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A health problem educating patients what it is and how it can be addressed and prevented

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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The NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP)

I was reading my latest edition of GP magazine  or my ‘medical comic’ as my husband says and there was an article on the National  AAA Screening Programme  which began in March 2009, following research that showed it could reduce the rate of premature death from ruptured AAA by 50 per cent. The roll-out across the whole of England should be complete by 2013, as Ealing has not been screened yet those over 65yr old men should be hearing more about this in the coming weeks.

What is an Abdominal Aortic Aneurysm?
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An abdominal aortic aneurysm is a dilation (ballooning) of part of the aorta that is within the abdomen. An abdominal aortic aneurysm (AAA) usually causes no symptoms unless it ruptures (bursts). A ruptured pAAA is often fatal. An AAA less than 55 mm wide has a low chance of rupture. An operation to repair the aneurysm may be advised if it is larger than 55 mm, as above this size the risk of rupture increases significantly.
40 mm-55 mm: about a 1 in 100 chance of rupture per year.
55 mm-60 mm: about a 10 in 100 chance of rupture per year.
60 mm-69 mm: about a 15 in 100 chance of rupture per year.
70 mm-79 mm: about a 35 in 100 chance of rupture per year.
80 mm or more: about a 50 in 100 chance of rupture per year.
As a rule, for any given size, the risk of rupture is increased in smokers, males, those with high blood pressure, and those with a family history of an AAA.
Here we go again prevention again  those same old high risk factors appearing again!

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It has been claimed that no aspect of vascular disease management has changed as much in the past decade as the management of abdominal aortic aneurysm (AAA). Repair of an abdominal aortic aneurysm may be performed surgically through an open incision in the abdomen and inserting a graft or in a minimally-invasive procedure called endovascular aneurysm repair (EVAR) which involves inserting a stent-graft via the major arteries in the legs (femoral artery) Under X-ray guidance involving no abdominal incision. The EVAR  can be carried out under epidural and in patients that would be unable to cope with a general anaesthetic.
It reminded me of those on -call days as a surgical houseman admitting someone with a leaking AAA  involved a long surgical procedure and often a prolonged hair-raising recovery which in those days for me meant little sleep  and watchful waiting…    often going back to theatre as the rather crude grafts leaked or became infected as the surgery was performed by a General  surgeon  rather than the skilled vascular surgeons of today. Many patients were too ill to cope with general anaesthetic and the complication and death rate was high.
Those days are past the prognosis for treatment has drastically improved so it makes sense to screen and offer a good outcome to those who are found to have an AAA before symptoms such  as a pulsing feeling in the abdomen, similar to a heartbeat and/or pain  in the  abdomen or lower back are apparent.
< NHS AAA Screening Programme
A new NHS AAA Screening Programme is being gradually introduced across England and aims to reduce deaths from ruptured Abdominal Aortic Aneurysms through early detection.

