Pressure points: 7 facts about hypertension you can't afford to ignore.They should have seen it coming. Health officials had been pleased to see high blood pressure rates drop between 1960 and 1991. But the nation's obesity obesity, condition resulting from excessive storage of fat in the body. Obesity has been defined as a weight more than 20% above what is considered normal according to standard age, height, and weight tables, or by a complex formula known as the body mass index. epidemic was looming looming: see mirage. . And with Americans eating out more often, anyone who measured the sky-high salt levels in restaurant foods could have predicted trouble. Last July, researchers reported the bad news: high blood pressure is, once again, on the rise. And if you think you don't have to worry about it, you're wrong. More than one out of four adults--and one out of two people over age 60--has high blood pressure. Thirty percent of them don't know Don't know (DK, DKed) "Don't know the trade." A Street expression used whenever one party lacks knowledge of a trade or receives conflicting instructions from the other party. they have it. Twenty-five percent are on medication but their pressure is still above safe levels. Another 10 percent are doing nothing to lower their blood pressure. Yet the evidence for keeping blood pressure low couldn't be more compelling. "Controlling blood pressure lowers the risk of stroke by 35 to 40 percent and the risk of heart attack by 20 to 25 percent," says Aram Chobanian Aram V. Chobanian (born August 8, 1929 in Pawtucket, Rhode Island) was president ad interim of Boston University from 2003 until June 9, 2005, when, in recognition of Chobanian’s work, the Board of Trustees voted to remove “ad interim” from his title and , a hypertension hypertension or high blood pressure, elevated blood pressure resulting from an increase in the amount of blood pumped by the heart or from increased resistance to the flow of blood through the small arterial blood vessels (arterioles). expert and acting president of Boston University Boston University, at Boston, Mass.; coeducational; founded 1839, chartered 1869, first baccalaureate granted 1871. It is composed of 16 schools and colleges. . It also cuts the risk of congestive heart failure congestive heart failure, inability of the heart to expel sufficient blood to keep pace with the metabolic demands of the body. In the healthy individual the heart can tolerate large increases of workload for a considerable length of time. , kidney disease Kidney Disease Definition Kidney disease is a general term for any damage that reduces the functioning of the kidney. Kidney disease is also called renal disease. , and dementia dementia (dĭmĕn`shə) [Lat.,=being out of the mind], progressive deterioration of intellectual faculties resulting in apathy, confusion, and stupor. In the 17th cent. . Here's what you may not know about your blood pressure. 1 Your odds of high blood pressure are 90 percent. If you think high blood pressure is someone else's problem, you're wrong. An estimated 29 percent of adults--more than 58 million Americans--have high blood pressure, up from 25 percent in the early 1990s. But the rest of us aren't in the clear. Blood pressure rises with age in the U.S., so sooner or later, yours is almost certain to reach the level that experts call "high" (see "How High is High?"). "Even if your blood pressure is normal at the age of 55, your life-time risk of developing hypertension is close to 90 percent," says Boston University's Aram Chobanian, who chaired the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. (1) But that doesn't mean that people should wait until their blood pressure is so high that they need drugs to lower it. "Most people will never get hypertension if they follow our lifestyle recommendations," says Stephen Havas, an epidemiologist epidemiologist an expert in epidemiology. at the University of Maryland University of Maryland can refer to:
n.pr established in 1948, this division of the National Institutes of Health is responsible for research and education on cardiovascular, pulmonary, systemic diseases, and sleep disorders. . (2) "At worst, they'll need fewer drugs." The bottom line is clear, says Havas: "Blood pressure is an issue for the entire American public." 