HBP Booklet

7/30/2019 HBP Booklet

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C o n t e n t s

Introuction 1

Bloo Pressure—What is it?How do We Measure it? 3

Myths an Facts About High

Bloo Pressure 9

What Causes Hypertension? 11

determining the Cause of Hypertension 15

Effects of High Bloo Pressure 16

Other Risk Factors For Heart disease 19

Nonrug Treatments For High Bloo Pressure 19

Treatment of High Bloo Pressure With Meication 27

What You an Your doctor Cando to Keep Your Bloo Pressure

as Low as Possible 38

Home Bloo Pressure Monitoring 39

To Sum Up 40

Facts to Remember 41

Glossary 44

Copyright© 2007 Le Jacq

3 Enterprise drive, Suite 401

Shelton, CT 06484

phone: 203-944-9740 fax: 781-388-0500





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I n t R o D U C t I o n

H

ypertension (high bloo pressure)is still the most common reason that

ault Americans see their octors. Approximately one in four aults have thisconition. It is estimate that about 5–10million people may have high bloo pressurebut are unaware of their illness.

This booklet, “High Bloo Pressure— What You Shoul Know About It an What You Can do To Help Your doctor Treat It,” will provie information about what high bloo pressure is an how it can be treate.Importantly, it will tell you what you can

o to make your treatment more successfulan prevent the kins of complications, likestrokes or heart attacks, that use to occur much more frequently in people with high bloo pressure years ago, before we haeffective treatment.

Hypertension is just the medical term for

high blood pressure. Hypertension oes NOTsuggest too much tension or nervousness.Throughout this book we will be using the

wors hypertension an high bloo pressure

interchangeably.Making the iagnosis of hypertension is

fairly simple an oes not require a lot of meical tests. Although treating this conition

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usually requires a change in lifestyle or the useof meication, it can be successfully manage

in most people. If you have been tol that youhave high bloo pressure, you shoul not befrightene; it is something that you an your octor can control.

What Used To Happen To People With

High Blood Pressure? At the age of 57, Franklin delano Roosevelt(F.d.R.), the 32n Presient of the U.S., wasfoun to have an elevate bloo pressure of l70/90 mm Hg. (A normal pressure varies

between 120–130/ 75–85 mm Hg.) He hano symptoms of heart isease or bloo vessel amage. Over the next few years, thePresient experience a slow rise in bloopressure with levels in 1941 an 1942 of 180–190/105 mm Hg. In 1943 an 1944, his

bloo pressure rose to levels of 200/110 mmHg. He began to feel short of breath an haother symptoms of heart failure. Examinationreveale that his heart ha enlarge, thathe ha begun to have some problems with

kiney function, an that he might have haseveral small strokes. His symptoms becamemuch worse an, as everyone knows, thePresient ie of a massive brain hemorrhage(stroke) on April 12, 1945, at the young ageof 63 years.

His treatment was to rest as much aspossible, to stay on a low fat, low salt iet, anto take mil seatives, such as phenobarbitol.In the 1930s, 1940s, an early 1950s, there

were no effective treatments available. Since

that time, many meications have beenintrouce an have been use successfully.Ha the Presient live 15–20 years later, hemost certainly woul have live longer. Hisstory woul have ene ifferently.



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In the 1940s an 1950s many people were retire at relatively young ages or

place on isability an refuse insurancebecause their bloo pressures were too high.Their lives were shortene. Treatment haschange all that. This book will help youlearn about high bloo pressure an other risk factors for heart isease. It will tell you

what you can o to change these risk factorsan prolong your life. Finally, it will tell youhow you can work with your octor to treat

your high bloo pressure successfully.

B l o o D P R e s s U R e — W H A t I s I t ?

H o W D o W e M e A s U R e I t ?

A Serious National ProblemHigh bloo pressure—hypertension—is one

of the most serious iseases in the U.S. Itcontributes irectly or inirectly to almost900,000 eaths a year. It costs you an thegovernment many billions of ollars a year.

High blood pressure is treatable. Many

eaths can be prevente if hypertension isfoun early an manage properly. High bloopressure is a major reason why people havestrokes or heart attacks. The goo news is thatstroke eaths have ecrease by about 60% aneaths cause by heart isease have ecreaseby more than 50% over the past 20–25 years;much, but obviously not all, of this increase inlife span can be attribute to earlier an better treatment of high bloo pressure.

How Do We Recognize Hypertension?Unlike a toothache or backache, high bloopressure may not prouce any symptoms. Somepeople can tell when their bloo pressure is



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elevate, but the only sure way to tell is to haveit measure. People may not know they have

high bloo pressure until it begins to causetrouble with the heart, brain, or kiney—asin the case of F.d.R. To keep a check on your bloo pressure, there is a simple, painless testthat only takes about 1 minute. This test hasbecome so routine that almost everyone has

ha their bloo pressure taken at least once or twice, usually uring regular checkups.

What Is Blood Pressure?Bloo pressure is the force exerte by thebloostream against the walls of arteries.Everyone has to have some bloo pressure.It is absolutely necessary to get bloo to our

vital organs an muscles.Normally, each time our heart beats (about

60–80 times a minute at rest), it pushes bloo

out into the larger arteries, which are the tubes or vessels that carry bloo from the heart. The bloothen flows into smaller arteries to various partsof the boy, such as the liver, the kiney, or thebrain, an then returns to the heart through the

veins. The smaller arteries, calle arterioles, can

open wie (ilate) or close (constrict) (Figure).The beating action of the heart may be

compare to a pump. The arteries may becompare to the tubing of a hose. The smallbloo vessels or the arterioles are like a nozzle.

If the nozzle is kept open, water will flow freely through the hose, an little pressure is built upon the walls of the hose. If, however, the nozzleis clampe own, increase pressure is built upon the sies of the hose an the pump must work harer. In the same way, if the arterioles or small

bloo vessels remain open as the heart beats,bloo pressure in the arteries remains fairly low or normal. If they narrow, higher bloo pressureresults. Of course, the circulation is a close



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system, an bloo is not leaking out anywherebut is being pushe through in surges every timethe heart muscle contracts or “pumps.”

Bloo pressure can vary wiely. It can rise when you are excite or nervous or while you

exercise, or it may become low when you sleep.Most people o not know that bloo pressureis high just before they wake up in the morning(6–8 a.m.). It remains at these levels uring theay an ecreases uring sleep. Bloo pressuremay vary within the course of a ay by as much

as 20–30 points in someone with “normal”bloo pressure an even more in someone with untreate hypertension. Therefore, a singlereaing shoul not be use to make a iagnosisof high bloo pressure.

Measuring Blood Pressure—The Blood Pressure Test The amount of pressure in the artery ismeasure by the level of air or mercury in

ArteriolesIf these are "open"pressure is less.

Arterioles

If these are toonarrow pressureincreases behindthem.

Ar teries

Ar teries

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V e i ns

Heart

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a tube, which is part of a bloo pressureinstrument calle a sphygmomanometer (sfig-

mo-mah-nom-eter). A bloo pressure cuff isplace aroun the upper arm an inflate

with air until the circulation in the artery istemporarily cut off. A valve in this instrumentis opene an air is graually release fromthe cuff. The person who is measuring the

bloo pressure places a stethoscope over the artery on the inner sie of the elbow tolisten for the first soun of bloo rushingthrough the artery as the pressure in thecuff is lowere. The number on the gauge

at the moment that this occurs representsthe pumping or systolic (sis-tal-ik) pressure.This is the pressure prouce in the artery

when the bloo is pushe forcibly from theheart into the large bloo vessels. Aitionalair is graually release from the cuff. When

all beating souns stop, the number on thepressure gauge represents the resting or iastolic (i-ah-stal-ik) pressure. This is thepressure that remains in the arteries whenthe heart is relaxing between beats.

