Articles on Medical Diseases and Conditions

Tag: High Blood Pressure

  • Home Monitoring of High Blood Pressure

    Your doctor may ask you to start taking your blood pressure at home and recording it. Doing so will give both you and your doctor a more complete understanding of how much your blood pressure varies during the day, and how well your medication is working to control your con- dition. It also eliminates the “white-coat hypertension” factor (see page
    39), which can complicate the process of diagnosis. Self-measurement is never a substitute for having your blood pressure checked by a health- care professional; it complements and con?rms the measurements taken at your doctor’s of?ce. If there is a large discrepancy between readings at home and in the doctor’s of?ce, bring in your home blood pressure monitor for your doctor or nurse to check for you.

    You will need to purchase a blood pressure monitor (see below) that you feel comfortable using at home. You can ?nd a selection of these devices at any pharmacy or medical supply store. You may wish to learn more about them by reading a consumer review magazine, and your doctor can help you decide which one will work best for you. You can choose between two basic types: a digital monitor or an aneroid monitor.

    Digital Monitors

    A digital, or automatic, monitor is the most popular blood pressure measuring device because it is easy to use. The gauge and the stetho- scope are in one unit, the digital screen is easy to read, and the de?ation is automatic. You can choose between an automatic or a manual in?a- tion device. The chance of human error is much less than it is when using an aneroid monitor. To use a digital monitor, follow these steps:
    1. Place the cuff around your upper arm. Turn on the machine.
    2. Push the button to activate the in?ation device, or squeeze the hand bulb on a semiautomatic model. After the cuff is in?ated, the instrument will automatically start to de?ate.
    3. Look at the digital screen to see your reading. Both your systolic and diastolic measurements will appear. Write the numbers down, with the systolic reading over the diastolic reading.
    4. Press the exhaust button to fully de?ate the cuff.
    5. If you want to repeat the measurement, wait 2 or 3 minutes.
    A drawback of the digital monitor is that it is highly sensitive, and body movements or an irregular heartbeat can affect its accuracy. Be careful about the placement of your arm and application of the cuff. The device requires batteries and needs factory repair or readjustment when problems arise. Digital monitors are somewhat more expensive than aneroid devices, depending on what model you choose. A fully automatic model may be twice the cost of an aneroid device, and the most expensive ones can be several hundred dollars.

    Aneroid Monitors

    An aneroid, sometimes called a spring gauge, monitor is relatively inexpensive, lightweight, and portable. (Aneroid means “containing

    no liquid.”) Some cuffs have a built-in stethoscope, which is easy to work with. The gauge has a round dial that indicates the amount of pressure in the cuff, and you can read it easily in just about any posi- tion, as long as you are looking directly at it. Some models have a large, easy-to-read gauge, a cuff with a ring closure for one-handed use, and a de?ation valve that works automatically. To use an aneroid monitor, follow these steps:
    1. Put the earpieces for the stethoscope into your ears, with the ear- pieces facing forward.
    2. Extend your arm at about the level of your heart on a table or a chair arm, and wrap the cuff snugly around your upper arm, with the lower edge of the cuff about an inch above your elbow. Place the dial where you can see it clearly.
    3. Place the stethoscope disk on the inner side of your elbow crease
    (over the pulse).
    4. Rapidly in?ate the cuff by squeezing the rubber hand bulb to a reading 20 or 30 points above your last systolic (top) measure- ment. (In?ating the cuff a little at a time gives an inaccurate read- ing.) When you stop pumping, you will not hear any pulse sound because the cuff is temporarily stopping the ?ow of blood through your artery.
    5. De?ate the cuff slowly (about 2 or 3 mm Hg per second on the dial). Keep your eye on the dial and listen carefully for the ?rst sound of the blood ?ow returning. Write down the number the pointer is on; that is your systolic blood pressure.
    6. Continue de?ating the cuff. Listen until you no longer hear your heartbeat, and note the reading. This number is your diastolic blood pressure.
    7. Record the numbers with the systolic reading over the diastolic reading (for example, 140/80).
    8. If you want to repeat the procedure to con?rm your reading, wait
    2 or 3 minutes before you rein?ate the cuff.
    There are some disadvantages to using an aneroid monitor. It is a fairly delicate, complex device that can be easily damaged. You will need to have it checked for accuracy at your doctor’s of?ce or pharmacy at least once a year, or if you drop it or bump it. If it is damaged, it will need factory repair. It may be dif?cult to use if your hearing or sight is impaired, or if you have dif?culty squeezing the hand bulb.

