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FLORENCE NIGHTIGALE AND WILD GARLIC

Last weekend I decided to take advantage of the sun and go for a stroll down the tow path past Kew to Richmond. It was a glorious afternoon  and one of the thrills at this time of year is gathering willd garlic which grows in  abundance on the towpath. The rich slightly acidic clay soil is perfect for this delicacy and nibbling the leaves and white flowers on the way home gets your mouth in shape for a simple supper of gently simmered wild garlic added to pasta tossed in a good quality olive oil  and sprinkled with Parmesan or blue cheese. Alternatively, it can be a good substitute for Basil to make a tasty pesto.

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Allium ursinum or ramsoms often grow alongside bluebells in deciduous woodlands with moist soils, preferring slightly acidic conditions. It flowers before deciduous trees leaf in the spring, filling the air with their characteristic garlic-like scent. The flower stem is triangular in cross-section and the leaves are broadly lanceolate similar to those of the lily of the valley. Check first by gently rubbing the leaves in your hands an d smelling the characteristic smell.

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When I visited Jekka’s Herb farm near Bristol it was during our discussion about herbs that she told me that Florence Nightingale used to mix this with English white wine to make a concoction and use it as an antiseptic on the wards.

Hence, with  its antibacterial, antibiotic, antiseptic and anti … well, just about everything, properties, it makes sense to pack as much into your diet as you can. The headline health benefit of garlic is its effectiveness in reducing blood pressure and, hence, heart disease and the risk of stroke. Although all garlic has this property, wild garlic has the greatest effect on lowering blood pressure.

Jekka Mcvicar for those who don’t know has a know established reputation of being a herb guru but describes herself as an organic herb grower.  She cultivates more than 500 varieties of herbs and has written an excellent illustrated book discussing the culinary and medical use of herbs aswell as an acclaimed cookbook. She shows at Chelsea Flower Show and has been visited by well known chefs such as Raymond Blanc, Jamie Oliver and Heston Blumenthal. Her big claim to fame is that she played and sang at the first Glastonbury in 1970 which impressed my daughter on our last visit. With credentials like those, visiting her at her farm near Bristol where you can listen to one of her talks , browse her herbs now in raised beds and termed a Herbetum and more importantly  have chance to purchase some potted herbs is something I enjoy immensely and thoroughly recommend to keen gardeners. I have to say I make a point of visiting the farm at least once a year.

http://www.jekkasherbfarm.com

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Letter to a Diabetic

                                                                     

                                       

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                                            Dr Brenda Patricia Down,

                                              Getwell surgery,

                                              Manuka Lane,

                                               Andover, B4 UD1

                                                                                                                     

                                                                                       March 20th 2015    

Mrs Diane Mellitus

6, Sweetwater Drive,

Andover  B4 1LL

Dear Diane, 

I am writing to you as I am very worried that I have not seen you in surgery for sometime and your last blood tests were not good and showed that your diabetes is poorly controlled. I know that if you come to see me, together we can improve the situation considerably.

The problem is that, although you may not feel too bad, if your blood sugar is high for a long time your body is slowly becoming damaged. Gradually, the large blood vessels in your body will become clogged. As a result, you are more likely to have a heart attack, stroke or have difficulty walking without severe leg pain. It also effects the small blood vessels and this effects your eyes causing cataracts or damage to the back of your eyes and it may effect your kidneys. The high sugar effects the nerves, especially in your feet and hands, so that you can’t feel things properly.

I know you love sewing gifts for your family, but if your eyesight gets worse and you can’t do much with your fingers you will really miss making all those lovely gifts.  They so rely on you to do repairs and it won’t be that long before the grandchildren will be on the way! I also know how independent you are and how you like to get out and about.

Do you know that I saw a diabetic patient last week who has lost such a lot of weight and has been walking the new dog each day. I could not believe how his blood sugars have improved, his blood pressure has come down and his cholesterol is normal, which means I have been able to stop nearly all of his tablets. He is so happy that he will look better in his swimming trunks and with the money he has saved on quitting smoking he has decided to take his wife on a Caribbean cruise!

