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CARDIOLOGY

BLOOD PRESSURE

 

Blood pressure management section contains the most recent information obtained and based on the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of high Blood Pressure, and how to apply it on the different aspects of daily living, in order to draw and design a healthy lifestyle for hypertension patients.

 

YOU HAVE HIGH BLOOD PRESSURE: NOW WHAT?

 

Well, you’re not alone. You’re one of about 50 million Americans who have high blood pressure, and you probably have a lot of questions: What is high blood pressure? What does it mean? How will it affect you? And what can you do to stay healthy? Here are the answers you need.

 

Step 1: Defining blood pressure

You may not realize it, but you’ve already taken the first step toward controlling your high blood pressure: awareness. Nearly one- third of those who have high blood pressure (hypertension) don’t know they have it. Many don’t find out until they have a stroke, heart attack or one of the other conditions related to uncontrolled high blood pressure. That’s why people refer to it as the silent killer.

“When someone finds out that he or she has high blood pressure, the first step is to become informed about what high blood pressure is and what it is not,” says Sheldon Sheps, M.D., chairman of the working group on the 1997 national hypertension guidelines and a high blood pressure specialist at Mayo Clinic, Rochester, Minn. “To understand high blood pressure, you need to understand blood pressure.”

The healthy human heart beats about 60 to 70 times a minute at rest. With each beat, blood is forced through your arteries and takes oxygen and nutrients to your organs and tissues. The force the blood exerts against the walls of your arteries is called blood pressure. High blood pressure is diagnosed when this force is excessive — that is, you have consistent readings of a systolic pressure (first number) of 140 to 159 millimeters of mercury (mm Hg) or diastolic pressure (second number) of 90 to 99 mm Hg, or higher. This excessive pressure can eventually cause your arteries to harden and thicken, making it more difficult for your heart to pump blood.

The term hypertension doesn’t refer to tension or stress in your life. Someone who has no discernible stress may have high blood pressure, and a person with a lot of stress may have normal blood pressure. Hypertension can happen to anyone. High blood pressure is the most common chronic illness in America and plays a major role in the development of:

*                                    Stroke

*                                    Heart disease

*                                    Kidney failure

*                                    Blindness

*                                    Vascular dementia

 

Step 2: Making decisions

Blood pressure varies over time and with activity level, so you may need to get at least two separate pairs of readings before your doctor can make the diagnosis. After high blood pressure is diagnosed, you’ll probably need additional tests. You could well find yourself confronting both good news and bad news after a thorough blood pressure evaluation. The good news: You don’t have high blood pressure. The bad news: If your blood pressure is 120 to 139 mm Hg systolic or 80 to 89 mm Hg diastolic — ranges once considered just fine — you have prehypertension. In either case, it’s important to take action. “Your doctor will assess your total cardiovascular risk before initiating a treatment program,” says Dr. Sheps. That includes a personal and family medical history, blood tests, urine tests and an electrocardiogram. Your doctor also will want to determine whether you have any underlying disease or organ damage caused by high blood pressure.

About 85 percent of high blood pressure cases are referred to as essential or primary hypertension because the cause is unknown. The remaining cases are called secondary hypertension, caused by conditions such as diabetes, kidney and kidney artery diseases, disorders of the adrenal or thyroid glands, or pregnancy. Treating the condition that caused it can sometimes eliminate secondary hypertension. If you have prehypertension, essential hypertension or secondary hypertension that persists after the underlying condition is treated, other measures are in order.

“One of the first things a person must understand is that this is for a lifetime,” says Dr. Sheps. “Treatment usually involves changes in lifestyle and often drug therapy.”

You can prevent, reduce and help control high blood pressure if you:

* Lose weight. Even a 10-pound weight loss can have a significant effect on your blood pressure.

* Exercise more. A vigorous, 30-minute walk most days of the week will help you lower your blood pressure.

* Limit alcohol. Consume no more than two drinks a day for men and one drink a day for women.

* Quit smoking. Tobacco not only substantially increases your risk of dying of a heart attack or heart failure but also can reduce the effectiveness of your blood pressure medication.

* Eat healthy. Components of a healthy diet include limited sodium, increased potassium and calcium, low-fat foods, and more fruits and vegetables.

If you have prehypertension but are otherwise healthy, lifestyle modifications may be all you need to control your blood pressure. If you have hypertension, particularly if it’s along with another condition such as diabetes or kidney disease, you very likely need prescription medications as well. Many types of blood pressure drugs are available. Work with your doctor to find the prescription that helps you. If you think medications are causing uncomfortable side effects or if cost is a factor, talk to your doctor — an alter- native may be possible.

