scar, or weaken blood vessels. A person may not necessarily feel unwell if they have hypertension or high blood pressure. 
&nbsp;

Do not start or stop any medication without first talking to a doctor. Women who are already taking medicine to lower their blood pressure and trying to get pregnant should consult their doctor first. If they&rsquo;re pregnant already, it&rsquo;s important to inform the doctor immediately. This is so the doctors can change the medication as soon as possible because some medicines are simply not safe to take during pregnancy.

Other than medications, lifestyle changes like eating a balanced diet and physical activity (e.g., walking or swimming) are important to reduce high blood pressure. 
&nbsp;

[1] Hypertension. World Health Organization.

[2] Nania R. Women may overlook risk of hypertension. AARP.

[3] Estrogen-only pills for menopause may raise women’s High Blood Pressure Risk. WebMD.

[4] Worldwide trends in hypertension prevalence and progress in treatment

[5] High blood pressure (hypertension) and pregnancy. NHS choices.

[6] Durso SC. Hypertension: What you need to know as you age. JHM.

[7] High blood pressure: What is high, symptoms, causes, and more. Medical News Today.

[8] High blood pressure: What women need to know. Cedars.

Link Between Diabetes And Hypertension

According to the World Health Organization (WHO), diabetes and hypertension 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

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

Uncontrolled Hypertension – The Silent Threat

Most of them belong to middle- or low-income countries.<a href="#accordion">[1]</a>&nbsp;In Pakistan, specifically, the figure is around 18.9%.<a href="#accordion">[2]</a>

However, the real problem is that 46% of these individuals have no idea they have high blood pressure.<a href="#accordion">[1]</a>&nbsp;Despite its prevalence, the lack of symptoms &ndash; or failure to recognize them &ndash; can turn this seemingly harmless condition into a serious issue. 
&nbsp;

Hypertension is when the blood pressure is consistently high. It&#39;s typically defined as having a blood pressure reading of 130/80 mm Hg or higher.

Hypertension is often called the &quot;silent killer&quot; because it can go unnoticed for years, causing damage to various organs without any symptoms. 
&nbsp;

Understanding Complications Of Uncontrolled Hypertension

These include:

<ul>
	<li>
	<h5>Heart Disease</h5>
	</li>
</ul>

Uncontrolled hypertension is a significant risk factor for heart disease, including coronary artery disease, heart attack, and heart failure. 
&nbsp;

<ul>
	<li>
	<h5>Stroke</h5>
	</li>
</ul>

Hypertension can damage or block blood vessels leading to the brain. 
&nbsp;

<ul>
	<li>
	<h5>Kidney Damage</h5>
	</li>
</ul>

Conditions like kidney disease or kidney failure are often associated with hypertension. Chronic high blood pressure causes kidney damage by constricting or narrowing the blood vessels. 
&nbsp;

<ul>
	<li>
	<h5>Vision Loss</h5>
	</li>
</ul>

Thick or ruptured blood vessels in the eyes can result in blindness. 
&nbsp;

<ul>
	<li>
	<h5>Peripheral Artery Disease (PAD)</h5>
	</li>
</ul>

Peripheral artery disease is a condition with reduced blood flow to the limbs. One of the risk factors for PAD is hypertension. 
&nbsp;

<ul>
	<li>
	<h5>Aneurysms</h5>
	</li>
</ul>

Aneurysms develop when blood vessels weaken or bulge due to increased blood pressure. They can be life-threatening if ruptured. 
&nbsp;

<ul>
	<li>
	<h5>Cognitive Decline</h5>
	</li>
</ul>

There is growing evidence that uncontrolled hypertension can contribute to cognitive decline and dementia, including Alzheimer&#39;s disease. 
&nbsp;

<ul>
	<li>
	<h5>Sexual Dysfunction</h5>
	</li>
</ul>

Hypertension can affect sexual function in both men and women. Moreover, erectile dysfunction, vaginal dryness, or decreased libido often cause anxiety and intimacy challenges. 
&nbsp;

<ul>
	<li>
	<h5>Complications During Pregnancy</h5>
	</li>
</ul>

For expectant mothers, uncontrolled hypertension can lead to complications such as preeclampsia, which endangers both the mother and the baby. 
&nbsp;

In conclusion, the complications of uncontrolled hypertension can significantly impact your health and quality of life. In some cases, high blood pressure can even prove fatal.

