Check Your Blood Pressure for National Heart Month
By Susan Beane, M.D., Vice President and Medical Director, Healthfirst
High blood pressure, also known as hypertension, is the most common cardiovascular disease in the U.S.One in three American adults has hypertension, and one of the reasons for its prevalence is that people rarely have symptoms. That’s why it’s called the “silent killer.” I asked my colleague, Dr. Judith Mitchell, Associate Professor of Medicine and Director of the Heart Failure Center at SUNY Downstate Medical Center, to share more about this widespread disease.
Dr. Susan Beane: What is high blood pressure exactly?
Dr. Judith Mitchell: When we look at the top number (the systolic blood pressure) and the bottom number (the diastolic blood pressure), a reading of 120 over 80 mm Hg is considered normal. Above 140 over 90 is considered hypertension.
Dr. Beane: What are the risk factors for high blood pressure?
Dr. Mitchell: Being overweight or obese increases the risk of hypertension and diabetes. Stress and a sedentary lifestyle are also big ones. A diet that is high in salt (sodium) is another risk factor. Spices often are full of salt. Patients often use spices, such as garlic power, thinking they are avoiding salt, without realizing that most of these formulations are mostly salt. Read the label.
Patients who have sleep apnea, often seen in patients who snore or are obese, have a higher risk for hypertension. If you snore or have a loved one who snores, tell the doctor, because a sleep study may show they have sleep apnea. Patients with sleep apnea are more likely to develop hypertension and more likely to develop resistance to the usual treatments for hypertension. Genetics are another factor. If your parents and close relatives have high blood pressure, you are at risk of developing the disease.
Dr. Beane: What conditions can high blood pressure lead to?
Dr. Mitchell: I think the things we think of commonly are strokes, and they can be devastating and life changing. Heart attacks, kidney disease, and eye disease can happen, too.
Dr. Beane: What are the treatment options for high blood pressure?
Dr. Mitchell: Medications are definitely high on the list. In fact, most people with hypertension need them. But lifestyle changes are critical: walking, reducing the salt in diet, cholesterol monitoring, avoiding tobacco, reducing alcohol, avoiding illicit drugs like cocaine, and weight control can really help, especially in that prehypertension phase.
Some over-the-counter drugs can increase blood pressure. So when you see your doctor, it’s really important to mention not only the meds that you are prescribed, but also over-the-counter medicines. Common over-the-counter medicines and herbal supplements that have the potential to increase blood pressure or affect its treatment include Advil, Aleve, Motrin, Ephedra (ma huang), Ginkgo (ginkgo biloba), and Ginseng (Panax quinquefolius and Panax ginseng).
Dr. Beane: What are the most frequent questions you get from patients regarding their high blood pressure?
Dr. Mitchell: The most common question and highest misconception is that once their pressure is treated, they can stop their medication. Not only is that not true, it’s dangerous. I encourage people to continue the lifestyle changes, continue to lose the weight, restrict salt, increase exercise, and we may, over time, see that we can reduce medication. It’s a rare case when a patient can be totally off medication.
Another question they ask, especially men, is how this will affect sexual function. I encourage my patients and get them to talk about any side effects and/or concerns. Hypertensive disease is a possible cause of impotence, because hypertension affects the blood vessels throughout the whole body. Effectively treating high blood pressure is one way to prevent that development. It’s important to talk with the doctor so together you can choose the appropriate medication that lets you avoid or limit side effects.
Dr. Beane: What advice do you have for patients about managing their high blood pressure?
Dr. Mitchell: I think you should be an active participant in your health. You know more than any caretaker will know about who you are. When you go to the doctor, bring a list of questions.
Take your blood pressure at home, and learn how to do it appropriately. Record it, and bring in the apparatus when you go to your doctor, because not all [devices] are accurate.In the doctor’s office, you can compare the reading of your device with the reading from the office machine.
Also, make your family and friends a part of your care. Tell them what you’re trying to accomplish so they might be more likely to take a walk with you every day or they could remind you to take your medications and support your healthy eating habits.
Dr. Beane is Vice President and Medical Director at Healthfirst. For more tips on leading a healthier lifestyle, visit the Healthfirst website at www.healthfirst.org.