High Blood Pressure Kills: Control It Today!

Common sense may not be all that common, and what is worse, it might even be WRONG!

So let us apply common sense to the treatment of blood pressure.

High blood pressure kills. When it does not kill, it causes serious illnesses.

So common sense would dictate that lowering your blood pressure would help you avoid all those problems, right?

Not so fast.

What does high BP do?

hypert

It creates havoc!

Close to a billion people in the world have high blood pressure (BP), also called hypertension. Four out of ten adults over 25 have this disease, which causes heart attacks, strokes, kidney failure, blindness, and poor circulation in the legs.

In 2010, high BP was the leading cause worldwide for years of life lost as a result of death or disability.

Risk begins where?

Normal blood pressure is now defined as less than 120/80 millimeters of mercury (mm Hg). The “top number” is the systolic BP, occurring when the heart muscle contracts to pump blood out to the rest of the body. The diastolic BP (bottom number) occurs when the heart muscle relaxes, and the heart fills up with blood returning to it from the rest of the body.

Interestingly, according to a study published in the prestigious journal Lancet in 2002, the risk of heart disease and vascular disease increases progressively as the BP goes above 115 mm Hg systolic. This is, of course, well within the so-called normal range.

So should we lower the systolic BP to 115 mm Hg?

There is no good evidence for any benefit from that, except in the recently-stopped SPRINT trial, which we shall discuss in detail later.

Does lowering BP help?

It certainly does.

stroke

Treating hypertension can reduce the risk of having a stroke by 35–40%.

MI

It also drops your risk of having a heart attack, but by a more modest 15–25%.

The risk of developing heart failure can go down by up to 64% by treating high BP appropriately.

There is also a strong link between high BP and kidney failure. Uncontrolled hypertension is the second most common cause of end-stage kidney disease in the US, and it also leads to a more rapid worsening of chronic kidney disease.

So how low to go?

The common recommendation currently is to lower the systolic BP below 140 mm Hg.

By and large, randomized, controlled trials of patients with high BP document the benefits of lowering systolic BP to below 150 mm Hg. Data for lowering the BP below that level are more limited.

A study published in the New England Journal of Medicine in 2010 showed that in patients with type 2 diabetes mellitus, whether you reduced the systolic BP to below 140 or below 120 mm Hg, the rate of occurrence of major cardiac events (such as heart attack or death from cardiovascular causes) did not change significantly. However, the rate of stroke was lower in those people whose systolic BP target was below 120 mm Hg. http://www.nejm.org/doi/full/10.1056/NEJMoa1001286.

How about a stroke?

Does a lower BP goal help prevent further strokes?

A study published in the Lancet in 2013 addressed this issue. http://www.ncbi.nlm.nih.gov/pubmed/23726159?dopt=Abstract.

The researchers took a group of patients with a previous stroke, and tried to lower their systolic BP to below 130 mm Hg. They also took another group of similar patients, but this time the target was below 150 mm Hg.

What were the results? There was no significant difference between the two groups in the overall risk of having another stroke. However, the risk of having a bleed in the brain was lower in the lower BP target group.

What are the guidelines?

guidelines

Well, you can take your pick.

There is the JNC 8, or the Eighth Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. But you also have the ASH/ISH (American Society of Hypertension/International Society of Hypertension). Not to forget the ESH (European Society of Hypertension). All of them have set out guidelines recently. All are different.

Not to be outdone, the ACC/AHA (American College of Cardiology and American Heart Association) have issued a “scientific advisory” on treating hypertension.

Of course, the newest kid on the block is the SPRINT study, which was stopped early in August 2015.

Which one to choose?

We will address all of the guidelines mentioned above in our next article in this series.

So stay tuned.

What should you do in the meantime?

Conclusions

  • control
  • Check your BP regularly, and in the manner outlined previously in http://goo.gl/pSIJSz.
  • Recognize the problems which high BP can create.
  • kidneys
  • Remember that controlling your BP WILL lead to significant benefits.
  • Discuss with your personal physician what your BP target should be. He or she knows your health conditions and is best placed to give appropriate and personalized advice.

Want to read more?

JPEG HTN

These issues, and others, are discussed in greater detail in my eBook “High Blood Pressure: 10 Reasons Your Blood Pressure Is NOT Under Control,” available at:

http://goo.gl/t3h2zs.

Success or Bust: Why We Keep Chasing Our Tails!

“When I grow up, I want to become the biggest failure in the history of mankind!”

“I want to aim for the title of the worst tennis player on the planet!”

You never hear these sentiments from anybody. Nobody shoots for failure. All of us want to aim for the heavens, to become the biggest stars in the firmament.

We want to succeed.

Lack of failure?

However, we have difficulty defining success. We do not want to fail. But avoiding failure is not the same as succeeding.

Be the best?

Well-meaning slogans surround us. “Be all you can be!” But what exactly is that? How does anybody know that they have become all that they could become? Unless, of course, they are the best at what they do. And who would decide that?

Judging the best

The Best!

The Best!

In some fields of endeavor, this is easy. Tennis has its championships. So does golf. Even team sports have so-called “world championships.” A baseball team is on top of the world today. But next year, they might be down in the dumps. Has the best suddenly become the worst? And how much is the difference between the best and the worst?

Shifting goals?

Say you are a golfer. You are ranked number one in the world. Then you go on to lose the next few major tournaments. You lose your crown. Are you no good now?

Well, you might still be among the top ten players. Is that a good enough definition of success?

What if you drop to number thirty in the world? Are you still successful?

And these rankings keep changing every few months, if not more often. Is it reasonable to define success on a quarterly basis? Is that a reasonable way for people to judge their lives, their efforts, their careers?

That elusive success

In the field of sports, you can get a report card, or a ranking, or a score card. But what about other spheres of life?

Are you a successful parent, or spouse? Are you a brilliant lawyer, doctor, electrician?

Try defining it!

The achievement of a goal, aim, or purpose, is how success is often defined.

Others call it the attainment of popularity or profit.

“The correct or desired end of an attempt” is the opinion of the Merriam-Webster dictionary.

Judging by results?

Let us look carefully at those definitions.

Attempts are supposed to be successful if they have the correct or desired ending.

What is the correct ending? The desired result of human endeavor? Some pursuits have no ending. Doctors are always “in practice.” There is no perfection.

Perfect?

