High Blood Pressure

Hypertension Exercise Program

Best Treatment for Hypertension

Get Instant Access

High blood pressure, or hypertension, increases your chances of developing heart disease or kidney disease and of having a stroke. About one in every four American adults has high blood pressure but may not be aware of it. It is often called "the silent killer" because it usually causes no symptoms. However, high blood pressure is easy to diagnose, and there are practical steps you can take to bring your blood pressure under control.

Blood pressure is the force of blood pushing against the walls of the arteries that carry blood throughout your body. It is measured in millimeters of mercury, or mm Hg, using an instrument called a sphygmomanometer (pronounced sfig'mo-mah-nom'e-ter). Blood pressure is highest when the heart contracts (beats) and pumps blood into the arteries. This is called the systolic pressure. Between beats, when the heart is resting, the pressure falls. This is called the diastolic pressure. A blood pressure reading is always given as a combination of these two pressures; the high (systolic) pressure is written above or before the low (diastolic) pressure. For example, if your blood pressure reading is 120 over 70, it is written as 120/70 mm Hg; 120 is the systolic pressure, and 70 is the diastolic pressure.

Heart, Blood, and Circulation

Common

Health

Concerns

Different activities make your blood pressure rise or fall. For example, normally, blood pressure rises when you are exercising and falls when you are resting. A blood pressure reading of 140/90 mm Hg or lower is generally considered normal. High blood pressure is classified according to guidelines that reflect the levels at which blood pressure begins to pose significant health risks.

The guidelines for classifying blood pressure are shown in the following table:

Blood Pressure Classifications for People Age 18 and Older

Category Systolic Diastolic

Optimal blood pressure Lower than 120 mm Hg

Normal blood pressure Lower than 130 mm Hg High-normal blood pressure 130 to 139 mm Hg High blood pressure

Stage I 140 to 159 mm Hg

Stage II 160 to 179 mm Hg

Stage III 180 mm Hg or more

Lower than 80 mm Hg Lower than 85 mm Hg 85 to 89 mm Hg

90 to 99 mm Hg 100 to 109 mm Hg 100 mm Hg or more

A diagnosis of high blood pressure is based on two or more blood pressure readings taken at separate visits to the doctor's office. If your systolic pressure falls into one category and your diastolic pressure into another, the higher reading will be used to classify your blood pressure. For example, a blood pressure of 160/90 mm Hg would be classified as stage II. A reading of 170/120 mm Hg would be classified as stage III.

Because diastolic pressure represents the lower and more constant level of pressure in the arteries, physicians may emphasize it more, especially in younger people. However, the systolic blood pressure is more important for determining the risk of heart attack or stroke.

People with high blood pressure have elevated blood pressure most of the time. Their blood is pushing against the walls of their arteries with higher than normal force. If left untreated, high blood pressure can lead to:

• Atherosclerosis. Uncontrolled high blood pressure causes the artery walls to thicken and lose elasticity. This encourages formation of fatty deposits on the artery wall, which narrow the channel and interfere with blood flow throughout the body. In time, atherosclerosis can lead to a heart attack or a stroke.

• Enlarged heart. High blood pressure causes the heart to work harder. Over time this causes the heart muscle to thicken and stretch. The heart becomes less efficient and has to work harder and harder to pump blood throughout the body. Eventually this can result in heart failure.

Kidney damage. The kidneys act as filters to rid the body of wastes. Over a number of years, high blood pressure can narrow and thicken the blood ves-

sels of the kidneys. The kidneys then filter less blood, and waste builds up in the bloodstream. This could lead to kidney failure. When kidney failure occurs, dialysis (a technique to remove waste products from the blood and excess fluids from the body) or a kidney transplant may be necessary. • Stroke. High blood pressure can weaken the walls of the arteries or cause them to thicken. A weakened artery wall in the brain could break, causing a hemorrhage. If a blood clot blocks one of the narrowed arteries, a stroke may occur.

In most cases, the cause or causes of high blood pressure are unknown. This type is known as primary or essential hypertension. Primary hypertension cannot be cured, but it can be controlled. Secondary hypertension is caused by, or is "secondary" to, another disease. For example, some cases of high blood pressure can be traced to tumors of the adrenal gland, chronic kidney disease, or hormone abnormalities. Secondary hypertension can be cured by treating its underlying cause.

