Tag: High Blood Pressure

  • High Blood Pressure:Overweight and Obesity

    n the last 25 years or so, people in the United States have become pro- gressively more overweight and obese. Today, about 65 percent of Americans are considered overweight and about one-third are obese, and the numbers of obese and overweight people keep rising. To check if you
    are overweight or obese, see the body mass index table on page 101.
    Also important is how one’s body fat is distributed. A disproportion- ate amount of body fat, especially if it is distributed around your waist area, creates an even greater risk of developing a range of health prob- lems, including high blood pressure, high blood cholesterol, diabetes, heart disease, and stroke. Research shows that an overweight or obese person’s heart muscle changes and pumps less effectively, even without evidence of heart disease.
    Independent of any other factors, obesity seriously increases your risk of developing cardiovascular disease. Obesity is associated with high levels of “bad” LDL cholesterol and triglyceride levels, lower levels of “good” HDL cholesterol, higher blood pressure, and diabetes. It also harms your muscles and joints and increases your risk of certain kinds of cancers, including cancers of the breast, prostate, and colon.
    Most people who are obese simply consume more calories than they burn off. It is most probably that combination of rich diet and lack of physical activity that has led to our epidemic of obesity in the United States. But other causes also contribute to the problem:

    • Obesity tends to run in families. This is largely a result of shared lifestyle behaviors.
    • Aging slows your metabolism, making it more dif?cult for your body to burn calories quickly, so you don’t need as many calories to maintain your weight. As we get older, we need to be concerned about calorie intake.
    • Men burn more energy when they are at rest than women do, so they need more calories to maintain their weight. After meno- pause, a woman’s ability to burn calories decreases still more.
    • Foods that are high in calories and fat but relatively low in nutri- tional value, served or purchased in excessively large portions, are a habit for many people.
    • Lack of exercise is strongly related to obesity. More than two- thirds of Americans report no habitual physical activity.
    • Childhood obesity tends to lead to adult obesity. Researchers think that the fat cells a person forms as a child remain into adult- hood. Dieting in adulthood decreases the fat-cell size rather than the number.
    • Some illnesses such as an underactive thyroid or depression can cause obesity, but this occurs only rarely.

    Body Mass Index

    A useful way to estimate your body fat is a formula called the body mass index (BMI). The BMI is an assessment of your weight relative to your height and is a good indicator of the proportion of fat in most people’s bodies. You can calculate your BMI by multiplying your weight in pounds by 703, dividing by your height in inches, then dividing again by your height in inches. (For example, let’s say your weight in pounds is
    140, and you are 67 inches tall. Multiply 140 by 703 to get 98,420. Divide that by 67 to get 1,468.95. Divide again by 67 to get 21.92. This is your BMI value.) Since these calculations are fairly complicated, see the convenient chart of body mass index by height and weight . According to the National Institutes of Health:
    8

    • A BMI less than 18.5 is considered underweight.
    • A BMI from 18.5 to 24.9 is considered normal. In this range you are at minimal risk of heart disease, provided you have no other risk factors.

    • Some individuals are inappropriately classi?ed as overweight or obese due to large muscle mass or frame size.
    • A BMI from 25.0 to 30.0 is of?cially classi?ed as overweight. In this range, your risk of cardiovascular disease increases slightly.
    • A BMI of 30.0 or more is considered obese. Your risk level is high.

    • A BMI of 40.0 is extreme obesity or morbid obesity. Your risk level is extremely high.

    Waist CircumferenceAnother way to estimate body fat is by measuring your waistline. Your waist circumference is the measurement of your natural waist, just above your navel. A high-risk waistline is more than 35 inches for women and more than 40 inches for men, and indicates central obesity. Waist cir- cumference is a means of determining whether you tend to store fat around your waist (for an apple shape) or around your hips and thighs (for a pear shape). Apple-shaped people tend to have higher levels of “bad” cholesterol and triglycerides that clog arteries and raise the risk of heart disease.

  • Moderating Your Alcohol Consumption

    Drinking too much alcohol can be harmful to your cardiovascular sys- tem in numerous ways: it can contribute to high blood pressure, raise your level of harmful triglycerides, and add empty calories that contribute to overweight or obesity. Excessive drinking or binge drinking can lead to stroke, diseases of the heart muscle (cardiomyopathy), and disturbances of the rate or rhythm of the heartbeat (arrhythmias).
    Some recent research suggests that a person who has a pattern of frequent, heavy drinking, especially over a lifetime, is much more likely to develop insulin resistance syndrome, a dangerous cluster of risk factors for heart disease. Also, heavy episodic drinking is a harmful pattern. Studies support the guidelines recommending moderate alcohol consumption: if you do drink, it’s much healthier to have one drink a day than to have seven drinks on the weekend.
    If you enjoy drinking alcohol occasionally, the heart-healthy recom- mendation is straightforward: drink in moderation, which means no more than one drink a day if you are a woman, or two drinks a day if you are a man. One drink is de?ned as one 12-ounce can of beer;
    11?2 ounces of 80-proof liquor such as vodka, gin, Scotch, whiskey, and  others; 1 ounce of 100-proof liquor; or a 4-ounce glass of wine. Drink- ing with food may be better, because food slows down the absorption of alcohol. A person who drinks alcohol with a meal usually drinks more moderately.
    You may have read about ?ndings that moderate consumption of alcohol, especially red wine, has health bene?ts. It now appears that all forms of alcohol are associated with these bene?ts. Studies have suggested that moderate drinking raises HDL cholesterol, helps prevent blood clots, reduces the risk of heart attack and the most common type of stroke (ischemic), and reduces blockages in the arteries in the legs, among other ?ndings. Men over 50 years of age appear to derive the greatest cardiovascular bene?t. Study is focused on certain components in red wine or dark beer called ?avonoids and other antioxidant compounds, which may contribute to the effect on HDL cholesterol. A sub- stance called resveratrol, found in red wine, may be the agent that reduces blood clot formation.
    Alcohol is certainly not the only way to derive these bene?ts, how- ever. Some of these substances can also be found in grapes or red grape juice, and antioxidants are found in many fruits and vegetables Exercise increases HDL. Aspirin can reduce blood-clotting. Researchers are still not sure whether wine, beer, or liquor is more bene?cial, and the interaction of other lifestyle factors is still in question. Even drinking in small amounts can dim your alertness and affect your coordination and reaction time, increasing the chances of accidents and falls. When you weigh the possible bene?ts of drinking alcohol against the many serious risks, there is no reason to start drinking every day if you do not already.