2 Your "normal" blood pressure may no longer be normal. Has your doctor called your blood pressure "normal"? It may no longer be. Last year, experts redefined "normal" to mean a blood pressure of less than 120 over less than 80. (That used to be called "optimal.") Anyone with systolic blood pressure Systolic blood pressure Blood pressure when the heart contracts (beats). Mentioned in: Hypertension (the upper number) of 140 or more or diastolic blood pressure Diastolic blood pressure Blood pressure when the heart is resting between beats. Mentioned in: Hypertension (the lower number) of 90 or more has high blood pressure. (That didn't change.) Everyone in between "high" and "normal" has "prehypertension." (That used to be called "normal" or "high-normal.") An estimated 45 million people--roughly one out of five adults--are in the prehypertensive range. The idea behind the name change isn't to scare them. "We don't want to make people nervous for no good reason," says Norman Kaplan, a hypertension authority at the University of Texas Southwestern Medical Center in Dallas. "Marking someone with a blood pressure of 122 over 82 as having a disease would be a mistake. We want to motivate people to improve their lifestyle." The goal isn't just to postpone post·pone tr.v. post·poned, post·pon·ing, post·pones 1. To delay until a future time; put off. See Synonyms at defer1. 2. To place after in importance; subordinate. drug therapy. "Starting at blood pressures as low as 115 over 75, which is considered normal, the risk of heart disease and stroke begins to rise," says Chobanian. And it doubles for each 20-over-10-point increase. So the harm starts long before people get treatment. "Stiffness and other damage to arteries Arteries Blood vessels that carry oxygenated blood away from the heart to the cells, tissues, and organs of the body. Mentioned in: Adrenergic Blockers, Angiotensin-Converting Enzyme Inhibitors, Antihypertensive Drugs, Hypertension, Thrombolytic Therapy, worsen wors·en tr. & intr.v. wors·ened, wors·en·ing, wors·ens To make or become worse. worsen Verb to make or become worse worsening adjn with age and make high blood pressure more and more difficult to treat," explains Claude L'Enfant, former director of the National Heart, Lung, and Blood Institute. 3 You may be under treatment but out of control. Nearly 60 percent of people with hypertension are being treated for the condition, but only about half of them manage to get their blood pressure below "high"--that is, under 140 and under 90. "That's physician noncompliance noncompliance failure of the owner to follow instructions, particularly in administering medication as prescribed; a cause of a less than expected response to treatment. noncompliance ," says Kaplan. "Some of those patients may not be taking their medications, but it's more likely that doctors aren't giving them the right drugs." Most people with high blood pressure need at least two medications to get below 140 over 90, say officials. (If you have diabetes or chronic kidney disease Chronic kidney disease (CKD), also know as chronic renal disease, is a progressive loss of renal function over a period of months or years through five stages. Each stage is a progression through an abnormally low and progressively worse glomerular filtration rate, which is , you need to get below 130 over 80.) "Some physicians' attitude is that all they have to do is put the patient on a pill and forget about it," says Kaplan. Patients shouldn't let them, he adds. "They have to keep working with the doctor to reach a blood pressure that's safe." And that doesn't necessarily mean medicine. "If people aggressively follow our lifestyle recommendations, far fewer would need two drugs," notes Havas. 4 If you're over 50, systolic blood pressure matters more than diastolic Diastolic The phase of blood circulation in which the heart's pumping chambers (ventricles) are being filled with blood. During this phase, the ventricles are at their most relaxed, and the pressure against the walls of the arteries is at its lowest. . Once you're over 50, your systolic blood pressure (the higher number) starts to climb. "As people get older, the blood vessels Blood vessels Tubular channels for blood transport, of which there are three principal types: arteries, capillaries, and veins. Only the larger arteries and veins in the body bear distinct names. get more rigid," explains Kaplan. It's not just age, but clogged arteries, that makes them stiffer. Systolic pressure systolic pressure n. The highest arterial blood pressure reached during any given ventricular cycle. measures how hard the blood presses against your artery artery, blood vessel that conveys blood away from the heart. Except for the pulmonary artery, which carries deoxygenated blood from the heart to the lungs, arteries carry oxygenated blood from the heart to the tissues. walls when your heart beats Discography Track listing # Title 1. I'll Be Over You 3:46 2. Tokyo 3:14 3. Hey (I've Been Feeling Kind Of Lonely) 3:06 4. Only Wanna Be With You 3:54 5. Play It For The Girls 3:30 6. Blue 3:12 7. Purest Delight 3:02 8. . "In older people, the blood vessels don't dilate dilate /di·late/ (di´lat) to stretch an opening or hollow structure beyond its normal dimensions. di·late v. To make or become wider or larger. , or expand, as much as in younger people," says Kaplan. So the pressure rises. Diastolic pressure diastolic pressure n. The lowest arterial blood pressure reached during any given ventricular cycle. , which measures how hard the blood presses against artery walls between heartbeats, may be too low in older people. "In a younger person, when blood flows out of the large arteries and into smaller vessels, the arteries contract," explains Kaplan. But in older people, stiffness keeps the arteries from contracting between beats, so blood pressure drops more than it should. "A diastolic pressure lower than 70 in older people is a risk factor because it reflects atherosclerosis atherosclerosis (ăth'ərōsklərō`sĭs): see arteriosclerosis. atherosclerosis or hardening of the arteries in the arteries," he explains. 