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The roll-out of the National Screening Programme  began in March 2009, following research that showed it could reduce the rate of premature death from ruptured AAA by 50 per cent. The roll-out across the whole of England should be complete by 2013.
The NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP) has been rolled out across England and increasing numbers of men will have to  choose whether to undergo screening, which accounts for
approximately 2% of all deaths in this population group.
The NAAASP only screens men aged 65 and over. However,younger men, or women with a family history, can be scanned under existing NHS procedures.
GPs are recommended to consider referring patients with a sibling or parent with an AAA for a scan at the medical imaging department at an age five years younger than that at which their relative’s AAA was first diagnosed.
Self-referral may be appropriate  if a patient missed out on an automatic invitation.
Screening for AAA
An AAA occurs because of degeneration of the wall of the abdominal aorta. Large AAA are rare, but can be very serious;ruptured AAA accounts for about 5,000 deaths every year in England and Wales. Small AAA pose little immediate risk, but can expand, so it is essential to monitor them.
The screening process for AAA is a simple ultrasound scan and patients receive their results immediately. This ensures that men with a small AAA who require regular ultrasound surveillance are identified and offered advice on reducing cardiovascular risk factors. Their GP may be asked to review their medication and reassess their BP monitoring.
Antiplatelet and statin therapy is recommended for men with a small AAA and smoking cessation can reduce the rate of expansion, in addition to its other health benefits.
Other screening outcomes include a small number of men with an aorta of 5.5cm diameter or more, who are referred to a vascular surgery team. Most men who have no signs of an AAA are reassured.
The main risk factors for AAA are smoking, hypertension and a family history (first-degree relative with AAA). Men who are most likely to benefit from self-referral for screening are therefore those in their late 60s and early 70s who have one or more of these factors.
Each GP practice is informed when a patient of theirs is screened, then updated with the results. Patients can then discuss the results with their GP.
For more information:-
Benefits and risks
Despite only just completing national roll-out, the programme has already delivered promising results. NAAASP data for 2012-13 show that 209,000 men were screened for the first time during the year, with 77% of those invited actually attending.
More than 3,000 aneurysms were detected. While most were small and will need regular monitoring, a few patients werenreferred to vascular surgeons to discuss possible treatment options.
More than 300 large aneurysms were detected by screening and treated during the year, and the programme is making progress towards its aim of reducing deaths from ruptured AAA among men aged 65 and over by up to 50%.
In addition to delivering clinical benefits, the NAAASP has been assessed by the UK National Screening Committee as deliveringnvalue for money to the NHS.
There are, however, risks associated with AAA treatment, which are clearly communicated to men when they are invited for screening.
If a large AAA is detected or develops, intervention carries risk – the mortality rate following elective AAA repair is about 2%.

Screening is a patients choice and if unsure it is always advise able to consult your GP regarding individual risks and benefits.

 
 

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Are Yew taking a Calcium Channel Blocker such as Amlodipine ?

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In 1021, Avicenna introduced the medicinal use of Taxus baccata for phytotherapy in The Canon of Medicine.

I hope that when I explain what this means you will find it all as fascinating as I did……
Firstly, Avicenna, who is he?

Avicenna (Ibn Sīnā) was born c. 980 in Qishlak Afshona, a village near Bukhara (in present-day Uzbekistan), the capital of the Samanids, a Persian dynasty in Central Asia and Greater Khorasan. His mother, named Setareh, was from Bukhara; his father, Abdullah, was a respected Ismaili scholar from Balkh, an important town of the Samanid Empire, in what is today Balkh Province, Afghanistan.

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Avicenna had memorised the entire Qur’an by the age of 10. He learned Indian arithmetic from an Indian greengrocer, and he began to learn more from a wandering scholar who gained a livelihood by curing the sick and teaching the young. He also studied Fiqh (Islamic jurisprudence) under the Hanafi scholar Ismail al-Zahid.
He began to study medicine at the age of 16, and not only learned medical theory, but also attended the sick gratuitously and according to his own account, discovered new methods of treatment.
As a teenager, he was greatly troubled by the Metaphysics of Aristotle, (as I am sure many of you will sympathise with!!!)which he could not understand until he read al-Farabi’s commentary on the work. For the next year and a half, he studied philosophy.
Avicenna had memorised the entire Qur’an by the age of 10.  He learned Indian arithmetic from an Indian greengrocer, and he began to learn more from a wandering scholar who gained a livelihood by curing the sick and teaching the young. He also studied Fiqh (Islamic jurisprudence) under the Hanafi scholar Ismail al-Zahid.

