As presented last month, hypertension, or high blood pressure, is a common disease associated with several illnesses, including heart disease and stroke.
As heart disease is the number one killer and stroke is the number three killer in the United States, the stakes could not be higher. Although treatment can prevent these diseases, a study by the Centers for Disease Control, titled “National Health and Nutrition Examination Survey” (NHANES), showed that only 34 percent of Americans with hypertension were at their target blood pressure. Which means that more than three quarters of people with hypertension are not treated appropriately.
The good news is that hypertension can be controlled. Clinical studies have shown that successful treatment of hypertension results in a one fourth reduction in the rate of heart attacks and a one third reduction in the rate of strokes. Thought of in different terms, only 100 people need to be treated for five years to save two lives. Once diagnosed, you and your provider can set out a treatment strategy, some of the basic principles are below.
First, most health care providers will start a basic evaluation. There are several important medical conditions that directly cause hypertension, which when treated appropriately, can actually correct the condition. Once these important diseases are excluded, treatment can be initiated.
Most treatment strategies start with a basic assessment of “modifiable” risk factors. As compared to the non-modifiable risk factors like: age, gender and genetics; modifiable risk factors can actually be altered. One of the most important modifiable risk factors is smoking. Tobacco directly elevates blood pressure and damages blood vessels, causing atherosclerosis or “hardening of the arteries.”
A second risk factor is intake of salt. Salt retains water, which directly raises blood pressure. The scope of American salt intake is huge. The average American consumes one to three tablespoons of salt daily, or roughly 10 pounds of salt a year. The trouble is not just the added salt, but the “hidden” salt in our diets. Roughly three quarters of our daily salt intake comes from salt already in our food. The worst offenders are processed, canned and ready prepared meals, including fast food.
The best way to avoid this is to throw out your saltshaker, use a salt alternative and start reading labels. Dining out can also be tricky, but most restaurants can help you make reduced salt or salt-free choices.
Alcohol plays a key role in blood pressure control. It seems that small quantities of some alcohol may be helpful, yet excessive alcohol is known to be harmful. Intake of greater than two alcoholic beverages daily actually increases the risk of developing hypertension by 1.5 to 2 fold. Therefore, intake of one alcoholic beverage seems to be OK, yet anything greater than two drinks a day is going to worsen your hypertension and overall health.
Next comes physical activity. Long known to promote good health, physical activity helps to lower blood pressure. By various mechanisms, exercise causes weight loss and the building of healthy lean muscle, all of which help to regulate blood pressure. In studies, for every two pounds of weight lost there was a 0.5 to 2 mmHg reduction in baseline blood pressure. Before starting any exercise, check with your physician to see if you are able to safely start a work out routine.
If these measures are not successful in getting you to reach your target blood pressure, your health care provider may recommend one or more anti-hypertension medications. They are highly effective at reducing blood pressure and must be supervised closely by your providing physician. However, it is important to understand some basics about anti-hypertension medications.
All medications come with prescription education materials, listing how the medication works, possible side effects and what other medications to avoid. Your prescribing physician will also detail any special instructions to observe while taking the medication. Ask your doctor relevant questions and inform your physician if you think you are not tolerating the medication. Additionally, never abruptly stop your medication without first consulting the prescribing physician, as abrupt cessation of your anti-hypertension medication can cause an unsafe rebound elevation in blood pressure.
There are many highly effective anti-hypertension medications, so that therapy may be tailored to fit your specific needs. In general, antihypertensive medications can be broadly grouped into several categories. There are the diuretics, which lower blood pressure by increasing urine and sodium output (water pills). There are the ACE Inhibitors and their “pharmacologic cousins” called ARBs, which reduce blood pressure at the level of the kidneys and blood vessels. There are the calcium channel blockers and beta blockers, which directly relax the blood vessels and can slow the heart rate. There are the alpha blockers and nitrates, which specifically relax the blood vessels. Lastly, there are combinations pills, which are formulated with several anti-hypertension medicines in one pill.
As there are a multitude of these medications, finding the right medication is critical. Most people with hypertension will need to be on at least two medications to get to their target blood pressure.