Thus, bloo pressure is recore in twonumbers as millimeters of mercury (mm Hg).For example:

120 mm Hg systolic (pumping pressure)80 mm Hg iastolic (resting pressure)

The measurement above woul be spoken of as “120 over 80,” with the systolic (higher)number always given first, followe by theiastolic number. Some bloo pressure cuffsthat employ electronic evices or igital

reaout technology o not require the useof a stethoscope to listen for souns. Bloopressure is taken automatically an isplayeon a small screen or signale by a beepingsoun. There are some instruments that can



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recor bloo pressure from a finger. However,

the accuracy of these evices has not beenproven an they are not recommene if you are planning to buy a bloo pressuremachine to take your pressures at home.Bloo pressure shoul be taken when youare relaxe with your arm at the level of your

mi chest area.

What Is Normal Blood Pressure?So-calle normal bloo pressure may be aslow as 70/50 mm Hg in infants, or as high as about 130/80 mm Hg in aults. “Normal”bloo pressure for people uner 18 is usually below 120/80 mm Hg. Over the age of 18, a reaing up to about 130/80 mm Hgis consiere within the normal range. Anoptimal or ieal BP in an ault is about 120/80.

A iastolic (lower number) reaing between85–90 mm Hg is consiere “high-normal” or prehypertension. A systolic (upper number)reaing of 130–139 mm Hg is also consiere“high-normal” or prehypertension. If an

adult’s blood pressure is consistently 140/90

mm Hg or higher, he or she has high blood

pres sure or hypertension.

The risk of heart or bloo vessel problemsincreases as bloo pressure rises above



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normal levels, regardless of age. The higher the pressure, the greater the risk. As you can

see in the fourth “myth” on pages 9–11, oler people o not nee higher bloo pressurelevels to supply bloo to the brain or kiney.

Any reaing above the “normal” level requiresfollow up an possible treatment. One or twoelevate bloo pressure reaings, even just

to levels of 140–145/90–95 mm Hg, may inicate something about the future. Thesenumbers cannot be ignore. Untreate, evenhigher levels of bloo pressure may evelop,an the risk of kiney failure, a heart attack,

or stroke is increase. If you are one of those people with a bloo pressure that iseven occasionally high, it is probably wiseto have it rechecke perioically. If themeasurements remain at or above 140/90mm Hg, your octor will probably suggest

a change in iet or an exercise program; inmany cases you will have to take meication.Of course, not everyone with high bloopressure on one or two occasions goes on toevelop permanent high bloo pressure.

What About Low Blood Pressure?People use to believe that low bloo pressure(e.g., about 110/70 mm Hg or below in anault) was angerous. Except in rare cases,this is not true. We know that the lower

your bloo pressure (both the upper anthe lower reaing), the less chance you haveof getting a stroke or heart attack. In somecases, people with low bloo pressure may tire easily or feel faint when staning in a hotroom, or after a few alcoholic rinks, but inmost cases they have no symptoms.



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M y t H s A n D F A C t s A B o U t H I G H B l o o D P R e s s U R e

MYTH: Hypertension means that a person istense or anxious. FALSE

FACT: Hypertension means high bloopressure. You o not have to be nervous, tense,or jumpy to evelop high bloo pressure.Many calm people suffer from hypertension. Itis true that stressful situations may temporarily elevate bloo pressure, an that over the yearsrepeate prolonge stress may have a longterm effect, but this is not always the case.

MYTH: Loss of excess weight is by itself enough to cure bloo pressure. FALSE

FACT: Obesity (being fat) is associate with hypertension—more overweight people have

high bloo pressure than thinner people.Losing weight, however, oes not guaranteethat bloo pressure will return to normallevels, but it will usually ecrease to someegree. Too often an overweight person with

hypertension is tol to lose weight as their only treatment. Weight loss is important,but in many cases aitional treatment isnecessary. Of course, thin people also canhave high bloo pressure.

MYTH: Hypertension is a isease of ol age.FALSE

FACT: Most people evelop high bloopressure between 35–50 years of age. Someof the more serious cases may actually beginat younger ages.

MYTH: Oler people nee higher bloopressure to get bloo to vital organs. FALSE



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FACT: A 70 year ol with a reaing of 140/90mm Hg has a better future than one with a

pressure of 170/90 mm Hg. The higher thebloo pressure, the greater the chance of having a stroke, a heart attack, or kiney failure, at any age.

MYTH: The iastolic bloo pressure (lower

reaing) is more important than the systolic(upper reaing). FALSE

FACT:Not so—an elevate systolic bloo pressureby itself is more preictive of problems.

MYTH: Once you have high bloo pressure,an it affects your brain or heart, there isnothing you can o about it. FALSE

FACT: Just the opposite—you can o a great

eal about it. Lowering your bloo pressureby proper treatment will often preventfurther brain an heart problems. Frequently,an enlarge heart becomes smaller, antherefore, healthier as bloo pressure levelsare lowere (see “Treatment of High BlooPressure With Meication” on page 27).

MYTH: Hypertension significantly restricts aperson’s life. dEFINITELY FALSE

FACT: A person with high bloo pressurecan an shoul lea a normal life—if they aretreate.

MYTH: Meicines that lower bloo pressuremake people feel ba an cause sexual

problems. FALSE

FACT: Fewer than 10% of people experienceannoying sie effects which may inclue sexual



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problems. Changing meication or oses of meication usually can minimize or eliminate

these effects. Lowering blood pressure mayactually make you feel better.

MYTH: Herbal substances an plants, such as garlic, are effective in lowering bloopressure. FALSE

FACT: Careful stuies have not proven thisto be true.

W H A t C A U s e s H y P e R t e n s I o n ?

I n more than 90% of the cases, we o notreally know what causes hypertension!However, we o have some theories.

For some reason, in certain people the smallbloo vessels at the en of the arteries seem tocontract more forcefully than in other people.This causes an increase in pressure within thearteries. This may be ue to an increase incertain nerve impulses with a release of toomany arenaline-like substances; high bloo

pressure results. In some other people, thekineys are unable to wash out enough salt(soium). As soium an flui buils up inthe boy, the heart must pump an increasingamount of bloo with each beat. This alsoincreases the bloo pressure.

We o not know why these things beginto happen—why the small bloo vesselsconstrict or narrow more than they aresuppose to, or why the kiney is unable toget ri of the amount of salt some people take

in. But we unerstan what is happening,an therefore, we can treat hypertensioneven if we o not always know exactly whatcauses it.

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In a very small number of people, efinitecauses can be foun. For instance: 1) In less

than one-half of 1% of people with high bloopressure, one or both arenal glans, which arelocate above the kineys, will secrete largeamounts of arenaline into the bloostream.This can cause “attacks” that may be similar toanxiety attacks, i.e., heaaches, sweating, an

a rapi heartbeat. 2) In 2%–3%, a longstan-ing or chronic kiney inflammation (infection,e.g., pyelonephritis or nephritis) may causehypertension. 3) In about 2% of cases, one of the arteries to a kiney narrows, ecreasing

the amount of bloo that flows to the kiney.The kiney then emits into the bloostreama chemical calle renin, which causes thebloo pressure to rise. Although hyper tensionis relatively uncommon in chilren, this may be a cause of high bloo pressure in about

15%–20% of the cases in chilren 10 years or younger. 4) Other problems, such as an exessof a hormone that causes an increase in saltan water, may cause high bloo pressure insome cases. 5) The use of birth control pills

will raise the bloo pressure slightly in many women; in a small number, long term use may result in continuing high bloo pressure. 6)Hypertension may evelop in a small number of pregnant women uring the last few months of pregnancy as part of “toxemia of pregnancy.”

Does Heredity Affect Blood Pressure?Stuies have shown that chilren with oneparent with high bloo pressure have a greater chance of eveloping the isease than those

with no high bloo pressure in the family.Certain genes have been ientifie that probably contribute to this problem. When both parentshave high bloo pressure, the os are greater still. This does not mean, however, that all



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children of parents with high blood pressure

will develop it , but it suggests that they are

more likely to become hypertensive.

Dietary and Environmental Factors That May Affect Blood PressureThe effect of environment has also beenstuie. En vironment may be less important

than hereity in etermining who will or willnot evelop elevate bloo pressure. Thereare, however, certain factors, such as a high saltintake, that probably play an important role.

In the U.S., bloo pressure often rises with

age, but this is not so for the entire worl. Insome countries (e.g., parts of Brazil) wherethere is little salt (soium) in the iet, aultshave the same bloo pressure levels as chilren.On the other han, black populations, both ininustrialize countries such as the U.S. an in

the Bahamas or the West Inies, generally havehigher rates of hypertension than whites. Thereason for this is not known. Suggeste causesare a high salt (soium) intake, changes in the

way the kineys hanle salt, too much stress, or too little potassium or calcium in the iet.

Salt. Eating extra amounts of salt may causetrouble but not for everyone. There arepeople who are "Salt Sensitive" an others

who can eat lots of salt an not notice a

change in bloo pressure. In some people with a family history of hypertension, a high salt iet starting at infancy may increase therisk of eveloping high bloo pressure at alater age. Infants an young chilren fromthese families shoul be encourage to go ona low salt iet at as early an age as possible.

Human beings, even those who o heavy work in hot climates, nee very little salt tosurvive. Most of us eat about two teaspoonfuls



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(10–12 grams) per ay. We really only nee lessthan half a teaspoonful a ay regarless of our

occupation or aily activities. Unfortunately,once hypertension evelops, moeratelowering of salt in the iet, without other treatments, usually will not ecrease bloopressure to normal levels except in some lesssevere cases. Eating foos, such as fruit or fruit

juices, which have a high potassium contentor nonfat airy proucts, like skim milk, which are goo sources of calcium, may help to keepbloo pressure normal.

Fatty foods—Cholesterol. People in theU.S. still consume a great eal of meat anairy proucts, but the amount is consierably less than 10–15 years ago. Animal fats ten toraise bloo cholesterol levels. (An elevatecholesterol level is, in aition to high

bloo pressure, a major risk factor for heartisease.) People with hypertension shoul beparticularly careful to keep their cholesterollevels uner control. Heart attacks o notnecessarily result from the American “ratrace,” or a seentary lifestyle alone; ietplays an important role. It may surprise youto know that very active people in Finlanan Hollan, where iets are high in fat, haveabout as many heart attacks as Amer icans.

What to do about diet? If you have high bloopressure, your octor, in aition to treatingthis, may also recommen that you reuce theamount of fat, saturate fat, an cholesterol in

your iet to limit or reuce another major “risk factor” for heart an bloo vessel isease. This

woul inclue eating more white meat chicken(without the skin) an fish, rather than beef.

Your physician may also suggest rinking skimor 1% milk instea of whole milk, an cutting



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own on the amount of whole milk cheese,butter, an eggs that you eat. You o not,

however, have to turn your househol into aiet kitchen to stay on a low fat iet. It can beone by keeping a few basic rules in min.

Fatty foos, such as processe pork an

bacon, also contain large amounts of salt. These

foos shoul certainly be avoie. So-calle

“fast foos” usually contain lots of salt an

fat, especially saturate fat, which raises your

bloo cholesterol level more than anything

else in the iet. Foo manufacturers must

now list the amount of soium, fat, saturate

fat, an cholesterol, as well as the number of

calories, on each foo package. This helps you

select healthier choices. It is a goo iea to

avoi (or only eat occasionally) foos that have

more than 150 mg of soium in each portion

(see page 22 for a list of high salt foos).One important point—there is some

evience that staying at a esirable weightkeeps your bloo pressure from becominghigh. You shoul try as har as possible to

keep your chilren from becoming heavy. An overweight aolescent usually becomesan overweight ault with a greater chance of having high bloo pressure.

D e t e R M I n I n G t H e C A U s e o F H y P e R t e n s I o n

H ow oes your octor ecie whether

you have “essential” (“primary”) high bloo pressure (from no apparent

cause) or whether you are one of the people

with a rare specific cause for hypertension? A careful meical history, a physical

examination, an a few simple tests willusually tell. It is reassuring to know that:

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1. People with high bloo pressure usually onot have to be in the hospital for stuies;

2. Expensive, complicate, or painful testsusually are not necessary;3. One or two visits to a octor’s office or

clinic will complete the “workup.”

A urine an bloo test will rule out the presence

of significant kiney isease as a cause of high bloo pressure. A bloo test for potassiumlevels usually (but not always) rules out thepresence of too much of a certain hormonefrom the arenal glan. A patient’s history might

suggest the nee for some special tests on thekineys or a 24-hour urine sample. Usually,however, after several bloo pressure checksan some simple tests, the octor is reay toavise specific treatment for hypertension, or to suggest when you nee follow-up.

What Are The Effects Of HighBlood Pressure?Enlarged heart. Just as a person’s biceps or arm muscles get bigger after weightlifting over a perio of time, the heart muscle enlarges if it has to work harer than usual to push blooout into the vital organs of the boy. This is

what happens to the heart of a person with “untreate” high bloo pressure. Increasepressure can be tolerate for many years, but

sooner or later, as the heart muscle stretchestoo much or gets too thick, the heart is nolonger able to function properly. Bloo is notpumpe forwar into the rest of the boy.Some of it backs up in the lungs. The heartfails. This is what happene to F.d.R.

Just as you can reuce pressure in ahose by opening up the nozzle an letting

water flow freely through it, a person’s bloo

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pressure can be lowere by ilating (opening)the small arteries. Then the heart oes not

have to pump as har each time it beats. After bloo pressure has been returne to normalan has remaine normal for several monthsor a year or two, there is a goo chancethat the heart muscle will return towar itsnormal size. Heart failure is rare in people

whose blood pressure has been controlled.If high bloo pressure is not foun or

is poorly treate, there is also increasingpressure on the walls of the small bloo

vessels of the brain, the kiney, an the rest

of the boy. Several things can happen.

Stroke. In the brain, as pressure increases,amage occurs to the lining of the bloo

vessels, an little blisters may form. Theseare calle aneurysms (an–u–rizms). These

aneurysms are very small, but occasionally may break suenly. This causes a “stroke,”

with hemorrhaging (bleeing) into the brainan weakness on one sie of the boy or a loss of speech. In aition, a stroke may

be cause by progressive narrowing of oneof the vessels in the brain, a process which is mae worse by hypertension. This alsohappene to F.d.R.

Uremia. (Failure of the kineys to function

properly). In the kiney, continue high bloopressure may cause increasing amage, with narrowing an thickening of the arteries. Thisreuces the amount of flui that the kiney can filter out into the urine. Since the kiney eliminates waste proucts from our boy,these proucts now buil up. The resultcan be kiney failure with "uremia." Someuremic patients may have to get a specialkiney treatment (ialysis) or unergo kiney



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transplants. It is estimate that about 20%–25%of patients who are now on ialysis programs

starte out with “slightly elevate bloopressure” which was not treate effectively. Early treatment of hypertension can usually

prevent this serious complication. Treatment,even after some bloo vessel amage hasoccurre, will often elay further amage to

the kiney. This is especially true with someof the newer meications.

Atherosclerosis. (Harening of the arteries).

Finally, an most important, if bloo pressure

is not controlle, some of the fat that normally circulates in our boy is pushe more rapily

into the walls of the amage arteries. Plaques

(collections of fatty material) buil up in the

arteries, like rust on the insie of a pipe. This

conition is calle atherosclerosis, an iscommonly referre to as “harening of the

arteries.” It can happen to some egree in all

the arteries in the boy. The higher the bloo

pressure an the more fat (cholesterol) in the

bloostream, the faster the process. All of us evelop some harening of the

arteries as we get oler, even if our bloo pressureis normal. People with untreate or unetectehigh bloo pressure get atherosclerosis an itscomplications at an earlier age.

Heart Attack. If the arteries that supply blooto the heart itself, the “coronary arteries,”become clogge with fatty material, thebloo flow to portions of the heart is reuce.

