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- Herausgeber: John Wiley & Sons
- Kategorie: Ratgeber
- Sprache: Englisch
- Veröffentlichungsjahr: 2011
New info on high blood pressure in women, children, and the elderly The fun and easy way to take charge of hypertension and add years to your life! Are you battling high blood pressure? This updated guide explains all the latest breakthroughs in the detection, treatment, and prevention of high blood pressure, helping you determine whether you're at risk and develop a diet and exercise program to keep your blood pressure at healthy levels. You'll also find new information on protecting your heart, kidneys, and brain and dealing with secondary high blood pressure. * Measure your blood pressure properly * Develop a successful treatment plan * Improve your lifestyle habits * Evaluate new drug therapies * Find resources and outside support
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High Blood Pressure for Dummies®, 2nd Edition
by Alan L. Rubin, MD
High Blood Pressure For Dummies®, 2nd Edition
Published byWiley Publishing, Inc.111 River St.Hoboken, NJ 07030-5774www.wiley.com
Copyright © 2007 by Wiley Publishing, Inc., Indianapolis, Indiana
Published simultaneously in Canada
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Sections 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748-6011, fax (201) 748-6008, or online at http://www.wiley.com/go/permissions.
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LIMIT OF LIABILITY/DISCLAIMER OF WARRANTY: The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by physicians for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Readers should consult with a specialist where appropriate. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom.
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Library of Congress Control Number: 2007933275
ISBN: 978-0-470-13751-2
Manufactured in the United States of America
10 9 8 7 6 5 4 3
About the Author
Alan L. Rubin, MD has been managing and studying high blood pressure for three decades. He is a bestselling author whose previous books, Diabetes For Dummies,Diabetes Cookbook For Dummies, and Thyroid For Dummies, have been major successes. Letters of praise from numerous readers verify the important role that his books have played in their lives. The books have been translated into seven languages, and there are special editions for the United Kingdom, Canada, and Australia. His books provide the latest information on every aspect of their subject while being written in an easy-to-understand format that’s full of humor and wisdom.
Dr. Rubin has practiced endocrinology in San Francisco since 1973. He teaches doctors, medical students, and nonprofessionals through classes, lectures, and articles. He has been on numerous radio and television shows, answering questions about diabetes, thyroid disease, and high blood pressure. He serves as a consultant to many pharmaceutical companies and companies that make products for high blood pressure.
Dr. Rubin discusses many health issues in the numerous “Healthcasts” that he has recorded, which may be heard or downloaded at his Web site, www.drrubin.com.
Dedication
This book is dedicated to my mother, Edith. Besides the fact that I would not exist were it not for her (with a little help from my father, Julius), she always let me know in no uncertain terms that I could do anything I set my mind to. This is the fourth For Dummies book I have written, and that knowledge helped to get me through each one. Not only did she give me total verbal approval, but she backed it up by making sure I got a great undergraduate education at Brandeis University and medical education at New York University School of Medicine. Most important of all, she made sure I knew that I was loved.
Author’s Acknowledgments
Unlike a baby, this book has more than two parents. The people who worked on it are dedicated, bright, and cheerful, and they deserve a standing ovation. The original concept belongs to Kathy Nebenhaus, who was Lifestyles Publisher when the first edition began and is now Vice President of Professional and Trade Publishing at Wiley Books. Acquisitions Editor Michael Lewis was tremendously helpful throughout the writing of the book, smoothing all the rough edges that inevitably surround such a major project. Project Editor Georgette Beatty had a very clear idea of how the book would best serve its readers and offered many helpful suggestions to accomplish this. Copy Editor Pam Ruble made sure that my words, my sentences, and my paragraphs followed the rules of the English language. Last but definitely not least, Myron H. Weinberger, MD, was the technical editor for this book, utilizing his great knowledge of this subject to assure that my information is consistent with current medical practice. To all of them, I owe major thanks.
Publisher’s Acknowledgments
We’re proud of this book; please send us your comments through our Dummies online registration form located at www.dummies.com/register/.
