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FREE NHS HEALTH CHECKS

Ealing Borough has one of the highest uptakes of free NHS Health Checks in the country. That means residents are reducing their risk of developing heart disease, stroke, diabetes and kidney disease.

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If you are aged between 40 – 74years old , have not had a health check in the last five years and have not already been diagnosed with certain conditions you will  be invited for a Free NHS  Health Check. The checks only take 20 minutes and hopefully will give  you peace of mind and good advice on staying well.

Even if you feel perfectly well and lead a healthy life style it is worth having it. Some conditions do not have early symptoms. It is estimated that 850,000 people are unaware that they have type 2 diabetes. I remember when I first joined the practise on simple urine screening I picked up 19 asymptomatic diabetics in 6 months including a 19 year old young man.

We as GP’s are increasingly aware that people need to be educated as to what is a healthy weight, the safe levels of alcohol aswell as the importance or regular exercise. If after discussing your results you are found to be at risk of getting one of these diseases your healthcare professional can offer support to help lower the risks.

For more information visit   www.nhs.uk/nhshealthcheck

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Reflections of heart stories – Mrs. Jones

When I first started at the practice in Ealing I remembered a dear couple from Swansea who I saw in surgery on a regular basis. I have to say that I had a bit of soft spot for them as we often reminisced about Wales as I knew the house she was brought up in and understood her enjoyment of laverbread and cockles.
Laverbread and cockles
Laverbread or ‘bara lawr’ in Welsh is an important traditional food of historical value. A national delicacy made from seaweed, it is collected from the beach then washed and cooked to a soft greenish black paste. Made from laver, one of the most nutritious varieties of seaweed, laverbread is full of health benefits. Rich in minerals and vitamins, full of protein and low in calories, this is a real superfood. A rare plant source of vitamin B12, it is also full of iron and iodine. She was always delighted if I managed to bring some from Swansea market bringing back those memories of welsh breakfast where it is served with bacon and egg. Failing that a few Welsh cakes were just as acceptable.
Welsh cakes

She was brought up in Swansea, Wales and as a young teenager had contracted St Vitus dance (also known as Sydenham’s Chorea) and described it very well and was able to demonstrate the involuntary, rapid, uncoordinated jerking movements primarily affecting the face, hands and feet movements associated with the condition. It was named St.Vitus Dance as St Vitus is patron saint of dancers. This condition was not uncommon many years ago And was found to be more common in females than males, most patients were children, below 18 years of age.
St Vitus dance
It was caused as a result of Group A beta-hemolytic Streptococcus infection and occurred in 20-30% of patients of patients with Rheumatic Fever or up to 6 months following the acute infection.
A vast majority of people at sometime in their life will develop a streptococcal infection of the throat characterised by a fever and white spots on the tonsils and swollen neck glands but nowadays this can be easily treated with antibiotics, usually Penicillin with good effect and it is very rarely associated with more widespread infections other than Scarlet Fever.
It was not uncommon in the 1950,s and 1960’s and I recall my mother saying to me as a child if I was fidgeting excessively, “Keep still have you got St Vitus Dance.?”

Mrs.Jones went on to develop an inflammation of the heart and the important valves of her heart were damaged. In my early days in Medicine I saw many patients with Rheumatic Heart Disease and we were disciplined in medical school to train our ears to listen out for murmurs in the heart using our stethoscopes in order to diagnose this problem. Patients were after brought in as test cases for our final examination. At that time we did not have the technology to aid our diagnoses. Needless to say not every medical student acquired this skill and as qualified doctors still could not pick out a murmur on auscultation. This resulted in many people remaining undiagnosed until they were having emergency surgery or developed another illness or went into heart failure during childbirth.
I recall several maternal deaths due to this at that time and young adults being diagnosed and needing heart surgery often carried out by a General Surgeons.
Ultimately,pig heart valves were used to treat these patients and then metal artificial valves, the clicking of which was audible to the patient and they often complained that it kept them awake at night.

Mrs.Jones tended to restrict her lifestyle and grew up as a slim,but feisty young woman and then decided to study for nursing at St. Mary’s hospital and it was when she became pregnant that her heart condition was diagnosed.

When she acquired St Vitus Dance she was not able to be treated with Penicillin as it had not been discovered when she developed this illness. Fleming recounted that the date of his discovery of penicillin was on the morning of Friday, September 28, 1928. It was a fortuitous accident: in his laboratory in the basement of St. Mary’s Hospital in London (now part of Imperial College).

