Tag Archives: stroke

Know Your (New) BP Numbers. Then take steps to lower them.

High blood pressure, or hypertension, has been in the news recently. Hypertension has long been known to be a major risk factor for heart disease and stroke, so diagnosing and treating high blood pressure has always been important. A new report has changed the blood pressure classifications to reflect research suggesting that what was previously considered “too high” is really too high. Given the new report, this is a good time to review the diagnosis, health effects, and treatment of high blood pressure. This is the topic of my Health & Fitness column in the Aiken Standard this week.

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Hypertension is called the “silent killer” because it often has no symptoms but contributes to many heart attacks and strokes and is associated with type 2 diabetes, heart failure, and kidney disease. Since the risk of these conditions is related to the severity and how long your blood pressure has been high, blood pressure should be measured regularly.

 

The new guidelines lower the blood pressure at which more aggressive treatment is recommended for some patients who are at high risk for a heart attack or stroke. The guidelines also change the classifications of blood pressure, which may mean your doctor could start treatment sooner.

 

Know your numbers

Your blood pressure includes two numbers, both measured in millimeters of mercury (mmHg). The top number, systolic, is the pressure in your arteries while your heart is contracting and pumping blood. The bottom number is the diastolic pressure, which occurs between beats when the heart is relaxed. Both numbers are important.

According to the new guidelines, normal blood pressure is less than 120 mmHg systolic and less than 80 mmHg diastolic. If your blood pressure is between 120–129 mmHg systolic and 80–89 mmHg diastolic, you have elevated blood pressure. Stage 1 hypertension is 130–139 mmHg systolic or 80–89 mmHg diastolic and stage 2 hypertension is a blood pressure 140/90 and higher.

What is now called elevated BP and stage 1 hypertension used to be called “prehypertension.” The new classification should draw attention to the fact that the blood pressure is too high and prompt doctors and patients to begin treatment.

 

Get it down

If your blood pressure is above normal you should take treatment seriously. Lifestyle changes including eating a healthy diet, regular physical activity, weight control, and quitting smoking are all effective and essential for lowering blood pressure.

There are also many effective (and affordable) medications that your doctor can prescribe to lower your blood pressure. Take them as directed and don’t forget that they are designed to work with healthy lifestyle habits.

 

Keep it down

The aim, of course, isn’t simply to reduce your blood pressure using medications. Your ultimate goal should be to keep your blood pressure low without relying on medications, all of which have at least some negative side effects.

The best way to maintain a normal blood pressure is through daily exercise, eating a healthy diet, losing weight if you are overweight, and quitting smoking. A good place to start is the DASH diet, which is high in fruits, vegetables, and fiber and low in sodium and added sugar. The DASH diet has been shown to modestly lower blood pressure and lead to weight loss.

Since blood pressure tends to increase with age, even if you have normal blood pressure now you should take steps to prevent high blood pressure in the future. Adopting a lifestyle that includes daily physical activity, healthy eating habits, managing stress, and not smoking is essential for preventing high blood pressure. Additionally, these same health habits will help you prevent most other chronic disease including diabetes, heart disease, and many cancers.


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Don’t wait until you get sick: What you can do to prevent heart disease.

I have been writing recently about heart disease, how it is diagnosed, and what you and your doctor can do to treat it. In order for your doctor to start treating you for heart disease risk factors such as high blood pressure, high cholesterol, or diabetes you need to be diagnosed with one of these conditions. This requires proactively seeing your physician for screening before you start experiencing the consequences of these conditions.

But most people don’t visit their doctor until they have symptoms, and many wait until a more serious event (a heart attack, for example) occurs to seek medical attention. By this time, the disease process has progressed and managing it becomes the goal. It is possible to prevent both the conditions that lead to heart disease as well as reduce the risk that you may have a heart attack or stroke.

Your risk of heart disease is largely determined by health-related attributes and behaviors called risk factors. Some of these risk factors cannot be changed, including age, sex, and family history. Other risk factors are modifiable, meaning you can change them to reduce your risk. These modifiable risk factors include smoking, high blood pressure, high cholesterol, diabetes, obesity, and physical inactivity.

