Men are most at risk to go untreated, according to a recent study by the University of Texas Southwestern Medical Center in Dallas. Young to middle-aged men are the most likely to be unaware of the problem, since many don't go to a doctor unless they feel sick. "Because it's not associated with any specific symptoms early in its course, high blood pressure is not something that typically takes someone to a physician’s office," says Dr. Daniel W. Jones, a former president of the American Heart Association and dean of the School of Medicine at the University of Mississippi. "It just doesn’t get your attention." But it should. There's a reason high blood pressure is called "the silent killer."
LOWER YOUR RISK
As people live longer, their risk of developing hypertension (defined as blood pressure of 140/90 or higher) increases, particularly after age 45. "Overweight and obesity are a big part of the increasing prevalence," says Dr. Jeffrey Cutler, a consultant to the NHLBI and National Institutes of Health (NIH). "The increasing consumption of salt in our diets may be a factor too, because obesity raises a person’s sensitivity to the blood-pressure-raising effects of salt." There are steps you can take to reduce your risk, though, no matter what your age or current health. "In the vast majority of people, a very healthy lifestyle can prevent hypertension," Dr. Jones says.
Lose weight
A study at the University of Padua in Italy found that overweight people who lost between 9 percent and 13 percent of their body weight experienced on average a 6.2-point drop in their systolic blood pressure (the top number) and a 3.6-point drop in their diastolic pressure (the bottom number)—improvements that were sustained six years later.
Change how you eat
Some people appear to be more sensitive to salt than others, putting them at higher risk for developing hypertension. Nevertheless, doctors recommend that most people lower their salt intake and increase their potassium. An easy way to do this is to follow the DASH (Dietary Approaches to Stop Hypertension) plan, which the NIH developed to lower blood pressure without medication. It has less salt, fat, and sugar than the typical American diet and includes fruits, vegetables, low-fat dairy foods, whole-grain products, fish, poultry, nuts, and seeds. The DASH plan is usually the first-line treatment, along with exercise, for people with pre-hypertension—unless they have a chronic disease such as diabetes or kidney problems, in which case they may be prescribed medication, too, Dr. Jones says. It also is recommended for those who have full-blown hypertension and are taking drugs to treat it.
Exercise regularly
Regular exercise can improve your aerobic conditioning, which will result in a healthy drop in blood pressure, explains Domenic A. Sica, M.D., a professor of medicine and chairman of clinical pharmacology and hypertension at Virginia Commonwealth University. It doesn't have to be vigorous: In a recent review of 26 studies, researchers at the Beth Israel Deaconess Medical Center and Harvard Medical School's Osher Institute concluded that low-impact exercises such as tai chi can reduce blood pressure. Meanwhile, a study at Syracuse University found that resistance training can lower blood pressure in those who have pre- or stage-1 hypertension.
Get enough sleep
"When you go to sleep at night, blood pressure typically drops 15 percent to 30 percent, and your heart rate can drop as much as 30 percent," says Dr. Sica. The overnight reduction can positively affect your blood pressure the next day. On the other hand, a short or fragmented night’s sleep can produce the opposite effect, increasing blood pressure the next day.
TREATMENT OPTIONS
Manage your medications
Several classes of drugs can be used to control hypertension, including diuretics, ACE inhibitors, angiotensin receptor antagonists, beta-blockers, calcium channel blockers, and a drug (approved in 2007) that inhibits renin, a kidney enzyme. In many cases, people will require two or more drugs to bring their blood pressure into the normal range. Because various drugs work in different ways, they can have a complementary, often synergistic effect in reducing blood pressure. Plus, if you use more than one, you usually can take a lower dose of each, which can help you avoid some of the potentially unpleasant side effects (such as swelling, flushing, and headaches), says Dr. Sica.
It is important that you stick with the medication regimen outlined by your doctor. If your blood-pressure readings still aren’t getting into the optimal zone, expect to have your prescriptions or dosages adjusted. "Sometimes you need to try different combinations of drugs until you find the one that works for you," Dr. Sica advises.
Monitor yourself
Doctors recommend that people with hypertension regularly monitor their blood pressure at home. Blood pressure can vary considerably, fluctuating as much as 30 percent over a relatively short period of time, depending on environmental conditions or what you’re doing, says Dr. Jones. Home monitoring can help you see how your blood pressure shifts throughout the day and is affected by various activities. Knowing what makes a difference can help you get your blood pressure into the target range.
WHAT THE NUMBERS MEAN
The only way to tell if you have high blood pressure before it takes a toll is to have regular checkups. Because pressure can vary throughout the day and be affected by whether you are standing or sitting, doctors will often take more than one reading during a single visit.
- Top number: Called "systolic pressure," it measures the pressure within blood vessels as your heart beats.
- Bottom number: This records "diastolic pressure," which happens between beats while your heart is at rest.
- Normal: Under 120/80
- Pre-hypertension: 120/80 to 139/89
- High blood pressure: Over 140/90
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