Exposure to personal black carbon increases systolic BP

A study has demonstrated an association between personal black carbon and ambulatory BP unraveling another layer of the relationship between urbanization and hypertension

The air pollution and cardiometabolic disease (AIRCMD-China) study conducted in 2012 in Beijing, China assessed the personal black carbon using microaethalometers in patients with metabolic syndrome for 5 consecutive days from February to July.

Black carbon is the sooty black material emitted from gas and diesel engines, coal-fired power plants, and other sources that burn fossil fuel. It constitutes a major part of particulate matter (EPA). It is also a marker of combustion-related anthropogenic air pollution

Simultaneous ambient fine particulate matter concentration was obtained from the Beijing Municipal Environmental Monitoring Center and the US Embassy.

On day 4 and onwards, 24-hour ambulatory BP and variability in heart rate were measured. Arterial stiffness and endothelial function were obtained at the end of day 5.

The mean (SD) of personal black carbon and fine particulate matter during 24 hours was 4.66 (2.89) and 64.2 (36.9) μg/m3. Exposure to high levels of black carbon in the preceding hours was associated significantly with adverse cardiovascular responses.

A unit increase in personal black carbon during the previous 10 hours was associated with an increase in systolic blood pressure of 0.53 mm Hg and diastolic blood pressure of 0.37 mm Hg (95% confidence interval, 0.17–0.89 and 0.10–0.65 mm Hg, respectively), a percentage change in low frequency to high frequency ratio of 5.11 and mean inter-beat interval of −0.06 (95% confidence interval, 0.62–9.60 and −0.11 to −0.01, respectively).

These findings highlight the public health effect of air pollution and the importance of reducing air pollution.

(Source: Hypertension. 2014;63:871-7)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Nocturia may be a sign of high blood pressure

Nocturia is not only caused by urinary problems but also by systemic diseases such as hypertension. Trips to the toilet at night are a sign of high blood pressure and/or excess fluid in your body, suggests a new study presented at the 83rd Annual Scientific Meeting of the Japanese Circulation Society (JCS 2019).

The Watari study examined the association between nocturia and hypertension in residents of Watari who had an annual health check in 2017. Blood pressure was measured and information on nocturia was obtained by questionnaire. Participants with blood pressure 140/90 mmHg or higher or prescribed antihypertensive drugs were considered hypertensive.

Nocturia (one or more nocturia events per night) was significantly associated with 40% greater chance of having hypertension after controlling for possible confounders. And, as the number of nocturia events per night increased, so did the risk of hypertension. Nearly 70% of the 1,882 participants who answered the questionnaire had nocturia.

However, the authors also caution that this association may be influenced by factors such as lifestyle, salt intake, ethnicity, and genetic background.

(ESC News Release, March 30, 2019)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

It’s time to change food labeling policy to tackle the obesity epidemic in the country

It’s time to change food labeling policy to tackle the obesity epidemic in the country

The Health Ministry has made it mandatory for some medicines to have a red vertical line on their strips to sensitize the public to the fact that these medicines are meant to be consumed only with the doctor's prescription. Most notable of these ‘prescription-only’ drugs are antibiotics. This Red line campaign is intended to create public awareness about antibiotic resistance, which has emerged as a major public health problem.  

It is also now mandatory to display pictorial health warnings covering 85% of the tobacco product packages as a means to discourage consumption of tobacco by the people.

There is an upsurge of obesity in India, which is rising at an alarming pace. India has the second highest number of obese children in the world after China. Normal weight obesity is the new epidemic of the society. A person could be obese even if his/her body weight was within the normal range. An extra inch of fat around the abdomen increases the chances of heart disease by 1.5 times.

Overweight and obesity are well recognized as predisposing to lifestyle disorders such as type 2 diabetes, hypertension, dyslipidemia, metabolic syndrome. Unhealthy diet comprising of foods high in saturated fats, sugar and salt (junk food, processed food) along with a sedentary lifestyle are major contributors to overweight and obesity. Hence, there is an urgent need to prevent and control obesity.

Along the lines of the Medicines with red line campaign and pictorial health warnings on tobacco products, the Heart Care Foundation of India (HCFI) suggests that packages of all food products that contain high levels of sugar, calories, salt and saturated fats should carry a ‘red dot’ or a ‘red arrow pointing upwards” on the food label, which carries the nutritional content of that particular food product as a symbol warning the consumer that the food product contains unhealthy amounts of fats, sugar and salt. 

Chile introduced a new food labeling system in 2016 to tackle obesity. Food packages that are high in sugar, calories, saturated fat, and salt now carry black, stop-sign warnings with the words “Alto en” or “high in.”  “Alto En Calorias” – high in calories, “Alto En Grasas saturadas” – high in saturated fats, “Alto En Sodio” – high in sodium and “Alto En Azucares” – high in sugar.

Such a change in the food labeling policy may discourage the public from choosing such foods products not only for themselves, but most importantly for their children.

Overweight and obesity in childhood also predispose children to lifestyle diseases later in life. Hence, it is important to encourage healthy eating habits early in life.

HCFI has also written to the health ministry for consideration of this suggestion.

Dr KK Aggarwal

Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

First BP should be checked at age three

 As per American Academy of Pediatrics of the National High Blood Pressure Education Program 2004 all high risk children aged 3 years or older should have their blood pressure measured at least once at every health acre visit.