 

Step 3: Monitoring your blood pressure

Frequent monitoring is one of the most important elements in managing your blood pressure. Your health status will determine how often you’ll need to have your blood pressure checked. Your doctor may ask you to monitor your blood pressure at home and keep track of the readings on a log sheet. Your doctor can help you choose a device to measure blood pressure at home and teach you how to use it.

 

Step 4: Finding resources

You need good, reliable and accurate information to manage high blood pressure. The best source of information is your doctor. Other sources include public libraries, the Internet, and groups and organizations for people with hypertension. Use caution and common sense to decide if the information you find is reliable. Here are some tips to help you evaluate it:

* Consider the source. If you’re doing online research, consider who’s sponsoring the Web site before making any decisions based upon the information provided. Not all sponsors are as knowledgeable and objective as others.

* Look for medical professionals on the editorial board or board of directors. Publications and organizations usually list boards in the front pages of journals or via a link on a home page.

* Check the publishing date. Material, even when from a reliable source, can become dated.

* Check with reference librarians. They are trained to help you find the most obscure information.

* Talk to others who have high blood pressure. Learn what they have to say about handling their diagnosis.

If you doubt the reliability of any information, check with your doctor.

 

© 1998-2004 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these mate- rials may be reprinted for noncommercial personal use only. “Mayo,” “Mayo Clinic,” “MayoClinic.com,” “Mayo Clinic Health Information,” “Reliable information for a healthier life” and the triple-shield Mayo logo are trademarks of Mayo Foundation for Medical Education and Research.

 

A NEW NORMAL: EXPERTS TOUGHEN BLOOD PRESSURE GOALS

If you thought your blood pressure was OK, it might not be low enough after all.

A revised national classification system, announced on May 14, 2003, toughens up blood pressure guidelines, saying the familiar standard of 120/80 millimeters of mercury (mm Hg) is no longer considered good enough to prevent serious or deadly health consequences. In fact, that old standard is now classified as prehypertension, likely to worsen and cause a heart attack or stroke if left untreated. “You’re not home free if your blood pressure is 120/80,” notes Sheldon Sheps, M.D., emeritus professor of medicine and former chair of the Division of Hypertension in the Department of Internal Medicine at Mayo Clinic, Rochester, Minn.

“There’s a major risk of developing full hypertension if you don’t make changes in your lifestyle or take other steps to control your blood pressure,” says Dr. Sheps, who served on the committee that drafted the new national guidelines.

 

Raising the bar

The updated guidelines set a stricter standard for what’s considered normal blood pressure, add the new category of prehypertension and streamline classification of the types of hypertension. No matter what category your blood pressure falls under, adopting healthy lifestyle habits can help keep it under control. Once your blood pressure rises above 115/75 millimeters of mercury, your risk of cardiovascular complications starts increasing. The new guidelines encourage the adoption of healthy lifestyle habits, such as regular exercise and limited sodium consumption, to help keep blood pressure in check. Left untreated, high blood pressure can cause a variety of cardiovascular complications including heart attack and stroke — two of the three leading causes of death among U.S. adults — as well as heart and kidney failure and vision loss. The guidelines also recommend that doctors treat high blood pressure more aggressively with medications. The guidelines were issued in the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC) and published in the Journal of the American Medical Association in May 2003. The JNC represents a coalition of leaders from 46 professional, public, voluntary and federal health care agencies, including the American College of Cardiology, the American Diabetes Association, the American Heart Association, the American Public Health Association, the American Society of Hypertension, and the National Heart, Lung, and Blood Institute.

The JNC last issued blood pressure guidelines in 1997. Since then, compelling new evidence indicates that those classifications weren’t strict enough.

Hypertension rates have continued to climb, along with the serious health problems — and medical costs — associated with high blood pressure. More than 50 million U.S. adults now have high blood pressure, and most who have it don’t control it well enough to prevent its associated health complications. And the recommendation for better preventive measures reflects evidence showing that even people who have normal blood pressure at age 55 have a 90 percent chance of developing hypertension as they get older unless they actively take steps to prevent it.

 

A new normal

Under the new guidelines, your blood pressure is normal only if it’s below 120/80 mm Hg. In the past, normal was anything below 130/85 mm Hg, and optimal — the blood pressure most healthy people should aim for — was a reading of 120/80 or lower. But new evidence shows neither of those readings are low enough to prevent cardiovascular complications. In fact, some data indicate that 115/75 mm Hg should be the new gold standard. Once your blood pressure rises above that threshold, your risk of cardiovascular disease may begin to increase.