Some of the people who helped bring this book to market include the following:
Acquisitions, Editorial, and Media Development
Project Editor: Georgette Beatty
(Previous Edition: Alissa Schwipps)
Acquisitions Editor: Michael Lewis
Copy Editor: Pam Ruble
(Previous Edition: Esmeralda St. Clair)
Technical Editor: Myron H. Weinberger, MD
Editorial Manager: Michelle Hacker
Editorial Assistants: Erin Calligan Mooney, Joe Niesen, Leeann Harney
Cover Photo: © Dynamic Graphics
Cartoons: Rich Tennant (www.the5thwave.com)
Composition Services
Project Coordinator: Jennifer Theriot
Layout and Graphics: Carl Byers, Joyce Haughey, Stephanie D. Jumper, Heather Ryan, Erin Zeltner
Special Art: Illustrations byKathryn Born, MA
Anniversary Logo Design: Richard Pacifico
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Indexer: Potomac Indexing, LLC
Publishing and Editorial for Consumer Dummies
Diane Graves Steele, Vice President and Publisher, Consumer Dummies
Joyce Pepple, Acquisitions Director, Consumer Dummies
Kristin A. Cocks, Product Development Director, Consumer Dummies
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Kelly Regan, Editorial Director, Travel
Publishing for Technology Dummies
Andy Cummings, Vice President and Publisher, Dummies Technology/General User
Composition Services
Gerry Fahey, Vice President of Production Services
Debbie Stailey, Director of Composition Services
Contents
Title
Introduction
About This Book
Conventions Used in This Book
What You’re Not to Read
Foolish Assumptions
How This Book Is Organized
Icons Used in This Book
Where to Go from Here
Part I : Understanding High Blood Pressure
Chapter 1: Introducing High Blood Pressure
Understanding Your Cardiovascular System
Measuring Your Pressure and Understanding the Measurement
Looking at the Risk Factors for High Blood Pressure
Focusing on the Consequences of High Blood Pressure
Lowering High Blood Pressure with Different Treatments
Protecting Children, Pregnant Women, and the Elderly
Staying Informed
Chapter 2: Detecting High Blood Pressure
Focusing on Blood Pressure Gauge Fundamentals
Taking Your Blood Pressure Correctly
Avoiding an Inaccurate Reading
Understanding the Numbers
Lowering Blood Pressure Too Much
Recognizing the White Coat Effect and Other Causes of Variable Readings
Taking Your Blood Pressure at Home
Taking an Ambulatory Reading
Getting the Right Assessment
Chapter 3: Determining Whether You’re at Risk
Clarifying What You Can’t Control
Preventing High Blood Pressure with Lifestyle Changes
Chapter 4: Dealing with Secondary High Blood Pressure
Finding Secondary High Blood Pressure Early
Evaluating the Role of Your Kidneys in Secondary High Blood Pressure
Discovering Hormone-Secreting Tumors That Elevate Blood Pressure
Recognizing a Genetic Disease as the Cause for High Blood Pressure
Checking Out Other Causes of Secondary High Blood Pressure
Part II : Considering the Medical Consequences
Chapter 5: Defending Your Heart
Introducing the Mighty Pump
Blocking Blood Flow to the Heart Muscle
Developing Heart Failure
Avoiding the Risk Factors
Chapter 6: Shielding Your Kidneys
Examining the Role of Your Kidneys
Damaging the Kidney
Managing Malignant High Blood Pressure
Coping with End-Stage Renal Disease
Chapter 7: Protecting Your Brain
Understanding the Causes of Brain Attacks
Avoiding Brain Attacks by Reducing High Blood Pressure
Surveying Additional Predisposing Conditions
Moving Fast When You See Symptoms of a Brain Attack
Capturing Brain Function on Film
Multiplying the Treatments for Brain Attacks
Making Your Way Back through Rehabilitation
Part III : Treating (Or Preventing) High Blood Pressure
Chapter 8: Developing a Successful Treatment Plan
Achieving Your Treatment Goal
Outlining Lifestyle Modifications
Chapter 9: Choosing Foods that Lower High Blood Pressure
DASHing Down Your Blood Pressure
Reducing Your Weight to Lower Blood Pressure
Trying Other Diets
Using Outside Help
Chapter 10: Keeping Salt Out of Your Diet
Making the Connection between Salt and High Blood Pressure
Proving the Salt-Blood Pressure Connection
Determining Whether You’re Salt Sensitive
Lowering Your Salt Intake
Chapter 11: Avoiding Tobacco, Alcohol, and Caffeine
Playing with Fire: Tobacco and High Blood Pressure
