Aim at abdominal reduction instead of weight reduction- Prof. Ahmad Bilal

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Proceedings of PHL Conference-II
Aim at abdominal reduction instead of 
weight reduction- Prof. Ahmad Bilal
Comprehensive assessment and individualized
care for selection of drug therapy is important
- Dr. Fawad Farooq

PESHAWAR: Prof. Imran Saeed was the first speaker in the session devoted to Risk Stratification and Diagnosis during the PHL Annual Conference held at Peshawar from 6-8th March 2020. He discussed in detail the use of right tools for blood pressure monitoring. High Blood Pressure, he said, was on top of the modifiable risk factors. We need to use standard procedures for blood pressure measurement. We have to take into account the White Coat Hypertension. C-section may be the result of high blood pressure. Masked hypertension is much more important. Prof. Shahbaz Kureshi remarked that Ambulatory Blood Pressure monitoring is ideal.

Prof. Mohammad Ayub highlighted the importance of nuclear technology in diagnostic imaging. Patients with Left Ventricular hypertrophy, he said, have poor prognosis. Use the right modality. Good history and physical examination are extremely important. Prof. Nusrat Ara remarked that one can diagnose Coarctation of Aorta with good history and clinical examination.


Prof. Ahmed Bilal

Dr. Fawad Farooq from NICVD Karachi discussed the Micro and Macro Vascular complications in Hypertension. He laid emphasis that one must confirm the diagnosis. All high blood pressure may not be hypertension. He also referred to micro and macro vascular complications which if managed in time will reduce morbidity and mortality. It will also save the patients from target organ damage. He emphasized the importance of comprehensive assessment of the patient and individualized care while selecting drug therapy.

Prof. Ahmad Bilal from Faisalabad Medical University suggested that we must have a Tape in our bathrooms and every male and female should measure their waist. Male should have a waist of upto 35 inch while female; girls should have a wait of 30 inch. Any measurement above that needs treatment. He also advised the participants to install step counter on their mobile phones and it will help them in managing metabolic syndrome. More than six thousand steps daily are needed; it will help you prevent many diseases. At present more than 50% of our population, he stated, was suffering from hypertension, 26% are suffering from diabetes and if we add those with impaired glucose, it will come upto 40%. Almost 50% of our population is obese and out of this 20% are overweight. He laid emphasis that our efforts should be directed at reducing the abdomen not the weight. He also referred to the White Fat, Yellow Fat and the Brown Fat. It is the white fats which are the terrorists who go out and do bomb blasts. He also talked about the epigenetic which is destroyed by fast food. At the medical schools, we give degrees but do not educate people. Life style changes are extremely important and very much needed. He suggested that we must educate people to become slow eaters. About six thousand steps walk daily is a must; ten thousand steps are needed for prevention of metabolic syndrome. It is important to eat something in a very little quantity before going for walk. Plain rice will not result in obesity. Managing metabolic syndrome is an important aspect of preventive cardiology, he added.


Dr. Tahir Naveed highlighted the importance of CT Angiography in Acute Chest Pain. All patients coming in emergency, he said, are treated free but we must remember that some one pays for that. He discussed in detail diagnosis of acute chest pain, management of Acute Coronary Syndrome and Pulmonary embolism. Dr. Imran Hameed spoke about management of masked hypertension. Ambulatory Blood Pressure Monitoring is good but this modality is not available at most of the medical institutions, he added.

Prof. Saulat Siddique discussed the importance of home blood pressure monitoring and its significance in BP control. Home BP monitoring, he opined, is a useful tool provided one knows how it use it. The BP instrument must be validated and one should also make sure to use correct size of the cuff. Take two to three readings after one or two minute’s interval. Readings, he pointed out, are altered by Cuff size. It is also important that the arm should be at the right position while taking BP, monitor must be validated to begin with, use right size of the Cuff and ensure correct place of the heart level. Blood Pressure will also vary at various time hence take the Blood Pressure at the same time.


Prof. Hafeezullah Khan was the next speaker who spoke about the evolving role of single pill combination in the management of hypertension. He pointed out that reduction of 10mmhg blood pressure reduces the risk of CAD by 20%, Stroke by 27%, and Heart Failure by 28% and all cause mortality by 13%. Studies also show that only 17% of the people treated for hypertension have achieved blood pressure control. Hence it is important to treat these patients to get to the targets. Combination of ACEIs, ARBs and Diuretics are being used. Combination of two drugs control blood pressure in 60% of the patients. At present one third of the patients are taking three drugs. He was of the view that increasing the dose of any antihypertensive will not work but we need to add a new drug if patients is not under control. It will also help in reducing the blood pressure, reduction of stroke that is why more people are now using three drugs combination. This combination is also economical but it can also lead to hypotension if not used properly. He then highlighted the safety and efficacy of single pill combination of Perindopril/Indapamide and Amlodipine in uncontrolled essential hypertension. Higher is the blood pressure, higher is the reduction with the use of this combination. This combination single Pill is safe, effective, enhances patient compliance with therapy. Inclusion of Amlodipine reduces the chances of cough which is a known side effect of ACE Inhibitors. It has fewer side effects and ensures better compliance, he remarked.

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