5 High blood pressure increases your risk of dementia. The higher your blood pressure, the higher your risk of stroke, heart attack, congestive heart failure, and kidney disease. If that's not enough to motivate you, researchers have added dementia to the list. Thinking ability declines because high blood pressure impairs blood flow to the brain. "It's usually because people with high blood pressure have mini-strokes or are more apt to have obstruction obstruction /ob·struc·tion/ (ob-struk´shun) 1. the act of blocking or clogging. 2. block; occlusion; the state or condition of being clogged.obstruc´tive ob·struc·tion n. or narrowing of the small penetrating blood vessels that nourish nour·ish v. To provide with food or other substances necessary for sustaining life and growth. remote areas of the brain," explains Boston University's Aram Chobanian. The brain cells that get too little blood can die. "You may not pick up a loss of speech or paralysis paralysis or palsy (pôl`zē), complete loss or impairment of the ability to use voluntary muscles, usually as the result of a disorder of the nervous system. , as you would with a stroke," he adds. But the damage is real. 6 Start with diet, not drugs. Experts agree: everyone should follow a lifestyle that lowers blood pressure (see "What Works"). But in the doctor's office, that advice often gets lost. "Most physicians give little attention to lifestyle and focus on drugs," says the University of Maryland's Stephen Havas. That's a shame, he adds, because "there's something everyone can do, regardless of what category their blood pressure falls into." Doctors may emphasize weight loss because it delivers a big bang big bang Model of the origin of the universe, which holds that it emerged from a state of extremely high temperature and density in an explosive expansion 10 billion–15 billion years ago. for the buck. But that approach can backfire. "Losing 40 pounds would lead to a huge drop in blood pressure," says Havas. "But how many people can lose 40 pounds and then sustain that drop in weight?" In fact, you don't have to lose enough to look good in a bathing suit. If you're overweight Overweight Refers to an investment position that is larger than the generally accepted benchmark. Notes: For example, if a company normally holds a portfolio whose weighting of cash is 10%, and then increases cash holdings to 15%, the portfolio would have an overweight , systolic blood pressure drops about one point for every two pounds you shed. And aerobic aerobic /aer·o·bic/ (ar-o´bik) 1. having molecular oxygen present. 2. growing, living, or occurring in the presence of molecular oxygen. 3. requiring oxygen for respiration. 4. exercise--about 30 minutes a day--can lower your blood pressure even if you never lose a pound. "Weight loss can be a bear," says Havas. "But most people can take a walk every day, eat lower-sodium foods and more fruits and vegetables, and restrict alcohol to one or two drinks a day." Cutting sodium would be far easier if the food industry, especially restaurants, would stop dumping on so much salt (see "Shaking the Salt," p. 6). The American Public Health Association The American Public Health Association (APHA) is Washington, D.C.-based professional organization for public health professionals in the United States. Founded in 1872 by Dr. Stephen Smith, APHA has more than 30,000 members worldwide. and the National Heart, Lung, and Blood Institute have urged food makers to cut sodium by half over the next ten years. "Much of the rise in blood pressure that occurs with age is due to the excess sodium we're exposed to for decades," notes Havas. And the DASH diet--with its load of fruits, vegetables, and low-fat dairy foods--may do more than curb blood pressure. (See "The DASH to Lower Blood Pressure.") "The same diet that lowers blood pressure may lower the risk of cancer and osteoporosis osteoporosis (ŏs'tēō'pərō`sĭs), disorder in which the normal replenishment of old bone tissue is severely disrupted, resulting in weakened bones and increased risk of fracture; osteopenia as well as heart attacks and strokes," says Havas. 7 Measure your own blood pressure. Here's how blood pressure should be measured, according to according to prep. 1. As stated or indicated by; on the authority of: according to historians. 