IMA and HCFI propose the Rule of 20 in identifying factors associated with hypertension

IMA and HCFI propose the Rule of 20 in identifying factors associated with hypertension
Hypertensive crisis fixed by electronic pressure measuring instrument over white background

On World Hypertension Day, IMA and HCFI call for understanding the numbers, and also taking a step forward in identifying and managing the symptoms

 New Delhi, May 17, 2017: About one-third of India’s urban population and one-fourth of the rural population are hypertensive, according to a recent study published in the Journal of Hypertension. It has been found that high blood pressure is responsible for almost half the ischemic strokes that are also called brain attacks, akin to a heart attack. It also increases the chances of hemorrhagic strokes.

Hypertension often goes unnoticed as it attacks the body without showing any symptoms at all. The 17th of May every year marks the World Hypertension Day, with the theme this year being ‘Know your numbers’. Experts opine that early detection of blood pressure and its management may reduce the complications of hypertension as also the risk of death.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “High blood pressure is one of the leading causes for stroke contributing to over 50% in blockages (ischemic stroke) and leads to bleeding in the brain. This condition can damage arteries throughout the body, creating conditions where they can burst or clog more easily. Weakened arteries in the brain, resulting from high blood pressure, put people at a much higher risk of stroke. There are many factors and conditions which can lead to high blood pressure, for example, smoking, lack of physical activity, excess salt in the diet, consumption of alcohol, stress, and genetic history of high blood pressure.”


The IMA recently conducted a national study on ambulatory blood pressure measurement amongst doctors in partnership with HCFI and Eris Lifesciences. The study revealed that 21% of the doctors surveyed had masked hypertension or isolated ambulatory hypertension. In simple terms, their BP readings were normal when evaluated through the conventional clinic measurement technique but high when checked through the ABPM technique. Masked hypertension is associated with an increased long-term risk of sustained hypertension and cardiovascular morbidity.

“Ambulatory Blood Pressure Monitoring is globally accepted as the gold-standard method towards detecting hypertension. It evaluates a patient’s BP continuously over a period of 24 hours and helps diagnose masked or white coat hypertension, conditions in which a patient’s BP readings are inaccurate due to certain environments. It is important to increase your intake of fresh fruits, vegetables, olive oil, and omega-3 foods to help lower high BP levels. Apart from this, it is a good idea to consume sprouted or 100% whole grains as also reduce your sodium intake. The real culprits behind increased sodium intake include processed and ultra-processed foods,” opined Dr Aggarwal.

Understanding the Rule of 20 in Hypertension can go a long way in identifying and managing the causes and symptoms of hypertension.

  • Prevalence of hypertension is 20% in the society
  • Only 20% of people are aware about Hypertension at any given time.
  • The morbidity and mortality due to hypertension is 20%.
  • Only 20% people get treated for hypertension and at any given time.
  • Only 20% of hypertensives are well controlled at any given time.
  • The risk of CAD and heart attack in hypertension is 20%
  • Risk of peripheral vascular disease in hypertension is 20%
  • Risk of paralysis in hypertension is 20%.
  • The severity of hypertension is decided by increments of 20 mm Hg each
  • In white coat hypertension, a person can have rise of more than 20 mm systolic blood pressure.
  • 20 mm Hg systolic blood pressure can be reduced by life style management alone.
  • 20 mm Hg systolic blood pressure can be reduced by one drug intervention.
  • Up to 20 ML of 80 proof 40% whisky is safe in hypertension.
  • 10 KG weight reduction can reduce systolic blood pressure by 20 mm Hg
  • Reduction of salt to 6 grams and intake of DASH diet can reduce systolic blood pressure by 20 Mm Hg
  • Look for a cause of hypertension, if blood pressure first time appears before the age of 20
  • Each and every IMA member should monitor BP of at least 20 patients per day.
  • 20 Cores people are seen by IMA member every year
  • In last 20 years, the community systolic blood pressure has gone up by 20 mm hg.
  • IMA has more than 20,000 office bearers.

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