Hyderabad, December 19th, 2017 : Doctors at Apollo Cancer Institute led by Senior Surgical Oncologists, performed a complicated Robotic surgery, spanning over four hours to remove a rare tumour called Aortocaval Paraganglionoma, causing serious life threatening complications to a 30 year old  young man. This is the first such procedure attempted in the twin states of Telangana and Andhra Pradesh, for an extra adrenal tumour.

Aortocaval Paraganglionoma is a rare tumour that develops from cells outside the adrenal glands between the two main blood vessels of Vena Cava and Aorta, in close proximity of the critical nerves in the abdominal area. This tumour, which can be malignant in 40% cases, can occur in any age group, but is usually seen in young adults. These tumours have very short history due to dangerously high Blood Pressure and often present early. They require good clinical expertise to diagnose early. In the long run they can cause irreversible heart and kidney damage and lead to brain stroke.

The patient Mr B. Raju Naik, a Sales Officer by profession from Warangal, was in extreme distress, when he visited Apollo Cancer Institute. The tumour led to release of excessive hormones causing uncontrolled hypertension and consequently severe headache, convulsions, loss of vision, heart and kidney damage, within a short period of one month since the initial symptoms. He visited three different hospitals, which stabilised his unusually high BP with four medicines, diagnosed the ailment and referred to us for further treatment. However during this interim period he had episodes of siezure, unconsciousness, dizziness, visual disturbance.

The permanent cure for this problem is by Surgery, which was attempted after initial control of BP by many medicines. The surgery itself is very tricky and risky. While administering anaesthesia and performing surgery, the BP can rapidly shoot up to dangerously high levels and abruptly fall to very low levels. Therefore an expert team of anaesthetists led by Dr G Shekhar Reddy, constantly monitored and deftly handled the situation during the course of the surgery. The case was also complicated because of the unusual location of the tumour in an area which is inaccessible and risky.

In this patient the tumour was embedded deep in the abdomen and densely struck on two major blood vessels of the body (IVC & Aorta), making it difficult for us to identify a safe approach to it. This prompted us to utilise the deft manoeuvrability offered by Robot to remove the tumour and we foresaw a better outcome with robotics than Laparoscopy or Open Laparotomy, says Dr Hemanth Vudayaraju.

The tumour was eventually removed by a robotic surgery approach in which 5 small incisions (1cm or less) were made and long instruments placed in the abdomen. The surgery was performed with the surgical Robot controlled by the surgeon instead of the usual Open Laparotomy approach which requires a 15 – 20 cm incision. The procedure lasted 4 hours. The patient has since recovered well from the procedure and was fit for discharge on the 3^rd day, instead of the 10 days. Now, a week after the surgery he is totally off the hypertension medicines.

Robotic Surgery presents innumerable advantages to the surgeon and the patient, including magnified 3D vision, high instrument dexterity, high precision, small or no scars, less pain, rapid recovery, no wound related compilations, minimal blood loss, therefore no need for blood transfusions. Hospital and ICU stay for the patient is reduced, early recovery means rapid return to normalcy and work, says Dr Chinnababu Sunkavalli.

About Apollo Hospitals

It was in 1983, that Dr. Prathap Reddy made a pioneering endeavour by launching India’s first corporate hospital – Apollo Hospitals in Chennai. Over the years Apollo Hospitals has established itself as home to the largest cardiac practice in India with over 160,000 cardiac surgeries. Apollo Hospitals is also the world’s largest private cancer care provider and runs the world’s leading solid organ transplant program.

As Asia’s largest and most trusted healthcare group, its presence includes 9,215 beds across 64 Hospitals, 2,500 Pharmacies, over 90 Primary Care and Diagnostic Clinics, 110  plus Telemedicine Centres and 80 plus Apollo Munich Insurance branches spanning  the length and breadth of the Country.

As an integrated healthcare service provider with Health Insurance services, Global Projects Consultancy capability, over 15 medical education centres and a Research Foundation with a focus on global Clinical Trials, epidemiological studies, stem cell & genetic research Apollo Hospitals has been at the forefront of new medical breakthroughs with the most recent investment being that of commissioning the first Proton Therapy Center across Asia, Africa and Australia in Chennai, India. Every four days, the Apollo Hospitals Group touches a million lives, in its mission to bring healthcare of International standards within the reach of every individual.

