Articles on Medical Diseases and Conditions

Tag: Blood Pressure

  • Managing Your Weight

    One of the most important things you can do to control your blood pressure—and prevent heart disease—is to keep your weight at a healthy level. If you are overweight, you are more than twice as likely to develop high blood pressure than if you maintain a healthy weight. Even if you are only 10 pounds more than you should be, taking off that little bit of extra weight can signi?cantly lower your blood pressure. Your weight interacts with other factors, such as cholesterol levels and risk of diabetes, to affect your overall cardiovascular health in more complicated ways. But the relationship between your weight and high blood pressure is relatively easy to understand.
    As you gain weight, you put on mostly fatty tissue. Like any other tissue in your body, fat requires oxygen and nutrients to live. As your fatty tissue increases, the amount of blood circulating through your body also must increase. You retain more sodium and water, which increase your blood volume, and a larger volume of blood causes greater pressure against your arterial walls. When you take off weight, those negative effects are reversed, and your blood pressure comes down to a
    healthier level.

    Healthful Eating Habits

    Limiting sodium and following a healthful diet that is low in fat helps prevent or control hyper- tension, even in people of normal weight. Potas- sium helps protect against high blood pressure, in part by enhancing the excretion of salt. This nutri- ent occurs in certain foods, especially fruits and vegetables. If you take potassium in supplements, you will not derive the same bene?t that you get from consuming it in your diet. Most people get enough potassium through eating foods that con- tain it; the exception is those on diuretic drugs, who may need to take supplements.
    Your intake of sodium (salt) in foods is a critical factor in controlling blood pressure. Too much salt causes you to retain water, thereby increasing blood volume and blood pressure. Although sodium is an essential mineral, health experts recommend that a person consume less than 2,400 milligrams (mg, or 2.4 g) per day, which is only about 1 teaspoon of table salt. That includes all salt contained in foods, as well as the salt you add while you are cooking or at the table. A typical American diet often includes about 4,000 mg (4 g) of salt—far more than a person needs. To control high blood pressure, or if you are over 50 or black, limit daily sodium intake to 1,500 mg or less.
    All animal products, such as meat and dairy products, contain sodium. Processed and restaurant foods are notoriously high in sodium; to see a clear example of that, check the nutrition label on a can of soup or a bottle of ketchup. You can consume signi?cant quantities of salt without ever picking up a salt shaker. Three-fourths of the salt that peo- ple in the United States consume comes from processed or restaurant food. By contrast, fresh fruits, vegetables, and grains have little or no sodium unless you add it.

    Exercise Regularly

    Being physically active is a great way to help manage your blood pres- sure and bene?t your overall health in many other ways at the same time. During aerobic exercise, the heart works harder and pumps more blood to supply oxygen to the hard-working muscles. You might think that this action would increase blood pressure over time. But the increase in heart output is accompanied by widening of the blood vessels that supply the muscles, substantially reducing the resistance to blood ?ow. Regular exercise actually increases the number of capillaries that supply muscle tissue, further reducing resistance. Your heart, arteries, and lungs become more ?t, helping to protect you against heart disease.
    Also, exercise is the essential calorie-burning partner to sensible dieting as a means of controlling your weight. A moderate exercise program combined with a healthful diet will make it much easier to lose that extra ten pounds (or more), which can signi?cantly lower your blood pressure. The bene?ts of exercise do not stop there: physical activity helps protect against not only high blood pressure, but also against heart disease, diabetes, stroke, and cancer. Plus, exercise lifts your mood, protects against osteoporosis, and helps you manage stress, so it enables you to work toward several of your goals at once.
    You do not need to become an athlete. Aerobic exercise (which means exercise that causes the body to use oxygen to fuel the muscles) includes a broad range of activities such as walking, bicycling, climbing stairs, social dancing, and gardening. In order to get the cardiovascular bene?ts, you should aim for exercising 20 to 30 minutes at a time at least 5 days a week; recent government recommendations advise 1 hour a day if you are overweight. Most people can start a moderate exercise plan without consulting their doctors. If you are already moderately active, you will get greater bene?t from exercising longer or more often, or choosing a more vigorous form of activity. If you are not sure how to get started, try a simple walking program. Set aside time 5 days a week or more to walk around your neighborhood, take a lunchtime break from work, or go to a gym or a shopping mall.
    • Week 1. Walk slowly for 5 minutes to warm up your muscles, walk briskly for 5 minutes to get your heart working, then walk slowly for 5 minutes to cool down.
    • Week 2. Do 5 minutes of warm-up walking, increase your brisk walking to 7 minutes, then cool down for 5 minutes.
    • Week 3 and beyond. Walk slowly for 5 minutes, then increase your brisk walking by 2 minutes each week until you are up to 30 minutes or more, fol- lowed by 5 minutes of slower walking.
    Many people can start their exercise program more intensively, walking 20 minutes briskly, rather than 5 minutes, in week 1, then increasing that baseline of 20 for weeks 2 and 3. However, if you are over 50 and have not been physically active, if you have already had a heart attack, or if you have a family history of heart dis- ease, talk to your doctor before increasing your level of activity. If you have heart disease already, your doctor might use a stress test to assess your capacity to exercise and to individualize your exercise program.
    Even if you do not engage in formal exercise or set aside a special time for walking, you can increase your fitness by becoming more active in your daily life. Examples include walking rather than driving short dis- tances, parking far away from a store or mall entrance, and walking up one ?ight or down two ?ights of stairs. Purchase and use a pedometer to measure how many steps you walk every day, and gradually increase your activity until you walk at least 10,000 steps per day.

