Articles on hypertension

Causes of Hypertension and How to Avoid It

Dr. Yogesh Kumar, Ayurveda
Hypertension or high blood pressure is an increase in the blood pressure which is or can be harmful for the body. It is rapidly becoming a devastating disease as there is a patient of hypertension in every family. It could be your grandparents, parents, you or someone you know. Most Patients with hypertension are unaware of its presence as they do not experience any major signs and symptoms till accidently come to know they have hypertension. Hypertension remains undiagnosed in the early stages in half of the people suffering from hypertension.What is hypertension? How can I know I have hypertension?It is very hard to specify the definition of hypertension many factor influence in the diagnosis of hypertension like age, presence of other serious illness, weight, and many more. There is a controversy as what is a normal blood pressure. A normal blood pressure is the range of blood pressure where the person has no chance of getting hypertensive complaints in the long term.In order to make it simple if a person having blood pressure reading more than 140/90 mm Hg and presence of other risk factors is said to have hypertension. Blood pressure is measured by a device called Blood pressure monitoring apparatus or Sphygmomanometer.What causes hypertension?There are a number of reasons that are being linked directly to hypertension.Sedentary life style: With all the comfort of today’s world burn very less calories then required and that can be a precipitating factor for diseases like hypertension and diabetes.Bad eating habits:Fast food: Fast food or junk food is a major cause of hypertension as it is full of fat and other harmful components. This type of food can cause narrowing and blocking of blood vessels and hence cause a subsequent rise in the blood pressure.Smoking: smoking of cigarette bides, cigar, hookah causes hypertension more rapidly than other causes and should be immediately stopped. It causes hardening of blood vessels and ultimately hypertension.Drinking alcohol:  Alcohol consumption increases the risk of hypertension and heart disease.Stress: Stress also plays a part in increasing blood pressure and further can lead to heart diseases, if not managed well.High amount of salt in diet: A diet rich in high sodium found commonly in salt increase the blood pressure.Heredity: Hypertension is found in people whose parents were known hypertensive.Age: People in early forties to 5th decade start to experience hypertension. Although people in early age can also have high blood pressure.Other: Patients suffering from other severe diseases like obesity, kidney disease, and diabetes are at the risk of developing hypertension later.Pregnancy: Some pregnant females can experience high blood pressure in pregnancy.It should be treated like urgency.How can I avoid hypertension?Tips to avoid hypertensionRegular exercise: A brisk walk for 45 minutes every day should be taken. It is the best exercise for a hypertensive patient. Heavy exercises should be avoided.Diet: Patients suffering from hypertension or at the risk of hypertension should switch to diet specially designed to control their blood pressure levels. This includes fat free  and low salt diet.Avoid all saturated oils like coconut oil, butter, ghee and choose olive oil, canola oil, sunflower oilRestrict to use 2 tsp oil per day.Increase fibre rich diet, vegetables and fruits. Fruits with edible covers should be eaten with covers.Low fat diet: Absolute no to cholesterol rich foods like butter ghee unskimmed milk deep fried foods.In non vegetarian diet yellow of egg, red meat, marbled beef, goose, hamburger, deep fried fish.Smoking cessation: smoking doubles the risk of heart diseases in patients suffering from hypertension. In hypertension patients smoking should be strictly stopped as well as passive smoking should be avoided as it has equal amount of risk.Restricted use of alcohol drinks: Alcohol increases the fat level in the blood and should be avoided. If not should be restricted to 2 times per week in small amount.Stress management: Meditation for 15 minutes every day. The aim should be to blank the mind from tension of everyday life. One should think positively about own health, job and family. Try to live life with a relaxed mind. You can take lesson for stress management from an expert tutor.Yoga: Yoga asana to relax the body (Shav asana),Pranayama: A breath control exercise which gives a peaceful feeling to mind and soul. It should be done 10-15 minutes daily, in guidance of an expert.

