By: Jean Johnson for Heart1
Part 2 Part 1
In the first part of this series on hypertension, we discussed the idea that experts now consider pre-hypertensive blood pressure readings between 120/80 and 139/89 mm Hg to be warning signs. People whose pressure ranges in this area are advised to make lifestyle changes that will bring their readings back down into more normal ranges.
|The National High Blood Pressure Education Program offers eight tips on controlling hypertension:
Talk with your health care professional. “Ask what your blood pressure numbers are and ask what they mean.”
Take medication as prescribed.
Lose weight if you are overweight and maintain a healthy weight. There’s no way around it: extra pounds place an undue burden on the circulation system.
Eat heart-healthfully: lots of fruits, vegetables, and low-fat dairy products.
Reduce salt and sodium intake. “Avoid fast foods that are high in salt and sodium.”
If you drink alcoholic beverages, do so in moderation. “For men that means a maximum of two drinks a day, for women, a maximum of one.”
Become more physically active. “Work up to at least 30 minutes of a moderate-level activity, such as brisk walking or bicycling, each day. If you don’t have 30 minutes, try to find two 15-minute periods or even three one-minute periods for physical activity.”
In this part, we’ll focus on one aspect of lifestyle that is currently sending rates of high blood pressure soaring: the worldwide epidemic of overweight and obesity. We’ll also include the latest on the controversy over which types of drugs are most effective at controlling hypertension.
At issue, of course, is potato chips and too much computer time, cars, and a raft of labor-savings devices that have created a sedentary society. As Irene Sampson noted, “I’ve found that the way people eat is an indicator on how they live the rest of their life. The chip people tend to be parked in front of their televisions. My mother who was a champ when it came to cooking from scratch and seeking out opportunities for adventurous eating. She was slim and active all her life as well. So to me it’s a mindset as much as anything.”
Research Probes Obesity-Related Hypertension
In research published in a 2006 issue of Hypertension, Murray D. Esler, MD, PhD and his colleagues confirm that we as a people are in a jam both with our eating and activity habits. They also conclude that since eating habits are so difficult to change, intervention with medication is likely the most prudent approach for physicians to take for treatment. Murray says: “obesity and hypertension are intimately associated.”
“Obesity prevalence is soaring in industrialized countries and is progressively increasing in the developing world. Altered patterns of nutrition and reduction in work-related energy expenditure have led to obesity becoming a truly global issue. Dietary calorie intake is modified by multiple social, economic, and cultural issues,” Esler et al write.
Harvard Medical School states that high blood pressure drugs are a major controversy. Some guidelines say that “the first choice should be an inexpensive diuretic (water pill)” and yet, “some experts argue that an ACE inhibitor or a calcium-channel blocker is a better place to start.” Harvard goes on to explain that a cookie-cutter approach to treating high blood pressure is not realistic and that physicians need to assess individual patients to determine appropriate courses of intervention. “Most people need more than one medication to get their blood pressure under control,” Harvard adds, “and one of these should probably be a diuretic.”
Research from the Journal of the American Society of Nephrology contributes to the discussion from a kidney-disease perspective. Results from a study of 1180 type 2 diabetic patients with high blood pressure prompted Piero Ruggenenti, MD and his colleagues at the Mario Negri Institute for Pharmacological Research in Bergamo, Italy, to conclude that angiotensin-converting-enzyme (ACE) inhibitors are effective in lowering blood pressure.
In addition to the hypertension benefits from ACE inhibitor trandolapril – which was combined with another blood pressure drug, verapamil – Ruggenenti’s team found that type 2 diabetics also received protective benefits related to kidney disease. This finding is noteworthy, of course, since diabetes is a leading cause of kidney disease. The research also found ACE inhibitors to be useful in helping patients who have trouble keeping their blood pressure within adequate ranges. “ACE inhibitor therapy has a further protective effect, in particular when the BP is poorly controlled,” stated the Italian research team.
As the Harvard Medical School notes, “High blood pressure, like almost everything else in medicine, is a highly personal condition. Preventing it, and keeping it from doing you harm, requires careful individualized evaluation from your doctor and focused commitment on your part.”