The teenager achieved full status as a qualified physician at age 18,and found that “Medicine is no hard and thorny science, like mathematics and metaphysics, so I soon made great progress; I became an excellent doctor and began to treat patients, using approved remedies.” The youthful physician’s fame spread quickly, and he treated many patients without asking for payment. div>

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Secondly,what is The Canon of Medicine (Arabic: القانون في الطب‎ al-Qānūn fī al-Ṭibb) is an encyclopedia of medicine in five books compiled by Ibn Sīnā (Avicenna) and completed in 1025.[1] It presents a clear and organized summary of all the medical knowledge of the time. The Canon is considered one of the most famous books in the history of medicine.one of the chapters is dedicated to cardiology and treatment of hear conditions.Avicenna dedicated a chapter of the Canon to blood pressure. He was able to discover the causes of bleeding and haemorrhage, and discovered that haemorrhage could be induced by high blood pressure because of higher levels of cholesterol in the blood. This led him to investigate methods of controlling blood pressure.
Avicenna introduced the medicinal use of Taxus baccata for phytotherapy.

Phytotherapy is the study of the use of extracts from natural origin as medicines or health-promoting agents. The main difference of phytotherapy medicines from the medicines containing the herbal elements is in the methods of plants processing. Traditional phytotherapy is a synonym for herbalism and regarded as alternative medicine by much of Western medicine. Although the medicinal and biological effects of many plant constituents such as alkaloids (morphine, atropine etc.) have been proven through clinical studies, there is debate about the efficacy and the place of phytotherapy in medical therapies.
Despite Western medicines reservation about the use of herbs the herbal drug “Zarnab”(derived from Taxus baccata)was as a cardiac remedy by Avienna. This was the first known use of a calcium channel blocker drug, which were not in wide use in the Western world until the 1960s.

Taxus baccata is a conifer native to western, central and southern Europe, northwest Africa, northern Iran and southwest Asia. It is the tree originally known as yew, though with other related trees becoming known, it may now be known as English yew, or European yew.

There has been a long association of yew trees in churchyards and there are at least 500 churchyards in England which contain yew trees which are older than the building itself. It is not known why there is this link but there are many theories- from yews being planted over the graves of plague victims to protect and purify the dead (as in All saints,Isleworth where there is a lage Yew growing over a large Plague pit) image
to the more mundane in that yews could be planted in churchyards as it was one of the only places that cattle did not have access and therefore would not be poisoned by eating the leaves. Yew trees are taken as symbols of immortality in many traditions, but are also seen as omens of doom. For many centuries it was the custom for yew branches to be carried on Palm Sunday and at funerals. In Ireland, it was said that the yew was ‘the coffin of the vine’ as wine barrels were made of yew staves. As the wood is so robust, in Medieval times it has been used in making long bows.
A yew tree that many of you may have seen is the one at the entrance of the door to St.Mary’s ‘Perivale our local lovely venue for concerts.
http://www.st-marys-perivale.org.uk/
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When I read about Avicenna and his herbal medicine Zarnab, a patient called Clifford I looked after about 33yrs ago sprung to mind. This was when I worked as a GP in Maesteg,South Wales. He had been a miner but what I remember most was that he was a pigeon fancier and I remember visiting him regularly and in his lounge the walls were covered with framed photographs of various pigeons he had raced or tossed. He was now virtually bedbound and the he was considered a ‘Cardiac cripple’ which meant he could barely move without getting angina. Angiograms, coronary bypass or modern drugs for angina weren’t available and the few patients that were referred for surgery had to travel to London to the Hammersmith or the Brompton. Then one day I saw a pharmaceutical rep in surgery and he told me about a new drug called Nifedipine (Adalat) that was being recommended for angina aswell as hypertension and it was proving to be very effective, also if the patient bit the orange capsule(NO longer recommended) relief from angina was longer lasting than GTN tablets which was all that was available. I immediately thought of Clifford and was able to offer them to him and it was marvellous to see him come to the door on my next visit. This was my first experience of a Calcium Channel Blocker and experiencing its great value. Incredible to think it took the Western World mealy a 1000 yrs to rediscover this medication. Now a more refined drug called Amlodipine is first line in all patients >55 yrs and Black people for hypertension and we very rarely see patients so incapacitated by angina.
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Read more fascinating facts about Yew in my next blog
Posted by Dr Bayer