  • Reading Nutrition Labels

    Food labels tell you a great deal about the contents of foods, and they are a big help in making reasonable choices to limit the fat, sodium, and cholesterol in the foods you eat. Both the ingredients list and the nutri- tion facts panel are useful. By law, the ingredients list is in descending order of weight to give you an idea of the proportions of the ingredients in the package. The nutrition facts label tells you the number of serv- ings in the package, as well as the amount and percentage of recom- mended daily values, such as total fat, saturated fat, cholesterol, sodium, ?ber, and carbohydrates (including sugar). As the label tells you, these percentages are based on a diet of 2,000 calories a day. The label also tells you the ?ber and sugar content of the food. At the bottom of the panel, the percentages for vitamins A and C, calcium, and iron are listed (see the following section, “Nutrients”).
    If you are concerned about heart disease, you will probably be pay- ing closest attention to the percentages of fat, saturated fat, and sodium. As a general rule, choose foods that are low in saturated fat; avoid foods containing trans fats and sodium. A daily value of 5 percent or less sat- urated fat is low; 20 percent or more is high. If you consume a food high in fat at one meal, it is wise to try to balance that with low-fat items at the next meal.
    Another item to look for is trans fat, which is formed when vegetable oil is hardened (hydrogenated) in the manufacturing process (see page 30). Like saturated fat and cholesterol, trans fat raises harmful LDL cholesterol levels in the blood. Check the ingredients list for trans fat, shortening, or hydrogenated or partially hydrogenated veg- etable oil and limit your use of products containing them. Recently, the FDA began requiring that the amount of trans fat be listed on the nutrition panel under total fat and saturated fat. However, the labeling regulations allow as much as 0.5 g of trans fat per serving to be listed as “0 g,” so make sure the label does not mention hydrogenated oil or par- tially hydrogenated oil, both trans fats.

    Nutrients

    Whether you are at risk of cardiovascular disease or not, a healthy, bal- anced diet is one of the best ways to take care of your body. Eating a variety of fresh foods is bene?cial in part because these are the best sources of nutrients that your body needs. A great deal of research has focused on speci?c vitamins and minerals in an effort to isolate those that are of particular bene?t to your heart and blood vessels. At this time, many of these ?ndings are inconclusive. Some physicians recom- mend taking a multivitamin and mineral supplements each day, but there is no evidence this is bene?cial. (See page 89 for recommenda- tions about omega-3 oil supplements.)

    Antioxidants

    Antioxidants are believed to slow oxidation of harmful LDL choles- terol, a process that may cause the development of fatty buildups in the arteries (see page 152). Antioxidant vitamins (E, C, and beta carotene, a form of vitamin A) are found in fruits, vegetables, whole grains, and nuts. These foods are all part of a heart-protecting diet. Experts recom- mend a diet rich in the food sources of antioxidants, but studies show no bene?t to taking antioxidant supplements to prevent atherosclerosis or any other cardiovascular disease. In fact, one study showed negative effects from taking large doses of supplement vitamin E. This is prob- ably because supplement forms of vitamin E are processed substances that differ from the natural vitamin E that occurs in the foods men- tioned above.

    Calcium

    Doctors recommend getting plenty of calcium in your diet by eating low-fat dairy products and vegetable greens such as kale, broccoli, and soybean products. Daily calcium requirements vary by age and gender. The DASH diet, which is rich in calcium because it recommends eight servings or more a day of fruits and vegetables, as well as low-fat dairy, is proven to lower blood pressure (page 47). Use of calcium supple- ments to prevent high blood pressure has not been proven.

    Iron

    Some research has indicated that a high level of iron stored in the body may be linked to a greater incidence of heart attacks. But many other studies have failed to demonstrate this effect, and research continues. There is no evidence today to support reducing your iron intake or to justify screening of patients with cardiovascular disease to check their iron levels.

    Minerals

    Magnesium, a mineral found in leafy vegetables, dried peas and beans, nuts, and seeds, may have a positive effect on blood pressure. But the link is not clear enough to recommend the use of magnesium supple- ments. Magnesium-rich foods are good for you in any case.
    The effects of other minerals on heart health are the subject of research, but there are no clear-cut conclusions. Fluoridation of public water supplies is not harmful to your cardiovascular system. A relation- ship between water hardness and heart health has not been demon- strated. Some sources of water are high in sodium, and a person with a tendency toward high blood pressure should avoid such drinking water. A number of trace elements including zinc, copper, cadmium, and lead have been studied without any demonstrable impact on cardiovascular disease.

    Potassium

    Potassium is an essential element that plays a role in balancing the ?uid content between body cells and body ?uids. Eating foods rich in potas- sium may protect some people from developing high blood pressure. Some people who take diuretics to control high blood pressure may be potassium-de?cient because potassium is lost in increased urination. Doctors may recommend that these people take potassium supplements or eat foods rich in potassium. Bananas, cantaloupe and honeydew mel- ons, oranges and grapefruit, prunes, raisins, tomatoes, and low-fat dairy products are all rich in potassium and are part of a healthy diet. On the other hand, some blood pressure medications such as ACE inhibitors cause the body to retain potassium, so your doctor may advise you to limit intake of potassium-rich foods (including salt substitutes contain- ing potassium).

  • Eating Healthfully for a Lifetime

    Of all the advancements made in our understanding of heart disease and how to prevent it, perhaps the greatest is the clear, consistent
    link between healthful eating habits, coupled with regular exercise, and the prevention of heart problems. By following some fairly simple guidelines about how to eat healthfully, you can substantially improve your overall heart health and reduce your risk of developing high blood pressure, high blood cholesterol, and overweight or obesity, three of the major contributors to cardiovascular disease. The bene?ts don’t stop there; very similar dietary habits also help you prevent breast, prostate, and other cancers; control type 2 diabetes; avoid osteoporosis (bone loss); and perhaps lengthen your life. For an excellent diet plan to improve your health, see the information on the DASH diet. As you start eating more healthfully, you will probably get the most satisfaction from the immediate benefits: you’ll have more energy and you’ll shed excess pounds. Today, eating better is also easier and more enjoyable because a delicious variety of fresh, good-for-you foods are more widely available for more seasons of the year than ever before.
    Of course, there is also no shortage of diet advice, nutritional claims for speci?c food products, and con?icting headlines about the value—or the hazards—of certain foods. Don’t let fads or eye-catching news stories distract you from a commonsense approach to your diet.

    You’ll do better if you don’t think about dieting, but about developing new ways of eating for the long term.
    If you are trying to accomplish a speci?c goal, like lowering your blood pressure or your cholesterol levels, your doctor may work with you to develop an eating plan designed to help you achieve your target. But for those of you working on an overall heart-healthy eating pattern, the American Heart Association has developed a set of general guide- lines to help you change your current habits for the better and maintain a healthy pattern throughout your life; see the box above.

