According to the health experts, it could be a key strategy to avert or minimise the impending super storm of non-communicable diseases (NCDs) such as heart attacks, stroke, cancers, chronic respiratory diseases, and diabetes.
Although easy to diagnose and relatively simple to treat with low cost medicines, high blood pressure is now a full-fledged health crisis with at least one in four adults suffering from this condition in the country.
It is also considered the world's largest killer, responsible for at least 8.5 million deaths and 218 million disabilities adjusted life years (DALY). Worldwide at least 1.4 billion people live with this chronic condition.
In India, untreated and uncontrolled blood pressure has become a leading cause for premature death and disability.
"More than 63 per cent of all deaths in India are due to NCDs and a large number of these deaths are linked to the underlying condition of hypertension," said Dr Pankaj Bharadwaj, Additional Professor, AIIMS Jodhpur, at a brainstorming session, held in the national capital, to stop the alarming rise of hypertension.
"Although incremental efforts for screening have been made in recent years, among people with high blood pressure, only half have been diagnosed and of those, only one in 10 have blood pressure under control," he said, adding it is because discontinuing or being irregular with BP medicines, leaves people without a protective cover.
Diabetes, another NCD and affecting a whopping 7.7 crore Indians, also contributes significantly to high blood pressure levels.
A study of more than 3,000 patients of Type 2 diabetes conducted by Amrita Hospital, Kochi, revealed that six out of ten diabetes patients suffer from uncontrolled blood pressure, with three out of those six having no prior history of hypertension.
The incidence of retinopathy, peripheral neuropathy and peripheral arterial disease of the lower limb are also much higher among diabetes patients suffering from uncontrolled blood pressure.
Further, in people with diabetes, coexisting hypertension can triple the risk of coronary artery disease (CAD), double the total mortality and stroke risk, and can be responsible for up to 75 per cent of all cardiovascular ailments, revealed the study published in the journal Frontiers in Public Health.
The recently released National Family Health Survey (NFHS) 5 report also reveals several alarming trends. Among them, the growing concern is that more and more younger people are falling prey to hypertension.
The findings also lend credence to the fact that although easy and affordable to treat, treatment adherence rate is the poorest. Only about 7 per cent women and 6 per cent men who have been diagnosed with high blood pressure are on regular medication.
Experts claim that uncontrolled hypertension -- a major risk factor for heart attack and stroke - is probably one of the main reasons why over the last decade, cardiovascular diseases have emerged as the top killer in India.
"A nation-wide awareness campaign for prevention, treatment and adherence of hypertension is the need of the hour," said Dr Sudarsan Mandal, Deputy Director General, NPCDCS, from the Ministry of Health and Family Welfare.
It also revealed rising cases of hypertension in females in the 21-40 age group, indicating that hypertension is a health problem in the younger female population as well.
A total of 16,847 dialysis patients were covered by the study done by NephroPlus, a leading dialysis care brand in the country.
According to the study, excess weight, lack of exercise or activity, and a diet high in sodium combined with genetic predisposition place older women at risk of developing high blood pressure.
NephroPlus also deep-dived into the subject to understand the effects of hypertension in various age groups, sex, and zones of the people from 0 to 60 years, with findings showing that diet and medications influence blood pressure control among dialysis patients.
"Hypertension is present in two-third to three-fourth patients on haemodialysis. Blood pressure count is influenced by the frequency of dialysis (70 per cent are in 2 weeks or less than 2 per week haemodialysis). In addition, diet and medications influence blood pressure control among dialysis patients," said Dr Suresh Sankar, Senior Vice President, Clinical Affairs, at NephroPlus.
The study revealed prevalence of hypertension in patients with chronic kidney disease (CKD), highlighting the importance of managing blood pressure at a very early stage.
According to him, hypertension is a leading cause of kidney disease and kidney failure.
"Over time, uncontrolled high blood pressure can cause arteries around the kidneys to narrow, weaken or harden. These damaged arteries cannot deliver enough blood to the kidney tissue. It can lead to injury to kidney filters, protein loss in the urine, and kidney damage," he said
Uncontrolled hypertension, a common disorder, is associated with increased long-term risk of several severe conditions. However, awareness of the health risks of uncontrolled hypertension is not well understood.
Even when patients are under the care of specialists, they frequently have a limited understanding of fundamental aspects, including symptoms, diet options, medications benefit and risks, and the importance and ease of self-monitoring
The unanswered questions in India include timing of blood pressure measurement, the significance of systolic or diastolic blood pressure, type of medications, and fluid management on dialysis patients with lower frequency of dialysis.
"This study provides a national snapshot of the effect of hypertension on dialysis patients in the population across India. Hypertension is easy to detect, preventable, treatable, and inexpensive. Incorporating a healthy lifestyle by including adequate fruits and vegetables and less processed food is necessary. One should be physically active and perform the exercise at least 30 minutes five times a week. Say no to smoking and maintain body weight in the recommended range," added Dr Sankar
According to Kamal D. Shah, Co-Founder and Director (Guest Services) at NephroPlus and the study's co-author, dialysis patients must keep their blood pressure levels in check.
In patients undergoing dialysis, normal blood pressure may be defined as the mean ambulatory blood pressure of less than 135/85 mmHg during the day and less than 120/80 mmHg by night.
The study using Pop-up health check stations in England found a possible link between "unhealthy' shopping centres and the number of cases of suspected or diagnosed high blood pressure.
The research team classified retail outlets as "unhealthy" if they either had a fast-food takeaway, a bookmaker, a tanning salon or a payday loan business.
The health check stations found 72 per cent of those frequenting "unhealthy" shopping centres with high BP.
"The least healthy shopping centres are all within some of the most socially-deprived areas of the country, so the results of this study exemplify the stark health inequalities that are entrenched across the UK," said Shirley Cramer CBE, Chief Executive of the Royal Society for Public Health.
To reach this conclusion, the team from City, University of London set up the one day Pop-Up health check stations in seven shopping centres across England.
Blood pressure readings were offered 50 per cent of the time to attract potential volunteers with a more comprehensive and familiar health screening.
The difference in the proportion of readings of high blood pressure was also a statistically significant result, translating into a 72 per cent increased likelihood of suspected or diagnosed high blood pressure being reported in an 'unhealthy' shopping centre relative to a 'healthy' shopping centre.
"The British Heart Foundation also recently called for NHS health staff to take blood pressure checks at gyms, barbershops and football stadiums and offer blood pressure checks in the workplace," said David Crabb, Professor of Statistics and Vision Research who led the research team.