 
2 Comments

Posted by on June 28, 2013 in Training and Advice

 

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C-r-y

imageOne early morning in February 3 years ago the phone rang and it was the wife of our Best man at our wedding. She was letting us know that she had woken in the night to a strange sound and following attempts at resuscitation by herself and the ambulance crew he had died suddenly. He was a handsome,highly intelligent,charming doctor/dentist/medical director of a pharmoceutical company who had been negotiating with NICE to accept Aricept as a treatment for Dementia.He had also been training for his 7th full marathon which he had taken part in and raised thousands of pounds for leukaemia following the death of his son’s best friend at the age of five.It was unbelievable and a total shock to all such a loss of someone so special. The night before he had been listening to opera with friends singing along with gusto and passion as he was also a musician, a pianist with talent.The funeral was an amazing musical tribute and those who spoke talked about his life with humour and sadness. Afterwards, his friends and colleagues commented that he had seemed the healthiest of everybody and as we chatted agreed it would have been a great party but it lacked one person. He was an ordinary East End lad made good commonly known as ‘Paul boy’! His only fault was that he was a Tottenham supporter which meant many an Saturday afternoon or a Boxing Day was spent in raucous banter whilst ‘the lads’ watched their rivals play – nothing more exciting than a London Derby!
This was an adult sudden cardiac death (SCD)as there was no evidence of disease on examination of his body after death and it was presumed death was due to sudden cardiac arrest,when the heart abruptly and without warning stops pumping.
Ironically, the week after he died the drug was passed!

I was reminded of this when a young attractive 25year old lady attended surgery recently devastated as she had lost her young partner in the same way. This young man had died suddenly without warning and his young partner and family had been left devastated.
She then told me that his mother had become very keen to support the charity CRY was founded in 1995 to raise awareness of conditions that can lead to young sudden cardiac death (YSCD); sudden death syndrome (SDS); SADS. She was also taking part in the CRY Heart of London Bridges Walk 2013 on 7th July. There main reason for supporting this charity is that it funds screening of anyone who could considered at risk as shown on the link. What a brave lady, the love she had for this man was tangible and this family had also lost someone very special whose life had just begun. The family are keen to support this charity as it raises money to screen anyone at risk and support research projects aswell as support bereft families.

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http://www.c-r-y.org.uk/general_information_on_cardiac_s.htm

CRY holds ECG screening clinics for those aged 14 to 35 at a number of established locations around the UK including Belfast, Cardiff, Colchester and London.The CRY mobile screening unit facilitates various screening events at other locations in the UK – often organised by CRY supporters. Details of where these clinics are and how to book are on the website.

What happens when sudden cardiac death(SCD) occurs
When SCD occurs, no blood can be pumped to the rest of the body. It is responsible for half of all heart disease deaths.
Sudden cardiac death occurs when the heart’s electrical system malfunctions. It is not a heart attack (also known as a myocardial infarcation). A heart attack is when a blockage in a blood vessel interrupts the flow of oxygen-rich blood to the heart, causing heart muscle to die. So if the heart can be compared to a house, SCD occurs when there is an electrical problem and a heart attack when there is a plumbing problem.
The most common cause of cardiac arrest is a heart rhythm disorder or arrhythmia called ventricular fibrillation (VF). The heart has a built-in electrical system. In a healthy heart, the sinoatrial node, the heart’s natural “pacemaker” triggers the heartbeat, then electrical impulses run along pathways in the heart, causing it to contract in a regular,rhythmic way. When a contraction happens, blood is pumped.
But in ventricular fibrillation, the electrical signals that control the pumping of the heart suddenly become rapid and chaotic. As a result, the lower chambers of the heart, the ventricles, quiver or fibrillate instead of contracting, and they can no longer pump blood from the heart to the rest of the body. If blood cannot flow to the brain, the brain becomes starved of oxygen, and the person loses consciousness in seconds. Unless an emergency shock is delivered to the heart to restore its regular rhythm using a machine called a defibrillator, death occurs within minutes. It’s estimated that more than 70 percent of ventricular fibrillation victims die before reaching the hospital.
When CPR and an AED (automated external defibrillator) are used together, the chance of survival following a cardiac arrest goes up to 50%, a ten-fold increase over CPR alone.