Heart, Blood, and Circulation

Risk Factors for High Blood Pressure

You are at increased risk for develop-i ing high blood pressure if you have one or more of the following risk factors:

You have close family members (parents, grandparents, or siblings) who have high blood pressure. You are African American. You are a male over age 35. You are overweight. You do not exercise regularly. You use tobacco products (cigarettes, cigars, pipe, or smokeless tobacco). You regularly consume more than two alcoholic drinks per day.

Preventing High Blood Pressure

Anyone, regardless of age, sex, race, or heredity, can lower his or her risk of developing high blood pressure or lower existing high blood pressure by taking the steps described here.

Maintain a healthy weight. As your body weight increases, your blood pressure rises. In fact, being overweight can make you two to six times more likely to develop high blood pressure than if you maintain a desirable weight (see the weight chart on page 69).

It's not just how much you weigh that is important; it also matters where your body stores excess fat. Your body shape is inherited from your parents, just like the color of your eyes and hair. Some people tend to store fat around their waists, while others store fat around the hips and thighs. "Apple-shaped" people who store extra fat at the waist appear to have higher health risks than "pear-shaped" people who store fat around the hips and thighs.

No matter where your extra weight is located, you can reduce your risk of developing high blood pressure by losing weight. Even a small weight loss can make a big difference. And if you are overweight and already have high blood pressure, losing weight can help you lower your blood pressure.

To lose weight, you need to consume fewer calories than you burn. But don't try to lose weight too quickly. The healthiest way to lose weight and keep it off is to do it gradually, by losing about a pound a week. By taking in 500 calories less

Common

Health

Concerns per day and being more physically active, you should be able to lose about a pound (which equals 3,500 calories) a week.

Losing weight and keeping it off involves making permanent lifestyle changes. Here's how to eat healthfully and lose weight:

• Choose foods that are low in calories, sugar, and fat. Naturally, choosing low-calorie foods cuts calories. But choosing foods low in fat also can cut calories. Fat is a concentrated source of calories, so eating fewer fatty foods will help reduce your calorie intake. Cutting back on butter, margarine, fatty salad dressings, fatty meats, skin on poultry, full-fat dairy products such as milk and cheese, fried foods, and sweets will also improve your cholesterol profile.

• Choose foods that are high in fiber. These include fruits; vegetables; whole-grain foods such as cereal, pasta, and bread; and dried peas and beans. Foods high in fiber are excellent substitutes for foods high in fat. The former are lower in calories and are a good source of essential vitamins and minerals.

• Limit serving sizes. When trying to lose weight, it's not just the types of foods you eat, but how much you eat. To take in fewer calories, you need to limit your portion sizes. Try especially to take smaller helpings of high-calorie foods such as fatty meats and cheeses. And try not to go back for seconds. Today many restaurants take pride in serving large portions of food. This does not mean that you have to clean your plate. Choose the doggy-bag option; eat only half of what you are served and take the rest home for an excellent "free meal" the next day.

• Keep track of what you eat, when you eat, and why you eat. Write it down. Note whether you snack on high-calorie foods while watching television or if you skip breakfast and then eat a large lunch. Once you clearly see your eating habits, you can set goals for yourself—for example, cutting back on TV snacks or, when you do snack, having fresh fruit, low-fat or air-popped popcorn, or vegetables such as carrots and celery. If there's no time to eat breakfast at home, take fruit, a bagel (skip the cream cheese), or whole-grain cereal with you to eat at work. Changing your eating habits will help you change your weight (see page 73).

Exercise regularly. Another way to lose weight and control blood pressure is through regular physical activity. Cutting down on fat and calories combined with regular exercise can help you lose more weight and keep it off longer than with either diet or exercise alone.