We like to see results, especially good results, or desired results. But results are not always going to be favorable to us, and the world does not revolve around our desires.

There are other people on this planet, too, and they have their own desires. Two teams compete, and one has to lose. Is that team a failure, no good?

Real life

Student

Let us take other examples. Say you have children, and you obviously do your best to raise them well. But do you always get the desired results? You might want your kid to go to Harvard. If, however, he ends up in the local community college, are you a failure as a parent? And is your child doomed to fail in this world? Not necessarily. Many people who went on to achieve greatness studied in average colleges, and some did not attend college at all.

Teachers

Are teachers rich?

Some of the people who have had the most profound influence on me have been my teachers, especially middle school and high school teachers. None of them were rich, and none were famous. Many of them are no longer alive. But they live on in my mind. Were they successful?

Actions and results

If we keep judging success by results, we will invariably end up feeling miserable, or at least dissatisfied, in the long run.

The reason is two-fold

Results are transient. A star manager can, and often does, get fired. Successful shows on TV do not run forever. Mansions on the beach frequently end up as fodder for divorce lawyers. Even Tiger Woods could not maintain his dream sequence of golf championships. And then what?

Results are not under our control

This is one of the most bitter pills to swallow, especially in the modern world. We are taught to work hard, play hard, climb the ladder, and rule the roost.

Except that there may not always be a roost to rule.

Actions rule

Common sense dictates that actions are, for the most part, under our control. Especially our own actions. After that, our sphere of influence narrows considerably, and often stops.

But we continue to want to control everything: other people, events, results. And we continue to feel that that will make us happy and successful. We might be proved wrong, but we do not learn; perhaps because we do not want to learn.

Fear

We keep doing what we are programmed to do by society, because we are afraid that the alternative will mean failure, unhappiness, and loss of face.

Failure?

We cling to an antiquated belief system, because “everybody does it.” Everybody chases money, and fame. And becomes disillusioned, but does not want to admit it publicly.

Where does that leave us?

We need a new approach, based on age-old wisdom.

Success, happiness, and satisfaction are not found in external circumstances. The key to these lies within us, and can be found with introspection, clarity of thought, and a sense of perspective.

People living in miserable conditions have shown remarkable courage and achieved a state of peace that most of us cannot even imagine.

Concentration camp survivors have described methods they used to rise above their circumstances.

Nelson Mandela did not let years of imprisonment make him bitter, and radiated an inner joy which enabled him to forgive his tormentors.

Conclusion

  • External circumstances are transient. Using money, fame, and material possessions to determine our worth is likely to lead to frustration.
  • Living in the present, and making the most of the present moment, brings peace.
  • The past is gone. We should learn from it, and then move on. Constantly reliving the past will not bring joy or satisfaction.
  • The future is uncertain. It is not guaranteed, and is not under our direct control.
  • Human beings share this planet, and are more alike than different. A sense of empathy and kindness, and a focus on others, rather than always on us, will bring inner peace.
  • A strong feeling of gratitude, rather than of entitlement, will lead to humility, and lasting joy.
  • Focusing on appropriate actions, which are always under our control, rather than on results, which are unpredictable, will lead to satisfaction.
  • A successful life is a life of enjoying the moment, acting compassionately, responsibly, and without undue concern about outcomes.

What do you think?

I would love to know!

Please share your thoughts in the comments section.

Want to Protect Your Heart? Control High Blood Pressure!

If every third American adult came down with malaria, we would be outraged. The public would demand immediate action to start proper treatment, and monitor the results. Then we would also demand steps to prevent any such a calamity from happening again.

blood

Then why is it that high blood pressure (high BP, or hypertension), which is as serious a public health threat, is treated so casually: by patients, doctors, the government, and the public alike?

I feel well, I must be well!

happy

This is one of the most common reactions of the average person. If your head hurts like crazy, you will call your doctor’s office and scream at the receptionist till you receive an early appointment. Or you would race to the nearest emergency room.

If your stomach felt ready to explode, you wouldn’t tell your spouse, “Honey, I’ll go see the doc next month, promise!”

But with high blood pressure, most people never have any symptoms. Even if the blood pressure is dangerously high. So the patient is lulled into a false sense of security.

The data should scare you!

Every third American adult 20 years or older has high BP. That is close to 80 million adults!

It is worldwide!

Do not feel that you are fine if you are not an American. WHO data from 2012 reveal similar percentages of prevalence of hypertension all over the world. In fact, two-thirds of all the people with high BP live in the developing world.

It kills!

Sufferers may feel fine, but hypertension is deadly.

hrt

Around half of all deaths from heart disease and stroke worldwide are caused by high blood pressure.

If you are 50 years old, your life expectancy is likely to be approximately 5 years lower if you have high blood pressure compared to your peers of the same age with normal blood pressure.

You can prevent it

Complications of uncontrolled blood pressure are fairly easy to prevent.

Even a small improvement in blood pressure for a short time can improve cardiovascular outcome substantially.

stroke

A 10 mm Hg (millimeters of mercury) lower systolic BP (the top number) is linked to a 50-60% drop in the risk of dying from a stroke. It is also associated with a 40-50% lower risk of dying as a complication of blockages in the heart (coronary artery disease).

Controlling blood pressure adequately also slows the progression of heart failure and kidney failure.

So how are we doing?

The National Health and Nutrition Examination Survey (NHANES) data from 2003-2010 reveal that almost 36 million (35.8) Americans did not have their blood pressure under control.

Of these, 14.1 million did not even know that they had high BP.

However, 5.7 million of these people knew they had hypertension, but were not on medications.

Amazingly, 16 million Americans knew they had high BP, and were on medications, but still did not have their BP under control.

Thirty-six million people!

That is a lot of people!

Treating high blood pressure is not rocket science. Leaving thirty-six million people uncontrolled should not be acceptable.

Are they poor and uninsured?

No.

doc

Nearly 90% of American adults with poorly controlled blood pressure have a usual source of healthcare.

Nearly 90% have health insurance.

Nearly 90% received health care in the previous year.

So clearly we are missing opportunities to improve the outcomes of these people.

What is the root problem?

Everybody blames somebody else. And there may well be enough blame to go around.

There are clearly issues with non-standardization of the way BP is measured in clinics and hospitals.  There are also questions about the utility of office versus patient home versus ambulatory measurement of BP, and the prognostic value of each of these.