Relating Alcohol to High Blood Pressure
Getting High on Caffeine
Chapter 12: Lowering Blood Pressure with Exercise
Understanding the Benefits of Physical Activity
Preparing for Exercise
Knowing the Right Levels of Exercise
Exercising to Lose Weight
Exercising for Strength
Lowering Your Blood Pressure with Alternative Therapies
Chapter 13: Adding Drug Therapy
Establishing Drug Characteristics
Presenting the Classes of Drugs
Diuretics
Drugs That Act on the Nervous System
Vasodilators
Calcium Channel Blocking Agents
Angiotensin-Converting Enzyme Inhibitors
Angiotensin II Receptor Blockers
Choosing a Drug
Recognizing Drug Side Effects
Identifying Brand Names
Part IV : Taking Care of Special Populations
Chapter 14: Helping the Elderly
Evaluating Mental Ability
Assessing Blood Pressure
Improving Nutrition to Lower Blood Pressure
Changing the Lifestyle to Lower Blood Pressure
Taking Drugs to Lower Blood Pressure
Avoiding Dangerous Falls in Blood Pressure
Chapter 15: Handling High Blood Pressure in Children
Measuring Blood Pressure Correctly
Interpreting the Results of the Measurement
Considering the Causes of Elevated Blood Pressure
Pinpointing the Cause of Your Child’s Elevated Blood Pressure
Beginning Treatment with Lifestyle Changes
Advising Your Child about Strenuous Exercise
Using Drug Therapy
Chapter 16: Treating High Blood Pressure in Women
Understanding How a Woman’s Blood Pressure Responds to Pregnancy
Recognizing What Causes High Blood Pressure during Pregnancy
Dealing with High Blood Pressure after Delivery
Using Female Hormone Treatment in the Presence of High Blood Pressure
Part V : The Part of Tens
Chapter 17: Ten Simple Ways to Prevent or Reduce High Blood Pressure
Making Sure You Have High Blood Pressure
Determining Whether You Have Secondary High Blood Pressure
Adopting the DASH Diet
Losing Weight by Reducing Kilocalorie Intake
Reducing Salt in Your Diet
Giving Up Tobacco and Excess Alcohol
Starting an Exercise Program
Enhancing Your Treatment with Mind-Body Techniques
Using Drugs to Lower Blood Pressure
Avoiding Drugs That Raise Blood Pressure
Chapter 18: Ten (Or So) Myths about High Blood Pressure
High Blood Pressure Is an Inevitable Result of Aging
The Treatment Is Worse Than the Disease
You Must Restrict Your Life Because You Have High Blood Pressure
You Need Treatment Only for a High Diastolic Blood Pressure
High Blood Pressure Means Pills for the Rest of Your Life
You Can Give Up Treatment after a Heart or Brain Attack
You Can Avoid Exercise Because of High Blood Pressure
If You Feel Fine, You Can Skip Your Blood Pressure Medications
High Blood Pressure Can’t Be Controlled
Treatment Is Limited to Nervous, Anxious People
The Elderly Don’t Need to Be Treated
High Blood Pressure Is Less Dangerous in Women
Chapter 19: Ten New Discoveries about High Blood Pressure
Gauging the Effect of Lowering Blood Pressure
Realizing that Prehypertension Isn’t Benign
Predicting (And Preventing) High Blood Pressure
Predicting Adult High Blood Pressure by Measuring Childhood Blood Pressure
Determining Whether All Stroke Patients Have High Blood Pressure
Evaluating the Effect of Job Strain
Knowing Whether Alcohol Is Good or Bad if You Have High Blood Pressure
Using Gastric Bypass to Lower Weight and Blood Pressure
Checking Whether Your Blood Pressure Drug Affects Diabetes
Considering the Significance of the ALLHAT Study
Appendix: Resources for the Latest Information
National Heart, Lung, and Blood Institute
American Society of Hypertension
National Kidney Foundation
National Institute of Diabetes and Digestive and Kidney Diseases
American Heart and Stroke Associations
National Stroke Association
United States National Library of Medicine
The Mayo Clinic
Lifeclinic Health Management Systems
Other Sites
: Further Reading
Introduction
When I was growing up, my mother often used the pressure cooker to make dinner in a hurry. The idea was that under higher pressure, the food got done faster. High blood pressure in people is like that. If you permit yourself to have high blood pressure, you’ll get done faster too. What do I mean by done? I’m talking about all the medical complications like heart attack, stroke, and kidney failure — and the shortened life span.