    Fruits and Vegetables

    The good news just keeps pouring in about the healthy bene?ts of fruits and vegetables in your diet, especially for your heart. Fruits and

    vegetables are the best source of vitamins, minerals, and ?ber. They have few calories and no cholesterol, and are low in fat and sodium. You can ?ll up on them at meals and snack on them in between. Generally, the most colorful fruits and vegetables are the most loaded with vitamins, including antioxidant vitamins.
    Antioxidant vitamins are so called because they may slow down the process of oxidation in your arteries—a chemical process that enables cells in your artery walls to more easily absorb fatty acids and LDL cholesterol. As a result, antioxidant vitamins may reduce the accumulation of plaque in the arteries that can lead to atherosclerosis and stroke. The major antioxidant vitamins are vitamin E (found in vegetable oils, wheat germ, and nuts), vitamin C (found in green and red peppers, broccoli, spinach, tomatoes, pota- toes, and citrus fruits), and carotenoids (found in yel- low, dark green, and red vegetables and fruits). It is important to know that taking vitamin supplements does not have the bene?cial effects of a balanced diet.
    Any fruits and vegetables you choose are a healthy addition to your diet. Some major research shows that fruits and green, leafy vegetables (spinach, kale, collards) are especially associated with a reduced risk of developing heart disease.

    Eating Plan for Healthy Americans

    The American Heart Association has designed these guidelines to help you reduce your risk of cardiovascular disease. Following this plan will improve your overall condition if you already show signs of heart and blood vessel problems, or even if you are currently enjoying good health. These are general guidelines; see also the DASH diet, pages 47–50.
    • Eat a variety of fruits and vegetables (nine or more servings per day).
    • Eat a variety of grain products, including whole grains (six or more servings per day).
    • Include fat-free and low-fat milk products, fish, legumes (dried peas or beans), skinless poultry, and lean meats.
    • Choose fats and oils with 2 grams or less of saturated fat per tablespoon and no trans fats, such as liquid and tub margarines, olive oil, and canola oil.
    • Balance the number of calories you eat with the number you use each day. To arrive at that number, multiply the number of pounds you weigh now by 15 calories. This represents the number of calories you burn in one day if you are moderately active. If you exercise very little, multiply your weight by 13 instead of 15.
    • Exercise to stay fit and to burn the number of calories you eat. Walk or exercise actively in some other way at least 30 minutes on most days of the week; one hour a day or more is considered optimal.
    • Limit your intake of snacks, soft drinks, or candy that are high in calories.
    • Eliminate foods high in saturated fat or trans fat, such as full-fat milk products, fatty meats, tropical oils, and partially hydrogenated vegetable oils. Instead, sub- stitute more foods from the first four categories listed in the first column of this box.
    • Trim your salt consumption.
    • Drink alcohol in moderation, if at all. That’s one drink a day if you are a woman or two drinks a day if you are a man. One drink is
    12 ounces of beer, 4 ounces of wine, 11?2
    ounces of 80-proof spirits, or 1 ounce of
    100-proof spirits.

    Daily Servings of Fruits and Vegetables

    Eat at least eight servings a day of fruits and vegetables—more is even better. Choose from all fruits and vegetables except coconut, which contains harm- ful tropical oils. Consider olives and avocados as fats (see page 90). Starchy vegetables such as potatoes are included in the category of grains and grain products (see page 86).
    Examples of serving sizes:
    • One medium piece of fruit
    • 1?2 cup chopped, cooked, or canned fruit
    • 3?4 cup (6 ounces) fruit juice
    • 1?4 cup dried fruit
    • 1?2 cup cooked or raw vegetables
    • 1 cup raw leafy greens
    • 3?4 cup (6 ounces) vegetable juice

    Grains and Grain Products

    Grains, grain products such as breads, and starchy vegetables are rich in complex carbohydrates, which provide you with energy. They also con- tain vitamins, minerals, and fiber. Contrary to what many people believe, they are also usually relatively low in fat and calories. If you are eating less fat and sugars (also a type of carbohydrate), you can health- fully ?ll up on grains. There are two important points to remember: choose whole grain products, and watch out for added fat, calories, and sodium in the preparation or processing of these foods.
    Whole grains are healthier than re?ned grains because they retain the germ (the nutrient-rich core of the grain) and the bran (the outer layer of the grain, containing nutrients and most of the ?ber). If you are unsure about whether a product is whole grain, check the label for the term “whole wheat” or “whole grain” as the ?rst item in the ingredients list. Choose whole grain breads, English muf?ns, bagels, and bread- sticks; whole grain pastas; and brown rice. Limit white rice, white bread, and egg noodles.
    It’s easy to consume hidden or not-so-hidden calories in the way you prepare foods or the way they are processed. Of course, limit high-fat and sweetened products such as croissants, sweetened cereal, crackers, and potato chips. (Unsalted pretzels and plain popcorn are better snack substitutes.) When you are cooking at home, cut back on butter and cheese and use seasonings liberally to boost flavor. Check sodium levels carefully if you use boxed grain mixes.
    The ?ber in foods comes in two forms: soluble (meaning that the ?ber is partially broken down in your intestine) or insoluble (the ?ber passes through your system without being broken down). Both types of ?ber are part of a healthy diet. Soluble ?ber is found in oat bran, oatmeal, beans, peas, citrus fruits, and apple pulp; it helps lower cholesterol. Insoluble ?ber, found in whole wheat breads and cereals, cabbage, beets, carrots, cauli?ower, and apple skin, encourages good bowel function but does not lower cholesterol.
    Fat-free and Low-fat Milk Products

    Dairy products provide you with protein, cal- cium, and nutrients including phosphorus, niacin, ribo?avin, and vitamins A and D. Right now, the impact of calcium on the risk of heart disease is not entirely clear, but people who do not consume much calcium tend to have higher blood pressure, so dietitians recom- mend getting plenty of calcium from foods (1,000 milligrams per day for adults below the age of 50; 1,200 milligrams per day over 50). Fat-free or low-fat (1?2 percent or 1 percent) dairy products contain slightly more nutrients than whole or 2 percent milk but are much lower in fat, saturated fat, cholesterol, sodium, and calories. If you have dif?culty giving up whole milk (31?2 or 4 percent fat), try decreasing gradually to get accus-
    tomed to the difference.
    For those who eat cheese, choose natural or processed cheeses with no more than 3 grams of fat per ounce and no more than 2 grams of sat- urated fats per ounce. Part-skim cheeses such as mozzarella are popular with those watching calories and fat content. If you like ice cream as a dessert, choose instead sherbet or sorbet, low-fat yogurt, low-fat ice cream, or low-fat pudding.

