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Heart 2 Heart - Know your numbers

20 May 2011
We know that cardiovascular disease (CVD) is the number one killer in Malaysia and many countries all over the world, ac­counting for about 25 percent of deaths in Malaysia every year, but do you know what the big­gest single risk factor for CVD is? It is none other than hyperten­sion - a condition affecting 1.5 billion people worldwide.

To understand hypertension, let us look at what a normal reading is first. Heart is an or­gan which primary function is to pump blood throughout the body. It has two phases: the re­laxation phase, known as dias­tole, where blood fills up the left ventricle, and the contraction phase, known as systole, where blood is squeezed out of the heart into the circulation.

Blood pressure is the force applied against the walls of the arteries as blood travels through them. Blood pressure measure­ment or reading consists of two numbers, for example 110/70, which is read as 110 over 70. The first or the number on top de­notes the blood pressure during systole, and the number below it indicates the pressure in diasto­le. You have an abnormally high blood pressure if the reading is more than 140/90, and if your blood pressure is consistently above this level, then by defini­tion, you have hypertension. Incidentally, the optimal blood pressure is less than 120/80 and a reading in between that and 140/90 falls into the pre-hyper­tension category.

Hypertension kills. Seven mil­lion people die all over the world every year. By causing damage to arteries around the heart caus­ing coronary heart disease (CHD) and heart attack, and the brain leading to stroke and bleeding in the brain, hypertension also damages other organs leading to kidney failure, gangrene of the feet, eye complications and erectile dysfunction.

With the number of adults with hypertension in Malaysia continuing to rise - from 33 percent in 1996 to a shocking 43 percent in 2006 - we are ap­proaching uncertain and diffi­cult times ahead.

Let us examine a few more im­portant facts. About two-thirds of hypertensive individuals walk around not realising they have a time-bomb ticking inside. Of those who have been identi­fied as having hypertension, only about a third are taking medications as prescribed. Not surprisingly, just over a quarter have their blood pressure under control.

Hypertension remains one of the most active areas of medical research and never before have we had, in our armamentarium, so many drugs to control this deadly condition. Why then are we doing so badly? Statistics are showing that we are losing this battle and something needs to be done fast.

So what can we do? Believe it or not, it is actually quite simple. Know your objective and set your targets to achieve this.

The objective of treatment of hypertension or any disease for that matter is to prevent ill­ness and premature death. Our targets, therefore, has to be to get the blood pressure within a specified range. As mentioned earlier, 140/90 is the upper limit of normal. However, if certain conditions exist, then the goal post will need to be moved. The targets will be different. For example, the target blood pres­sure for anyone with diabetes or chronic kidney disease is less than 130/85. But how many dia­betics and kidney disease suf­ferers do we see in clinic whose blood pressure can we safely say fall within this desirable range? Remember that almost three-quarters of hypertensives out there still do not have their blood pressure controlled and they are literally a walking talk­ing time-bomb!

Just some words of advice.

Know what your blood pres­sure is. If you have not seen a doctor recently, pay him or her a visit.

Take control of your health by keeping tabs of your blood pressure. I advise my patients to invest in a digital blood pressure machine. The price ranges from RM200 to RM400 for a decent machine.

If your blood pressure is ab­normally high consistently, you have hypertension and you must follow your doctor's advice to the letter.

Management of hypertension always begins with modifying your lifestyle: stop smoking (if you are), lose weight, eat healthy food (especially low in salt), exer­cise plenty and avoid stress (now this is hard!).

Once your doctor starts you on medication, assume it is for life. If you get any side-effects from the medication such as cough or swelling of the feet, do not stop without consulting your doctor.

Keep up to your appoint­ment with your doctor. Your blood pressure may change with time as your arteries get stiffer through the years. You may re­quire a higher dose or the addi­tion of a new drug to maintain your blood pressure target. If you don't see your doctor regularly, you run the risk of having your hypertension under-treated.

It is a myth that taking drugs for so long can harm you. Not taking drugs that control your blood pressure is what is going to kill you!

Hypertension is only one of many cardiovascular risk fac­tors, though probably the most important. You should also ad­dress the other risk factors such as smoking, obesity, high cho­lesterol, diabetes and sedentary lifestyle, if present.

Hypertension is a global epi­demic and continues to rise in an alarming trend. In Malaysia and many parts of the world, we don't have the threat of war, ter­rorism or major natural disaster. However, we do have this silent enemy that strikes from within when we least expect. This en­emy must be stopped at all cost and we will only succeed if ev­eryone works together.

On this note, I wish to high­light the work done by the nu­merous organisations and bod­ies all over in the global combat against hypertension, especially that by the World Hypertension League (WHL). Through the World Hypertension Day which is celebrated on 17th May each year, and with a theme of "Know your numbers, target your blood pressure", the WHL wish to reach out to everyone by increasing the awareness of hypertension and the importance of meeting the specified targets to over­come the deadly effects of this condition.

The Malaysian Society of Hy­pertension (MSH) is also running an awareness campaign in con­junction with the World Hyper­tension Day. They have created a Facebook page which brings postings on hypertension and its complications. There is also an online poll which I strongly urge all of my readers to partici­pate. By answering only five very easy questions, which include your age and gender, you stand to win one of three state-of-the-art digital home blood pressure machines on offer, as well as putting you well on the road to health without hypertension. Please visit for more details.

If you have any questions or comments, please write to me at haizal@tropicanamedical­ See you again next Wednesday.
Is it normal to feel my heart beating?

Question: I have been noticing my heartbeat more in the past week especially at night before Igo to sleep. Is this something I should be wor­ried about?

Answer: The sensation of your heart beating, also known as palpitation, is usually quite normal. You can get that after a period of exercise, when you are down with a fever or when you are frightened or anxious. I get it every week when I rush to meet deadlines for my Heart2Heart articles!

Palpitation when you are neither having exercise nor have any form of mental stress is also quite common especially in the quiet of the night when there is least distraction. What you can do is to feel your pulse at your wrist and count it over a minute. If the total count is less than 100, then most likely you have a normal heart rhythm. If your heart rate is high when you ly­ing still, then it may be a cause for concern and you should consult your doctor urgently, especially if you have other associated symptoms such as dizziness, breathlessness and having cold sweats. You may have one of the uncom­mon heart rhythm problems such as atrial fibrillation (heart beating irregularly) or supraventricular tachycardia (heart beating regularly and fast).

Avoid having coffee or any caffeinated drinks in the evening or before bedtime as it can speed up your heart and cause palpitation. For those who drink alcohol, try to avoid this too before going to bed.

If these measures fail to relieve your symptoms, which as I said earlier might not be a cause for worry, then you might want to see your doctor for an opinion. If he or she feels your condition warrants further assessment, then you may be subjected to some tests such as ECG and 24-hour ECG recording (Holter test) as well as blood tests.

This article was published in  on 18 May 2011.

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