As the childhood obesity rate has increased, so has the prevalence of high blood pressure in children and teenagers, said Padma Shri and Dr. B C Roy national Awardee Dr. K K Aggarwal President Heart Care Foundation of India.

The prevalence of hypertension among US children and adolescents ranges from 1% to 5%. The prevalence of hypertension among obese children is 11%.

Dr. Aggarwal further added that in the forthcoming 20^th MTNL Perfect Health Mela being organized from 23^rdto 27^th October, 2013 at Constitution Club of India, there will be special provision for consultations available to the obese children by doctors from all pathies.

Facts about obesity in children

1.     Natural fast food is good for the health

2.     Examples of fast food are milk, dry fruits and fruits,

3.     Artificial fast food or junk food is bad for the health

4.     Junk food contains refined bad fats and transfats

5.     Trans fats reduces the amount of good cholesterol and raised the levels of bad cholesterol in the body

6.     Soft drinks if taken more than one drink a day are harmful to the health

7.     Sweets contain more than 30% sugar and are harmful to the body

8.     One should avoid white sugar, white maida and white rice

9.     Jaggery is better than sugar

10.     All girls should eat jiggery and white gram once a week

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National Commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 63425 people since 1st November 2012.

The CPR 10 Mantra is – “Within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.” 

#AskDrKK: Is diabetes and hypertension responsible for heart diseases in the young?

#DrKKAnswers: Diabetes and hypertension are less common in young heart patients than in older patients. However, most young people have insulin resistance.

Dr KK Answers:What is resistant hypertension?

Resistant hypertension is defined as failure of 4 drugs to treat hypertension. 

Source: Hypertension 2011; 57:1069.

Dr KK Answers: Which diuretic to choose in hypertension

In a retrospective cohort study of men aged 35-57 yrs with hypertension (Multiple Risk Factor Intervention – MRFIT trial) during 6 years of follow-up, cardiovascular events (defined as heart attack, paralysis, bypass surgery, heart failure, left heart enlargement, peripheral artery disease, or angina) were significantly less common with chlorthalidone compared with hydrochlorothiazide. 

Source: Hypertension 2011; 57:689

Dr KK Answers: Are women with gestational diabetes at an increased risk of developing hypertension after the index pregnancy?

Women with gestational diabetes mellitus (GDM) are at a significant increased risk of developing hypertension after the index pregnancy. A study examined the association between GDM and subsequent risk of hypertension after the index pregnancy among 25,305 women who reported at least one singleton pregnancy between 1991 and 2007 in the Nurses' Health Study II.  During 16 years of follow-up, GDM developed in 1,414 women and hypertension developed in 3,138.

Source: Diabetes Care 2011 Jul; 34(7):1582-4. 

Dr KK Answers: Should we treat stage 1 hypertension?

In patients with Stage 1 hypertension and one additional cardiovascular risk factor achieving a sustained 12 mmHg reduction in systolic upper blood pressure over 10 years will prevent one death for every 11 patients treated. In the presence of heart disease or target organ damage, only nine patients would require such blood pressure reduction to prevent a death.

Dr KK Answers: What is stage 1 hypertension?

Systolic upper blood pressure 140-159 mmHg and/or diastolic lower blood pressure 90-99 mmHg

Dr KK Answers: What is primary hypertension?

The cause of 90-95% of the cases of high blood pressure isn’t known and is called essential or primary hypertension.

Dr KK Answers: What is J shaped curve in hypertension?

When the blood pressure or blood cholesterol levels of large groups of people are plotted on a graph against heart disease mortality, it often results in a J-shaped curve.

This curve shows that those with higher blood pressure and/or cholesterol levels, closer to the top of the curve, are more likely to die from heart disease. 

The curve also shows that those at the lowest end of the curve (with very low blood pressure and/or cholesterol levels) also have increased heart disease mortality, which accounts for the J shape. 

This is known as the J-curve phenomenon.

Do not ignore nose bleed

Nosebleed is a common problem, occurring in up to 60 percent of the general population and is often due to a respiratory illness or dry conditions. Dryness of the nose is common in summer because of the use of air conditioners and also in winters due to the cold, dry weather, said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India and Dr. Aru Handa, Department Co–coordinator and Senior Consultant Dept. of ENT, Moolchand Medcity.
Some common reasons for nosebleeds are as follows:
1. Nasal allergies
2. Blowing the nose too hard or trying to remove something from inside the nose.
3. A result of "popping" the ear
4. Nasal exposure to chemicals
5. Frequent sneezing or having an upper respiratory infection
6. Use of nasal spray or a blood–thinning drug, such as aspirin
7. Inhaling air that is extremely dry or cold
8. Having undergone recent surgery on the nose or elsewhere on the face
9. Breaking the nose or a similar injury
10. Uncontrolled high blood pressure
Properly instructed patients may achieve control of bleeding unassisted. The correct procedure involves grasping the nose alae distally. The patient should be advised not to check for active bleeding, but instead to maintain constant pressure for at least five minutes.
Other maneuvers include bending forward at the waist while sitting up (to avoid swallowing blood), placing a plug of cotton wool or tissue paper into the bleeding nostril (sometimes coated with antibiotic ointment), expectorating blood that accumulates in the pharynx, and a cold compress applied to the bridge of the nose.
These maneuvers should also be taught to high–risk patients for use at home.