All you wanted to know about hypertension …

By Dr Hassan M CougahOne of the most common lifestyle diseases, high blood pressure or hypertension can lead to serious health consequences or even death if it’s left uncontrolled. Known as a ‘silent killer’, high blood pressure causes more fatalities than any other disease, and this usually happens through many complications like heart attack, coronary artery disease, stroke, heart failure and chronic kidney disease.Scientifically, blood pressure is the pressure inside the arteries, which results from the movement of blood with each heartbeat. Blood pressure should always be in a range that maintains perfusion of organs, without causing any harm to them, which means that it should neither be too low, nor too high.The normal range of blood pressure was defined after too many studies which found that when blood pressure becomes higher than a definite limit, the risk of many complications (including death) increases.So why is this killer called ‘silent’? Because in most cases it exists without any symptoms and remains undetected for years, though it has been there working hard on damaging the vital organs of the body. Although it’s very serious, it is very simple to diagnose and easy to treat and the most important fact is — in most cases it can be prevented. How will you know?Either by its symptoms like headache, dizziness, fatigue, nose bleeding etc  or by its complications like palpitations, difficulty of breathing on effort (when climbing stairs or carrying heavy things), chest discomfort or pain (on effort or during emotional stress), increased urinary frequency especially at night, or even sexual dysfunction.But remember it’s called ‘silent’ because most cases do not have any symptoms, and the best way to be sure that your blood pressure is normal is to check it.CausesObesity: Which became pandemic in many regions of the world, including the Gulf countries, is frequently accompanied by hypertension and not uncommonly by other diseases as well like diabetes (high blood sugar) which increases the risk of hypertension even more.Physical inactivity and sedentary lifestyle: Office type of work and limited exercise. Unhealthy food: Too much intake of fatty meals and high salt content (salt contains sodium which, in excess, causes  increased water retention in the body and hence increased blood pressure)Diagnosis Hypertension can be diagnosed simply by checking blood pressure at a clinic but it should be checked while the person is physically and emotionally at rest, and at least on two separate visits. Some people have high blood pressure only at the clinic and not at home. This is called the ‘white coat effect’ of being in the clinical environment. Blood pressure has two components: Systolic (the higher number which accompanies systole of the heart) and diastolic (the lower number accompanying diastole of the heart). The normal blood pressure according to the latest recommendations should not exceed 120 (systolic) and 80 (diastolic).According to its severity, hypertension is classified as: High, normal (or Prehypertension), Stage 1 and Stage 2. In 5% of cases, we can find a specific cause of hypertension (and this is called secondary hypertension) but in the remaining 95% we cannot (which is called primary hypertension). However, this does not change the fact that in all cases controlling hypertension is possible by treatment.     EvaluationThe first step is to confirm its diagnosis and classify its severity. To confirm hypertension we should rule out the ‘white coat effect’, but at the same time we should clarify if there is ‘masked hypertension’ which is defined as having hypertension at home or during daytime activities but normal blood pressure at the clinic.Both cases can be clarified by using ambulatory blood pressure monitoring, which is using a special device to monitor and register blood pressure measurements at regular intervals throughout 24 hours, while the person is in normal life and during his usual activities.In the second step, the evaluation is done to assess if there is any other cardiac risk factor and if there is any harm caused by hypertension in various organs of the body (which is termed: end-organ damage).Cardiac risk factors other than hypertension include: smoking, diabetis mellitus (high blood sugar), hyperlipidemia (high blood cholesterol or triglycerides), obesity, family history of ischemic heart disease at an early age and impaired renal function. These risk factors increase the cardiovascular risk of hypertension and increase the necessity of a well-controlled blood pressure.For assessing end-organ damage, we need to do some basic investigations like electrocardiography (ECG) and laboratory tests (including: blood sugar, renal function tests, electrolytes, urinalysis and lipid profile).In the third step, the evaluation of hypertension is done to look for any specific cause behind it. This is very important in some situations like: in children and young adults, when hypertension is resistant to treatment, and in special situations like pregnancy. Treatment Lifestyle changes are important in treating all kinds and degrees of hypertension and also in its prevention. These changes include:Weight reduction: Decreasing weight by sport and healthy diet is very helpful in controlling hypertension. Smoking cessation: Quitting smoking decreases blood pressure and the risk of many other diseases like cancer.Physical activity: Brisk walking for 30-60 minutes a day, most days of the week, decreases blood pressure and improves physical and emotional wellbeing.Low-salt diet: Decreasing salt intake to less than 6g per day (including all sources like processed and canned food) is necessary to control blood pressure.Low-fat diet: Low-fat dairy products, meat and chicken without fat, fruits and vegetables decrease the risk of hypertension. Final adviceYou should watch out and fight this silent killer before it takes you without warning!