Understanding Hypertension (High BP)

Dr. Sfurti Mann, General Physician
High Blood Pressure is often called the “the silent killer”, because it has no symptoms, so you may not be aware that it’s damaging your blood vessels, heart and other vital organs of the body.Do not make the mistake of assuming that symptoms will alert you to the problem of high BP. Everybody needs to know their BP numbers. If left untreated, high blood pressure also called Hypertension – can lead to a range of serious health problems, including Heart disease and Stroke.As per WHO (World Health Organization), high BP affects every 3rd person above the age of 18. The proposition increases with age, from 1 in 10 people in their 20s & 30s to 5 in 10 people in their 50s.Both sexes are at equal risk of developing hypertension. In India, 23.10% men and 22.6 % women above 25 years suffer from Hypertension.Single reading of high BP is not the basis for diagnosing Hypertension. You should have consecutive high readings over time. Likewise, one normal reading does not mean you don’t have Hypertension.Criteria for Hypertension is as under:BP ClassificationValue of BP(mm Hg)Optimal <120/80Pre Hypertension 120/80- 139/89Grade 1 Hypertension 140/90- 159/99Grade 2 Hypertension > Or = 160/100“Isolated Systolic Hypertension” is when systolic BP is more than 140 mm Hg but diastolic BP remains normal. It is seen especially in elderly, due to stiffening of arteries.“Accelerated Hypertension”- A rapid, sudden increase in BP.Lifestyle modifications we all must undertake to tackle Hypertension are as follows:Weight Reduction : Attain and maintain a BMI OF < 25 kg/m2.Dietary Salt Restriction to less than 5gram per day from all sources.DASH (Dietary Approaches to Stop Hypertension) type dietary plan- Rich in fruits, vegetables, low fat dairy products, reduced saturated and total fat.Moderation of Alcohol Consumption- consume less than 2 drinks/day in men and less than 1 drink per day in women.Physical Activity- Regular aerobic activity e.g., brisk walking for at-least 30min/day.Quit SmokingControl blood glucose, cholesterol levels by following a healthy lifestyle and medications as prescribed by your doctor.Try and take steps to reduce your stress levels by meditation, pranayama techniques and Yoga.I will soon share with you all the common misconceptions about Blood Pressure.Wish everyone a healthy living!

Hypertension in Pregnancy

Dr. Pallavi Vasal, Gynecologist/Obstetrician
                                                                      Hypertension is defined as high blood pressure (B.P). A person has high blood pressure when the systolic pressure (the top number in BP reading) is greater than 140mmHg and the diastolic pressure (the bottom number) is greater than 90mm Hg.Hypertension can lead to many health problems. During pregnancy severe and uncontrolled hypertension can cause complications to both mother and baby.Causes of high blood pressure in pregnancy -1. Chronic hypertension - is high blood pressure that is present before the lady is pregnant or that occurs in first 20 weeks of pregnancy.2. Gestational hypertension – is high blood pressure that occurs during the second half of pregnancy that is after 20 weeks of pregnancy.3. Pre-eclampsia - is high blood pressure after 20 weeks of pregnancy associated with proteinuria (an abnormal amount of protein in the urine) . Pre-eclampsia is a serious BP disorder which can affect all the organs of a lady.The woman can present with complaints of severe headache, swelling over face and hands, changes in vision, vomiting, pain in upper abdomen or decrease urine output.The RISK of developing pre-eclampsia are more in women who -Are pregnant for the first timeHave had pre-eclampsia in previous pregnancy or have family history of pre-eclampsia.Are 40 years or olderHave multiple pregnancy (more than 1 baby in utero)Have history of chronic hypertension, kidney disease or both.Are obese IVF conceptionHave medical conditions such as diabetes, thrombophilias or lupus.RISKS  of high BP for baby -Growth restrictionPreterm deliveryPlacental abruption that is premature detachment of placenta (afterbirth) from the wall of uterusCaesarean deliveryIntra uterine deathHence it is very important for the lady who is planning to conceive or is pregnant to keep her BP within normal limits.PRECAUTIONS TO BE TAKEN FOR HIGH BP DURING PREGNANCY - Before Pregnancy-Keep the blood pressure under control. Reduce salt intake and do physical exercise. Loose weight if overweight .Lady needs to discuss with her doctor that she wants to become pregnant so that the doctor may change the medication to one which are safe in pregnancy or change the dose of medication if she is trying to conceive. 2) During Pregnancy-Take care of your diet that is a diet which is low in salts (avoid processed foods, pickles, pappad etc) and eat food rich in vitamin C, D and antioxidants.Lifestyle modifications that is exercise regularly .Walk and practice yoga if possible and keep weight gain under control.Avoid alcohol and tobaccoGo for antenatal check ups with your obstetrician and make sure that BP and urine are examined in each checkup. If the lady is feeling unwell any time during pregnancy , consult the doctor immediately.Being proactive and taking care of herself, going for regular prenatal and antenatal check ups, the lady with hypertension can deliver a healthy baby.