Aerobic exercise provides added benefits. It helps improve the fitness of your heart, blood vessels, and lungs, which, in turn, protects you against heart disease. Activities such as stair climbing, bicycling, swimming, brisk walking, running, and jumping rope are called "aerobic," which means that the body uses oxygen to make the energy it needs during the activity. Aerobic activities provide health benefits if done at the right intensity for at least 20 to 30 minutes, three to four times per week. If you think you don't have time to exercise, try to exercise for two 15-minute periods or even three 10-minute periods during your day. You will still gain health benefits. (For more information on the health benefits of aerobic exercise, see page 56.)

You need to see your doctor before starting an exercise program if you:

• have a health problem such as high blood pressure

• tend to feel dizzy or faint

• have difficulty breathing after a mild workout

• are middle-aged or older and have not been active

• are planning a vigorous exercise program

Otherwise, get up off the couch, get out, get active, and get fit.

Choose foods that are lower in salt. Most Americans take in more salt (sodium) than they need, which may help explain why the United States has higher rates of high blood pressure than countries where people eat less salt. Salt attracts water. Normally, if you have eaten too much salt, your kidneys eliminate the excess salt from your body along with a certain amount of water. But if your kidneys cannot get rid of the extra salt, your body retains the water that clings to the salt, which raises blood volume and, in some people, blood pressure.

Certain people appear to be salt-sensitive, which means that their blood pressure goes up when they eat salt. Researchers think that about half of all people with high blood pressure are salt-sensitive and that as many as 70 to 80 percent of blacks are salt-sensitive. Other groups that seem to have a high incidence of salt sensitivity are older people, people who have diabetes, and people who are overweight. There is a good chance that if you are a member of one or more of these groups, decreasing your salt intake would be beneficial to your health.

Research suggests that the average person needs only about 200 milligrams of sodium per day. Doctors recommend that people with high blood pressure take in no more than about 6 grams of salt per day, which equals about 2,400 milligrams of sodium, or about 1 teaspoon of table salt. A teaspoon of salt may seem like a lot to you, but remember that this refers to total salt intake for a day. This includes salt in processed and prepared foods, salt added during cooking, and salt sprinkled on food at the table. Americans eat an average of 4,000 to 6,000 milligrams of sodium each day, so many people could probably benefit from cutting back on their salt intake.

The key to cutting back on salt is in teaching your taste buds to enjoy less salty foods. Here are a few tips for cutting back on salt:

• Check food labels for the amount of salt in the foods you buy. Choose foods that are low in sodium. Look for labels that say "sodium-free," "very low in

Heart, Blood, and Circulation

Common

Health

Concerns sodium," "low sodium," "light in sodium," "reduced sodium," "less sodium," or "unsalted." Then check the label for the amount of sodium per serving. Choose fresh or frozen vegetables, or canned vegetables labeled "no salt added." Choose fresh poultry, fish, and lean meat rather than canned, cured, smoked, or processed varieties.

Use herbs, spices, salt-free seasoning blends, and lemon juice instead of salt to add flavor to your food.

Cook rice, pasta, and hot cereals without salt. Avoid using instant or flavored rice, pasta, and cereal mixes because they usually have added salt. Choose "convenience" foods that are low in sodium. Cut back on frozen dinners, packaged dinners such as macaroni and cheese, packaged mixes, canned soups or broths, and salad dressings, which often contain large amounts of sodium.

Buy low-sodium, reduced-sodium, or no-salt-added versions of canned soups, dried soup mixes, or bouillon; canned vegetables and vegetable juices; low-fat cheeses; margarine; condiments such as ketchup or soy sauce; crackers and baked goods; processed lean meats; and snack foods such as chips, pretzels, and nuts.

Rinse canned foods, such as tuna, to remove excess sodium.

Drink alcoholic beverages only in moderation. Drinking too much alcohol can lead to the development of high blood pressure. To prevent high blood pressure, or if you already have high blood pressure, limit yourself to no more than two drinks per day. A drink is defined as 1V2 ounces of 80-proof distilled spirits, 5 ounces of wine, or 12 ounces of beer (regular or "lite").

Do not use tobacco. Although it is not a direct cause of high blood pressure, smoking puts you at risk of developing the disease. The chemicals in tobacco smoke can damage the artery walls, making them more susceptible to plaque formation. Plaques narrow the arteries and interfere with blood flow to the heart, brain, and other organs and tissues. Blood clots can form on the rough surface of a plaque. A blood clot or plaque can block an artery, causing a heart attack or a stroke.