"In our study, over half those recorded as having high blood pressure were aware of having the condition or reported a history of high blood pressure," said the team in a paper published in the journal BMC Public Health.
The superfood, described as the "most complete food source in the world", contains a specific protein which was found to relax arteries in the laboratory and in animals, the Daily Mail reported.
Spirulina, scientifically called arthrospira platensis, is technically a type of bacteria.
Researchers at the Mediterranean Neurological Institute in Pozzilli, Italy, isolated certain molecules from the spirulina to test its health benefits.
They simulated the effects of digesting spirulina on isolated arteries and animals in the lab.
"We reproduced what happens in the human gut after ingesting the substance," lead author Albino Carrizzo was quoted as saying.
"This way we have been able to isolate the peptides that would be absorbed by our body," he added.
The study, detailed in the journal Hypertension, also discovered for the first time a molecules in spirulina, called SP6, which lowered the blood pressure of animals.
When put into the body SP6 is thought to stimulate a process in the body which releases nitric oxide.
The spirulina triggered relaxation of the artery, a process called vasodilatory action, which can help lower blood pressure by increasing the amount of blood pumped in one motion.
This is an effect caused by nitric oxide, a chemical known for maintaining healthy blood pressure, the researchers reported.
Spirulina contains protein, iron, potassium, magnesium, and many other minerals and is widely used in supplements and smoothies for a host of conditions including weight loss, hay fever, PMS and diabetes.
Though more research is needed into the potential of spirulina, but the findings are promising for the future of "natural" treatments for high blood pressure, the researchers noted.
The study found that risk factors such as smoking, high blood pressure, family history of heart disease and chronic kidney disease were more prevalent among the patients who experienced a relapse.
"When treating younger patients with a history of heart attack, clinicians should emphasise better control of high blood pressure, high cholesterol and diabetes," said Joanne Karen Recacho-Turingan, a cardiology student from The Medical City in Manila, Philippines.
"Other modifiable risk factors to highlight in patient history and address with these patients include smoking habits and obesity," Recacho-Turingan added.
The findings were presented at the Asia Conference 2018 in Shanghai.
For the study, researchers analysed 133 young patients and found that males (90.1 per cent) with an average age of 40.9 years, experienced a second heart attack compared to females (9.9 per cent) with an average age of 39.6 years.
In addition, in these male patients, chest pain was the most common presenting symptom (81.8 per cent) while 90.9 per cent had unstable vital signs.
Heart attack in young patients can cause disability and even death at the prime of life. There are often serious consequences for these patients, their families and the health system, which can lead to an increased economic burden, according to the study.
"We must make sure to work with these patients on their modifiable risk factors to reduce their risk not just for a second heart attack, but hopefully, even preventing the first," Recacho-Turingan noted.
Previous studies have defined young heart attack patients as less than 45-years-old while some used a less than 40-year-old cut-off.
The study showed that an elevated risk of heart attack was found among women with high blood pressure, and Type-1 and Type-2 diabetes, but not with a high body mass index (BMI).
"Overall, more men experience heart attacks than women. However, several major risk factors increase the risk in women more than they increase the risk in men, so women with these factors experience a relative disadvantage," said Elizabeth Millett, epidemiologist from The George Institute in the UK.
Generally heart attack patients experience symptoms of chest pain, shortness of breath, and pain in their arms, back, neck, jaw or stomach. But, women are likely to experience additional symptoms such as unusual tiredness, dizziness, cold sweats, and nausea or vomiting.
For the study, published in the journal The BMJ, the team examined 4,72,000 participants aged 40 to 69. 56 per cent of them were women.
High blood pressure, diabetes and smoking increased the risk of a heart attack in both sexes but their impact was far greater in women.
Smoking increased a woman's risk of a heart attack by 55 per cent more than it increased the risk in a man, while hypertension increased a woman's risk of heart attack by an extra 83 per cent relative to its effect in a man.
Type-2 diabetes, which is usually associated with poor diet and other lifestyle factors, had a 47 per cent greater impact on the heart attack risk of a woman relative to a man, while Type-1 diabetes had an almost three times greater impact in a woman.
"These findings highlight the importance of raising awareness around the risk of heart attack women face, and ensuring that women as well as men have access to guideline-based treatments for diabetes and high BP, and to resources to help them stop smoking," Millett said.
Hypertension is relatively common in pregnancy and lactation may be a means through pregnancy-related vascular risk factors including chronic hypertension, gestational hypertension, and preeclampsia could be mitigated.
The findings by researchers Eliana Bonifacino from Montefiore Hospital, in Pennsylvania, US, showed that breastfeeding for as short as one to four months can decrease the risk of high BP in nursing mothers, as well as protect them across an extended follow-up of years up to decades.
Among 15 studies reviewed that had longer-term follow-up, 67 per cent of those evaluated for elevated blood pressure--and 100 per cent of the studies that assessed for an outcome of hypertension--showed a protective association with lactation, the researchers reported in the paper published in the journal Breastfeeding Medicine.
"Once again, it is confirmed that breastfeeding provides major health benefits not only to the infant but, also, no less so, to the nursing mother," said Arthur I. Eidelman, Editor-in-Chief of Breastfeeding Medicine.
Lactation is protective against many risk factors for cardiovascular disease, Type-2 diabetes in addition to benefits seen with as little as one month of the process, according to the study.
People with healthier gums were found to have lower blood pressure and responded better to BP-lowering medications, compared with individuals who have periodontitis -- serious gum infection that damages gums and can destroy the jawbone.
Importantly, poor oral health was found to interfere with blood pressure control in people diagnosed with hypertension.
They were 20 per cent less likely to reach healthy BP ranges, compared with patients in good oral health.
The findings stressed that patients with periodontal disease may warrant closer BP monitoring, the researchers said.
"Physicians should pay close attention to patients' oral health, particularly those receiving treatment for hypertension, and urge those with signs of periodontal disease to seek dental care," said Davide Pietropaoli, a post-doctoral student from the University of L'Aquila in Italy.
"Likewise, dental health professionals should be aware that oral health is indispensable to overall physiological health, including cardiovascular status," Pietropaoli added.
For the study, published in the journal Hypertension, the team examined more than 3,600 people with high BP.
The target blood pressure range for people with hypertension is less than 130/80 mmHg.
Patients with severe periodontitis were found to have systolic pressure (top number) that was, on average, 3 mmHg higher than those with good oral health.
