What is Matka Medicine? The introduction explains it all. Matka Medicine has two broad sections. The first where I discuss the various “matkas” or factors that affect our health and the second where I write and talk about how we can empower ourselves and take steps to live long, healthy, using current, validated data and science in our quest to be atmasvasth.
In the end our health is our responsibility and no doctor or healthcare system, especially in India is really going to take the time out to help us live long, healthy, unless or until we fall sick - the idea is to try and not become ill in the first place.
Question 1: Which disease is the single biggest killer in India in the age group of 50-69?
The answer is A. Hypertension or high blood pressure (Fig. 1) is the single biggest killer in India. In 2019, approximately 570,000 people died due to hypertension, amounting to 19.8% of all deaths in this age group. Across all age groups, the number of deaths attributable to hypertension was 1.35 million or 13.5 lakhs, accounting for 14.37% of all deaths.
Fig. 1: A comparative chart of causes of death in the 50-69 age group in India
Hypertension is elevated blood pressure. The systolic (upper) or the diastolic (lower) or both values can be high. Both should be normal. The accepted cut-offs for a long time were values greater than 140 systolic and 90 diastolic , but the definition of hypertension was changed to values above 130 systolic and/or 80 diastolic in 2017 by ACC/AHA . Many studies have shown that the lower the blood pressure, the longer people live disease free .
Question 2: How many people are said to have hypertension in India above the age of 18 as defined by the 140/90 cut-off?
A. 100 million (10 crores)
B. 200 million (20 crores)
C. 300 million (30 crores)
D. 400 million (40 crores)
The correct answer lies between B and C. 234 million people out of 762 million adults above the age of 18, as per the 2011 census have high blood pressure, as reported by a study, where blood pressure measurements performed on a single day in camps across India in 2015 . If the new guidelines of 130/80 are applied to this same study, then the number of people with hypertension in India goes up to 460 million which is a prevalence of 3 out of 5 or 60% . Whether 30% or 60%, the number is alarmingly high.
As individuals, what should we be doing?
All of us need to measure our own cardiovascular (CV) risk ourselves using either QRISK3 or the Framingham ACC/AHA method as I had written about earlier. We should also measure our own blood pressure over a few days at different times using any standard home based instrument (I use OMRON, but you can use whatever is available and accessible). Home blood pressure (HBP) measurements are now considered quite reliable and accurate .
If your 10 years CV risk is low (less than 10%) and the blood pressure is normal, that’s great news. However, with a low CV risk, if the blood pressure is mildly high (130-139 or 80-89), you can try and manage without medication.
Question 3: Which of these non-pharmacologic methods helps with hypertension control?
A. Physical activity
B. Sensible eating and low sodium
C. Cessation of smoking
D. All of the above
E. None of the above
The correct answer is D. All the first 3 help, though the most effective is physical activity (PA). A new scientific statement by AHA, published earlier this week  places PA front and centre in the management of hypertension, whether it is without drugs (mild hypertension, low CV risk) or supplementing medications (moderate to severe hypertension, high CV risk).
If your CV risk is high, and/or the HBP measurements are consistently above 140/90, then it is best to first see a doctor to plan further management. But even then, PA must supplement medication.
Question 4: What is the minimum PA recommended ?
A. 30 minutes of walking every day for 5 days
B. 30 minutes of running every day for 5 days
C. 30 minutes of strength training every day for 5 days
D. Mix of walking, running, strength training on different days
E. All of the above
F. None of the above
The correct answer is E.
The PA guidelines in the scientific statement are directly taken from the Physical Activity Guidelines for Americans, which mention 150-300 mins / week of moderate intensity exercise (brisk walking) or 75-150 minutes of vigorous intensity PA (running) or a combination of the two. So basically at the bare minimum, 30 minutes of brisk walking 5 times a week or 30 minutes of running 2-3 times a week would work and you can mix and match. Walk one day, run another day, longer walks and runs over weekends and similar combinations are all fine. To these we have to add some form of strength training at least twice a week, which could be with free weights or machines, or include yoga, tai-chi or any other method that allows resistance muscle training.
In short, PA helps us control our blood pressure and along with sensible eating, sodium control, cessation of smoking, weight loss and adequate sleep, helps at least 1/3rd of us with hypertension manage without medication, thus helping us in our quest to be “atmasvasth” (Fig. 2).
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