    Meat, Poultry, and Fish

    Eating relatively small portions of meat, poultry, or ?sh will still provide you with adequate amounts of protein, B vitamins, and iron. The trick is to limit your portion sizes and think of meats as a side dish or garnish rather than as the centerpiece of your meal. Try mixing small amounts of meats with pasta, rice, or vegetables for a ?lling entr?e.
    When you shop for meats, look for cuts with little or no visible fat. Choose “choice” or “select” rather than “prime” cuts of beef. Lean veal, lamb (leg or loin), and pork (tenderloin or loin chop) are good choices. Lean ham is a good choice, although cured ham and Canadian bacon are higher in sodium than other meats. Most ground meats today are clearly labeled with the percentage of fat; look for lean or extra lean, with no more than 15 percent fat. Organ meats such as liver are high in cholesterol but are iron- rich. You can enjoy small portions of these meats once or twice a month. When you prepare meat, make sure that you trim off visible fat before cooking, and cook without adding fat: broil, roast, grill, or stir-fry with a little olive oil.
    Poultry meats (chicken, turkey, Cornish hens) are low in fat if you take off the skin before you cook them. Ground turkey is low in fat; check the label for the per- centage of fat in ground chicken. Low-fat processed sandwich meats (low-fat chicken or turkey, turkey ham, lean boiled ham) are available now, but check sodium levels on the label.
    Fish, particularly oily ?sh, is an excellent source of protein but does not contain the saturated fats found in other meats. The recommended two servings a week are a minimum—eating ?sh and shell?sh more frequently helps you lower your dietary fat and cholesterol. Choosing ?sh and seafood may be confusing at ?rst because of some precautions about the health bene?ts of certain types. Here are a few key points:
    • Oily or fatty ?sh are particularly good for you because they have high levels of omega-3 fatty acids (see box on page 89). Oily ?sh include mackerel, lake trout, herring, sardines, albacore tuna, and salmon.

    • Sword?sh, king mackerel, shark, and tile?sh may contain undesir- able levels of mercury, while farm-raised ?sh contain environ- mental contaminants. Exposure to mercury is a concern especially for children and for pregnant and nursing women. For the general population, however, the bene?ts of eating ?sh far outweigh the hazards. Eating a variety of ?sh reduces your risk of adverse effects caused by levels of mercury or other contaminants.

    • Although some shell?sh (such as shrimp and cray?sh) are higher in cholesterol than most ?sh, they are lower in saturated fat and total fat than meats and poultry, so they are still a heart-healthy choice.

    Daily Servings of Meat, Poultry, and Fish

    Eat no more than two servings (6 ounces total) of cooked lean meat, poultry, or fish per day. Choose fish two or more times a week.
    Examples of serving sizes (3 ounces):
    • A piece of beef the size of a deck of cards
    • A hamburger 3 inches across and 1?2 inch thick
    • Half a chicken breast
    • A chicken leg and thigh without skin
    • 3?4 cup flaked fish

  • High Blood Pressure:Exercise and Weight Loss

    If you need to lose weight, you and your doctor or registered nutrition- ist can design a healthy diet plan, which will involve determining a level of calorie intake that is appropriate for you—but one that contains at least 1,200 calories per day. Your exercise plan should ensure that you burn more calories than you consume. The healthiest and most effective way to lose weight is to limit the energy consumed in food, and then increase the amount of energy burned off by exercise, to achieve a slow but steady weight loss. Most experts recommend losing 1 to 2 pounds per week.
    To lose 1 pound in 1 week, you need to burn about 3,500 excess calories; that is, you need to burn about 500 calories more per day than you consume. Dieters are plagued by the plateau phenomenon. When you achieve about a 10 percent weight loss, your body compensates by slowing your metabolism. It is important to keep exercising and not get discouraged during this time.

    Exercise as a Part of Every Day

    Your plans to exercise more are much more likely to succeed if you think of exercise as a pleasure rather than an obligation. It is important to choose activities that you enjoy and then ?nd ways to make them eas- ier to do often. Here are some tips to keep you going:
    • Develop a variety of physical activities that you can choose from so that you don’t get bored. In addition to a walking routine, alter- nate sessions of some goal-oriented activity like gardening or a more intensive activity like bicycling to keep you interested.
    • Find a friend or family member to exercise with you. You’ll both enjoy the sociability and both get the physical benefits. Wear comfortable, appropriate clothing when you work out, including shoes that ?t properly and suit your activity.
    • Listen to music or watch television to keep yourself entertained.
    • Avoid overdoing it. You don’t need to be an athlete, and you don’t need to exhaust yourself. Start with low-level or moderate exercise, then gradually increase the intensity and the time you spend, until you are up to a half hour or a full hour per day, most days.
    • Look for ways to make your daily activities more physical. Do your own housework or yard work instead of hiring someone. Walk to the store instead of driving. Choose the long, hilly route instead of the shortcut.
    You can also get more active in small ways that may not increase your heart rate but will burn up energy throughout the day. Instead of look- ing for ways to save effort, be imaginative about making yourself more active, whether you are at home, at the of?ce, or on vacation. Here are a few tips to get you started, but you can think of dozens more:
    • Stop using the TV remote. And if you want a drink while you’re watching TV, don’t ask someone else to get it for you—get up and walk to the kitchen.
    • Stand up and walk around while you talk on the phone. If you are waiting at a train station or airport, walk around instead of sitting.
    • In a parking lot, choose a space farther away from the store instead of the one closest. Or park several blocks from your destination and make a round trip to and from your errand.
    • Take every opportunity to climb stairs, at home or in public. Take the stairs instead of an elevator or an escalator.
    • Participate in charity events that require you to walk or play a sport.
    • When you’re traveling, take advantage of a hotel swimming pool or exercise room. Also, schedule a walking tour of a new city, rather than driving around.
    • Consider buying exercise equipment like a stationary bicycle and use it while you listen to music or books on tape or watch TV.
    • Make sure you are getting exercise during recreational time— walk instead of using a golf cart, rent a rowboat or a canoe instead of a motorboat, or play singles tennis instead of doubles.
    • Purchase a pedometer, and walk with a goal of 10,000 steps a day.
    Every 2,000 steps equal about a mile.

    Exercising if You Are Older or Disabled

    If vigorous activities are not an option for you because of advanced age or physical disabilities, some daily exercise will still bring health bene- ?ts. If you can walk, garden, or swim, gradually increase to longer ses- sions to get more bene?t without overdoing it. Some sports like table tennis, croquet, or shuf?eboard are excellent ways to get moving. If you are in a wheelchair, you can spend 30 to 40 minutes a day doing arm exercises or actively using the chair to get some good exercise. If possi- ble, join a class that offers a modi?ed exercise plan that suits your abil- ity. Such classes may be available through a senior citizen center, a retirement community, a hospital, or a YMCA.

    Where Do I Start?

