Tag Archives: hypertension

Strike Away Stroke..FAST

Its World Stroke Day..so it might be timely to reiterate what I consider the most important point in handling someone who is suspected of suffering from ‘brain attack‘ – acting FAST.

stroke_prevention2Of the four points, perhaps the last is most crucial in determining the chances of survival and the probability of recovery. Every second delayed in receiving treatment means more brain cells die . The thing about the brain is once cells die, they do not get replaced, unlike other organs in the body like the liver.

Nowadays, its possible to dissolve the clot causing the stroke (the ischemic variety, not the bleeding form) by injecting a clot-dissolving medicine into the veins; but to re-emphasize, time is of utmost importance.

One might wonder – how do you prevent stroke in the first place?

A study conducted in England by four researchers, one of whom came from Malaysia and was a classmate of mine, showed quite conclusively that one could reduce the chances of getting stroke by 50% if one adopted the following measures:

  • not smoking
  • being physically active
  • limiting their alcohol intake to not more than 14 units a week
  • fruit and vegetable intake of at least five servings a day.

Apart from the above, it is well-known that the presence of the following risk-factors also predispose to stroke: high blood pressure, diabetes, high cholesterol, atrial fibrillation (irregular heart-beats), heart disease and certain blood diseases which cause clotting.

As they say, prevention is better than cure.

 

Strike Away Stroke FAST

Some readers of this blog asked what they can do to prevent  a stroke from hitting them. Plenty!

A very recent research study just released  stroke_prevention2in the British Medical Journal by 4 authors, one of whom is a Malaysian classmate who now works in the UK, reveals 4 things that people can do to reduce the chances of getting a stroke by half.

The study, conducted in England involving 20,000 people over 11 years, showed that they could reduce the chances of getting stroke by 50% if they did all the following life-style measures:

  • not smoking
  • being physically active
  • limiting their alcohol intake to not more than 14 units a week
  • fruit and vegetable intake of at least five servings a day.

Apart from the above, it is well-known that the presence of the following risk-factors also predispose to stroke: high blood pressure, diabetes, high cholesterol, atrial fibrillation (irregular heart-beats), heart disease and certain blood diseases which cause clotting.

One does need to realise, however, that some risk-factors cannot be changed or eliminated. Try changing your age (the chance of having a stroke approximately doubles for each decade of life after age 55), sex (more common in men), your relatives( your stroke risk is greater if a parent, grandparent, sister or brother has had a stroke) or the fact that you have had a previous stroke or transient ischemic attack (TIA, or warning strokes)!

The whole idea of getting away from stroke is to eliminate as many of the above risk-factors as possible and to lead a healthy lifestyle.

See my related article “Mending A Stroke In Time”.

Medications: When Newest Isn’t The Best

drug money

Big Bucks Can Sometimes Blur The Integrity of Scientific Studies

Its all very well for big pharmaceutical companies (pharmas) to release a new medication with a big bang , what with the enormous money invested in its research, development  and  production . However, not often enough, such new launches become unstuck when  unexpected side-effects appear after a few months on the market, despite the most strenuous prelaunch testing and extensive marketing as a blockbuster-to-be.

Unexpected side-effects aside, what’s potentially more serious is  when clinical trials (designed to prove a drug’s efficacy before its official launch) are falsified, thereby giving end-users erroneous data proclaiming (falsely) the drug’s efficacy. Such appears to be the case with regards to the Kyoto Heart Study.

What was the significance of this study? This study by Japanese scientists was greeted with great fanfare in 2009 and centres around the ability of a medication ,already extensively used for the treatment of high blood pressure, to reduce the possibility of getting stroke by 50% when used in high-risk patients. This was a milestone in drug treatment for hypertension and enabled the maker, Novartis , to make it one of the best-selling drugs in the world.

Diovan

The drug itself, valsartan, which is marketed as Diovan has been on the market since around 2001 for the treatment of hypertension and belongs to the new group of ARBs (angiotensin-receptor blockers). In fact, its patent expired in 2012, thereby enabling any pharma to produce its own version, so-called generic drug.

Jap_Kyoto

Dr Hiroaki Matsubara, of the Kyoto Heart Study

And now the bombshell: Last Friday, Japan’s minister of health, Norihisa Tamura, as well as university officials at Kyoto Prefectural University announced that the Kyoto Heart Study data were “very likely” fabricated, Apparently, incomplete data was used and some of the scientific investigators were in fact employees of Novartis.

The reaction to this has been deafening. the respected European Heart Journal retracted the study from its 2009 issue. There has been widespread condemnation among medical circles, resulting in the resignation of the principal Japanese investigator from the Kyoto University, Dr Matsubara.

This episode puts into perspective the over-reliance of the efficacy of new medications on so-called landmark scientific studies, whose integrity may be subject to the temptations of big bucks and commercialism. Often, the losers are the consumers themselves.

 

Why Malaysia’s Former PM Slept Through Meetings

He has been the butt of jokes and the subject of ridicule by bloggers and political commentators, but Malaysia’s former Prime Minister, Tun Abdullah Ahmad Badawi (2003-2009) has now explained his frequent dozing off during meetings to a relatively recently discovered medical condition which afflicts thousands of people.

