New
Hope for Those with High Blood Pressure
More than two-thirds of the 65 million Americans with high
blood pressure require two or more anti-hypertensive medications to manage
their condition, experts report. Many of these people also take medicines for
high cholesterol and diabetes.
That makes for a heaping mound of pills to swallow every
day.
"Anybody can take a few drugs for a few months, but these
people have to be on drugs indefinitely," says Dr. John D. Bisognano, director
of cardiac rehabilitation and clinical preventive cardiology at the University
of Rochester Medical Center.
But there is encouraging news on the horizon for people
with high blood pressure. Easier-to-take medications and novel medications
and devices promise to improve long-term hypertension management.
Basic research continues to sort out the causes of hypertension.
And vigorous prevention initiatives aimed at sparing children from this chronic
health problem breed hope for future generations of Americans.
Hypertension, often called "the silent killer," usually
occurs without symptoms but remains a leading risk factor for stroke, heart
attack, heart failure, and kidney disease. The only way to find out if you
have it is to have a blood pressure reading.
High blood pressure is literally the force exerted as blood
pumps into the arteries through the circulatory system and as the arteries
resist the flow of blood, says the American Heart Association.
Systolic pressure, the "upper" number in a blood pressure
reading, measures the force when your heart is contracting to pump out blood;
the "lower" diastolic number reflects the pressure when the heart is resting
between beats.
A normal blood pressure for adults is less than 120 mmHg
(millimeters of mercury) over less than 80 mmHg, and a reading of 140/90 mmHg
or higher is considered high, requiring medical intervention.
In 2003, the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure, a panel convened by the federal
government, added a new blood pressure category, called "prehypertension" -
to put people on warning about the potential risk they face. Prehypertension
is defined as a pressure of 120-139/80-89 mmHg.
For people with diabetes or kidney disease, the goal is
to reduce blood pressure to 130/80 mmHg.
"One of the problems you run into is people who are at the
highest risk - the people with diabetes and kidney disease - often require
lots of medications to get their blood pressure down, because every medication
gives you about a 10- to 15-point drop or so," Dr. Bisognano explains.
"If you're starting at 200 and need to go to 130, that's
a lot of medications," he adds.
No single medication has proved to be the magic bullet for
lowering blood pressure, so physicians typically rely on a number of different
pharmaceuticals, including diuretics, angiotensin receptor blockers, angiotensin
converting enzyme inhibitors, beta blockers, and calcium channel blockers.
Pharmaceutical developers are responding to the need to
make it easier for hypertensive patients to comply with medication regimens
by developing new combination products.
In the future, there will be more fixed-dose combos of antihypertensive
medications as well as pills that can treat more than one risk factor at a
time, predicts LeadDiscovery, a United Kingdom-based research outfit.
Pfizer Inc. was the first to offer such a two-in-one product.
In 2004, the company received approval from the US Food
and Drug Administration (FDA) to begin marketing Caduet, a pill that
contains both Norvasc for lowering high blood pressure and Lipitor for treating
high cholesterol.
There are a few new agents in the pipeline that hold promise.
One novel class of medications, called oral renin inhibitors, works by targeting
an enzyme released by the kidneys that can affect blood pressure. The first
of these agents to be introduced on the market is likely to be Aliskiren, a
Novartis drug currently in phase III testing.
Meantime, even a device to keep blood pressure at bay is
being tested. In March, physicians at the University of Rochester Medical Center
were the first in the nation to implant the Rheos, a battery-operated generator
that activates the body's natural blood pressure regulation systems.
Much like a pacemaker regulates heart rhythm, this device
stimulates nerves in the carotid arteries to tell the brain to reduce blood
pressure. Dr. Bisognano is part of the team that is testing the device.
Still, preventing hypertension in the first place is a far
better thing than having to rely on medicines or machines, clinicians agree.
That is why the National Hypertension Association (NHA) has
focused on basic research and education.
NHA researchers have shown,
for example, that salt-sensitive rats get high blood pressure when exposed
to excess salt.
"But the salt resistant ones are not bothered by it at all;
their kidneys get rid of it," notes Dr. William M. Manger, NHA chairman
and clinical professor of medicine at New York University Medical Center. At
least in salt-sensitive rats, it appears that excess salt to the brain causes
hypertension, he said. How that will play out in humans is still unknown, but
investigators are hopeful.
The NHA also sponsors VITAL
(Values Initiative Teaching About Lifestyle), a rapidly expanding school-based
initiative to change the lifestyle and behavior of young children.
It focuses on nutrition and exercise, a much broader agenda
than hypertension alone. But it fills a critical gap, according to Dr. Manger,
author of the not-yet-released book, Our Greatest Threats Protect Your
Children and Yourself, focusing on preventing unhealthy lifestyles.
"I think this VITAL program is the best thing we could do
for our nation," he says.
Always consult your physician for more information.
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High blood pressure can occur in anyone, but is particularly
prevalent in:
- persons with diabetes mellitus, gout, or kidney disease
- African Americans
- persons in their early to middle adult years; men in this age group have
higher blood pressure more often than women in this age group
- persons in their middle to later adult years; women in this age group
have higher blood pressure more often than men in this age group (more
women have high blood pressure after menopause than men of the same age)
- middle-aged and elderly persons - more than half of all Americans age
65 and older have high blood pressure
- persons whose parents or grandparents have/had high blood pressure
- obese persons
- heavy drinkers of alcohol
- women who are taking oral contraceptives
The following may contribute to an increase in blood pressure:
- being overweight
- excessive sodium intake
- a lack of exercise and physical activity
Many people can control high blood pressure by:
- choosing foods that are low in sodium (salt)
- choosing foods low in calories and fat
- choosing foods high in starch and fiber
- maintaining a healthy weight, or losing weight if overweight
- limiting serving sizes
- increasing physical activity
- practicing moderation if consuming alcoholic beverages
However, other persons must take daily medication to control
hypertension. Individuals with hypertension should routinely have their blood
pressure checked and be under the care of a physician.
Many of the strategies that produce successful weight
loss and maintenance help prevent obesity, a risk factor for high blood pressure.
Improving eating habits and increasing physical activity play a vital role
in preventing obesity and maintaining health overall.
Recommendations for adults include:
Eat five to nine servings of fruits and vegetables daily.
A vegetable serving is one cup of raw vegetables or one-half cup of cooked
vegetables or vegetable juice. A fruit serving is one piece of small to medium
fresh fruit, one-half cup of canned or fresh fruit or fruit juice, or one-fourth
cup of dried fruit.
Choose whole grain foods such as brown rice and whole
wheat bread. Avoid highly processed foods made with refined white sugar,
flour, and saturated fat.
Weigh and measure food in order to be able to gain an
understanding of portion sizes. For example, a 3-ounce serving of meat is
the size of a deck of cards. Avoid supersized menu items.
Balance the food "checkbook." Taking in more calories
than are expended for energy will result in weight gain. Regularly monitor
weight.
Avoid foods that are high in "energy density," or that
have a lot of calories in a small amount of food. For example, a large cheeseburger
with a large order of fries may have almost 1,000 calories and 30 or more
grams of fat. By ordering a grilled chicken sandwich or a plain hamburger
and a small salad with low-fat dressing, you can avoid hundreds of calories
and eliminate much of the fat intake.
Remember that much may be achieved with proper choices
in serving sizes.
Accumulate at least 30 minutes or more of moderate-intensity
activity on most, or preferably all, days of the week. Examples of moderate
intensity exercise are walking a 15-minute mile, or weeding and hoeing a
garden.
Look for opportunities during the day to perform even
ten or 15 minutes of some type of activity, such as walking around the block
or up and down a few flights of stairs.
Always consult your physician for more information.
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