    What Is Salt Sensitivity?

    In most people, the body regulates salt concentration carefully, and any excess salt will be eliminated in the urine or in perspiration. But for many people, eating too much salt causes their blood pressure to rise, a condi- tion known as salt sensitivity.
    For reasons that are not clear, some groups of people are more likely to be salt-sensitive than others. For example, as many as 70 percent of black people are salt-sensitive. Older people are also more likely to react this way. Almost half the people with high blood pressure are salt-sen- sitive, which is why salt reduction is such a prominent part of treatment. There is no way to test for salt sensi- tivity except to eat less salt for a while to see if your blood pressure goes down. The cumulative effects of a high-salt diet eventually raise blood pressure in most people.

    Quitting SmokingTobacco smoke contains literally thousands of substances that, alone or in combination, damage your health in many ways. In addition to damaging your lungs, smoking does harm throughout your cardiovas- cular system. It does not directly cause persistent high blood pressure, but it temporarily raises your blood pressure by constricting the diam- eter of the arteries to your heart, depriving your heart muscle of blood and oxygen. Every time you smoke a cigarette, your blood pressure goes up for about 30 minutes. A pack-a-day habit keeps your blood pressure up for 10 hours.
    Exposure to tobacco smoke over time damages the protective lining of your artery walls, making them more susceptible to the formation of plaque. Plaque narrows the arteries and interferes with blood ?ow to your heart, your brain, and the rest of your body. Smoking also causes your blood to clot more easily, for reasons that are not fully understood. The clots more easily adhere to the inner surfaces of arteries roughened by plaque. Smoking also decreases the good cholesterol in your blood; see “Managing Your Cholesterol Level,” .
    Smokeless tobacco products are not the way out. Although it is dif- ?cult to give up any tobacco habit, the enormous health bene?ts make it worth it. So if you smoke, quit. (For tips on aids to help you stop smoking, see the box above.) If you do not smoke now, do not even think about starting.

    Managing Stress

    Though stress does not cause high blood pressure, it can keep your blood pressure up when you are upset. The body normally responds to stress with the so-called ?ght-or-?ight response, which prepares the body either to meet challenges or to avoid them. A temporary increase in heart rate and blood pressure is a part of this physiological response, and it is stronger in some individuals than in others. Although stress is somewhat dif?cult to measure, research demonstrates some general ?ndings:

    • In some individuals, blood pressure spikes in response to stressful situations, and these people are at greater risk of developing high blood pressure.
    • Some people cope with stress in unhealthy ways, such as overeat- ing, smoking, or drinking alcohol, which become contributing factors to high blood pressure.
    You may not be able to alter your body’s unconscious response to stress, and you cannot always avoid stressful situations, but you can learn relaxation techniques or coping activities like physical exercise that will help modify the harm to your health. You can also talk to your doctor about the level of stress in your life as one of the factors involved in your high blood pressure.