"Patients with high blood pressure and the clinicians who care for them should be aware that good oral health may be just as important in controlling the condition as are several lifestyle interventions known to help control blood pressure, such as a low-salt diet, regular exercise and weight control," Pietropaoli noted.
According to the American Heart Association, normal blood pressure is below 120/80 mmHg.
People with a systolic blood pressure (the top number) of 130 mmHg or more at the age of 50 had a 45 per cent greater risk of developing dementia than those with a lower level at the same age.
The risk was 47 per cent even in people with no heart or blood vessel-related conditions.
"Our work confirms the detrimental effects of midlife hypertension for risk of dementia," said lead author Archana Singh-Manoux, Professor at the French National Institute of Health and Medical Research (INSERM) in Paris.
The reason for the increased risk of dementia includes the fact that high blood pressure is linked to silent or mini strokes (where symptoms often are not noticeable), damage to the white matter in the brain, which contains many of the brain's nerve fibres, and restricted blood supply to the brain.
This damage may underlie the resulting decline in the brain's processes, the researchers explained in the study of nearly 9,000 people, published in the European Heart Journal.
However, the association was not seen at the ages of 60 and 70, and diastolic blood pressure (the bottom number) was not linked to dementia.
"Our analysis suggests that the importance of mid-life hypertension on brain health is due to the duration of exposure," the researcher said.
"So we see an increased risk for people with raised blood pressure at age 50, but not 60 or 70, because those with hypertension at age 50 are likely to be 'exposed' to this risk for longer," she added.
Another study reported in the journal Cardiovascular Research showed that higher risk of developing dementia in hypertensive patients occurs due to significant alterations in three specific white matter fibre-tracts linked to executive functions, processing speed, memory and related learning tasks -- brain areas associated with dementia.
Heart failure is a leading cause of maternal morbidity and death, affecting relatively young reproductive-age women, especially among those with the presence of an additional disease or condition, such as hypertension.
The study found that although less than two per cent of all pregnancy-related hospitalisations occurred during the postpartum period, nearly 60 per cent of pregnancy-related heart failure hospitalisations took place during the same time.
"This finding lends support to using delivery-related hospitalisation as a window of opportunity to identify high-risk women and develop surveillance strategies before discharge," said Mulubrhan Mogos, Assistant Professor at the University of Illinois in Chicago.
In the study, published in the journal Circulation: Heart Failure, the team analysed more than 50 million pregnancy-related hospitalisations in the US.
The results showed that there was a 7.1 per cent increase each year in heart failure diagnoses among postpartum hospitalisations.
In addition, heart failure rates during the antepartum period, or prior to delivery, increased by an average of 4.9 per cent per year, which can be attributed to the presence of high blood pressure, diabetes, or other risk factors or conditions the women had before becoming pregnant.
Typically, women are discharged from the hospital within two to three days after delivery and are not evaluated by their health care providers again until six weeks later.
Hence, the researchers highlighted the need for close monitoring of high-risk women before they are discharged from the hospital after giving birth and through the postpartum period.
Hypertension or high blood pressure has become a major problem around the world. It increases the risk of developing heart attacks, strokes, kidney problems and may even lead to death in some cases.
However, achieving desired reductions in blood pressure often requires treatment with more than one medication. This increases the complexity of treatment, and patients often have difficulty adhering to regimens that involve taking multiple pills every day, the researchers said.
The new combination pill, or Triple Pill, consisted of the blood pressure medications telmisartan (20 mg), amlodipine (2.5 mg) and chlorthalidone (12.5 mg).
These medications use different mechanisms to reduce blood pressure by relaxing the blood vessels, so the heart does not need to pump as hard to send blood throughout the body.
"Most people -- 70 per cent -- reached blood pressure targets with the Triple Pill. The benefits were seen straight away and maintained until six months, whereas with usual care control rates were 55 per cent at six months and even lower earlier in the trial," said lead author Ruth Webster, post-doctoral student at the University of New South Wales in Australia.
"Based on our findings, we conclude that this new method of using blood pressure-lowering drugs was more effective and just as safe as current approaches," Webster added.
For the study, presented at the American College of Cardiology's 67th Annual Scientific Session 2018, 700 patients were randomly assigned to receive either the combination pill or usual care, with an average age was 56 years.
Compared with patients receiving usual care, a significantly higher proportion of patients receiving the Triple Pill achieved their target blood pressure at six months, the findings showed.
According to the researchers, clinical trials have previously demonstrated beneficial effects of dairy consumption on cardiovascular health. Yogurt may independently be related to cardiovascular disease risk.
"Our results provide important new evidence that yogurt may benefit heart health alone or as a consistent part of a diet rich in fibre-rich fruits, vegetables and whole grains," said co-author of the study Justin R. Buendia from the Boston University School of Medicine in the US.
For the study, published in American Journal of Hypertension, researchers included over 55,000 women aged between 30-55 with high blood pressure from the Nurses' Health Study and 18,000 men aged between 40-75 who participated in the Health Professionals Follow-Up Study.
In the Nurses' Health Study, participants were asked to complete a mailed 61-item questionnaire in 1980 to report usual dietary intake in the preceding year.
Participants subsequently reported any interim physician-diagnosed events including myocardial infarction, stroke and revascularisation.
The researchers found that higher intakes of yogurt were associated with a 30 per cent reduction in risk of myocardial infarction among the Nurses' Health Study women and a 19 per cent reduction in the Health Professionals Follow-Up Study men.
There were 3,300 and 2,148 total cardiovascular disease cases (myocardial infarction, stroke, and revascularisation) in the Nurses' Health Study and the Health Professionals Follow-Up Study, respectively, the researchers said.
Higher yogurt intake in women was associated with a 16 per cent lower risk of undergoing revascularisation.
In both groups, participants consuming more than two servings a week of yogurt had an approximately 20 per cent lower risks of major coronary heart disease or stroke during the follow-up period.
When revascularisation was added to the total cardiovascular disease outcome variable, the risk estimates were reduced for both men and women but remained significant.
Higher yogurt intake in combination with an overall heart-healthy diet was associated with greater reductions in cardiovascular disease risk among hypertensive men and women, the researchers noted.
Postmenopausal women with estrogen deficiencies are more susceptible to vascular and muscle problems.
Climbing stairs may offers them the benefits of both aerobic and resistance exercise. It may not only improve cardiorespiratory fitness, but also leg muscle strength without their having to leave the house or pay a fee.
