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.




6R27SJPMJJ99               What is hypertension?

Hypertension is blood pressure that persistently stays higher than normal. Blood pressure is the force of blood against artery walls as the heart pumps blood through the body. Blood pressure can be unhealthy if it exceeds 140/90. (140 refers to the highest level reached with each heartbeat, and the 90, the low between these beats.) 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!

High blood pressure can be controlled or prevented if you take these steps:

  • Maintain a healthy weight.
  • Be physically active.
  • Follow a healthy eating plan, which includes foods that do not contain a lot of salt (sodium}, often referred to as the DASH diet..
  • Do not drink a lot of alcohol.

Diet affects high blood pressure. “DASH” stands for “dietary approaches to stop hypertension.” Following the DASH diet and reducing the amount of sodium in your diet will help lower your blood pressure. If pressure is presently normal, this diet will also help prevent high blood pressure, which, as noted, is extremely common.

What is the DASH diet?

The DASH diet is a diet that is low in saturated and trans fat, cholesterol, and total fat. It is rich in fruits, vegetables, and low-fat dairy foods. The DASH diet also includes whole-grain products, fish, poultry, and nuts. It encourages fewer servings of red meat, sweets, and sugar-containing beverages. It is rich in magnesium, potassium, and calcium, as well as protein and fiber.

How do I get started on the DASH diet?

The DASH diet requires no special foods and has no hard-to-follow recipes. Start by seeing how DASH compares with your current eating habits.

The DASH eating plan illustrated below is based on a diet of 2,000 calories a day. Your healthcare provider or a dietitian can help you determine how many calories a day you need. Most adults need somewhere between 1600 and 2800 calories a day, which varies according to physical activity. Serving sizes for different foods vary from 1/2 cup to 1 and 1/4 cups. Check product nutrition labels for serving sizes and the number of calories per serving.

Make changes gradually. Here are some suggestions that might help:

  • If you now eat fewer than 1 or 2 servings of vegetables a day, add a serving at lunch and another at dinner.
  • Puree vegetables and add them into soups, stews, and sauces.
  • If you have not been eating fruit regularly, or have only juice at breakfast, add a serving to your meals or have it as a snack.
  • Drink milk or water with lunch or dinner instead of soda, sugar-sweetened tea, or alcohol. Choose low-fat (1%) or fat-free (nonfat) dairy products so that you are eating fewer calories and less saturated and trans fat, total fat, and cholesterol.
  • Read food labels on margarines and salad dressings to choose products lowest in fat and sodium.
  • If you now eat large portions of meat, slowly cut back—by a half or a third at each meal. Limit meat to 6 ounces a day (two 3-ounce servings). Three to 4 ounces is about the size of a deck of cards.
  • Have 2 or more meatless meals each week. Increase servings of vegetables, rice, pasta, and beans in all meals. Try casseroles, pasta, and stir-fry dishes, which have less meat and more vegetables, grains, and beans.
  • Use fruits canned in their own juice. Fresh fruits require little or no preparation. Dried fruits are a good choice to carry with you or to have ready in the car.
  • Try these snacks ideas: unsalted pretzels or nuts mixed with raisins, graham crackers, low-fat and fat-free yogurt or frozen yogurt, popcorn with no salt or butter added, and raw vegetables.
  • Choose whole-grain foods to get more nutrients, including minerals and fiber. For example, choose whole-wheat bread, whole-grain cereals, or brown rice. Although whole grains are a healthy choice, large portions can lead to weight gain. A portion of grain is 1/2 to 1 cup. A cup of food is about the same size as your fist.
  • Use fresh, frozen, or no-salt-added canned vegetables.

·        Remember to also reduce the salt and sodium in your diet. Try to have no more than 2300 milligrams (mg) of sodium per day, with a goal of further reducing the sodium to 1500 mg per day. Two thirds of a teaspoon of table salt equals about 1500 mg of sodium. However, even if you can’t achieve these goals, recent research shows that even modest reductions in salt intake can produce lesser, but beneficial, reductions in blood pressure.

Some important ways to reduce sodium are the following:

  • Eat food products with reduced-sodium or no salt added. In general, canned soups contain far too much sodium.
  • Use less salt when you prepare foods and do not add salt to your food at the table.
  • Read food labels. Aim for foods that contain less than 5% of the daily value of sodium
  • Watch out for sodium hidden in canned sauces, instant soups, salad dressings, frozen dinners and packaged foods in general.
  • Avoid large portions of baked goods, such as pancakes and biscuits, which are extremely high in sodium due to the baking soda content.
  • When eating at restaurants or grocery shopping, choose low sodium alternatives.

The DASH eating plan is not designed for weight loss. But it contains many lower-calorie foods, such as fruits and vegetables. You can make it lower in calories by replacing high-calorie foods with more fruits and vegetables. Some ideas to increase fruits and vegetables and decrease calories include:

  • Eat a medium apple instead of 4 shortbread cookies. You’ll save 80 calories.
  • Eat 1/4 cup of dried apricots instead of a 2-ounce bag of pork rinds. You’ll save 230 calories.
  • Have a hamburger that’s 3 ounces instead of 6 ounces. Add a 1/2 cup serving of carrots and a 1/2 cup serving of spinach. You’ll save more than 200 calories.
  • Instead of 5 ounces of chicken, have a stir fry with 2 ounces of chicken and 1 and 1/2 cups of raw vegetables. Use just a small amount of vegetable oil. You’ll save 50 calories.
  • Have a 1/2 cup serving of low-fat frozen yogurt instead of a 1-and-1/2-ounce chocolate bar. You’ll save about 110 calories.
  • Use low-fat or fat-free condiments, such as fat-free salad dressings.
  • Eat smaller portions. Cut back gradually.
  • Use food labels to compare fat and calorie content in packaged foods. Items marked low fat or fat free may be lower in fat but not lower in calories than their regular versions.
  • Limit foods with lots of added sugar, such as pies, flavored yogurts, candy bars, ice cream, sherbet, regular soft drinks, and fruit drinks.
  • Drink water or club soda instead of cola or other soda drinks.

For more information, see the Guide to Lowering your Blood Pressure with DASH at: