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Heart Smarts: Understanding Hypertension
Other studies confirm the need for better consumer awareness about high blood pressure. According to a March 2000 survey by The National Council on Aging (NCOA), nearly half of all Americans age 50-plusdo not know their own systolic and diastolic blood pressure numbers. In addition, the survey revealed that respondents do not understand the factors that contribute to hypertension. "The research reveals an information deficit about the dangers of untreated high blood pressure and the condition's deadly potential," says Gary Rogal, M.D., Chief of Cardiology Services for the Saint Barnabas Health Care System. What is Hypertension? High blood pressure, or hypertension, is defined in an otherwise healthy adult as a systolic blood pressure of 140 mm Hg or higher and/or a diastolicpressure of 90 mm Hg or higher.Blood pressure is measured in millimeters of mercury (mm Hg). The systolic number measures the blood pressure level when the heart contracts; the diastolic number measures the blood pressure level when the heart fully relaxes. According to the AHA, in 90-95 percent of cases the cause of high blood pressure is unknown. In the remaining cases, hypertension is a symptom of an underlying problem, such as a kidney abnormality. "Hypertension is a silent disease that affects tens of millions of people," says Gary Friedman, M.D., Clinical Director of Transplantation at Saint Barnabas and a practicing nephrologist who treats hypertensive patients. "Over the last 20 years, the frequency of hypertensive patients experiencing kidney failure has escalated, particularly in the older population." Why Hypertension is Harmful "From a cardiologist's perspective, hypertension is a major risk factor for coronary artery disease," says Dr. Rogal. When the pressure within the blood vessels becomes elevated (hypertension), the heart must work harder than normal. Functioning at a higher level makes the heart and arteries more prone to injury. The heart tends to enlarge and weaken with overuse and the arteries become hardened. The longer that the diseased state persists, the worse the coronary problem may become over time. Compared to people with controlled high blood pressure, people with uncontrolled high blood pressure are three times more likely to develop coronary heart disease, six times more likely to develop congestive heart failure and seven times more likely to have a stroke. Hypertension also increases the risk of kidney failure and eye damage. "The kidneys have three million small filters, each the size of the head of a pin," says Dr. Friedman. "The blood vessels in these filters are fragile and subject to damage from high blood pressure." Do You Have Hypertension? To learn if you have hypertension, the first step is to visit your family physician or internist. "In addition to a blood pressure check, taking some basic laboratory tests, including blood and urine testing, will give your physician a very good sense of whether or not you are dealing with hypertension," says Dr. Rogal. "The family physician can start the patient on medication and there is no need to see a specialist unless there are other issues involved." Specialty consultations occur if the patient does not respond to medication, if he or she has hypertension due to a secondary cause such as a kidney problem, or if he or she has complex or multiple medical problems, such as heart failure. Those with heart-related medical problems are generally referred to a cardiologist. Those with medical problems not related to the heart are referred to a nephrologist. For some individuals, a visit to a physician for a blood pressure test may actually cause their blood pressure to rise higher than usual. Dr. Friedman often has his patients use a home blood pressure cuff from a pharmacy to more accurately gauge if true hypertension exists. "We call it 'the white coat syndrome'," says Dr. Friedman. "Somewhere in the neighborhood of 20 to 25 percent of people experience a rise in blood pressure from the stress of a physician's visit. If this is the case, it is definitely better to measure the pressure at home." Hypertension Treatment The goal of hypertension treatment is first to try and lower blood pressure to an acceptable level through non-medical means, explains Dr. Rogal. This includes weight loss, sodium restriction/dietary changes, exercise (if medically safe) and stress reduction. The next line of defense is medications. Antihypertensives, such as beta-blockers and diuretics, are often used. Beta-blockers reduce the heart rate and the heart's output of blood; diuretics rid the body of excess fluids and sodium. Another class of hypertensives, called sympathetic nerve inhibitors, reduces blood pressure by inhibiting the nerves from constricting blood vessels. Another group, called vasodilators, causes the muscle in the blood vessel wall to relax and widen. Still another class, called ACE inhibitors, interferes with the body's production of a chemical that causes arteries to constrict. "Each regimen has to be tailored to the particular patient's problems," says Dr. Rogal. "Those taking medication require regular surveillance, with a visit to a physician at least twice a year." In Conclusion "Hypertension is a very treatable condition," Dr. Rogal says. "While those who are newly diagnosed should recognize the serious potential for diseases caused by hypertension, they should also know that it can be dealt with effectively in most cases."
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According to the American Heart Association (AHA), more than 50 million Americans suffer from high blood pressure, which can cause stroke, heart failure, kidney disease and contribute to death. Alarmingly, one-third of those affected are unaware that they have high blood pressure, reports the AHA.