It&#39;s essential to monitor your blood pressure regularly and work with your healthcare provider to manage it effectively. Remember, taking control of your blood pressure today can prevent these complications and ensure a healthier tomorrow. 
&nbsp;

Key Takeaways

<ul>
	<li>Hypertension is usually a silent condition with no symptoms.</li>
	<li>Uncontrolled high blood pressure increases the risk of health complications, such as heart disease, stroke, kidney damage, and vision loss.</li>
	<li>Managing hypertension through lifestyle changes and medication is essential to preventing these complications and maintaining overall health.</li>
	<li>Regular blood pressure monitoring and medical checkups are crucial for early detection and management.</li>
</ul>

[2] Elahi, A., Ali, A.A., Khan, A.H. et al. Challenges of managing hypertension in Pakistan - a review. Clin Hypertens 29, 17 (2023).

Staff Writer

تعارف

بلڈ پریشر سے مُرادوہ دباؤ ہے،جو خون کی گردش کی وجہ سے شریانوں پر پڑتا ہے.<a href="#accordion">[1]</a> اِس دباؤ یا قوت کی وجہ سے نہ صِرف اعضاء کو آکسیجن اور غذائی اجزا ءکی فراہمی ممکن ہوتی ہے بلکہ اس کے علاوہ،قوت مدافعت کے لئے ،خون کےسفید ذرّات/خلیات اور اینٹی باڈیز اور ہارمونز مثلاً اِنسولین کی فراہمی بھی ہوتی ہے.<a href="#accordion">[2]</a> 
مزید یہ کہ،آکسیجن اور غذائی اجزاء کی فراہمی کے علاوہ،بلڈ پریشر کے ذریعے استحالہ کی اختتامی نقصان دہ باقیاتharmful metabolic end products&nbsp;اورکاربن ڈائی آکسائڈ اور جگر اور گُردوں سے نکالے جانے والے فاسد مادّوں کو بھی نکالنے میں اپنا کردار ادا کرتا ہے۔ 
&nbsp;

بلڈ پریشر کو چیک کرنے کے طریقے کی وضاحت

جب خون کا دباؤمعمول کی حد سے بڑھ جاتا ہے تو اسے بلڈ پریشرhypertensionکہتے ہیں۔بلڈ پریشر کو دَو اعدادسے ظاہر کیا جاتا ہے ۔ پہلا نمبرانقباضی /systolicشریانوں کے دباؤ/ پریشر کو ظاہر کرتا ہے جب دِل کے عضلات سُکڑ کر خون کو جسم کی جانب دھکیلتے ہیں۔جب کہ دوسرانمبرانبساطی/diastolicشریانوں کے اس دباؤ/پریشر کو ظاہر کرتاہے جب دِل دھڑکنوں کے درمیان وقفہ کی حالت میں ہوتا ہے.<a href="#accordion">[1]</a> اِن دَو نمبروں کے ذریعے ڈاکٹر اور صحت کی دیکھ بھال کرنے والے متعلقہ فرد کی مجموعی صحت کے بارے میں اندازہ لگاتے ہیں۔

بلڈ پریشر میں ہلکےاورعارضی طور پر پیدا ہونے ردّو بدل معمول کی بات ہے اور ایسا بہت سے اسباب کی وجہ سےہوتا ہےتاہم،اگر کسی فرد کےبلڈ پریشرمیں، معمول سے ہٹ کر آنےوالی تبدلیاں لمبےعرصے تک&nbsp; جاری رہتی ہیں تو یہ طبّی لحاظ سے،زیادہ پیچیدیہ اورگہری صورت حال کی نشان دہی کرتی ہے،اوراس پر مزید تحقیق کسی مستند معالج سےکروانی چاہئے۔اعدادوشمار کے لحاظ سےتجزیہ کرنے کے لئے بلڈ پریشر کےپانچ درجے /کیٹیگریز بیان کی گئی ہیں۔<a href="#accordion">[3]</a> 
&nbsp;

<h5 dir="RTL">نارمل رینج</h5>

ہر صحت مند انسان کے لئےبلڈ پریشر کی معمول کی حد۔نارمل رینج 120/80 mm Hg شمار کی جاتی ہے.<a href="#accordion">[4]</a>متوازن غذا اور جسمانی سرگرمیاں دِل کی دھڑکنوں میں ہم آہنگی قائم رکھنےمیں مدد دیتی ہیں اور بلڈ پریشر معمول کی حد میں رہتا ہے.<a href="#accordion">[4]</a>