It also offers the additional benefits of lowering blood pressure and arterial stiffness -- thickening and stiffening of the arterial wall -- fat loss, improved lipid profiles, and reduced risk of osteoporosis, the findings showed.
"This study demonstrates how simple lifestyle interventions such as stair climbing can be effective in preventing or reducing the negative effects of menopause and age on the vascular system and leg muscles of postmenopausal women with hypertension," said JoAnn Pinkerton, Executive Director at the North American Menopausal Society in Cleveland, US.
For the study, published in the journal Menopause, the researchers surveyed over postmenopausal women who were trained four days a week and climbed 192 steps two to five times a day.
The results showed that stair climbing led to reductions in arterial stiffness and blood pressure and increases in leg strength in stage 2 hypertensive postmenopausal women.
According to the researchers, the tool named "fluorescently labeled elastomeric contractible surfaces" (FLECS) can measure the physical strength of individual cells 100 times faster than current technologies.
"Our new experimental platforms are capable of screening millions of molecules to identify the best drug candidates for the right patients," said co-author of the study, Reynold A. Panettieri Jr. Professor at Rutgers Robert Wood Johnson Medical School in the US.
"FLECS" key component is a flexible rectangular plate with more than 100,000 uniformly spaced X-shaped micropatterns of proteins that are sticky so cells settle on and attach to them.
The X's embedded in the plate are elastic, so they shrink when the cells contract. The X's are made fluorescent with a molecular marker to enable imaging and quantification of how much the shapes shrink.
For the study, published in the journal Nature Biomedical Engineering, researchers analysed drugs that make cells either contract or relax, using human smooth muscle cells that line airways in the body -- in effect, simulating an asthma attack in the lab.
The researchers compared the results of those tests to what was already known about how lung tissue reacts to the drugs and found that "FLECS" captured the same types of reactions -- only more precisely because it could analyse the reactions in cell-by-cell detail.
The researchers also conducted an additional experiment where they tested the force of macrophages, cells in the immune system that rid the body of potentially harmful particles, bacteria and dead cells.
They found that when a typical macrophage receives a signal that an infection is present, it can exert force approximately 200,000 times its own weight in water.
"Our tool tracks how much force individual cells exert over time, and how they react when they are exposed to different compounds or drugs," said Dino Di Carlo, Professor of bioengineering at the University of California, Los Angeles.
Pre-eclampsia occurs when a woman develops hypertension and elevated protein in the urine during pregnancy.
Women with severe pre-eclampsia can be seven times more susceptible to developing future cardiovascular disease compared to women with a normal blood pressure during pregnancy, said one of the study authors Laura Benschop, a researcher at Erasmus Medical Center, Rotterdam, the Netherlands.
More than 41 per cent of the women in the study, published in the American Heart Association's journal Hypertension, had high blood pressure in the year after pregnancy.
"The problem is high blood pressure after pregnancy often goes unnoticed because many of these women have normal blood pressure readings in the doctor's office," Benschop said.
"We aimed to determine how common it is for women who have pre-eclampsia to have high blood pressure in the year after pregnancy, by looking at more than just their blood pressure readings in the doctor's office," Benschop said.
The researchers studied 200 women who during their pregnancies were diagnosed with severe pre-eclampsia.
They followed the women for one year after their pregnancies, monitoring blood pressure during the day and night and taking blood pressure readings in the clinic.
The most common type of hypertension detected was masked hypertension, which is normal blood pressure in the doctor's office, but high readings outside of the office, the study said.
"Our findings suggest women who have high blood pressure during pregnancy should continue to monitor their blood pressure long after they've delivered their babies. It's not only important to monitor blood pressure in the doctor's office, but also at different times of the day and night, at home," Benschop said.
The researchers wanted to find out how the prevalence of diabetes and hypertension in India varied by state, rural vs. urban location, and by sociodemographic characteristics such as education and household wealth.
Rates of diabetes and hypertension are high among middle-aged and elderly people across all geographic measures and sociodemographic groups in India, said the study published in the journal JAMA Internal Medicine.
Overall, the prevalence of diabetes was 6.1 per cent among women and 6.5 per cent among men.
The prevalence of hypertension was 20 per cent among women and 24.5 per cent among men, the research showed.
The study also found unexpectedly high rates of hypertension among young adults.
The prevalence of hypertension in the age group 18-25 years was 12.1 per cent, according to the study.
"Understanding how diabetes and hypertension prevalence varies within a country as large as India is essential for targeting of prevention, screening, and treatment services," said lead author Pascal Geldsetzer, a doctoral student at Harvard T.H. Chan School of Public Health in Boston, Massachusetts.
The researchers used health data collected from 1.3 million adults across India between 2012 and 2014, which included plasma glucose and blood pressure measurements.
The findings showed the rates of diabetes and hypertension varied widely among states.
Household wealth and urban location were positively associated with both conditions, and the prevalence of diabetes and hypertension among middle-aged adults in the poorest households in rural areas was also high -- 5.9 per cent had diabetes and 30 per cent had hypertension.
"Diagnosis of hypertension and diabetes is straightforward but mostly untapped due to lack of awareness and regular medical checkups," said study co-author Ashish Awasthi from the Indian Institute of Public Health, Gandhinagar, Gujarat .
India, home to more than a sixth of the world's population, is in the midst of a rapid epidemiological transition.
The rates of non-communicable diseases have risen in recent decades and are likely to continue as India's population ages and urbanises.
"India needs to focus on these two silent killers as well as other non-communicable diseases to reduce the burden of preventable premature morbidity and mortality. If unchecked, we will see a lot more victims of these two diseases in next two decades," Awasthi said.
Pascal Geldsetzer of Harvard University and colleagues looked at health data collected from 1,320,555 adults across India between 2012 and 2014, which included plasma glucose and blood pressure measurements.
Overall, the diabetes prevalence was 6.1 per cent for women and 6.5 per cent for men, and hypertension prevalence was 20 per cent for women and 24.5 per cent for men, with marked variation among states.
Household wealth and urban location were positively associated with both conditions, and the prevalence of diabetes and hypertension among middle-aged adults in the poorest households in rural areas was also high.
Specially, hypertension was higher among adults under 45 than previously estimated and was higher than in Central and Eastern Europe, the region previously estimated to have the highest rates for young adults.
The findings were published online in the US journal JAMA Internal Medicine.
"Understanding how diabetes and hypertension prevalence varies within a country as large as India is essential for targeting of prevention, screening, and treatment services," Geldsetzer said in a Harvard press release.