The bottom line: The lower your blood pressure, the better, as long as you are otherwise healthy.

 

A new category

The new guidelines also include a category called prehypertension. Prehypertension is a systolic pressure (top number) ranging from 120 to 139 or a diastolic pressure (bottom number) ranging from 80 to 89. So, under these new classification criteria, if your blood pressure is right at 120/80, you have prehypertension — your blood pressure isn’t normal or optimal. And you can have prehypertension even if just one of the two numbers in your blood pressure reading is elevated. For instance, if your systolic pressure seems fine at 118 but your diastolic pressure is 84, you have prehypertension. The guidelines include this category to underscore the increasing health risks as your blood pressure rises. It signals the need for better education of both health care professionals and the public to prevent the development of hypertension, the JNC report says.

 

A new staging system

As before, the new guidelines classify blood pressure as outright hypertension beginning at 140/90 mm Hg. But the new guidelines do away with the old, more complicated system of categorizing hypertension into three risk groups called A, B and C based on three stages of hypertension, plus such factors as your sex and other health problems you may have. Instead, hypertension now simply falls into two categories:

* Stage 1. Includes a systolic pressure ranging from 140 to 159 or a diastolic pressure ranging from 90 to 99.

* Stage 2. The most severe hypertension, this includes a systolic pressure of 160 or higher or a diastolic of 100 or higher.

And as with prehypertension, only one of the numbers — the top or bottom — needs to be high for you to meet these criteria.

 

Taking action

The new guidelines don’t do away with all of the previous recommendations. As before, they continue to urge the adoption of healthy lifestyle habits, no matter what your blood pressure — normal or not. Among them:

* Maintaining a healthy weight

* Following the low-sodium, low-fat DASH eating plan

* Reducing dietary sodium consumption

* Getting regular physical activity

* Drinking alcohol only in moderation

If your blood pressure is normal according to the new standards, these kinds of healthy habits can help you avoid developing hypertension. If you have prehypertension but are otherwise healthy, lifestyle modifications may be all you need to reduce your blood pressure to less than 120/80 mm Hg.

Making healthy lifestyle modifications can also help reduce your blood pressure when you have full-blown hypertension. But that alone probably won’t be enough to effectively control your blood pressure, especially if you have stage 2 hypertension. Chances are, you’ll need at least two types of high blood pressure medications (antihypertensives) to reduce your blood pressure to a safer level. The goal for most people with hypertension is to reduce blood pressure to below 140/90 mm Hg.

 

Getting more aggressive

If you have certain high-risk medical conditions, you need even more aggressive treatment to prevent or control high blood pressure, the guidelines note. If you have diabetes or chronic kidney disease, for instance, keep your blood pressure below 130/80 mm Hg.

Other high-risk conditions include:

* Heart failure

* Previous heart attack

* High risk of coronary disease

* Previous stroke

These conditions themselves pose a major threat to your health. And they can make it difficult to keep your blood pressure low. But controlling your blood pressure can help prevent these conditions from worsening or help you avoid developing other cardiovascular disease.

Some antihypertensives can help protect your heart and blood vessels from the damage these diseases can cause. So you’ll likely need to take them even if you don’t have hypertension. Some antihypertensives are better for certain conditions than for others. For instance, a diuretic may be a good choice if you have heart failure, but not if you’ve had a heart attack.

If you have high blood pressure in addition to one of these high-risk conditions, the threat to your health increases. That means you and your doctor need to treat your conditions more aggressively, the JNC report says. You’ll likely need to take a few different kinds of antihypertensives, perhaps along with other kinds of treatments, such as low-dose aspirin or cholesterol-lowing medications.

 

Determining where you fall

So how do you measure up? An isolated instance of an elevated reading doesn’t necessarily mean your blood pressure is too high. Your health care team must measure your blood pressure several times before determining where you fall in the new classification system. The new guidelines outline how to evaluate blood pressure. You must visit the doctor’s office at least twice — the time period depends on your situation. During each visit, a health care professional will take your blood pressure two or more times while you’re seated. The average of those measurements determines how your blood pressure is classified.

When’s the last time you had your blood pressure checked? If it has been more than two years, it’s time to pay a visit to your doc- tor. In healthy adults, blood pressure screening should begin at age 21, with repeat evaluations at least every two years, or more often depending on your current health, medical history and risk factors for cardiovascular disease. 

 

Out of control

Only about one-third of people with high blood pressure have it effectively controlled — below 140/90 mm Hg. Yet the higher your blood pressure, the higher your risk of heart attack, heart failure, stroke and kidney disease.

