High blood pressure, a major risk factor for heart disease, affects about one in five New Zealanders and Australians. However, this virtually symptomless-but potentially dangerous--condition is easy to treat with the right lifestyle and drug choices.
There are now many options for lowering your blood pressure, especially given recent drug advances. Treatment usually depends on how severe your condition is (see on shortly). If your numbers are only slightly elevated, you may be able to avoid drugs altogether by making some sensible lifestyle changes. These might include altering how much you eat, exercise and weigh, as well as how much alcohol you drink and how you deal with stress. As you work on lowering your blood pressure, check your levels often to be sure you're on course. Daily readings on a home monitor (see on later) are good for more serious cases; biweekly checks on a do-it-yourself machine at a local pharmacy are fine for milder ones.
As a general rule, many experts say if your blood pressure is in the range of 140 to 159 mm Hg systolic or 90 to 99 mm Hg diastolic and it hasn't responded to changes in your lifestyle after six months to a year, you'll need to start taking medication. A single drug is often very effective, although in some cases a second drug may be needed too. If you're able to control your blood pressure very well for a few years, weaving lifestyle changes into your daily routine, you might get the green light from your doctor to lower your drug dose or even stop taking the drugs completely.
Treatment Options
For anyone with mild hypertension, the most powerful thing you can do to naturally lower your blood pressure is to follow a sensible diet (see page 178) and slash your dietary sodium. There's a 50 percent chance that you may have the type of hypertension that is salt-sensitive, and the more sodium you take in (through table salt and foods high in sodium), the higher your blood pressure will be.
What is happening
With most diseases, a doctor can explain why it's occurring. Not so with high blood pressure, which is often a complex result of who you are (genetics), what you eat and how you live. There are three main ways your body raises its blood pressure. Your heart can change the rate and strength of its beats, forcing blood to move more vigorously through your system. Your smaller arteries (arterioles) can constrict for various reasons--plaque on your vessels, for instance, or emotional stress--making higher pressure necessary to circulate your blood. And your kidneys can keep more water in your body, creating more blood volume to pound through your vessels. The kidneys do this by releasing hormones that increase your body's supply of sodium (and a salty diet provides a ready source).
When someone's blood pressure is routinely high, doctors diagnose it as hypertension. If you're like most people with high blood pressure, you probably have primary (once called essential) hypertension. Even though its cause is unknown, it accounts for about 90 percent of cases. If only a few people (about 10 percent) can high blood pressure be linked to something specific, such as kidney disease or long-term use of certain drugs (NSAIDs, corticosteroids, oral contraceptives). This latter is known as secondary hypertension, and eliminating the underlying problem is often the only treatment you'll need.
It's natural for blood pressure to fluctuate throughout the day, reflecting what you're doing. It drops during sleep, for instance, and spikes during exercise or in times of stress or pain. Most people know that their optimal blood pressure is supposed to be 120/80. The systolic number on the top (120) indicates the highest pressure exerted on your artery walls as the heart contracts to pump the blood out; the diastolic on the bottom (80) reflects the moment of lowest pressure, when it relaxes between contractions.
Overtime, high blood pressure can inflict lasting damage. Your overworked heart muscle may get so big that it becomes flabby and inefficient, causing heart failure. Vessels that supply blood to your eyes, brain and various organs may become so stretched or strained that they leak or burst, causing stroke or internal bleeding.
With most diseases, a doctor can explain why it's occurring. Not so with high blood pressure, which is often a complex result of who you are (genetics), what you eat and how you live. There are three main ways your body raises its blood pressure. Your heart can change the rate and strength of its beats, forcing blood to move more vigorously through your system. Your smaller arteries (arterioles) can constrict for various reasons--plaque on your vessels, for instance, or emotional stress--making higher pressure necessary to circulate your blood. And your kidneys can keep more water in your body, creating more blood volume to pound through your vessels. The kidneys do this by releasing hormones that increase your body's supply of sodium (and a salty diet provides a ready source).
When someone's blood pressure is routinely high, doctors diagnose it as hypertension. If you're like most people with high blood pressure, you probably have primary (once called essential) hypertension. Even though its cause is unknown, it accounts for about 90 percent of cases. If only a few people (about 10 percent) can high blood pressure be linked to something specific, such as kidney disease or long-term use of certain drugs (NSAIDs, corticosteroids, oral contraceptives). This latter is known as secondary hypertension, and eliminating the underlying problem is often the only treatment you'll need.
It's natural for blood pressure to fluctuate throughout the day, reflecting what you're doing. It drops during sleep, for instance, and spikes during exercise or in times of stress or pain. Most people know that their optimal blood pressure is supposed to be 120/80. The systolic number on the top (120) indicates the highest pressure exerted on your artery walls as the heart contracts to pump the blood out; the diastolic on the bottom (80) reflects the moment of lowest pressure, when it relaxes between contractions.
Overtime, high blood pressure can inflict lasting damage. Your overworked heart muscle may get so big that it becomes flabby and inefficient, causing heart failure. Vessels that supply blood to your eyes, brain and various organs may become so stretched or strained that they leak or burst, causing stroke or internal bleeding.
LIKELY FIRST STEPS
- Lifestyle changes (stress reduction, weight loss, regular exercise, low-sodium diet) to naturally lower your blood pressure.
- If revised lifestyle measures fail, medications--or combinations of different drugs--to medically lower your blood pressure.
