Getting it checked, changing your lifestyle, taking medication
can keep it under control
by Hallie
Levine, AARP, August 5, 2019
En español |
More than 100 million U.S. adults — almost half — have high blood pressure,
according to new statistics from the American Heart Association (AHA). Even
scarier, the number of deaths from hypertension rose by nearly 38 percent from
2005 to 2015. “Many people with high blood pressure aren't aware that they have
it, and even in those cases that they are aware, their condition isn't well controlled,”
says Willie Lawrence, chief of cardiology at the Research Medical Center in
Kansas City, Missouri, and a spokesperson for the AHA. However high your own
numbers, experts say there are critical things to know about this silent
killer.
More people are being diagnosed with hypertension
The sky-high numbers of Americans with high
blood pressure is due in part to the fact that standards
changed in 2017. And when the American Heart Association and the
American College of Cardiology (ACC) redefined blood pressure limits, the new,
more stringent standards pushed over 31 million Americans from borderline high
blood pressure to bona fide hypertension.
"You're now considered to have
hypertension if you have blood pressure of at least 130 for the systolic [top]
number or 80 for the diastolic [bottom] number,” Lawrence explains.
(Previously, the number was 140/90.)
Experts note there is a solid scientific basis
and a real need for the lower thresholds: If all American adults over age 45
were able to keep their blood pressure below the new standard of 130/80, it
would prevent 3 million strokes and heart attacks over the next decade,
according to a 2018 study published in the medical journal Circulation.
'White coat hypertension’ can be dangerous
Sometimes, people who have high blood pressure
at their doctor's office actually have normal blood pressure in other settings,
such as their home, a condition known as “white coat hypertension.” But
although many doctors dismiss it, new research suggests the in-office spike may
portend trouble ahead: Untreated white coat hypertension appears to more than
double the risk of dying from heart disease, according to a review published in
June in Annals of Internal Medicine.
"It may be that patients with white coat
hypertension experience a rise in blood pressure whenever they're stressed,”
explains Lawrence. If your blood pressure is frequently high in your doctor's
office but normal at home, you may want to consider 24-hour ambulatory blood
pressure monitoring, where your physician sends you home with a device that
checks your blood pressure every 20 to 30 minutes during the day and hourly at
night. This will help your doctor determine whether your blood pressure rises
with anything even remotely stressful, or if it's just an in-office occurrence.
Even if your blood pressure seems perfectly
normal at your doctor's office, it's a good idea to periodically get your blood
pressure checked, either with a home blood
pressure monitor or at a walk-in clinic at a pharmacy. “There's
a condition known as ‘masked hypertension,’ where your blood pressure is normal
at your doctor's office but it goes up at other times of day or in other
settings, such as work or at home,” Lawrence says. Up to 1 in 8 adult Americans
may have this condition, according to a 2017 study published in the American Journal
of Epidemiology. If you get an elevated result more than
once or twice, talk to your doctor.
Lifestyle makes a huge difference
If you're diagnosed with stage 1 hypertension
(a top number between 130 and 139, and/or a bottom number between 80 and 89),
you may think you need to start medication. But for most people in this group,
the only prescription is for a change in lifestyle, says Michael Hochman,
director of the Gehr Family Center for Health Systems Science at Keck Medicine
of USC in Los Angeles. In fact, a 2017 Johns Hopkins study published in
the Journal of the American College of Cardiology of more
than 400 adults with stage 1 high blood pressure found that combining a
low-salt diet with the heart-healthy DASH (dietary
approaches to stop hypertension) diet rich in fruits,
vegetables and whole grains, plus low-fat dairy, fish, poultry, beans, seeds
and nuts, lowered blood pressure as much as medication. Similarly, a study
presented last year at the American Heart Association's annual meeting found
that people with hypertension who exercised three times a week and followed the
DASH diet were able to lower their blood pressure on average 16 mm Hg systolic
and 10 mm Hg diastolic without medication after 16 weeks.
You also don't need to do much exercise to see
results: Just 30 minutes of moderate morning exercise like walking on
a treadmill lowers blood pressure for the rest of the day among older men and
women who are overweight or obese, according to a study published in February
in the medical journal Hypertension. The study also found that women who
take brief, frequent breaks from sitting throughout the day enhanced the blood
pressure benefits of morning exercise even more.
It's also important to limit salt and alcohol,
both of which can raise blood pressure, says William Haley, a cardiologist at
the Mayo Clinic in Jacksonville, Florida. The AHA recommends people with high
blood pressure keep their sodium intake below 1,500 mg a
day. (Check labels, since up to 75 percent of the sodium people
consume is hidden in processed foods.) Limit yourself to one drink a day (the
equivalent of four ounces of wine) if you're a woman, and two drinks if you're
a man.
If you do need medications, you may need more than one
"About 40 percent of my patients need
three blood pressure medications to get their hypertension under control,” says
Haley. If your systolic blood pressure is between 140 and 145, the first line
of treatment is usually a diuretic like chlorthalidone or hydrochlorothiazide.
But these can drive up blood sugar levels, Haley says, so if you have type 2
diabetes or are at risk of it, he recommends starting instead with either an
ACE inhibitor or a calcium channel blocker. If you have kidney disease, ACE
inhibitors or another type of blood pressure medication, angiotensin II
receptor blockers (ARBs), are recommended. These have both been shown to slow
the progression of kidney disease.
If your systolic blood pressure is higher than
145, you'll usually need to start with two of these drugs, and, if your blood
pressure isn't brought below 130 after a month or two, three drugs will likely
be considered. The preferred three-drug regimen is either an ACE inhibitor or
ARB, a long-acting calcium channel blocker such as amlodipine, and a
long-acting thiazide-like diuretic like chlorthalidone, says Thomas Brott,
professor of neurology and director for research at the Mayo Clinic in
Jacksonville. The good news is that a multidrug approach seems to be very
effective while minimizing side effects like weakness, dizziness, headache and
muscle cramps. A 2017 review published in the medical journal Hypertension of over 20,000 people with high blood
pressure found that combining two medications, each at a quarter dose, was just
as effective as taking one blood pressure medication at the standard dose — and
taking four medications each at a quarter dose worked twice as well.
Controlling blood pressure helps more than your heart
Treating hypertension may also lower your
chances of developing mild cognitive impairment (MCI), a condition that's often
a precursor to dementia. People who tried to get their blood pressure under
120/80 were 19 percent less likely to develop MCI than those who aimed for
simply under 140/90, according to a study published this year in the Journal
of the American Medical Association. “What's good for your heart as far as
blood pressure control is good for your brain, too,” says Luke Laffin, a
cardiologist at the Cleveland Clinic.
But high blood pressure affects more than your
brain and your heart: It affects your kidneys, too. Uncontrolled high blood
pressure damages the arteries around the organs, making it harder to deliver
enough blood to your kidney tissue, explains Laffin. This means your kidneys
aren't able to get the oxygen and nutrients they need, which makes it much
harder for them to do their job of filtering blood and regulating fluid in your
body. It also makes it more difficult for them to produce the hormone
aldosterone, which helps your body regulate blood pressure. As a result, your
body gets trapped in a vicious cycle where both your blood pressure and kidney
function continue to worsen.
High blood pressure also has other insidious
effects, like increasing risk of impotence in men and lessening sexual arousal
in women. It can also damage the tiny blood vessels around your eyes, causing
blurred or even complete loss of vision. That's why it's so important to keep
track of your blood pressure numbers and, if they're elevated, take steps to
lower them, says Laffin.
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