When one of the vessels is completely closeoff, there is a temporary stoppage of all blooflow to that part of the heart. Portions of theheart muscle are amage. We say that a“heart attack” has occurre.



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M A n y o F t H e s e e F F e C t s C A n B e

P R e v e n t e D B y t R e A t M e n t

Other Risk Factors ForCardiovascular DiseaseIn aition to high bloo pressure, the risk of heart an bloo vessel (cariovascular)

complications is greatly increase by smoking,a high bloo cholesterol level, iabetes, anbeing overweight. For example, a stuy of thepopulation in Framingham, MA, eterminethat a person with even slightly elevate bloo

pressure runs a greater risk of having a strokethan a person with normal bloo pressurean an even greater risk if they are a iabeticor a smoker or have a high bloo cholesterollevel. These other risk factors for heart iseaseshoul therefore be correcte if possible, in

aition to lowering the bloo pressure.

What You Can Do To Reduce The Risk Of Heart Disease And Stroke?Lose weight if you are overweight. Even

small amounts of weight loss may lower bloopressure in some people. However, weight lossoes not always result in a continue loweringof bloo pressure. Staying at a esirable weightreuces your chances of having a heart attack.

To recap, high bloo pressure may cause:

• Thehearttogetlarger • Littleblisters(aneurysms)intheblood

vessels in the brain • Progressivenarrowingofthekidney

bloo vessels • Increasedrateofhardeningofthe

arteries all over the boy, especially inthe heart, brain, an kineys

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The chart on page 22 shows you how toestimate your ieal or esirable weight.

Remember, “fa” or “miracle” iets onot work over a long perio of time. While

you may lose weight on a low-carb or high-fatiet, these are not recommene—too little isknown about their long-term effects. Losing

weight epens on taking in fewer caloriesthan you burn up. A gain in weight results if energy (calories) intake is greater than energy (calories) use up. If you use up 3500 caloriesmore than you take in over a perio of time,

you lose 1 lb That is, if you take in 2000 calories

a ay an “burn up” 2500 calories a ay, you will lose 1 lb a week (500 calories/ay x 7 ays= 3500 calories = loss of 1 lb). Another way to burn up calories is to increase your activity level. There is nothing magical about this;

but to maintain weight loss, these changehabits of eating an exercise nee to becomea permanent part of your lifestyle. Losing

weight, if appropriate, is probably the single

most important nondrug treatment for high

How To Figure Out Ideal OrDesirable Weight In Adults

Men Women

106 lbs for 100 lbs for the 1st 5 ft the 1st 5 ft6 lbs for each 5 lbs for each

aitional inch aitional inch Example:a 5 ft 10 in man a 5 ft 5 in womanshoul ieally shoul ieally

weigh 166 lbs weigh 125 lbs106 + (10 x 6 = 60) 100 + (5 x 5 = 25)

These weights are approximate. A variation of 5–10 lbs is acceptable.



21

blood pressure. The chart on this page showshow to estimate the number of aily calories

you nee to maintain your weight.

Watch your salt and fat intake. Reuce

your intake of salty, high fat foos. Eat balancemeals, with fruits, vegetables, grains an, asnote, more skinless chicken, fish, an leanmeat rather than heavily marble meat. Eatfewer eggs an less bacon. Use skim or 1%milk instea of whole milk. In general, it is a

goo iea to use little or no salt at the table or in preparation of foo; use paprika, pepper,oregano, cloves, cinnamon, or lemon juiceinstea. Eat fewer foos that are obviously salty or preserve in salt or brine.

Weight reuction an/or salt restrictionmay ecrease bloo pressure to normal levelsan eliminate the nee for specific meicationin about 15-20% of iniviuals with less severeegrees of hypertension, especially in the

How To Estimate The NumberOf Daily Calories You Need To Maintain

Your Weight*

Ieal weight × 13 if you are seentary 15 if you are moerately active17 if you are very active

Example: Wt. 166 (5’10” man) × 15(moerately active) = 2490calories/ay

Wt. 125 (5’5” woman) × 13(seentary) = 1625 calories/ay

(These are approximate numbers.)*Remember, if you take in 500 calories/ay less than you nee, you will lose 1 lb/wk—people over 60 years of age require fewer calories to maintain boy weight.



22

elerly. The list above inicates some foos

that contain a high salt or soium content thatshoul be limite or avoie if you have high bloo pressure.

Here Are Some Other Clues To Help Reduce Your Salt Intake

•Cutdownontheamountofsaltusedatthe table.

•Reduce salt used in cooking a little bit

each ay until you no longer use any. •Read food labels to find the amount of

soium in foos. Avoi or limit foos with more than 150 mg in each serving.

• Choose foods which do not list salt as

one of the first three ingredients.

•Look for foodswith thewords “sodium

Some Foods With A High Salt Or Sodium

Content—These Should Be Limited Or Avoided If You HaveHigh Blood Pressure

“Fast foos” OlivesPotato chips Commercially

Pretzels prepare soupsSalte crackers BouillonBiscuits HamPancakes SausagesMost commercial Frankfurters

pastries or cakes Smoke meatsPickles or fish Sauerkraut SarinesSoy Sauce Tomato juiceCatsup Many canneMany kins of vegetables

cheese

*Note: Look at labels!



23

free,” “low soium,” “very low soium,”or “unsalte” on the label.

•Usefreshorfrozenfruitsandvegetables whenever possible. (Many contain largeamounts of potassium, a mineral that may be beneficial to some people with high bloo pressure.)

•Limit choices of smoked, cured, or

processe meats. •Rinse canned foods to remove some of

the salt. •If you crave the tasteof salt, tryoneof

the lower salt substitutes, especially ones

with ae potassium. •Unfortunately,morethan50%ofthesalt

we eat comes from processe foo. It isifficult to limit soium intake if eatingout or eating a lot of processe foos ispart of your lifestyle. Remember, if you

are being treated for heart failure, tryto keep your sodium intake below 2000

mg (<2 gm)/day.

•Blood pressure responses to limiting

soium intake vary. In some “salt sensitive”

people, pressures will ecrease; in those who are not “salt sensitive” they may notchange. There is no easy way to prove

whether or not you are “salt sensitive.”But, in general there is no own-sie tolimiting salt intake.

Stop Smoking Until recent years, most publicity about theproblems of smoking warne about lungisease, such as bronchitis, emphysema, anlung cancer. But you shoul be aware thatsmoking also injures bloo vessel walls anspees up harening of the arteries. Smokingis a major risk factor for a heart attack. Thesmoke itself (carbon monoxie) probably



24

causes much of the amage to bloo vessels.The immeiate effect of a few cigarettes on

bloo pressure may not be great, but chainsmoking may cause chemical changes thatten to raise bloo pressure over time. People

just shoul not smoke cigarettes.In orer to avoi a possible weight gain

when you stop smoking, it is a goo iea to

cut own on foo intake at the same time.It is interesting to note that the risk of a

heart attack in a person who once smoked

but who has stopped is almost the same as it

is for a person who has never smoked. You

will reuce the risk of a heart attack by about50% in 1 year an eliminate it by a consierableegree within 1–3 years after you stop smoking,no matter how long you were a smoker.

During the past 20 years, the American

public has responded to the message about

risk factors. Total tobacco consumption hasbeen reduced by more than 25%, salt intake

by more than 25%, and the use of saturated

fats by more than 30%; deaths from heart

disease have decreased by more than 50%.

Exercise Is Good For YouGo ahea! do whatever you like to o, buto it at least 3 or 4 times a week for at least30–40 minutes each time, if possible. If youlike to jog, then jog, but o not try to “prove

anything.” If you prefer to take long walks, or swim, or play tennis, hanball, or basketball,or if you just want to rie a bicycle, even astationary one in your beroom or basement,go ahea an o it. Regular exercise is helpful

but there is no efinite proof that the benefitsof a vigorous exercise program are any greater in reucing bloo pressure or heartattack risks than those of a more moerateone, which may only involve taking a brisk



25

walk for 30 minutes 3 or 4 times a week.Regular exercise also makes you feel better,

helps to burn some calories, an may help toreuce the levels of fat in the bloostream.Exercise alone may help lower bloo pressurein some people with hypertension. dynamicor motion exercises are much better for youthan exercises such as weight lifting. These

may help you evelop bigger muscles, butthey may not help you live longer.