Decoding Hypertension

Dr. Kshamashree Madle, Yoga and Naturopathy
Hypertension is defined as repeatedly elevated blood pressure exceeding 140/90 mm Hg i.e. above 140 mm Hg Systolic Pressure and above 90 mm Hg Diastolic pressure. The point to note here is that, for elevated blood pressure to fall under ‘Hypertension’ category, it needs to be consistently high in 3 readings taken in a single visit. The following chart gives a brief understanding of stages of Hypertension.DECODING HYPERTENSIONNow let us look at Hypertension in a different way. Physics defines:Pressure = Force/AreaNow we know thatForce = Mass * AccelerationMass = Density * VolumeSo according to this formula:Pressure = (Density * Volume * Acceleration)/AreaIn other words, if Density, Volume or Velocity of any object increases and the area in which the object is, decreases, then the pressure increases.  Now, if we look at Blood Pressure, then we can easily deduce that anything which:Increases the Density of Blood such as increased fat contentIncreases the Volume of Blood such as water retentionIncreases the Velocity of Blood in Arteries such as elevated heart rateDecreases the Area of Arteries such as blockage in arteriesWill in fact increase the blood pressureCauses of HypertensionALLOPATHIC MANAGEMENT OF HYPERTENSIONDiuretics – Promotes elimination of water in urine thereby reducing volume of blood and reducing pressureBeta Blockers – Reduces force of Heart rate thereby reducing velocity of blood in Arteries and enhances reduction in BPVasodilators – Relaxes the walls of arteries for smooth passage of blood or in other words increases Arterial area thereby reducing BP.However, these drugs and are not without side effects. Once started they have to be continuously taken because they are not formed within the body .They work until they are in the system. They do not work on specific areas only and would have the same effect on Blood or Arteries all over the body. NATURAL WAYS TO MANAGE HYPERTENSIONYoga - Relaxes the entire system and helps deal with Stress induced HypertensionNutrition - Reducing the sodium in your diet and eat a variety of foods rich in particular nutrients that help lower blood pressure and reduce the blockages in arteriesAyurveda - Medications as well as therapies to balance the Tri Doshas which has led to HypertensionThe Natural interventions which help in management of Hypertension areCondition Specific Yoga TherapyHealthy NutritionYoga based Stress Management TechniquesLifestyle ModificationA combination of 2 or more of these will help in managing hypertension in a healthy way.

Understanding Hypertension- Bust the Myths!

Dr. Sfurti Mann, General Physician
Bust the myths, know the facts.In my previous article 'Understanding Hypertension(high BP)', I talked about what is Hypertension and what measures can be taken to prevent it. Now, I'll be talking about the common misconceptions and myths associated with Hypertension and help you know the facts.Common misconceptions about Hypertension are as follows:I feel normal, I do not have to worry about BP- It is estimated that every 3rd individual above the age of 25 years has high BP and most of them do not know it or do not experience any symptoms. Know your BP numbers.I use sea salt or Sendha namak instead of regular salt, I don’t need to restrict my intake-Chemically table salt and sea salt are the same- 40% Sodium-and count the same towards total Sodium consumption. Alternative salt options contain as much sodium.I do not use table salt in my food, my BP can not rise- 75% of Sodium we consume is hidden in processed foods like tomato sauce, soups, pickles, canned and prepared mixes. Watch labels for sodium content in the form of Sodium chloride, Sodium bicarb. (Baking soda) or MSG(Mono Sod. Glutamate)Watch for added salt.I was diagnosed with high BP and I have normal BP after taking medications, so I can discontinue the medications and do not need regular BP check ups- Hypertension is a chronic condition. Follow your doctor’s recommendations for regular BP management. By your co-operation you can successfully reach your treatment goals and enjoy the benefits of a healthy life. Make sure, you  know about your BP medications & follow your physician's instructions.Wine is supposed to be good for the heart, so I can consume as much as I want- If you drink alcohol, including wine, do so in moderation. Regular use of alcohol can dramatically increase BP. It also has deleterious effects on your heart, brain, cholesterol levels and liver.  Have alcohol in moderation.There is nothing I can do, it runs in my family and I too will get it-  Hypertension can be prevented by following a healthy lifestyle and awareness about factors which are risk factors for high BP.Medications cause side effects, so I should not have any- There are various classes of anti- Hypertensive medications. It may take some time to regularize your BP medications, nonetheless, you need to take medications as per your doctor’s recommendations, because untreated Hypertension can be very dangerous for your health.Once I begin BP medications, I will have to continue same medicine forever- There can be BP fluctuations, and medicines also need to be changed, added or reduced depending on your BP and other factors. Grade 1 Hypertension may even be reversed back to normal with lifestyle modifications and medications may not be needed. But only your doctor is the right person to decide on that.KEEP BLOOD PRESSURE AT BAY AND ENJOY A HEALTHY LIFE. I will soon follow up with another article on BP medications, things you must know about.