While there are medications that can lower blood pressure and cholesterol and treat diabetes, these modifiable risk factors are best addressed by lifestyle changes. Adopting healthy habits has the potential to have a bigger effect on heart attack risk than medical management. There are three important health behaviors that, together and separately, have a powerful effect on reducing heart attack risk:

Stop smoking. There is no way around this one. Quit! Ask your doctor about prescription medications that can make quitting easier. Nicotine replacement therapy in the form of patches, gum, and lozenges can help manage cravings and are available over the counter. Ultimately, though, quitting smoking is a behavior change that takes motivation, willpower, and time. But it is worth it—your risk of heart attack can drop 50–70% within five years of quitting.

Be active everyday. The importance of physical inactivity as a risk factor for heart disease is often overlooked. But make no mistake, being active on a regular basis is one of the most important things you can do to improve your heart health. Whether you have other risk factors or not, physical activity can reduce your chance of having a heart attack. And if you do have a heart attack, your active lifestyle improves your chances of survival and returning to a normal lifestyle.

The benefits of exercise are well-established and impact heart disease risk in a multitude of ways. Physical activity helps with weight control, lowers blood pressure, improves blood lipids, and prevents and treats diabetes. Think of this as a great health “deal.” By modifying one risk factor—inactivity—you can also promote beneficial changes in four others—obesity, hypertension, high cholesterol, and diabetes. There is no other treatment, drugs included, that can have such a broad impact on heart disease risk!

Improve your diet. If you are like most Americans, your diet is too high in saturated fat, salt, and added sugar and lacking adequate whole grains, fruits and vegetables, and fiber. This type of diet is associated with obesity, high blood pressure, high cholesterol, and diabetes. All of these conditions are risk factors for heart disease, so you may literally be eating your way to a heart attack.

It turns out that adopting a healthier eating pattern is important in reducing your risk of heart disease. Saturated fat intake can lead to abnormal blood lipids and high salt intake is linked to high blood pressure. While eating sugar doesn’t cause diabetes, the type of diet described above is associated with weight gain and diabetes. Just like with physical activity, a healthy diet can lead to improvements in several other risk factors.

The potential impact of these three health behaviors is great. Even modest changes in diet and activity can lead to improvements in risk factors and reduced heart attack risk. More intensive lifestyle modification can produce even greater benefits. In one famous study, daily exercise, a low-fat vegetarian diet, and stress management actually caused regression of heart disease, meaning that the blockages in the coronary arteries were smaller following treatment. While you may not follow such a strict program, becoming more active, eating a healthier diet, and quitting smoking can go a long way to improving your heart health.

What you need to know about heart disease

February is American Heart Month, a time to raise awareness about heart disease, the leading cause of death among adults in the United States. Heart disease, sometimes called coronary heart disease or coronary artery disease, is responsible for nearly 375,000 deaths each year, mostly from heart attacks. Over 13 million adults have been diagnosed with heart disease and, if other cardiovascular diseases like high blood pressure, heart failure, and stroke are included, that number jumps to 80 million. (more statistics are available from the American Heart Association)

The process that leads to heart disease is called atherosclerosis and is characterized by the accumulation of cholesterol-containing plaques in the coronary arteries, the vessels that supply blood to the heart. These plaques narrow the vessels and reduce the amount blood delivered to the heart. The heart requires a constant supply of oxygen to beat and any narrowing in the vessels reduces blood flow and interferes with normal heart function. A decrease in oxygen delivery can cause chest pain (angina pectoris), especially during activity or exertion. It is usually relieved with rest, but can limit normal activities. A complete blockage in blood flow causes a heart attack, also called a myocardial infarction or MI, in which the heart muscle is damaged, sometimes permanently. Many MIs lead to death because dangerous arrhythmias—abnormal heart rhythms—develop that lead to cardiac arrest.

The traditional view of heart disease holds that the cholesterol plaques progressively narrow the arteries until they close completely, a process similar to a blockage in a pipe in your house. It turns out that the process of atherosclerosis is more complex. In fact, most heart attacks occur because of vessels that are around 50% blocked.

Current evidence shows that inflammation plays an important role in the accumulation of plaque in the vessel walls. Additionally, inflammation plays a role in making the plaques unstable and prone to rupture, resulting in a blood clot in the artery which completely blocks the flow of blood leading to a heart attack. This makes more sense if you think of the inside of a blood vessel like your skin. A cut on your finger results in inflammation and the formation of a blood clot which stops blood flow. A similar process occurs inside the coronary arteries to lead to an MI.