If you’re between 40 and 70 years old, you have even more incentive to keep your blood pressure low. In that age range, each increase of 20 mm Hg in systolic pressure and 10 mm Hg in diastolic pressure doubles your risk of cardiovascular complications, starting at 115/75 mm Hg. That means if your blood pressure is 135/85 — technically considered only prehypertension — your risk of a heart attack or stroke is double that of someone with a blood pressure of 115/75.

 

The payoff of prevention

On the other hand, taking steps to reduce blood pressure may save your life or allow you to live longer, with better-quality years. Sustaining a reduction of 12 mm Hg in systolic pressure for 10 years will prevent one death in every 11 people treated for hyper- tension, the JNC report says. And in those with existing cardiovascular disease or organ damage, such as kidney disease, that reduction has an even bigger benefit, preventing one death in every nine people treated.

“That’s a huge impact,” Dr. Sheps says.

In the end, there’s no room for complacency anymore.

“Because you face such a significant risk of developing hypertension during your lifetime, you can’t be complacent, even if you think your blood pressure is low enough now,” Dr. Sheps says. “Most hypertension can be prevented with lifestyle changes. And just working toward your blood pressure goals, even if you don’t actually meet them, will have significant benefits to your health.”

 

 

MONITORING YOUR BLOOD PRESSURE AT HOME

 

By taking control of your high blood pressure, you can lower your risk of complications, such as heart disease and stroke. To help you gain control and maintain control, your doctor may recommend that you monitor your blood pressure at home.

Blood pressure is measured using a manometer (sphygmomanometer). Even though mercury-based manometers are being phased out because of the danger of environmental mercury poisoning, blood pressure measurements are still expressed in mil- limeters of mercury (mm Hg).

There are two numbers in a blood pressure reading:

* Systolic pressure is the first number. It is the blood pressure when your heart pumps.

* Diastolic pressure is the second number. It is the blood pressure when your heart rests.

Average normal adult blood pressure is less than 120 systolic over 80 diastolic. These numbers vary with activity and are higher when you exercise and lower when you’re at rest. If your blood pressure is consistently more than 140/90 mm Hg at rest, you have high blood pressure. Diagnosis of high blood pressure is based on the average of blood pressures properly measured in a doctor’s office several times on each of two or more occasions.

If your doctor recommends that you monitor your blood pressure at home, he or she will help you determine how often you need to monitor, at what time of day and when you need to return for more office visits. Blood pressure generally is lower at home by 5 units — for example, 135/85 at home would correspond to 140/90 at your doctor’s office.

Contact your doctor if you have blood pressure readings of 180/110 mm Hg or higher, says Sheldon Sheps, M.D., emeritus pro- fessor of medicine, Mayo Clinic, Rochester, Minn. Also call your doctor if you experience chest pain, shortness of breath, severe headaches or heart palpitations. People with high blood pressure are at greater risk of stroke, heart attacks and kidney damage.

 

Types of manometers

Four types of home blood pressure manometers are available:

* Mercury manometers

* Aneroid manometers

* Digital or electric manometers

* Wrist manometers

A fifth type of manometer, the finger manometer, is available, but this type of manometer isn’t recommended due to its inaccurate readings, says Dr. Sheps.

Your doctor can help you choose a manometer and show you how to use it correctly. You can find home blood pressure manometers at medical supply stores, pharmacies.

 

 

 

HYPERTENSION DRUGS: TREATING MORE THAN JUST BLOOD PRESSURE

 

Your doctor has just given you a prescription for your high blood pressure (hypertension). As an added benefit, you’re told, the prescription may also help control your occasional migraine headaches.

Surprised?

“Not only do hypertension drugs help control elevated blood pressure, but some actually offer additional health benefits,” says Sheldon Sheps, M.D., a specialist in hypertension at Mayo Clinic, Rochester, Minn. “These can include treating heart failure, complications of diabetes or symptoms resulting from coronary artery disease. Some may reduce stroke, heart disease and new onset diabetes beyond just the lowering of blood pressure.”

 

Different drugs, different functions

Hypertension is caused by a variety of factors, and different classes of drugs are used to treat these different factors. The drugs may affect parts of your body that aren’t related to your blood pressure, resulting in benefits beyond simply lowering your blood pressure. For example, angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARB) act on specific chemicals in your body to lower your blood pressure. At the same time, their effect on these chemicals allows your body to reduce excess thickening in your heart and blood vessels and to use blood sugar (blood glucose) more effectively. The main classes of hypertension drugs and the added benefits they can provide are listed below.