* Dr Hassan Muhammad Cougah is a cardiologist at Atlas Medical Centre, DohaVitamin C as cancer treatment?By Monte MorinCould pumping roughly 2,000 oranges’ worth of vitamin C into a patient’s bloodstream boost the effectiveness of anti-cancer drugs and mitigate the gruelling side effects of chemotherapy?In research published in the journal Science Translational Medicine, scientists found that high doses of vitamin C — administered intravenously — increased the cancer-killing effects of chemotherapy drugs in mice, and blunted toxic side effects in humans.But even though the research seems to offer the promise of effectiveness for a new method of cancer treatment, vitamin C, or ascorbate, is unlikely to inspire the vigorous, and expensive, research necessary to become an approved tumour remedy, experts say.Due to a decades-long history of discredited health claims, as well as the inability of pharmaceutical companies to patent an essential nutrient, vitamin C is among the unlikeliest compounds to attract funding for cancer research.“There’s been a bias since the late 1970s that vitamin C cancer treatment is worthless and a waste of time,” said Dr Jeanne Drisko, a study co-author and the director of integrative medicine at the University of Kansas Medical Center. “We’re overcoming that old bias.”The furore surrounding vitamin C began with the chemist Linus Pauling, a two-time winner of the Nobel Prize, who proposed that heavy doses of ascorbate could prevent and treat most cancers. Although Pauling’s broad claims could not be supported in clinical trials, large doses of vitamin C are still used as an alternative form of cancer treatment for thousands of patients, outside of mainstream medicine. Drisko and colleagues argue that vitamin C is worth re-examination, and say the US government should fund further research. One of the problems with earlier studies, they say, is that ascorbate was taken orally, not intravenously.“When you swallow a pill or eat an orange, vitamin C is absorbed at a certain rate by the gut and excreted very quickly by the kidneys,” Drisko said. “But when you give it intravenously, you override that. Plasma levels can get very high.”Researchers examined the effects of vitamin C on a variety of cancer cells in the lab, and in ovarian cancer cells in mice. When high concentrations of ascorbate entered the space between cells, they said, it formed hydrogen peroxide.Senior author Qi Chen, an assistant professor of pharmacology, toxicology and therapeutics at the University of Kansas, said the hydrogen peroxide went to work on cancerous cells in several ways: It damaged their DNA, it stressed their metabolism and inhibited their growth. This weakening improved the effectiveness of traditional cancer drugs like carboplatin and paclitaxel, the authors said.Surprisingly, the hydrogen peroxide did not harm the non-cancerous cells, researchers found. While they said it remains unclear exactly why this is the case, they suspect it has to do with the inefficient way cancer cells convert glucose to energy, when compared with regular cells.“Ascorbate causes an energy crisis for the cancer cells,” Chen said.A third part of the research involved a small trial study with 27 cancer patients, a portion of which were given vitamin C with chemotherapy — provided they did not have kidney problems.The purpose of the trial was to see if the vitamin C sickened patients, not whether it was more effective than standard treatment. Many more patients would be required to make that determination.Not only did the patients who were given vitamin C do well, they tolerated chemotherapy better than those who did not receive it, the authors said. They had more energy, and experienced less nausea.“That was surprising,” Drisko said. “We did not expect to find that.” — Los Angeles Times/MCTOverweight kids more at risk of obesity by 14Children who are overweight in kindergarten have four times the risk of becoming obese by eighth grade, researchers report. “Half of childhood obesity occurred among children who had become overweight during the preschool years,” the scientists wrote recently in the New England Journal of Medicine.And as kids got older, their chances of becoming obese fell. The researchers set out to track not the prevalence, but the incidence of childhood obesity, about which they said little is known. That is, they wanted to know the rate at which new cases of obesity occurred in children ages 5 to 14 in an effort to get at effective interventions.“Emerging from the finding that a substantial component of childhood obesity is established by the age of 5 years are questions about how early the trajectory to obesity begins and about the relative roles of early-life home and preschool environments, intrauterine factors and genetic predisposition,” the researchers wrote. In an accompanying editorial, Steven Gortmaker of the Harvard School of Public Health and Elsie Taveras of Massachusetts General Hospital wrote that the study should lead to some ideas about interventions to prevent obesity, with evidence pointing to ideas “that focus on children’s environments and that aim to alter early life systems” as probably the most effective.The researchers, from Emory University, looked at 7,738 children who went to kindergarten in 1998 and were studied over the years through the Early Childhood Longitudinal Study. The results, they said, were consistent with other national studies. When they started kindergarten, 12.4% of the children were obese; an additional 14.9% were overweight. In eighth grade, 20.8% were obese, 17% overweight.The annual incidence of obesity decreased from 5.4% in kindergarten to 1.7% from fifth through eighth grade, the study showed.They looked at some characteristics of the children who were overweight or obese as well.Though they found no difference between children with a low birth weight and those with a normal birth weight, they found that babies born with a high birth weight (more than 4,000g, or about 8.8lbs) had a significantly higher prevalence of obesity.Wealthy children — those from the wealthiest 20% of families — had a lower prevalence of obesity in kindergarten than the other children. The highest prevalence was among the children in the second-poorest 20% — with nearly 26% of them becoming obese by eighth grade. — By Mary MacVean, Los Angeles Times/MCT