Why Hypertension Patients Need to Visit an Eye Surgeon?

Dr. Manoj Rai Mehta, Ophthalmologist
Eye is the only organ in the human body where blood vessels of all calibres can be seen clearly. Right from arteries to capillary network to veins.  This provides a unique opportunity to an eye specialist to evaluate changes in the blood vessels and convey their implications to other specialist. Cardiologists, Obstetricians and Internal Medicine specialists especially seek such information from their ophthalmic colleagues.A patient with hypertension should be seen by an ophthalmologist to record changes in the blood vessels of retina as well as the retinal grounds.  This information is shared with the treating doctor who selects appropriate medicines and adjusts their dose.  At times an ophthalmologist suspects hypertension and sends the patient to an internist for evaluation.  Hypertensive Retinopathy is an important indicator of life prognosis as well as adequacy of control of blood pressure.    Spasm of blood vessels (angiospasm).  Excessive spasm in the vessels indicates inadequate controlReactive Sclerosis.  Blood vessel walls thicken and make their walls opaque.  This indicates a chronically raised blood pressure.  Vessel walls turn copper to silver hue in due course if the pressure is not controlled.  Some sclerosis comes with age as well- arteriosclerosis, which an experienced ophthalmologist can differentiate from reactive sclerosis.       Hard Exudates.  These are residual deposits of fat and protein that leak out of blood vessels when the pressure is very high.  They can at times cause irreversible damage to the retina leading to poor vision.Soft Exudates. These represent areas of infarction in the superficial retinal layers implying a lack of oxygen supply to an area.Haemorrhages.  They can be different in shape and present at different depths in the retina. Flame shaped superficial haemorrhages are typically seen in hypertensive retinopathy.Papilloedema. This is a serious condition in which swelling in the brain occurs an dis picked up during eye examination.  Patient should be hospitalised immediately when such an observation is made.Needless to say a detailed examination of eyes is an integral part of "hypertension management" as it gives important information to an internist. Adequacy of BP control, t iteration of dose, speed with which pressure is to be brought down as well as selection of drugs are guided by the ophthalmic examination.An eye surgeon is an important stake holder in hypertension management and regular exchange of clinical information with treating doctors enhances quality of life and longevity of a patient.      