In an accompanying editorial, Alka Kanaya of the University of California, San Francisco, wrote that the new report "is not only a stark warning of the looming crisis of cardiovascular diseases in India, but can also serve as a call to action for the country".
"India needs to focus on these two silent killers as well as other non-communicable diseases to reduce the burden of preventable premature morbidity and mortality," Ashish Awasthi, co-author of the new study and faculty at the Indian Institute of Public Health, elaborated in the press release.
"If unchecked, we will see a lot more victims of these two diseases in next two decades," Awasthi added.
The study showed that immediately after 30 minutes of sauna bathing, participants' mean systolic blood pressure (the top number) reduced from 137 mmHg to 130 mmHg, and their diastolic (the bottom number) blood pressure from 82 mmHg to 75 mmHg.
Their systolic blood pressure remained lower even after 30 minutes of sauna bathing.
Further, researchers observed an increase of vascular compliance, while also increasing heart rate similarly to medium-intensity exercise.
This study demonstrates that sauna bathing for 30 minutes has beneficial effects on arterial stiffness, BP, and some blood-based biomarkers, said the researchers, led by Jari Laukkanen, Professor and Cardiologist at the University of Eastern Finland.
The findings shed light on the physiological mechanisms through which health benefits, which are caused by the heat exposure of sauna, may develop.
Previous studies have indicated that regular sauna bathing is associated with a reduced risk of coronary diseases and sudden cardiac death, hypertension, Alzheimer's disease and dementia.
Frequent sauna bathing has also been associated with a reduced disk of respiratory diseases and lower CRP levels.
For the new study, published in the European Journal of Preventive Cardiology, the team analysed the effects of a 30-minute sauna bath in 100 participants to understand the changes that take place in the human body during and after having a sauna.
Vascular compliance was measured from the carotid and femoral artery before sauna, immediately after sauna, and after 30 minutes of recovery.
The findings showed that organ damage -- damage to the heart and blood vessels -- from high blood pressure does not only occur in adults, but also in teenagers.
Importantly, the damage in teenagers occurs at blood pressure levels that are below the clinical definition of hypertension in the age group, the researchers said.
"Some adolescents may have organ damage related to blood pressure and are not targeted for therapy," said Elaine M. Urbina, Director at the Cincinnati Children's Hospital in Ohio.
"Imaging of the heart may be useful in youth in the high-normal range of blood pressure to determine how aggressive therapy should be."
High blood pressure in teenagers is defined on the basis of percentiles, rather than blood pressure level as in adults.
In the study, presented at the 2017 American Heart Association (AHA) Council on Hypertension in San Francisco, the team looked at whether organ damage in teens develops below the 95th percentile -- the clinical definition of high blood pressure in teenagers.
The researchers examined blood pressure and measured organ damage in 180 teenagers (14-17 years old, 64 per cent white, 57 per cent males).
The results showed evidence of organ damage even among the youth categorised as "normal" with blood pressure less than in the 80th percentile.
It also revealed heart and vessel damage in the mid-risk group, which had blood pressures in the 80th to 90th percentiles and the high-risk group, with blood pressures above the 90th percentile.
So far, since its inception last year, a total of 1,33,84,332 women and men, aged 30 years and above have been screened for common NCDs at these HWCs.
As per the data provided by the Ministry on Friday, 1,30,03,064 men and women have been screened for hypertension, in which 9,01,994 cases are newly identified while 22,69,192 are on treatment.
Diabetes is the second most screened NCD at wellness centres with 97,78,916 cases in which 8,90,663 are newly identified while 12,13,860 are on treatment.
Among cancers, oral cancer is on the rise in India as 71,85,388 men and women have been screened since 2018 with 13,747 new identified cases while only 1,495 are under treatment.
Out of 1,33,84,332 patients, 16,67,090 are women patients who are diagnosed with breast cancer which comes second in cancer cases screened in HWCs with 12,098 as newly identified ones and 1,848 being treated.
Cervical cancer has overall 12,26,799 cases with 11,923 newly identified while 872 are on treatment.
According to the Health Ministry, Andhra Pradesh has the highest number of HWCs with 1,361 currently operational. Tamil Nadu has set up 1,318 HWCs, while UP has 912. Karnataka and Kerala have 700 and 678 HWCs respectively.
The first HWC under Ayushman Bharat was inaugurated by Prime Minister Narendra Modi at Jangla in Bijapur, Chhattisgarh on April 14, 2018. Since then 10,252 HWCs have been operationalised.
"Our study indicates if you need to urinate in the night -- called nocturia -- you may have elevated blood pressure and/or excess fluid in your body. If you continue to have nocturia, ask your doctor to check your blood pressure and salt intake," said study author Satoshi Konno of Tohoku Rosai Hospital in Sendai, Japan.
The study examined the link between nocturia and hypertension in the general Japanese population.
The researchers enrolled 3,749 people who had an annual health check in 2017. Blood pressure was measured and information on nocturia was obtained through questionnaire.
Nocturia (one or more nocturia events per night) was significantly associated with hypertension, showed the findings presented at the 83rd Annual Scientific Meeting of the Japanese Circulation Society (JCS 2019).
The risk of hypertension rose significantly as the number of nocturia events per night increased.
"We found that getting up in the night to urinate was linked to a 40 per cent greater chance of having hypertension. And the more visits to the toilet, the greater the risk of hypertension," Konno said.
"Sleep should be a time for recreation, unwinding, and restoring energy levels. If you have stress at work, sleep helps you recover," said study author Karl-Heinz Ladwig, Professor at Technical University of Munich, Germany.
"Unfortunately poor sleep and job stress often go hand in hand, and when combined with hypertension the effect is even more toxic," Ladwig said.
The study included around 2,000 hypertensive workers aged 25-65, without cardiovascular disease or diabetes.
Compared to those with no work stress and good sleep, people with both risk factors had a three times greater likelihood of death from cardiovascular disease, showed the findings published in the European Journal of Preventive Cardiology.
People with work stress alone had a 1.6-fold higher risk while those with only poor sleep had a 1.8-times higher risk, the study said.
In the study, work stress was defined as jobs with high demand and low control -- for example when an employer wants results but denies authority to make decisions.
"If you have high demands but also high control, in other words you can make decisions, this may even be positive for health," said Ladwig.
"But being entrapped in a pressured situation that you have no power to change is harmful," Ladwig added.
