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Volume 3, Issue 1

The Trinidad & Tobago Heart Foundation

March 2008

Live Healthier, Live Longer! An Interview on Hypertension with Dr. Roy Tilluckdharry Dr. Roy Tilluckdharry is a Consultant in Cardiology, Internal Medicine and Chest Diseases. He has been in Medical Practice for Thirty-Two years, is a Fellow of the American College of Cardiology and is the Medical Director of Cross Crossing Medical Centre, San Fernando.

Q: Why is Hypertension of such concern to us? A: Hypertension or High Blood Pressure is so important to us because this condition is one of the leading causes of strokes, heart failure, kidney failure, heart attacks and premature deaths. It is very common. It is estimated that up to 80% of the population will be hypertensive in their lifetime and patients with uncontrolled Hypertension die prematurely. Q: What is Hypertension? A: Our arterial blood vessels like household pipelines are made to take a certain pressure as the heart pumps blood. The best pressure is 120/80, which is 120mmHg systolic, when the heart makes its maximum contraction, over 80mmHg diastolic, when the heart is relaxing between beats. More than those values on a constant basis causes a strain on the heart and damages the blood vessels. Q: What is the normal Blood Pressure limit? A: Up to 120/80. Of course, exertion, stress, emotion, fright, and exercise causes the blood pressure to temporarily go above those levels and that is normal, but with relaxation, the blood pressure should come back to below 120/80 within 30 minutes. Also, many normal people can have a blood pressure as low as 90/50.

In This Issue An Interview on

Healthy Choices

Hypertension with

for 2008

New Research Findings You Can Put to Use. Now.

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Page 7

Dr. Roy Tilluckdharry Pages 2,3

A Good Night’s Sleep is Very Important for Good Health! Page 8

HEALTHY FOOD: Lemon Chicken with Oregano - Page 8

The Trinidad & Tobago

Management Committee

Executive Members:

Heart Foundation

Rooms 46 & 47, Building 1, Eric Williams Medical Sciences Complex, Mount Hope.

President Vice President Secretary Treasurer

Dr. Allan McKenzie Dr. Roy Tilluckdharry Mr. Paul Regis Mrs. Joan Awardy

Tel/Fax: (868) 662-6993 E-mail:


Dr. Rasheed Rahaman (Consultant Cardiologist) Dr. Sateesh Ramphall (Consultant Cardiologist) Ms. Laverne Fernandes Mrs. Janet Soobratee Ms. Lana Walters Mr. Ronnie Bissessar Dr. Feroze Omardeen Dr. Kamal Rampersad

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An Interview on Hypertension with Dr. Roy Tilluckdharry Continued from page 1 Q: What is low Blood Pressure? A: This is a term used loosely for someone with what doctors would regard as normal blood pressure, usually meaning that it is not high. However, there are some emergencies like shock, dehydration, slow heart beats that make a low blood pressure critical, necessitating urgent treatment. Q: Why does Hypertension cause so many complications with such wide availability of medical care and medicines? A: (i) Many people who have a high blood pressure are not aware they are hypertensive, as they do not have symptoms and never had their blood pressure taken. ii) Some patients who had a high blood pressure documented often disregard this information as they attribute it to some stress of the day or night before. iii) People who know they have high blood pressure are not taking their medications or do so intermittently. They do not monitor the need for a higher dosage. Q: What causes Hypertension? A: Most Hypertension is idiopathic or essential - meaning that it results from an inherited tendency. A small percentage is as a consequence of other causes like kidney disease or due to blood vessel diseases. A person with the inherited tendency usually has an insidious increase of the pressure as they age. Lifestyles can aggravate the inherited tendency. Q: What are the lifestyles which tend to elevate Blood Pressure? A: Emotional Stress, Overweight and Obesity, Lack of Exercise, Dietary indiscretion, Excess salt in diet & Excess Alcohol Intake. Q: How is emotional stress important? A: Stress causes increased secretion of stress hormones from the adrenals

which causes constriction of blood vessels and increases force of pumping of the heart muscles. Both of these increase blood pressures. It is wellknown that certain forms of meditation like transcendental meditation and biofeedback can cause lowering of blood pressure. Q: What about overweight and obesity? A: The fat from overweight and obesity has miles and miles of blood vessels which gives the heart more work to do. We know that for every 2 Ibs weight loss, blood pressure reduces by ImmHg and weight reduction can lower blood pressure up to 20 mmHg. Q: What about lack of exercise: A: Exercise causes dilatation of blood vessels. It also helps with weight and stress control. Walking 30 minutes for most days of the week can lower blood pressures by up to 10mmHg. Q: What about diet? A: The so-called D.A.S.H. Diet, which is rich in fruits, vegetables, low fat, dairy products, and reduced saturated fat can lower blood pressures by up to 15mmHg. Also, reducing salt intake and using foods high in calcium and magnesium reduced blood pressure by up to 5mmHg. Q: What about alcohol? A: More than two drinks per day in men and 1 drink per day in women causes elevation of blood pressures by at least 5mmHg. Alcoholism is one cause of difficulty in controlling one's blood pressure. Q: Can lifestyle modification alone control Blood Pressure? A: Mild Hypertension in persons with bad lifestyle may normalize with lifestyle modifications, but it is unlikely if blood pressures are moderate or severely elevated. Also, the genetic tendency in addition to age related thickening of the arteries can cause blood pressure to go

up to 200/120. Medications will be needed. Q: Do we have good medications to normalize Blood Pressure? A: Yes - most patients can have good control of blood pressure with lifestyle modification and antihypertensive medications available. Q: Is there one good pill that is good for all Hypertension? A: No. There are many types of blood pressure medications which work in different ways. Different patients will respond to and tolerate different medications better. So, the doctor usually would choose the appropriate ones. On the whole, one type of blood pressure medication will for the most lower blood pressure by about 25mmHg. So depending how high the blood pressure was initially, more than one and up to four types may be needed to adequately control blood pressure. Q: Some patients worry when they have to use more than one medication. Are they justified? A: No. We often have to use two types of medications individually or combined in one pill, so as to minimize a side effect a patient may be having. Some doses of two medications individually or combined are better tolerated and the patient is more likely to comply. Some may have to use up to four types and higher doses. The rule is that we should take as much as is needed to get correct control. Q: Can a patient get a full life even with Hypertension? A: Yes. We have gone a long way over the last 50 years when only few types of medications were available. Today, we have a wide variety of medications, which are well tolerated. If a person complies, he can look forward to a long and healthy life. Remember that lifestyles are very important in combination with medications. Continued in next issue

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Healthy Choices For 2008! Brought to you by Unilever Source: Are you trying to make healthy choices in 2008? You should be aware of some nutrients that could be a stumbling block to your desired new healthy lifestyle.

The skinny on fats Fats and oils are part of a healthy diet and play many important roles in the body. Fat provides energy and is a carrier of important nutrients such as vitamins A, D, E, and K and carotenoids. But fat can impact the health of our hearts and arteries in a positive or negative way, depending on the types of fat we eat. Experts recommend getting between 20 and 35 percent of calories from total fat, with most fats coming from sources of "good" fat, such as fish, nuts, and vegetable oils.

Limit saturated and trans fats, and cholesterol Eating too many saturated and trans fats, or cholesterol, may raise the level of LDL (bad) cholesterol and increase the risk of heart disease. A saturated fat, the type of fat that is solid at room temperature, is found mostly in animal-based food products. A trans fat is made when liquid vegetable oil is processed to become solid. And cholesterol is a fatty substance found only in animal-based products like egg yolks and whole milk. It is important to eat less than 10 percent of your calories from saturated fats. Examples of foods that tend to have saturated fats are fatty cuts of meat, whole milk products, cakes, cookies, pies, crackers, candy, candy bars, household shortening, and creamers. Limiting these foods can reduce saturated fats in your diet. An easy and quick way to reduce saturated fats is to trim excess fat from meat and poultry and remove the skin from poultry.

Trans fats are mostly found in food products made with s h or te ning an d par ti all y hydrogenated vegetable oils liquid oil that is processed to become a solid fat. Most of the trans fats that people eat come from cakes, cookies, crackers, pies and fried potatoes,. Look for partially hydrogenated oil in the ingredient list - and limit these foods. Limiting consumption of many processed foods is a good way to reduce trans and saturated fats.

Be wise about fat. Choose fats found in fish, nuts, and vegetable oils Most of the fat in your diet should come from sources of what are called polyunsaturated and monounsaturated fat. Polyunsaturated fats such as omega-6 and omega-3 fatty acids are good for you in moderation to replace the saturated and trans fats you have chosen to cut back on.

Salt Nearly all of us eat too much salt (sodium). On average, the more salt a person eats, the higher his or her blood pressure is. Most salt we eat comes from processed foods, not necessarily from the salt shaker. Some people are surprised by this, but if you consult the Nutrition Facts label - you’ll see "salt" listed as sodium there. For our purposes, we can use the terms "salt" and "sodium" interchangeably. Eating less salt is an important way to reduce the risk of high blood pressure, which may in turn reduce the risk of heart disease, stroke, congestive heart failure, and kidney damage. In addition to eating less other lifestyle changes prevent or delay getting blood pressure and may

salt, may high help

lower high blood pressure. These lifestyle changes include eating more potassium-rich foods, losing excess weight, being more physically active, and eating a healthy diet. OK…so nearly all of us eat too much salt, and most of us don’t get enough potassium - it is no wonder so many of us have high blood pressure! Everyone should get no more than 2,300 milligrams of sodium each day. People with high blood pressure, who are of African descent, and people who are middle-aged or older should get even less, because sodium from salt can affect these folks more than others. As you decrease the amount of salt you eat, your taste for salt will gradually decrease - and you won’t miss it. Adding spices to foods makes them more flavorful - another way to help you decrease the amount of salt you use when cooking. You can use foods to help increase the amount of naturally rich (not fortified) potassium you are getting in your diet. Potassium containing food sources include leafy greens such as spinach, bananas and fruit from vines such as grapes, root vegetables such as carrots and potatoes, and citrus fruits such as oranges and grapefruit.

