Health Leader, Blood Pressure 101

STORY BY

Nora K. Shire

High blood pressure is not called the Silet Killer for nothing. Most newly diagnosed patients are unaware that their pressure is misbehaving. Often hypertension sounds an alarm at the eleventh hour, after years of undisclosed existence.

In absence of cardiovascular symptoms, high blood pressure is usually discovered when the patient books a visit for something else.

And now, discovery is coming sooner than later.

Health associations such as the American Heart Association and the National Heart, Lung, and Blood Institute recently revised both cholesterol guidelines and hypertension guidelines in response to copious studies suggesting that damage occurs at very early stages-much earlier than previously imagined.

A downward trend

"The definition of hypertension is being revised downward," says Dr. Marc D. Malkoff, associate professor in the Department of Neurology at The University of Texas Medical School at Houston. "Now, 120 over 80, once thought to be normal, is considered pre-hypertension and should be treated with diet and exercise."

Since most people with high blood pressure usually do not have symptoms, it is important to have it checked during annual exams. If a condition is brewing, preventive measures can be taken.

Besides the systolic and diastolic numbers creeping up, another warning sigh is a family relative with hypertension. The closer the relationship, the more at-risk you are.

"For the physician, the objective is to get those numbers down, whether it is by diet and exercise or medications or a combination," Malkoff says.

As a member of the UT Stroke Treatment Team, Malkoff sees patients with long-standing hypertension in both the emergency center and the Intensive Care Unit at Memorial Hermann Hospital. Some are barely managed, others have never been diagnosed, and only a few are well-managed.

"I see people who have neglected their problem or had their condition neglected by others. Other patients did not know they had it," Malkoff says, and adds that some were not responsibly monitored by their physicians.

"I tell patients that hypertension or high blood pressure is bad news. It is one of the biggest stroke factors they can have, and that this condition accelerates atherosclerosis," Malkoff says.

The damage done

When blood pressure rises and remains high, the increased force on vessel walls can damage those vessels as well as the heart, kidneys, eyes and brain.

Hypertension is the basis of most strokes, both directly and indirectly. It is a risk factor for heart attacks and a cause of cardiovascular death, he explains, adding that it is also a common cause of renal failure.

Hypertension affects the kidney because the kidney has to regulate its blood flow very precisely, like the brain does. Increased blood pressure induces changes in the kidney's regulation of blood flow. Eventually damage to the small vessels in the kidneys disrupts blood flow and injures the entire organ.

Malkoff says that if the patient has diabetes, there is a second condition that creates havoc because sugar causes negative changes in the filtering process of the kidneys. "Now, there is a double whammy," he explains.

The changing numbers of hypertension signify what is happening in the body as the blood flows constantly. The systolic pressure is the force with which the blood surges as it moves through the arteries with each heartbeat. Diastolic is the pressure when the heart is resting between beats. (See Blood Pressure - Part One)

There are 3 types of hypertension:

primary or essential for which there is no cause
secondary hypertension or non-essential that has a definite but controllable cause such as pregnancy or certain medications
isolated systolic in which the systolic pressure is higher than normal when the heart beats but returns to normal between the beats

"Men get hypertension earlier than women. After menopause, females catch up with the males," Malkoff says. About 1 in 5 adults in the U.S. has high blood pressure. African-Americans develop hypertension almost twice as often as Caucasians. Essential hypertension makes up 90 percent of the cases in persons over 45.

Self-monitoring, self-help

If you think you are in the hypertension range, Malkoff recommends getting several blood pressure checks over a 3-6 month period. If the numbers do not go down, talk to your doctor about diet, exercise and medication.

For those who want to check their own pressure at home with a monitor, Malkoff cautions: "The numbers can be reliable, but be sure to bring the monitor into the doctor's office and ask the staff to check it against their monitor. If the two agree, that is a good way to go."