The research, published in the journal Epidemiology, studied 5,531 adults from 28 peri-urban villages near Hyderabad city.
"Women spend most of their time near their households in this study area - 83 per cent of their daily time as compared to 57 per cent for men -- which could explain why we observe a stronger association in women than in men", said study author Ariadna Curto from Barcelona Institute for Global Health (ISGlobal), Spain.
For the study, the research team measured systolic and diastolic blood pressure of participants and estimated their annual residential exposure to fine particulate matter (PM2.5) and black carbon.
The participants also answered a survey to determine socio-economic status, lifestyle and household characteristics, including the type of cooking fuel which they generally used (biomass or clean).
Notably, all participants were exposed to fine particulate matter levels above the 10 µg/m³ limit recommended by the World Health Organization (WHO). Average exposure to PM2.5 in this study was 33 µg/m3.
Based on the blood pressure measurements, almost half of participants (46 per cent) were identified as hypertensive, with high proportions of participants with undiagnosed and untreated hypertension.
The results show that an increase of 1µg/m3 in PM2.5 exposure was associated with a 4 per cent increase in hypertension prevalence in women as well as a higher systolic and diastolic blood pressure - an increase of 1.4 mmHg and 0.87 mmHg respectively. In men, the association observed was weaker.
The research indicates that long-term exposure to particulate matter is associated with a higher prevalence of hypertension, regardless of the type of fuel used for cooking.
"In the light of our lack of association with black carbon, it is important to keep in mind that this is a peri-urban area, where the sources and chemical makeup of air pollution differ to urban areas mostly dominated by traffic sources", Curto said.
The mechanisms by which air pollution could contribute to high blood pressure "include inflammation and oxidative stress, which may lead to changes in arterial function", said study coordinator Cathryn Tonne.
This finding by P.G. Talwalkar, Diabetologist at Shushrusha Hospital in Mumbai, further confirms that Vitamin D deficiency leads to chronic diseases.
"Pregnant women in India have up to 84 per cent prevalence of Vitamin D deficiency, which also correlates with the level of Vitamin D deficiency in their newborns," said Srirupa Das, Medical Director, Abbott India, Mumbai.
"In adults, Vitamin D deficiency is associated with low bone mass and muscle weakness, which results in increased risk of fractures and bone disorders such as osteoporosis," Das said.
In the study conducted on 1,508 individual, researchers said that in Mumbai there is 88 per cent prevalence of Vitamin D deficiency in urban adults.
It also revealed that 84.2 per cent of Type 2 diabetes patients were Vitamin D deficient, as were 82.6 per cent of hypertension patients.
"Our study also investigated co-occurrence of deficiency with hypothyroidism and obesity or overweight condition. A majority (76 per cent) of hypothyroid patients had low levels of vitamin D. Moreover, 82 per cent of patients were obese, indicating that there may be a link between the deficiency, its comorbidities and body weight," said Talwalkar.
"These findings highlight the need for routine screening to ensure early diagnosis and effective management of Vitamin D deficiency to help reduce the burden and risks associated with non-communicable disease," Talwalkar added.
The causes of Vitamin D deficiency in a sun-drenched country like India are manifold, said the researchers.
Most people do not receive adequate exposure to sunlight, as modernised lifestyles have resulted in less time spent outdoors for work or leisure.
Moreover, high levels of air pollution can hamper Vitamin D absorption in the skin.
While there is evidence of regular, room-temperature yoga's positive effect on blood pressure, little is known about hot yoga's potential impact on blood pressure, said researchers who presented the study at Hypertension 2019 Scientific Sessions in the US.
"The results of our study start the conversation that hot yoga could be feasible and effective in terms of reducing blood pressure without medication," said study author Stacy Hunter, Assistant Professor at Texas State University.
Hot yoga is a modern practice, typically offered in a hot, humid atmosphere, with room temperatures around 105 degrees Fahrenheit.
For the study, the research team recruited 10 men and women, between ages 20-65 years. Participants had either elevated blood pressure (systolic blood pressure between 120 mmHg to 129 mmHg and diastolic pressure less than 80 mmHg) or stage 1 hypertension (130 mmHg to 139 mmHg systolic and 80 mmHg to 89 mmHg diastolic pressure.)
The research team randomly assigned five participants to take 12 weeks of three times-weekly hour-long hot yoga classes and they assigned the other five to a control group of no yoga classes.
They compared the average blood pressures of the two groups after the 12 weeks.
The researchers looked at average 24-hour blood pressure readings, as well as perceived stress and vascular function of participants in both groups.
They found systolic blood pressure dropped from an average 126 mmHg at the study's start to 121 mmHg after 12 weeks of hot yoga.
Average diastolic pressure also decreased from 82 mmHg to 79 mmHg in the hot yoga group.
According to the study, average blood pressure did not change among the five adults in the control group, those who did not take hot yoga classes.
Perceived stress levels fell among those in the hot yoga group but not in the non-yoga group, the research said.
For the study, the research team from Care Well Heart and Super Specialty Hospital in Amritsar, investigated the relationship between a high fibre diet and its impact on cardiovascular disease risk factors.
"Comprehensive evaluation of etiological effects of dietary factors on cardiometabolic outcomes, their quantitative effects and corresponding optimal intakes are well-established," said the study's lead author Rohit Kapoor.
According to guidelines from the National Institute of Nutrition and the Indian Council of Medical Research, the recommended dietary allowance (RDA) for dietary fibre is 40gm/2000kcal.
Patients in this study had Type 2 diabetes and a calorie intake of 1,200-1,500kcal, causing their RDA for fibre to be 24-30gm.
The fibre intake of these patients was increased up to 20 to 25 per cent from the recommended allowances for them to be consuming a high fibre diet.
The study tracked 200 participants' fibre intake for six months and included check-ups at the start of the study, three months and six months.
Participants were provided with diet prescriptions, which included detailed lists of different food groups with portion sizes in regional languages.
The researchers tracked participants' fibre intake several ways, including having patients send photos of their meals on WhatsApp, which not only helped in knowing their fibre intake but also helped approximate portion sizes, and telephone calls three times a week during which detailed dietary recall was taken.
Participants on a high fibre diet experienced significant improvement in several cardiovascular risk factors, including a nine per cent reduction in serum cholesterol, 23 per cent reduction in triglycerides, 15 per cent reduction of systolic blood pressure and a 28 per cent reduction of fasting glucose.