Please make an appointment soon so that we can get to grips with controlling your diabetes as it is not only me who is worried  about you, but your family must also be concerned and I know you are so important to them.

Best Wishes,

Dr  B.P. Down

Family doctor

PS Did you manage to get to that meeting with Right Start to learn more about diabetes? If you want to look up to find out more about Diabetes try http://www.diabetes.org.uk it is a really good website. 

 
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Posted by on March 20, 2015 in Training and Advice

 

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But I feel well I don’t need any medication!

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During my time as a GP I have heard this on countless occasions after taking someone’s blood pressure for the third time and telling them they will need to be treated.

Indeed when I first started on my career blood pressure medication was certainly not free of side effects and many caused severe postural hypotension resulting in profound dizziness,  lightheadedness, unsteadiness, or feeling of loss of balance to the point of fainting when simply getting out of a chair. Many patients who felt well when they presented after being given medication then developed blurred vision, confusion, general weakness and nausea. It was not surprising that many people refused to continue or simply avoided having their blood pressure taken! However, enough patients took medication for doctors to discover how lowering people’s blood pressure could prolong life and prevent heart and circulatory disease particularly strokes.
Pharmaceutical companies have gradually produced medication with fewer side effects and now we can offer treatment with minimal side effects.

One of the most popular blogs I have written was last years blog on hypertension
https://102theavenue.wordpress.com/2013/05/17/hypertension-t…pertension-day/ ‎which focused on healthy heart – healthy blood pressure.

As a campaign to reduce the incidence of heart and circulatory disease last year the government proposed that everyone over the age of 40 years should have their blood pressure checked and this was one of every GP’s targets to make sure that was done and will remain an ongoing target. There was an increase of 9.5% of people having their blood pressure recorded in 2013/14. However, it is everyone’s responsibility to know your blood pressure!

Infact, World Hypertension Day 2014 the theme is KNOW YOUR BLOOD PRESSURE
WHD

High blood pressure is just one of the risk factors for developing heart and circulatory disease, along with high cholesterol, diabetes and other lifestyle factors. As many as 5 million people in the UK are walking around, undiagnosed, with high blood pressure.

The only way to know whether you have high blood pressure is to have it measured.
Your blood pressure can be measured at most pharmacies, in the work place or gym and many people have machines in their homes.(for home machines make sure they are approved by consulting a list of currently validated machines on British Hypertension Society  http://www.bhsoc.org//index.php?cID=246)
British hypertension
Blood pressure UK
has campaigned for people to take their blood pressure
You can have your blood pressure checked for free anywhere in the UK by simply logging in to the following website and putting in your postcode to find the nearest blood pressure station.
KNOW YOUR NUMBERS
http://www.bloodpressureuk.org/microsites/kyn/Home/Freebpchecks/Findfreecheck

High blood pressure – or hypertension

This means that your blood pressure is constantly higher than the recommended level. High blood pressure is not usually something that you can feel or notice, but over time if it is not treated, your heart may become enlarged making your heart pump less effectively, which could lead to heart failure.

Having high blood pressure increases your chance of having a heart attack or stroke.

Are you too old to be treated?
The benefits of treatment of hypertension in older patients (ie over the age of 80years is evident, reducing BP to a level of 150/80 is associated with large reductions in stroke, mortality and heart failure risk. Different regimens with equal BP reductions have similar effects on outcomes, so should be individually tailored. Systolic blood pressure (elevated top reading) rather than Diastolic blood pressure (elevated bottom reading) reduction is significantly related to lower Cardiovascular risk in older people.

There isn’t always an explanation for the cause of high blood pressure, but these can play a part:

  • not doing enough physical activity
  • being overweight or obese
  • having too much salt in your diet
  • regularly drinking too much alcohol
  • having a family history of high blood pressure.

Even if you don’t have high blood pressure, making simple lifestyle changes may help prevent you having it in the future.

What can you do to reduce your blood pressure?
If your doctor or nurse says you have high blood pressure, he/she is likely to encourage you to make some lifestyle changes to help reduce it. This may include increasing your physical activity, losing weight, reducing the salt in your diet, cutting down on alcohol and eating a balanced, healthy diet.