    Other Types of Monitors

    You may see mercury monitors, which are considered the standard for blood pressure measurement. The mechanism is simple and works by gravity, giving consistent, accurate readings. However, a mercury monitor is generally not recommended for home use because of the danger of mercury spills. The device has a long glass or plastic mercury tube that must be carefully protected against breakage. The device is bulky and must be kept upright, and the gauge must be read at eye level. It is dif?cult to use if you have a hearing or vision impairment.
    You may see ?nger or wrist monitors that look convenient. These devices are not very accurate, however. They are highly sensitive to position and body temperature and are usually significantly more expensive than other types of monitors.
    You can also buy portable devices that continuously monitor and record your blood pressure day and night. For some people, this method is the most effective way to get a clear picture of blood pressure variances and the effect of medications. Your doctor will tell you whether you require this type of monitoring.

    Take your time making your choice about what kind of home moni- tor to buy. Talk to your doctor about which kind is most suitable for you. As you shop, consider these features:
    • Cuff size. Cuffs come in different sizes—including children’s models—and the right size is very important for accurate meas- urement. Your doctor’s of?ce or pharmacy can tell you what size you will need. If you need a size that is not standard, it can be ordered for you.
    • Readable numbers. Be sure that the numbers on the gauge are easy for you to read.
    • Cost. Do not assume that the most expensive is the best. You have many models to choose from and a wide price range. The most important consideration is accuracy.
    • Care and storage. Some models may require storage in a certain position, protection from bumps, or protection from heat.
    After you have bought a device, take it to your doctor’s of?ce and have it tested for accuracy. Ask a health-care professional to show you exactly how to use it and what to do if you get an elevated reading. Find out how to get your device checked and recalibrated periodically.

  • The DASH Diet

    The National Heart, Lung, and Blood Institute (part of the National Institutes of Health) has developed a comprehensive eating plan called the DASH (Dietary Approaches to Stop Hypertension) diet. The DASH diet is low in saturated fat, cholesterol, total fat, and sodium. It emphasizes fruits, vegetables, and low-fat dairy foods; it includes whole grain products, ?sh, poultry, and nuts; and it recommends less red meat and fewer sweets. Major studies have demonstrated that the DASH plan works better than other heart-healthy eating plans to help most people reduce their blood pressure. Most people who stick to the plan for a month can signi?cantly lower their blood pressure, and the effect lasts as long as you stay on the plan. The DASH plan also works for people with normal blood pressure who are trying to prevent an increase. In any case, along with following the DASH diet you should make or con- tinue modi?cations to your lifestyle, including exercising and stopping smoking.
    Following the DASH diet may enable some people to go without medication, or to use fewer medications than they otherwise would. However, do not discontinue any medication or lower the dose with- out talking to your doctor ?rst.
    The DASH plan is two-pronged, involving the eating plan itself and

    lowering sodium intake as a means of treating hypertension. The diet can be adapted to different levels of sodium intake, depending on a per- son’s individual sensitivity to salt. The reduction of blood pressure is greatest at the lowest level (1,500 mg or less of dietary sodium per day).
    In many instances, diets or eating plans are based on the ideas or the- ories of one or two people, sometimes doctors but not always. In the case of the DASH diet, you can be assured the bene?ts of the DASH eating plan were proven in two research studies funded by the federal government and conducted in several cities.
    The DASH diet coupled with sodium reduction is a remarkable approach for treatment of high blood pressure for many reasons:
    • It works for a wide variety of people—those with or without high blood pressure, old and young, men and women, blacks and other races, obese or slender, active or inactive.

    • The diet is more effective in lowering blood pressure than other heart-healthy diets, and the low-sodium version is even more effective than other low-sodium diets.
    • The plan works quickly, lowering blood pressure readings in as lit- tle as 2 to 4 weeks.
    • In addition to its effectiveness at lowering blood pressure, it also lowers blood cholesterol levels, another important factor in pre- vention of heart disease (see page 23).
    The DASH eating plan is especially rich in fresh fruits and vegeta- bles (eight or more 1?2-cup servings per day) in part because these foods are low in salt. They are also rich in potassium, calcium, and