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This is why you may see Automated External Defibrillator (AED) machines are being hung on walls in supermarkets or other public places. I have frequently seen them in French supermarkets and hyper stores.
It is amazing that the nearest limited access AED is in Twickenham in a fitness club and the nearest 24 hr public access AED machine is outside an accountants office. To see the location of AED machines click on the link below:-
http://www.aedlocator.org/AEDLocations.php
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Who should be screened?
It is recommended that screening is requested via your GP if there have been any young sudden deaths in the family. Or if there are symptoms of:

Chest Pain (exercise related)
Severe Breathlessness
Palpitations
Prolonged Dizziness
Fainting/Blackouts

This checklist has been designed to help you determine whether you have a heart rhythm problem. If you have more than one of the symptoms below, see your GP.

    • Have you fainted or passed out during exercise, while emotional or when startled?
    • Have you ever fainted or passed out after exercise?
    • Have you ever had extreme shortness of breath during exercise?
    • Have you ever had extreme fatigue associated with exercise (much more so than others of your age and level of fitness)?
    • Have you ever had discomfort, pain or pressure in your chest during exercise?
    • Has a doctor ever ordered a test for your heart?
    • Have you ever been diagnosed with an unexplained seizure or fit?
    • Have you been diagnosed with epilepsy that fails to respond to medication?
    • Have you ever had exercise-induced asthma that medication didn’t control well?
    • Are there any family members who had a sudden, unexpected, unexplained death before age 50 (including cot death, car accident or drowning)?
    • Are there any family members who died suddenly of heart problems before they were 50?
    • Are there any family members who have had unexplained fainting or seizures?
      Do you have any relatives with the following conditions:
      Hypertrophic cardiomyopathy: thickening of the heart muscles.
      Long QT syndrome: a condition that results in a very fast, abnormal heart rhythm, which can cause fainting.

What is happening by way of research?

VeniceArrhythmias, a biannual meeting started in 1989 and, year after year, has become one of the most important international congresses in the field of arrhythmology with almost 3000 attendees and with more than 400 invited speakers.
As you read many cardiologists and electrophysiologists are preparing their abstracts to be presented at the Venicearrythmia conference next held in October 2013
VeniceArrhythmias, a biannual meeting started in 1989 and, year after year, has become one of the most important international congresses in the field of arrhythmology with almost 3000 attendees and with more than 400 invited speakers.image
At other venues and during the year there will be similar events. It is through these events that there have been major breakthroughs in screening and prevention of sudden death.Research in the channelopathies and cardiomyopathies is progressing rapidly and in the future it is expected that the majority of the genes involved will be discovered.
In the future, it may also be possible to diagnose all carriers easily – even in those people who have a normal ECG reading. It may also be possible to choose the best treatment based on the type of mutations involved, and the treatment may even be designed based on this knowledge.
In the meantime, better understanding of these conditions and improvements in methods for diagnosis should still result in better management. It is crucial that, when a heart disease such as a channelopathy or cardiomyopathy is diagnosed, all immediate blood relatives should be evaluated by a specialist cardiologist to find out if they have an inherited heart disease.

IMPORTANT
It needs to be considered in sudden death in especially younger adults where the post Mortem fails to provide a cause of death, it is important to send the heart to a pathologist who specialises in this field of medicine and this may be a relative, friend or attending doctor who makes that request.
However, to help this research and appreciate the true incidence there must be a change in the Law.
In the UK, unexplained sudden death is frequently recorded as due to death from natural causes. Until the law is changed and coroners have to refer hearts on to specialists we will not know the true figures. CRY’s fast track coroner / pathology service enables the cause of death in a sudden death case to be established more quickly and accurately than might otherwise happen if left to a local coroner lacking expertise in cardiac pathology.