Salt’s effects on your body
Salt
Salt works on your kidneys to make your body hold on to more water.

This extra stored water raises your blood pressure and puts strain on your kidneys, arteries, heart and brain.

 Reducing salt by 3g/day might prevent approx 10,000 deaths and 10,000 Cardiovascular events each year
 This would exceed the benefits of smoking cessation programmes, weight loss interventions and statins
 Reducing salt intake by as little as 1g/day may be more cost effective than BP lowering drugs

High sodium effervescent drugs should be avoided in patients with or at risk of hypertension or Cardiovascular events.
It is advised not to take soluble Over The Counter(OTC) medication such as painkillers, vitamin C etc. (NB this does NOT apply to 75mg dispersible aspirin which is fine. See what is the sodium content of medicines? )

The Consensus Action on Salt and Health (CASH) has looked at examples of the most popular foods eaten by several different age groups based on the National Diet and Nutrition Survey (NDNS), and has compiled ‘typical shopping baskets’, which have revealed some alarming results. For example, based on types of foods eaten by a student (18-22 year old), a shopping basket of higher salt products can contain up to 58g of salt, while that of a mother (30-39 year old woman) can contain up to 64g of salt – the equivalent of 128 bags of crisps. However, if they were to make some simple switches to lower salt options, the shopping basket of the student could be reduced to 22g of salt and that of the mothers’ could be reduced to 18g of salt, the equivalent of just 36 bags of crisps – cutting their salt intake by a staggering 62% and 72% per week respectively. This shows us that by making more informed choices we could all improve our long term health and reach the 6g a day maximum recommended intake for salt.

Heart and saltHow to reduce salt intake

(6g of salt a day is the maximum you should eat, and the less you eat the better.)
NB 6g of salt = 2400mg sodium

Sodium: reduce intake to
o 80% of salt is hidden in processed foods, and only 20% added
 Bread, breakfast cereals, table sauces tend to be high in salt
o To avoid hidden salt, start label looking and look for
 Low salt (1.5g per 100g food) avoid!
o Confusingly, some labels cite sodium rather than salt content
 1g sodium = 2.5g salt, so 0.6g per 100g food is high Potassium: potassium rich foods include:
 Fruit (not just bananas!), pulses, beans, vegetables (esp spinach), oily fish, chicken

10 practical tips

  • Eat out less
  • Remove the salt shaker from the dinner table
  • Add other flavours (herbs and spices) when you’re cooking
  • Remove the salt cellar from the dinner table
  • Eat less processed foods
  • Use fresh or frozen vegetables
  • Use shop-bought sauces and marinades sparingly
  • Limit processed and cured meats
  • Use lower salt cheeses
  • Pay attention to sweet foods
  • Use the FREE SaltSwitch App is a new feature of the popular health app, FoodSwitch, which was developed by CASH. The app allows users to scan the barcode of nearly 90,000 packaged foods sold across major UK supermarkets using their smartphone camera to receive immediate, easy to understand colour-coded nutritional information along with suggested similar, less salty products by 100g.

Salt reduction programme results released on 15/4/2014 showed has led to a fall in population blood pressure. From the fall in blood pressure that was due to salt reduction, there has been a saving of approximately 18,000 stroke and heart attack events a year, 9,000 of which would have been fatal

Another way of reducing salt is increasing potassium but if you are taking medication for blood pressure discuss this with your doctor.

Why potassium helps to lower blood pressure
potassium is a chemical which helps to lower blood pressure by balancing out the negative effects of salt. I heard potasquoted as”Potassium could be called the great detergent of arteries.

Your kidneys help to control your blood pressure by controlling the amount of fluid stored in your body. The more fluid, the higher your blood pressure.

Your kidneys do this by filtering your blood and sucking out any extra fluid, which is then stores in your bladder as urine. This process uses a delicate balance of sodium and potassium to pull the water across a wall of cells from the bloodstream into a collecting channel that leads to the bladder.

Eating salt raises the amount of sodium in your bloodstream and wrecks the delicate balance, reducing the ability of your kidneys to remove the water. By eating more fruit and vegetables, you will increase your potassium levels and help to restore the delicate balance. This will help your kidneys to work more efficiently – and help to lower your blood pressure to a healthy level.