Are You Indian? Careful About Diabetes and Hypertension

Ms. Swati Kapoor, Dietitian/Nutritionist
Research over the last several years has shown that Indian bodies and genetics are different from their western counterparts. Not in a good way- Indians suffer from abdominal obesity compared to people in the west, whose bodies are uniformly obese. As a result of this, Indians are at a higher risk of diabetes and hypertension.There are currently 41 million diabetic people in India and this number is expected to rise by 170 per cent in the next 20 years. Even today, India has the largest population of diabetics in the world. By 2050, India is projected to be diabetes capital of the world. Today, one in every three Indians has high blood pressure, which is expected to shoot by 60 per cent in the next 20 years.Read to know more about 8 steps to get rid off high blood pressure.Not much can be done about the genetic risk of Indians, but a lot can be done to take measures about reducing your risk. Important Guidelines1. First, get yourself tested for blood sugar and hypertension. Read more about wonder fruits for diabetes.2. Watch your diet and exercise. The Indian diet is very high in carbohydrates. Watch the type of carbohydrates that you put into your body- some carbohydrates promote fat storage. 3. You don't have to cut out fat from your diet. Just eat the healthy fat. Here are snacks that are delicious and healthy- Almonds keep you fitYoghurt reduces fatApple fights cancerGuavas build immunity4. If you have not exercised in a while, then this is your chance to start- start with a walk, and graduate to a jog. There are innumerable benefits of running. The classic pushup exercise also builds muscle and burns fat.You're never too old to get in shape! If you need to lose weight, get on a healthy weight loss plan, with a balanced diet and an effective exercise routine.

High Blood Pressure Is a Silent Killer

Dr. Mubarak Raja, Diabetologist
In medical term Hypertension means HIGH BLOOD PRESSURE·       It is one of the most common cardio-vascular diseases.·       Many people have Hypertension for years without any symptoms.·       Uncontrolled pressure can cause significant damage to the body.·       It is otherwise called as “SILENT KILLER’’.FACTORSWHICH INCREASE BLOOD PRESSURE:LIFESTYLE:Lack of adequate physical exercise and a sedentary lifestyleincreases the risk of high blood pressureSTRESS:Physicaland emotional stress encountered in private life or work place increases Bloodpressure.OBESITY:Therisk of Hypertension increases with obesityAGE:HTmay be encountered at any age, but as one grows older , the chances of Developinghigh BP increases.DIETARY SALT INTAKE:an excessive amount of salt in the diet can cause high BPALCOHOL:  Regular and heavy consumption of alcohol increases BP. Generally there are no symptoms for mild to moderately high BP.The best way to check BP once in every three monthsIn few patients there may be symptoms like :Lack of sleepGiddinessBlurred visionBrain damageEye damageHeart attackKidney failurePatients with Diabetes and Hypertension need to be very careful as the above risks increase even further with Diabetes.§  Do not check BP immediately after taking food§  Do not check BP when you are tense§  Do not check Bp immediatelyafter urination§  Do not check BP immediately after you rush into a clinic. Wait till your breathing becomes normal.ü Drugs alone may not be sufficient to control BP.Lifestyle modifications arevery important to reduce BPAvoid excess strain andstress both in the office and at home.Should have a good sleep of6 - 8 hrs/dayReduce excessive salt indietAvoid pickles, pappads andsalty fish Avoid too spicy foodsAvoid oily and cholesterolrich foodsUse only Safflower,sunflower or refined oilsIncrease green leafyvegetables in foodFresh fruits can be taken inlarge quantitiesAvoid smoking and alcoholRegular aerobic exerciseWalking/Skipping/Jogging/Swimming daily ½ to 1 hr preferably in the morninghoursReduce weight if you areobeseWith all the above measures,Drugs(tablets) are important in controlling BPTake your medicines regularly as prescribed by the doctor

Am I Hypertensive??