پیدائش کے وقت بچّے کا بلڈ پریشر64/40 mm Hg ہوتا ہےجو آگےچل کر بلوغت کی عمر میں120/80 mm Hgہوجاتا ہے۔ بہت سےقدرتی اورانسان کے پیدا کردہ عوامل کی وجہ سےبلڈ پریشر میں اُتار چڑھاؤ آتا رہتاہے۔مثال کےطور پر،پُرجوش تقریر کرنےکےبعد یا دوڑ لگانے کےبعد اگر بلڈ پریشرناپا جائےتو اِس کی ریڈنگ ممکنہ طور پرزیادہ آئے گی۔یہ بالکل معمول کی بات ہے کیوں کہ بڑھےہوئی گلوتی سطحadrenal levelsکی وجہ بلڈپریشربڑھ جاتا ہے اوردِل کو مقابلہ یا راہ فرار اختیار کرنے جیسی صورت حال سےنمٹنے کے لئے زیادہ آکسیجن فراہم کی جاتی ہے۔<a href="#accordion">[3]</a> 
&nbsp;

<h5 dir="rtl">بلڈ پریشر کی بڑھی ہوئی حد</h5>

یہ صورت حال مریضوں کے لئےانتباہ&nbsp;ہوتی ہے اور انہیں بلڈ پریشر کی زیادتی کا علاج مزید خرابی پیدا ہونے پہلے کروالینا چاہئے۔جب مستقل طور پر،بلڈ پریشر کی رِیڈنگ زیادہ آئےتواسےبلڈ پریشر کی بڑھی ہوئ حد شمار کیا جاتا ہے۔جب انقباضی /systolic پریشر 120-129 mm Hg ہو اور انبساطی /diastolic &nbsp;پریشر80 mm Hg سے کم ہو تو ممکن ہے کہ ایسی صورت میں ڈاکٹرمختلف تشخیص &nbsp;کرنے کا فیصلہ کرسکتا ہے۔<a href="#accordion">[3]</a>

ایسے افراد جن کا بلڈ پریشر مستقل طور پر بڑھا ہُوا ہو تو اُن کی زندگی کے شروعاتی سالوں کےدَوران مختلف قِسم کےکورونری امراض لاحق ہونے کا اِمکان ہوتا ہے.<a href="#accordion">[5]</a>طویل عرصے تک بڑھے ہوئے بلڈ پریشر کا علاج نہ کروانے کی صورت میں شریانوں کے کسی حِصّے میں&nbsp; میں پھیلاؤ پید اہوسکتا ہے۔بڑھے ہوئے بلڈ پریشر کی وجہ سے دِل کے فَیل ہوجانے کا اِمکان بھی بڑھ جاتا ہے۔مزید یہ کہ، گُردوں کی نالیوں کو نقصان پہنچنے کی وجہ سےگُردوں کےمعمول کے افعال متاثر ہوسکتے ہیں۔کیوں کہ آنکھوں کے اندر پائی جانے والی باریک شریانیں اِس قِسم کے نقصان سے محفوظ نہیں ہوتیں لہٰذا،بلڈ پریشر میں اِضافے کی وجہ سے نظر کے مسائل بھی پید اہوسکتے ہیں بلکہ بینائی کو بھی نقصان پہنچ سکتا ہے.<a href="#accordion">[4]</a> 
&nbsp;

<h5 dir="RTL">بڑھے ہوئے بلڈ پریشر کا پہلا مرحلہ</h5>

اگر علاج نہ کیاجائےتو بڑھا ہُوا بلڈ پریشر آگے چل کر پہلے مرحلے میں داخل ہو سکتا ہے۔پہلے مرحلے میں،انقباضی/systolicپریشر کی حد 130-139 mm Hgہوتی ہے اور انبساطی/diastolic پریشر کی حد 80-89 mm Hgتک رہتی ہے۔<a href="#accordion">[3]</a>&nbsp;بلڈ پریشر کے اِس مرحلے میں،ماہرین معمول کی سرگرمیوں اور رہن سہن میں تبدیلیوں پر زور دیتے ہیں۔وہ ایسی صور ت میں،شریانوں میں کولیسٹرول،چکنائیوں وغیرہ کی بنیاد پرپید اہونے والے امراض،مثلاً دِل کا دَورہ یا اسٹروک کےخطرے کی بنیاد پر&nbsp;ادویات بھی تجویز کرسکتے ہیں۔<a href="#accordion">[3]</a> 
&nbsp;

