What is Hypertension (High Blood Pressure)?

Blood pressure represents the force of blood against artery walls as the heart pumps this substance through the body. Pressure is reported in the form of two numbers, i.e. an upper level, called “systolic” and a lower level called “diastolic.”  As an example, a typical normal pressure reading may be 120/80. This means that each time the heart contracts, it generates a peak level of 120 millimeters of pressure in the major arteries of the body (holding up a mercury column that high), and between contractions, while the heart is resting, the pressure retained by these same arteries drops to a low of 80 millimeters.  Traditionally, blood pressure was thought to be unhealthy if it exceeded 140/90, and the most important level is now found to be the upper, or systolic. But as research becomes available, these values are subject to change and have been modified in differing groups such as the elderly or in diabetics. High pressure is one of the leading causes of heart attacks and strokes. In general, the higher your blood pressure, the greater the health risks. If you think that’s not your problem, think again, for this condition affects at least one third of our adult population, and with increasing age, the proportion goes even higher!

But first, what levels of blood pressure are appropriate? As noted above, ideal values should range around 120/80. Until recently, we physicians believed that, in general, systolic pressures exceeding 140 were dangerous; however, individuals with diabetes or chronic kidney disease are more vulnerable to cardiovascular problems and thus required an even lower level of 130 or below. Therefore, those exceeding these limits required treatment with drugs. On the other hand, unless associated with other diseases and/or symptoms such as dizziness and fainting, chronic “low blood pressure”, is not considered abnormal and actually a sign of good health; therefore, we will deal exclusively with high pressures.

Based upon evolving research, most people age 60 or more don’t need drugs until their levels reach 150 systolic and those with diabetes or chronic kidney disease only need such treatment if their pressure reaches or exceeds 140. Some research even suggests that drug treatment isn’t proved to help most people (without these complicating conditions) until the systolic pressure reaches 160. I believe that, for those over the age of 60, a reasonable goal is 150, and, for those with diabetes and kidney problems, 140 is the appropriate target. In choosing drug therapy, we must take care to achieve satisfactory pressure lowering without introducing undesirable side effects such as persistent coughing, erectile dysfunction, frequent urination, and even dizziness and loss of consciousness.  Unfortunately, to reach proper goals, we often need multiple drugs that involve higher costs and a greater likelihood of  side effects.

Before starting drugs, consider the following points

First, is the pressure really persistently high? Pressures are notoriously variable, and many people demonstrate “white-coat” hypertension, meaning that the pressure is normal at home but temporarily elevated during the anxiety imposed by the stressful surroundings of a physician’s office. Such misleading pressures can easily be corrected by the use of a home pressure monitor. Here you can repeatedly check your own pressure at different times of the day. Instruments for measuring pressure are accurate, inexpensive and easy to use. According to Consumer Reports, two (of many) good monitors are Rite Aid Deluxe Automatic, priced at approximately $60, and Omron 7 Series, at approximately $70. For best accuracy, empty your bladder in advance, rest for at least 5 minutes, place the cuff on bare skin at heart level, relax and remain quiet during the measurement. In order to properly inform your physician, keep a log of measurements and note when each is recorded during the day.

If, after multiple checks at home, your pressure is persistently high, there may still be no need for drug treatment.  Lifestyle changes alone should usually be tried first: These include weight reduction, exercising more, reducing sodium (salt) intake, and consuming less alcohol. If your systolic level is moderately elevated (150 to 160 for people aged 60 or more), consider drugs only if six months of lifestyle changes are unsuccessful.

If drugs are necessary, we have a large variety to choose from. Often we begin with a diuretic, or “water pill”, such as hydrochlorothiazide, which is available as an inexpensive generic preparation. Often this drug must be combined with another drug such as one falling in the category of the so-called “ACE inhibitors”, (enalapril, lisinopril, and others), which, besides lowering blood pressure, have the added advantage of reducing the development and complications of kidney disease. Other drug classes can be used depending upon the need for further pressure reduction and/or side effects, and your physician can clue you in on the various choices.

Finally, after changing lifestyle, with or without drugs, target levels for systolic pressure should be no more that 140/90 for those under the age of 60 or have diabetes or kidney disease, and below 150/90 for those aged 60 or above. In most instances, one must monitor the success of treatment by employing home monitoring on a regular basis.

With proper management, you can greatly reduce your chances for heart diseases and strokes, thereby greatly increasing life expectancy, happiness and independent living.