People whose bloo pressure has beencontrolle at normal levels shoul be able toexercise without ifficulty or fear, but check

with your physician if you ecie to start any kin of vigorous program.

Lessening Of TensionReucing tension may not represent effectivetreatment for lowering bloo pressure, but it

can't hurt. Whenever possible, o things thatmight relax you (other than taking a tranquilizer).Rea. Take up a hobby. Take long walks. Such activities frequently help to ecrease the amountof arenaline (which constricts or narrows bloo

vessels) an allow the bloo vessels to open up.Bloo pressure will be lowere temporarily. Do not depend on relaxation techniques,

vacations, or “getting away from it all” to

lower your blood pressure permanently.

For example, “biofeeback” an “TM”

(transcenental meitation) are still beingrecommene to treat high bloo pressure.

Although the bloo pressure of most of usmight be lowere for a short perio of timeif we relaxe, sat still, an looke out the

winow, or concentrate on a pleasant subjectfor a part of the ay, these techniques o notresult in a reuction of elevate bloo pressureover time except perhaps in some less severecases. You must not epen on them alone.



26

Drinking And High Blood Pressure We all know about the effects of overuse of

alcohol on the liver, the brain, an the heart.There is also some evience that heavy use of alcohol—more than 3–4 oz of 100 proof whiskey,18 oz of wine, or 36–48 oz of beer each ay—canalso raise bloo pressure. However, an occasionalalcoholic beverage is not a ba thing for people

with high bloo pressure, an there is even someevience that people who have one rink a ay may have fewer heart attacks than those who onot rink at all. Remember, however, that alcoholhas a lot of calories. If you are trying to lose weight,

you shoul keep this in min. Limit aily alcoholintake to about one an a half or at most 2 rinksof 80 proof liquor. You shoul also set a limit of about 1–2 glasses of beer an 2 glasses of wine aay. Because women ten to be smaller than men,about one half of the above amount may be more

appropriate. Pregnant women shoul not rink alcohol. Remember, if you have a family history

of alcoholism, or have a sensitivity to alcohol,

you should not drink at all.

Medical Treatment All these lifestyle modifications may help,but specific medical treatment is vital if blood pressure remains higher than 140/90mm Hg. Cutting out smoking, losing weight,exercising, relaxing more, an, most especially,reucing your salt an fatty foo intake are all

very goo for you. But, except in some lesssevere cases, these may not by themselveslower elevate bloo pressure over time. Inmost cases, you must use meications anusually continue to take them inefinitely.

Many people with high bloo pressure areobese, have abnormal levels of certain fatty or cholesterol-like substances in the bloo (lipilevels), an have a tenency towar iabetes(metabolic synrome); therefore, efforts



27

shoul be mae to normalize bloo sugar an lipi levels with iet an meication, if

necessary. In aition, after bloo pressurehas been controlle, a small ose (81 mg/ ay) of aspirin shoul be taken in an effort topossibly prevent a heart attack.

tReAtMent oF HIGH BlooD PRessURe WItH MeDICAtIon

Specific Medications For High

Blood Pressure

do not feel that you have “faile” if you enup taking meication. One of the mistakes

in treatment is to depend totally on lifestylechanges to control blood pressure.

If you have been unsuccessful in reucing your bloo pressure to goal levels (below 140/90 mm Hg) or even lower if you haveiabetes, kiney, or heart isease after 2–3

months of attempting to change your habits(if they neee to be change), your physician

will probably ecie to give you meication.If your bloo pressure is initially very high—for example, more than about 160/100 mm

Hg—or if you have other risk factors, such asiabetes, or are a smoker, your octor may ecie to begin meication after just one

visit or after only a short (2–4 weeks) trialof nonrug treatment. There are more than100 bloo pressure lowering rugs available

on the market in the U.S. Some of them, likeiuretics, have been in use for 50 years; othershave been introuce more recently. Studies

have demonstrated that the reduction of

blood pressure will prevent progression from

less severe to more severe hypertension, will

prevent enlargement of the heart and heart

failure, and will dramatically reduce strokes,

stroke deaths, and heart attack deaths. Benefithas been note in both young an ol persons,

t R e

A t M

e n

t o

F H

I G

H

B

l o

o

D

P R e

s s U R e W

I

t H

M

e D I C

A t I o

n



28

even in people over 80 years of age—gettingbloo pressure own to below 140/90 mm Hg,

or as note below 130/80 mm Hg if you haveiabetes or kiney isease, if at all possible is agoo iea at all ages.

Many ifferent rugs have been carefully teste an shown to reuce strokes an heartattacks. In 2003, the Joint National Committee

on detection, Evaluation, an Treatment of High Bloo Pressure recommene iureticsas initial treatment unless there are specificinications for the use of other rugs. Therapy

with other agents such as the ACE inhibitors,

angiotensin receptor blockers, calcium channelblockers, an beta blockers has also beenfoun to reuce the complications of high bloo pressure. In a majority of cases, 2 of these ifferent meications may have to beuse in combination.

Diuretics , or so-calle water pills, wash out extrasalt or soium from the boy an from bloo

vessel walls an allow the bloo vessels to ilate,thereby reucing bloo pressure. There are

many ifferent brans of iuretic rugs. Somecommonly use iuretics inclue chlorthalionean hyrochlorothiazie. Physicians may prescribe various kins for ifferent people. For example, some iuretics will only be effectivefor 4–6 hours, while others will keep bloo

pressure low for as long as 48 hours.diuretics are well tolerate an most

people are able to continue their use for many years without ifficulty. Their use has resultein a reuction in cariovascular events both

in the young an elerly. Some of the sieeffects of these agents are liste in the charton pages 36–37. diuretics are also available incombination with meications that preventpotassium loss which may occur when these



29

rugs are use. In aition, they are also usein combination with almost all of the other

bloo pressure lowering rugs.Recent recommenations of the National

Committee suggest that combinations of aiuretic an other meications may be acceptableas initial therapy in patients with iabetes or bloo pressure higher than 160/100 mm Hg

(see chart on page 30). Your octor may elect toimmeiately start you on such a combination.

ACE inhibitors are a class of rugs that is wiely use. Some of these are liste in the

chart on pages 36–37 an inclue Aceon,®

Altace®, Capoten™, Lotensin®, Mavik ®, Prinivil®, Vasotec®, an Zestril®. The use of these rugsprevents the prouction of a chemical thatcauses bloo vessels to constrict. The vesselsopen up an bloo pressure is lowere. These

rugs are especially effective in people with heart failure when they are use along with aiuretic, a beta blocker, an igitalis. Recurrenceof heart failure an mortality are reuce. They are also especially useful in patients with iabetes

an kiney isease; a combination of an ACEinhibitor an a iuretic may be the preferretreatment in such a situation.

Meications relate to the ACE inhibitors, theangiotensin II receptor blockers (ARBs) ,

inclue Atacan®, Avapro®, Cozaar ®, diovan®,Micaris®, an Benicar ®. These meications acton the same chemicals as the ACE inhibitors butat a ifferent location. Bloo pressure is reuce.These are also effective in treating heart failureor in slowing own the progression of kiney isease, especially in iabetics. While a cough may occur in about 15%–20% of patients whoare taking an ACE inhibitor, cough is rare with the ARBs.



30

A recently introuce meication, Tekturna® (aliskiren), a renin inhibitor, inhibits an enzyme

that stimulates chemicals that constrict bloo vessel—bloo vessels ilate. This meication will probably be use in combination with other agents.

