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Dr K K Aggarwal

Seven Behaviors Cut Heart Deaths

By Dr K K Aggarwal
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Seven heart–healthy behaviors can reduce the risk of death from cardiovascular disease. In a prospective study, by Enrique Artero, PhD, of the University of South Carolina, and colleagues and published in the journal Mayo Clinic Proceedings, those who met 3–4 of the American Heart Association’s ‘Simple Seven’ heart–health criteria had a 55% lower risk of cardiovascular mortality than those who met no more than two of those practices over 11 years.

Four core behaviors

1. No smoking

2. Normal body mass index

3. Engaging in physical activity

4. Eating healthfully

Three parameters

1. Cholesterol lower than 200 mg/dL

2. Blood pressure lower than 120/80 mm Hg

3. Not having diabetes

A mix of exercise protocol is better

By Dr K K Aggarwal
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A combination of weight training and aerobic exercise is the best prescription for overweight patients at risk for diabetes and heart disease.

Only aerobic exercise is also good as it reduces weight and inches off the waistlines. Just weight lifting alone has very little benefit.

According to a study published in the journal American Journal of Cardiology, people in the weight-training group gained about 1.5 pounds and those in the aerobic group lost an average of 3 pounds and half an inch from their waists.

Those who did both weight and aerobic training dropped about 4 pounds and 1 waistline inch. This group also saw a decrease in diastolic lower blood pressure and in a metabolic syndrome score.

Both the aerobic-only group and the combined-exercise group also lowered their levels of bad triglycerides.

 

Top 10 Ways to Keep the Kidneys Healthy

By Dr K K Aggarwal
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We all want our kidneys to last for a lifetime. We should all show our love for kidneys by adopting 10-step program for protecting kidney health. Start with monitoring blood pressure and controlling weight and then move on to the rest of the kidney-healthy tips.

• Monitor blood pressure and cholesterol.

• Control weight.

• Don’t overuse over-the-counter painkillers.

• Monitor blood glucose.

• Get an annual physical exam.

• Know if chronic kidney disease (CKD), diabetes or heart disease runs in your family. If so, you may be at risk.

• Don’t smoke.

• Exercise regularly.

• Follow a healthy diet.

• Get tested for chronic kidney disease if you’re at risk.

Keeping blood pressure in the safe zone

By Dr K K Aggarwal
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Keeping your BP below 120/80 is the ideal goal to avoid a host of afflictions, including heart disease, kidney failure and erectile dysfunction. When lifestyle changes fail to fix the problem, doctors tend to reach for the prescription pad and add medication.

• Reduce sodium intake. DASH diet keeps sodium to 2,300 mg per day (about one teaspoon of salt). Cutting it to 1,500—not easy, but doable—works even better. The DASH diet can lower your systolic pressure (upper number) by 10 points or more.

• Monitor your pressure at home. This can give you instant feedback on the benefits of diet and exercise and give you and your doctor a more accurate picture of your blood pressure. This is valuable, because some people experience “white coat hypertension,” in which blood pressure spikes higher than normal when measured at the doctor’s office.

• Limit your alcohol intake. For men, the suggested limit is 1 to 2 alcoholic drinks per day, defined as 1.5 ounces (1 shot glass) of 80–proof spirits, a 5–ounce serving of wine, or a 12–ounce serving of beer. (For women it’s no more than one drink a day.)

• Take more meds if you need to—but take the right ones. (Healthbeat)

Blood pressure drugs should be taken at night.

