What
is High Blood Pressure? High blood pressure is one of the most common cardiovascular
medical concerns. It is often known as a silent killer, as many patients are unaware
that they have it. This is why regular blood pressure screening is essential to
prevent the complications of this disease. Blood pressure is usually expressed
as two numbers. The top number represents the pressure in your blood vessels while
the heart is contracting, the bottom number represents the pressure inside your
blood vessels while your heart is relaxing. A normal blood pressure is defined
as 120's/70's. Mild blood pressure elevation is 130's/80's. Moderate is defined
as 140's/90's and severe is defined as anything greater or equal to 150/100.
What
are the complications of high blood pressure? High blood pressure takes it's
toll on many important organs in the body. By causing damage to the inner lining
of the blood vessels, plaques and clots can form. In the brain this can lead to
a devastating stroke. In the heart, this damage can lead to a heart attack. In
the retinal artery, the damage to the blood vessel can cause blindness. In the
kidney, the damage can result in kidney failure requiring dialysis. High blood
pressure is second only to diabetes as the leading cause of kidney failure and
loss of vision in the United States.
What
can I do to prevent or treat high blood pressure?
Exercise. Regular exercise is key to well being. People who exercise regularly can also
reduce their blood pressure. Ideally we should exercise three times a week for
at least 30 minutes. Two thirds of the time should be aerobic and get your heart
rate up, one third should be anaerobic muscle strength workouts. For those who
can not fit large workouts into their routine, I ask for five minutes of exercise
before hitting the shower. Just do as many sit ups, push ups or jumping jacks
as you can. The results will speak for themselves.
Nutrition. Eating properly to avoid sugar or caffeine highs or lows is important to keep
your appetite under control. Eating processed, carbohydrate heavy meals and snacks,
will usually result in a high sodium diet, and therefore should be avoided. Eating
multiple small unprocessed natural snacks and meals will help to keep your sodium
consumption to a minimum. Additionally you should avoid fast food, and should
never add salt to your food.
Weight
Loss. Reducing your weight 10-15% will have a substantial effect on your blood
pressure. For many of our patients eating properly and exercising work as well
to reduce blood pressure as standard medications that are prescribed. For more
detailed weight loss information, click here.
Do
I need medication for my blood pressure?
There
are several classes of medications that are commonly used to treat high blood
pressure. Although in depth information is available through other websites (Rxlist.com
and others) some summary information is provided below.
B
blockers are
used to relax the smooth muscle lining of the blood vessels and lower your heart
rate, thus reducing your blood pressure. In some pateints they cause impotence
or excessive fatigue. B blockers should be used with caution in patients who have
respiratory disease or congestive heart failure. They are particularly useful
in preventing heart attacks in patients who have had their first heart attack.
Diuretics (water pills) are medications that force your body to waste salt. According to
the commonly accepted standard for the treatment of high blood pressure, a diuretic
should be the second, if not the first medicaiton prescribed for the treatment
of high blood pressure. It works synergistically with other blood pressure medications,
and reduce the rate of heart attacks and other cardiovascular complications better
than most other medications used to treat high blood pressure. Patients taking
diuretics should have blood work done on a regular basis, as it is possible for
sodium or potassium levels too fall to low.
ACE
Inhibitors (Angiotensin receptor inhibitors) are a hormonal therapy for high
blood pressure. They are very effective pills that work particularly well to delay
the progression of kidney disease so often seen in patients with diabetes. They
control both blood pressure and heart failure in patients with heart failure and
to prevent heart attacks in patients who have coronary artery disease. They can
cause an annoying cough, and in rare cases an allergic reaction. Patients taking
Ace Inhibitors should also have blood work taken on a regular basis to prevent
potassium levels from getting to high. High or low potassium levels are not well
tolerated by the body. ARB's (Angiotensin Receptor Blockers) are similar
to ACE Inhibitors in most respects, except they cause few side effects. Patients
who are pregnant or who intend to become pregnant should never take ACE Inhibitors
or ARB's.
Ca
Channel Blockers are the last major common group of medications. The older
first generation blockers reduced heart rate and relaxed the blood vessels to
lower blood pressure. The newer second generation blockers do not affect heart
rate, but more dramatically relax blood vessels to reduce blood pressure. The
second generation medications also commonly can cause swelling in the lower legs,
and therefore may sometimes be given with a diuretic to cancel out the side effects.
It is rare to manage patients only with Calcium Channel blockers, as they do not
have the advantages that the other classes of medications possess. They are usually
but not always used in addition to other medications.
Copyright
Tareq Abedin, MD 2007
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