In a rare honour, the Government of India issued a commemorative stamp in recognition of Apollos contribution, the first for a healthcare organization. Apollo Hospitals Chairman, Dr. Prathap C Reddy, was conferred with the prestigious Padma Vibhushan in 2010. For more than 30 years, the Apollo Hospitals Group has continuously excelled and maintained leadership in medical innovation, world-class clinical services and cutting-edge technology. Our hospitals are consistently ranked amongst the best hospitals globally for advanced medical services and research.

Hyderabad, May 16th, 2017: World Hypertension Day (WHD) is observed on 17th of May every year to raise awareness on Hypertension and World Hypertension League (WHL) ensures its observation world over. The theme of WHD is ‘Know Your Numbers’ with an aim to increase awareness on high blood pressure. The theme being pertinent considering that only 50% of those with hypertension are aware of their condition. In certain communities the awareness is as dismally low as 10%. Of those who are diagnosed, less than half are treated and only a small percentage achieve normal BP levels. WHD is to raise the awareness levels and make individuals conscious about hypertension and the necessary precautions. Incidentally, the South Asia Regional Office of World Hypertension League is located in Hyderabad at Apollo Hospitals, Jubilee Hills.

• incidence as high as 36% amongst adults in urban areas & 30% of the adults in the rural areas
• being responsible for 1.1 million deaths annually, accounting for nearly 11% of all deaths in India
• afflicting ‘growing’ number of children and young

High BP can cause heart attacks, heart failure, stroke-paralysis, loss of memory, and kidney failure. If these complications occurs,life becomes miserable—frequent visits to the doctor, frequent hospitalizations, chronic illness, surgery, stents, dialysis, loss of productivity, and deprivation of life. Fortunately, one can diagnose high BP easily, get treated in order to remain healthy. If the diagnosis is doubtful, one can undergo 24 hr BP recordings with an automatic device—to confirm or exclude the diagnosis. Every adult should know their BP number—like knowing one’s name, age, weight, height, YOU MUST KNOW YOUR NUMBERS. Get the BP checked. Otherwise, you are gambling with life.

All individuals should have a BP less than 140/90; those with diabetes, heart disease, kidney disease should have a BP less than 135/85. BPs greater than 140/90 will cause irreparable damage, as it is the No.1 cause of heart disease, stroke, paralysis and dementia in our country, and the patient can become a huge social/financial burden for the family. To live long and free of disease, one needs to keep the BP normal always—24 hours a day. No exceptions, he says.

National studies have shown that nearly 30-35% of adults in Hyderabad and Telangana have high BP levels. But sadly, only less than 10% know that they have high BP. Unless we control high BP in Hyderabad and in our state, danger is looming, a Tsunami is heading our way. All this suffering can be avoided through awareness, early diagnosis, and correct management of high BP. People should be aware that unless checked, they may be in the dark. GET THE BP CHECKED. And be treated. Costs including financial/social/societal of untreated high BP are astronomical. According to estimates the annual cost of medical care of patients with hypertension related disease in India is $20 billion. Vascular surgery, heart surgery, dialysis, transplantation, and stroke rehabilitation are very expensive. So, be smart and prevent these complications by keeping your BP normal. With life-style changes, dietary caution, and medicines, it is possible to lower your BP. But if the BP is neglected or not treated early on, it is tough to get it under control. So, the key is awareness, early diagnosis, and early treatment. Waiting is harmful. BP will not evaporate, it stays and gets worse.

Mind you, BP has to be treated indefinitely. If you are on the medicine, you have to take it indefinitely and not cyclically. BP medicines are not like antibiotics, you should not stop the medicines unless advised by the doctors. Patients assume that the treatment is only for few days and then, they stop. No, BP treatment is not seasonal or as you wish. You must remain on treatment unless there is a reason and that too only under medical supervision. Don’t take life in your hands; don’t go through the red signal of high BP. Go through when the signal becomes green, which is normal BP.

In some patients, the high BP could be because of “secondary” hypertension, like Thyroid gland disease, adrenal gland problems, blockage of circulation to the kidney, certain kidney ailments. Heavy snoring/ sleep apnea can cause very high BP and the remedy is to treat the snoring disorder. BP problems in pregnancy can be extremely dangerous for the mother and the fetus. Excessive alcohol use or pain relievers can cause high BP. Patients with secondary hypertension can be cured or improved by correcting the underlying cause. The doctors can suspect a secondary cause and if it is fixed, BP will become normal.

It also manifests differently in different people, in some the blood pressure goes up only in the doctor’s office or hospital, but is normal outside (at home or work), this is called “white coat hypertension.” Nervous individuals, and “tense” people may have white coat hypertension. In some others, the blood pressure is normal in the doctor’s clinic or hospital but is high outside (at home or work). This is called “reverse” white coat hypertension or “masked” hypertension. We can diagnose these abnormal condition by measuring 24 hr blood pressure (at home or work) with an automatic machine.

Unfortunately, high BP is striking young individuals in our city, the condition is turning alarming and a cause for great concern. If we don’t take care of this immediately, the young are at a risk of stroke/paralysis, heart attack, and kidney failure. BP should be checked even in the young at schools, colleges, work place, IT industry, etc. The trend of high BP in the young is extremely serious and requires urgent attention.

Apollo hospital’s BP clinic and BP institute specialize in hypertension where proper testing , monitoring, and treatment facilities are available through dedicated staff—specializing in hypertension, a one of its kind Clinic in Asia. At Apollo, we can even measure the blood pressure in the heart (non-invasively) and it is one of the best ways to know if you really have high blood pressure. In some people high blood pressure may be due to a cause in the body called “secondary” hypertension. Certain endocrine gland diseases, blockage of circulation to the kidney, and kidney problems can cause “secondary” hypertension which can be cured by correcting the underlying cause. We have many patients in whom the blood pressure was “cured” by correcting/rectifying the underlying cause. Evaluation for “secondary” hypertension is very critical in young individuals with hypertension. Don’t forget the correct “work-up.” By choosing appropriate treatment, blood pressure can be made normal. Choosing the right drugs is the key to successful control of hypertension.

Here are actual examples of few patients seen last week at Apollo in whom the blood pressure was very high but could be controlled and made normal by proper and precise use of blood pressure lowering medicines.

Patient Age Blood pressure before treatment Blood pressure after correct treatment

1 41/M              160/102   110/70
2 58/F               172/104   120/70
3 65/F               182/100   120/72
4 65/M              160/108   110/70
5 41/M              180/102   110/70
6 72/F (Dr)        160/102   132/82
7 65/M              166/94     142/82
8 41/M              154/100   132/82

The moral is—know your BP number, like knowing your weight and height. KNOW YOUR BP number—like knowing your age. No excuse. Healthy individual contributes to a healthy family which contributes to a healthy society which contributes to healthy nation. Without a healthy nation, GDP or growth rate become irrelevant.

This is significant considering that only 50% of those with hypertension are aware of their condition. In certain communities the awareness is as dismally low as 10%. Of those who are diagnosed, less than half are treated and only a small percentage achieve normal BP levels. WHD will raise the awareness levels and make individuals conscious about hypertension and the necessary precautions.

Briefing media about World Hypertension Day and its importance in Indian context at a Press conference at Apollo Health City, Hyderabad, Dr. Venkata said, India is unfortunately being dubbed as the ‘Hypertension Capital’ of the world, due to Hypertension
Incidence being as high as 36% amongst adults in urban areas and 30% of the adults in the rural areas.
Being responsible for 1.1 million deaths annually, accounting for nearly 11% of all deaths in India
Afflicting ‘growing’ number of children and young

The Indian medical fraternity is gravely concerned about the impending threat of Blood Pressure overwhelming the Indian populace and we as a nation being on the brink of significant health related repercussions including cardiovascular disaster, stroke, peripheral artery disease, chronic kidney disease etc. This he says can be stemmed only through concerted measures to detect and treat hypertension effectively.