Patients do not always follow instructions. Physicians do not always follow treatment guidelines. And then there are confusing and often contradictory guidelines issued by different “expert panels.”

How to get better?

office

We need to rethink our entire approach to treating people with high blood pressure.

Among other measures, innovative health-care delivery models are being looked at. These include team-based care, patient-centered medical homes, and efforts to improve medication adherence.

System-wide strategies

Kaiser Permanente implemented a program in Northern California to improve blood pressure control among its patients by creating a hypertension registry to keep track of patients with high blood pressure and the care they were receiving. They instituted several system-wide protocols to monitor and improve the quality of care of these patients.

The result: In 2001, 44% of their patients had their blood pressure under control, while in 2010, this improved to 87%.

During roughly the same period, death rates from stroke in this group went down by 42%, heart attacks went down by 24%, and the most serious types of heart attacks went down by 62%.

Conclusion

  • Controlling blood pressure leads to tremendous benefits.
  • The healthcare system is currently doing a very poor job of blood pressure control.
  • We will need innovative thinking and reforms to improve this state of affairs.
  • It is time to get serious!

Want to read more?

My book “High Blood Pressure: 10 Reasons Your Blood Pressure Is NOT Under Control” deals with these issues in more detail, and is available here:

http://goo.gl/t3h2zs.

Why More People Do Not Take Their Blood Pressure Medications

“Why can they not take their pills as I told them to?”

“Why do they always prescribe pill after pill? We have to buy groceries, too!”

Doctors grumble that patients do not follow their instructions. Patients grumble about the number of pills they have to take, and their costs.

The result: Nearly half the patients who have high blood pressure continue to have poor control.

Just the facts, ma’am!

There are about 7 billion people in this world.

Nearly a billion of them have high blood pressure, also called hypertension. Not all of them are even aware of their condition, because hypertension quite often does not cause any symptoms early on, thus meriting its name, “The Silent Killer.”

Of the millions of patients who see their doctors for blood pressure, only half experience decent control.

The USA

Every third American adult 20 years or older has hypertension.

bbl

Almost two out of three Americans 60 years or older have hypertension.

Three out of ten adults 80 years or older are taking 3 or more different classes of blood pressure medications.

Billions spent!

The estimated direct and indirect cost to the US for hypertension was $46.4 billion in 2011. The result: only 50% control!

Why to worry?

heart

Worldwide, high blood pressure is the top-ranked avoidable cause of premature death.

Poor control of this common condition will set you up for heart attacks, heart failure, kidney failure, strokes … and the list goes on.

If this does not stir us into action, what will?

How to fix it?

You can’t fix it until you find out what is the reason for this mess.

Incorrect BP measurement

This is a big problem. We need to standardize how blood pressure is checked. Please refer to our earlier post where this is discussed in detail: http://goo.gl/pSIJSz.

Pills and the man

For a medication to work, the prescription must be written: for the right drug, and in the right dose.  It must then be filled by the patient, who should take it as prescribed.

As they say, however, there is many a slip between the cup and the lip.

How many pills?

tabs

Nearly 70% of Americans are on at least one prescription medicine.

More than half receive 2 prescriptions. Thirty two million people take 3 or medications daily in the US.

How about 5 or more prescription drugs? Twenty percent of Americans take that many.

Americans aged 65-69 take nearly 14 prescriptions yearly, with the number going up to 18 in people aged 80-84 years.

The total spending on prescription drugs was $250 billion in 2009, about 12% of the total money an average American spent for his or her health care.

The failure to take medications correctly, for whatever reason, increases medical costs by up to $290 billion a year.

Take your pills? Yeah, right!

drugs

The more the number of pills you are supposed to take every day, the less likely you are to take them.

A study published in the Journal of Managed Care Pharmacy in 2012 showed that patients with chronic diseases are more likely to take once a day medications correctly than medicines which are to be taken several times a day.

Patients take once a day medications correctly 80% of the time, on an average. This drops to almost 50% when dealing with medications requiring four times a day dosing.

Fixed dose combinations

If patients are prescribed two different medicines for high blood pressure, less than 70% of them take their pills as prescribed. If they are prescribed a fixed dose combination of the same drugs in the form of one pill, the compliance rate goes up to almost 80%.

Write/Right prescription?

Inadequacies of the healthcare system also contribute to poor blood pressure control.

Many patients lack easy access to health care. Some do not have proper continuity of care, going from emergency room to emergency room, or clinic to clinic. It is difficult for them to be on a well-designed care plan, and often their medicines keep getting chopped and changed. Not surprisingly, many of them have uncontrolled blood pressure.

For some patients admitted to a hospital, the discharge planning process is inadequate, leaving the patient confused about which medications to take and for how long.

Fill the prescription!

rx

According to one study, new medications for high blood pressure were not filled by patients 20-22% of the time. A pill existing only on a prescription pad will not bring your blood pressure down!

But it is not always the patient’s fault.

Food or medicines?

drug costs

Drug costs keep going up.

Even among patients with some kind of drug insurance, there is the issue of co-pays. The more medicines you are on, the more is the pain of co-pays.

Insurance companies and employer groups have found that if they reduce or eliminate co-pays, patient compliance with medications improves.

Doc, I forgot!

forget

It is difficult to remember to take medications day after day.

Then there are patients who have issues with declining memory.

Fortunately, there are aids available, such as boxes with labeled compartments, and also phones with reminder alarms.

Side-effects

This is a fairly common reason for a patient to stop taking his or her medications. If your high blood pressure does not cause any symptoms, but the pill your doctor gives you for it makes you feel bad, you won’t take it for long.

Conclusions

  • If a patient does not take medications correctly, it is usually symptomatic of wider, deep-rooted issues.
  • We need to focus more on patient education.
  • The healthcare system has to address issues of access and affordability.
  • Drug companies must come up with better and wider patient-assistance programs.
  • We need to simplify the drug regimes of the vast majority of patients.

Want to read more?

High blood pressure is a major threat to humanity worldwide.

Current levels of blood pressure control are unacceptable.

The multiple factors complicating blood pressure control are discussed in more detail in my book, “High Blood Pressure: 10 Reasons Your Blood Pressure Is NOT Under Control,” available at http://goo.gl/t3h2zs.

 

 

 

 

 

 

Is Your Blood Pressure Really High?

