Is it High or Low?

You cannot feel it, taste it, smell it, or see it. But if you have it, and do not take care of it, odds are it will kill you. We are talking, of course, about hypertension, otherwise known as high blood pressure. It is also called the silent killer, and with good reason, says cardiologist J. James Rohack, M.D., who is chair-elect of the American Medical Association and a professor of Medicine at Texas A&M University. "When a person's blood pressure is elevated, many times people do not have symptoms of headache or dizziness or shortness of breath or chest pain. But over time, that high blood pressure will cause the vascular system to undergo changes that can lead to heart attack, stroke, or heart failure," he says. High blood pressure not only affects the heart, but the kidneys. "One of the major reasons people get end-stage kidney disease and have to be on dialysis is because of high blood pressure that has been undetected and uncontrolled," says Dr. Rohack. "At that point, the damage to the kidneys is permanent."

The Missing Millions

To make matters worse, the majority of people with high blood pressure are either undiagnosed or not properly treated. "Recent data published confirm that a third of people who have high blood pressure have it under control, another third know they have high blood pressure but it is not under control, and the other third of people with hypertension have no idea that they have it," says Dr. Rohack. "Considering that over 80 million Americans have hypertension, you are literally looking at more than 20 million who have it under control, another more than 20 million know they have high blood pressure but it is not controlled, and then another third are completely unaware that they have high blood pressure." There is a strong genetic component to hypertension, so if anyone in your family has been diagnosed, you should be especially vigilant. "Almost every hypertension patient I have seen has had a parent, sibling, or grandparent who has high blood pressure. That means that anyone with family history should be even more alert to checking their blood pressure regularly," says Richard L. Klein, M.D., a physician in Automatic Data Processing's Medical Department in Roseland, New Jersey. Another important point to keep in mind for people who do not have high blood pressure now is that after you turn 55, you have a 90 percent risk of developing it. All the more reason to get tested every year.

Detection Data

Blood pressure is still measured the good old-fashioned way - with a blood pressure cuff. But they have become more accurate over the years. Home monitoring devices are much more readily available and easy to use as well. However, because your pressure varies so much depending on the time or day and environment, several readings must still be taken to get an accurate diagnosis (especially for those who suffer from "white coat syndrome," which means they develop high blood pressure in a doctor's office!) To understand what your reading means, remember that your blood is always exerting pressure on the walls of your arteries - but when the heart is pumping, the pressure is higher than in between beats, when the heart is at rest. That is why two numbers are needed to give an accurate picture: The top, or higher number, which measures systolic pressure - the pressure on your blood vessels when the heart is contracting or pumping. The bottom, or lower number, which measures diastolic pressure - the pressure on your blood vessels when the heart is at rest. Keep in mind that your blood pressure measurement exists in a continuum. Hypertension or high blood pressure means your blood pressure is consistently higher than normal - but there are many varieties of high, and normals that are on the borderline of high. Even if you have not been diagnosed with hypertension, your results may show that you need to take precautions.

Lowering the Bar

It used to be that hypertension was defined as anything higher than 140/90. However, all that changed recently, because of new guidelines set by the Joint National Committee on Prevention, Detection Evaluation, and Treatment of High Blood Pressure. The changes were based on a study that found that people with a blood pressure of 135/85 had double the cardiovascular risk of people with 115/75. We now consider blood pressures between 120-139 over 80-89 as prehypertensive, instead of either normal or borderline. The definition for high blood pressure is still above 140 systolic or 90 diastolic. "That is very sobering, because for years we had dismissed 135/85 as either normal or borderline," says Dr. Lawrence Byrd, Hypertension Section Chief at St. Barnabas Medical Center and Director of the Renal Center of Bayonne, New Jersey. "Now we are saying, wait a minute - there is a doubling of risk. We could be avoiding a great number of heart attacks, strokes and so on if we could somehow lower the blood pressure toward that number."

Treatment Tactics

So what happens if you are diagnosed as hypertensive? For 90 percent of Americans, your high blood pressure will be due to a combination of inherited tendencies and lifestyle issues. Because 10 percent of people have high blood pressure due to other medical problems such as tumors or blood vessel problems, your doctor also needs to rule those out. Next, you will want to sit down with your doctor and come up with a treatment program that combines lifestyle changes with possible medication. If you can bring it down with a change of diet and other natural means, then do it! At that point, because high blood pressure has an impact on many other health issues, be sure your doctor knows if you have any other medical conditions such as diabetes or high cholesterol.

Lifestyle Lessons

The most important lifestyle changes you can make to improve your blood pressure are:

Dr. Byrd recommends you set realistic goals. Three hours of aerobic exercise a week, (that is just a half-hour, six days a week), can be a huge benefit. So can avoiding fast food restaurants and high sodium foods. Quitting smoking is especially important. "It is the change that has the highest yield of any of the lifestyle changes," Dr. Byrd says.

Not Your Grandfather's Blood Pressure Medication

The good news in the battle to control high blood pressure is that "the number of medications to manage high blood pressure is far greater than 20 years ago," says Dr. Rohack. (For more details, see below.) "I grew up in era when there was barely anything to treat high blood pressure, and what there was had awful side effects," recalls Dr. Byrd. "You could not think straight, you got drowsy, confused, and lethargic and sometimes you lost your sex drive. Those things scared a couple of generations off. "The most practical thing people need to understand is, this is not your father's or grandfather's medicine. We now have a number of medicines that are virtually free of side effects. There are multiple classes of medications, each with its own characteristic range of side effects and benefits, and each one benefits different patient categories. If you are willing to work with us, we can tailor a regimen that is successful and well tolerated that did not exist just a few years ago." Because there are so many options, it may take some time to hit upon the right medication or combination of medications. And, because high blood pressure can have several causes, do not be surprised if you need two or three medicines, or more - depending on how serious your condition is.

The Medication Mix

Following are the three categories of medications used to control blood pressure. If your blood pressure is elevated, you may be asked to take one or more of them. Be sure to alert your doctor about any side effects.

Interaction Insight

Over-the-counter cold and pain remedies are so taken for granted that we often do not think of them as medicines. But blood pressure patients need to be especially careful. For example, non-steroidal drugs like Aleve, Advil, Nuprin, and Motrin, as well as prescription Vioxx and Celebrex, can interact negatively with blood pressure medication. Common decongestants such as Sudafed (pseudoephedrine) can also increase blood pressure. "I must see half a dozen people a week who have suffered worsening of their usual blood pressure control because of something they have started taking for back pain or a cold," says Dr. Byrd. Lots of caffeine can also raise blood pressure in some people. There are a few cautions with particular food supplements (such as large doses of Vitamin E), so do your research to understand the issue and let your doctor know what you are taking.

And Keep In Mind

Other things you should know about high blood pressure: Pregnant women, African Americans and people with a family history are particularly susceptible. Emotional stress and high blood pressure are not synonymous and the relationship between the two is still not well understood. Hypertension can be controlled, and it is reported that it can not be cured. The only way to know is to go and have your blood pressure checked regularly!

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The Culbreths

Please note: the information contained herein has been compiled from various sources. The above statements have not been evaluated by the U.S. Food and Drug Administration. We make no claims, either expressed or implied, that any treatments mentioned in this newsletter will cure disease, replace prescription medication, or supersede sound medical advice.