Kulvinder Pollono

Approximately 1 in 3, more than 100 million, American adults have high blood pressure. But only half of those people have their condition under control. Many people develop high blood pressure when they are in their late 30’s or early 40’s, and it occurs more frequently as people age. However, because of the obesity epidemic, more and more children are also developing high blood pressure.

Blood pressure is defined as the force of blood pushing against the walls of the arteries as the heart pumps blood. High blood pressure – also known as hypertension – is a disease in which blood flows through blood vessels (arteries) at a higher than normal pressure.

Blood pressure is measured with two numbers. The first, or top number, is the pressure in your blood vessels when your heart beats, called the systolic pressure. Systolic pressure is the higher of the two numbers. The second, or bottom number, measures the force of blood in your arteries while your heart is relaxed between beats. The bottom number is the lower of the two and is called the diastolic pressure.

Normal pressure is 120/80 or lower. Your blood pressure is considered high (stage 1) if it reads 130/80. Stage 2 high blood pressure is 140/90 or higher. If you get a blood pressure reading of 180/110 or higher more than once, seek medical treatment right away. A reading this high is considered “hypertensive crisis.”

Readings between 120/80 and 129/89 are considered pre-hypertension. People with pre-hypertension do not have blood pressure as low as it should be but are not yet considered to have high blood pressure.

Early detection of high blood pressure is very important. Often referred to as the “silent killer” because it may show no symptoms, high blood pressure puts you at an increased risk for heart disease, heart failure, and stroke, among other things. According to the Centers for Disease Control and Prevention, in 2013, more than 360,000 deaths in the United States included high blood pressure as a primary or contributing cause.

Treatment of high blood pressure often starts with lifestyle changes, including decreasing salt in your diet, losing weight if necessary, stopping smoking, cutting down on alcohol use, and regular exercise.

In addition to lifestyle changes, medications are often used to lower blood pressure. There are several types of medications that treat high blood pressure with each type of medication having benefits and risks that should be carefully weighed by you and your health care provider. Most people take more than one medication in order to bring their blood pressure down to their treatment goal.

Your blood pressure medication should begin to work within days. However, because high blood pressure is a long-lasting medical condition that often has little or no symptoms, remembering to take your medications can be a challenge. Combination medicines, long-acting or once-a-day medications, may be used to decrease the burden of taking numerous medications and help ensure medications regularly. Once started, the medication should be used until your doctor tells you to stop.

Controlling your blood pressure should be part of a healthy living plan and lifelong task. The damage that high blood pressure causes your internal organs does not cause any symptoms until serious damage has been done.

By taking charge of your health, you can help control the silent killer. It’s all about knowing who, what, why, and how!

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The world’s biggest vaccine producer has found itself under growing pressure to meet global Covid-19 jab delivery targets, after export restrictions were imposed by the Indian government in response to surging Covid-19 cases in the country.

The Serum Institute of India (SII) last year pledged to provide 550 million AstraZeneca (AZ) vaccine doses to 92 low- and middle-income countries under Gavi’s COVAX Facility, but the government’s instruction to prioritise domestic demand will see international deliveries of the AZ vaccine significantly delayed. The situation is particularly dire for Africa, where much of the vaccine supply was set to be delivered through COVAX.

At over 112 million doses so far, India has administered the most AZ shots – labelled there as Covishield – in the world. Despite the initial success of its vaccination programme, the country has since been overwhelmed by a second wave of the virus; some 200,000 Covid-19 cases have been reported daily in the country since 15 April, and at least five states are seeing severe vaccine shortages. India’s capital Delhi went into lockdown this week, with hospitals in the area reporting a lack of beds, oxygen and necessary medicines.

Back in February, SII CEO Adar Poonawalla tweeted an appeal for patience from those expecting vaccine deliveries: “Dear countries & governments, as you await #COVISHIELD supplies, I humbly request you to please be patient, [Serum Institute of India] has been directed to prioritise the huge needs of India and along with that balance the needs of the rest of the world. We are trying our best.”

This month, Poonawalla told Indian news outlet NDTV that despite restricting its vaccine output to India only, the manufacturer was “still short of being able to supply to every Indian”.

Under mounting pressure to meet both India’s target of 250 million people vaccinated by July and the institute’s international commitments, SII recently appealed to the government for funding to help ramp up its “very stressed” production capacity. According to a report by the Economic Times, the Indian government is set to grant the SII’s request of 30 billion rupees – which it hopes will be enough to boost production of the AZ vaccine from 70 million doses to over 100 million by the end of May.

If demands from its own government weren’t enough, the SII was this month served a legal notice by AstraZeneca for failing to meet international vaccine delivery obligations.

Poonawalla told Business Standard: “I cannot comment on the legal notice as it is confidential, but we are examining all avenues to amicably manage and resolve legal disputes over contractual obligations that Serum Institute is not able to fulfil due to its prioritisation of Indian supplies.”

The difficult circumstances SII finds itself in have been compounded by a US ban on the export of raw materials needed to produce Covid-19 vaccines. In response to the pandemic, President Biden this year invoked the Defense Production Act, legislation that grants US vaccine makers priority access to specialised materials and equipment.  While the act is helping manufacturers ramp up vaccine production efforts on American soil, it can result in shortages for companies making vaccines overseas.

Analysis by the Economist predicts that India will see production lines come to a halt in a matter of weeks unless the US provides a number of critical items, from vaccine ingredients to filters and plastic tubing used in manufacturing. In addition to AZ, SII is set to manufacture millions of Novavax jab doses in the coming months – so further production issues could mean strained relations with more than one pharma company.

Taking to Twitter last week, Poonawalla urged Biden directly to end the export ban:

Reuters reported on Tuesday that the export restrictions could eventually be lifted following a discussion between foreign ministers from the US and India. According to a US official, Biden was considering India’s request to scrap the ban and would act upon it “at the earliest”.

As the biggest vaccine maker in the world, producing as many as 1.5 billion doses every year, SII is among the organisations best equipped to meet the unprecedented demands of Covid-19. Poonawalla even said in an interview with the Independent that it would be “relatively straightforward for [SII] to be able to handle” a situation like the pandemic. Now, with India facing the world’s worst surge in coronavirus infections, economically disadvantaged nations relying largely on SII for vaccines, and dwindling supplies of items essential to jab production, the manufacturer is facing more obstacles than it had predicted.

Interactive map designed by Ovanes Penchev. Click here for a more detailed look at inequalities in Covid-19 vaccine manufacturing capacity, courtesy of Investment Monitor.

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