Tests That Predict Risk

There are a number of tests that can be performed to determine if some- one is in a group that is at high risk for cardiac arrest. These include:
Echocardiogram – a painless test in which ultrasound waves are used to create a moving picture of the heart. The test can measure the strength of the heart’s pumping function (ejection fraction) and identify other problems that may increase a person’s risk for SCD.

Electrocardiogram – A painless test in which electrodes are attached to the patient’s chest to record the electrical activity of the heart in order to identify abnormal heart rhythms. Certain arrhythmias could point to an increased risk of SCD.imageHolter monitor – A cell phone-size recorder that patients attach to their chest for one to two days, recording a longer sampling of their heart rhythm. After the recorder is removed, the tape is analyzed for signs of arrhythmia.
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Event recorder – a pager-sized de- vice that also records the electrical activity of the heart over a longer period of time. Unlike a holter moni- tor, it does not operate continuously. Instead, patients activate the de- vice whenever they feel their heart beating too quickly or chaotically.
Electrophysiology study (EPS) – This test is performed in a hospital. A local anesthetic is used to numb areas in the groin or neck and thin flexible wires called catheters are
advanced through veins into the heart under x-ray to record its electrical signals. During the study, the electrophysiologist studies the speed and flow of electrical sig- nals through the heart and paces the heart to see if arrhythmias can be induced. The physician can also determine if a patient has had a prior heart attack or evidence of prior heart damage without know- ing it. All of this information can help determine whether the patient is in a group at higher risk for SCD.There is another interesting device
The AliveCor Heart Monitor app is designed for medical professionals, patients and health conscious individuals to record, display, store and transfer accurate single-channel electrocardiogram (ECG) rhythms. These recordings could be saved on the mobile phone or shared with others (such as your doctor) via email. The app is CE-mark approved.
imageThe Heart Monitor snaps onto your iPhone 4 or 4S like a case and wirelessly communicates with the app on your phone. No pairing between your iPhone and the Heart Monitor is required. The free AliveECG app will be available for download from the Apple App Store when you receive your Heart Monitor. Once in the app, create a free account and you’re ready to begin recording ECGs. It’s that easy to get started. http://www.AliveCor.com provides you with anytime, anywhere, fully secure, online access to all of your ECGs. Once you have the Heart Monitor and the AliveECG app you can create an account that gives you access to your ECG data.

Prevention

There are a number of things people can do to decrease the likelihood of becoming a victim of sudden cardiac death. To begin with, living a “heart healthy” life can help reduce the chances of dying of cardiac arrest or other heart conditions. This includes ex- ercising regularly, eating healthful foods, maintaining a reasonable weight, and avoiding smoking.
Treating and monitoring diseases and conditions that can contribute to heart problems, including high blood pressure, high cholesterol, and diabetes, is also important.
Finally, for some patients, preventing sudden cardiac death means controlling or stopping the abnormal heart rhythms that may trigger ventricular fibrillation.

Treating arrhythmias is done in three ways:

Medications – Medications, includ- ing ACE inhibitors, beta blockers, calcium channel blockers, and antiarrhythmics, can control abnormal heart rhythms or treat other conditions that may contribute to heart disease or SCD. But taking medication alone has not proved to be very effective in reducing cardiac arrest. These medications are sometimes taken by patients who also have an ICD, in order to reduce how often it fires.