<h5 dir="RTL">بڑھے ہوئے بلڈ پریشر کا دُوسرا مرحلہ</h5>

بڑھے ہوئے بلڈ پریشر&nbsp; کے پہلے مرحلے کا علاج کامیاب نہ ہونے کی صورت میں،تو بلڈپریشر کے دُوسرے مرحلے کےشروع ہونا کا اِمکان ہوجاتا ہےجس میں بلڈ پریشر کی رِیڈنگ140/90 mm Hg یا اس سے زائد ہوتی ہے.<a href="#accordion">[3]</a>&nbsp;اس مرحلے میں ماہرین،رہن سہن کے طریقوں اور ادویات میں تبدیلی کی تجویز دے سکتے ہیں۔دُوسرے مرحلے والے مریضوں کا علاج کرنے دَوران کلینک کو درست بلڈ پریشر،بلڈ پریشر کو کنٹرول کرنے والےمعمولات،اِن معمولات میں حسب ضرورت تبدیلی لانی چاہئے تا کہ مطلوبہ بلڈ پریشر حاصل ہوسکے۔اسی طرح،کلینک کو ، مریض پر علاج کے اثرات،مریض کے استحکام،اورآگے چل کردِل کے امراض پیدا ہونے کےخطرات کو بھی مدّ نظر رکھنا چاہئے.<a href="#accordion">[6]</a> 
&nbsp;

اگر کسی فرد کا بلڈ پریشر زیادہ رہا ہو تو اُس کے لئےبلڈ پریشر کا بحران پیدا ہونے اِمکان زیادہ ہوجاتا ہے۔ایسی صورت میں فوری اور مناسب علاج کی ضرورت ہوتی ہے۔لہٰذا یہ بات اہم ہے کہ مطلوبہ علاج میں دَیر نہ کی جائے۔اگربلڈ پریشر کی معمول کی چَیکنگ دَوران رِیڈنگ 120/80 mm Hgسے زیادہ آجائے تو پریشان ہونے ضرورت نہیں۔گہرا سانس لیجئے،پانچ منٹ کا وقفہ کیجئے،اور ایک بار پھر اپنا بلڈ پریشر چَیک کروائیے۔لیکن اگر دونوں مرتبہ رِیڈنگ زیادہ ہی آتی ہے تو فوری طور پر کسی ہسپتال یا ڈاکٹر سے رجوع کیجئے.<a href="#accordion">[3]</a>&nbsp;اِس قِسم کی بڑھی ہوئی رِیڈنگ سے بلڈ پریشر کے بحران کی نِشان دَہی ہوتی ہے۔

مزید یہ کہ،بلڈ پریشرکی رِیڈنگ 120/80 mm Hgسے زیادہ ہونے کی صورت میں متعلقہ فردمیں آگاہ کرنے والی دیگر پریشان کُن 
علامات ظاہر ہوسکتی ہیں جن سے اعضاء کے ممکنہ نقصان کی نِشان دہی ہوتی ہے.<a href="#accordion">[7]</a> 
&nbsp;

ہر روز ہسپتال جانے کےبجائے گھر پر بلڈ پریشر ناپنے کا آلہ استعمال کرنے میں خرچ کم آتا ہے۔یہ آلہ خریدنے کے لئے ڈاکٹر کی جانب سے تجویز حاصل کرنا ضروری نہیں۔یہی وجہ ہے کہاب گھروں میں اس آلے کا استعمال بڑھ رہا ہے۔تاہم بلڈ پریشر کی وجہ سے پیدا ہونے والی زیادہ سنگین کیفیتوں اور پیچیدگیوں کی صورت میں، اس آلے کا استعمال،بنیادی معالج سے ملاقات اور مشورے کا نعم البدل نہیں ہے۔اس کے علاوہ،گھر پر استعمال ہونے آلے کی کچھ حدود بھی ہوتی ہیں.<a href="#accordion">[7]</a>&nbsp;تاہم،آگہی کے ساتھ آلہ خریدنے پر مؤثر آلہ دستیاب ہوسکتا ہے۔

متعلقہ فرد کی عمر، صحت اور مرحلے کے لحاظ سے بلڈ پریشر کو&nbsp; مطلوبہ حد میں رکھنے کے لئے،اُنہیں باقاعدگی سے بلڈپریشر کی رِیڈنگ کو موازنے اور علاج کی پیش رفت کی تصدیق کرنے کے&nbsp; لئے نوٹ کرنا چاہئے۔حقیقت پسندانہ بات یہ ہوگی کہ مریض کو طویل سفر اور بھاری معاوضہ دے کر بلڈ پریشر کی رِیڈنگ حاصل کرنے کے بجائے ڈاکٹر کی جانب سے اُسے گھر پر بلڈ پریشر مانیٹرگ یونٹ استعمال کرنے کا مشورہ دِیا جائے۔

