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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