However, it is possible to have too much of a good thing. To make sure that you don’t overdose on potassium, it is best to get your daily potassium from natural sources (fruit, vegetables and other foods) and avoid taking supplements.
To reap the benefit of more potassium in your life, try to eat at least five portions of fruit and vegetables every day. (A portion is about the same size as your closed fist). Not only will this help to lower your blood pressure, it will also help you to avoid certain cancers, bowel problems and even heart attacks or strokes.

Good sources of potassium include: potatoes, sweet potatoes, bananas, tomato sauce (without added salt or sugar), orange juice, tuna (fresh, frozen or tinned, but avoid tuna packed in brine), yoghurt and fat-free milk.
Potassium

If you have kidney disease, or are taking certain blood pressure medications, a large increase in potassium could be harmful. In this case, avoid taking potassium supplements and check with your doctor before dramatically increasing your potassium intake.

If your blood pressure is very high or these lifestyle changes do not reduce it enough, your doctor is likely to prescribe you medication to control it and to reduce your risk of having a heart attack or stroke.

Especially if you are 40 years or older get your blood pressure checked and
KNOW YOUR NUMBERS

 
 

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HYPERTENSION…..today is WHD – world hypertension day!

Periodically we have to check to ascertain that all patients on our hypertension register have had a blood pressure reading in the last 6-9 months and usually we have to chase up more than half the patients and 10% do not respond after 3 requests; many are found to be uncontrolled due to poor compliance of medication putting their cardiovascular disease risk at stake.

High blood pressure (hypertension) is the major risk factor for cardiovascular disease. Hence, in 2002, it was named ‘the number one killer’ by the World Health Organization (WHO) in The World Health Report.

Every year, 17 May is dedicated to World Hypertension Day (WHD).

WHD

The theme for 2013 is Healthy Heart Beat-Healthy Blood Pressure.

This was inaugurated in May 2005 and has become an annual event: the purpose of the WHD is to promote public awareness of hypertension and to encourage citizens of all countries to prevent and control this silent killer, the modern epidemic.

In the UK the incidence is more than 12 million in adults aged 16- 75years.

In the Department of Health’s 2010 ‘Health Survey for England’ the prevalence of hypertension in adults of 16 years or older was 31.5% in men and 29.0% in women. After the age of 70 years 40-50% are affected.

The full data are available on their website http://www.dh.gov.uk/ or directly at: http://www.ic.nhs.uk/webfiles/publications/003_Health_Lifestyles/HSE2010_REPORT/HSE2010_Trends_commentary.pdf

Prevalence of hypertension is also collected by General Practices nationally and published via the Quality and Outcomes Framework: http://www.qof.ic.nhs.uk/

In our practice we have 300 patients with high blood pressure and we participate in Quality Outcomes Framework (QOF) where we are committed to recording a blood pressure at a minimum of 9 month intervals and then treating to control the blood pressure at the recommended level by medical treatment and lifestyle advice.
You can view how well the practice is doing on the website http://www.qof.ic.nhs.uk/ and we are shown to be above the expected targets thanks to our hard-working staff and co-operation of patients.
Moreover, this achievement will significantly reduce the incidence of stroke and heart attack.

If you are over 40 yrs of age or have a family history and have not had your blood pressure taken in the past 5 years please call in to have this done.

1) What is Hypertension (high blood pressure)

Blood pressure is simply the physical pressure of blood in the blood vessels. It is similar to the concept of air pressure in a car tyre.

The pressure in the arteries depends on how hard the heart pumps, and how much resistance there is in the arteries.
It is thought that slight narrowing of the arteries increases the resistance to blood flow, which increases the blood pressure.
The cause of the slight narrowing of the arteries is not clear. Various factors probably contribute.

2) How is it measured?

A common blood pressure might be 120/80 (said as ‘120 over 80’). These values are quoted in units known as millimeters of mercury (mmHg).

There are 2 numbers because the blood pressure varies with the heartbeat. The higher pressure (120) represents the pressure in the arteries when the heart beats, pumping blood into the arteries.
This pressure is called systolic pressure.