2. In keeping with: according to instructions. 3. the National Heart, Lung, and Blood Institute: "Persons should be seated quietly for at least five minutes in a chair (rather than on an exam table), with feet on the floor and arm supported at heart level.... At least two measurements should be made." Five minutes? Two measurements? Other than the 45 minutes that you may spend sitting in the waiting room, it's unlikely that the nurse or doctor will wait another five minutes for you to relax. "The measurement of blood pressure is one of the sloppiest procedures in clinical medicine," says the University of Texas's Norman Kaplan. "But it has one of the biggest impacts. We put people on therapy for the rest of their lives based on it." That's one reason why you should measure your blood pressure at home, says Kaplan. "Taking your own blood pressure is the only way to monitor it effectively. Every family ought to have a blood pressure device." Part of the problem is "office hypertension office hypertension See White coat HTN. ," also called "white coat hypertension white coat hypertension Office hypertension A transient ↑ in blood pressure that occurs in apprehensive Pts on seeing a 'white coat', especially if the Pt is ♀ and the doctor ♂, possibly resulting in inappropriate anti-hypertensive therapy. ." Blood pressure rises in doctors' offices because the patient is nervous. "The data say that 20 to 30 percent of patients have office hypertension and it goes up with age," says Kaplan. "I think it's because older people anticipate something terrible being found when they go to the doctor." Once your blood pressure is under control, you only need to measure it once a week, says Kaplan. "You can buy a blood pressure device at Target, WalMart, or the corner drug store," he notes. "It's about $35 if you pump up the cuff by hand. For $60 or $70, you press a button and the cuff inflates by itself." Consumer Reports magazine periodically rates the devices, he adds. "The only unreliable ones are those that take your blood pressure with a cuff on the finger. They're expensive and not worth it." People who are too overweight to put a cuff on their upper arm have other options. "You can usually order a larger cuff from the company," Kaplan explains. Alternatively, "measuring your blood pressure with a device that uses a cuff at the wrist is quite reliable." Older people should take their blood pressure both sitting and standing. "About 20 to 30 percent of healthy older folks have postural hypotension postural hypotension n. See orthostatic hypotension. postural hypotension Orthostatic hypotension, see there ," says Kaplan. When they stand up, their blood pressure drops, they get lightheaded light·head·ed adj. 1. Faint, giddy, or delirious: lightheaded with wine. 2. Given to frivolity; silly. light , and they may fall. "Take a couple of measurements seated and then as soon as you stand up, take it again," he advises. If your pressure drops by at least 20 points, you have postural hypotension. Make sure to tell the doctor at your next visit.
How High is High?
If your systolic and
diastolic pressures fall
into different categories,
your risk depends on the
higher category.
SYSTOLIC DIASTOLIC
Hypertension (High) 140 90
Prehypertension 120 80
Normal
Numbers apply to adults who
aren't taking drugs to lower
their blood pressure.
Source: National Heart, Lung, and
Blood Institute.
What Works
If your blood pressure is high, here's how much lifestyle
changes should lower it. So far, studies have found that
taking calcium, fish oil, or herbal supplements has little or
no effect on blood pressure.
Drop in Systolic
Advice Specifics Blood Pressure
Lose excess For every 20 pounds you 5 to 20 points
weight lose
Follow a Eat a lower-fat diet rich in 8 to 14 points
DASH diet vegetables, fruits, and low-
fat dairy foods
Exercise daily Get 30 minutes a day of 4 to 9 points
aerobic activity (like brisk
walking)
Limit sodium Eat no more than 2,400 mg 2 to 8 points
a day (ideally 1,500 mg)
Limit alcohol Have no more than 2 drinks 2 to 4 points
(if you drink) a day for men; 1 for women
(1 drink = 12 oz. beer, 5 oz.
wine, or 1.5 oz. 80-proof
whiskey)
Source: The Seventh Report of the Joint National Committee on
Prevention, Detection, Evaluation, and Treatment of High Blood
Pressure (www.nhlbi.nih.gov/guidelines/hypertension).
The DASH to Lower
Blood Pressure
Researchers don't know exactly why the DASH diet lowers
blood pressure. (DASH stands for Dietary Approaches to
Stop Hypertension.) It s not just the abundance of fruits and
vegetables (8 to 10 small servings a day). It s not just the
calcium and protein in the low-fat dairy foods (2 or 3 servings
a day). It's not just the small servings of meat, poultry,
and fish (up to 2 a day). Each of those factors may make a
small difference.