If you are relying on monitors stationed in drugstores, malls, grocery stores, remember two things:

Sit down in the waiting chair a moment before you put your arm in the cuff. Most likely you have been pushing a shopping cart or running in from the parking lot, so your pressure may have a higher reading. (If you were checking it in the doctor's office, you would have been seated for awhile.)
Even though getting your pressure checked at the mall is better than not checking it at all, these machines may not be serviced and recalibrated regularly. Take 2 readings several minutes apart. If they are wildly different, the machine may need calibration.

Also, remember that the monitor—especially the digital variety—is very sensitive. Stay completely still while you are checking your pressure. If you move, sneeze, laugh, talk, it will register higher.

Hypertension is a complicated condition which anyone can have, even the very calm and the very thin.

Other factors associated with hypertension are:

habitual alcohol use
excessive use of sodium
weight gain
anxiety or stress
ethnicity
genetic predisposition
arteriosclerosis
pain
pregnancy
diabetes mellitus
cocaine use
drug/alcohol withdrawal
anesthesia
various medications and medication interactions

If you have hypertension, be sure to have your blood pressure checked regularly (your doctor will tell you how often), stop smoking, avoid excessive salt intake, eat more fruits and vegetables as well as foods high in fiber, reduce stress on and off the job, drink moderately, exercise regularly, and keep weight within normal limits.

For many, it is a challenge cutting down on salt. Sodium causes water retention, and that makes your heart work harder than it should. The National High Blood Pressure Education Program recommends no more than 2,400 mg. of salt per day. That's about one teaspoon of the table variety.

Doctor, heal thy self

"I have hypertension as well as sleep apnea, which is an uncommon cause, and I take medication," says Malkoff. "In the winter of 2003, I saw my blood pressure going up and told myself this had to stop. I started exercising and have lost 20 pounds and five inches off my waist. Even losing 10 pounds can make a big difference. I changed my diet, and I now plan ahead. Five nights a week I eat a vegetarian meal.

"To control this condition takes concerted effort every day, and I think that is where many people trip up. It is a challenge that takes a long, long time, but the result is a better quality of life."

UPDATED: 8-31-2004

Health Tip:

Fireworks
Don’t lose your independence
on Independence Day!

They’re beautiful, hypnotic, inspiring and dangerous. Each year, thousands of injuries occur from fireworks. The Centers for Disease Control and Prevention (CDC) cite

In 2006, 11 dead and an estimated 9,200 treated in emergency departments for fireworks-related injuries in the United States.
An estimated 5 percent of fireworks-related injuries treated in emergency departments required hospitalization.

Most injuries involved:

Hands (2,300 injuries), eyes (1,500 injuries), and the head, face, and ear (1,400 injuries).
Burns were the most common injury type to all body parts except the eyes and head areas, where contusions, lacerations and foreign bodies in the eye occurred more frequently.

Most common fireworks involved:

Firecrackers, associated with the greatest number of estimated injuries at 1,300. There were 1,000 injuries associated with sparklers and 800 associated with bottle rockets.
Sparklers, accounting for one-third of the injuries to children younger than 5.

Between 2000-05, more than one-third of the fireworks-related deaths involved professional devices that were illegally sold to consumers.

According to the American Academy of Ophthalmology, if you are going to light firecrackers:

Use a specially designed stick, or "punk," rather than a match to light fireworks.
Have a bucket of water ready.
Always follow manufacturers' directions and dispose of used fireworks properly.
Never give a firecracker or sparkler to a child.
Never use a bottle rocket.
Do not light firecrackers bigger than your pinkie, do not light them indoors, and avoid relighting duds.
Never put fireworks in your pocket, throw them while lit, or make homemade firecrackers.
In case of eye injury, do not touch the eye. Tape a clean paper cup over the eye to prevent contamination or further injury. Immediately seek medical attention from an ophthalmologist (eye MD).

What is banned nationwide: Any firecracker with more than 50 milligrams of explosive powder and any aerial firework with more than 130 milligrams of flash powder is banned under federal law, as are mail order kits and components designed to build these fireworks.