The lower pressure (80) represents the pressure in the arteries when the heart is relaxed between beats.
This pressure is called diastolic pressure.

3) Does it vary in an individual ?

Blood pressure can be quite variable, even in the same person.

4) what makes the blood pressure vary?

Blood pressure goes up and down with different normal daily activities. For example, exercise, changes in posture and even talking changes blood pressure.

Blood pressure tends to be higher during the day than at night and higher in the winter than in the summer.

Blood pressure also rises when we grow older, particularly systolic blood pressure. Before adulthood, blood pressure rises in parallel with height.

In adult years, weight and blood pressure are closely related. When weight goes up, blood pressure tends to go up and we can lower blood pressure by losing weight.

5) Does it vary in individuals?

Blood pressures differ between individuals. Some people have low, some average and some high blood pressure levels.

6) What is the definition of high blood pressure?

There are various definitions of high blood pressure, which is also known as hypertension, but most doctors consider blood pressures of 140/90 and greater to be high.

The precise values that doctors might interpret as high blood pressure depend to an extent on individual circumstances. For example, in patients with diabetes, the definition of hypertension is considered by some to be pressures greater than 130/80.

The definition of hypertension is used by doctors to help decide which patients would benefit from medical (lifestyle and drug) treatment to lower pressure.

The definitions depend on the balance of risk of not lowering blood pressure (heart attack and stroke, etc) versus the risks of treatment (drug side effects, etc).

This explains why hypertension is defined at lower blood pressure levels in diabetic subjects. For the same blood pressure, cardiovascular complications (that is damage to the heart, blood vessels and brain) are more likely in diabetics and blood pressure reduction offers benefit even when a diabetic’s blood pressure is not as high as regular definitions of hypertension.

7) Why is blood pressure important?

Blood pressure is important because it is the driving force for blood to travel around the body to deliver fresh blood with oxygen and nutrients to the organs of the body.

However, high blood pressure is important because it leads to increased risk of serious cardiovascular disease, with complications such as heart attack, heart failure, stroke, kidney failure and blindness.

8) What is the cause of high blood pressure ?

For the vast majority of people with high blood pressure no precise explanation is ever found. For this reason, such cases are said to have ‘essential’ hypertension.

These cases are likely to result from a range of factors that could be broadly grouped into genetic and environmental (lifestyle) factors that work together to raise blood pressure.

Because genes and environmental are shared within families, it is not uncommon for people with high blood pressure to know of relatives with the same condition.

In a minority of cases of hypertension (less than about 5%) a precise cause can be identified. These include hormonal imbalances and kidney diseases that can result from genetic problems, occasionally tumors (usually benign) and blood vessel narrowing. Doctors are trained to look for signs of these specific conditions, as they are often curable.

High blood pressure is more common is older age groups and in people with a family history of hypertension. It is also more frequent in those who are overweight. However, high blood pressure can affect young thin people with no family history, so no one should consider himself or herself immune from high blood pressure.

9) Why is it important to control blood pressure ?

It is the goal of good clinical practice to reduce high levels of pressure wherever possible in order to reduce the risk of complications such as heart attack and stroke.

10) How is high blood pressure controlled?

Changes to lifestyle such as weight loss, reduced salt intake, reduced alcohol consumption or exercise are often the first line of treatment. If these approaches don’t return blood pressure to acceptable levels then drug treatment is usually required.

11) How do you know if you have high blood pressure?

The truth is you cannot know your blood pressure unless you have it measured and every adult should know his or her blood pressure.

Although headaches and nose bleeds can be the result of very high blood pressure, there are many more innocent causes for these common ailments.

12) How can you help to control blood pressure?

A healthy lifestyle and a sensible diet are important. One of the most important things is to keep weight under control. Less weight means lower blood pressure, and it also means less diabetes, less stress on muscles and joints and less stress on the heart.

13) Can high blood pressure be cured?

Commonly we hear ‘can I stop taking my tablets now’ or ‘I have finished the course’

It is rare for hypertension to disappear by itself. The general rule is that blood pressure gets higher with time and the risk of complications goes up also.