Here's a sample DASH diet for someone who eats 2,000 calories
a day. For more information, go to www.nhlbi.nih.gov/health/public/
heart/hbp/dash/new_dash.pdf or check your library or bookstore for
The DASH Diet for Hypertension: Lower Your Blood Pressure in 14
Days--Without Drugs, by Thomas Moore, Laura Svetkey, Pao-Hwa, and
Njeri Karanja (Pocket Books, 2001).
Food & Servings Examples of 1 Serving
Grains & grain products 1 slice bread
7 to 8 a day 1/2 cup dry cereal
1/2 cup cooked rice, pasta, or
cereal
Vegetables 1 cup raw leafy vegetables
4 to 5 a day 1/2 cup raw non-leafy vegetables
1/2 cup cooked vegetables
3/4 cup vegetable juice
Fruits 3/4 cup fruit juice
4 to 5 a day 1 medium fruit
1/2 cup fresh, frozen, or canned
fruit
1/4 cup dried fruit
Low-fat of fat-free dairy foods 1 cup fat-free or 1% milk
2 to 3 a day 1 cup low-fat yogurt
1 1/2 oz. non-fat cheese
Meats, poultry, & fish 3 oz. broiled or roasted lean meat,
2 or less a day skinless poultry, or seafood
Nuts, seeds, & beans 1/2 cup cooked beans
4 to 5 a week 1/3 cup nuts
2 Tbs. sunflower seeds
Added fats, oils, & salad 1 tsp. oil or soft margarine
dressings 1 tsp. regular mayonnaise
2 to 3 a day 1 Tbs. low-fat mayonnaise
1 Tbs. regular salad dressing
2 Tbs. light salad dressing
Snacks & sweets 1 medium fruit
5 a week 1 cup low-fat yogurt
1/2 cup low-fat frozen yogurt
3/4 cup pretzels
1 Tbs. maple syrup, sugar, jelly,
or jam
3 pieces hard candy
Source: www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf.
Shaking the Salt
Eating out tonight? Getting takeout? Is your "home-cooked" meal
something you remove from a package and heat? Odds are you're
swallowing much more salt than you would if you started with
fresh chicken, turkey, seafood, vegetables, etc., and added your
own flavorings (garlic, vinegar, spices, lemon, olive oil). If
you do rely on others to cook, here's a sampling of how much sodium
you can save if you choose the right brand. Any food labeled
"healthy" is a good bet because it can have no more than 480 mg
of sodium per serving (or 600 mg if it's an entree or meal).
Instead of Sodium Try Sodium
Campbell's 860 mg Healthy Choice 480 mg
Chunky Classic Old Fashioned
Chicken Noodle Chicken Noodle
Soup (1 cup) Soup (1 cup)
Knorr Lemon 790 mg Uncle Ben's 410 mg
Herb with Flavorful Lemon
Jasmine Rice & Herb Rice
(1 cup) (1 cup)
Oscar Mayer 800 mg Healthy Choice 480 mg
Honey Ham Honey Ham
(3 slices-63 g) (2 slices--56 g)
Pasta Roni Garlic 890 mg Vermicelli with 0 mg
Olive Oil with olive oil and
Vermicelli fresh garlic
(1 cup) (1 cup)
Ragu Old World 1,560 mg Classico Sweet 560 mg
Traditional Pasta Basil Marinara
Sauce (1 cup) Sauce (1 cup)
Stouffer's 1,470 mg Healthy Choice 600 mg
Macaroni & (equivalent Macaroni and
Cheese (12 oz.) to 1,100 mg Cheese (9 oz.)
in 9 oz.)
Uncle Ben's 1,180 mg Healthy Choice 530 mg
Chicken Chicken Broccoli
Fettuccine Alfredo (11.5 oz.)
Alfredo Pasta
Bowl (12 oz.)
Wish-Bone 490 mg Kraft Light Done 270 mg
Italian Dressing Right Italian
(2 Tbs.) Dressing (2 Tbs.)
(1) Hypertension 42: 1206, 2003 or www.nhlbi.nih.gov/ guidelines/hypertension. (2) www.nhlbi.nih.gov/health/prof/heart/hbp/pphbp.htm. |
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