There are close to a billion people in the world with high blood pressure, and almost half of them do not have it under control.

Full pay, half the job

Imagine hiring a painter who paints only half your house, but charges you the full amount. This is what the healthcare system is doing to patients with high blood pressure (also called hypertension).

Not acceptable!

It would be bad enough if only money were involved. Here, however, we are talking about disastrous consequences of poor blood pressure control.

Heart disease, including heart attacks, strokes, kidney failure, vascular disease … the list goes on. Uncontrolled hypertension takes a very heavy toll.

Deaths rise

bloo

In the last ten years, according to the CDC, the number of people dying from illnesses related to high blood pressure has increased by 66% in the US (compared to a 3.5% increase in the number of deaths from all other causes combined in the same time frame).

And with all the high-tech and fancy gadgetry available to us, we cannot control high blood pressure.

Where to start?

First things first.

Are we really measuring BP correctly?

Just do it?

bp machine

It should be pretty simple, right, to measure someone’s blood pressure?

Every adult who goes to see a doctor, or enters a hospital, has his or her BP checked. They slap a cuff on you, and boom! It is done!

Not so fast!

Incorrect technique leads to inaccurate and unreliable results.

It sounds obvious, but needs to be restated.

Correct methods of checking blood pressure need to be revisited and re-emphasized.

One high reading= hypertension?

sphyg

Before we go any further, it is important to emphasize that the diagnosis of high blood pressure, or hypertension, should only be applied after obtaining at least 3 readings of the person’s blood pressure over the course of at least 2 visits to the doctor’s office.

ACC advice

This is how the American College of Cardiology recommends obtaining a blood pressure reading, whenever possible:

  1. The patient should be settled and comfortable for at least 5 minutes before checking the blood pressure.
  2. The patient should be sitting down with the back supported, with his or her feet well supported on the floor.
  3. The arm should be supported in the horizontal position, with the blood pressure cuff at the level of the heart.
  4. At least 2 measurements should be obtained.
  5. The blood pressure should also be measured with the patient standing up for 1-3 minutes, because posture can affect the blood pressure.
  6. An appropriate sized blood pressure cuff should be used. The bladder of the cuff should go around at least 80% of the circumference of the upper arm.
  7. When evaluating a new patient, blood pressure should be checked in both arms, and the arm with the higher reading should be used for BP checks at subsequent visits.

AMA advice

The American Medical Association has some additional pointers:

  1. The patient should empty his or her bladder before getting a blood pressure check. A full bladder can raise the systolic BP (top number) by 10-15 millimeters of mercury (mm Hg).
  2. The legs should be uncrossed. Crossing the legs can raise the systolic BP by 2-8 mm Hg.
  3. The BP cuff should be placed over the bare arm; putting it over clothing can artificially raise the systolic BP by 10-40 mm Hg.
  4. No talking! A patient having a conversation with the person checking his or her blood pressure can experience a rise in systolic BP of 10-15 mm Hg.

What else?

coffee

The patient should preferably avoid tobacco, alcohol and caffeine use for at least 30 minutes before having a BP measurement.

It is also important to have the doctor’s office temperature in a comfortable range.  The blood pressure is likely to rise if the patient is feeling cold.

Proper calibration

Blood pressure measuring instruments should be regularly calibrated in accordance with the instructions of the manufacturer. Machines can malfunction!

SPRINT trial

It is interesting to note how blood pressure was measured by the investigators in this recent scientific study, which was stopped a year early by the National Heart, Lung and Blood Institute because of potentially life-saving information which had already been gathered. Although a detailed report of the study has not yet been released, they did announce significant benefits from lowering blood pressure beyond current recommendations.

However, one should not jump to conclusions till we receive more information about the risks and benefits of treatment, and which groups of patients were included and excluded from the study.

SPRINT BP details

  • BP was measured in an office setting.
  • An automated machine was used (an Omron machine). This is not an endorsement by me of a specific company, but just a statement of fact.
  • The machine waited for 5 minutes, and then took 3 BP measurements, and averaged them.
  • The BP was measured while the staff were out of the room.

According to Dr William C. Cushman, a network principal investigator in the SPRINT study, “With the way it’s (BP check) done in office practices today, even if it’s done with a good machine and by somebody who knows how to take blood pressure, it is often 5 or 10 mm Hg higher than that.

CONCLUSIONS

  • Checking blood pressure sounds simple, and can be simple.
  • However, several important precautions need to be taken.
  • Ignoring these steps can lead to inaccuracy and inconsistency when serial blood pressure readings are followed, and the patient can at times receive an inaccurate diagnosis.

Want to read more?

JPEG HTN

For a more detailed analysis of BP control, and reasons for lack of control, you can refer to my eBook: “High Blood Pressure: 10 Reasons Your Blood Pressure Is NOT Under Control,” available at http://goo.gl/t3h2zs.

 

If You’re Happy And You Know It, Clap Your Hands!

People get richer; countries get richer. Yet, happiness remains elusive.

Do we know anything?

If you want to pursue anything, or search for anything, you need to know what it is.

If you want a tiger, but keep chasing rabbits, you will end up disappointed.

So what are we looking for? What do we want to measure? Can we even measure it?

Money? Satisfaction?

All of us want to be happy. Or so we say. Sometimes, however, our actions suggest quite the opposite. So either we do not know what we are looking for, or we only pay lip service to the pursuit of happiness.

money

Quite often, we believe that becoming rich will automatically make us happy. So we make vigorous efforts to earn money, hoping that happiness will follow. We are disappointed when it does not.

Much has been written about the connection between money and happiness. There is some evidence that above an income level of $75,000 per year, money does not contribute significantly to happiness, or at least day-to-day feelings of joy. This is discussed further in a previous post: http://goo.gl/nhiLXp.

Satisfaction can be another issue. Nobody is ever satisfied with the amount of money they are earning, and most of us would like to earn more.

Happiness in the world

Human beings are keenly interested in money. So countries have long been ranked according to how rich they are, as broadly reflected by their Gross Domestic Product (GDP). However, the realization soon emerged that the richest countries are not necessarily the happiest.

But how do you go about measuring happiness? It is tough enough in an individual, never mind a country. The first World Happiness Report of 2012 showed us the way, and the latest report is from 2015.