Although not ‘cured’ as such, modern therapeutic approaches to blood pressure are very effective and generally very safe. However, if treatment is stopped the high blood pressure usually returns reasonably quickly.

14) What are the effects of high blood pressure?

Any degree of high blood pressure is associated with increased risk of stroke and heart attack, but the higher the pressure, the higher the risks.

15) How is high blood pressure treated?

If blood pressure is persistently 140/90 and greater, then some form of treatment is required, although in the first instance this might be adjustments to lifestyle, such as diet and exercise.

However, if the blood pressure is repeatedly greater than 160/110, then there is usually a need to begin drug treatment immediately, rather than relying on lifestyle changes alone.

Sustained blood pressures of over 200/120 are considered potentially dangerous and if associated with for example visual trouble or heart failure they require emergency treatment.

16) Will hypertension cause any damage to my body?

Left unchecked, high blood pressure will over the years cause damage to the blood vessels of the heart and brain that leads to heart attacks and strokes. It also places extra strain on the heart, causing thickening of the heart muscle and heart failure and it damages the kidneys and can lead to kidney failure.

17)Are there any side effects to medication?

These days drugs are safe and generally free of major side effects, but no drug is completely free of side effects in all patients.

As blood pressure drugs work by reducing blood pressure, sometimes too great a fall in blood pressure can cause dizziness on standing. This can be a problem in the summer months and especially when rising quickly from squatting. Dizziness on standing also can be worse in older patients.

There are a variety of other symptoms that can result from blood pressure medications and if these appear in the days or weeks after treatment has begun you should consult your doctor. However, do not stop medications yourself without medical advice, as sometimes the blood pressure will rebound to very high levels that can be dangerous.

18) Can I measure my own blood pressure?

Yes but it is advisable to use a machine recommended by the British Hypertension Society(BHS).
Seek advise from GP,nurse or pharmacist.
The machines should be calibrated annually.
The following Machines are validated by BHS

Lloyds Pharmacy LBP 1 *(D) £30.00 International Protocol
Lloyds Pharmacy LBPK 1 *(D) £30.00 International Protocol

19) Can your risk of stroke or heart attack be calculated?

During a consultation when recording blood pressure and other details this can be calculated.

This risk calculator uses the Framingham risk equation[1] and the adjustments as suggested by the Joint British Societies’ (JBS2) paper[2] and the JBS Cardiovascular Risk Assessor.[3]
More details are obtainable on http://www.patient.co.uk or ask one of the clinicians when you attend the surgery. Those patients who have a high risk are seen more often and offered support regarding their lifestyle ie. diet, exercise,weight loss,smoking cessation

It is not the only risk calculator in use. In 2010 the National Institute for Health and Clinical Excellence (NICE) decided it could no longer recommend that the Framingham risk equation be used, as it tends to over-estimate risk by approximately 5% in UK men.[4] The decision also coincides with the emergence of the QRISK® calculator which has been shown to predict risk more accurately. The QRISK® calculator is available at http://www.qrisk.org. For further information on QRISK® see our cardiovascular risk assessment article.

20) What is the Government doing to prevent cardiovascular disease at population level?

The Government has addressed and continues to address the risk at both the population and individual level. The Department of Health asked the National Institute for Health and Clinical Excellence (NICE) to produce public health guidance at population level. This involves multiple agencies and is outlined in the public health guidance PH25 publication.
publications.nice.org.uk/prevention-of-cardiovascular-disease-ph25

In summary

Recommendation include the following:-

A) Salt
The Food Standard Agency has made considerable progress in reducing salt in everyday foods and this continues.

B) Saturated fat

The Food Standard Agency, consumers and industry have reduced the population’s intake (halving the average intake from 14% to 6-7% might prevent 30,000 CVD deaths and prevent a corresponding number of new cases of CVD annually. Eg promoting semi-skimmed milk for children aged over 2 years.

C) Trans fat
Industrially-produced Trans fatty acids (IPTFA) constitute a significant health hazard. Those who regularly eat fried fast-food may be consuming a substantially higher amount of IPTFA . In some countries e.g Denmark ,Austria and New York have successfully banned IPTFA.