The nicotine in tobacco is a powerful stimulant that causes the heart rate to increase, the arteries to constrict, and blood pressure to rise. Smoking also affects cholesterol levels in the blood: it can increase LDL ("bad" cholesterol) levels and decrease HDL ("good" cholesterol) levels. All of these tobacco-induced effects can contribute to the development of high blood pressure.

Although it is sometimes promoted as a smoke-free alternative to cigarettes and cigars, smokeless tobacco also puts you at risk of developing high blood pressure. The nicotine, sodium, and licorice contained in smokeless tobacco products all can raise blood pressure. Considering these health risks, it makes sense to give up your tobacco habit now.

Here are some other factors that may help prevent high blood pressure:

Potassium. A certain amount of potassium is essential for proper body function. Eating foods rich in potassium may help protect some people from developing high blood pressure. Many people get enough potassium from eating fruits, vegetables, dairy products, and fish, so potassium supplements are rarely needed. Too much potassium can disturb your heart rhythm. Calcium. People with low calcium intake have higher rates of high blood pressure. It is best to get the calcium you need—1,000 to 1,500 milligrams per day for adult men (see page 303)—from the foods you eat. Low-fat and nonfat dairy products such as milk, yogurt, and cheese are excellent sources of calcium. It has not been proven that taking calcium supplements helps prevent high blood pressure.

Magnesium. A diet low in magnesium may make your blood pressure rise. However, doctors do not recommend taking magnesium supplements to help prevent high blood pressure. The amount of magnesium you get in a healthy diet is enough. Magnesium is found in whole grains; green, leafy vegetables; nuts; seeds; and dried peas and beans.

Fish oils. A type of fat called omega-3 fatty acids is found in fatty fish such as mackerel and salmon. Evidence suggests that eating fish at least twice a week can help reduce high blood pressure. Talk to your doctor if you are considering taking fish oil supplements. Most fish, if not fried or prepared with added fat, are low in saturated fat and calories and are a good source of essential nutrients.

Fats, carbohydrates, and protein. Varying the amount and type of fats, carbohydrates, and protein in the diet has little if any effect on blood pressure. But for overall heart health, it is crucial to limit the amount of fat in your diet, especially the saturated fat found in foods such as fatty meats and full-fat dairy products. Saturated fats raise your blood cholesterol level, and a high cholesterol level is another risk factor for heart disease. Foods high in fat are usually also high in calories. Foods high in complex carbohydrates (starch and fiber) are often low in fat and calories—so eat these foods in moderate amounts instead of eating high-fat foods. Always check food labels (see page 7).

Caffeine. The caffeine found in coffee, tea, and colas may cause blood pressure to rise, but only temporarily. In a short time your blood pressure will return to its previous level. Unless you are sensitive to caffeine, you do not have to limit caffeine intake to prevent high blood pressure. Garlic and onions. Increased amounts of garlic and onions have not been found to affect blood pressure. Of course, they are rich in antioxidants and are tasty substitutes for salty seasonings.

Stress management. Stress can make blood pressure go up for a while and over time may contribute to high blood pressure. Stress management techniques

Common

Health

Concerns such as biofeedback, meditation, and relaxation (see page 118) can help you to deal positively with the stress-producing events in your life, and may help you control your blood pressure.

Medications for High Blood Pressure

Medications are usually prescribed for people whose high blood pressure cannot be controlled through lifestyle changes, such as following a healthy diet and exercising regularly. In the past, many people with high blood pressure simply stopped taking their medications because of the unpleasant side effects. It used to be said that the treatment for high blood pressure was worse than the disease. This is no longer true. Newer and more effective drugs have been developed that have fewer side effects. Most people who take antihypertensive medications (drugs that lower blood pressure) feel better after they start taking them.