    If you are inactive, any level of activity is a start in the right direction. A basic walking plan that increases your level of exercise gradually is an excellent beginning (see page 81). The key is to start slowly and build up; the goal is not to start a program quickly that you will need to stop; it is to develop a lifetime habit of regular exercise. The benefits of being more active far outweigh any risks for most people. Talk to your doctor before starting to exercise more if:
    • You have ever had any kind of a heart problem, especially a heart attack.
    • You have a family history of premature coronary artery disease.

    • You have diabetes.
    • You have problems with your bones or joints, such as osteoporosis or arthritis.
    • You have high blood pressure and are not on medication.
    • You are very overweight.
    • You have high levels of cholesterol in your blood.
    • You smoke.
    • You are over 60 and you are not accus- tomed to any regular exercise.


  • How Much Cardiovascular Exercise Do You Need?

    To promote cardiovascular benefit for most people, about 30 minutes a day of moderate to vigorous aerobic activity most days of the week is a good start; the latest recommendations, however, suggest that you work your way up to 1 hour of exercise per day if you are overweight. You can accumulate the total in 10- or 15- minute sessions if you want to, but check with your doctor if you are under treat- ment for heart disease. The main point is to make exercise a regular part of your lifestyle. Try to burn about 1,000 to 2,000 calories per week (see page 81). To get a sense of an effective exercise pattern, you can think in terms of the so-called FIT formula: frequency (days per week); inten- sity (how hard—moderate or vigorous) or percentage of heart rate; and time (amount of time in each session or day). You can adjust these elements to suit your schedule, just as long as you expend enough energy to accomplish your ?tness goals. For instance, you can make a point of taking a longer walk three times a week and a shorter jog two times a week.
    Frequency of exercise sessions and time spent in each session are easy to understand, even if it seems hard to ?nd the time to exercise.
    If you cannot exercise every day, try to plan your sessions on noncon- secutive days of the week. If you are breaking up your time into shorter sessions, don’t forget to warm up and cool down brie?y for each session. If your activity is more vigorous, the cool-downs and warm-ups are especially important.
    Intensity can be as simple as identifying moderate-level activities that ?t most naturally into your lifestyle, and then consciously sticking with them. A moderate activity raises your heart rate to at least 50 percent of its maximum (see box on page 78). A more practical de?nition of cardiovascular exercise might be any activity that raises your heartbeat to a level where you can still talk, but you start to sweat a little and breathe more heavily. If you have heart disease and your exercise is being planned with medical supervision, your peak heart rate achieved during exercise stress testing is a safe goal. But ask your doctor about this.
    Examples of moderately active pastimes are:
    • Brisk walking (3 to 4 mph)
    • Gardening or yard work
    • Active housework, such as vacuuming
    • Swimming
    • Tennis
    • Golf, if you don’t use a cart
    • Dancing
    More physically demanding forms of exercise, done regularly, raise your heart rate to 50 to 85 percent of the maximum and are especially bene?cial:
    • Aerobics classes
    • Jogging or running
    • Bicycling
    • Games such as racquetball or basketball
    • Cross-country skiing
    • Handball

  • High Blood Pressure:Exercise and Physical Activity

    Americans know exercise is good for them. A proliferation of health clubs and ?tness centers, joggers in every park and walkers in every shopping mall, and constantly changing fashion trends in exercise gear are all evidence that we’ve gotten the message. Ironically, at the same time, advances in technology and labor-saving devices (along with other factors) have made us more sedentary and more overweight.
    A sedentary lifestyle is hard on your entire body—muscles, bones, heart, lungs, arteries—because your body is a physical system that is built to move. In terms of cardiovascular bene?t, exercise ?rst strengthens your heart muscle and makes it pump blood more ef?ciently. In your bloodstream, it reduces harmful triglycerides, increases good HDL cho- lesterol, and improves the proportion of HDL to the bad LDL choles- terol. This effect is so important that being physically inactive is a major risk factor—just like smoking, high blood pressure, or high cholesterol levels—for developing coronary artery disease. It doubles your chances of having a heart attack.
    At the same time, exercise tends to lower your blood pressure and reduce elevated blood sugar levels if you have diabetes, both of which in turn reduce your risk of heart disease. Of course, exercise also helps you control your weight and reduce obesity. So when you exercise, you are working on your high blood cholesterol, high blood pressure, or diabetes. You are less likely to develop these problems if you are active. Even a moderate increase in physical activity—30 minutes or more of brisk walking most days of the week—is enough to have a signi?cant positive effect on your heart and blood vessels. Exercise can bene?t you, no matter how old you are or what your current ?tness level is.
    Exercise also helps you modify the effects of some other factors that are harmful to heart health. It reduces stress, anxiety, and depres- sion and their toll on your body. If you smoke, being active can make it easier to cut down or quit. Exercise never takes the place of other lifestyle changes you need to make to control as many of your risk fac- tors as you can (quitting smoking, eating more healthfully, and so on). However, a major research study in JAMA, the Journal of the American Medical Association, showed that overweight women who exercised had a longer life expectancy than overweight women who were not physically active.

  • Nicotine Replacement Products

    Nicotine replacement products, including patches, gum, nasal sprays, and inhalers, can be a valuable part of your overall strategy to stop smoking. They do not work perfectly, but they are a valuable aid in reducing the symptoms of nicotine withdrawal while you learn to adjust to living without cigarettes. These products are closely regulated by the U.S. Food and Drug Administration, and they are safe and effective for most people when used as directed (see the warning on page 73). They work by delivering a safer form of nicotine (the addictive component of cigarette smoke) without any of the cancer-causing and otherwise harmful substances. They may also desensitize nicotine receptors in your brain to reduce the satisfaction from smoking.
    Used properly, nicotine replacement products at least double your chances of success, and they are especially successful when used with other smoking cessation support methods, like telephone counseling or a for- malized program. You still have to change your behavior in order to kick your dependence on nicotine, but the drugs substitute for a cigarette in the meantime. They are available in several forms and can be used individually or in combination. Always talk to your doctor or other health-care provider about how to use these products safely and for maximum effect. If you experience unpleasant side effects, report them to your doctor.

    Patches

    If you choose to use nicotine patches, you wear a patch every day for
    6 to 8 weeks. The patches are easy to use; you can put one on under your clothes and leave it there all day without any other effort on your part. The patch delivers a low dose of nicotine for 16 to 24 hours, starting
    4 to 6 hours after you put the patch on. The patches are available in different doses so that you can taper off gradually. The most annoying side effect is a rash on the patch application site in some people. Other side effects include dizziness, nausea, and increased blood pressure. If you use a patch and are scheduled for an MRI (magnetic resonance imaging) procedure, tell your doctor or technician about the patch. Remove the patch at home the morning of the test, unless instructed otherwise, to prevent burns (the radiofrequency waves used in MRIs heat the patch to a dangerous degree). Do not smoke while wearing a patch; this is dangerous.