D) Marketing and promotions aimed at children and young people.
Current advertising restrictions have reduced the number of advertisements for foods high in fat,salt or sugar during TV programmes made for children and young people. This policy will be extended.

E) Commercial interests
Ensure dealings between government , government agencies and the commercial sector are conducted in a transparent manner that supports public health interests and is in line with best practice. ( including full disclosure of interests)

F) Product labeling
Clear labeling describing content of food and drink products helping consumers make an informed choice. Evidence shows that simple traffic light labeling works well.

G) Health impact assessment
Where relevant government departments should assess the impact of policies on the health of the population.

H) Common agricultural policy
Negotiate at EU and national level to ensure CAP takes account of public health issues.

I) Physically active travel
Ensure government funding supports physically active modes of travel (such as walking and cycling)

J) Public sector catering guidelines
To reduce CVD would be to improve nutritional quality of food provided by public sector organisations.

K) Take-always and other food outlets
Empower local planning authorities to restrict planning permission for these (e.g within walking distance of schools)

L) Monitoring
Independent monitoring using a full range of available data is vital when assessing the need for additional measures to address health inequalities. CVD is responsible for around 33% of the observed gap in life expectancy among people living in areas with the worst health and deprivation indicators compared with those living in other parts of England .

Recommendations 13-18 provide for a comprehensive regional and local CVD prevention programme. The aim is to plan, develop and maintain effective programmes.

Recommendations 19-24 expand further on implementing the above and extending it into all public sectors.

SUMMARY

THERE ARE USUALLY NO SYMPTOMS FOR HIGH BP

The risk of stroke is four times greater and the risk of myocardial infarction (a heart attack) two times greater if you have high compared with normal blood pressure. This risk increases the higher the level of a person’s blood pressure.

THE ONLY WAY OF REDUCE THE RISK OF DEATH OR SERIOUS CARDIOVASCULAR DISEASE IS BY FOLLOWING LIFESTYLE ADVISE AND TAKING APPROPRIATE MEDICATION

Hypertension is very common indeed and hence a major public health issue.
The prevalence is expected to increase considerably in the coming years.
In 2000, the estimated number of adults living with high blood pressure globally was 972 million.
This is expected to increase to 1.56 billion by 2025!

Lifestyle factors, such as physical inactivity, a salt-rich diet with high processed and fatty foods, and alcohol and tobacco use, are reasons for this increased disease burden, which is spreading at an alarming rate from developed countries to emerging economies, such as India, China and African countries.

Adequate treatment of high blood pressure lowers this cardiovascular risk towards normal levels.

THE GREATEST PROBLEM FOR CONTROLLING BLOOD PRESSURE IS COMPLIANCE WITH TREATMENT .

Despite very effective and cost-effective treatments, target blood pressure levels are very rarely reached, even in countries where cost of medication is not an issue.

Sadly, many patients still believe that hypertension is a disease that can be ‘cured’, and they stop or reduce medication when their blood pressure levels fall to normal levels.

Despite the availability of effective and safe anti-hypertensive drugs, hypertension and its related risk factors (obesity, high blood lipids, and diabetes mellitus) remain uncontrolled in many patients.

THE RULE OF THE HALVES

Only one half of the patients with high blood pressure in a population have been diagnosed, only half of those detected have been treated, and only half of those treated have been adequately treated to a normal blood pressure.

WHAT CAN YOU DO TO CONTROL BLOOD PRESSURE?
Stop smoking (if applies)
Alcohol & caffeine reduction (if applies)
Low fat diet high in fruit and vegetables nuts whole grains DASH diet
Low salt diet
Lose weight (if applies)
Regular exercise ( at least 20 mins 3 days/week)
Check blood pressure at least every 6 months ( or 5yearly if no problem at present)

WHAT CAN WE DO TO CONTROL BLOOD PRESSURE?
Offer smoking cessation support
Alcohol reduction support
Advise you to attend weight reducing classes or seek advise from nurse
Exercise prescription or discuss with nurse
Check your BP regularly and prescribe medication accordingly.
Check cholesterol, blood sugar and kidney function tests regularly.
Prescribe statins – cholesterol lowering medication .

hypertension 1

Written by Dr Jacqueline Bayer

 
Comments Off on HYPERTENSION…..today is WHD – world hypertension day!