    magnesium. Grains and grain products are another major component of the diet (seven to eight servings per day) because they supply energy and ?ber. The plan limits the amount of meat, sweets, and sugary drinks in order to reduce intake of fats and sugars, as well as sodium. The plan teaches you to sharply reduce your salt intake by avoiding processed foods, which are the source of most of the salt that Americans eat.
    If you are on the DASH plan, as with any other diet, the foods that you eat at one meal or over the course of a day may add up to more than the recommended servings. You also might consume more sodium on one day than on another. The important point is that your average for several days or a week should be close to the recommended amounts in order to derive the health bene?t.
    You also need to keep in mind that if your doctor has prescribed medication for your high blood pressure, you should not stop taking it. If you feel that following the DASH diet (or another diet plan) may have lowered your blood pressure, have your blood pressure checked at your doctor’s of?ce and discuss the numbers with him or her.

    Following the DASH Plan

    The abbreviated DASH eating plan shown here gives you an idea of what types of foods are recommended and in what amounts. This plan is based on 2,000 calories per day. Servings can be adjusted depending on your calorie needs and your desired level of sodium intake. You and your doctor can tailor a plan to suit you.

    Cutting Back on Salt and Sodium

    Small amounts of sodium occur naturally in fresh foods, but most processed foods are high in sodium content. Most is added in manufac- turing and processing. Most restaurants add a lot of salt to foods they prepare. The only way to know for sure is to check the nutrition label carefully. You can cut back on sodium substan- tially by remembering a few general tips:
    • Start by eliminating your use of table salt; an herbal salt substitute—available in a variety of flavors—is often helpful.
    • Learn to use spices instead of salt. Flavor your food with herbs, spices, lemon or lime juice, vinegar, or salt-free seasoning blends.
    • When you buy vegetables, choose fresh or frozen without sauce instead of sauced or canned.
    • Rinse canned foods, such as beans or tuna, to remove some of the sodium.
    • Always choose low-salt or no-salt prod- ucts when you can.
    • Buy fresh poultry, fish, and lean meat rather than canned, smoked, or processed forms.

    Limit cured foods (such as bacon or ham), foods in brine (such as pickles, olives, and sauerkraut), and condiments (such as MSG, mustard, ketchup, and barbecue sauce). Limit even low-sodium versions of soy sauce or teriyaki sauce (which contain lots of MSG); measure them as you would table salt.

    • Cook rice, pasta, and hot cereals without salt. Cut back on flavored rice, grain, or pasta mixes; they are loaded with salt.

    • Rely less on frozen dinners; canned soups, broths, and sauces; and bottled salad dressings. You can make a large quantity of something like tomato sauce using a low-salt recipe, and freeze it in smaller amounts for later use. You can make sim- ple vinegar-and-oil salad dressings in small quantities to use for a few days.

    • Most restaurants add a lot of salt to the foods they prepare. When you eat in a restaurant, ask which items can be pre- pared without adding salt. Ask if other spices can be used.

  • A Diagnosis of High Blood Pressure

    If your doctor diagnoses you as having hypertension, your ?rst reaction may be surprise, because you feel ?ne. That is not unusual. High blood pressure usually has no symptoms, and many people go for years with- out knowing they have it. Your heart, brain, and kidneys can handle increased pressure for a long time, and you can live for many years with- out any symptoms or discomfort. But getting treatment to lower your blood pressure is extremely important, because hypertension is a major risk factor for serious disease.
    High blood pressure can affect your body in six main ways:
    • Atherosclerosis Uncontrolled high blood pressure can cause the walls of the arteries to thicken and become less ?exible. Fatty deposits are more likely to form on the rigid walls, and the chan- nel in the artery narrows.
    • Stroke If a blood clot forms and lodges in a stiffened artery trav- eling toward your brain, it can cause a stroke. If the clot is in an artery that supplies blood to your heart, it can cause a heart attack. High blood pressure may also cause a stroke if a weakened blood vessel ruptures.
    • Aortic aneurysm High blood pressure contributes to the widening of a weakened aorta, and an aortic aneurysm can be fatal if untreated.
    • Enlarged heart High blood pressure forces your heart to work harder. Over time, the muscle thickens and stiffens, or the heart muscle may enlarge and weaken. As it weakens, it pumps less ef?- ciently, and you will feel weak and tired more often. Fluid may back up and congest the lung tissue.
    • Kidney damage The kidneys ?lter waste products from the blood. If the vessels of the kidneys are thickened and damaged,

    your kidneys will begin to fail, causing waste to build up in the bloodstream. Treatment for kid- ney failure requires dialysis, a mechanical means of ?ltering the blood.
    • Eye damage If you have diabetes, high blood pressure can cause the capillaries in your eyes to bleed. This condition, called retinopathy, can eventually lead to blindness.

