The ‘’Cuba Salud 2018 which concluded a few days ago attended by Sri Lankan delegates including the Health Minister discussed varying diseases including emerging non communicable diseases that have now overtaken communicable diseases. High Blood Pressure ( Hypertension) and Cholesterol were two of them.
The focus on HBP was timely since it is now the leading cause for death and disability in the world. The fact that it is a ‘silent disease since it has no symptoms of pre warnings’, makes it even more dangerous. . Anyone, even children can get it, the risk rising sharply with age resulting in a large proportion of those over 60s being affected by Hypertension ( High Blood Pressure).
An island wide study conducted in 2014, said to be the first self reported survey by the Census and Statistics Dept. on chronic illnesses, has given proof to this when it revealed that High Blood Pressure ( HBP) was much higher among the Lankan population aged 15 plus than any other chronic illness.
While genetics is a contributory factor, risk factors for High Blood Pressure stem from the excesses of modern living which has led to obesity and excessive consumption of salt in local diets. Hence, the medical profession has urged the general public, irrespective of age, to eat healthy diets and for those in the mid forties and upwards to minimize the risk of High Blood Pressure with regular check ups as younger adults are now being admitted to hospitals with acute HBP or high cholesterol which together make a deadly combination. They also warn those who fall into the pre-hypertension category to maintain healthy diets and follow the simple guidelines given to them by their physician.
“People with pre hypertension are more likely to develop High Blood Pressure if they don’t take steps to prevent it. This is why we have to keep reminding the public it is important to guard themselves against this silent disease which along with high cholesterol can cause heart failure, stroke and kidney disease”, says Chief Consultant Endocrinologist, Diebetologist , NHSL, Dr Noel Somasundaram.
Chatting to the Sunday Observer, he offered useful advice on how to identify HPB and Cholesterol, and how to prevent them from taking over your life and affecting the future generations as well by adopting simple life modification rules.
Excerpts …
Q. An island wide study conducted in 2014, said to be the first self reported survey by the Census and Statistics Dept. on chronic illnesses, showed that High Blood Pressure ( HBP) diabetes, asthma and arthritis were much higher among the Lankan population aged 15 plus than any other chronic illness. Is this true today?
A. Several studies have shown that among Sri Lankan adults close to 25% have cardiovascular disease such as high blood pressure and high cholesterol. In urban settings, particularly, in Colombo this could be as high as 40%. These are staggering figures.
Q. According to this study, High Blood Pressure topped the list at 39.4%, followed by Diabetes ( 30.4%) , Asthma (13.8%), Arthritis ( 11.4%) and Heart Disease (9.0%). Are all these diseases related? What is the link?
A. Most of these conditions are diseases of modern lifestyle. Cardiovascular diseases, diabetes, fatty liver disease are all a manifestation of rapidly changing lifestyle characterized by less physical activity and too much calories in the food. In addition, obesity and overweight lead to multiple problems including, diabetes, cardiovascular disease, cancers, and joint related problems such as osteoarthritis.
Q. Who are most at risk of getting these chronic diseases today, and why?
A. There are multiple ‘risk factors’. Genetic predisposition is a key factor as well as increasing age. However, there are behaviour related risk factors which can be modified to reduce the risk of each individual. These include too much food, decreased physical activity, cigarette smoking, too much alcohol.
Q. I read that there was no gender difference in the patients when it comes to older persons ( over 60 years). What is the situation of younger patients who are now being increasingly admitted for various chronic illnesses?
A. There is a slight gender difference with slight female preponderance for most of these conditions. Women tend to be more overweight than men and engage in less physical activity. In addition, women are more vulnerable to complications due to the gender bias. Young women of reproductive age are likely to pass on unhealthy genes and control mechanisms to their offspring that will result in perpetuation of the current epidemic of non communicable diseases.
Q. What do you consider the most significant adverse health impacts of High Blood Pressure?
A. Unfortunately, high blood pressure is a ‘silent killer’. One is not aware of it until complications have arisen. In addition, many people are under the impression that they can feel it when their blood pressure is high. This is wrong. In most people the manifestations are the complications such as, heart attacks, cerebrovascular accident or stroke, kidney failure, etc.
Q. Is it possible to identify the symptoms early? What are they? ( explain in detail)
A. As I have said earlier it is important to reiterate that the symptoms are usually absent until something unfortunate has happened. Our recommendations for detecting all cardiovascular conditions is to screen for them, not to wait till it is too late.
Q. How is HBP diagnosed clinically? Are there special machines for this?
A. The blood pressure can be easily measured by blood pressure detecting machines which are widely available. Manual ones including mercury or air based machines are used by health care staff. The new development is to use a much simpler electronic automated blood pressure monitor. Either industrial ones for use in health care institutions or smaller ones for the use of public are available.
Q. What is the ideal BP a normal person should have?
A. 130/80 mmHg. 130 should be the highest reading and for the diastolic pressure ideal reading should be less than 80.
Q. If one is already having BP, what is the level he/she should strive for? Is there a cut off point when the level enters a dangerous zone?
A. Even for those found to have high blood pressure the target values are the same. From 100-110 upwards there is an exponential rise in complications for individuals. Higher the blood pressure higher the risk of complications.