The researchers found a high fibre diet is inversely related to cardiovascular risk factors and plays a protective role against cardiovascular disease.
The study was presented at the ACC Middle East Conference 2019 together with 10th Emirates Cardiac Society Congress in Dubai.
Odisha figured among the top-10 in the country in hypertensive adolescents. With 5.4 per cent adolescents in the age-group of 10-19 years identified with high blood pressure level in Odisha, the State has been ranked at 9th among 30 states and UTs. The proportion in Odisha is much higher than the national average
Similarly, with 3.9 per cent adolescents in age-group 10-19 years having high cholesterol in blood serum, Odisha again figured among the top -10 in the country. The State was also among the top-10 states where the adolescents have a high level of bad cholesterol {Low Density Lipoprotiens (LDL)} and low concentration of good cholesterol {High Density Lipoproteins (HDL)}.
Such alarming facts on high prevalence of the risk factors that trigger heart disease in Odisha at a very young age were revealed recently by the first and largest ever Comprehensive National Nutrition Survey (CNNS) 2016-18.
This revelation is a sort of health exigency for Odisha. Because, the recently released report 'Medically Certified Cause of Death (MCCD)' by the Registrar General of India (RGI) flags the acuteness of heart-related ailments in the State. The report disclosed that Odisha had recorded a whopping 8,546 deaths annually, at a rate of at least 23 deaths every 24 hours. And two in every ten deaths were due to cardiac-related ailments.
The prevalence of adult disease conditions among children and adolescents in the State has been primarily attributed to unhealthy diet, tobacco use and sedentary lifestyle.
Consider this. Obesity is a factor behind conditions like hypertension, rise in low LDL, cholesterol and triglycerides. As per NFHS data, obesity in Odisha has grown significantly in the decade of 2005-06 to 2015-16.
The obesity prevalence in the State population was below 10 per cent in 2005-06, but had risen to around 20 percent in 2015-16.
And the major factor for the obesity taking roots fast in Odisha is the change in food habits like replacement of traditional cereal diets with instant noodles and fast food in all meals through the day . And intake of higher amount of transfats in foods also contributes to this.
For the same period, life expectancy for females is 70.2 years and 67.4 years for males.
For comparison, in last year's survey, the life expectancy had increased from 49.7 years in 1970-75 to 68.3 years in 2011-15. For the same period, life expectancy for females is 70 years and 66.9 years for males. So there has been an increase in life expectancy in general, and also for males.
On the non-communicable diseases, the survey notes that out of 6.51 crore patients who attended NCD clinics, 4.75 per cent people are diagnosed with diabetes, 6.19 per cent are diagnosed with hypertension, 0.30 per cent are diagnosed with cardiovascular diseases, 0.10 per cent are diagnosed with stroke and 0.26 per cent are diagnosed with common cancers.
As per the survey, the highest population density of 11,320 people per square kilometre was reported by the NCT of Delhi whereas Arunachal Pradesh has reported the lowest population density of 17.
On demographics, the survey found the high incidence of the young and economically active population. The survey notes that 27 per cent of the total estimated population of 2016 were below the age of 14 years and majority (64.7 per cent) of the population were in the age group of 15-59 years i.e. economically active population and 8.5 per cent population were in the age group of 60 to 85 plus years.
There has been a consistent decrease in the birth rate, death rate and natural growth rate in India from 1991 to 2017. As of 2017, India has registered a birth rate of 20.2 per 1,000 population and death rate of 6.3 per 1,000 population while the natural growth rate was 13.9 per 1,000 population in India. The birth rate in rural areas was higher than in the urban. Similarly, the death rate and natural growth rate were also higher in rural areas as compared to the urban.
The population, however, continues to grow, as the decline in the birth rate is not as rapid as the decline in the death rate.
The infant mortality rate has declined considerably (33 per 1,000 live births in 2016), however, differentials of rural (37) & urban (23) are still high.
The Total Fertility Rate (TFR) for the country was 2.3 whereas in rural areas it has been 2.5 and it has been 1.8 in urban areas during 2016 as per the latest available information.
On the health status indicators, the survey finds that on communicable diseases, in 2018, the maximum number of cases and deaths due to malaria have been reported in Chhattisgarh (77,140 cases and 26 deaths). The overall prevalence of the disease has diminished in 2012 and 2013 but there was a slight increase in 2014 and 2015 before it again started decreasing from 2016.
Dengue and Chikungunya, transmitted by Aedes mosquitoes, are a cause of great concern to public health in India.
Every year, thousands of individuals are affected and contribute to the burden of health care. Dengue outbreaks have continued since the 1950s but the severity of the disease has increased in the last two decades. However, the reported cases of Chikungunya in the country has shown a slight decrease from 67,769 to 57,813 in 2018 as compared to 2017.
There has been a considerable decrease in the number of swine flu cases/deaths in the year 2014 as compared with 2012 and 2013. However, the number of cases and deaths has been drastically increased in the year 2015. The numbers decreased in 2016 but again increased significantly in 2017 and 2018.
During the year 2015, 4.13 lakh people lost their life due to accidental injuries and 1.33 lakh people died because of suicide. Suicide rates are increasing significantly among young adults and the maximum number of suicide cases (44,593) is reported between the age group 30-45 years.
The total number of cases and deaths due to snakebite are 1.64 lakh and 885, respectively, in 2018.
The total number of disabled persons in India is 2.68 crore.
The study, published in the European Heart Journal, also found that heart failure patients taking drugs targeting the renin-angiotensin-aldosterone system (RAAS), such as angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), did not have higher concentrations of ACE2 in their blood.
"Our findings do not support the discontinuation of these drugs in COVID-19 patients as has been suggested by earlier reports," said study co-author Adriaan Voors from the University of Groningen in the Netherlands.
Some recent research suggested that RAAS inhibitors might increase concentrations of ACE2 in plasma -- the liquid part of blood -- thereby increasing the risk of COVID-19 for cardiovascular patients taking these drugs.
The current study indicates that this is not the case, although it looked only at ACE2 concentrations in plasma, not in tissues such as lung tissue.
"ACE2 is a receptor on the surface of cells. It binds to the coronavirus and allows it to enter and infect healthy cells after it is has been modified by another protein on the surface of the cell, called TMPRSS2," Voors said.
"High levels of ACE2 are present in the lungs and, therefore, it is thought to play a crucial role in the progression of lung disorders related to COVID-19," he added.
For the findings, the researchers measured ACE2 concentrations in blood samples taken from two groups of heart failure patients from 11 European countries.