    Limiting Alcohol Consumption

    Over time, heavy drinking increases your chances of developing high blood pressure. It also contributes to the development of heart disease in other ways. If you are taking hypertension medications such as beta- blockers, alcohol may interfere with their action. If you have high blood pressure, talk to your doctor speci?cally about how alcohol in large quantities affects your blood pressure. In moderation, drinking has ben- e?cial effects and is associated with lower risk of developing heart dis- ease. Moderation generally means up to two drinks a day for men or one drink a day for women , whether each drink is a glass of wine, a beer, or a mixed drink.

  • Prevention: A Healthier Lifestyle

    By now you’ve gotten the picture: preventing your blood pressure from creeping up, or bringing it down to a desirable level, always begins with healthy choices in many areas of your life. The bene?ts are by no means

    limited to your blood pressure alone; they also improve your heart health, reduce your chances of stroke and kidney disease, and give you an overall sense of well-being. No matter how many predisposing fac- tors for high blood pressure apply to you—being male, being black, having hypertension in your family, being older—you can reduce your blood pressure somewhat with changes in lifestyle. These are the areas to work on:
    • Start eating a low-fat, low-salt diet such as the DASH diet (see below).
    • Lose weight if you are overweight.
    • Exercise regularly.
    • Drink alcohol in moderation.
    • If you smoke, quit.
    • Learn to manage stress.
    • Do not take over-the-counter medications that can raise blood pressure, including decongestants or “energy products.”

  • Treatment Strategies

    Lifestyle changes or medication, or a combination of both, can lower your blood pressure. Lifestyle changes are recommended for everyone with elevated readings of any kind. For many people, the results of losing weight, exercising, limiting salt, and generally adopting a healthy eating plan can be as signi?cant as the use of any single medication. Many different types of medications are available, and different drugs or drug combinations work better for some people. You and your doctor have lots of options, and your treatment will be most successful if you work together to ?nd the treatments that work best for you.
    Your doctor will help you set a target reading and determine how to reach it. Do not hesitate to tell your doctor as much as you can about your eating, smoking, and drinking habits; whether you exercise regu- larly; or what other medications or supplements you take. The more you understand about the factors that contribute to your high blood pressure reading, the more likely you are to bring it down.
    Your doctor will approach your treatment by considering three fac- tors: the blood pressure reading itself; whether there is already some damage to your arteries or other organs; and whether you have other conditions, such as diabetes, that might affect your treatment. If you are still in the prehypertensive category and have no other complications, you may be able to bring your blood pressure down to less than 120/80 mm Hg in a year just by changing your lifestyle (see below).
    If you have stage 1 or stage 2 hypertension without organ damage or complicating conditions, the goal will be to bring your reading down to a prehypertensive level. Doctors have found that many people will need to take more than one medication to reach their target blood pressure. If you are at stage 1, lifestyle changes are an essential ?rst step. If lifestyle changes fail to achieve your target blood pressure, your doctor may subsequently prescribe a diuretic and maybe other drugs as well (see page 59). If you are in stage 2 hypertension (a reading of 160/100 mm Hg or higher) without complications, you will almost certainly need to take more than one drug, one of which will probably be a diuretic, to achieve good blood pressure control. But continue making lifestyle modifications—improvements in your diet and exercise habits—while taking the medications.
    If you have high blood pressure (stage 1 or stage 2), and you have another condition—for instance, you have already had a heart attack, you are at high risk for developing coronary artery disease (see page
    211), or you have kidney disease or diabetes—your doctor will prescribe medications that have proven to be bene?cial for your conditions. Of course, a healthier lifestyle is a must as well. With these conditions, achieving a blood pressure goal as low as 130/80 mm Hg may be the wisest course.
    Warning: Be alert for any signs of stroke. These include headache, confusion, weakness, numbness, dif?culty speaking, slurred speech, or weakness on one side of the body. If you have any of these signs, seek emergency treatment at a hospital promptly.
    No matter what your blood pressure reading, personal medical situ- ation, history, or treatment plan, sticking to the treatment is the only way to reach your goal. That goal starts with a number, but it is much more than that.