Gross National Happiness

Bhutan

The king of Bhutan coined this term in the 1970s to emphasize the importance of spiritual values and human emotions, and not just simply dollars and cents in evaluating the well-being of people and nations.

In 2011, the United Nations passed a resolution to make happiness a part of its agenda of global development.

The concept of Gross National Happiness stresses good governance, environmental awareness and conservation, cultural values, and sustainable development.

Mexico? Costa Rica?

The World Happiness report of 2015 lists Switzerland, Iceland, Denmark, and Norway as being the top four happiest countries in the world, with Canada being the fifth.

costa rica

Interestingly, Costa Rica is at number12, and Mexico at number 14, just above the United States at number 15. India is ranked number 117, out of a total of 158 countries listed.

What are the criteria?

Happiness and well-being are important markers of social progress. Public planners are increasingly focusing on these goals for the citizens of their respective countries.

Measuring these parameters objectively, and presenting data which cut across international differences is a challenge, which the authors of the World Happiness Report have been increasingly successful at meeting.

This report ranks 158 countries along a scale of happiest to least happy. The basis for the ranking is the quality of life of the people interviewed in those countries.

Six major factors

social

Three-quarters of the differences between these countries were felt to be the result of six factors: the Gross Domestic Product (GDP) of the country, life expectancy, generosity, social support, freedom, and corruption.

To prepare their report, investigators asked people to rate their lives on the whole using a numerical scale: 0 being the worst and 10 the best possible life.

GDP and life expectancy of the population obviously reflect the wealth of a nation, but the other factors mentioned above are indicators of autonomy, trust, and a sense of security. These are not necessarily related to wealth.

Rich country, happy country?

Not necessarily. The US was ranked eighth in GDP per capita (although it has the world’s largest GDP) and fifteenth in happiness. Canada has a GDP 20% lower than that of the US, but its happiness rank is higher at number five.

Social connections

community

People are growing richer in the US, on average, but their sense of social connection is going down, resulting in a lower ranking on the national happiness scale.

Trust

Fewer Americans now feel that they can trust other people. Nationally, 80% say that they can count on their neighbors. In some regions, this is much worse. Santa Monica in California recently combined data from surveys, social media, and administrative sources, and found that only half of their citizens felt they could depend on their neighbors.

So where does that leave us?

Right where common sense has always led us.

Money continues to be important, to allow people to keep body and soul together, and for countries to provide vital services to their citizens.

What we seem to have lost lately is a sense of perspective, of balance.

The mindless pursuit of wealth and sensory pleasures has had a numbing effect on individuals. We are losing a sense of purpose, of community.

Similarly, countries are neglecting investments in social capital, and chasing global power and hegemony.

Call to action

It is time for us to introspect.

friend

Family, friends, spirituality, and community are essential for human beings to flourish. And when individuals flourish, so do countries.

Eating, sleeping, and reproduction are not unique to humans. Animals do much the same.

help

Let us seek and cherish traits that make us special. If we do that, we will not need to ask ourselves if we are happy. We will be too busy helping others.

Enjoy the Present of Life: Let Go of the Past & Future!

“My parents did not love me as much as they loved my younger brother. My whole life is ruined. I will never amount to much.”

“All my friends are millionaires. In the next five years, I need to earn at least five million dollars. Otherwise, how will the world truly appreciate my value?”

We take perverse delight in dwelling in the past, or worrying about the future. In the process, we ruin the only thing we have, and can control: our present.

The past

stress

News flash: The past is gone, over, done with. That is why it is called the past. In grammar, it is appropriately called the past tense. It has passed. But it still makes us tense.

Rumination

Most humans take delight in thinking about the past. That is all right, to some extent. It is, after all, a part of our lives.

Nostalgia can bring us some pleasure. We relive some of the happy moments of our lives, and our sense of joy is rekindled. That can give us a new vigor to move forward with optimism.

Problems with nostalgia

However, nostalgia can also hurt.

The word itself is formed by joining two Greek words: nóstos, meaning “homecoming,” and álgos, meaning “pain, ache.”

Swiss mercenaries who fought wars far away from home in ancient times obviously suffered from anxiety. A 17th century medical student labeled this as a medical condition, and called it nostalgia, which was felt to be a type of melancholy.

Good old days

type

Many of us get emotional when thinking of the past. If we have happy memories of people or places from our past, we think of them frequently. This can improve our mood. Positive feelings of self-regard have been documented in people who have a “sentimental longing for the past.”

However, our vision can also be biased. With the passage of time, we acquire rose-tinted glasses, and tend to have a distorted image of previous occurrences. Positive experiences are highlighted. Painful memories are sometimes suppressed. It is not unusual for us to lose perspective when reliving the past. Thus nostalgia often has a bitter-sweet undertone.

There is also a tendency for people to want to return to the “good old days,” which may not have been that good in their totality. For instance, the old days in South Africa included the abhorrent effects of apartheid. Similarly, the past in the USA was not that pleasant for African Americans.

Habitual worriers

Nostalgia has been shown to create problems for a group of people who worry “all the time.” This becomes a habit for them, and they have repetitive and automatic thoughts which they cannot control. They are constantly trying to resolve issues which have been festering for a long time. Quite often, the chronic problems are not solved, but the worriers are left with residual feelings of anxiety and depression.

worry

In such habitual worriers, dwelling on the past often leads to a worsening of their chronic anxiety and depression. This appears to happen even when they think about pleasant events in the past. The reason is usually a stark contrast between what they think was a pleasant past, and their current unsatisfactory reality.

Ignoring the present

No matter how good or bad the past was, it is now over. One should certainly review the mistakes one made in the past, and learn from them. Beyond that, dwelling on the past is, at best, a waste of time and mental energy. Life is led in the present moment, and spending that time focused on the past means frittering away a precious resource.

How about the future?

future

Quite often, when we are not occupied with the past, we start worrying about the future.

Most of us have goals, ambitions, and plans. We have a vision for our future: a successful career, a wonderful spouse, great kids, a house in the suburbs. We have it all figured out. And we want to pursue that vision vigorously.

However, while we are all wrapped up in that planning, we overlook a few key details.

Plans

“If you want to make God laugh, tell him about your plans.”

-Woody Allen

It is well and good to make plans. That is probably better than leading a completely unstructured life. Most people have goals, and that focuses their minds.

plan

However, it is wise not to get too engrossed in your plans. Plans, no matter how meticulously made, do not always come to fruition. That is why people make a “Plan B.” Even that does not always work out.