There were 1,485 men and 537 women in the first group, the index cohort, which was designed to test the researchers' hypotheses and research questions. Then the researchers validated their findings in the second group of 1,123 men and 575 women, the validation cohort.
The research team assessed the number of clinical factors that could play a role in ACE2 concentrations, including the use of ACE inhibitors, a history of chronic obstructive pulmonary disease, and coronary artery by-pass graft.
They found that male sex was the strongest predictor of elevated ACE2 concentrations. ACE2 is found not only in the lungs, but also the heart, kidneys and the tissues lining blood vessels, and there are particularly high levels in the testes.
The researchers speculate that its regulation in the testes might partially explain higher ACE2 concentrations in men, and why men are more vulnerable to COVID-19.
Last month, the study, published in the journal Frontiers in Public Health, found that men are more than twice as likely to die from the disease as compared to women.
Another study from the American Journal of Respiratory and Critical Care Medicine showed that males over 50 with non-communicable chronic diseases such as hypertension, diabetes and coronary heart disease are at greater risk of death from coronavirus.
(IANS)
Hypertensive individuals and increased age are high-risk factors for Covid-19 infection, said Dr Shiva Raju, Senior Consultant Physician and Diabetologist, KIMS Hospitals, Secunderabad. He advised such individuals to remain at home, take regular medication for blood pressure, closely monitor BP level at home and ensure a low salt diet - less than 3 grams per day.
Such individuals should also avoid taking more than two coffees per day, avoid alcohol intake and pain killers.
A study shows six per cent of those died of Covid-19 were patients with known hypertension and associated diabetes. The Covid-19 mortality rate for normal patients is two per cent. Patients who are taking ACE inhibitors and ARB may have a higher risk of Covid-19 infection but the evidence is inconclusive.
Dr Meeraji Rao, Senior Consultant Interventional Cardiologist, Continental Hospitals, Hyderabad, believes that inactive daily routines due to the ongoing lockdown could result in dangerous health conditions, even before the pandemic hits the individual.
It is important that every individual with possible underlying health ailments, take daily readings of blood pressure as this will help monitor fluctuations. A close watch on blood pressure and diabetes levels will help in creating a lifestyle that is best suited to stay healthy.
"During normal days, an individual moves around and has an active life; but it is important for people to stay active and healthy even under lockdown. It is strongly advised that people exercise at least for 2-3 hours every week to ensure their metabolism functions well, and they remain healthy," he said
The doctor said patients already suffering from hypertension can continue with their earlier medications even during this pandemic while those who have developed high blood pressure during these times must seek expert opinion when it comes to ACE inhibitors and ARB medicines.
"Stress is one major reason people tend to develop hypertension, and the risk of this condition is higher in these times of pandemic and associated lockdown. It is strongly advised that people maintain a healthy sleep cycle to help beat health risks. Hypertension patients need not do vigorous exercise, but can ensure they stay healthy by doing brisk walking for 30 to 60 minutes each day."
"Hyper Tension.... the word itself explains one of the major cause for it. This is nothing but a condition where one's blood pressure is beyond 120/80," explained Dr Saji D'Souza, Chairman and Managing Director, KSAC Group of Hospitals.
Almost every individual will have raised BP due to many factors including loss of elasticity of arteries and veins, atherosclerosis wherein the arteries are blocked with salts/cholesterol etc and stress-induced.
A person who has unpredictable variations and the level of BP going beyond 180/120 need to take medical advice as this might invite stroke, cardiac arrest or even death.
He pointed out that Ayurveda suggests a balanced diet and exercise. Proper excretory and blood circulatory systems keep the body away from not only hypertension but also other diseases. Ayurveda emphasises on good food, exercise and sound sleep for the perfect harmony on one's own health, he added.
(IANS)
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As per the Health Risk Assessment (HRA) Score, 1 in 2 Indians is either in the 'High Risk' or 'Borderline' category. This is a massive 12 per cent improvement from last year's figures where 62 per cent Indians fell into the 'Unhealthy' category.
According to GOQii's latest India Fit Report 2021, majority of people can become healthy by making few adjustments to their lifestyle. Reduction in commute time and lockdown probably allowed Indians to focus more on their health and making their immune system stronger. From a gender wise perspective, men are healthier in comparison to women. From an age wise perspective, the younger generation is unhealthier in comparison to the older generation.
Blood Pressure
About 15 per cent of users have reported high BP in 2020 in comparison to 13.4 per cent in 2019. This figure, according to the report, has steadily increased over the last 4 years. About 35 per cent users also reported this disease runs in the family which is a significant figure. Blood pressure cases among older adults are just triple of those in adults. Safe to say, then, that people above 45 are at more risk of having hypertension.
Diabetes
An analysis conducted by a full-stack digital ecosystem for diabetes care and management revealed that the average pre-pandemic fasting sugar levels in January till mid-February was 138 mg/dl whereas in March till mid-April it rose to 165 mg/dl. One-third claim this disease runs in the family. The percentage of those suffering from diabetes went triple, from adults to older adults.
Cholesterol
About 13 per cent users reported high cholesterol, a figure that has remained stable for the past two years. On the other hand, only 4 per cent mentioned they had heart issues which is a major decrease from 8.6 per cent in 2019.
Alcohol
Figures for drinking have reduced for almost all of the age groups and across a majority of cities. Many reasons can be accounted for the same. To start with, the biggest reason can be the onset of the nationwide lockdown because of the Covid-19 pandemic. Travelling was restricted and all the major places where usually people used to drink earlier like cafes, restaurants, bars etc. were shut down. All of these cumulatively decreased the drinking of the people as the only option they were left with was to drink at home, which was not a feasible option for a lot of people. Some comfortably did that, while a majority were not that comfortable in drinking amid their family members and hence the number reduced this year.
As compared to last year's data, there is a significant reduction in the number of people falling sick in every age category this year. This could be due to the increased awareness in people regarding immunity levels through healthy lifestyle and nutrition food choices. The dip in pollution levels across the nation could also be a reason for this.
The report also revealed that stress levels remained high throughout the year. The survey outcome highlighted a rise in stress index from 4.98 in Mid-year to 5.11 at end of the year. Forty-five per cent are currently plagued with depression.
City-wise, Surat, Jaipur and Patna are the top 3 healthiest cities in India, respectively, as revealed by the survey whereas Lucknow, Kolkata and Chennai are the unhealthiest.
(Siddhi Jain/IANS)