Hypertension also known as High blood pressure (high BP) is a major risk factor for heart attacks, heart failure, kidney failure, stroke-paralysis and loss of memory. The normal BP level for all adults should be under 140/90 mm Hg day and night. If the patient also has diabetes, the BP level should be close to 130/80 mm Hg. Once hypertension is documented, certain life style changes have to be made, including reduction of salt intake, alcohol consumption and weight, besides greater physical activity and use of individual anti-hypertensive drug or drug combinations as initial therapy.

According to Dr there are problems in effectively controlling High BP in India including non-compliance by patients in taking prescribed medicines regularly and stopping of taking medication once the BP level becomes normal under the notion that they are cured, he says.

The Apollo Institute for Blood Pressure Management, the only comprehensive centre in entire South Asia for the evaluation and treatment of high Blood Pressure with latest techniques, has advanced tools to accurately diagnose hypertension. The Institute has an automatic device to monitor and record Blood Pressure round the clock and provide entire BP profile. This is significant as BP level not receding during sleep can be ominous with risks of stroke, paralysis and heart attacks. The Institute and Blood Pressure Clinics at Apollo also have facility to check the blood pressure in the heart (central aortic blood pressure). It is the BP level in the heart which is the true indicator of the BP and not the measure of the BP in the arm. The Institute lays thrust on measuring the damage to heart, brain and kidneys from high BP and counselling on corrective treatment. The advanced protocols Apollo Institute for Blood Pressure Management, practices has contributed to it being designated as the South Asia office of the World Hypertension League (WHL)/ WHO, to co-ordinate BP control efforts in the region.

Hyderabad, May 15^th, 2015: World Hypertension Day (WHD) is observed on 17th of May to raise awareness on Hypertension. The theme of WHD is ‘Know Your Numbers’ with an aim to increase awareness on high blood pressure. This is significant considering that only 50% of those with hypertension are aware of their condition. In certain communities the awareness is as dismally low as 10%. Of those who are diagnosed, less than half are treated and only a small percentage achieve normal BP levels. WHD will raise the awareness levels and make individuals conscious about hypertension and the necessary precautions.

• incidence being as high as 36% amongst adults in urban areas and 30% of the adults in the rural areas.
• being responsible for 1.1 million deaths annually, accounting for nearly 11% of all deaths in India
• afflicting ‘growing’ number of children and young

The Indian medical fraternity is gravely concerned about the impending threat of Blood Pressure overwhelming the Indian populace and we as a nation being on the brink of significant health related repercussions including cardiovascular disaster, stroke, peripheral artery disease, chronic kidney disease etc. This he says can be stemmed only through concerted measures to detect and treat hypertension effectively.

Hypertension also known as High blood pressure (high BP) is a major risk factor for heart attacks, heart failure, kidney failure, stroke-paralysis and loss of memory. The normal BP level for all adults should be under 140/90 mm Hg day and night. If the patient also has diabetes, the BP level should be close to 130/80 mm Hg. According to him, once hypertension is documented, certain life style changes have to be made, including reduction of salt intake, alcohol consumption and weight, besides greater physical activity and use of individual anti-hypertensive drug or drug combinations as initial therapy.

According to Dr, there are problems in effectively controlling High BP in India including non-compliance by patients in taking prescribed medicines regularly and stopping of taking medication once the BP level becomes normal under the notion that they are cured, he says.

The Apollo Institute for Blood Pressure Management – the only comprehensive centre in entire South Asia for the evaluation and treatment of high Blood Pressure with latest techniques, has advanced tools to accurately diagnose hypertension. The Institute has an automatic device to monitor and record Blood Pressure round the clock and provide entire BP profile. This is significant as BP level not receding during sleep can be ominous with risks of stroke, paralysis and heart attacks. The Institute and Blood Pressure Clinics at Apollo also have facility to check the blood pressure in the heart (central aortic blood pressure). It is the BP level in the heart which is the true indicator of the BP and not the measure of the BP in the arm. The Institute lays thrust on measuring the damage to heart, brain and kidneys from high BP and counselling on corrective treatment. The advanced protocols Apollo Institute for Blood Pressure Management, practices has contributed to it being designated as the South Asia office of the World Hypertension League (WHL)/ WHO, to co-ordinate BP control efforts in the region.