Dr. Supritha K M, General Physician
BP/HYPERTENSION/HIGH BLOOD PRESSURE??We usually encounter many people saying-"I have BP!!", "I always have low BP", "My BP is always high(150/100mm of Hg) & thats normal for me!!"What is this BP?It is the pressure exerted by the blood when it flows through blood vessels.Why is BP so important??          This is the one which determines nutrients(Ex:O2) delivered & toxins (Ex:CO2) removed from target/end organs[Brain.kidney,liver]           In simple/layman's term i can put it as "The pressure of water source(through hose pipe)determines the growth of a plant"where the pipe can be related to blood vessels & plant to end organs.             Hence in case of low pressures decreased nourishment might  lead to under development/decreased performance of organs.Where as high pressure may end up causing damage to organs .What is normal BP??Systolic of 100-140mm of Hg, Diastolic of 60-89mm of Hg is considered as normal.Systolic-The pressure at the heart pumps blood sround the body.Diastolic-as the heart relaxes & refills with bloodAnything <100/60 mm of Hg is low BP>140/90mm of Hg is taken as high BPSO,My BP was 144/92mm of Hg during my last visit to doctor!! so am I hypertensive??do i have to start on medication?NO!!??There are few physiological conditions/changes during which BP can be high at certain situations:Acute illness-viral fever/respiratory infections/stressimmediately after physical activityimmediately after a large meal/caffineimmediately after smokingThe thought of going to a doctor for illness/any trivial reasons(White coat hypertension)Ideally a person without under the influence of any of the above mentioned situation & minimum of 3BP measurements taken in calm environment at different timing & different days showing >140/90mm of H is considered/diagnosed as hypertensive.How do I know I'm hypertensive/what tests can be done to detect HTN?              HTN is purely clinical diagnosis,there are no lab tests/investigations to detect HTN.                                            Hence make sure you get your pressures checked every time you get in touch with your health care                  provider (opportunistic screening)       What about the tests doctors advise when they notice High BP??-ECG,S.Creatinine,USG abdomen & other blood investigations??           These tests are done to determine the(a)possible effect of prolonged persistent high BP on end organ/damage to organs.(b)Aid in determining possible secondary causes of HTN in suspected people(Renal artery stenosis/hyperaldosteronism etc....)          Signs/symptoms to W/F in HTN??The organ damage would set in far earlier than the first symptom/sign of high BP is noted!!So,it is also called as  "SILENT KILLER". The reason why we are seeing most of known yougsters are having heart attacks, strokes leading to temporary/permanent damage to one's life. The reason why we doctors stress on regular checkup to diagnose early so that proper action can be taken at the earliest.Of course some people might have few vague symptoms like: Headache, chest discomfort during stressful environment.Which have to be addressed at the earliest with regular follow ups.       How do I manage my BP/Treatment of HTN:         (1)Life style changesChange in diet-low salt dietregular physical activity (min 30-40min 4-5days a week)Weight reductionstress managementQuitting smoking,moderate alcoholdiet rich in fruits & vegetables,low saturated fat     DRUGS/MEDICATION FOR HTN:          We often confront many patients saying:"Whenever i feel little better or on non stressful days I usually skip my medication!!!""I usually fast on thursdays & saturday ,so i don't take my medication on those days!!""I never skip my medication!!Whenever i remember during my busy schedule I take my medication daily!!""I was feeling dizzy/weakness I skip my medication!!"Dizziness/weakness could be because of High BP also,low blood sugar level & many other causes. "I was told to have BP variation few months back, since then whenever I have headache/chest discomfort  I take my father's/mother's medication as they are also hyprtensive!!"     NO!!That is not the right way....!!!    Few drugs have better effects in young/middle aged people where as they have to be avoided/used cautiously in elderly people(B-blockers) who are prone for peripheral vascular disease.      Treatment usually starts with lifestyle modifications in early diagnosis,&  without organ involvement/secondary causes.    Slowly drugs are started as single medication ,if not much changes after lifestyle modification  & dose titration done ,also multiple drugs may be involved keeping in mind patient's co-existing conditions & response to medication to achieve target BP of <130/90mm of Hg .   It is not just reaching the target BP ,it has to be maintained at it throughout the day. Which is why timing of medication is very important.        Anti-hypertensive medication has no relation with food!!So fix a timing & has to be taken at that particular time(few min margin is accepted-30min).        Taken at different timing--->alters body's biological response--->variation in hormone/chemical response--->Less effectiveness of medication--->organ damage will set in,also may demand for inadverent addition of more combination/dose escalation to reach target BP!!         To avoid these confusion ,be frank with your physician-give complete details of your signs/symptoms & daily routine so that physician is aware of loop holes of treatment!! to guide you better.Also clear any doubts & follow the advise.        How frequently should I see physician??At initial stages, once diagnosed as hypertension & started on treatment (lifestyle change/drugs) one should consult every 15days to keep a track of BP ,to see the effect of treatment & titration of drug dosage & coombination medication if requiered. Once target BP(<130/90mm of Hg)is achieved,one has to follow up every 3months for BP monitoring & once a year complete health check to keep a watch on progression/or effect of HTN on end organs,so that proper intervention can be initiated if required.     What does recent studies show?Easily stressed teens have increased risk of HTN later in life(also known as Type A personality)sedentary life style, unhealthy food habits.Coffee increases risk of cardiovascular events in young adults with mild HTN.SNORING/SLEEP APNEA-one of the very important risk factor but often neglected cause.                      TAKE HOME MESSAGE:-Check your BP whenever you meet your health care provider.-Do follow up at regular interval if found abnormal-No self diagnosis & self medication.