Combinations of an ACE inhibitor with a

iuretic (Capozie®, Lotensin HCT®, Prinzie®, Vaseretic®, or Zestoretic® ) or an ARB with a iuretic (Atacan HCT®, Avalie®, Benicar HCT®, diovan HCT®, or Hyzaar ® ) have beenshown to increase the number of people who

respon to goal bloo pressure levels of below 140/90 mm Hg from about 40%–50% whenonly one rug is given to about 75%–80%.These meications may also be consiere for initial treatment.

Some Available CombinationMedications*

1) Beta Blocker/Diuretic 4) ARB/Diuretic

Inerie LA Atacan HCTLopressor HCT AvalieTenoretic Benicar HCTZiac diovan HCT

Hyzaar Micaris HCTTeveten HCT

2) ACE Inhibitor/Diuretic 5) Calcium

Capozie Channel Blocker/

Lotensin HCT ACE Inhibitor Prinzie, Zestoretic Lexxel Vaseretic Lotrel

3) Two Different Diuretics Tarka Alactazie 6) ARB-CCB dyazie, Maxzie Exforge

Mouretic Azor

*Not all available combinations are liste.



31

Calcium channel blockers have been in usefor more than 20 years. They act by preventing

calcium from entering bloo vessel walls or heartmuscle. There are several ifferent types of theseagents; some will mostly block the effects of calcium on bloo vessels. Others will also affectthe heart rate. drugs such as dynaCirc CR ®,Norvasc®, Plenil®, Procaria XL®, or Sular ®

are effective in ilating bloo vessels, whereasCalan® SR, Carizem® Cd, or Isoptin® SR may ilate bloo vessels but also slow own the heartrate. Calcium channel blockers are also availablein combination with ACE inhibitors. Examples

inclue Lexxel®

, Lotrel®

, an Tarka®

an ARBs.These inclue Exforge® an Azor TM.

Beta-blockers have been in use for more than35 years. Examples of beta-blockers inclueLopressor ® an Tenormin®. These rugs

reuce the effect of arenaline on various partsof the boy. They slow own the heart ratean reuce its force when it contracts, which reuces the work of the heart; bloo pressureis lowere. The use of these agents, usually with

a iuretic, has resulte in a reuction of strokes,heart failure, an, in some instances, heartattacks. In people who have alreay ha a heartattack, beta-blockers will help prevent further heart problems.

Recent stuies suggest that the use of beta-

blockers oes not reuce stroke as much asother meications an may not be a preferremeication in hypertensive patients withoutheart isease.

Other medications. There are many other effective rugs available, such as alpha/ beta-blockers—Coreg® or Normoyne® / Tranate®. The alpha-blockers—Carura®,Hytrin®, or Minipress® may be useful in



32

combination with other meications an willoften help to relieve the symptoms of an

enlarge prostate in men. Apresoline®

anLoniten® ilate bloo vessels irectly. drugsthat are no longer use very much inclue:

Alomet®, Catapres®, an Serpasi®. These rugsmay cause sie effects, such as epression,rowsiness, or fainting, especially in large

oses. They have mostly been replace by theother meications liste above.

In most cases, taking 1–2 pills a ay will controlless severe high bloo pressure, but only about

40%–50% of people will have their pressures

decreased to normal levels with any one of themedications when given alone, regardless of

the drug chosen for initial treatment . Black anelerly patients ten to get better results with aiuretic or a calcium channel blocker. Caucasiansan younger patients generally respon better

to an ACE inhibitor, an ARB, or a beta-blocker.In more severe cases, 3–4 ifferent pills may beprescribe. This is not commonly necessary ancan be a nuisance an quite expensive. It is well

worth it; however, if it is necessary to bring bloo

pressure own to normal levels an preventfuture illnesses an isability. The use of any oneof the available combinations may help to limitthe number of pills that you might have to take.

Possible Side Effects From Medications

That Lower Blood PressureSie effects may occur when any rug istaken. In some instances, even simple aspirinmay cause stomach trouble. Some peopleare allergic to rugs like penicillin, an thesame is true for meications that lower bloopressure. For example, a few people takingiuretics may experience weakness an musclecramps because, in aition to salt (soium),another important mineral, potassium, may be



33

washe out of the boy. This is not common when low oses are use. (Some combination

meications, like dyazie®

, Maxzie®

, or Alactazie® prevent this from happening.) A chronic cough may result from the use of an

ACE inhibitor. Some other possible sie effectsof bloo pressure lowering rugs are liste.Importantly, most people taking meication

for high bloo pressure o not experiencesie reactions. (See Possible Sie Effects chart,pages 36–37.) If you have high blood pressure

and you experience any of these side effects,

do not stop the medication; this could lead

to trouble. Instead, call your doctor to seewhat can be done about them, or ask if the

dosage of the drug should be reduced or the

prescription changed to another drug. Your physician knows about these possible effects.He or she shoul be able to correct them in

most instances. It is actually not uncommonfor people to feel better on meications whentheir bloo pressure is lowere.

Treatment Results Can Be Dramatic

Charles R., a 43 year ol lawyer, was examinefor insurance coverage in 1955. He was anactive, vigorous man. His bloo pressure was230/140 mm Hg. He ha no heaaches, nosign of kiney or heart trouble, no symptoms,an was quite upset by the finings.

Charles R. is typical of thousans of people with high bloo pressure who may have nosymptoms. Thanks to meication, his bloopressure was lowere to normal levels in aperio of several months. It remaine withina normal range for more than 40 years. Inthe 1940s, this vigorous, active man woulalmost certainly have ie of a stroke, heartattack, or kiney failure in 5–7 years. He iie, in 1996, but at the age of 84. He is a goo



34

S o m e P

o s s i b l e S i d e E f f e c

t s O r R e a c t i o n s T o C o m m o n l y U s e d B l o o d P r e s s u r e L o w e r i n g D r u g s –

T h e s e M a y O c c u r I n A b o u t 1 0 % – 1 5 % O f

P a t i e n t s

T r a d e N

a m e s

P o s s i b l e S i d e E f f e c t s

T h i a z i

e d i u r e t i c s :

E s i

r i x

®

I n c r e a s e u r i n a t i o n

,

H y

r o i u r i l ®

w e

a k n e s s , m u s c l e c

r a m p s ,

H y g

r o t o n

®

j o i n t p a i n s ( g o u t – r a

r e ) ,

L a s i

x ®

i m

p o t e n c e

L o z o l ®

Z a r o x o l y n

®

B e t a - B l o c k e r s :

C o r g a r ®

I n s o m n i a , n i g h t m a r e s ,

I n e r a l ®

s l o w p u l s e , w e a k n e s s

, a s t h m a t i c

L o p

r e s s o r ®

a t t

a c k s , c o l h a n s

a n f e e t ,

S e c t r a l

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i m

p o t e n c e ( v a r i e s w

i t h

T e n o r m i n ®

i f

f e r e n t r u g s )

Z e b

e t a ®

T r a d e N a m e s

P o s s i b l e S

i d e E f f e c t s

C a

l c i u m B l o c k e r s :

A

a l a t C C ®

S w e l l i n g o f l e g s , i z z i n e s s ,

C

a r e n e

®

p a l p i t a t i o

n s , h e a a c h e s , f l u s h e s

d

y n a C i r c C R ®

N

o r v a s c

®

P

r o c a r i a - X L ®

P

l e n i l ®

S

u l a r ®

C

a r i z e m

® S R o r C

d ,

M a y s l o w

h e a r t r a t e

d i l a c o r X R ®

V

e r e l a n

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® S R ,

C o n s t i p a t i o n

C o v e r a - H S ™ ,

I s o p t i n

® S R

A l p h a - B l o c k e r s :

C

a r u r a

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d i z z i n e s s

, h e a a c h e s ,

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f a t i g u e , p a l p i t a t i o n s

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T r a d e N a m e s

P o s s i b l e S i d e E f f e c t s

B e t a - B l o c k e r s W i t h O t h e r A c t i o n s :

C o r e g

®

d i z z i n e s s

N

o r m o y n e

®

o r T r a n a t e

®

A C E

I n h i b i t o r s :

A c c u p r i l ®

C o u g h , s k i n r a s h ,

A c e o n

®

A l t a c e

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l o s s o f t a s t e , w e a k n e s s ,

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k i n e y p r o b l e m s

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M

a v i k ®

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o n o p r i l ®

V a s o t e c

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Z e s t r i l ® o r P r i n i v i l ®

A n g i o t e n s i n R e c e p t o r

B l o c k e r s :

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d i z z i n e s s

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35

L e s s C o m m o n l y U s e d D r u g s

C e n t r a l l y A c t i n g d r u g s :

C a t a p r e s ®

d r y m o u t h ,

W y t e n s i n

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r o w s i n e s s , f a t i g u

e ,

s e x u a l y s f u n c t i o

n

A l o m e t ®

d r o w s i n e s s , e p r e s s i o n ,

i m p o t e n c e , f e v e r

V a s o i l a t o r s :

A p r e s o l i n e

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H e a a c h e s , r a p i

h e a r t

b e a t , j o i n t p a i n s

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H e a a c h e s , r a p i

h e a r t

b e a t , e x c e s s i v e h a i r

g r o w t h , j o i n t p a i n

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O t h e r M e i c a t i o n s :

R a u i x i n ™

S t u f f y n o s e , n i g h t m a r e s ,

S e r p a s i l ®

e p r e s s i o n

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®

A f o r m o f i m p o t e

n c e ,

i z z i n e s s , i a r r h e a



36

example of the many people who have beentreate successfully an whose lives have been

prolonge without the fear of a serious illnesssuch as a stroke or heart failure at a young age.

Staying on Medication: A Major Problem—“If It Only Hurt A Little”People with low back pain, bursitis, or

pneumonia go to a physician looking for relief.They accept anything their octor suggests togain relief from pain or other symptoms. On theother han, people with high bloo pressure,because they may have few or no symptoms,

are often annoye at being tol that they willhave to take meication for something that oesnot appear to be bothering them. “If it only hurta little,” it woul be easier to get people uner treatment. None of us likes to be labele as sick,an none of us likes to take meication when

we are feeling well. Getting people to complywith treatment is one of the main problems in

dealing with hypertension.

In some instances, symptoms resultingfrom hypertension—such as an early morningheaache which isappears uring the ay—o cause a patient to go to a octor. Morecommonly, the patient feels fine, an it isonly on a routine examination that high bloopressure is iscovere. To fin out what your bloo pressure is, you must have it checke.

Sometimes Treatment Can Be Simple A marrie 20-year-ol patient of mine iscovereat a routine examination that her bloo pressure

was 155/105 mm Hg. There was no family history of hypertension. She ha not been uner any tension an was perfectly healthy. She

was, however, taking birth control pills. (Oralcontraceptives are a known cause of high bloopressure in a few women.) She stoppe the birth



37

control pill an, within 3 months, her bloopressure returne to normal. As she continue

to use another metho of contraception, her bloo pressure remaine normal.Only a small percentage of women who

use birth control pills develop high blood

pressure. If your bloo pressure is foun to beelevate an you are taking birth control pills,

they shoul be stoppe if possible before other methos of treating the high bloo pressure areemploye. Make sure to tell your octor aboutthis or any other meications you may be taking.The use of some “col remeies,” pills to treat

arthritis, herbal remeies, or rugs like cocainemay also increase bloo pressure.

Treatment Or Cure?Moern rug treatment oes not curehyper-tension. It keeps bloo pressure at

normal levels, but usually only as long as itis continue. If treatment is stoppe, thebloo pressure usually goes back to whereit was before, although in some instancesthis may not happen for several to as longas 6–9 months. If octors o not explainthis or patients fail to realize how importantcontinue treatment or follow up is,complications may occur. An example of this

was a patient, a 53-year-ol school teacher, who stoppe her treatment because a frien

ha aske her: “Why are you taking so much meication?” Her pressure rose from a normallevel (uring treatment) of 130/80 mm Hgto 210–220/115–120 mm Hg an within 4months, she ha a stroke. It shoul never have happene, an it woul not have, if sheha continue her meication. Fortunately,she i recover almost all of the functionshe lost an her bloo pressure was againbrought uner control with meication.



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W H A t y o U A n D y o U R D o C t o R C A n D o to

KeeP yoUR BlooD PRessURe As loW As PossIBle

R ecent national statistics show that thenumber of people with high bloopressure who are being treate has

increase from less than 20%, 20 years ago,to as high as 70%–80% in some communities.

However, only about 35%-45% of people with high bloo pressure are being controlle atlevels of below 140/90 mm Hg.1) It is up to you to have your bloo pressure

checke.

2) If it is elevate, it is the responsibility of thephysician to prescribe the right combinationof meications an other treatment to bring

your bloo pressure back to normal levels.3) In the final analysis, it is up to both you an

your octor to recognize how important

treatment is an to follow a program thatkeeps your bloo pressure uner control.Often, a pharmacist or other health careprofessional will be able to help you get over the “rough spots” an stay on therapy. If,

despite medication, and a reasonable diet and exercise program, your blood pressure is

still higher than 140/90 mm Hg, you should

ask your doctor why —a change in your

treatment may be indicated. If you have

diabetes or kidney disease, efforts should be

made to get your pressure to about as closeto 130/80 mm Hg as possible.

In some cases, after bloo pressure has beennormal for a year or more, it may be possible toreuce meication or, in rare cases (especially if a weight loss of more than 10–15 lbs hasoccurre), to eliminate it completely. Carefulfollow up is important in these instances.

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H o M e B l o o D P R e s s U R e M o n I t o R I n G

Monitoring your bloo pressure at homemay be suggeste by your octor or

you may be someone who just likes to“know the numbers.” Usually home monitoringis not complicate. Either a regular cuff with a stethoscope or one of the igital reaout or

electronic bloo pressure monitors can be use.Obtaining several bloo pressure reaings inbetween octor visits may be useful in situations

where the iagnosis of high bloo pressure issuspecte but has not been clearly establishe.

It is also helpful where pressures may only beintermittently high in the setting of a meicaloffice or clinic (so-calle “white coat” hyperten-sion). In these instances, if reaings at home arealways below 130/80 mm Hg, your physicianmay elect to see you just every 6–12 months

without suggesting specific treatment.Home monitoring also may be useful

in cases where bloo pressure is ifficultto control or where meications are beingchange frequently. An example of this was

Carl C., a 58-year-ol man who complaineof izziness an whose initial office bloopressure reaings ha been about 200/110 mmHg. Three ifferent meications were requireto control his office pressure but he continueto complain of episoes of izziness. After he

monitore his bloo pressure at home, it wasiscovere that his symptoms ha resultefrom bloo pressures that actually were now too low, not too high. Treatment was ajusteaccoringly an the izziness isappeare.

If you monitor your pressure at home,remember that the reaings, especially thesystolic pressure, can fluctuate by 20–30 mmHg at various times of the ay an can changefollowing exercise, excitement, etc. do not be

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alarme by these changes. Above all, o notbecome an anxious “bloo pressure taker,”

focusing too much of your attention on your bloo pressure. There are far too many people who have become overly concerne or obsesse with their bloo pressure or cholesterol numbers.Home bloo pressure monitoring is useful for many people if it is not overone. It is not

recommene for everyone with high bloopressure. 24-hour blood pressure monitoring

with special equipment is rarely indicated.

t o s U M I t U P

H ypertension is a major health problemthat results in much family tragey,many thousans of lost work ays,

an a great eal of human grief. It costs the

government an you billions of ollars a year.In some cases, it is a isease that might evenbe prevente if more people watche their saltintake an their weight. It is a isease that can becontrolle; moern treatment can save lives.

Aequate treatment of high bloo pressure

has reuce the incience of strokes anstroke eaths as well as heart attacks. It haspractically eliminate heart failure resultingfrom hypertension an has prevente many cases from progressing from less severe to

severe hypertension or kiney failure. Evenin patients with less severe hypertension(bloo pressures of 140–160/90–100 mm Hg),effective long-term treatment significantly reuces eaths from heart isease an strokes.Treatment appears to be worth the cost an

the possible risk of sie effects. As note, stuies have also establishe

the benefits of treating high bloo pressurein oler people even if just the upper reaing

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(systolic pressure) is elevate, e.g., a bloopressure of 160–170/80 mm Hg. Strokes,

heart attacks, an heart failure are reuce if bloo pressure is lowere (even in someone80 years of age or oler).

As note, many people who have high bloo pressure are also obese, have abnormallevels of various fatty substances in the bloo

as well as a tenency towar evelopingiabetes. These other possible problemsshoul not be ignore.

F A C t s t o R e M e M B e R

•High blood pressure may not cause

symptoms. Usually the only way to finout if you have it is to have your bloopressure measure.

•Tests to evaluate blood pressure areusually simple, an hospitalization israrely necessary. When bloo pressure isuner control, octor visits nee not befrequent (2–4 times a year).

•Theoutlookforpeoplewithhighblood

pressure is excellent. In most cases, their habits nee not be change a great eal.They can look forwar to a long life,free of many of the fears that use toaccompany this iagnosis, as long as they

continue treatment.•Beingheavyorobesemaygoalongwith

having high bloo pressure, but losing weight alone may not control bloopressure in many people. Losing weightif you are heavy is a goo iea for

many other reasons, even if it oes notcompletely control your bloo pressure.

•Smokingisbadforyou,andyoushould

stop it (or never start) to prevent heart

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isease as well as lung amage. Butstopping smoking by itself will not lower

bloo pressure.•Ifyouareveryanxious,relaxingortaking

tranquilizers or seatives may help tolower bloo pressure in some less severecases, but these treatments will not work in the majority of patients.

•Alowsaltdietmayhelptolowerbloodpressure in some people with less severehypertension, but most people cannotstay on a rigi enough salt restricte iet tolower bloo pressure aequately without

specific meication. A moifie low-salt an high-potassium iet, however,shoul be followe in all cases. This may increase the effectiveness of meication.

•If modifying your eating habits and

lifestyle oes not lower your bloo

pressure, keep in min that there areexcellent meications to reuce bloopressure an control it in a large majority of patients.

•Although side effects or annoying

symptoms may occur in a smallnumber of people with some of thebloo pressure lowering rugs, theseusually can be controlle or eliminateby changing osages or switching toanother meication.

•Above all, remember that being ontreatment oes not mean that your bloopressure is controlle. If your bloopressure is not below 140/90 mm Hg,or below 130/80 mm Hg if you have

iabetes or kiney isease, espite lifestylechanges an meication, ask your octor why. Some aspect of your treatmentmay have to be change. Normal bloopressure cannot be achieve in everyone,



43

but about 80%–85% of people with high bloo pressure can be successfully treate

regarless of the severity of their isease.



44

G l o s s A R y

Aneurysms: Small blister-like expansions of bloo

vessels. They represent weak spots in the artery. They may rupture an cause bleeing or a hemorrhage.

Atherosclerosis: “Harening” of the arteries. Fatty

material is eposite in the walls of arteries, which are

thereby narrowe.

Angiotensin or AII Receptor Blockers (ARBs): Meicationsthat block the effects of substances that cause bloo

vessels to narrow.

Blood Pressure: Pressure exerte against the walls of

the arteries.

Systolic (upper reaing)—pressure recore at

the time when the heart is pumping. Diastolic (lower reaing)—pressure recore

when the heart is resting, in between beats.

Normal (over age 18)—up to 135/85 mm Hg. A

bloo pressure reaing of 135–139/85–89 mm Hg

is consiere “high-normal.”

Isolated Systolic Hypertension (ISH): A systolic bloopressure above 140 mm Hg an a iastolic bloo

pressure below 90 mm Hg inicates ISH.

Calcium Channel Blockers: Meications that interfere

with the movement of calcium in an out of the bloo

vessel walls. dilation of bloo vessels an a lowering of

bloo pressure result from their use.

Cardiovascular: Refers to heart an bloo vessels, e.g.,

iseases of the cariovascular system.

Cholesterol: A fatty substance in our boies that is

necessary for proucing certain hormones, etc. It

is foun in many foos (milk, eggs, an meat, etc.). Vegetables, grains, an fruits o not contain any

cholesterol. If too much cholesterol is present in the

bloo, the process of “harening of the arteries” may

be hastene.

Converting Enzyme Inhibitors (ACE Inhibitors):

Meications that block the formation of a substancethat constricts bloo vessels.

Coronary: Refers to the heart, e.g., coronary arteries are

those arteries that supply bloo to the heart muscle.

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Diuretics: “Water pills”—meications that wash out salt

(soium) from the boy an help to reuce elevate

levels of bloo pressure.

Hypertension: High bloo pressure. A consistent bloo

pressure recoring of more than 140/90 mm Hg.

Lipids: Fatty substances in the bloo—total cholesterol,

high- an low-ensity cholesterol, an triglyceries. These

are often abnormal in people with high bloo pressure.

Metabolic Syndrome: People who are obese (waistmeasurement >38 inches in men an >34 inches in women),

have high-normal or prehypertensive bloo pressure levels,

borerline bloo sugar levels (110–125 mg/L), an certain

abnormalities in lipis in the bloo have the metabolic

synrome. These abnormalities shoul be correcte, if

possible, to avoi heart an kiney isease.mm Hg: Millimeters of mercury. The bloo pressure

numbers in this booklet refer to the height to which

your bloo pressure woul push a column of mercury.

Potassium: A mineral in the cells of the boy that may

be washe out by iuretics, especially in high oses.

Can be foun in foos such as bananas an orange juice.“Salt substitutes” usually contain potassium.

Salt: Common table salt is soium chlorie. Potassium

chlorie is a salt substitute.

Sodium: A component of salt (about 40% of salt is soium).

This is a mineral that may contribute to high bloo pressureif taken in large amounts by certain people.

Sphygmomanometer: A evice that measures bloo

pressure.

Stroke: Suen loss of function of a part of the brain ue

to interference with its bloo supply. May be cause

by a clot (thrombosis) or rupture of a bloo vessel

(hemorrhage).

Sympathetic Nerves: Nerves that, when stimulate,

constrict or narrow bloo vessels an cause bloo

pressure to rise.

Uremia: The result of kiney failure. Waste prouctsaccumulate in the boy when the kiney fails to excrete

enough of them in the urine.

Vascular: Refers to bloo vessels.



Marvin Moser, MD is a Clinical Professor of

Meicine at the Yale University School of Meicinean was the Senior Meical Consultant to theNational High Bloo Pressure Eucation Program of the National Heart, Lung, an Bloo Institute from1974 to 2002. He was Chairman of the first JointNational Committee on the detection, Evaluation

an Treatment of High Bloo Pressure, an amember of the six subsequent committees. He isa Fellow of the Council for High Bloo PressureResearch of the American Heart Association ana Hypertension Specialist of the American Society of Hypertension. He is the author of 11 books,

incluing Lower Your Blood Pressure and Live

Longer , Week by Week to a Strong Heart , Heart

Healthy Cooking For All Seasons, an Clinical

Management of Hypertension. He was a Co-Eitor an contributor to the Yale University School of

Medicine Heart Book an has publishe more than

500 scientific papers in the fiel of hypertensionan cariology. He is Eitor in Chief of The

Journal of Clinical Hypertension an has receivenumerous awars for research an treatmentof high bloo pressure from the InternationalSociety of Hypertension, The National Heart, Lung,

an Bloo Institute, an the American Society of Hypertension. He is an honorable fellow of theRoyal College of Physicians an Surgeons.





Documents

HBP Booklet