As a result of this disease she developed significant valvular heart disease and miraculously survived and infact was nearly 90yrs before she died. She had the complication of Atrial fibrillation which is a heart condition that causes an irregular and often abnormally fast heart rate.
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A normal heart rate should be between 60 and 100 beats a minute when you are resting, and is regular. You can measure your heart rate by feeling the pulse in your wrist or neck. In atrial fibrillation, the heart rate may be over 140 beats a minute, although it can be any speed.
The main difference between a normal rhythm and atrial fibrillation is that you are unable to predict when the next heart beat will come along, as the heart rate is irregular.
This may lead to a number of problems, including dizziness and shortness of breath. You may also be aware of a fast and irregular heartbeat (palpitations) and feel very tired, breathlessness, dizzy and can experience chest pain (angina) but the worst fear is having a stroke.

Moreover,the way the heart beats in atrial fibrillation it reduces the heart’s efficiency and performance. This can result in low blood pressure and heart failure.

Mrs.Jones was able to tap out her atrial fibrillation in the surgery our on visits to the hospital and gleefully educated many student nurses and doctors into recognising this condition. Remarkably, she only developed mild heart failure and never had a stroke.
If you look at my previous blog this will demonstrate how to take the pulse and to recognise atrial fibrillation

https://102theavenue.wordpress.com/2014/02/07/know-your-pulse/
Or upload the app below on to your iPhone – my son assures me it is easy to use
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When to see your GP
Make an appointment to see your GP if:

  • you notice a sudden change in your heartbeat
  • your heart rate is consistently lower than 60 or above 100 – especially if you are experiencing other symptoms of atrial fibrillation
  • See your GP as soon as possible if you have chest pain.
  • If you notice a sudden change in your heartbeat and have chest pain, see your doctor immediately.

What is happening in the heart when someone develops atrial fibrillation.

The atria are the upper two chambers of the heart that receive blood from the rest of the body. They pump blood into the lower two chambers (the ventricles). Then the ventricles pump blood to the rest of the body. During atrial fibrillation, the atria do not beat normally. Instead, they quiver or “fibrillate.”

Normally, electrical impulses from a small part of the atrium called the sinus node cause the atria to beat. The electrical signal then goes through another part of the heart called the atrioventricular node. Then it goes down to the ventricles, and causes them to beat. First the atria, then the ventricles: it is coordinated, and so the heart pumps blood efficiently. The atria pump, filling the ventricles with blood, and then the ventricles pump.

In contrast, during atrial fibrillation, the electrical impulses come from all over the atria. Instead of pumping efficiently, the atria just quiver. There is an irregular and rapid heartbeat. There is no coordination between the atria and the ventricles. As a result, the atria do not pump all of their blood into the ventricles. Also, the ventricles sometimes pump when they don’t have a lot of blood in them.

A normal heartbeat is 60 to 100 beats per minute, and very regular: beat…beat…beat…beat. During atrial fibrillation, the heart beats at 80 to 160 beats per minute, and is very irregular: beat..beat…..beat….beat.beat.beat….beat.
When the hearts beats rapidly and irregularly, it cannot pump blood out of the heart efficiently. As a result, some people get short of breath. Some people faint.

Atrial fibrillation can lead to the formation of blood clots inside the atria. This is a serious, longer-term problem. These blood clots can travel out of the heart and get stuck in an artery to the lungs (causing a pulmonary embolism), an artery to the brain (causing a stroke) or an artery elsewhere in the body.

How atrial fibrillation is treated
bearing in mind that even if the atrial fibrillation is intermittent it still poses a risk of developing a stroke.

Treatment may involve:

  • medication to prevent a stroke by calculating the level of risk
  • medication to control the heart rate or rhythm
  • cardioversion, where the heart is given a controlled electric shock to restore normal rhythm
  • Catheter ablation, to prevent atrial fibrillation from occurring
  • having a pacemaker fitted to help your heart beat regularly

http://www.nhs.uk/Conditions/Atrial-fibrillation/Pages/Treatment.aspx

Especially during the past 12months Dr Livingston and myself along with our practise nurse have been on a mission to pick up undiagnosed cases of atrial fibrillation and we have diagnosed several cases and they have been treated accordingly. This is something that all doctors should be doing regularly especially if you are over the age of 65.
By the number of older patients I see equipped with modern technology I think they should be either uploading the App or asking their family to do it for them!

 
 

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SOMETHING FISHY ABOUT THIS!

imageMany of you reading this will understand that feeling when you are preparing to have an annual performance appraisal. What you have done, how have you performed since your last appraisal and what you are going to do in the next year with a particular emphasis on addressing your learning needs and how you can improve patient care.

You will all be aware that in General Practise we are going through significant changes and we will have more than enough to think about regarding organisational changes. However, we all like to remind ourselves that besides this that health and ways of treating medical conditions are also changing considerably.
Last year as well as attending many meetings regarding organisational changes I attended meetings to discuss particular patients (with their consent) with other GP’s, specialists and other health care professionals how their care could be improved within primary care.
I also attended structured lectures or small seminars on specific medical problems and I decided to focus on cardiology.
By doing all this it has a significant impact on patient care in that it improves skills of diagnosing a condition, knowledge of appropriate treatment and to find a propitious time for referral.