    Gum

    Nicotine gum delivers nicotine through the mucous membranes in your mouth. It acts on your system in 20 to 30 minutes. Starting on your quit date, you will chew 10 or 15 pieces of the gum each day for about 3 months. You will have to

    WARNING!
    Nicotine Replacement and
    Heart Disease
    If you have certain types of heart problems such as irregular heartbeat or chest pain, nicotine replacement drugs may not be right for you. Although these products are safe for most people with heart disease, your doctor will evaluate your risk. Most of the products are over-the-counter drugs; don’t start using them without checking with your doctor first.

    learn the “chew-and-park” system in order for it to be effective: you chew the gum slowly until you get a distinctive taste or tingle in your mouth, and then “park” it between your gum and your cheek for a full
    30 to 60 seconds. You repeat this chew-and-park cycle, without drink- ing any beverages, for about half an hour for each piece of gum. Some people get a sore jaw, hiccups, or nausea. These effects are usually mild.

    Nasal Sprays

    A nasal spray is a fast-acting nicotine delivery system. Starting on your quit date, you use the spray one or two times an hour, and if you get an urge to smoke, up to no more than ?ve times an hour. You generally continue using the spray for about 3 months, tapering off gradually. Some people experience nose and throat irritations, which usually disappear after the ?rst week or so of use.

    Inhalers

    A nicotine inhaler, available by prescription, is a plastic cylinder with a nicotine capsule inside. You place the device in your mouth and suck in nicotine vapor that is absorbed into the mucous membranes in your mouth. Some people like the inhaler because using it mimics some aspects of puf?ng on a cigarette. You need to puff on the device four or ?ve times a minute for as long as 20 minutes to deliver an effective dose of nicotine. You will use the device 6 to 16 times a day for about 3 months, and then taper off for about another 3 months. Some people get slight mouth or throat irritations.

    Lozenges

    The lozenge is a promising form of nicotine replacement. It is quick- acting and easy to use, because you just let it dissolve in your mouth without biting or chewing. You can use it similarly to nicotine gum.
    You may use a combination of a slow-release product like the patch and one of the quick-release products like the gum, sprays, or inhalers to help you through the nicotine withdrawal process. There is no one product or combination of products that has proven to be more effective for long-term success. Talk to your doctor about how to manage your smoking cessation medications and how to bolster their effectiveness with counseling and support.

    Drugs

    A drug called bupropion hydrochloride, which contains no nicotine, is approved by the Food and Drug Administration for smoking cessation. It is a form of antidepressant that increases the level of a substance called dopamine in your brain, just as nicotine does. Bupropion may be appropriate for any smoker trying to quit, but it may be especially attractive to people who have tried nicotine replacement without success or who do not wish to use nicotine in any form. It may also help lessen weight gain after smoking cessation. If you use bupropion, you start about a week before your of?cial quit date and continue for 2 to 3 months. Side effects in some people include dry mouth, sleep dif?culties, and nausea, which tend to disappear over time. The drug may not be safe for people who have or have had a seizure disorder, brain injury, or eating disorders. You will need to thoroughly discuss your medical history before taking this drug (or any other); for safety’s sake do not take bupropion prescribed for someone else.
    Varenicline, a relatively new drug, works to block the action of nico- tine in the body by blocking receptor sites on cell membranes. In a major research study, people who took varenicline were much more likely to give up smoking in a 12-week period than those who took a placebo (sugar pill) or bupropion. People who took varenicline in the study reported a reduced craving for nicotine and fewer other with- drawal symptoms than those taking a placebo. However, side effects of varenicline include nausea, headache, and insomnia.

  • High Blood Pressure in Special Groups

    Although high blood pressure is a common disease among all Americans, some groups are at higher risk, for reasons that are not fully understood. People in some racial or ethnic groups are more likely to develop high blood pressure. Some people are at higher risk because of other dis- eases, such as diabetes. Often these factors are interrelated; for instance, diabetes occurs frequently in people who are overweight, people with diabetes often have high blood pressure, and overweight is a contribut- ing factor in high blood pressure. Metabolic syndrome—also called insulin resistance syndrome—is a constellation of related factors such as obesity, high cholesterol levels, diabetes, and high blood pressure. The point is to know the factors that put you at risk for high blood pressure and then to take steps to bring your blood pressure under control.

    Black Americans

    No one knows why, but black men and women are more likely to develop high blood pressure than white Americans. It often develops at a younger

    age, and it tends to be more severe. As a result, blacks are also more likely than whites to develop hypertension-related health problems such as an enlarged heart, retinopathy (damage to the blood vessels in the eye), heart disease, kidney disease, and stroke. The solution to these dispro- portionate common health problems is awareness and treatment:
    • If you are black, it is especially important to have your blood pres- sure checked regularly. If it is elevated, you and your doctor can begin treatment immediately.
    • A healthy lifestyle will go a long way to prevent and control your high blood pressure and reduce your risk of serious problems. Understanding that you are in a high-risk group is good motiva- tion to, for instance, start building eight or nine 1?2-cup servings of fruits or vegetables per day into your diet.

    Women

    Almost half the 65 million Americans with high blood pressure are women. The disease is more common among black and Hispanic women than in any other group. As a woman grows older, her chance of having high blood pressure becomes greater than a man’s. A woman may have had normal blood pressure throughout her life, but after menopause, she is considerably more likely to develop hypertension.
    A woman’s reproductive life may also affect her blood pressure. In some women, using birth control pills or becoming pregnant can raise blood pressure. Here are some considerations to keep in mind:
    • If you have high blood pressure and you are pregnant or consid- ering pregnancy, work with your doctor to control your blood pressure before and during the pregnancy. Many women with high blood pressure have healthy babies, but prenatal health care is especially important. If you are on medications for high blood pressure, talk to your doctor about whether you should be taking them while you are pregnant. Some blood pressure medications such as ACE inhibitors should not be used during pregnancy. However, do not stop taking the medications without consulting your doctor ?rst.
    • High blood pressure during pregnancy (called gestational hyper- tension) occurs in about 6 to 8 percent of pregnancies. It is more common among women with chronic hypertension or diabetes. Gestational hypertension can lead to a condition called preeclamp- sia, which can be life-threatening to both the mother and the fetus.
    • If you have had gestational hypertension or preeclampsia during a pregnancy at some time in your life, you may be at higher risk for developing high blood pressure or other cardiovascular problems later in life. Your doctor should know about this part of your med- ical history.
    • Blood pressure usually does not increase signi?cantly as a result of hormone therapy for menopause in most women, with or without high blood pressure. However, hormone therapy can increase blood pressure in some women, so if you need to take hormone therapy for menopausal symptoms, your doctor will want to check your blood pressure initially and then monitor your blood pres- sure regularly. Also, using oral contraceptives may cause blood pressure to rise.
    • Even if high blood pressure has never been a problem for you, take extra care to monitor yourself after menopause. Get your blood pressure checked regularly.
    • Every woman can reduce her risk of developing high blood pressure, or help control high blood pressure, by eating more healthfully, being physically active, and drinking in moderation. High blood pressure is a highly preventable condition.

