Your BP and Mozart
The Philippine Society of Hypertension is currently conducting an in-depth course on the prevention and treatment of elevated blood pressure in the country at the Manila Doctors Hospital conference hall. The statistics on hypertension still remain depressing for the more than 1,500 members of the society spread all over the country, 360 of whom are certified hypertension specialists. “It’s a multifactorial problem, and a multidisciplinary, multipronged approach is necessary to really remarkably reduce the prevalence of hypertension in the country,” stressed Dr. Dante Morales, who is the current president of the society.
Dr. Morales and the other specialists—like former Health Secretary Esperanza Cabral—sharing their expertise in the four-day course are one in encouraging the 225 doctors who registered for the course to focus on primary preventive measures. The best time to control hypertension is before one becomes definitely hypertensive. There is such a stage as a prehypertensive stage wherein one may present with a high normal blood pressure—still theoretically normal but already associated with some risk if left untreated. Since high blood pressure does not come alone, and usually presents with other risk factors like diabetes, cholesterol problems and overweight, the risk gets multiplied several fold even if the BP is just high normal in range.
A challenge
It remains a challenge that not every Filipino adult know what their BP is. It only takes a few minutes to have one’s BP checked, and in many medical missions, many are diagnosed—with repeated BP determinations—to have markedly elevated BP although they have no symptoms which could make them suspect they have hypertension. The only way to find out is to have one’s BP checked with any reliable device.
A patient came to us once with a BP of 220/120 mmHg, which was just accidentally discovered when a jobless nurse going around the barangay with a BP sphygmomanometer convinced her to have her BP checked for P20. Because she had no symptoms, she couldn’t believe she had a markedly elevated BP, but when we checked it ourselves several times in the clinic, her BP readings were even higher. She had to be confined for a few days to bring down her BP to safer levels. I also told her to thank that nurse profusely for almost forcing her to have her BP checked. She was a walking time bomb, ready to explode with a stroke or heart attack, and that nurse helped save her.
Combination of science, art
The four-day hypertension course is a combination of the science and art of dealing with hypertension. Most of the topics discussed are highly technical, but some topics also deal with the art, such as convincing patients of practical lifestyle changes that can help bring down their BP. “When we analyze clinical trial results to find out what antihypertensive drug is best for the patient, that’s science; but when we spend more time explaining to the patients the various therapeutic options to treat hypertension and prevent complications, that’s the art of medicine,” explained Dr. Bernadette Tumanan-Mendoza.
Some treatments can also have adverse side effects on the patients, and doctors must not forget to adhere to the primary dictum of ‘Primum non nocere’ (First, do no harm),” advised Dr. Eugene Reyes during his talk. Doctors must take time to explain all these to the patients. If the doctors don’t, then the patients have the right to ask, Dr. Mendoza said.
Relaxation techniques
Although most hypertensive patients will require drug therapy to control their BP, there are instances when all patients need to do is practice some relaxation techniques. We stressed the benefits from regularly doing the “calming breathing” technique which we discussed in one of our columns sometime ago. Another relaxation technique is music therapy. I remember one international conference when Prof. Peter Sleight, a highly respected consultant cardiologist in Oxford, United Kingdom, discussed this form of therapy. His name has become a byword among clinicians because he has been involved in many landmark cardiovascular trials which have shifted paradigms in the way doctors treat patients with various types of heart ailments.
But that morning, he gave a different type of lecture which seemed to be apart from his usual high-brow dissertations. As he walked to the podium, Mozart music was being played and he didn’t start his lecture until the music piece ended. With a wide smile on his face, he swayed his body rhythmically and raised his hands gently as if conducting an orchestra. And as the music ended, he heaved a sigh and said, “Music now plays an increasing role in disparate areas… and that includes cardiovascular health.”
Effects of music
Professor Sleight, who must be in his early 80s already, has taken a sabbatical from his professorial post in Oxford to spend some time with Italian colleagues in the University of Pavia. Together they are working on researches focusing on the effects of music on the nervous system particularly the part called autonomic nervous system, which we could not voluntarily control. A malfunction of this part of the nervous system can cause havoc in our entire body particularly the circulation and leads to high blood pressure, fast heart rates, irregular heartbeats and various types of medical conditions.
It has long been presumed that music has a soothing effect on the body and spirit, and Professor Sleight and his team are now making science back it up. There are now paramedical groups and even institutions utilizing music therapy as part of complementary medicine. Eventually, with the data that Professor Sleight’s group might come up with, it may be recognized as a scientific adjunct and integrated as part of mainstream medicine. Mozart would have been elated to hear that.