مطلوبہ آلہ خریدنے پہلے نَیٹ پر تلاش ضرور کیجئے اور درست تفصیلات&nbsp;والا آلہ خریدئے۔اِس ضمن میں آپ اپنے ڈاکٹر سے بھی مشورہ لے سکتے ہیں۔ہر سال اِس آلے کو بھی چَیک کروائیے۔آلہ خریدنے کے بعد اسے ڈاکٹر یا نرسنگ اسٹاف کےپاس لے جایئے اور اُن سے اِس کا استعمال سیکھئے ۔اِس طرح آپ اِسے سے درست رِیڈنگ حاصل کر سکیں گے.<a href="#accordion">[7]</a>&nbsp; 
&nbsp;

خلاصہ

ہائی بلڈ پریشر کی وجہ سے مستقل نقصان اور زندگی بھر چَلنے والی پیچیدگیا ں پیدا ہوتی ہیں لہٰذا، بلڈ پریشر کے مختلف مرحلوں&nbsp; اور انہیں مانیٹر کرنے کے بارے میں سمجھنا ضروری ہے ۔بڑھتی ہوئی عمرکے ساتھ بلڈ پریشر میں اِضافہ،انقباضی/systolic&nbsp;پریشر میں رفہ رفتہ اِضافہ ہونے کی وجہ سے ہوتا ہے۔

پچاس سال سے زائد عمر والے افراد میں،انقباضی/systolic&nbsp;پریشر، بلڈ پریشر کی سب سے زیادہ عام قِسم ہے۔اور یہ بات،خون کی نالیوں اورشریانوں کےدرمیان عدم مطابقت کی مریضانہ نوعیت کو ظاہر کرتی ہیں.<a href="#accordion">[6]</a>&nbsp;انبساطی/diastolic پریشر کی نسبت،انقباضی /systolic پریشر کی صورت میں دِل کے امراض کا زیادہ خطرہ پیدا ہوتا ہے۔تاہم ،دونوں صورتوں میں تجویز کردہ ادویات اور رہن سہن میں ضروری تبدیلیاں کی جانی چاہئیں۔ 
&nbsp;

اہم نکات

اگرچہ ہائی بلڈ پریشر کے حوالے سے بہت سے ذیلی موضوعات بھی ہیں تاہم درج ذیل نکات کو یاد رکھنا ضروری ہے:

<ul dir="rtl">
	<li>جب معمول کا بلڈ پریشر مستقل طور پر بڑھ جائے تو اسے ہائی بلڈ پریشر کہتے ہیں۔ بلڈ پریشر کی پیمائش دَو&nbsp;رِیڈنگ کے ذریعے کی جاتی ہے: انقباضی /systolic اور انبساطی /diastolic۔</li>
</ul>

<ul dir="rtl">
	<li>انقباضی /systolic بلڈ پریشر،دِل کے عضلات سُکڑنے سے بنتا ہے جب کہ انبساطی/diastolicپریشر دِل کے دھڑکنوں کے درمیان وقفےسےبنتا ہے۔</li>
</ul>

<ul dir="rtl">
	<li>بلڈ پریشر کی نارمل حدود،انقباضی/systolic پریشر کے لئے120 mm Hg&nbsp;سے کم &nbsp;اور انبساطی /diastolicپریشرکے لئے،80 mm Hg سے کم ہوتی ہے۔</li>
</ul>

<ul dir="rtl">
	<li>بلڈ پریشر کی بڑھی ہوئی صورت میں،انقباضی /systolic پریشر 120-129 mm Hg اورانبساطی /diastolicپریشر80 mm Hg سےکم ہوتا ہے۔</li>
</ul>

<ul dir="rtl">
	<li>ہائی بلڈ پریشر کے پہلے مرحلے میں،انقباضی /systolic پریشر130-139 mm Hgہوتا ہے جب کہ انبساطی /diastolicپریشر 80-89 mm Hg ہوتا ہے۔</li>
</ul>

<ul dir="rtl">
	<li>ہائی بلڈ پریشرکے پہلےمرحلے میں،انقباضی /systolic پریشر140 mm Hg یا اِس سے زائدہوتا ہے جب کہ انبساطی/diastolicپریشر 90 mm Hgیا اِس سے زائد ہوتا ہے۔</li>
</ul>

<ul>
	<li dir="rtl" style="text-align: right;">ہائی بلڈ پریشر کے بحران کےدَوران،انقباضی /systolic پریشر کی رِیڈنگ 180 mm Hg سے بڑھ جاتی ہےجب کہ انبساطی/diastolicپریشرکی رِیڈنگ 120 mm Hgسے زیادہ ہوتی ہے۔ایسی صورت میں فوری طبّی مدد کی ضرورت ہوتی ہے۔</li>
</ul>

[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.