Living with hypertension…
diet and exercise go a long way
Although its precise cause is unknown, heredity, high salt diet, obesity, physical inactivity, sleep apnea (labored breathing with loud snoring), and excessive alcohol intake are often associated with Hypertension.
More than 25% of the adult population in the U.S. has hypertension (HTN), and though most people with HTN are symptom free, it takes its toll in the form of arteriolosclerosis (hardening of the arteries), leading to heart attack, stroke, kidney failure, and peripheral arterial disease if left untreated.
Hypertension is defined as systolic blood pressure (upper number) of 140 mmHg or more or diastolic blood pressure (lower number) of 90 or above in an adult. “Pre hypertension” is a blood pressure (BP) between 120 to 139 systolic or 80 to 89 diastolic, which often progresses to higher levels as a person ages. Most patients with BP above 160/100 require two or more medications to bring it down to an acceptable level—below 140/90. “White Coat Hypertension” is a term used when BP is elevated in the doctor’s office, but not at home. It is more common in women and is attributable to anxiety. Many with “white coat hypertension” go on to develop persistent HTN.
Most people with HTN have the so-called “Essential Hypertension.” Although its precise cause is unknown, heredity, high salt diet, obesity, physical inactivity, sleep apnea (labored breathing with loud snoring), and excessive alcohol intake are often associated with HTN.
“Secondary HTN” is a term used for HTN due to a definable cause such as kidney or endocrine disease. Certain medications such as decongestants, steroids, female hormones, and street drugs such as cocaine and amphetamines can also raise BP.
Other factors which can contribute to HTN include smoking, which causes hardening of arteries over a period of years; excessive caffeine intake—more than four cups of coffee per day; and also certain “health foods” containing ephedra and ginseng.
Individuals with family history of HTN are more prone to develop it and should take steps to prevent its onset. Maintaining a normal body weight goes a long way towards keeping the BP down. Physical activity such as walking, jogging, and playing sports burn up calories and keeps one from gaining weight. These activities also open up arteries in the limbs, thereby increasing vascular capacity and reducing blood pressure.
Salty and preserved foods, which are high in sodium, should be avoided. A normal American diet contains ten to thirty grams of salt per day while the body needs only two to four grams per day. One gram of salt contains approximately 500 mg of sodium. One should get into the habit of reading the food constituents and avoid foods that contain more than 200 mg of sodium per serving. High potassium containing foods, such as fruits and vegetables, reduce BP. Daily alcohol intake in any form (cocktails, beer, wine, etc.) if ingested more than one serving by women and two by men can raise BP over a period of time and should be curtailed.
Quitting smoking, cutting down on coffee and avoiding “health foods” that can raise BP will lower it.
The first and foremost treatment of HTN is life-style modification. Those who are overweight must lose weight. Even a few pounds reduction in weight can decrease blood pressure and make it easier to control with medications. Proper diet and regular exercise go a long way in lowering BP. A low salt diet (less than four grams of salt or two grams of sodium per day), high potassium intake in the form of fruits and vegetables, regular exercise for at least 30 minutes a day and reducing or eliminating alcohol greatly help reduce blood pressure.
When HTN is not controlled with life-style modification, prescription drugs are used to control it. The most effective medication to treat HTN is a diuretic (water pill) such as hydrochlorothiazide (HCTZ). In almost half the cases HCTZ alone is enough to control HTN. In the remaining patients, it is used in combination with other antihypertensive drugs. Diuretics can lower blood potassium level.
Proper diet and regular exercise go a long way in lowering BP.
Angiotensin converting enzyme inhibitors (ACEI) such as lisinopril (Zestril) reduce the formation of hormone angiotensin-2, which raises blood pressure. These are very effective antihypertensive drugs. A common side effect, particularly in women, is cough and a tickling sensation in the throat. Those for whom an ACEI is able to control hypertension, but causes side effects, another class of drugs, angiotensin receptor blockers (ARBS) such as losartan (Cozaar) are equally effective and rarely cause cough.
A newer drug, aliskiren (Tekturna), is also as effective as ACEI and ARBS. The so called “calcium blockers” such as amlodipine (Norvasc) are also effective antihypertensive drugs, but can cause retention of fluid, headache, and constipation.
Beta-blockers such as atenolol (Tenormin) are also effective antihypertensive drugs when used in combination with a diuretic. Another class of drugs, “alpha blockers” such as doxazosin (Cardura) is no longer used commonly as a large study showed that they could cause heart failure when used without a diuretic. Vasodilators, such as hydralazine (Apresoline), are used in combination with a diuretic and beta-blocker when other drugs fail to control HTN.
Sometimes a physician may have to try different drugs one after the other or a combination of drugs until BP is controlled. In almost all cases, it should be possible to control HTN with life-style modification and medications with no, or minimal, side effects.
The most common and feared side effect of antihypertensive drugs in men is erectile dysfunction. It may occur due to reduction in blood pressure or as a direct side effect from medications. It can occur with almost all antihypertensive drugs. Medications such as sildenafil (Viagra) can be used to overcome this side effect without causing any interaction with the antihypertensive drugs.
As previously stated, hypertension is very common; family history plays an important role in causing it. It can be prevented and blood pressure lowered by losing weight, initiating an exercise regimen, and following a low salt diet. Medications can control hypertension with minimal side effects.
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"Living with hypertension…
diet and exercise go a long way"
Dr. Hodkin attended the University of Miami and graduated magna cum laude with a Bachelor of Science in chemistry and biology. He earned his medical degree from the University of Florida School of Medicine in Gainesville, where he received a four-yea...