 

Initial treatment choices

 

Diuretics (furosemide, hydrochlorothiazide, indapamide, others). Commonly referred to as water pills, diuretics reduce the amount of fluid in your body. They cause your kidneys to excrete more sodium in your urine than they would normally. The sodium takes with it water from your blood. This means there’s a smaller volume of blood pushing through your arteries and, consequently, less pressure on your artery walls.

In addition:

* Diuretics can help reduce the fluid retention (edema) or fluid buildup in your heart, lungs or the rest of your body — especially your legs and feet — that result from heart failure.

* Certain types of diuretics decrease the frequency of kidney stones and reduce your risk of developing osteoporosis. These diuretics reduce the amount of calcium in your urine, so less calcium is available for kidney stone formation. This also results in increased amounts of calcium in your blood, which can help reduce your chances of developing osteoporosis or lessen the severity of existing osteoporosis.

* In low doses, diuretics may favorably affect type 2 diabetes (formerly called adult-onset or noninsulin-dependent diabetes). For example, many people with diabetes count sodium and fluid retention as the cause of their high blood pressure. By lowering their blood pressure they gain all the usual benefits without aggravating their diabetes.

* Spironolactone, another type of diuretic, has been shown to improve heart function in people with heart failure.

 

Beta blockers (atenolol, metoprolol, propranolol, others). Beta blockers primarily work by blocking the effects of certain adrenaline-related chemicals in your body, causing your heart to beat more slowly and less forcefully.

Additional benefits:

* They may reduce your risk of a second heart attack.

* They can help control angina and a rapid heart rate.

* They can be used to treat heart failure, glaucoma, migraines, anxiety, hyperthyroidism and some tremors.

 

Angiotensin-converting enzyme (ACE) inhibitors (benazepril, enalapril, lisinopril, others). ACE inhibitors help relax your blood vessels by blocking the formation of a natural chemical inside your body that narrows blood vessels.

Additional benefits:

* ACE inhibitors are helpful in treating heart failure by improving heart function.

* They can reduce your risk of a heart attack if you have coronary artery disease and can reduce your chances of developing heart failure after a heart attack.

* They help protect your kidneys from damage, particularly if you have diabetes.

* They reduce the occurrence of a second stroke or transient ischemic attack (TIA) in people with high or high normal blood pressure.

* They reduce the occurrence of new onset diabetes.

 

 

Angiotensin II receptor blockers (ARB) (candesartan, irbesartan, losartan, others). ARBs act in a manner similar to ACE inhibitors, but they block the action of the chemical instead of the formation of the chemical.

Additional benefits:

* Study continues to determine if these drugs provide heart protection similar to ACE inhibitors. They do reverse heart enlargement (left ventricular hypertrophy) from high blood pressure more than beta blockers do.

* ARBs reduce kidney damage, especially in people with diabetes.

* They prevent strokes in high-risk patients.

* They reduce occurrence of new onset diabetes.

Calcium channel blockers (calcium antagonists) (amlodipine, diltiazem, nifedipine, verapamil, others). These medications help relax blood vessel muscles. Some slow your heart rate.

 

Additional benefits:

* They can be used to treat angina.

* Some types treat a rapid heart rate.

* Some may be useful for protecting your kidneys, particularly if you have diabetes or can’t take an ACE inhibitor or ARB.

* They may be helpful for persistent diarrhea related to irritable bowel syndrome — they can reduce your number of bowel movements per day.

* They may be useful in treating migraines and may benefit people with Raynaud’s disease.

* Older people may benefit from certain calcium blockers in preventing stroke.

 

Supplemental therapy

 

Alpha blockers (doxazosin, terazosin, others). These drugs prevent muscle contractions in your small arteries. They also reduce the effects of the natural chemicals in your body that narrow your blood vessels. This class doesn’t work as well as diuretics in preventing heart failure and shouldn’t be used alone to manage high blood pressure.

Additional benefits:

* Alpha blockers can improve urine stream for older men with benign prostatic obstruction.

* They may modestly lower your blood cholesterol and triglyceride levels.

 

Central-acting agents (central adrenergic inhibitors) (clonidine, guanabenz, guanfacine, methyldopa, others). Instead of working on your blood vessels, these medications work on your brain. They prevent your brain from telling your nervous system to increase your heart rate and narrow your blood vessels.

Additional benefits:

* They can help reduce the symptoms of panic attacks.

* They can lower your incidence of low blood sugar.

* They can reduce the severity of drug or alcohol withdrawal.

 

Which drug is right for you?

Choosing the right drug or combination of drugs depends on your age, overall health and what medications you already take.

Cost may be an additional factor. But consideration should also be given to other medical conditions you have that might be influenced — positively or negatively — by certain hypertension drugs.

