Departments
Health Matters
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Week of 17 October 1997 |
Vol. I, No. 8 |
Health
Matters
Keeping the pressure off
How serious is hypertension, and what can I do to control it?
Hypertension, or high blood pressure, is a symptomless condition with a grim nickname: "the silent killer." It can eventually produce severe complications, such as heart failure, kidney failure, and stroke. However, Irene Gavras, M.D., staff physician at Boston Medical Center and professor of clinical medicine at Boston University School of Medicine, warns that it is often misunderstood. "Being hypertensive is not the result of nervous tension and has no connection to a high-strung personality," she says. Similarly, she adds, hypertension is not related to having enlarged (or varicose) veins.
A blood pressure reading, quickly and easily obtained with a device called a sphygmomanometer, reveals the pressure exerted on artery walls when the heart contracts (systole) and relaxes (diastole). Normal blood pressure is lower in children and gradually increases throughout adulthood. In adults, normal blood pressure is less than 140/85 (read "140 over 85," the top number being systolic pressure). Those with blood pressures slightly above 140/85 are considered to have borderline hypertension, and patients of any age are considered hypertensive if their blood pressure is higher than 160/95. All healthy people should have their blood pressure checked once a year; doctors may check the blood pressure of borderline or hypertensive patients more often.
About 15 percent of people have hypertension across all age and ethnic groups, with the highest prevalence in African Americans, who also tend to suffer from more complications. Roughly 50 percent of people older than 65 are hypertensive, although it appears in men at a younger age than in women.
While there may be no symptoms of hypertension, serious complications can ensue if it is not treated. "Probably the most common disease caused by hypertension is heart failure," Gavras says. "The heart becomes enlarged, and as a result, it becomes weaker and cannot pump as strongly as it once did." The weakened heart can produce shortness of breath and fatigue and could eventually fail altogether. Moreover, hypertension can cause heart attacks by producing blockage in the coronary arteries.
For the most part, hypertension cannot be prevented. A healthful diet (low salt, low fat) and regular exercise will slow its effects, however. Smoking and heavy drinking will aggravate hypertension, but small amounts of alcohol (one drink per day), especially red wine, can actually protect the heart. Your physician may recommend taking aspirin in small doses to thin the blood. Gavras recommends that hypertensive patients inform their doctor of all over-the-counter drugs they use regularly.
If you are diagnosed with hypertension, your doctor will assess the type from which you suffer. "The vast majority of cases of hypertension are called primary, a condition that can be controlled, but not cured. Secondary hypertension, however, occurs in about 5 percent of cases and is usually the result of some physical condition, such as a kidney abnormality, or rarely, a tumor. These cases can be cured by surgical treatment. Young patients who develop severe high blood pressure very quickly, unlike the more gradual increase that we normally find, are more likely to suffer from secondary hypertension," Gavras says.
Once your doctor evaluates your cardiovascular risk factors and your general health, you can begin a regimen that will lower your blood pressure. Drug therapy is given if the hypertension is severe, or if the blood pressure fails to respond to diet, exercise, and lifestyle changes. Successful treatment will reduce your risk of developing complications, although the risk of heart attacks may remain higher for those with hypertension despite optimal therapy.
Gavras emphasizes that it is vital to continue taking medication regardless of any initial side effects. "Don't stop taking hypertension medication just because you have side effects," she warns. "Go back to your doctor, who can develop a new treatment regimen for you. You may initially feel better by stopping the medication, but in the long run, you definitely will not be better off."
"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information on hypertension or other health matters, call 638-6767.