By Dr K K Aggarwal
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Uncontrolled blood pressure can lead to heart attacks, paralysis and heart failure. Most such attacks occur in the early morning hours. Pulse, blood pressure and thickening of platelets are all higher in the early morning hours. Controlling early morning blood pressure can reduce cardiovascular mortality. According to a study published in the Journal of the American Society of Nephrology, among patients with chronic kidney disease and high blood pressure, taking at least one antihypertensive drug at bedtime significantly improves blood pressure control, with an associated decrease in risk for cardiovascular events. The study included 661 patients with chronic kidney disease who were randomly assigned either to take all prescribed anti BP drugs on awakening or to take at least one of them at bedtime. Patients were followed for a median of 5.4 years; during that time, patients who took at least 1 BP–lowering drug at bedtime had approximately one third of the cardiac risk compared with those who took all medications on awakening. A similar significant reduction in cardiac deaths, heart attacks and paralysis was noted with bedtime dosing. Patients taking their medications at bedtime also had a significantly lower mean BP while sleeping. For each 5 mmHg decrease in mean sleep–time systolic upper BP, there was a 14% reduction in the risk for cardiovascular events during follow–up. Potential explanation for the benefit of night time treatment may be associated with the effect of night time treatment on urinary albumin excretion levels. Urinary albumin excretion is significantly reduced after bedtime, but not morning, treatment.

Focus only on upper blood pressure if over 50 years of age

By Dr K K Aggarwal
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For patients aged over 50, doctors only need to monitor the upper systolic blood pressure, and can ignore the lower diastolic blood pressure reading. As per a report published in the journal The Lancet, patients are not getting their systolic blood pressures adequately controlled because there is such an emphasis on diastolic pressure. The fact is that people over the age of 50 probably do not even need to measure diastolic – it’s only the systolic blood pressure that should be the focus.

Generally, systolic blood pressure continues to increase with age, while diastolic pressure starts to drop after age 50, which is the same time when cardiovascular risk begins to rise. Therefore, there is an increased prevalence of systolic hypertension past age 50, whereas diastolic hypertension is practically nonexistent. Rising systolic pressure is the most significant factor in causing stroke and heart disease.

For people under 50, the scenario may be different. About 40 percent of adults under 40 years of age have diastolic hypertension, and about a third of those between 40 and 50 have the problem. For these patients, a continued emphasis on both systolic and diastolic blood pressures is needed. However, controlling systolic blood pressure, even among these younger patients, almost always results in adequate control of diastolic blood pressure, too. For people 50 or older, systolic pressure is high if it is 140 mmHg or above.

Blood pressure drugs should be taken at night

By Dr K K Aggarwal
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Uncontrolled blood pressure can lead to heart attacks, paralysis and heart failure. Most such attacks occur in the early morning hours. Pulse, blood pressure and thickening of platelets are all higher in the early morning hours.

Controlling early morning blood pressure can reduce cardiovascular mortality. According to a study published in the Journal of the American Society of Nephrology, among patients with chronic kidney disease and high blood pressure, taking at least one antihypertensive drug at bedtime significantly improves blood pressure control, with an associated decrease in risk for cardiovascular events.

The study included 661 patients with chronic kidney disease who were randomly assigned either to take all prescribed anti BP drugs on awakening or to take at least one of them at bedtime. Patients were followed for a median of 5.4 years; during that time, patients who took at least 1 BP–lowering drug at bedtime had approximately one third of the cardiac risk compared with those who took all medications on awakening. A similar significant reduction in cardiac deaths, heart attacks and paralysis was noted with bedtime dosing. Patients taking their medications at bedtime also had a significantly lower mean BP while sleeping. For each 5 mmHg decrease in mean sleep–time systolic upper BP, there was a 14% reduction in the risk for cardiovascular events during follow–up. Potential explanation for the benefit of night time treatment may be associated with the effect of night time treatment on urinary albumin excretion levels. Urinary albumin excretion is significantly reduced after bedtime, but not morning, treatment.

Fluctuating blood pressure more harmful

By Dr K K Aggarwal
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In the elderly persons with high blood pressure, further fluctuations and spikes in blood pressure readings can affect their ability to think clearly and other cognitive function.

As per a North Carolina State University study, in people whose systolic blood pressure is 130 mm Hg or higher, the cognitive functions get impaired on days when their blood pressure spikes and fluctuates. On the other hand, in people with normal blood pressure, the cognitive functions do not get impaired if their blood pressure spikes or fluctuates.

Several studies in the past have found a link between high blood pressure and dementia, which is marked by a loss of memory and other cognitive abilities, including the ability to speak, identify objects or think abstractly. In another study it was found that treating high blood pressure in the very elderly may help reduce their risk of developing dementia.