Former PM Badawi - a victim of OSA

In an interview in the latest issue of Health Today, a bimonthly publication for medical professionals, he discloses his initial state of denial for many years that he had obstructive sleep apnoea (OSA), a condition usually caused by blockage of the breathing passages in the mouth or throat causing the sufferer to snore, stop breathing while asleep and consequently feel drowsy during the day. Other symptoms include:

  • snoring
  • choking while sleeping
  • daytime sleepiness (at meetings and at the wheel)
  • morning headaches
  • poor memory, depression, irritability,sexual impotence.

There is an increasing awareness towards this treatable condition because doctors have discovered a link between OSA and high blood pressure, heart attacks, stroke and death. A personal anecdote…I recall a few years ago,  a middle eastern gentleman who had scoured the globe in search of a treatment to lower his blood pressure. Despite being tried on a host of  medications, his blood pressure remained notoriously high. By the time he saw us professionally, he was about to give up in despair until we noted that he would doze off easily while talking to us. A visit to the ENT specialist resulted in some minor surgery to widen his breathing passage in the throat. and needless to say, his blood pressure dropped to normal within a few days without a single pill!

To better visualise what happens during OSA, watch this interesting video:

I had also written several times before on this fascinating but potentially lethal condition. You can access them here:

Back to Abdullah Badawi – in 2007 he underwent a successful nasal operation in Australia and can now claim that he has been cured of OSA and does not fall asleep unknowingly anymore..

 

High Blood Pressure? No, Its Not!

Quite a number of patients were referred to me the last few weeks for the management of high blood pressure (hypertension) which had proved somewhat resistant to medications.  Their blood pressures had been recorded high by their attending doctors. Those with their own blood pressure machines had protested that their readings were quite normal at home although their doctors insisted otherwise.

Having blood pressure checked by a doctor can make the reading artificially high

 

Fact: A third of hard-to-treat high blood pressure may actually be ‘fake’ and instead a patient’s nervous response to being seen by a doctor, as reported recently (here). This phenomenon has been known for some time and fondly called white-coat hypertension, in reference to the fact that quite a number of people with normal blood pressure developed nervous tension or stress when they were confronted by a doctor; which in turn is reflected by raised blood pressure readings, albeit temporary. When they were removed from the stress situation, blood pressure quickly reverted to normal levels, which accounts for the normal readings such patients obtain  with their own machines when at home.

Portable wrist monitors can measure BP readings over 24 hours

In some of these patients, blood pressure medications were actually prescribed which caused severe side-effects when they returned home and blood pressure normalised. Medications are quite unnecessary in such cases.

How does one make sure that one’s blood pressure is truly high and not due to stress-induced causes? Simple, in most hospitals, doctors can ask patients to wear a device that monitors the blood pressure regularly over 24 hours (24-hour portable ambulatory blood pressure monitoring). Today’s devices are not so bulky and cumbersome and can often resemble a wrist-watch.

The really bigger problem is trying to get those who have not gotten a blood pressure reading for many years on the mistaken belief that they did not have symptoms (hypertension is usually silent – hence the acronym ‘silent killer’) or were simply unaware that they were at risk.

Pardon the Sleep…its OSA!

Picture these four situations:

  1. Have you slept in a meeting although the discussion has been far from boring?
  2. Do you suffer from chest-pains from hitting the steering wheel too often when dozing off while driving? (No, I’m serious!)
  3. Has your spouse commented that he/she had to rouse you up when you were sleeping at night  because he/she noticed you had apparently stopped breathing?
  4. Has your blood pressure been difficult to control despite being put on many different anti-hypertensive medications?

What do the above conditions have in common? They belong to patients who have presented  with various manifestations of obstructive sleep apnoea (OSA) -breathing pauses during sleep caused by obstruction of the upper breathing passages. To understand better, watch this video:

This relatively newly-recognised situation has in fact been around for ages, but it has been only recently that doctors have accepted this as a separate condition with profound life-threatening complications.

While more common in the obese and middle-aged, others may present with symptoms such as:

  • snoring
  • choking while sleeping
  • daytime sleepiness (at meetings and at the wheel)
  • morning headaches
  • poor memory, depression, irritability,sexual impotence

So what’s the big deal?

Well, apart from the fact that OSA causes excessive sleepiness and tiredness and is a health hazard at work or on the road (to others as well!) , it has now been linked to a host of other conditions:

  • increased risk of heart attacks, strokes and death
  • high blood pressure resistant to most medications
  • brain-cell damage due to lack of oxygen

The good thing is something can be done about it, using latest techniques.

For instance, to diagnose this condition, people used to need to stay in hospital’s sleep lab to undergo a sleep study (polysomnogram). Nowadays, portable devices are available (even in Malaysia) where one just needs to wear this device and have the recording in the comfort of your own bed.

In terms of treatment, a whole host of new methods are available apart from the traditional C-PAP mask that is quite inconvenient to use. In fact, one of the most effective forms of treatment is to just lose weight!

Two points are worth noting:

  1. Inform your surgeon if you are going for surgery as OSA patients can sufffer from prolonged absent breathing periods (apnoea) and may suffer complications following anaesthesia.
  2. Snoring does not equal OSA. A lot of people snore but they do not stop breathing for more than 10 secs while asleep.This is quite normal.
Follow

Get every new post delivered to your Inbox.

Join 184 other followers

%d bloggers like this: