Heart - Emcure Pharmaceuticals Ltd.

7
Pune, September 26, 2010
Changing lifestyles and decreasing physical activities
are posing greater risks of heart attacks, but nearly
76 percent people have never done a cardiac check to
assess the hazard they face.
A
s the World Heart
Day is being observed
Sunday,
findings of a survey reveal that nearly 60 percent of people between the
ages 20 and 65 don't feel they
have any risk of heart attack,
even though nearly 20 percent already have a family
history.
The survey shows that people in the 20-30 age group
were the most optimistic
about not developing heart
diseases even though a majority of them have never got
a heart checkup done.
However, doctors say that
with changing lifestyle, three
times rise has been registered in heart diseases
among youths, which include
coronary heart disease, heart
failure and stroke.
As a result of changing
lifestyle, the average age at
which a person may suffer a
heart attack has come down
from 40 years to 30 years. It's
a matter of great concern for
India, sedentary lifestyle,
hectic schedules, no physical
activity, and smoking and
drinking habits are the factors leading to heart diseases
among youths,' he adds. According to the World Health
Organisation (WHO), cardiovascular diseases are the
world's largest killers, claiming 17.1 million lives a year.
Negligence towards the
risk has been dubbed by doctors as one of the biggest reasons behind the rapid growth
in the number of cardiac diseases cases. The theme this
year is 'Workplace Wellness Take Responsibility for your
own Heart Health, focusing
on the need to generate
awareness. Doctors agree
that emphasis is now needed
on the preventive measures.
In a country like India
where we have different
kinds of food habits and very
negligible percentage of the
population performing daily
exercises, we need to stress
more on the preventive aspect of cardiac ailments. In
addition to the stressful life,
obesity, diabetes and smoking
add to the risk.
World Heart Day that is celebrated on the last Sunday of
September every year was first
celebrated in the year 1999 with
an aim to promote wellness of
heart.
Today it is celebrated in
more than 100 countries and by
many people including cardiologists, hospitals and non medical professionals as well. As estimated by the World Health Organisation (WHO), cardiovascular diseases remain the
world's largest killers, claiming
17.1 million lives per year.
With this year's themeWorkplace wellness, World
heart day will be celebrated by
focusing on young professionals' health including IT, corporates, and many more. The
theme that rightly mentions
workplace wellness will help
youth to understand the importance of healthy behaviours and lifestyle because cardiovascular illnesses that was
best known as the ageing disease is nowadays gripping
many young professionals.
Heart problems are more
commonly seen nowadays
Listen to your Heart
...was what Dr JS Dugal,
Head of Cathlab Jehangir
Hospital, had to say when
asked about what he would
like people to do on World
Heart Day. Your heart may be
sending you signals that you
should heed. Very often we
neglect the radiating pain in
the hands and shoulders,
breathlessness, profuse sweating on exertion, chronic, unresolving pain in the stomach.
When these symptoms persist
and do not resolve it is better
to consult your Physician or,
even better, get a heart check
done.
When asked who should
take extra care of their heart
Dr Dugal had this to say.
According to him, Diabetes
and Hypertension are the first
stages on the highway to
Heart Attack. Those who suffer from these ailments, or
even if they have a history in
the family, must take extra
care of their heart.
Obviously those with a history of heart disease in the
family. Nowadays there is a
significant number of young
patients with advanced heart
disease.
Poor Lifestyle, stressful
lives and sedentary habits are
responsible factors in these
cases. Dr Dugal gave the example of a 40 year old with 2
major and total blocks on
whom, they had recently done
a complex angioplasty during
a cardiac workshop that was
transmitted live to an audience
of
international
Cardiologists at Amsterdam.
Women are naturally
protected from Heart disease
until menopause. Thereafter
their natural protection diminishes and they need to
take care of their hearts.
Today we have recourse to
new blood tests that can tell us
about the levels of markers
like
Homocystein,
Apolipoprotein, Lipoprotein,
from which we can accurately estimate your risk for heart
disease.
Advanced imaging like the
CT Angio allows us to literally look into your heart and
check for blockages and other
problems that are not apparent. Since these are expensive
investigations we have made
special discounted heart check
packages, which are affordable
and will help you protect your
future, he added.
among people between 20 and
35 years of age and has become
a serious problem that needs
immediate attention and
which is why this theme.
The rise of cardiovascular
problems among youth can be
attributed to major reasons
and risk factors like sedentary
lifestyle, bad eating behaviour,
smoking, alcohol intake, unusual sleeping hours, inadequate intake of fruits/vegetables, obesity and lack of
exercise.
Wellness at workplace has
become the priority that will
not only help the organisation
going but will also benefit the
employee by reducing his/her
absenteeism to work.
Wellness at workplace has
become the priority that will
not only help the organisation
going but will also benefit the
employee by reducing his/her
absenteeism to work. To keep
the employees stress free and
away from cardiac ailments
healthy lifestyle can be adopted at the workplace like eating
right, keeping away from
alcohol and tobacco.
Blessing and a Ray of Hope For Heart Patients
he heart muscles are deficient
of blood supply and oxygen
due to blockages in coronary
- the heart's blood supplying arteries which cry, needs attention before
the patient gets a massive heart attack and at times even death. Every
fourth person who gets a heart attack dies before he reaches the hospital - The World Health Organisation in its recent report have indicated that 60% of the worlds deaths
arising out of heart attacks are
going to be from India.
It is there fore important to understand this disease and take alternative measures by increasing
blood supply to the heart before it is
damaged severely and the Heart
Transplant is the only solution. In
light of this Global Heart Foundation has an excellent and easy solution to solve this problem called
EECP - Enhanced External Counter
Pulsation.
EECP is a US FDA approved treatment and recognised by cardiologists all over the world. With the
help of this US made machine, new
collateral blood vessels to the heart
are opened up, hence increasing the
blood flow to the heart and in turn
make the heart stronger. (It is like
addition of a new army).
The heart is a pump which supplies blood to each part of the body
by positive pressure. When the
heart receives blood from the various parts of the body there are no
pumps, it is by negative pressure
that this blood is received, and thus
T
this blood does not flow through the
small blood vessels, nor are the
collaterals open .
In this EECP technique cuffs are
tied to the legs and thighs which are
rhythmically deflated and inflated
during systole and diastole - which
is the pumping out and pumping in
of the blood into the heart. During
this filling phase or pumping in
phase EECP pushes Venus blood towards the heart by positive pressure
with the effect that blood starts
flowing through these multiple tiny
vessels (which are abundant in the
heart) and thereon opens collateral
not only in the heart but the entire
body. Since this treatment is given
one hour at a time for 35 hours these
blood vessels remain open for many
years to come. This could be called
as "Natural Bypass" - without surgery. This treatment is use full in intractable angina, for patients who
want to avoid heart bypass surgery,
angioplasty, patients who have diffused coronary arterial disease, patients who don't want to repeat cost-
ly & risky procedures due to re
blockages or due to recurrences - i.e.
2nd time angioplasty or heart bypass surgeries - which may cost in
lacs of rupees, heart failure patients, patients whose ejection fraction is less than 35%, acute myocardial infarction patients. The effect of this treatment could be assessed on well recognised stress
thallium test. There is a remarkable
reduction in angina, significant improvement in exercises capacity, improves functional status and gives a
better quality of life for the patients. When the heart failure is ischaemic or non ischaemic this
treatment reduces the admission in
ICCU as emergency and prevents
major heart attack episodes. This
treatment also reduces cardiac after
load drastically and peak oxygen intake is improved. International
EECP registry has documented
the results and benefits of this
treatment irrespective of age, ventricular function and diabetes is no
bar for this treatment . This treatment has a staunch record of
being very safe and effective non-invasive and also a cheap & affordable
treatment.
For
more
information you may log on to
www.globalheartfoundation.org
—Dr. Sharadchandra Deshpande
Sr. Medical Director - Global Heart
Foundation.
Mob: 9850277773
Email:
info@globalheartfoundation.org
LIVING WITH HYPERTENSION
Hypertension today afflicts a large
section of population who may or may
not be aware of it. Hypertension means
a sustained rise in blood pressure
above the normal -120 Systolic and 80
Diastolic. Hypertension is a chronic
condition for which one has to take
medicines life long. If left unmanaged,
hypertension can be a silent killer-it
can be fatal as it may damage kidneys,
eyes and can lead to stroke or heart
attack. How does one live with
Hypertension? Should high blood
pressure affect life-style? The answer
is NO…if it is managed well. It is not
very difficult. One needs a certain
discipline in life and then can a good
quality life. But for this, one should
remember the following:
> Regular check-ups ---Keep BP
below 120/80
> Take medicines regularly
> Regular exercise- brisk walk for at
least 30 minutes daily
> Reduce stress
> Enjoy your work
> Develop a hobby
> Maintain a healthy weight-Don't
let a paunch show - it is
unhealthy.
> Eat well balanced diet- less of fats
and NO junk food.
> Reduce salt intake
> Don't smoke.
Let's accept it. Hypertension needs to
be managed. And management is in
our hand. I too am a hypertensive for
many years. Yet I work hard and late
hours too, do Gym, take long flights and
travel extensively. I manage my blood
pressure well. You too can do that. And
live a good quality life.
—Arun Khanna-COO,
Emcure Pharma
Classifieds
INITIATIVE BY DNA CLASSIFIEDS ON WORLD HEART DAY
Mumbai, September 26, 2010
8
HEART ATTACKS - Prevention and early
treatment is the key to success
H
eart disease is the
single
largest
cause of death in
India with heart
attacks being accountable for
one third of all deaths caused
by heart diseases. In India,
the incidence of heart disease has doubled during the
last
20
years
due
to the changes in economic
development and lifestyle
modifications.
In comparison to the west,
the disease is affecting us at
a younger age. The rate of
heart attacks among Indians
younger than 40 years of age
in the last few years was five
times higher compared to
other populations. The recent
statistics show that one out of
ten heart attacks happen
before the age of 35.
Ischemic heart disease is
increased oxygen demands
during exercise, walking or
any other physical activity.
This results into severe pain
in the chest region which
may radiate to left arm. This
is known as angina pectoris
(Angina = pain; pectoris =
chest in Latin) The pain of
angina is usually temporary
and is relieved by rest or by
taking a tablet of glyceryl
trinitrate or sorbitrate (drug
that expands the coronary
arteries).
However, at times there
may be rupture of the cholesterol plaque which then
gets superimposed with blood
clot. This may result into sudden and complete block of the
coronary vessel. When there
is no adequate oxygen, the
muscle starts dying. The
death of heart tissue as a re-
definitely reduce the risk of
heart diseases.
Symptoms of heart
attack:
The symptoms of a heart attack vary from one person to
another. They can range from
a severe pain in the centre of
the chest, to having mild chest
discomfort. Classic symptoms of a heart attack may include chest pain associated
with shortness of breath, profuse sweating and nausea.
The chest pain may be described as tightness, fullness,
a pressure, or an ache. Unfortunately, many people do
not have these classic signs.
Other presentations of heart
attack may include indigestion, jaw ache, pain only in
the shoulders or arms, short-
ness of breath, or nausea
/vomiting or dizziness. This
list is not complete, since
many times people can experience a heart attack with
minimal
symptoms.
In
women and the elderly, heart
attack symptoms can be atypical and sometimes so vague
as to be easily missed.
The only complaint may be
extreme weakness or fatigue.
In diabetics, there may not be
any pain at all as result of affection of nerves due to diabetes (Silent myocardial
infarction).
Hence immediate medical
help is mandatory. Many people die before they present for
medical care because they ignore their symptoms. The diagnosis of myocardial infarction will be confirmed by
the doctor after taking an
electrocardiogram.
When to call for
medical help?
Any chest pain should be
treated as medical emergency,
as classic symptoms of heart
attack may not occur in all.
Time = Muscle :
Although biochemical and
functional abnormalities as
well as severe loss of heart
contractility begin immediately following coronary obstruction; it takes about 2040 minutes for irreversible
muscle injury to occur.
Prompt treatment and recanalisation of coronary arteries can minimize the size
of the infarction, preserve
cardiac functioning and
minimize the risk of death.
Early treatment reduces
the size of scar tissue and reduces further complications
like heart failure, life threatening arrhythmia (abnormality of the heart rhythm
and cardiac arrest (sudden
stoppage of cardiac beating
that often results in to
death).
WORLD HEART DAY
H
as a result of inadequate
blood supply to the heart
muscles (Ischemia - lack of
blood supply). The major
forms of heart diseases are
myocardial infarction, angina pectoris and congestive
cardiac failure.
Heart is made up of cardiac muscles which require
continuous blood flow to provide oxygen supply that allows it to work. Heart muscle
gets the blood supply from
coronary arteries. Left anterior descending coronary artery is the artery that supplies majority of the left
ventricle.
The commonest cause of
heart disease is narrowing of
coronary arteries as a result
of cholesterol plaque. A cholesterol plaque narrows coronary vessels and restricts the
amount of blood flow. The
blood flow in a narrowed
coronary artery may be
enough for the heart muscles
to work at rest, but may not
be adequate to meet the
sult of prolonged ischemia
(lack of blood supply) is
termed as "myocardial infarction" (myo=muscle +cardial=heart) Infarction=death
due to lack of oxygen. The
heart muscle does not regenerate and so even if the patient survives an attack, he or
she will have to live with a
portion of their heart being
non functional and complications resulting from the
same.
Risk factors for heart
attack:
Ischemic heart diseases are
mainly as a result of deposition of cholesterol plaque
into the coronary arteries
(also known as atherosclerosis). The risk factors for ischemic heart disease include:
family history, hypertension,
diabetes, high cholesterol levels and smoking. Majority of
these conditions are as a result of stress, obesity, lack of
exercise, unhealthy eating
habits which if prevented can
By Dr. P. Bhandari, MD based on article authored by
Dr. Sameer Mehta, MD, FACC,MBA, Interventional
Cardiologist, Associate Professor of Medicine,
University of Miami published in the Indian Heart
Journal special issue (Sept-Oct 2009)
stroke. A heart-healthy workplace encourages a healthy diet,
physical activity and a smokefree environment. Further, almost half of the deaths due to
chronic diseases occur in the
productive age group (15-69 yrs).
A healthy workforce can result
into increased productivity, loss
of absenteeism, enhanced staff
retention and lowered medical
cost. At this 10-year milestone,
the World Heart Federation is
urging governments, healthcare
professionals, employers and individuals to reduce the burden of
heart disease
and
stroke.
On occasion of the
World Heart
Day, several
activities
are organized worldwide
by
member and
non-member organizations. The
World Heart
Federation
would be launching a global cardiovascular disease 10-year report card in partnership with
the World Health Organization
and the World Economic Forum
as well as would take comparative survey of heart-healthy occupations.
The activities in India would
involve social media (Youtube,
Twitter, Facebook, etc.), conference/seminars
to
healthcare,walks, walkathon,
exhibitions, press activities, competitions, awareness surveys and
public awareness seminars.
On this World Heart Day,
everyone is called upon to take responsibility for their own heart
health and say "I work with
Heart".
World Heart Federation © Jason Joyce
eart attacks and strokes
have emerged as major
killers in developed as
well as developing countries
killing 17.1 million lives a year.
They are of a great concern to
medical community and society
in general. Over 80% of cardiovascular disease deaths take
place in low-and middle-income
countries. Tobacco use, an unhealthy diet, physical inactivity
and harmful use of alcohol increase the risk of heart attacks
and strokes.
Since the year 2000, World
Heart Day has
been organized by World
Heart Federation in participation with
World Health
Organization
(WHO) supported by several member
and non-member organizations worldwide.
The aim of
this activity is
to disseminate the message that
at least 80% of premature deaths
results from heart disease and
stroke could be avoided if the
main risk factors, tobacco, unhealthy diet and physical inactivity, are controlled.
It is organized worldwide on
the last Sunday of September
every year. This year, 26th September 2010 is World Heart Day.
Workplace Wellness
The theme for this year's
World Heart Day is "workplace
wellness".
Over half of our waking
hours are spend working, the
workplace is ideal to promote
heart-healthy messages and
raise awareness about the risk
factors for heart disease and
Take responsibility for your
own heart health
Ten simple tips to keep your heart healthy
> Healthy food intake - Eat at least 5 servings
of fruit and vegetables a day and avoid
saturated fat and processed foods.
> Get active & take heart - 30 minutes of activity
each day
> Say no to tobacco - Risk of coronary heart
disease will be halved within a year and will
return to a normal level over time.
> Maintain a healthy weight - Weight loss, with
lowered salt intake, leads to lower blood
pressure, a major risk factor for stroke and
heart disease.
> Know your numbers - Visit a healthcare professional who can measure your blood pressure, cholesterol and glucose levels, together
with waist-to-hip ratio and body mass index
(BMI). Once you know your overall risk, you
can develop a specific plan of action to
improve your heart health.
> Limit your alcohol intake - Excessive alcohol
intake can cause your blood pressure to rise
and your weight to increase.
> Insist on a smoke-free environment - Demand a
tobacco ban - ensure your workplace is 100%
smoke-free.
> Bring exercise to the workplace - Include
physical activity in your working schedule cycle to work if this is possible, take the
stairs, exercise or go for a walk during your
lunch breaks, and encourage others to do so
too.
> Choose healthy food options- Ask for healthy
food at your work canteen, or find nearby
cafes or restaurants that serve healthy
meals.
> Encourage stress-free moments -whilst stress
has not been shown to be a direct risk fact or
for heart disease and stroke, it is related to
smoking, excessive drinking and unhealthy
eating, which are risk factors for heart disease. Take time for lunch away from your
workplace to get some fresh air. Have regular
breaks during the day - try stretching or
exercising for 5 minutes twice a day.
Control Hypertension
H
is a major risk factor and better control can lead to prevention of 300,000 of the 1.5 million annual deaths from cardiovascular
diseases
in
India.
What is Normal BP?
Blood pressure is measured
with a help of an instrument
called sphygmomanometer.
Systolic BP is the pressure in
hirality is the science of similar looking components
of a molecule whose mirror images are not super-imposable. These similar but not super-imposable parts
do not behave similarly in
the body. Hence the two
versions of the same molecule may differ in efficacy and safety. Chirally
pure products are just one
of these two forms that
are 'purified' to give only
one form with known,
sure and precise action
and safety. The unique advantages of these pure
molecules are that they require almost half the dose
to produce equal decrease in blood pressure, exert less metabolic load on the body and also have a favourable side effect
profile and have less chances of interacting with other
drugs. For further information on please browse
www.chiralemcure.com.
C
arteries when the heart is
pumping blood and diastolic
BP is the pressure when heart
is getting filled with blood. The
normal upper limits for systolic and diastolic blood pressure are 120 mm of Hg and 80
mm of Hg respectively. A person is termed as hypertensive
if he has elevated systolic > 140
mm Hg and/ or diastolic BP >
90 mm of Hg two or more times
during sitting or lying down
position.
Risk factors for hypertension:
Many factors affect blood
pressure in our body including
salt intake, status of nervous
system, kidneys or blood vessels, also levels of different
body hormones. About 90%
cases of hypertension are not
associated with any major illness in the body and are
termed as primary or essential
hypertension.
Only 10% of the hypertensive cases result due to kidney,
endocrine, heart and other
problems. Although no direct
cause has identified itself,
there are many factors which
contribute to the development
of essential hypertension: Increased age, family history,
In a heart attack the treatment is to ensure blood
supply (Reperfusion) to the myocardium at the earliest.
1. Administration of clot-busting agents
(thrombolytics)
The most common method adopted is the use of thrombolytic agents as they are simple and easy to administer.
It can be administered in a well equipped (Cardiac) ambulance or a nursing home with ICU facilities and ensure
that patient gets the right treatment on right time and save
the precious time as Time=Muscle.
According to the recent recommendations, thrombolysis should be performed within 30 minutes of onset of chest
pain for best results.
Till recently, the agents available in our country could
be administered completely in an hour or more only. They
produce some undesirable side effects (allergic reactions).
2. Elaxim in Heart Attacks
All these issues have been addressed by the path-breaking
work done in bio-engineering at Pune by the introduction
of Tenecteplase (Elaxim), by Gennova Biopharmaceuticals,
a 100% owned subsidiary of Emcure Pharmaceuticals Ltd,
Pune.
This revolutionary agent has been available in the world
market for about seven to eight years, now. This medicine
is the most widely used agent in the United States for
Thrombolysis (breaking up a clot).
Tenecteplase can be administered in a matter of seconds
(5-10) easily as a single injection.
The treatment can be administered even at the home of
the patient, in an ambulance (Pre-Hospital) or a Nursing
home with ICU facilities. This medicine offers the best
results when compared to the existing agents, has the
least incidence of side effects and is the easiest agent to
administer.
This is very important in small towns and villages of India, where cath-lab facility may not be available immediately Studies have shown that this agent offers results comparable to Angioplasty when administered within 2-3 hrs of
an attack. Elaxim is now available at approximately 800 centers across the country. Elaxim has been administered in
nearly 16000 patients, and has saved thousands of lives . A
recently presented study in the Indian Heart Journal shows
that Elaxim has a success rate of more than 85% in Indian
heart attack patients. One of the emerging modalities is the
Pharmaco-invasive management (Angioplasty following
thrombolysis) is a better, safer option than Primary
Angioplasty.
3. Coronary angioplasty
In angioplasty, a catheter containing a balloon is
passed into the coronary vessel in order to remove the
obstruction.
This is usually accompanied with fitting of a stent (a scaffold to maintain the artery in an open state) at the site of occlusion. Coronary angioplasty should be performed within
90 minutes of onset of chest pain for best results. But this
method is expensive ,time consuming and has to be performed in a tertiary care hospital (Hospital with a Cath Lab)
only, by a skilled cardiologist. In today's scenario with ever
increasing traffic congestions, patients reaching hospital on
time and receiving the right treatment is a point of concern.
Can heart attacks be prevented?
To prevent heart attacks or other heart diseases, it is important to make changes in the lifestyle, and live a healthy
life. It is essential to maintain a good control of hypertension, diabetes and cholesterol levels. Undergoing medical
check-ups regularly is equally important.
For any further information please browse:
www.heartattackelaxim.com www.elaxim.co.in
C. Venkata S. Ram, MD, MACP,
FACC is the director of the
Clinical Research Institute of
Dallas Nephrology Associates. In
addition to his consultative
practice, Dr. Ram is a professor
of Internal Medicine at the
University of Texas Southwestern
Medical Center at Dallas and he
is the director of the Texas Blood
Pressure Institute.
PREVENT STROKE AND HEART ATTACKS
ypertension commonly
termed as high BP is a
medical
condition
where the arterial blood pressure remains persistently elevated. Cases of hypertension
are increasing rapidly among
Indian urban populations and
more than two-fifths of the Indian urban adult population
has hypertension.
High blood pressure (BP)
Treatment Options
For Heart Attacks
creases
the
risk
of
development of heart failure.
sedentary lifestyle, stress, obesity (especially around the abdomen), increased salt intake,
presence of diabetes, high
cholesterol levels, smoking.
Symptoms of hypertension:
Usually mild to moderate
hypertension is not associated
with any symptoms. But sudden rise of BP may be associated with headache, drowsiness, confusion, vision disorders, nausea, and vomiting.
Why should hypertension
be treated?
Untreated hypertension results into several complications. There could be sudden
rise in the blood pressure and
it may result into sudden
stroke due to bleeding inside
the brain tissue. Long term hypertension causes damage to
arterial wall and results into development of atherosclerotic
plaques.
These plaques can cause occlusion of heart, kidney and
brain vessels.
Thus untreated hypertension increases the risk for
heart attacks and strokes due
to clotting in the brain vessels.
Long term hypertension induces abnormalities in the
kidney function and can lead
to kidney failure.
Hypertension also causes
excess load on the heart and in-
Treatment of hypertension:
There are several medications
proven useful in the treatment
of hypertension including
beta blockers, calcium channel
blockers, ACE inhibitors and
diuretics.
The choice of medication is
dependent upon several factors like the level of hypertension, presence of other diseases asthma, diabetes, and
high cholesterol levels. The
medicines have to be taken daily at a given time as advised by
the doctor. Never stop the BP
medicines without asking
your doctor. It is very important to minimize the salt intake (two thirds of a teaspoon
of table salt per day) and avoiding fast foods, pickles etc that
contain high salt.
Advantages of chirally pure
drugs in hypertension:
Pune-based Emcure Pharmaceuticals Ltd, a pioneer in chiral technology has developed
S-Amlodipine (Asomex), SMetoprolol (Metpure-XL), SAtenolol (Atpure) which are
the chirally pure medicines for
hypertension and are available
in India as well as several other countries. Asomex is not associated with the typical ankle
swelling often seen with the
ordinary amlodipine.
These molecules as well as
their combinations have
shown good effectiveness and
safety in Indian patients. Global multicentric clinical studies
have been done showing the effectiveness of Asomex in
thousands of hypertensives.
Control the risk factors :
Maintaining healthy lifestyle,
avoiding of stress and minimizing salt intake (< 1500 mg
of sodium /day) in the diet
can minimize the risk of
hypertension.