Posted by on May 17, 2013 in Training and Advice

 

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Exercise…

Have you examined how much you and your family exercise each week?

I read this last week on Google news

Astonishing: A survey commissioned by The Ramblers found a quarter of people walk for less than nine minutes a day – and that includes time spent getting to the car, to work and to the shops

Read more here http://www.dailymail.co.uk/health/article-2320049/The-lazy-Britons-walk-just-minutes-day-Half-stay-healthy

We all age quicker when we’re not moving and the consequences of that are age-related diseases, such as diabetes, cardiovascular disease and cancer.’

NIH study finds leisure-time physical activity extends life expectancy as much as 4.5 years.

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I remember my mother taking regular exercise and spent everyday doing some form of exercise walking to the shops,to see friends and attending her social events as well as gardening, swimming and every Tuesday going to ‘swinging into shape’ (despite my father telling her she should claim her money back after all the years she had attended) an aerobic class, until well into her late eighties despite having arthritis. My father an ex-sailor enjoyed all water activities and actively encouraged us as well as helping with the local naval cadets which included young people who came from less advantageous backgrounds and this certainly kept some of them out of trouble. My grandfather was an amputee and he cycled to work daily on a bicycle and loved swimming.

This was a great example to their three children and we all followed her example by being involved in regular exercise in the same way and I am glad to say that their grandchildren are doing the same sort of exercise today-walking, swimming, gardening with the added yoga and cycling.

I am sure that many other families can say the same and on reflection this is such an important responsibility of a parent to set that example.

The recommended amount of exercise as suggested by the Chief Medical Officer is two-and-a-half hours a week of moderate physical activity each week.
Sadly, researchers suggest that almost half of us and not doing enough and moreover a quarter of us walk for less than nine minutes, or under an average of one hour a week – and that include walking to the car, to work or to the shops.

It is now established that there are probably about an estimated 12 million people in the UK who have hypertension and they are more likely to develop cardiovascular disease. This can be reduced by treating the hypertension and reducing lifestyle risks.

A key lifestyle intervention is increasing physical activity in those who are not active at present.

As healthcare professionals we are recommended to discuss diet and exercise with people with hypertension as both a healthy diet and exercise can reduce blood pressure. We will now be using GPPAQ which is a questionnaire which has been approved as a screening tool in primary care for patients aged 16-75yrs to assess activity level. All patients with less than ‘Active’ score will be offered some support to increase activity and followed up after 6 months.

We will also be actively screening all patients on our list of 40 yrs or over for hypertension and every 5 years. General health checks will also be offered.

Recent research at Edinburgh University suggests sunlight helps reduce blood pressure as UV light release a compound which reduces blood pressure and benefits of sunlight far outweigh the risk of skin cancer. Hence, outdoor activity is even more beneficial!

Patients have shared their ideas and activities with me for me to share with you….

Do you enjoy gardening? Have you explored our London Parks? Do you have a yellow book to visit Gardens open? Or are you a member of the National Trust? Do you know about walks in and around Ealing? A trip to Brighton? Running or cycling clubs? Rowing? Friends of Kew? Dog walking- yours or a friends ?

If you look at the surgery website you find activities in and around Ealing which may be of interest and motivate us to maintain our activity level.

On a final note what can you gain out 30 minutes moderate activity on five or more days of the week is the minimum recommendation provided there are no other contraindications.

7 benefits according to the Mayo Clinic

Exercise controls weight
Exercise combats health conditions and diseases
Exercise improves mood
Exercise boosts energy
Exercise promotes better sleep
Exercise puts the spark back into your sex life
Exercise can be fun

COME AND HAVE A LOOK ON OUR WEBSITE FOR SOME USEFUL RESOURCES TO SUPPORT YOU. CLICK HERE http://www.102theavenue.co.uk/health_links/

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Written by Dr Jacqueline Bayer

 
 

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