Q. What happens when a person’s BP exceeds permissible levels reaching very high levels? Name some complications.
A. You are asking whether there are acute complications i.e. those that develop suddenly as opposed to those that occur over a longer term. All of the chronic complications can develop when the blood pressure rises beyond certain levels usually blood pressure above 180 can lead to acute complications. These develop as a part of accelerated high blood pressure. Features include severe headache and bleeding into the brain, heart attacks, kidney failure etc can develop.
Q. The Ministry of Health, Nutrition & Indigenous Medicine has recently launched some important interventional measures to bring down non communicable diseases, such as, HBP, diabetes and cholesterol. One of these measures is to regulate the use of salt by 30% in our diets . Why is salt such a significant contributory factor in elevating our blood pressure?
A. When we talk about salt we are concerned about sodium chloride and in particular, sodium- which is an essential mineral in the body. Sodium regulates the blood pressure by controlling the volume of blood and hence the pressure. In normal quantities sodium will be essential for survival as the blood pressure in the normal range is needed for normal function of the body, including erect posture and mobility. Our modern diets have far too much salt for our own good. When there is long term exposure to too much salt blood pressure is elevated, and this leads to stiffness of arteries and changes in the kidney that lead to chronic high blood pressure. Lower salt content in the diet is important as this results in less high blood pressure.
Q. What should be the intake of salt for a normal person without HBP? How many teaspoons?
A. 5grams of sodium chloride or one tea spoon of salt per adult per day. This is easily exceeded in our foods because we have not just the salt we add directly but also because of indirect salt addition such as, what is in the processed food, fast foods, and commonly purchased food items.
Q. For those with HBP how many teaspoons are permitted? None? Or a couple per daily meals?
A. Restriction of salt consumption is a powerful therapy for high blood pressure and also for those with heart disease. Reduction to at least 5grams of sodium chloride or one teaspoon of salt per adult per day is strongly recommended.
Q. If you go on a saltless diet can you develop cramps or any other complication?
A. Some salt or sodium chloride is needed for normal function of the body, however, the key concept is to limit to normal levels. In most foods there is a certain amount of sodium chloride and we need not add salt to add sodium chloride. Therefore, it is possible to live without added salt.
Q. The Health Ministry has also taken steps to compel manufacturers to display the sugar contents of all sugar based food products in various colours using the traffic lights system. However, in some countries like the UK, the Netherlands and the Philippines, all sugar based drinks like coke and fanta are now being banned to prevent obesity and diabetes . Do you think Sri Lanka should follow in the same footsteps? From your experience abroad what can you say?
A. There are two aspects to the prevention of diseases. The first is the regulatory where the government is expected to bring about legislation and create the environment for health. Multiple steps can be taken such as, sale bans on advertising, allowing information to be transparent such as through labelling or colour coding. These are important steps. The other equally important step is personal responsibility where individuals take preventive steps such as, avoidance of unhealthy behaviour as well as demanding health friendly policies from the government.
Q. The 2014 study I referred to earlier mentioned that the incidence of NCDs was higher among those with lower literacy levels, with risky health behaviour, and non use of available preventive services being reported as highest ( 77%) in those with less than O/L qualifications. Your comments?
A. Unfortunately, it is true that health problems are highest among the poorer and the less educated. Multiple factors are at play. Knowledge leads to healthier behaviour and this is one factor. On the other hand, healthier foods are more costly and this is another risk factor that accounts for this disparity.
Q. The study further revealed that district wise the highest number of persons with NCDs were from Colombo and the lowest in Trincomalee? Why?
A. There is an urban preponderance for NCDs. Similarly, higher the urbanization higher the NCDs. It is no surprise that Colombo should be the NCD capital and as one moves away from Colombo the NCDs decrease.
Q. Are children also at risk of HBP?
A. If the current trends of childhood obesity continues, then yes, we are going to see more children with high blood pressure.
Q. As a Diabeticean tell us about emerging problems with regard to diabetes in Sri Lanka. It has been found that in Colombo alone some 3.3% children less than 15 were pre diabetic. Is this true? . How did this happen?
A. Changing lifestyle have meant that children are less physically active and consume unhealthy food. They are also overweight or obese and these risk factors lead to childhood illnesses such as, diabetes and high blood pressure.
Q. Can health diets play a role in reducing and maintaining healthy levels of NCDs in those already afflicted by them? Mention some local fruits and proteins as well as what is referred to a healthy lunch plate?
A. Definitely. As most people and children consume unhealthy foods and a high quantity several methods have been developed to inform the public on healthy foods. A simple method is the healthy plate method. It is recommended that half of the plate be filled with vegetables and the rest should be carbohydrate and proteins. For vegetable any Sri Lankan vegetable can be used. Examples of proteins include soy, fish or chicken.
Q. The Health Minister in his discussions at the recent Universal Health Coverage which opened in Sri Lanka a few days ago, referred to the introduction of the ‘Family Doctor ’concept where one physician would be appointed to look after the health of 5,000 people, to help early diagnosis and treatment. Do you see any problems in such a move considering the shortage of doctors, nurses, etc?
A. This is the path for making health available and accessible to the Sri Lankan population. I am sure we will face multiple obstacles. But, this has to be done in a step by step manner to face the current health challenges.
Q. With 1-2 persons having some form of health problem in this country, do you have a message with a focus on high blood pressure and cholesterol and their link to other NCDs?
A. Eat less, walk more, and don’t smoke !