    People with Diabetes

    Diabetes, a condition in which your body cannot make or respond properly to the hormone insulin, is occurring at an ever-increasing rate among Americans. Research suggests that, for reasons that are not completely understood, as many as 60 million Americans may have a condition called insulin resistance—an inadequate response to their own insulin—that greatly increases their chances of developing diabetes and heart disease at some time in their lives. Many authorities attribute the increase in the number of individuals with insulin resistance to lifestyle changes in the population, particularly weight gain and lack of exercise. The most common cause of diabetes-related death is cardiovascular disease, but many people are unaware of this link.

    Diabetes has a hereditary component, and people who have family members with diabetes are at greater risk for developing the disease. More women are affected than men, and black, Hispanic, and Native American people are especially susceptible. People with diabetes often have high blood pressure, high cholesterol, or both, which increases their likelihood of developing heart disease still further.
    People with diabetes are classi?ed by whether they produce suf?cient amounts of insulin. A person with type 1 diabetes does not produce any and must take insulin as a medication. Most people with diabetes (more than 90 percent) have type 2, meaning that they produce insulin (a hormone that changes glucose, or “blood sugar,” into energy), but their bodies are resist- ant to insulin’s action, and they do not utilize it prop- erly. As a result the body cannot transfer sufficient amounts of energy from food to body cells. Because the cells are not taking in glucose, it builds up in the blood, leading to “high blood sugar” (hyperglycemia), or diabetes.
    If you have type 2 diabetes, the changes in your body’s chemistry brought on by high glucose levels can increase the buildup of fatty deposits inside the arter- ies (atherosclerosis; see page 152), which can impede blood ?ow. These changes can also make the blood clot more easily, which can lead to a heart attack or a stroke. High blood pressure and high blood choles-

    terol combined with diabetes make the risk for heart attack or stroke greater than the risk from either one. The bottom line is that if you have diabetes you can greatly reduce your chances of cardiovascu- lar disease by bringing down your blood pressure or cholesterol as needed.
    Awareness of these links is the place to start to improve your health. By working with your doctor to control your high blood pressure, you can help reduce the risk of complications from diabetes. Controlling your blood pressure and cholesterol levels is likely to prolong your life and greatly improve its quality.

    Secondary High Blood
    Pressure

    About 5 to 10 percent of people diagnosed with high blood pressure have secondary hypertension, meaning that their condition is a secondary result of another prob- lem. These underlying problems may include a kidney abnormality, a structural abnormality of the aorta, a narrowing of certain arteries, or certain types of hor- mone abnormalities. These sec- ondary causes of high blood pressure are more common in children and young adults.
    These problems can usually be corrected, causing blood pressure levels to drop to healthy levels. For example, a surgeon can repair a narrowed or defective artery.
    When your doctor examines you, he or she can usually rule out these problems as causes of high blood pressure by taking a careful medical history, giving a thorough physical examination, taking blood tests, performing urinalysis, and taking some fur- ther tests. These tests generally do not require a hospital stay.

    Children

    Even babies and children can have high blood pressure. Doctors used to think that high blood pressure in children was secondary (caused by some other condition). But now they know that children can have primary hypertension—that is, high blood pressure—for unknown reasons. The condition may be hereditary. It is more frequent and severe in black families, although scientists do not know why.
    The average blood pressure level for children and teenagers has risen considerably over the past 25 years, mainly because of the increase in overweight and obesity. Today, guidelines for blood pressure in chil- dren include a prehypertension category, just as adult guidelines do. Like adults, children can have a syndrome of risk factors—including overweight, high blood pressure, and insulin resistance—that increases their risk of diabetes and heart disease.
    Treatment for children with high blood pressure usually involves the same types of lifestyle changes that bene?t adults: weight control, a healthful diet, and regular exercise. Doctors will prescribe medications if necessary. Ensuring that a child has a healthy weight and blood pres- sure early in life gives him or her a head start on preventing serious dis- ease later on.

    Living with High Blood Pressure

    If you are being treated for prehypertension or hypertension, you can monitor your own health in several important ways:
    • Be your own best advocate. Stay with your treatment plan—healthy lifestyle habits and medication—to get the best results.
    • Know your blood pressure and have it checked regularly. Those already being treated for high blood pressure should have theirs checked more frequently; ask your doctor how often. Make sure that your family mem- bers (parents, brothers and sisters, children) have theirs checked regularly, too.
    • Keep appointments with your doctor so that he or she can monitor your treatment and make adjustments if necessary. Ask your doc- tor or other health-care provider any ques- tions that interest or concern you about your treatment.
    • Follow a healthful diet, cutting down on fatty foods such as red meat and increasing your intake of fruits and vegetables and whole grains; also, exercise 5 times a week (or, more ideally, every day).
    • Keep track of your blood pressure. Remember, you cannot tell from the way you feel how high your blood pressure might be.
    • Keep a diary of your blood pressure reading every time you measure it at home, or have it checked by a health-care professional. Record the date and the reading. Find a handy placeto keep the diary. Bring your diary to your doctor’s appointment.
    • Talk to your doctor about the names and dosages of your blood pressure medications and how to take them. Don’t hesitate to ask questions. Again, keep a written record that you can refer to and show to family members. Keep a written list of your medications, including dosages, in your purse or wallet.
    • If you notice any problems (side effects) that you think could be related to your medica- tions, talk to your doctor about them. The problems may not be related to your medi- cine. Or you may need a change in dose, or perhaps another medicine might work for you without side effects.
    • Refill your blood pressure medications before they run out, even though you feel fine.
    • Tell your family members that you have high blood pressure and get their support for your treatment plan. If possible, have your partner or a family member go with you to your doc- tor’s office to hear firsthand about your medications and how to make lifestyle changes.
    • If you have a severe headache, changes in your vision, numbness on one side, or dizzi- ness, seek emergency medical treatment immediately. You could be having a stroke.
    • Have your eyes checked periodically by a qual- ified physician such as an ophthalmologist.