Life Style/diet/role of Salt in Hypertension??

Dr. Supritha K M, General Physician
SALT & HYPERTENSIONNow, in continuation to my previous article about hypertension,the next common question is about DIET/LIFE STYLE IN HYPERTENSION.As we all know the first thing that is advised for a patient,when diagnosed as HTN/Pre-HTN is "LOW SALT DIET","KEEP AWAY FROM STRESS"But how do you measure& cut down on the salt?What is the daily requirement of salt?What has salt got to do with HTN control?It is mainly the amount of Na++(sodium) in the salt which matters, which has a role with control of HTN.WHAT DOES Na++ DO?Na++ is one of the main electrolyte in ion transport that happens in the cells of the body, which leads to Increased contractile capacity of blood vessel wallalso to some extent stimulate growth of smooth muscle cell, thereby increasing vessel wall thickness, in turn the resistance offered by the vessel.Daily recommended dose of salt is 5gms/day.That is almost equal to LEVEL TEASPOON of salt.Amount of salt in our diet!! How do we measure the salt we consume??It is mainly the unseen/HIDDEN salt that is present in our daily diet habits!What is this unseen/HIDDEN salt-salt present in our snacks,pickles,chutneys,sauces(ex:soya sauces)ketchups,chips,salted biscuits,cheese,salted butter.Also most of the processed/packaged food also  have hidden extra amount of salt,because salt is added as a preservative.but most food lables only report sodium as grams per 100grams of food.To convert to  salt multiply by 2.5 i.e. 1gm of sodium per 100 gms of food is almost equivalent to the saltiness of seawater!How to control on salt intake?First & foremost thing is to avoid packaged & processed food.Only choose food items with no more than 0.3gms of sodium per 100gms of food Do not add salt to cooking,instead add only at the table,so that you'll have better control of your salt intake.Alternative is ,suppose in a family of 4 members the daily recommended salt intake is 3.5 level TSP per day,so that 0.5 gms will be given as a margin for hidden salt intake.Instead of salt one can add pepper,garlic,herbs(mint/oregano/parsley/coriander),Lemon as flavoring agents.Other dietary/lifestyle changes:Salt intake is one of the main dietary changes advised in hypertension.DIET:Other dietary changes include-Diet rich in Whole grains, fruits & vegetables (5 servings per day),Low fat dairy products & decrease on saturated fat & cholesterolThis can lower BP by upto 14mm HgFor more information one ca visit these websites-http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20046974,http://foodpyramidindia.org/Fruits & vegetables-1 serving =1cup of cut fruits/vegetables (or) 80-100 gms, of locally available fruits & vegetables per day i.e. 450-500 gms each day.But in India per capita consumption actual national average is 140GMS/DAY!!!ALCOHOL:Moderation in alcohol consumption-Men <14 units per weekWomen <7 units per week(ASH guidelines) One alcohol unit is measured as 10ml or 8gm of pure alcohol.This equals one 25ml single measure of whisky(ABV* 40%), or a third of a pint of beer(ABV* 5-6%) or half a standard glass of red wine i.e 175ml (ABV*12%)*ABV=Alcohol By VolumePHYSICAL ACTIVITY & STRESS MANAGEMENT:Atleast 30-60 min of moderate physical activity,min of 5days a week can lower blood pressure by 4-9mm HgMake sure you take stairs in you work place rather than lift,walk to the market,walk with your children to their school or activity center/tutions.Get involved in group activities:Dance /cook with friends & family, so that every one will have quality time together as well as a stress buster.In practical,all the above said things looks simple & easy,BUT the very important aspect is ADOPTION & MAINTENANCE of life style modifications,where most of us fail!Try & adhere to the changes one at a time.I would call it as INVESTING ON HEALTH!!We see people chasing behind possessions & positions,often forget on their health-at the end of it all you'll just be spending all your possessions on your illness!Now its your choice to draw a line b/w health & wealth!