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him 15 years ago. It really is true though, that home measurements are usually lower than
office. So, rule no. 2. Home measurement is a great idea, buy a digital sphygmomanometer if
you want, even learn to spell it, but get it calibrated by having a doctor take it at the same
time as you on a different arm then swap arms.
Don’t let doctors trick you into treatment you don’t need. If it’s 140/90 then the best option is try
lifestyle changes for 3 months before agreeing to drugs. Of course doctors don’t make money
from those who aren’t sick so don’t be surprised if some doctors you know disagree. Google it. If
it’s over 140 then there are health benefits to bringing it down to 130. Taking it down below 130
with drugs doesn’t improve outcomes, but if it’s below 120 without drugs it’s healthier. I’ll keep it
simple with 2 lifestyle changes as I wrote about obesity and meat last time. 1) No added salt
really does work! Studies are always on “low salt” diets for 3 months which makes no difference
as for most of us low salt is still too much. I used to run to work from Makindye to Naggulu and
back again twice a week. I’d be running in at 8.0am in the heat and running home around 4
or 5pm in the heat. 40 km a week hard running on the equator makes you sweat, I’d drink 2
litres before I could pee again, half of it coffee. I never added salt to food, though Rosie cooks
with it. The idea that “you need salt in the tropics” is a myth. I’m not suggesting you try running
40 k and drinking too much coffee, I’m just saying if your bp is above 120, try adding no salt to
your food for 3 months and instead drink a lot of fruit juice. We have a lot of sodium and
potassium in our cells and a lot of cells, so to change that ratio takes years of reduced salt and
increased potassium. I ate a lot of fruit and took no salt since I was a medical student. The
reason the drug group “diuretics” are the first choice blood pressure drug in many countries is
simple: they make you pee out sodium. If taking more salt “because you live in the tropics”
and then taking drugs to pee out salt doesn’t sound logical, it’s because it isn’t. So rule number
3. Stop adding salt to your food and eat a lot of fruit. 2) Exercise works. Walking is great. Running
is great. Swimming is great. Tennis is great. Golf is expensive. Gym is smelly and noisy but your
choice. Doesn’t matter what you do, just do it. Often. Get your heart pumping, get the blood
flowing, get those kidneys perfusing. And keep doing it until you’re 80. At least. So rule number
4 get off your b@ckside and give your cardiovascular system something to do. Lastly if your bp
is high, doesn’t come down with low salt and exercise and if you need drugs, do some reading
and talk to your doctor. Ask questions, there are a lot of options. Both hypertension and the
drugs used can cause impotence (is that why Rosie puts salt in my food?).
When I retired I had seen for years that everyone was put straight onto the latest most
expensive brand names. They were often designed as niche drugs for the minority that couldn’t
take the older drugs, and no better for most people. But they have just a few years to make
profits before the patent is over and the price drops to a tenth. So aggressive marketing
combined with compliant insurance companies meant they were given to every newly
diagnosed case without first trying the old regular routine. There’s a reason for treatments being
regular routine: after years of experience of millions of doctors they’re recognised as the best.
So last rule: healthy scepticism. Patients first, not profits, you have a right to ask questions and
good doctors welcome it. There is no one size fits all, take the drugs that suit you best.

Summary
Non communicable diseases are seldom headline but are the most important this century.
Blood pressure is a boring subject but is actually a major cause of cardiovascular disease,
including heart failure, strokes, kidney failure, and death. Hypertension and the drugs used to
treat it are also common causes of impotence so worth taking it seriously.
Avoid it, check it, treat it.
CONTACT THE SURGERY
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nurse@thesurgeryuganda.org thesurgeryuganda.org @TheSurgeryUganda (f)

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