    These potential complications of blood pressure are genuinely alarming, but remember, blood pressure can be significantly lowered with treatment. The great decreases in death from heart disease and stroke in this country in recent years are partly the result of success- ful treatment of high blood pressure, speci?cally:
    • The incidence of stroke can be reduced by 35 to
    50 percent.
    • The incidence of heart attack can be decreased by
    20 to 25 percent.
    • The incidence of heart failure can be decreased by more than 50 percent.

    The Silent Disease

    Some people think that high blood pressure causes symptoms such as nervousness, sweating, or difficulty sleeping. None of these is a symptom of hypertension, and these are not necessarily related. Many people who look and feel perfectly fit have high blood pressure, while some peo- ple who are overweight, smoke, or show other risk factors for heart disease have normal blood pressure. That’s why the only way to know for sure if you have high blood pressure is to be tested.
    A person with severe, un- treated high blood pressure may have headaches, dizziness, or nosebleeds, but probably not until the condition has reached an advanced, life-threatening stage. Again, even many people with uncontrolled high blood pressure still do not have any of these symptoms. Getting tested and getting treatment are the only answers.

  • Factors That Increase Your Risk for High Blood Pressure

    The vast majority of people—90 to 95 percent—with high blood pres- sure have a type called essential or primary hypertension, which means that the exact cause or causes are unknown. In other people, high blood pressure may occur because of an underlying problem such as a blood vessel abnormality, kidney disease, or thyroid disease.
    However, there are well-known factors that increase your risk of developing high blood pressure or tend to worsen an existing condition. If one or more of these risk factors applies to you, you are at greater risk.
    You may have these factors contributing to hypertension, some of which are not within your control:
    • Gender Men are somewhat more likely to develop high blood pressure until age 70 than women, but after age 70 women are at greater risk.
    • Race Blacks develop high blood pressure more often than whites, and it tends to develop earlier and be more severe.
    • Family history If your parents or siblings have high blood pressure, you are more likely to develop it.
    • Age Generally, the likelihood that you have high blood pressure increases as you age. However, it is not a normal part of aging, and some people never develop it. Men tend to develop it after age
    . Women are more likely to have it after menopause. Other factors are within your control:
    • Weight As your body weight increases, your blood pressure rises.
    • Lack of exercise An inactive lifestyle increases your likelihood of being overweight and of having high blood pressure.
    • Salt Many people with high blood pressure are sensitive to salt;
    eating too much salt raises blood pressure in most people.

    • Unhealthy diet A diet low in fruits and vegetables or high in fat increases your risk of developing high blood pressure.
    • Drinking too much alcohol Heavy regular intake of alcohol can increase blood pressure signi?cantly.
    • Medication Over-the-counter decongestants and nutritional supplements may increase blood pressure. Birth control pills may also increase blood pressure in some women.

  • High Blood Pressure

    Today, high blood pressure (hypertension) is probably the most modi?able common major risk factor for heart disease and stroke in
    the United States. About one out of every three American adults has high blood pressure, and the numbers are increasing as our country ages and becomes more overweight. High blood pressure can cause damage to the heart, blood vessels, and, over time, the kidneys.
    Current ?ndings suggest that high blood pressure is an even more widespread health problem than previously understood. Today, at age 55, even a person who does not yet have high blood pressure has about a 90 percent chance of developing it at some point in his or her life. Further- more, recent evidence shows that the damage to arteries that leads to heart disease, stroke, and other major problems begins at blood pressure levels that doctors once considered normal. Independent of other risk factors such as high blood cholesterol level or being overweight, the higher your blood pressure, the higher your chance of heart disease or stroke.
    About one third of Americans who have high blood pressure don’t know it. Hypertension is often called the silent killer because by itself it does not cause symptoms, but over time it can cause stroke, heart attack, and kidney failure, any of which can be fatal. Most people who know they have the condition still do not have it under control; that is, their blood pressure levels are higher than is considered healthy.

    These numbers make clear how important it is to get your blood pressure checked, and to start as early as possible to prevent or treat the development of high blood pressure. The very good news is that it’s easy to be tested and treated. Even better, high blood pressure is largely preventable.