  • Medications for High Blood Pressure

    In addition to lifestyle changes, many people with high blood pressure must take at least one medication or a combination of drugs to keep their blood pressure at a healthy level. These drugs, called antihyper- tensives, are highly effective and are an extremely important factor in reducing your risk of stroke, heart disease, and other major diseases related to high blood pressure. Many different types of drugs and combinations of drugs have been developed, so you and your doctor can work together to ?nd the ones that will successfully control your blood pressure with the fewest possible side effects. Although antihyperten- sives are powerful drugs, they have fewer unpleasant side effects today than ever before.
    If you have not been taking medications until now, and especially if you feel ?ne, you may not look forward to the idea of taking drugs that may have side effects and may be expensive. It could take some time to tailor your drug regimen to your needs, but do not get discouraged. Tell your doctor as much as you can about how the drugs make you feel. If

    you experience side effects, your doctor will probably substitute another medication that does not have the same effect on your body. Some peo- ple are able to reduce their need for medication if they can bring their blood pressure down and maintain it for a year or more, particularly if they lose weight as needed and adopt a healthier lifestyle generally. But you usually cannot stop treatment altogether. If the cost of your drugs is a problem, talk to your doctor about that, too. There may be lower- priced alternatives.
    Once you start taking prescription medications, do not stop or change your regimen without talking to your doctor ?rst. Even if the medicine is working and your blood pressure goes down, you need to continue taking the drug in order to get the bene?t. If you hear about a new drug or you talk to someone who is taking something different from what you are taking, talk it over with your doctor. Everyone responds differently to these medications and has a different medical history, so not every drug will be right for you. The most important goal is to get your blood pressure to a healthy level and keep it there for the rest of your life. Make sure to take your medication every day, even if you feel ?ne; if you have forgotten a dose, look at the patient informa- tion sheet that comes with your prescription to determine if you should take a “catch-up” dose or if it is preferable to wait till the next dose is due.
    There are eight major categories of antihypertensive medications, each with a different mechanism of action in your body. Within these eight categories, individual drugs have generic names and a brand name registered to a particular pharmaceutical company. Whatever the cate- gory of medication, taking medication may lead to a decrease of up to
    10 percent in your systolic blood pressure and 5 percent in your dias- tolic blood pressure. Many of these drugs are also prescribed for heart disease, so you can find more information about them on pages
    165–173 and 241–246. Here is a summary of the broad categories and their method of action:
    • Diuretics rid your body of excess ?uids and sodium through uri- nation, lessening the volume of blood that your heart has to pump. Your treatment will almost certainly begin with a diuretic, alone or in combination with another medication. Diuretics are some- times also used to enhance the blood-pressure-lowering effects of other drugs. Common examples include amiloride, bumetanide, chlorothiazide, chlorthalidone, hydrochlorothiazide, indapamide, metalozone, and spironolactone. The adverse effects of diuretics may include urinary frequency and low potassium levels.• Angiotensin-converting enzyme (ACE) inhibitors lower the levels of angiotensin, a chemical in your body that constricts your blood vessels, so your vessels expand, reducing resistance to blood ?ow, and allowing your heart to pump more ef?ciently. Examples include benazepril, captopril, enalapril maleate, and lisinopril. ACE inhibitors should not be used in pregnancy. They have a low incidence of side effects compared to other medications for high blood pressure. The most common side effect is a cough, which develops in 5 to 15 percent of cases. Rarely, people will have swelling in the face, a potentially dangerous side effect that means you should discontinue the drug immediately. However, talk to your doctor promptly to report your reaction and get another prescription.

    • Angiotensin-2 receptor blockers inhibit the effect of angiotensin (rather than lowering the level), so they too prevent angiotensin’s effects on your heart and vessels. They are often pre- scribed for people who cannot take ACE inhibitors. Examples include losartan, candesartan, and valsartan. Side effects may include nausea or a headache.

    • Alpha-blockers prevent your arteries from constricting and block the effects of the stress hormone epinephrine, which elevates blood pressure. These drugs are no longer highly recommended but are prescribed occasionally. Examples include doxazosin, prazosin, and terazosin. The major side effect is dizziness.

    • Beta-blockers (see illustration on page 62) decrease your heart rate and cardiac output, which lowers your blood pressure. Exam- ples include atenolol, metoprolol, and propranolol. Beta-blockers are commonly used to treat angina and are good choices for peo- ple with coronary artery disease and hypertension. Fatigue is a common side effect.

    • Calcium channel blockers inhibit the movement of calcium into your heart and blood vessels, which relaxes the muscles in the arterial wall that constrict the artery, preventing the narrowing of the artery. Examples include diltiazem, amlodipine, and vera- pamil. Side effects include leg swelling and constipation.

    Beta-blocker action
    7Beta-blocker drugs, often prescribed for hypertension, work by blocking the effects of epinephrine and norepi- nephrine—hormones that stimulate heart muscle cells and cause a more rapid heart rate. The drugs occupy receptor sites on the muscle cells to interfere with the hormones, preventing the increase in heart rate and low- ering the force of heart contractions. Both the heart rate and the strength of the contractions are controlled by neurons that carry nerve signals from the brain to the heart (see figure at right).

    • Centrally acting drugs (or central alpha agonists) act on the brain and the nervous system to lower your heart rate and prevent the arteries from narrowing but are rarely used now. Examples include clonidine, guanfacine, and methyldopa. Clonidine is unique in that in addition to being available in oral form, it is available in a skin patch, which is applied once a week. Side effects of centrally acting drugs include sedation, dizziness, dry mouth, and fatigue.

    • Vasodilators cause the muscular walls of the blood vessels to relax so that the vessels can dilate (widen). These drugs are used only in emergencies or for people whose blood pressure cannot be con- trolled with other drugs. Examples are hydralazine and minoxidil. Minoxidil may cause you to retain ?uids, so it should be used in combination with diuretics, which will help remove ?uid from your system.

    The more familiar you are with your drug program, the easier it will be to talk to your doctor about it and take the medications correctly so that they work as they should. Here are some important points to know about your high blood pressure medication or that of a family member whom you are assisting:
    • The name of the medication
    • What it does in your body
    • How often to take it and how much to take
    • What time of day to take it
    • What food, drink, or other medications you should avoid while taking it
    • How to store it (is it sensitive to heat or dampness?)
    • What reactions or side effects might occur and what to do if you get them
    • What to do if you miss a dose
    • Speci?c side effects if you are a woman and you become pregnant
    • When you need to re?ll your prescrip- tion so you do not run out.

    WARNING!

    Cold and Flu Medications
    Most over-the-counter cold and flu prod- ucts contain decongestants that can raise your blood pressure or interfere with your blood pressure medication. If you are on blood pressure medication, consult your doctor before you use any over-the-counter remedies. If your blood pressure is well con- trolled, your doctor may allow you to take cold and flu products for a few days. How- ever, decongestant-free products are avail- able that are safe and effective for coughs, colds, or flus. Always read the label carefully on any over-the-counter drug to be sure it does not contain any ingredients that raise your blood pressure or interfere with your treatment. In addition, if you are taking the over-the-counter medications ibuprofen or naproxen sodium for another problem such as arthritis pain, be sure to tell your doctor; these drugs can raise your blood pressure.