The carry home message is that if you have blood pressure that wildly fluctuates and you also have underlying high blood pressure, you might be in double trouble for poorer cognitive functioning.

Blood pressure measurement may detect proneness to heart attack

By Dr K K Aggarwal
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The ankle–brachial index (ABI), a simple, non–invasive 10–minute test should be incorporated into a routine physical exam for diagnosing peripheral arterial disease in the middle aged and the elderly, especially those with heart attack risk factors like smokers, diabetics and the ones with high BP or cholesterol levels.

With the patient in a supine position, the doctor takes blood pressure readings from both arms; he then takes blood pressure readings from both ankles with a sphygmomanometer and Doppler device. ABI value is calculated by dividing the higher systolic pressure in each leg by the higher systolic brachial pressure.

ABI scores should be interpreted as follows:

  • Greater than 0.90: Normal
  • 0.71 – 0.90: Mild obstruction
  • 0.41 – 0.70: Moderate obstruction
  • Less than 0.40: Severe obstruction
  • More than 1.30: Calcification of the vessels

Presence of peripheral arterial disease may indicate associated blockages in the heart and proneness to heart attack or paralysis.

Can blood pressure be higher in one arm?

By Dr K K Aggarwal
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A small difference in blood pressure readings between arms is normal. However, a difference of more than 20 mm Hg for systolic pressure (top number) or more than 10 mm Hg for diastolic pressure (bottom number) can be a sign of an underlying narrowing of the main arteries to that arm.

A difference of 10 to 15 mm Hg for upper systolic pressure that shows up repeatedly is a risk marker for vascular disease and future heart attacks.

Always have the doctor check both your arms for blood pressure and whichever is higher, use that arm for future blood pressure readings.

Can blood pressure be higher in one arm?

By Dr K K Aggarwal
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A small difference in blood pressure readings between arms is normal. However, a difference of more than 20 mm Hg for systolic pressure (top number) or more than 10 mm Hg for diastolic pressure (bottom number) can be a sign of an underlying narrowing of the main arteries to that arm.

A difference of 10 to 15 mm Hg for upper systolic pressure that shows up repeatedly is a risk marker for vascular disease and future heart attacks.

Always have the doctor check both your arms for blood pressure and whichever is higher, use that arm for future blood pressure readings.

Blood pressure measurement may detect proneness to heart attack

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , , | | Comments Off on Blood pressure measurement may detect proneness to heart attack

The ankle–brachial index (ABI), a simple, non–invasive 10–minute test should be incorporated into a routine physical exam for diagnosing peripheral arterial disease in the middle aged and the elderly, especially those with heart attack risk factors like smokers, diabetics and the ones with high BP or cholesterol levels.

With the patient in a supine position, the doctor takes blood pressure readings from both arms; he then takes blood pressure readings from both ankles with a sphygmomanometer and Doppler device. ABI value is calculated by dividing the higher systolic pressure in each leg by the higher systolic brachial pressure.

ABI scores should be interpreted as follows:

Greater than 0.90: Normal
0.71 – 0.90: Mild obstruction
0.41 – 0.70: Moderate obstruction
Less than 0.40: Severe obstruction
More than 1.30: Calcification of the vessels

Presence of peripheral arterial disease may indicate associated blockages in the heart and proneness to heart attack or paralysis.

Children should be screened for the heart before playing any sports

By Dr K K Aggarwal
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Sudden cardiac death amongst athletes is a rare but a devastating event. Most victims are usually young and, apparently, healthy but many have underlying undiagnosed heart disease.

As per American Heart Association Guidelines, children and adolescents undergoing athletic training need medical clearance. Majority of sudden deaths amongst athletes are due to malignant irregularities in the heart rhythm such as ventricular tachycardia and ventricular fibrillation. The precipitating factors can be prolonged physical training or unaccustomed athletic activities.

In athletes under the age of 35, the most common cause of death is underlying congenital heart disease and for those above the age of 35, it is the presence of blockages of the coronary arteries.