Implantable cardioverter defibrillators (ICDs) – These devices have been very successful in preventing sudden cardiac death in high-risk patients. Like a pacemaker, ICDs are implanted under the skin. Wires called leads run from the ICD to the heart, and the device monitors the heart to detect any abnormal rhythms. If a dangerous arrhythmia is detected, the ICD delivers an electrical shock to re- store the heart’s normal rhythm and prevent sudden cardiac death. The ICD can also act like a pacemaker if the heart is beating too slowly.

Catheter Ablation – In this technique, radiofrequency energy (heat), cryotherapy (freezing), or other energy forms are used to destroy small areas of heart muscle that cause the dangerous, rapid heart rhythms. The energy is delivered through catheters that are positioned through the veins or arteries to the heart. Catheter ablation is sometimes done in patients who have an ICD to decrease the frequency arrhythmias the number of ICD shocks.
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If anyone has any particular concerns Dr Livingston has a special interest in this condition and is very knowledgable and would be pleased to discuss any related problem.

Posted by Dr Bayer

 
 

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Healthy Eating

Healthy Eating
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A healthy diet is one that helps maintain or improve general health. It is thought to be important for lowering health risks, such as obesity, heart disease, diabetes, hypertension and cancer. A healthy diet involves consuming primarily fruits, vegetables, and whole grains to satisfy caloric requirements, provide the body with essential nutrients, phytochemicals, and fibre, and provide adequate water intake. A healthy diet supports energy needs and provides for human nutrition without exposure to toxicity or excessive weight gain from consuming excessive amounts.
I think it is a good idea that we all stop and think about what we are eating. Many of us make numerous excuses not to eat properly – we haven’t time, we can’t afford to, we don’t like healthy foods, they don’t agree with me……….but at the end of the day.
WE ARE WHAT WE EAT!
If we take time to plan our eating perhaps 30-40 minutes each week all these excuses would disappear. It is so important that we stock our kitchen carefully. I know if there are only biscuits in the surgery then that is what I eat but if I organise myself I can snack and can eat very healthily with not much effort. Reading the news today I was saddened to read of children’s food ignorance. http://www.bbc.co.uk/news/education-Cheese comes from plants and fish fingers are made of chicken, according to a significant number of children questioned on their knowledge of where food comes from.
The British Nutrition Foundation (BNF) included more than 27,500 children in the research and found that nearly a third (29%) of primary school children think that cheese comes from plants, and nearly one in five (18%) primary school children said that fish fingers comes from chicken.The survey also found that one in 10 secondary school children believe that tomatoes grow under the ground. The largest of its kind, the study was conducted as part of the BNF’s Healthy Eating Week, which is launched on Monday by The Princess Royal.More than 3,000 schools are participating in the week-long event, during which more than 1.2 million children will learn about healthy eating, cooking and where food come from. Roy Ballam, education programme manager at the BNF, said the high numbers of schools taking part shows there is an understanding of how important it is to encourage healthy eating. And so it goes on…….Most of us are aware what we should be eating and most supermarket produce relevant literature and children in school are taught formally about healthy food but despite that they remain ignorant. To find out more about healthy eating  refer to the section in nhs choices http://www.nhs.uk/Livewell/healthy-eating/Pages/Healthyeating.aspx.
Meals should be a social time to sit together to discuss the day, share each others concerns and as well as enjoy each others company. All members of the household whatever their age can help to prepare a meal and young teenagers ( before they want to opt out) can prepare a meal perhaps in the style of ‘come dine with me’ adding points for healthy eating. It is all great practice if they leave  home to go to University and learning to budget and cook healthily. Growing your own vegetables and herbs whether in a planter on a balcony or windowsill or finding a patch in the garden is very pleasing.  The supermarkets all seem to sell packets of seeds very cheaply and it so rewarding to eat your own. We are lucky to have a ‘Farmers Market’ in West Ealing on Saturday morning and look out for another one in Green Lanes, Hanwell.Healthy eating is an investment for future health and well being.

Written by Dr Jacqueline Bayer

 
 

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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 .

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Written by Dr Jacqueline Bayer

 
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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.

image life expextanxy

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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