With lifestyle modifications and mediations when necessary, you can reduce your blood pressure and improve your quality of life. These steps, with close supervision by your physician, can get you to your goal.
David M. Donaldson, MD, is an Auburn native and currently a cardiologist at Massachusetts General Hospital in Boston.
The good news is that hypertension can be controlled. Clinical studies have shown that successful treatment of hypertension results in a one fourth reduction in the rate of heart attacks and a one third reduction in the rate of strokes. Thought of in different terms, only 100 people need to be treated for five years to save two lives. Once diagnosed, you and your provider can set out a treatment strategy, some of the basic principles are below.
First, most health care providers will start a basic evaluation. There are several important medical conditions that directly cause hypertension, which when treated appropriately, can actually correct the condition. Once these important diseases are excluded, treatment can be initiated.
Most treatment strategies start with a basic assessment of “modifiable” risk factors. As compared to the non-modifiable risk factors like: age, gender and genetics; modifiable risk factors can actually be altered. One of the most important modifiable risk factors is smoking. Tobacco directly elevates blood pressure and damages blood vessels, causing atherosclerosis or “hardening of the arteries.”
A second risk factor is intake of salt. Salt retains water, which directly raises blood pressure. The scope of American salt intake is huge. The average American consumes one to three tablespoons of salt daily, or roughly 10 pounds of salt a year. The trouble is not just the added salt, but the “hidden” salt in our diets. Roughly three quarters of our daily salt intake comes from salt already in our food. The worst offenders are processed, canned and ready prepared meals, including fast food.
The best way to avoid this is to throw out your saltshaker, use a salt alternative and start reading labels. Dining out can also be tricky, but most restaurants can help you make reduced salt or salt-free choices.
Alcohol plays a key role in blood pressure control. It seems that small quantities of some alcohol may be helpful, yet excessive alcohol is known to be harmful. Intake of greater than two alcoholic beverages daily actually increases the risk of developing hypertension by 1.5 to 2 fold. Therefore, intake of one alcoholic beverage seems to be OK, yet anything greater than two drinks a day is going to worsen your hypertension and overall health.
Next comes physical activity. Long known to promote good health, physical activity helps to lower blood pressure. By various mechanisms, exercise causes weight loss and the building of healthy lean muscle, all of which help to regulate blood pressure. In studies, for every two pounds of weight lost there was a 0.5 to 2 mmHg reduction in baseline blood pressure. Before starting any exercise, check with your physician to see if you are able to safely start a work out routine.
If these measures are not successful in getting you to reach your target blood pressure, your health care provider may recommend one or more anti-hypertension medications. They are highly effective at reducing blood pressure and must be supervised closely by your providing physician. However, it is important to understand some basics about anti-hypertension medications.
All medications come with prescription education materials, listing how the medication works, possible side effects and what other medications to avoid. Your prescribing physician will also detail any special instructions to observe while taking the medication. Ask your doctor relevant questions and inform your physician if you think you are not tolerating the medication. Additionally, never abruptly stop your medication without first consulting the prescribing physician, as abrupt cessation of your anti-hypertension medication can cause an unsafe rebound elevation in blood pressure.
There are many highly effective anti-hypertension medications, so that therapy may be tailored to fit your specific needs. In general, antihypertensive medications can be broadly grouped into several categories. There are the diuretics, which lower blood pressure by increasing urine and sodium output (water pills). There are the ACE Inhibitors and their “pharmacologic cousins” called ARBs, which reduce blood pressure at the level of the kidneys and blood vessels. There are the calcium channel blockers and beta blockers, which directly relax the blood vessels and can slow the heart rate. There are the alpha blockers and nitrates, which specifically relax the blood vessels. Lastly, there are combinations pills, which are formulated with several anti-hypertension medicines in one pill.
As there are a multitude of these medications, finding the right medication is critical. Most people with hypertension will need to be on at least two medications to get to their target blood pressure.
With lifestyle modifications and mediations when necessary, you can reduce your blood pressure and improve your quality of life. These steps, with close supervision by your physician, can get you to your goal.
David M. Donaldson, MD, is an Auburn native and currently a cardiologist at Massachusetts General Hospital in Boston.