Doctor’s column: What to do about your blood pressure
ABOUT THIS COLUMN
Greg Feinsinger of Carbondale, who retired in February from Glenwood Medical Associates after 41 years as a family physician, is writing a 10-week series of columns on critical health issues for the Post Independent. The columns will appear in Tuesday’s Body & More pages.
The upper number of your blood pressure is called the systolic BP and is a measure of the pressure in your arteries when your heart contracts. The lower number is called the diastolic BP, and measures the pressure when your heart relaxes between each beat.
The March 2015 issue of Nutrition Action Healthletter points out that one in three Americans have hypertension (high BP) and only half of those have their hypertension under control. Another one out of three Americans have pre-hypertension, so two-thirds of us have abnormally high blood pressure.
It is easy to see how too much pressure in the arteries over the years damages them, particularly the delicate organ system called the endothelium, which lines the arteries. Eventually, untreated hypertension leads to strokes, heart attacks, kidney damage, dementia and more.
So what defines high blood pressure? As with many areas of medicine, there is some controversy about this. It is clear that normal blood pressure is less than 115/75, in that in people with blood pressures above that, the risk of heart attacks and strokes starts to climb. When the pressure is greater than 140/90, the risk curve is much steeper.
Current national guidelines suggest that BP readings up to 140/90 are acceptable, but doctors in heart attack prevention vigorously disagree. The problem with guidelines is that they are made by committees, and are always a compromise, are already outdated when they come out, and 50 percent of them are not based on solid science.
Almost all heart attacks and stokes are preventable, and heart attack prevention doctors feel that in order to do that, we must practice optimal care rather than standard care, and point out that there is a 10-year lag between the two. So we want our patients to have blood pressures of 120/80 or less, although sometimes older folks, in their 80s and 90s, do better with BPs a little higher than that.
There are many causes of hypertension, including the S.A.D. (Standard American Diet, which is high in salt, fat and sugar), being overweight, sleep apnea, sedentary lifestyle, emotional stress, genetics, certain medications such as ibuprofen and other factors.
Hypertension doesn’t usually cause symptoms until it’s too late (a heart attack or stroke occurs), and is therefore called “the silent killer.” So it’s important that you check your blood pressure at least a few times a year, either in your doctor’s office, a store that has a BP cuff or buying your own cuff.
The best treatment is lifestyle modification. Losing weight always helps, as does cutting back on salt, and adding potassium by eating more vegetables or by using salt substitutes such as No Salt and other brands (which is potassium chloride rather than sodium chloride). Note that you should not increase your intake of potassium if you have chronic kidney disease.
Going on a plant-based, low-fat, whole foods (unprocessed) diet is the healthiest way to lose weight and lower your blood pressure. Exercise helps as well, so if you have hypertension you should exercise aerobically such as brisk walking at least 30 minutes a day. Even breaking up the 30 minutes into three 10-minute segments helps.
If you have pre-hypertension, a month or two of lifestyle modification is certainly reasonable, before starting medication, as long as you monitor your BP and make sure it returns to a level of 120/80 or less. However, if your BP is 140/90 or higher or if lifestyle modification doesn’t bring your BP down to 120/80 or less, you need to start medication without procrastinating. Years ago, there were only about five medications for hypertension, large doses were used and patients often complained of side effects. Now there are multiple medication choices, and we can almost always find one without side effects. Sure, nobody wants to take pills, but it beats dying from or being disabled by a heart attack or stroke.
Dr. Feinsinger is a retired family physician who is available for free consultations about heart attack prevention, plant based nutrition, and other health issues. Call 379-5718 for an appointment.
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