Coping with hypertension
The systolic or upper number of your blood pressure is the pressure in your arteries when the heart contracts, and the lower number or diastolic is the pressure when your heart relaxes. High blood pressure is the biggest risk factor for strokes, and one of the primary risk factors for heart attacks. This makes sense, because when the pressure is too high, this damages the endothelial lining of your arteries, an important but delicate organ system. Large population studies show that when groups of peoples have blood pressures above 115/75, the risk of heart attacks and strokes starts to rise, and above 140/90 the rise is more dramatic.
At Glenwood Medical’s Heart Attack, Stroke, and Diabetes Prevention Center, our goal in general is to achieve blood pressures of around 120/80. However, in people over age 75 or so, a somewhat higher blood pressure may be optimal. This is because in older people, too low a blood pressure can cause light-headedness and falls. In determining whether someone has hypertension, it’s important to have more than one blood pressure reading. Our blood pressure varies somewhat from day to day, and with the time of day. And some people have “white coat hypertension” due to anxiety during the doctor visit, so it’s important for those people to take their blood pressure several times at home. A 24 hour blood pressure monitor may be useful as well. Even if you have “white coat hypertension,” however, there are studies that show that you are at some increased risk anyway, because your B.P. is probably elevated with other stressful activities as well.
Regarding treatment, lifestyle modification can definitely help. Regular aerobic exercise at least 30 minutes a day can lower your blood pressure, as can losing weight if you are overweight. Avoiding sodium chloride (salt) helps, along with daily use of potassium in the form of “No-Salt Salt” and other brands, found in the salt section of the grocery store. (Do not add daily potassium, however, without discussing this with your doctor, because if you have abnormal kidney function this could cause problems). Also, hypertension is very rare in populations who eat a plant-based, low-fat diet, no doubt in large part because these people tend not to be overweight. Meditation and biofeedback are other non-drug treatments.
If you are unwilling to make necessary lifestyle modifications, or if you do and you still have hypertension, several medications are available. Patients are always worried about side effects, but this concern might come from the days when we only had a few medications to treat hypertension, and they indeed often caused side effects. These days, there are several classes of drugs we can use and many choices within each class, and we should be able to find something that will not cause any side effects, and many of these medications are inexpensive.
If you have hypertension, you should buy a blood pressure cuff and check your blood pressure periodically, at different times of the day, and notify your doctor if it is running high. In some people the blood pressure is higher in one arm than the other, in which case always use the arm in which it is higher.
It’s really important to know your blood pressure numbers, no matter your age. Please think about how you can stay on top of what’s going on in your body.
Dr. Greg Feinsinger is the co-director of the Heart Attack, Stroke and Diabetes Prevention Center at Glenwood Medical Associates. He is a native of the Roaring Fork Valley and has been in practice for more than 40 years. He is an international Grand Master cross country ski racer and a competitive runner. He is available for appointments for heart health evaluation, as is his co-director, Dr. David Lorah. Call Dr. Feinsinger at 970-945-8503.
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