“Most patients are pleased that one drug once a day may help two conditions,” says Dr. Sheps.

 

THE DASH DIET: IT MAY BENEFIT YOUR BLOOD PRESSURE, AND MORE

 

For years doctors have recommended reducing sodium to help lower your blood pressure. Now they’ve discovered that a diet rich in fruits, vegetables and low-fat dairy products also can lower your blood pressure.

An eating guide called the Dietary Approaches to Stop Hypertension (DASH) diet may help you prevent or lower high blood pressure. And the diet may also provide other health benefits.

 

Common problem

About one in four American adults have high blood pressure (hypertension). Millions more have prehypertension, which means their blood pressure falls at the high end of the range formerly considered normal. Nine times out of 10, prehypertension progresses to full-blown hypertension after you reach age 55 unless you take steps to prevent it.

Treatment advice has typically consisted of lifestyle changes — eating healthy, reducing sodium, maintaining a healthy weight, not smoking, exercising and limiting alcohol — usually combined with medication. In recent years, diet has taken on an increasingly important role in blood pressure control.

 

Diet comparison

Participants in the study that proved the effectiveness of the DASH diet followed one of three diets:

* A diet that matched the average American diet

* A diet rich in fruits and vegetables

* A combination diet that was reduced in saturated fat and emphasized fruits, vegetables and low-fat dairy products.

Sodium consumption in all three diets was about 3,000 milligrams (mg) a day.

The result: The fruit-and-vegetable and combination diets both lowered blood pressure, but the combination diet was most effective.

In that group, the decrease was greatest for those with Stage I high blood pressure — then defined as above 140/90 millimeters of mercury (mm Hg) — with an average drop of 11.4 points in the top number (systolic pressure) and 5.5 points in the bottom

number (diastolic pressure). That’s about the same effect as some medications.

Researchers aren’t sure why the combination diet fared better. However, they believe it’s due to the mixture of nutrients provided rather than any single ingredient.

Here are the number of servings you should consume daily from each food group. Serving amounts are based on a diet of 2,000 calories a day.

 

What about sodium?

A low-sodium version of the DASH diet lowers blood pressure even further, as shown by another National Heart, Lung and Blood Institute study.

Study participants who followed a DASH diet containing no more than 1,500 mg of sodium per day experienced a dramatic average blood pressure drop of 8.9 mm Hg systolic and 4.5 mm Hg diastolic.

Current dietary guidelines say that you should limit your daily intake of sodium to no more than 2,400 mg. Government research says that many Americans typically consume more than 4,000 mg of sodium daily.

 

Widespread benefits

If your blood pressure is normal, the DASH diet may help you avoid blood pressure problems. If you have prehypertension, the DASH diet may lower your risk of developing high blood pressure — and all of the risks that go along with it — as you age. For more severe high blood pressure, it may allow you to reduce your medication. However, don’t stop or alter your medication without first consulting your doctor.

The DASH diet can’t do it alone, though. It’s important that you take other steps to control or prevent hypertension, such as:

* Exercising

* Losing excess weight, if necessary

* Not smoking

* Reducing sodium

* Limiting alcohol

 

More than a hypertension diet

The DASH diet may improve your health in other ways. Fruits and vegetables may reduce your risk of some cancers. The calcium in dairy products can lower your risk of osteoporosis. And a diet low in saturated fat and cholesterol can reduce your cardiovascular disease risk. The diet also lowers the amount of homocysteine in your blood, which when high is another risk factor for cardiovascular disease. An additional plus: The diet is made up of foods readily available at your local grocery store.

Physical activity helps control blood pressure

One of the most important things you can do to control your blood pressure is to become more active. Physical activity can help prevent you from getting high blood pressure (hypertension) in the first place. And if your blood pressure is already high, physical activity can help control and treat it.

A major reason high blood pressure is so common — one in four American adults have it — is that people aren’t active enough. Modern conveniences and lack of time foster sedentary lifestyles. About 38 percent of Americans age 18 and older don’t get any exercise, according to recent surveys from the Centers for Disease Control and Prevention. Only 23 percent exercise enough to actually help their cardiovascular fitness.

 

The benefits of staying active

Physical activity is crucial to controlling your blood pressure because it makes your heart stronger. A stronger heart can pump more blood with less effort. And the less your heart has to work, the less force, or pressure, that’s exerted on your arteries. Becoming more active can lower your blood pressure by as much as 5 to 10 millimeters of mercury (mm Hg). That’s the same effect some blood pressure medications have. Once you get moving, you might even be able to reduce some of your medications, although you should always talk to your doctor first.

