The American Heart Association (AHA) has revised its guideline for high blood pressure from 140/90 to 130/80. This new standard is based largely on the findings of the SPRINT (Systolic Blood Pressure Intervention Trial) study. The trial included data from over 9,000 participants and focused on determining if a BP target of 120 or less results in superior health benefits as compared to current standards. The results of the study were largely positive – they showed that maintaining BP levels of 120 or less reduced high blood pressure complications by 25% and risk of death by 27%. Since the study provided important evidence on the effectiveness of lowering BP levels to below the current acceptable levels, the AHA revised its high blood pressure standard to 130/80.
The AHA’s revision in BP guidelines could theoretically reduce cardiovascular diseases and offer health benefits to the community but it is also important to understand the limitations and flaws of this trial. 1. The subjects enrolled in the trial were already hypertensive and were on some antihypertensive treatments. So, are these new guidelines for non-hypertensive people or for existing hypertensive people in the community? 2. Wherein in a nation like India, diabetes and hypertension go hand-in-hand, the subjects enrolled in the SPRINT trial were non-diabetic. Hence, do these guidelines benefit a diabetic individual or not? 3. The conclusion of the SPRINT trial clearly states that in spite of intensive control of blood pressure, it has not reduced the incidence of heart attack and stroke or kidney diseases. Statistical significance for the same was not achieved.
The silver lining here is that this revision in BP guidelines could serve as an early warning system. The vast majority of the Indian population only make changes once they are diagnosed with high blood pressure. High blood pressure poses a serious health risk as it is the largest risk factor for heart disease. Hypertension is referred to as a ‘silent killer’ since most people with the condition do not experience any noticeable symptoms. If we accept the AHA’s revision, it means that people whose blood pressure levels are elevated but not yet high will be able to make lifestyle changes to reduce their risk of high blood pressure.
Lifestyle modifications, including body weight control, dietary changes, stress management, and adequate physical activity give hypertensive individuals a significant amount of control over their condition. These lifestyle modifications play an important role in the management of stage 1 and even stage 2 hypertension. For instance, it has been proven that weight loss of 1 kg reduces BP by 1 mm of Hg. As per a survey of 30,000 individuals carried out in Maharashtra by the Madhavbaug Institute of Preventive Cardiology; about 41% of senior citizens were found to be hypertensive. In order to increase public awareness on hypertension, Madhavbaug has conducted several campaigns and initiatives such as the ‘Arogyam Hriday Sampada’. A basic principle in Physics will help in the understanding of blood pressure wherein, if the volume in a closed container increases, pressure increases.
Both allopathy and Ayurveda offer ways to reduce BP; in the case of allopathy, patients are prescribed medications such as diuretics and vasodilators to manage their blood pressure. Ayurveda relies on herbs and natural compounds to control blood pressure levels. Madhavbaug has conducted preclinical studies for various herbs to come up with diuretic herbs, angiotensin converting enzyme (ACE) inhibiting activity herbs, and calcium channel blocking herbs which have proven to reduce blood pressure in hypertensive individuals. Hypertension increases the risk of heart attack by two to three times and Madhavbaug aims to reduce the incidence of heart attack-related deaths in the community through its 128 clinics and 2 hospitals in Maharashtra, Goa and Madhya Pradesh. Madhavbaug’s team of doctors combine modern technology with ayurvedic treatments and lifestyle coaching to ensure that people live a productive life without the stress of heart disease hanging.