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Supine hypertension–orthostatic hypotension
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New Delhi, April 29, 2019 :
SH/OH is a form of autonomic dysfunction characterized by hypertension when patients are supine and a clinically significant drop in blood pressure when they assume an upright posture. Treatment of this group of patients can be very challenging.
Orthostatic hypotension (OH) is a condition that is relatively common in elderly patients and those who suffer from diabetes mellitus and Parkinson’s disease. Some patients with OH will also develop concurrent supine hypertension (SH). This results from a defect in the functioning of the baroreceptors that normally maintain appropriate blood pressure upon assuming an upright posture.
OH and SH should be treated separately, and that non-pharmacological interventions should be employed first. For OH, these include smaller, more frequent meals and increasing water intake, along with other physical maneuvers to increase blood pressure (such as squatting).
As SH or OH becomes more severe, pharmacological measures should be taken, such as adrenergic agonists for OH or short-acting antihypertensives for SH.
These medications must be strictly monitored to minimize any undesired side effects that may worsen SH or OH. They strongly recommend the use of 24-hour blood pressure monitoring as a means to identify the timing and magnitude of daily fluctuations. This practice can further help to guide treatment.
Building Indian Consensus
WHO advise on screen time for children under five?
1.That for children under one-year sedentary screen time (such as watching TV or videos, playing computer games) is not recommended and that when sedentary, engaging in reading and storytelling with a caregiver is encouraged.
2.That children under two years of age should have no screen time whatsoever
3.For those aged two years, sedentary screen time should be no more than one hour; less is better.
4.That three and four-year-olds should not play with iPads or watch television for more than an hour a day ( less is better).
5.WHO recommends at least 180 minutes in a variety of types of physical activities for three-to-four-year olds.
6.Improving physical activity, reducing sedentary time and ensuring quality sleep in young children will improve their physical, mental health and wellbeing.
The Author of this article is Dr K K Aggarwal, Padma Shri Awardee
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