In addition, regular activity also helps you maintain a healthy weight, which, again, helps control blood pressure. And if your blood pressure is at a desirable level — that is, less than 120/80 mm Hg — physical activity can help prevent it from rising as you age. Here are a few things to bear in mind before you start an exercise program or increase your physical activity in a less formal way: * See your doctor first if you’re 40 or older and have never exercised, or if you smoke, are overweight, have a chronic health condition, have a family history of heart-related problems before age 55, are unsure of your health status, or if you have previously had chest discomfort, shortness of breath or dizziness when exerting yourself.

* If you take medication regularly, ask your doctor if increased activity will make it work differently or alter its side effects. Drugs for diabetes and cardiovascular disease can sometimes cause dehydration, impaired balance and blurred vision. Some medications can also affect the way your body reacts to exercise.

* If you check your own blood pressure, measure it before physical activity, not after, to ensure an accurate reading. That’s because activity can reduce your blood pressure for hours.

 

No pain, no problem

The motto of physical fitness used to be “No pain, no gain.” Many people thought they had to transform themselves into world-class athletes or spend hours in the gym each day to truly benefit from physical activity.

But no more.

Studies from the Centers for Disease Control and Prevention and the American College of Sports Medicine show that you don’t need to perform great feats of endurance. Simply adding some moderate physical activities to your daily routine will help. Mowing your lawn counts. So does dancing, scrubbing the floors or taking the stairs instead of the elevator.

Moderate is the key, though. Activities or chores that aren’t at least moderately exerting will offer little, if any, benefit. Just what is moderate activity? Any activity that you think is fairly light to somewhat hard to perform.

 

Types of activity

Total fitness involves three components: aerobic activity to improve your heart and lung capacity (cardiovascular health), flexibility exercises to improve flexibility in your joints, and strengthening exercises to maintain bone and muscle mass.

Of those three, aerobic activity is the best at controlling high blood pressure. An activity is aerobic if it places added demands on your heart, lungs and muscles, increasing your need for oxygen. Cleaning house, playing golf or raking leaves are all aerobic activities if they require a fairly light to somewhat hard effort.

Other common forms of aerobic activity:

* Walking

* Jogging

* Bicycling

* Swimming

* Exercise machines, including stationary bikes, treadmills, rowing machines, stair climbers and ski machines

Don’t do isometric exercises — straining of your muscles without moving. Muscle toning with weights is OK, but straining while doing isometrics can significantly increase your blood pressure.

 

Fitting it in

Be as active as you can each day. At a minimum, try to burn at least 150 calories daily doing aerobic activities. For moderately intense activities, that’ll take you about 30 minutes. The more you weigh, the less time it takes to burn calories, and the less you weigh, the more time. However, if you use 30 minutes as your guide, you’ll be close to getting the minimum amount of daily activity you need.

If it’s hard to carve out a 30-minute block of time in your busy schedule, try to do a series of 5- to 10-minute sessions throughout the day to rack up a total of 30. Park your car a bit farther away from work. Take a short walk during your lunch break. Sneak in some household chores while the baby’s playing. Three 10-minute periods of activity are almost as beneficial to your overall fitness as one 30-minute session.

Doubling up during your daily routine also builds up total activity time. Walk on your treadmill while chatting on the phone with friends, for instance. Or hop on your stationary bike while catching up on the day’s news.

 

Avoiding injuries

Injuries do sometimes happen during physical activity. You can reduce your risk, however, by following these guidelines:

Drink plenty of water. Water helps maintain normal body temperature and cools working muscles. To help replenish the fluids you lose, drink water before and after your activity.

Dress appropriately. Wear loose-fitting, comfortable clothing that allows perspiration to escape from your body.

Warm up and cool down. Stretching before an aerobic activity prepares your body for the upcoming activity. Stretching afterward helps improve your flexibility.

Be active regularly. Your risk of injury increases if you go back and forth between intense workouts and weeks of inactivity.

Avoid start-and-stop activities. A controlled, continuous form of activity, such as walking or cycling, generally produces less risk of a muscle pull or other injury than activities in which you start and stop frequently, such as basketball or tennis.

Don’t compete. Avoid the physical and emotional intensity that often accompanies competitive sports.

Let food digest. Wait 2 to 3 hours after eating a large meal before being active. Digestion directs blood toward your digestive system and away from your heart.

Tailor your activity to the weather. When it’s hot and humid, reduce your speed and distance. Or exercise early in the morning or later in the evening when it’s cooler.

Avoid activity near heavy traffic. Breathing carbon monoxide given off by automobiles reduces the oxygen supply to your heart.