Does the name “Pink Slime” sound nasty? The initial response by most of us is one of revulsion. The term “pink slime” was first coined in 2002 by a scientist, Gerald Zirnstein, who at that time was a microbiologist for the United States Department of Agriculture (USDA). He used the term in an internal e-mail, apparently not intending it to reach the general public. The term informally referred to lean, finely textured fatty scraps of meat remaining after steaks and roasts are carved out of beef. The fat is spun off, leaving lean meat, and any pathogenic bacteria are killed off by a small amount of added ammonia. Although it bears a “pinkish” color, this product is more rightly named “lean finely textured beef” (L.F.T.B.) When mixed into hamburger meat, it lowers the average fat content and provides additional protein. Consumer advocates indicate that this product is safe, nutritious and relatively inexpensive. I might add that hamburgers so altered are more heart healthy—or at least less “heart unhealthy”—and, as an added dividend, they contain fewer calories per unit volume.  Despite isolated reports to the contrary, taste tests have concluded overwhelmingly that addition of L.F.T.B. does not alter the flavor of hamburger in any adverse way, often being considered tenderer and not in any way “slimy”. The product also is quite safe, lacking any evidence of infections or other reported adverse effects. Absent any deleterious effects, no federal labeling or warnings are required.

Up to the beginning of 2011 approximately 70% of the ground beef sold in the U.S. contained this product, but that was before the media seized upon the negative connotations provided by its nickname, “pink slime”. After that the subsequent glare of negativity caused orders from supermarkets for ground beef containing this ingredient to plummet.

The spate of unfavorable media reports appears to have begun after the British host of “Jamie Oliver’s Food Revolution”, on ABC, did a segment on L.F.T.B. Oliver poured large amounts of ammonia and water on beef trimmings and asked viewers if they really wanted to eat it. The response was predictably negative. This episode was followed by ABC’s evening news program anchored by Diane Sawyer, in which they provided “startling results from ABC News investigation” that disclosed much of the ground beef sold in supermarkets contains what was called “pink slime”.   In March, 2012, Bettiina Siegel, a Houston blogger who writes about the school lunch program, posted an online petition demanding that the Agriculture Department stop using this ingredient in schools. It gathered 250,000 signatures, and the Agriculture department said, by the following Fall, it would allow schools to choose whether or not to use burgers containing L.F.T.B.

The causalities resulting from such mass hysteria included both the general public as well as Beef Products Inc, a major producer, who announced that it is closing three of its four plants and laying off about 650 workers. This has occurred despite statements defending this product issued by the Consumer Federation of American and the National Consumers League representing major nonprofit groups that advocate for safe food. Nonetheless, such defenses have been unable to stem the tsunami that has engulfed L.F.T.B.

Similar such attacks are leveled against any product that has been “genetically modified”, which as noted in my previous post of 6/21/13, poses no threat to the public!

What is the moral of this story?  Just as charlatans (snake oil salesmen) are able create an “illusion of validity” through audacious hyping of useless products, so too can a gullible public be misled by a simple, poorly chosen name into believing that a product that is safe, nutritious and cost-effective, is unsavory, ineffective or dangerous!


MORE BAD NEWS FOR SMOKE EXPOSURE: (As if there weren’t enough already!)

Give our kids a break! We have known for a long time that passive smoking threatens health. This is particularly so for the off springs of smokers. Children who are exposed to their parents’ smoking have a considerably higher risk of developing cardiovascular diseases as adults. That is the main result of the “Cardiovascular Risk in Young Finns Study” published recently by the American Heart Association.

For the study, researchers assessed the cardiovascular risk of children from Finland from the years 1980 and 1983. Blood samples from these children were collected at that time in order to measure the level of cotinine, a by-product of nicotine and thus a marker for passive smoke exposure. In addition, they looked for evidence of hardening of the arteries, i.e. plaque buildup in the neck (carotid ultrasound), as collected from the subjects in 2001 and 2007.

The highest percentage (84 per cent) of study subjects, in whom no cotinine level was detected, came from a household of non-smokers, followed by one parent who smoked (62 per cent) and a household in which both parents smoked (43 per cent). In addition, children exposed to parental smokers had a 1.7 times higher risk of plaque build-up in the arteries as adults compared to non-smoking study subjects. But within the smokers group there were enormous differences. The plaque risk was 1.6 times higher in children whose parents smoked, but tried to limit their children’s exposure. And in those who did not limit the exposure, the risk was four times higher.

The conclusion from this study should serve as a major warning to smokers: Since a child’s primary source of passive smoke exposure occurs at home, stop, or you will be placing your kids at great peril! Making matters even worse for your kids, however, the chance that a child will begin to smoke when reaching adulthood is much greater if their own parents are active smokers..