As per Heart Care Foundation of India, in every school/college, the attached doctor should evaluate all students with a 12 step history and examination to rule out high risk cases that need further evaluation.

The Foundation, along the lines of European Society of Cardiology, also recommends an additional standard 12–lead ECG before a medical clearance is given for both competitive as well as recreational athletic activities.

Master athletes who are above the age of 35 will need an additional exercise testing before they can be given a clearance for athletic activity.

Diagnostic echocardiography is indicated when clinical, historical and physical findings suggest possibility of structural heart diseases. Athletes on pacemakers should not engage in sports as bodily collision may damage the pacemaker system.

The 12–element AHA recommendations for pre participation cardiovascular screening of competitive athletes are as follows:

  1. Exertional chest pain/discomfort
  2. Unexplained syncope/near–syncope
  3. Excessive exertional and unexplained dyspnea/fatigue, associated with exercise
  4. Prior recognition of a heart murmur
  5. Elevated systemic blood pressure
  6. Premature death (sudden and unexpected, or otherwise) before age 50 years due to heart disease, in one relative
  7. Disability from heart disease in a close relative <50 years of age
  8. Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy, long–QT syndrome or other ion channelopathies, Marfan syndrome, or clinically important arrhythmias
  9. Heart murmur
  10. Femoral pulses examination to exclude aortic coarctation
  11. Physical features of Marfan syndrome
  12. Brachial artery blood pressure (sitting position, both arms)

Winter blood pressure 5 mm Hg higher than summer blood pressure

By Dr K K Aggarwal
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Winter blood pressure 5 mm Hg higher than summer blood pressure

The systolic (top number) and diastolic (bottom number) blood pressures rise and fall with change of season.

In a study by the Institute National de la Sante et de la Recherche Medicale of Paris and published in the journal Archives of Internal Medicine involving 8801 people aged 65 or older, average systolic blood pressure was five points higher during the winter than in summer.

Instances of high blood pressure (systolic blood pressure higher than 159, or diastolic higher than 94 mmHg) in the study were found in 33.4 percent of participants during winter but just 23.8 percent during summer.

The reason could be related to the baroreflex, a mechanism of blood pressure regulation that is modified in elderly subjects or a function of the sympathetic nervous system, which helps control involuntary actions such as stress response. A 5 mm change in blood pressure can explain why more heart patients die in winter.

Medical vrat

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Ever since people have stopped observing weekly fasts, the incidence on high blood pressure, diabetes and heart attack has increased.

Scientifically, it is now known that eating carbohydrates everyday increases the chances of heart attack.

Here are some ways we can observe weekly medical vrata:

Choose a fixed day in a week to observe fast. Eat only once that day (light meal). You can have water, jiggery water, mint water etc for the rest of the day.

If one cannot fast, then one can have fruits and fruit juices.

Single vrata meals can be either lunch or dinner and they should not contain carbohydrates or wheat cereals.

Wheat cereals can be replaced by Besan ki roti or Samak Rice (fruit), singhare ki roti (fruit), kuttu ki roti (fruit) or sabu dana.

Do not take any item prepared in vanaspati ghee on the day of fast.

If this fast falls on Ekadashi, restrict the intake of liquid to prevent water retention on the day of full moon.

The fast should also be observed along with other sensual fast i.e. one should live a satvik lifestyle on that day.

Anything which pleasures the senses should be avoided like aromas, erotic smell, reading and watching aggressive and tamsik literature or movies on the day of fast.

One should observe non-violence on the day of fast and this non-violence should be in action, speech and thought. On this day, one should not gossip, criticize, condemn or complaint about others and should not indulge in judgments unless they are a must. A classical example is, if someone abuses you on that day, you should say “kal dekhunga”.

Sexual vrata is also a part and parcel of traditional medical vrata.

On the day of vrata, reduce the intake of blood pressure and diabetes medicines. Insulin requirement may also reduce by 40% on the day of fast.

Read spiritual scriptures, as much as possible, on the day of fast and avoid the company of bad people.