So the best bet is to make a broad outline of what you want to do, and how you want to do it, and then focus on the present, asking yourself what it is that you can do right now which will improve the odds of success in the future. And then get to work in the here and now.

Predictions

“It’s tough to make predictions, especially about the future.”

-Yogi Berra

When we are not dwelling in the past, we are often preoccupied with the future. Everybody wants to have a secure, happy, and successful future. So we spend a lot of time worrying about it. We think of all the bad things which can happen to us, and then mentally conjure up methods of tackling them. From time to time, we visualize some of the good things we would like to occur to us down the road, and then worry about how bad luck could undermine our success.

fortune

The problem with this strategy is what Yogi Berra jokingly pointed out in the quote above. We are unable to predict the future. A lot of the bad things we worry about never happen. Some of the good things we would like also do not happen. We can plan, work hard, worry, and fret all we want. We cannot control what will happen in the future.

This is not to say that we should never plan, never make an effort. No. We should do the work which is under our control. And then we should let the future take care of itself.

So what is the answer?

mindfull

Live in the moment. Live the present to its fullest. The past is gone. The future is not knowable.

So be mindful of the moment. Because that is all that is promised to you: the present moment.

And life consists of a series of present moments.

Mindfulness meditation

This is a discipline which focuses on recognizing the value of the present moment, and living in, and taking pleasure in, the present moment.

A fundamental aspect of this is deep breathing, which we have discussed in a previous post: http://goo.gl/v9dQ0d.

Advantage of living in the moment

This is the most productive use of your time.

happy

It allows you to enjoy life, and also focus on the only things which are under your control: your thoughts and your actions.

The ancient Indian epic, the Gita, explains:

Karmanyevadhikaraste ma phaleshu kadachan (Gita 2:47)

“You have control only over your actions, and never on the results of those actions.”

Do your duty; be happy

This is one of the most important keys to leading a happy and satisfying life. Do what is right. Do your duty, your job, to the best of your ability. After that, let go of the past, and don’t worry over the future. Let the chips fall where they may.

Want to read more?

The above issues, and more, are discussed further in my book: How to Lead a Satisfying Life: 11 Universal Lessons from the Gita, which is available at:

http://goo.gl/4tp2t9.

Salt, Sodium, and Blood Pressure: Just The Facts!

salt

“Salt will raise your blood pressure and kill you! Throw away that shaker!”

“Hey, salt is not too bad! In fact, if you cut down too much, you will die early!”

The general public is losing confidence. Coffee is good for you, coffee is bad for you.  Fat will kill you, fat will liberate you. Every day, newspapers, magazines, the TV, all of them scream at us with contradictory health messages. It helps sales, but undercuts the credibility of the healthcare profession and the media.

So what is the deal?

As is often the case, the truth probably lies somewhere in the middle.

Science is an ever-changing field. New discoveries are made, and old thinking discarded. That is a sign of progress. After all, the earth was flat, till we discovered that it was really round.

So what should the average person do?

Evaluating the evidence behind various claims is a good way to start.

What exactly is salt?

Table salt is chemically sodium chloride (NaCl).

Scientific studies and professional agency recommendations often deal with sodium, rather than salt. To put their findings in perspective, salt is 40% sodium and 60% chloride.

spoon

One teaspoon of salt has approximately 2300 mg (milligrams) of sodium.

So what do the various agencies advise us to do?

American Heart Association (AHA)

In 2010, the AHA changed its advice, and now says that we should consume less than 1500 mg of sodium a day. This is less than a teaspoon of salt.

It does, however, make some exceptions.

Competitive athletes lose a lot of sodium in sweat, and need a higher salt intake. So do workers who face high degrees of heat, such as firefighters and foundry workers.

Finally, if your healthcare provider has given you different instructions about salt intake, the AHA says you should follow those.

WHO

The World Health Organization recommends a daily sodium intake of less than 2000 mg.

Dietary Guidelines for Americans

Their current advice is to limit daily sodium intake to less than 2300 mg (one teaspoon).

How much do we really eat?

ssalt

The average American consumes 3300-3400 mg sodium every day. That equals about one-and-a-half teaspoons of table salt daily.

Institute of Medicine (IOM)

This institute was established in 1970 under the charter of the National Academy of Sciences. It serves as an adviser to the nation to improve health. It provides independent, objective, evidence-based advice to policy makers, health professionals, and the public.

There is evidence for the health benefits of reducing dietary salt intake. However, recent data indicate that low sodium intake may carry risk, too.

As such, the Centers for Disease Control and Prevention (CDC) asked the IOM to examine this recent data and then recommend population-based strategies for sodium intake.

In May 2013, the IOM issued its report, which said that:

  • The newer studies had problems with the methods they used.
  • These studies also suffered from quality issues.
  • In spite of this, there is evidence of a link between high sodium intake and the risk of cardiovascular disease.
  • The available evidence supports population-based efforts to reduce excessive sodium intake in the diet.
  • There is not enough good-quality evidence to support the reduction of dietary sodium intake to 1500 mg or below.

More recent data

The PURE study was published in the New England Journal of Medicine in August 2014 http://goo.gl/X1Xxo5. The investigators studied more than 102, 000 people from 18 countries. They found that:

  • blood
  • Blood pressure went up with increased dietary sodium intake.
  • The systolic BP (top number) increased by an average of 2 mm Hg (millimeters of mercury) with a 1 g increase in sodium intake a day. The diastolic (lower number) went up by 0.8 mm Hg.
  • The rise in BP with higher sodium intake was more marked in those people who already had high BP to begin with.
  • Older people had a higher rise in BP with increasing dietary sodium

Death rates

The same issue of the New England Journal of Medicine had another article about sodium intake, high BP and also death rates http://goo.gl/iDYLBD.

The findings in this study were as follows:

  • People who had sodium intakes of 3-6 g daily had a lower risk of death and cardiovascular events than those whose intake was higher than 6 g a day.
  • This risk was even higher in patients who already had high BP to begin with.
  • Interestingly, however, people whose sodium intake was below 3 g daily also had a higher risk of death and cardiovascular events than those with an intake between 3-6 g daily.

Problems with the PURE study

This was not a randomized, controlled trial, which tends to produce more reliable conclusions. It was an observational study, and data from such studies are often less reliable.