Know the warning signs. Seek immediate care if you experience any of these:

* Tightness in your chest

* Severe shortness of breath

* Chest pain or pain in your arms or jaw, often on the left side

* Fast, irregular heartbeats (palpitations)

* Dizziness, faintness or nausea

Moderate activity shouldn’t cause discomfort. Your breathing might be increased and you should feel as though you’re working.

But you shouldn’t feel pain or experience exhaustion.

With these tips in mind, the health benefits of physical activity are likely to outweigh your risk of injury.

May 15, 2003

© 1998-2004 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. “Mayo,” “Mayo Clinic,” “MayoClinic.com,” “Mayo Clinic Health Information,” “Reliable information for a healthier life” and the triple-shield Mayo logo are trademarks of Mayo Foundation for Medical Education and Research.

 

OBESITY COMPLICATIONS

 

If you’re obese, you’re more likely to develop a number of potentially serious health problems. These may include:

* HIGH BLOOD PRESSURE.

As you put on weight, you gain mostly fatty tissue. Just like other parts of the body, this tissue relies on oxygen and nutrients in your blood to survive. As demand for oxygen and nutrients increases, the amount of blood circulating through your body also increases. More blood traveling through your arteries means added pressure on your artery walls. Weight gain also typically increases the level of insulin, a blood-sugar-controlling hormone, in the blood. The increase in insulin is associated with retention of sodium and water, which increases blood volume. In addition, excess weight often is associated with an increase in your heart rate and a reduction in the capacity of your blood vessels to transport blood. All of these factors can increase blood pressure.

* DIABETES.

Obesity is a leading cause of type 2 diabetes (formerly called adult-onset or noninsulin-dependent diabetes). Excess fat makes your body resistant to insulin, the hormone that helps your body maintain a proper level of a sugar (glucose) in your blood. If your body is resistant to insulin, your blood sugar is high — which isn’t good — and your cells can’t get the sugar they need for energy.

* ABNORMAL BLOOD LIPIDS.

A diet high in saturated fats — red meat and fried foods, for example — can lead to obesity as well as elevated levels of low-density lipoprotein (“bad”) cholesterol and reduced levels of high-density lipoprotein (“good”) cholesterol. Obesity is also associated with high levels of triglycerides. Triglycerides are the form in which most fat exists in food as well as in your body. Over time, abnormal blood fats can contribute to atherosclerosis — the buildup of fatty deposits in arteries throughout your body. Atherosclerosis puts you at risk of coronary artery disease and stroke.

* CORONARY ARTERY DISEASE.

This is a form of cardiovascular disease. It results from the buildup of fatty deposits in arteries that feed your heart. Over time these deposits can narrow your heart’s arteries, so less blood flows to your heart. Diminished blood flow to your heart can cause chest pain (angina). Complete blockage can lead to a heart attack.

* STROKE.

Obesity is associated with atherosclerosis — the buildup of fatty deposits in arteries throughout your body, including arteries in your brain. If a blood clot forms in a narrowed artery in your brain, it can block blood flow to an area of your brain. The result is a stroke. Being obese raises your risk of a stroke.

* OSTEOARTHRITIS.

This joint disorder most often affects the knees, hips and lower back. Excess weight puts extra pressure on these joints and wears away the cartilage that protects them, resulting in joint pain and stiffness.

* SLEEP APNEA

This serious condition causes a person to stop breathing for short periods during sleep and to snore heavily. The upper airway is blocked during sleep, which results in frequent awakening at night and subsequent drowsiness during the day. Most people with sleep apnea are overweight, which contributes to a large neck and narrowed airways.

* CANCER

Most types of cancer are associated with being overweight. In women, these include cancers of the breast, uterus, colon and gallbladder. Overweight men have a particularly higher risk of cancers of the colon and the prostate.

 

Obesity can also contribute to gallstones, solid deposits of cholesterol in the gallbladder, and gout, a joint disorder.

 

© 2003 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.

Dental implants: Say goodbye to dentures

For years dentures have been the only option for people with permanent tooth loss. Many who have dentures find it difficult to eat, laugh and converse normally. Some lose their self-confidence and withdraw from social activity.

Today, more and more people are choosing dental implants -- an alternative to conventional dentures, bridgework and missing teeth. Dental implants provide permanent replacement teeth instead of removable dentures. Many individuals are rediscovering the joys of eating and interacting with others without the clicks and wobbles of dentures. “Many people find implants more comfort- able, efficient and secure than conventional dentures,” says Phillip Sheridan, D.D.S., a specialist in periodontics at Mayo Clinic, Rochester, Minn.

 

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