If you experience unpleasant effects from your antihypertensive medication, discuss these effects with your physician, but continue to take the medication until the doctor tells you to stop. He or she probably will prescribe a substitute medication that will not produce the side effects. Because so many drugs are now available, your doctor can work with you to fine-tune your drug regimen so that you can get the best treatment with the fewest side effects. This also applies in terms of drug costs, which can account for 70 to 80 percent of the cost of treating high blood pressure. If you are concerned about the cost of your medications, discuss it with your physician or pharmacist to see if less expensive alternatives are available.

There are eight categories of antihyperten-sive medications, each having a different method of action. Following is a summary of the types of medications used to treat high blood pressure:

Monitor Your Blood Pressure

If you have been diagnosed with high blood pressure and your doctor has prescribed medication, he or she will ask you to measure your blood pressure regularly to see whether the medication is controlling it effectively.You can purchase a home blood pressure monitor at most pharmacies.

Monitor Your Blood Pressure

If you have been diagnosed with high blood pressure and your doctor has prescribed medication, he or she will ask you to measure your blood pressure regularly to see whether the medication is controlling it effectively.You can purchase a home blood pressure monitor at most pharmacies.

Diuretics increase excretion of water and sodium by the kidneys, thereby reducing the volume of blood the heart has to pump. Diuretics are helpful to blacks, older adults, and people with heart failure or low renin activity. (Renin is an enzyme involved in maintaining the balance of water and sodium in the body.) Possible side effects include erectile dysfunction, decreased sexual desire, muscle cramps, and fatigue. Examples include chlorothiazide, furosemide, and amiloride.

Beta-blockers slow the heart rate and block the output of renin by the kidneys. These drugs are helpful for people with high renin activity, a high resting heart rate, or coronary artery disease. Possible side effects include slow heartbeat, fatigue, and erectile dysfunction. Examples include atenolol, metopro-lol, and propranolol.

Alpha-blockers prevent arteries from constricting and block the effects of the stress hormone epinephrine, which increases blood pressure. These drugs are useful for people who have high cholesterol levels, diabetes, or poor circulation in the arms and legs (peripheral vascular disease). Possible side effects include headache, dizziness, and mild fluid retention. Examples include doxazosin, prazosin, and terazosin.

ACE (angiotensin-converting enzyme) inhibitors block the activity of an enzyme (ACE) that forms a hormone that causes narrowing of blood vessels. These drugs are useful for people with diabetes, congestive heart failure, high renin activity, or certain kidney diseases. The most common side effect is an irritating, dry cough. Examples include benazepril, captopril, enalapril maleate, and lisinopril.

Angiotensin-receptor blockers prevent the arteries from constricting and prevent the kidneys from retaining salt and water. They are useful primarily for people who cannot tolerate ACE inhibitors. Possible side effects are mild and include dizziness, fatigue, and stomach pain. Examples include losartan and valsartan.

Centrally acting drugs act directly on the brain and the nervous system to lower heart rate and peripheral resistance by keeping the arteries from narrowing. These drugs are helpful to people with peripheral vascular disease. Possible side effects include drowsiness, dry mouth, fatigue, and dizziness. Examples include clonidine, guanfacine, and methyldopa. Calcium channel blockers prevent narrowing of the artery walls and also may slow or block the development of plaques. They are helpful for blacks, older adults, and people with unsteady heart rhythms, diabetes, angina, or pulmonary hypertension. Possible side effects include constipation, ankle swelling, headache, and dizziness. Examples include diltiazem, amlodipine, and verapamil.

Vasodilators act directly on the smooth muscle of the arteries to widen artery walls. They are used only in emergencies and for people whose blood pressure cannot be controlled with other drugs. Possible side effects include an abnormally strong, rapid heartbeat (usually more than 100 beats per minute), increased fluid retention, and headache. Examples include hydralazine and minoxidil.

Heart, Blood, and Circulation

Was this article helpful?

0 0
The Smoker's Sanctuary

The Smoker's Sanctuary

Save Your Lungs And Never Have To Spend A Single Cent Of Ciggies Ever Again. According to a recent report from the U.S. government. Centers for Disease Control and Prevention, more than twenty percent of male and female adults in the U.S. smoke cigarettes, while more than eighty percent of them light up a cigarette daily.

Get My Free Ebook


Post a comment