AHA stance

The AHA does not agree with the conclusions of the IOM report, or the PURE study, citing methodological problems with the studies which have been evaluated. The heart association stands by its guideline of reducing daily sodium intake to below 1500 mg.

Doctors disagree; what should the patient do?

  • In general, most experts agree that the patient should follow the specific advice of his or her healthcare provider, who understands the complexities and details of the patient’s entire health situation.
  • Most experts also agree that excessive salt consumption is not a good idea.
  • bloood
  • In general, high salt intake tends to raise BP.
  • If you are an older individual, or already have high BP, it is likely that cutting down on salt will help you.
  • If you have uncontrolled high BP, it is possible that high salt intake is causing or worsening your problem.

How low to go on salt?

doctor

Talk to your doctor!               

He or she has most likely seen medical controversies come and go, and is usually well equipped to deal with conflicting “expert” opinions, and identify the path most likely to help you!

Upcoming book

Want to read more about BP and its control?

You will not have to wait long for the launch of my new book: “High Blood Pressure: 10 Reasons Your Blood Pressure is Not Under Control.”

Details will follow soon!

Secrets of Pride, Anger, and Social Emotions

“You are a genius!”

“You are such a total failure!”

Each one of us has an inner voice which keeps nagging us. It keeps a running scorecard of everything we do, and regularly passes judgment. One second it can take us to the top of a mountain, and the very next, bring us crashing down.

Why is this so?

Evolution

evolution

This is a convenient target to blame. We are wired this way. We cannot help ourselves.

To some extent, that is true.

Living beings need to survive, and propagate the species. Social animals want to move up the social hierarchy, because that improves the odds of survival and reproduction.

And thus are born instincts and emotions, which warn us against danger, and help us get ahead in the world.

Is this relevant today?

Yes and no.

Dangers to life and limb are of a different nature today. The stress system previously triggered by the roar of a tiger in the wild is now brought into play when we are sitting in traffic, fretting and fuming because we are late for a meeting. The hormones pouring into our bloodstream (cortisol and adrenaline), which were meant to aid fight or flight, now end up raising our blood pressure and blood sugar.

Are primary or basic emotions still useful?

To some extent, they are. They still alert us to the possibility of harm.

Anger, joy, sadness, surprise, fear, and disgust develop in the first 9 months of an infant’s life

fear

These basic human emotions have characteristic facial expressions which accompany them. An early signal of both fear and surprise is a widening of the eyes, which increases our field of vision, allowing a better chance of fast escape, as we can see more of our surroundings.

surprise

The emotions of anger and disgust show the same initial facial expression, a  wrinkled nose, which was likely designed to reduce the potential for breathing in particles dangerous to health.

Modern role

Many researchers believe that emotions affect our cognition, influence our thinking, and influence the way we make decisions.

Gut feeling

The human brain can take in vast amounts of information, process it rapidly, and present to us a plan for rapid action, without our having to think about it at a conscious level. Our emotions play a key role in this, through our “instincts,” or “gut feelings.”

In many situations, the amount of information available is so much that analyzing it carefully and consciously would take a lot of time. You might be in a car showroom, with the salesman pushing you to close a deal. But your brain sees a red flag, and tries to warn you. You start getting an uncomfortable feeling in the pit of your stomach. You do not know what it is, but your brain has been there before, and it is warning you that something is fishy, and you should leave. Only later do you find out that the sales person has a track record of duping customers. Your instincts, however, picked up some subtle cues and warned you in time.

But it can work against you

Emotions act in a very simplistic manner. They present you information about your surroundings and circumstances rather broadly, and you react to that without too much conscious thought. This, however, can also create problems in the modern world. When things do not go your way, you tend to get angry, and this could become a recurrent pattern. Chronic anger can create health problems, such as high blood pressure, and even heart disease.

Self-conscious emotions

These emotions can cause even greater problems.

pride

Pride, hubris, guilt, and shame are commonly considered to be “self-conscious” emotions. They develop later in life than the basic emotions of anger, fear, etc. (which can be seen by 9 months). Pride, for example, develops by the end of the third year of life.

These emotions depend on an interaction between a person and the society in which he or she lives.

Pride and social status

Society and culture often dictate what kind of a person we are expected to be. Pride helps us to regulate our behavior to gain the approval of society. It also motivates us to avoid actions of which society disapproves. Thus it helps us to avoid feelings of rejection.

Pride is an important building block for self-esteem, helping us to attain and maintain a certain status in society.

Pride and goal setting

People constantly evaluate social norms, and then set goals for themselves. If they meet or exceed those goals, they feel a sense of pride, which promotes further achievement. A failure to meet those goals leads to a sense of shame or guilt.

Thus pride depends on constant self-evaluation.

Is pride two emotions?

Pride and hubris are being studied afresh these days.

It is commonly felt that the difference between the two is only of degree. An excessive sense of pride is commonly called hubris, which is detrimental to emotional and social development.

Some researchers feel, however, that we need to distinguish between an achievement-based pride and a hubristic pride

Pride in achievement

Almost all of us have experienced this.

You run track, and come in first in a tough competition. Or you are a musician, and win an award for a fine performance. You might, perhaps, receive praise and a promotion for completing a project which wins your company new clients.

Most human beings would feel proud under these circumstances.

Hubristic pride

This is more problematic.

hubris

This is the pride a person feels because of who he thinks he is.

Most people in this category have a distorted sense of self-perception, and may have delusions of grandeur. They are often arrogant and conceited.

They feel that they deserve praise for who they are, not just for what they have achieved.

Impact of pride

Psychologists feel that an achievement-based pride helps to develop self-esteem, and promotes “good behavior” and the promotion of societal goals.

Hubris and narcissism

Unlike “regular pride,” hubristic pride is a clearly negative emotion, with strong ties to narcissism.

Such people frequently have deep-rooted insecurities. They might feel inadequate, and often harbor feelings of shame. To protect themselves from these emotions, they adopt a cloak of arrogance and self-aggrandizement.

This is a defensive process, and is maladaptive in nature.

Demonstration of pride

This depends on the cultural and social norms the persons grows up learning.

In Eastern, “group based” cultures, demonstration of pride aggressively is frowned upon, and pride is often considered a negative emotion.

