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High blood pressure

A silent and dangerous killer

Karen Miller
High blood pressure
Dr. Myechia Minter-Jordan, the CEO and president of The Dimock Center, warns her patients that you don’t feel high blood pressure until it’s too late. (Photo: Photo courtesty The Dimock Center)

Many people have trouble taking medicine when they feel fine and have no symptoms. That’s the problem with high blood pressure.

For the most part, high blood pressure is a silent assailant — even when it’s dangerously high. That’s one of the reasons that adherence to a medication regimen for the disorder is low. Roughly half of Americans treated for HBP adhere to their long-term therapy, noted the Centers for Disease Control and Prevention.

That’s a mistake. The disorder wreaks havoc — under the cover of silence. Lack of control of HBP can cause heart failure, heart attack, blindness, kidney failure, stroke and even dementia. That’s a hefty price to pay for a disease that for the most part can be easily controlled with medication and healthy lifestyles.

High blood pressure, also known as hypertension, is one of the most common medical conditions in this country. The American Heart Association estimates that 80 million, or one-third of the U.S. adult population is afflicted.

Blood pressure is the force exerted against the walls of the arteries when the heart contracts or beats. Arteries are the blood vessels that carry oxygen and nutrients to muscles and organs. The upper number, or systole, measures the pressure when the heart beats. The bottom number, or diastole, measures the pressure when the heart relaxes between beats.

Both numbers are important. “Both are associated with heart disease, stroke and heart failure,” explained Dr. Myechia Minter-Jordan, the CEO and president of The Dimock Center in Roxbury. “We look at them equally and treat if even just one is high.”

Normal blood pressure is less than 120/80; high blood pressure is 140/90 or more. In between the two is pre-hypertension — 121/80 to 139/89 — which is typically not treated. Recent research, however, suggests that even pre-hypertension can cause complications down the line.

Treatment for HBP is not cookie-cutter. “It varies by the individual,” Minter-Jordan explained. Severity, age and even race are considered. For instance, according to the Mayo Clinic, older people and African Americans can often control their pressure more effectively with calcium channel blockers than with other medications. Additionally, regardless of the type of medication, black people can often more successfully control their pressure with two medications, one of which is a diuretic to help rid the body of excess fluid, Minter-Jordan explained.

There are two types of HBP. Primary or essential — the most common type of HBP — has no identifiable cause, and tends to develop gradually over many years. Secondary HBP, on the other hand, is due to an underlying, identifiable condition, such as tumors and thyroid conditions.

In some cases, HBP occurs beyond one’s control. Age, race and family history play significant roles. Certain chronic conditions, such as kidney disease, diabetes and sleep apnea can increase the risk of HBP, as do some medications, including birth control pills and some over-the-counter medications.

More often than not, however, we bring it on ourselves. We are our own worst enemies. Unhealthy lifestyles contribute to the disorder. Overweight and obesity, lack of physical activity, tobacco use, excessive alcohol use and diet are all controllable factors. Stress can also increase the pressure, but is typically temporary. Pressure can return to normal when the stress subsides.

African Americans

For reasons not well understood, hypertension is prevalent in African Americans. As noted by the American Heart Association, more than 40 percent of blacks in this country are afflicted. Not only is HBP more common in blacks, it attacks earlier and is more severe than it is in whites.

Two risk factors in particular may be propelling the problem. Diabetes and obesity, both of which are common in blacks, are strongly linked to high blood pressure. In addition, researchers have found that there may be a gene that makes blacks more sensitive to salt. In those with the gene, even one-half a teaspoon of salt could raise blood pressure as much as 5 mm Hg.

Prevention

The good news is that many cases of HBP can be prevented or controlled with lifestyle changes. A healthy diet is key. In its landmark study the National Heart, Lung, and Blood Institute discovered that a diet low in sodium and rich in fruits, vegetables and whole grains significantly reduced both systolic and diastolic pressure, particularly in African Americans.

Maintaining a healthy weight is critical. Increased weight and fat cause the heart to beat with more strength in order to supply nourishment to a larger girth. Experts agree that losing just 5 pounds can lower pressure. The location of the additional weight is a factor. Central obesity, or added fat around the middle, is closely linked to diabetes, a risk factor for high blood pressure.

Physical activity is essential. It not only lowers blood pressure it reduces stress and helps keep weight under control. Smoking is taboo. Tobacco injures the walls of blood vessels and causes hardening of the arteries. Alcohol is generally fine as long as men limit their drinks to two a day and women to one a day. Alcohol can raise the blood pressure in even healthy people.

Current status

In spite of the availability of effective and inexpensive medicine, HBP is apparently not going away anytime soon and is on the rise in younger people. A study sponsored by the National Institutes of Health in 2011 found that 19 percent of roughly 14,000 men and women between the ages of 24 and 32 had HBP. In comparison, a similar previous study reported that only 4 percent of that age range had the condition.

In its 2015 update on heart disease and stroke statistics, the American Heart Association noted that despite a drop in deaths from heart disease and stroke, deaths attributed to HBP were on the rise, largely because of its impact on heart failure and kidney failure. HBP contributes to 1,000 deaths a day, noted the CDC.

Screening

Screening is most important. You can’t treat what you don’t know you have. Minter-Jordan recommends checking at age 18 with yearly follow-ups. Those with HBP should be checked more frequently.

As the years pass everyone must be more vigilant. Your heart and blood vessels are aging right along with you and can lose a step or two. Healthy lifestyles and medication, if necessary, can keep you going strong.