- For more complicated cases, eliminating the cause--whether it's a drug, illness or other underlying problem.
QUESTIONS TO ASK
- Is the drug that has just been prescribed likely to change the effectiveness of other medications I take? Could it affect my sex life?
- Is it safe for me to exercise? My blood pressure levels went way up when I took a stress test.
- At what point do I need to see a cardiologist?
- How likely is it that I will be able to get off hypertension medication? What would I have to do?
Treatments
There are now many options for lowering your blood pressure, especially given recent drug advances. Treatment usually depends on how severe your condition is (see on shortly). If your numbers are only slightly elevated, you may be able to avoid drugs altogether by making some sensible lifestyle changes. These might include altering how much you eat, exercise and weigh, as well as how much alcohol you drink and how you deal with stress. As you work on lowering your blood pressure, check your levels often to be sure you're on course. Daily readings on a home monitor (see on later) are good for more serious cases; biweekly checks on a do-it-yourself machine at a local pharmacy are fine for milder ones.
As a general rule, many experts say if your blood pressure is in the range of 140 to 159 mm Hg systolic or 90 to 99 mm Hg diastolic and it hasn't responded to changes in your lifestyle after six months to a year, you'll need to start taking medication. A single drug is often very effective, although in some cases a second drug may be needed too. If you're able to control your blood pressure very well for a few years, weaving lifestyle changes into your daily routine, you might get the green light from your doctor to lower your drug dose or even stop taking the drugs completely.
LIFESTYLE CHANGES
---------------------------------------------------------------------------------------------------------------------------------------------
Diet Follow a healthy diet; reduce salt; get omega-3s.
----------------------------------------------------------------------------------------------------------------------------------------------
Lower stress Relax with yoga and/or tai chi.
-----------------------------------------------------------------------------------------------------------------------------------------------
Weight loss & exercise Take off kilos and get moving
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Diuretics Help body to excrete water and salt.
------------------------------------------------------------------------------------------------------------------------------------------ Beta-blockers Ease heart's pumping action; widen vessels.
-------------------------------------------------------------------------------------------------------------------------------------------
ACE inhibitors Reduce an artery-constricting chemical.
-------------------------------------------------------------------------------------------------------------------------------------------
Angiotensin II receptor blockers Alternative to ACE inhibitors
--------------------------------------------------------------------------------------------------------------------------------------------
Calcium channel blockers Decrease heart contractions; widen vessels.
-------------------------------------------------------------------------------------------------------------------------------------------- Vasodilators Expand blood vessels; improve circulation.
--------------------------------------------------------------------------------------------------------------------------------------------
Alpha-blockers or central alpha-agonists Interfere with nerve impulses that cause arteries to constrict.
TAKING CONTROL
---------------------------------------------------------------------------------------------------------------------------------------------
Diet Follow a healthy diet; reduce salt; get omega-3s.
----------------------------------------------------------------------------------------------------------------------------------------------
Lower stress Relax with yoga and/or tai chi.
-----------------------------------------------------------------------------------------------------------------------------------------------
Weight loss & exercise Take off kilos and get moving
MEDICATIONS
------------------------------------------------------------------------------------------------------------------------------------------
Diuretics Help body to excrete water and salt.
------------------------------------------------------------------------------------------------------------------------------------------ Beta-blockers Ease heart's pumping action; widen vessels.
-------------------------------------------------------------------------------------------------------------------------------------------
ACE inhibitors Reduce an artery-constricting chemical.
-------------------------------------------------------------------------------------------------------------------------------------------
Angiotensin II receptor blockers Alternative to ACE inhibitors
--------------------------------------------------------------------------------------------------------------------------------------------
Calcium channel blockers Decrease heart contractions; widen vessels.
-------------------------------------------------------------------------------------------------------------------------------------------- Vasodilators Expand blood vessels; improve circulation.
--------------------------------------------------------------------------------------------------------------------------------------------
Alpha-blockers or central alpha-agonists Interfere with nerve impulses that cause arteries to constrict.
TAKING CONTROL
- Choose nutrients with blood vessels in mind. Omega-3 fatty acids found naturally in oily fish such as salmon will benefit hypertension by keeping your blood vessels flexible. Eat fish three times a week.
- Stay alert for symptoms. Although hypertension has a reputation as a mysterious 'silent' condition, some people develop recognisable symptoms. If headaches and vision problem occur, contact your doctor.
- Watch for seasonal changes. The weather affects blood pressure in some people. If you notice a significant increase during cold winter months, talk to your doctor about altering your treatment to compensate.
- Keep an eye on your top number. For years, doctors focused on the lower number in the reading--the diastolic. Now research indicates the top number--the systolic--is even more strongly linked to heart-related illness and death. Check with your doctor about options if your top number begins to rise.
- Don't drink too much grapefruit juice if you're taking a calcium channel blocker; it can boost the effects of this hypertension drug by inhibiting an enzyme in the small intestine that helps to metabolise a number of medications. This problem doesn't occur in all people and doesn't happen with all grapefruit juice. It 's most likely to occur when the medications is taken with the juice. Whole grapefruit may or may not have the same effect as the juice.
For anyone with mild hypertension, the most powerful thing you can do to naturally lower your blood pressure is to follow a sensible diet (see page 178) and slash your dietary sodium. There's a 50 percent chance that you may have the type of hypertension that is salt-sensitive, and the more sodium you take in (through table salt and foods high in sodium), the higher your blood pressure will be.
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