Heart failure has been something that Dr Livingston and myself looked at and during the past year we have significantly improved our way of diagnosing much earlier and being able to refer to a cardiology outpatient clinic rather than the patient presenting in a more advanced state and needing emergency admission often in extremis.
What is heart failure?
Heart failure affects 800,000 people in the UK. It is a serious condition caused by the heart failing to pump enough blood around the body at the right pressure.
It usually occurs because the heart muscle has become too weak or stiff to work properly.
If you have heart failure it does not mean that your heart is about to stop working. It means that your heart needs some support to do its job, usually in the form of medicines.
Breathlessness, feeling very tired and ankle swelling are the main symptoms of heart failure. Living with severe heart failure is a constant fight for life. Every year, thousands more families have to watch the people they love struggle with the distressing symptoms.
The symptoms of heart failure usually develop quickly (acute heart failure), but they can also develop gradually (chronic heart failure).
It is often difficult to diagnose as it has many causes and can occur when a number of problems usually ‘gang up’ on the heart, causing it to fail.
To learn more about heart failure the following website may be helpful:-
http://www.heartfailurematters.org/EN/Patient-Experience/EN-Patient-experience
This will also outline how patients with heart failure can adapt their lifestyle and detect early warning signs.

aBritish heart foundation. This month the British Heart Foundation has launched a research programme ‘Mending Broken Hearts’ at a critical stage in the UK in the fight against heart failure.

When you have a heart attack your heart will suffer damage that can never be repaired. In some people this can lead to heart failure, which in severe cases leaves you disabled and gasping for breath, with a life expectancy of less than five years. Oi

Living with severe heart failure is a constant fight for life. Every year, thousands more families have to watch the people they love struggle with the distressing symptoms.

Until now, there has been no hope of a cure. No way to mend a broken heart. But with recent advances in regenerative medicine, repairing a damaged heart is a realistic goal.
Mending Broken Hearts is the most ambitious research programme the BHF have ever carried out.

Researchers co-funded by the BHF have identified a molecule that tells certain stem cells in the embryo whether to become either heart muscle or blood vessel cells.
Zebra fish
The discovery – in zebrafish – tells us more about the origin of cells in the adult heart. This takes us another step closer to being able to make new heart muscle to repair the damage caused by heart attack – mending broken hearts.
Zebrafish are useful to scientists because they have a fully functioning simple heart and circulatory system. If part of their heart is removed, they can grow it back in a matter of weeks.
Intriguingly, the researchers believe that this molecule – called Fibroblast growth factor (Fgf) – is also the evolutionary switch that made complex four-chambered human hearts possible, from the two-chambered ‘tube’ we see in fish.

This provides important clues to researchers working towards the goal of mending broken hearts
The team from the University of Oxford – a BHF Centre of Research Excellence – say that during evolution a rise in Fgf levels tipped the balance so that more heart muscle was formed, meaning that the heart could become bigger and support a larger animal.
Professor Roger Patient, who led the research, said: “If we can find stem cells in the adult human heart that have the potential to form heart muscle and blood vessels, we may be able to manipulate this Fgf switch and create brand new heart muscle. This could bring significant benefit to heart attack patients or people with heart defects. At the very least, our research will help the production of these cells in the laboratory for use in heart repair.
Scientists have found another fish with similar powers and hope to harness it to help us mend broken hearts.
An amazing species of fish – called Astyanax mexicanus – could help scientists come up with a way to mend broken hearts damaged by heart attack.
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Research at University College London, led by Dr Yoshiyuki Yamamoto and Dr Mathila Mommersteeg is now being funded by the British Heart Foundation. These top scientists are interested in this fish, a close relative of the zebrafish, because it has the amazing ability to regenerate its heart tissue after damage. What’s unusual about Astyanax mexicanus is that it exists in two forms – sighted fish that live in rivers, and blind cavefish.
Despite being the same species, the river-dwelling fish can regenerate its heart tissue after damage – the cavefish cannot. Scientists want to understand the differences between these fish so they can learn more about what allows the river fish to mend its own heart.
Research like this helps provide clues towards finding a cure for heart failure.
Next time you visit The British Heart Foundation shops in West Ealing to either purchase or donate furniture or other items which they will collect free of charge you will be donating towards this important research.
http://www.bhf.org.uk/shop/our-local-shops.aspx

 
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Posted by on February 2, 2014 in Training and Advice

 

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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

 
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Posted by on May 17, 2013 in Training and Advice

 

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