The process that occurs in coronary arteries also takes place in other vessels. A blood clot that forms in a vessel in the brain can cause a stroke, sometimes called a “brain attack” because the process is similar to a heart attack. Narrowed vessels that reduce blood flow to the brain can cause a reversible condition called a transient ischemic attack (TIA) or mini-stroke. Narrowed arteries in the legs can cause muscle pain during exercise or activity.

Atherosclerosis is a process that starts when we are young and progresses as we age. It generally doesn’t cause symptoms like chest pain until the arteries are at least 70% narrowed, so most people are unaware that it is happening. The process is accelerated by conditions like obesity, diabetes, high cholesterol, and high blood pressure as well as risk factors like a high fat diet, lack of exercise, and smoking.

Genetics play a role, too, but since you can’t change your genes, the emphasis is placed on factors that you can control. It turns out that making lifestyle changes can greatly reduce your risk of heart attack, and may even reverse the process that causes heart disease.

I will continue to celebrate Heart Month with more information about how to assess your risk for heart disease and what you can do to prevent and treat heart disease.

 

Reducing your risk of heart disease

February is Heart Month, an ideal time to assess your risk of heart disease and take steps to improve your health. This is important because heart disease, sometimes called coronary artery disease, is the leading cause of death among adults in the United States. It is responsible for nearly 600,000 deaths each year, mostly from heart attacks. Millions more are at increased risk because of certain biological and behavioral risk factors.

Identifying your personal risk for heart disease and making efforts to improve your heart health is the topic of my Health & Fitness column in the Aiken Standard this week.

Some of these risk factors cannot be changed, such as age, sex, and family history, while others can be altered to reduce risk. These modifiable risk factors include smoking, high blood pressure, high cholesterol, diabetes, obesity, and physical inactivity. While your doctor can play an important role in treating these conditions, there is much you can do on your own to improve your heart health.

The first step is to get a good assessment of your heart health. If you haven’t done so recently, you should see your doctor to have your risk factors evaluated. This includes tests for blood glucose and blood lipids (including total, LDL, and HDL cholesterol and triglycerides), measurement of your blood pressure and body weight, and an assessment of other health factors such as your family history, whether you smoke, and your level of physical activity.

The next step is to treat the risk factors that you have. Depending on the severity and your own personal health history your doctor may prescribe medications to lower your blood pressure, blood glucose, or blood lipids. These medications are most effective when combined with lifestyle changes including good nutrition, exercise, and weight loss. In some cases, poor diet and lack of activity can counteract the beneficial effects of these drugs. Furthermore, these healthy habits may help you reduce the dosage, and limiting the side effects, or stop taking the medications altogether.

The other risk factors—obesity, inactivity, and smoking—really must be treated through lifestyle management. While there are medications that can help with smoking cessation and weight loss, being successful requires making lasting behavior changes. These habits can be difficult to change, and many people have tried before without success. Keep in mind, though, that everyone who is successful at quitting smoking, losing weight, or sticking to an exercise program has experienced his or her share of difficulty. The difference is that those people kept trying until they were successful. You can be successful, too.

Even small changes can have a big impact. Take exercise, for example. The benefits of as little as 30 minutes of physical activity per day are well established and impact heart disease risk in a multitude of ways. Physical activity helps with weight control, lowers blood pressure, improves blood lipids, and prevents and treats diabetes. Think of this as a great health “deal.” By modifying one risk factor—inactivity—you can also promote beneficial changes in four others—obesity, hypertension, high cholesterol, and diabetes. There is no other treatment, drugs included, which can have such a broad impact on reducing heart disease risk!

Of course, there are steps you can take beyond becoming more physically active to reduce your risk of heart disease. The list of beneficial changes you can make to improve your heart health is long, but keep in mind that even small changes can add up to a big benefit. 

Knowing which risk factors are most concerning can help you and your doctor make effective treatment decisions. Quitting smoking, increasing your physical activity (and reducing sedentary time), and eating a healthier diet can lead to improvements in heart disease risk factors and reduced heart attack risk. The best news is that these same changes can also reduce your risk of other serious health problems including many types of cancer, stroke, and lung disease.

 

 

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From USA Today earlier this week: Smoking bans cut number of heart attacks, strokes No real surprise here, but it’s always nice to see more data to show that smoking bans are working to improve health. Links to the studies … Continue reading