  • What Your Blood Pressure Reading Means

    National guidelines place your blood pressure into one of three categories: normal, prehypertensive, or hypertensive . Normal blood pressure is considered to be less than 120/80 mm Hg. If your blood pressure is equal to or higher than this for two or more readings on different days, you are classi?ed as either prehypertensive or hypertensive. The guidelines, based on the impact of high blood pressure, are aimed at getting you and your doctor started as soon as possible to bring your blood pressure down to healthy levels.

    Prehypertension

    If you have prehypertension (with readings consistently 120/80 or higher but below 140/90), you are in a group that used to be called high normal. Almost one-third of the U.S. adult population now falls into the prehypertensive category. The most recent guidelines identify this range as a warning zone, because people in it are considerably more likely to develop true hypertension later in life. The designation of “prehypertension” re?ects evidence showing that the risk of heart disease actually begins to climb at readings above 115/75 mm Hg. From that level, every increase of 20/10 mm Hg doubles the risk of death from heart disease. Changing to a healthy lifestyle is the only way to prevent this progression into high blood pressure.
    If you are in the prehypertensive category, you have a good reason to get motivated to start managing your blood pressure immediately through nondrug treatment. Even though you do not have high blood pressure, you can start making changes in your lifestyle that will bring your readings down to a lower, healthier level without medication; see pages 46–47. Lifestyle changes alone are likely to help you at this early stage. You and your doctor can start talking about setting priorities and taking de?nite steps to form some new habits.
    Start with your eating habits. Eat 8 or more servings of fruits and vegetables each day and less fat and saturated fat. Limit salt intake to less than 1,500 mg per day, or about 3?5 of a teaspoon of salt. If you are overweight, losing weight can be important. The bene?ts of weight reduction start early, with a loss of as little as 10 to 15 pounds, because with every 3 pounds you lose, there is an average corresponding drop of about 2 mm Hg in your systolic pressure. Build just 30 minutes of exer- cise into your schedule, at least ?ve days a week. Limit your alcohol intake to no more than one drink per day for women and two drinks for men (whether hard liquor, wine, or beer). These changes may not seem easy at ?rst, but they will pay big dividends if they mean you will not have to take medications.

    Systolic Hypertension

    The guidelines also say that systolic pressure (the top number) of more than 140 mm Hg should be treated regardless of the diastolic level (bottom number). Either your systolic or your diastolic number—or both—may be elevated. As you get older, your diastolic pressure usually decreases and the systolic pressure begins to rise.
    If only your systolic reading is high and your diastolic reading is nor- mal, you have the most common form of high blood pressure. It is called isolated systolic hypertension, and new guidelines emphasize its importance. Treating isolated systolic hypertension early, with lifestyle changes and medications if necessary, reduces the future risk of devel- oping heart disease and stroke. For example, with each reduction of 5 mm Hg in your systolic blood pressure, death from stroke is reduced about 14 percent and from heart disease by 9 percent. The potential impact on your quality of life is enormous.

  • Just What Is Blood Pressure?

    As your heart pumps blood through your arteries, the moving blood exerts pressure against the arterial walls. This force is measured as blood pressure. Your blood pressure rises normally in response to many everyday in?uences, such as exercise, caffeine, medications, or stressful situations, and then returns to a normal level. But if the pressure in your arteries is consistently higher than is healthy, your heart needs to work harder and your blood vessels and heart can become damaged.
    Blood pressure is determined by the force of the heart as it contracts (systole) and the resistance of the main arteries and smaller arteries (called arterioles) to blood ?ow. The other force is diastole or relax- ation. Healthy arterioles are muscular and highly elastic and stretch eas- ily as blood is pumped into them. Their ready squeezing action keeps blood moving. When the heart is pumping more blood, as during exer- cise, many of the arterioles expand to accommodate greater blood ?ow. Healthy arteries are also wide open, clear of any buildup or obstruction so that blood can ?ow freely. Diseased arteries lose their elasticity, and pressure rises.