However, in the more individualistic societies of the West, pride is usually considered a virtue. Rather than condemning it as a vice, Western societies like to encourage pride in both children and adults.

A deeper truth?

Even achievement-based pride can create problems.

This pride depends on positive results. However, results of our actions are never under our control. We can only control our own actions.

Results, pride, and self-esteem

If you praise yourself, or your child, mostly for achievements, you might be sending the wrong message.

You can try your best, and yet fail in an enterprise. Other times, you could cruise through your assignment, and still get positive results purely through luck. What would you rather praise and encourage, the effort, or the result? What is more likely to stand you in good stead through the course of a lifetime?

So what is the bottom line?

joy

  • Emotions are deeply ingrained in the human psyche.
  • We receive an evolutionary benefit from emotions, as they alert us to danger and promote prompt, subconscious action.
  • In the modern setting, many emotions are triggered inappropriately, or excessively, and they can hurt us, causing significant unhappiness and dissatisfaction with life.
  • Chronic anger, excessive sadness, and inappropriate fear can ruin many a life.
  • Excessive pride and shame can also have deleterious effects.
  • Emotions trigger thought and action.
  • It is vital that we understand and control our emotions and their triggers, in order to moderate our responses, and avoid becoming slaves to our emotions.
  • There is often a lack of association between effort, action, and achievement. Be careful what you praise and encourage.

Emotions, happiness & satisfaction

You can read more about this connection in my book, available here:

http://goo.gl/4tp2t9.

Is Pride Good, Bad, or Indifferent?

pride

Pride

Are you proud of what you have achieved in life? Are you a proud man? Is there a difference? Is pride good or bad? What is pride anyway?

Confusion

These questions have been confusing mankind for centuries. One reason might be that research has been limited because pride is not usually included in the category of basic emotions.

Basic emotions

These emotions are not limited by culture or nationality, but are felt to be truly universal.

Anger

Anger

Anger, fear, happiness, surprise, disgust, and sadness are commonly accepted as the basic emotions.

Another characteristic of these emotions is that they are accompanied by non-verbal expressions, which can be understood by almost anybody living anywhere in the world. For example, the facial changes which occur when a person is angry are usually not subtle, or limited by nationality.

Secondary or complex emotions

These develop later in the life of an infant, and depend on an ability to evaluate aspects of society, culture, and a sense of “self.”

Some of these emotions are combinations of the basic emotions.

Jealousy

Jealousy

Examples of these are envy, jealousy, and resentment.

This issue has been dealt with in a previous article here … http://goo.gl/hZ5Qlk.

Self-conscious emotions

I did it!

I did it!

This is an interesting, and at times confusing, set of emotions, which require a complex interplay between a person and society or culture.

The person develops a sense of individuality or “self.” He or she then looks around to see what society expects. This leads to goal-setting, and finally an evaluation whether those goals have been met. A sense of success or failure is the common result of such an evaluation.

Shame!

Shame!

This complex process is felt to be responsible for our “self-conscious” emotions of pride, hubris, guilt, and shame.

Why do we have emotions?

Emotions are clearly evolutionary in nature. They help us to survive, reproduce, and move up in the food chain.

Emotion and reason

We have the capacity for both. And they serve different functions.

Fear!

Fear!

Take a basic emotion like fear. In the good old days, when we heard a roar in the wild, it alerted us to danger to life and limb. We did not sit around, form a committee, and debate rationally the probabilities of a tiger attack. Instead, we were immediately gripped by a mortal fear, our fight-or-flight response took over automatically, adrenaline poured into our bloodstream, and we ran like crazy. And lived to fight and reproduce another day.

Aggression

In addition to just living, we also wanted to adapt and thrive. Here our rational being came into play. It helped us to venture out, capture animals, avoid danger ahead of time, develop agriculture, and enhance our welfare by forming tribes and societies.

Social good

Group living helped us, but also led to the development of more emotions. Individual survival now competed with group survival. An aggressive individual was of value, but could lead to trouble within the group.

Thus social and cultural norms and hierarchies were born. You could kill invaders, but not your neighbors in your tribe.

The tribes also needed leaders, and followers. The leaders enjoyed unique privileges. There was often competition to become a leader. Certain traits were valuable in a leader, and others were frowned upon.

Thus arose pride and shame.

Desire

There is another theory of emotions.

Human beings have desires. Some of these are basic, while others are conditioned by society or culture.

All of us have a desire to live. We also want to be successful, to be liked, to move up in society, to be accepted and admired.

Events in our daily lives either lead to the satisfaction of these desires, or their frustration. These events produce mental and physical changes in us, which we recognize as emotions.

For example, the presence of a tiger threatens our desire to live, so we experience fear.

Moving on up?

Moving on up?

Buying a flashy new car satisfies our desire to move up in society, and so we feel joy.

Denial of a promotion frustrates our desire to be recognized and admired, and we feel anger.

 Where does pride fit in?

Pride is confusing.

The Greeks both admired it, and detested it. They valued pride in their warriors, but also recognized the problems with excessive pride, or hubris.

 

Achilles

Achilles

Most of the characters in Homer’s “Iliad” were led to their ruin by pride.

Christianity

Since ancient times, Christian teaching has talked of the seven deadly sins, of which pride is one.

Dante

Dante

He was not bashful about his opinions. He considered pride to be the deadliest of the seven deadly sins.

Pride and the Gita

         Dambho darpo abhimanashcha krodhah parushyamevacha

          Ajnanam cha abhijatasya Partha sampadam asurim  (Gita 16:4)

This epic of ancient Indian philosophy and religion narrates how Lord Krishna, a Hindu god, described to his pupil Arjuna the specific traits of people born with a demonical nature: hypocrisy, arrogance, pride, anger, harshness, and ignorance.

Emotions and happiness

So what can we take away from this?

Do emotions help us?

In the modern setting, can they hurt us?

Is pride always good, or always bad?

Complexity can be reduced

By studying emotions in greater detail, we can understand their evolutionary benefits.

Similarly, we can also understand their potential to derail our pursuit for happiness and satisfaction in the modern world.

We will discuss this further in subsequent post.

Stay tuned!

Want to read more?

Confused about happiness? Your ship just came in!

Confused about happiness? Your ship just came in!

The pursuit of happiness and satisfaction is discussed in more detail in my book available here … http://goo.gl/4tp2t9.