Summing it up Let’s sum learned …




• Choose fats found in fish, nuts, and vegetables. • Know your limits on fats, salt, and sugars. • Use the Nutrition Facts label on foods. Look for foods low in saturated and trans fats, cholesterol, and sodium. • Choose and prepare foods and beverages with little salt

(sodium) and/or added sugars (caloric sweeteners). By making healthy choices every day and exercising regularly you will be off to a great start for a transformed lifestyle in 2008. ♥

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New Research Findings You Can Put To Use. Now. Source: Heart Insight Magazine, February 2008 - American Heart Organization

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A Good Night’s Sleep Is Very Important For Good Health! If you’re middle aged and sleep five hours or less a night, you may be increasing your risk of developing high blood pressure, according to research reported in Hypertension: Journal of the American Heart Association. “Sleep allows the heart to slow down and blood pressure to drop for a significant part of the day,” said James E. Gangwisch, Ph.D., lead author of the study and postdoctoral fellow at Columbia University’s Mailman School of Public Health. “However, people who sleep for only short durations raise their average 24-hour blood pressure and heart rate. This may set up the cardiovascular system to operate at an elevated pressure.” Gangwisch said that 24 percent of people ages 32 to 59 who slept for five or fewer hours a night developed hypertension versus 12 percent of those who got seven or eight hours of sleep. Subjects who slept five or fewer hours per night continued to be significantly more likely to be diagnosed with hypertension after controlling for factors such as obesity, diabetes, physical activity, salt and alcohol consumption, smoking,

depression, age, education, gender and ethnicity. The analysis is based on data from 4,810 people ages 32 to 86 who did not have high blood pressure at baseline. The survey asked participants how many hours they slept at night. During eight to 10 years of follow-up, 647 of the 4,810 participants were diagnosed with hypertension. Compared to people who slept seven or eight hours a night, people who slept five or fewer hours a night also exercised less and were more likely to have a higher body mass index. (BMI is a measurement used to assess body fatness). They were also more likely to have diabetes and depression and to report daytime sleepiness. “We had hypothesized that both BMI and a history of diabetes would mediate the relationship between sleep and blood pressure, and the results were consistent with this,” Gangwisch said. Sleep deprivation has been shown previously to increase appetite and compromise insulin sensitivity.

Short sleep duration was linked to a new diagnosis of high blood pressure among middle-aged participants, but the association was not observed among people age 60 or older, he said. Gangwisch said the differences between the younger and older subjects might be explained by the fact that advanced age is associated with difficulties falling and staying asleep. Another factor could be that subjects suffering from hypertension, diabetes, and obesity would be less likely to survive into their later years. Among study limitations, researchers found that high blood pressure often goes undetected. Study data showed that over 30 percent of people who had high blood pressure didn’t know they had it. Since the study is based on observational data, Gangwisch said more research is needed to confirm the association between short sleep duration and high blood pressure. “We need to investigate the biological mechanisms and, if confirmed, design interventions that will help people modify sleep behavior,” he said. ♥

HEALTHY FOOD: Lemon Chicken with Oregano 2 tsp 1/2 tsp 2 tbsp 1pound

canola or corn oil grated lemon zest fresh lemon juice chicken breast tenders (all visible fat discarded) 2 tbsp oregano (fresh or dried) 1 garlic clove, minced 1/8 tsp pepper 1/4 tsp paprika 2 tbsp snipped fresh parsley

Heat a large nonstick skillet over medium-high heat. Add the oil, lemon zest, and lemon juice, swirling to coat the bottom. Add the chicken, oregano, garlic and pepper. Cook, covered, for 3 to 5 minutes, or until the chicken begins to turn white. Turn the chicken. Cook for 3 to 5 minutes, or until the entire surface is white. Pour the pan liquid into a small

bowl to reserve. Cook the chicken, uncovered, for 2 to 5 minutes on each side, or until lightly brown.

Trinidad & Tobago Heart Foundation PUBLIC LECTURE SERIES

Sprinkle the paprika over the chicken. Pour the pan liquid into the skillet. Cook for 3 to 5 minutes, or until the chicken is no longer pink in the center, stirring frequently.

2nd Tuesday each month 5:00pm - 6:00 pm

To serve, transfer the chicken to plates. Sprinkle with the parsley.


Nutrition Analysis (per serving) Calories 152; Total Fat 4.0 g; Saturated 0.5 g; Polyunsaturated 1.0 g; Monounsaturated 1.5 g; Cholesterol 66 mg; Sodium 75 mg; Carbohydrates 2 g; Fiber 0 g; Sugars 0 g; Protein 26 g; Calcium 29 mg; Potassium 329 mg

The Trinidad & Tobago Heart Foundation

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Live Healthier, Live Longer! - March 2008 Issue  
Live Healthier, Live Longer! - March 2008 Issue  

Quarterly publication of the Trinidad & Tobago Heart Foundation