High blood pressure, or hypertension, as doctors like to call it, affects more than 65 million adults in the United States and between 15 and 25 percent of the rest of the world, according to the World Health Organization. This means that when you’re in a room with four other adults, one of the four of you probably has high blood pressure. One major problem is that a third of the people who have high blood pressure don’t know it; the disease is generally free of symptoms until it’s had time to do damage (over ten or more years). And that’s why high blood pressure is often known as the silent killer.
One source of optimism is that more than half of the other two-thirds who know they have high blood pressure are now receiving adequate treatment (37 percent of all people with blood pressure, up from the 27 percent I noted in my first edition). This means 16 percent of those who know they have high blood pressure are still inadequately treated and another 15 percent of them are untreated. Specialists don’t know exactly why there are still so many untreated and inadequately treated, but we know this book wasn’t around when the last set of statistics was gathered.
Translating percentages into numbers, around 41 million Americans are at risk from the complications of high blood pressure because of inadequate treatment, no treatment, or lack of awareness that they have the disease. The situation in most other countries is even worse.
For decades, the crusade to bring this vast problem under control seemed to be making great progress because the occurrence of strokes seemed to be declining. Although that control deteriorated for a while as the frequency of strokes increased, now we’re headed in the right direction again. The trouble is that the overall number of adults and children with high blood pressure is increasing as the population ages and gets heavier. Major investments of time, energy, and money are needed to deal with the millions of people still not receiving adequate blood pressure control.
Like diabetes, high blood pressure is a lifestyle disease. It tends to occur in more affluent nations, where food is plentiful and hard manual labor is less common. This fact is both a problem and a challenge. On the one hand, affluent societies don’t want to give up their benefits. On the other, these more fortunate folks don’t want to destroy themselves.
In this book, you can find everything you need to know about high blood pressure — its causes, its consequences, and its treatment. You’ll soon realize that high blood pressure is easy to recognize and just as easy to treat. Sure, great drugs are available for treating high blood pressure, but drugs inevitably come with side effects, a price tag, and doctor visits. Far safer and less costly is a dedication on your part to prevention — changing the lifestyle habits that lead to high blood pressure. You can find all the necessary information on how to make these changes as you read the chapters of this book, especially Part III.
I always like to have a bottom line in my books, and this one is no exception. The bottom line is this: You never have to suffer any of the consequences of high blood pressure. You have it within your brain and within your body to prevent or successfully treat high blood pressure. Imagine if all the people with high blood pressure heeded this advice and got theirs under control. Each year about 275,000 lives would be saved and a much larger number would be spared a life of suffering from its consequences. And that’s just in the United States, not to mention the rest of the world!
If you’ve read any of my previous books, Diabetes For Dummies,Diabetes Cookbook For Dummies, or Thyroid For Dummies, you know that I use humor to get my point across, a technique that characterizes the For Dummies series. I want to emphasize that I’m not trying to trivialize anyone’s suffering by being comic about it. In fact, Norman Cousins, who wrote Anatomy of an Illness as Perceived by the Patient (Bantam Doubleday Dell), showed how he cured himself of an incurable disease using humor, and other writers have shown that humor has healing properties. A positive attitude — far more than a negative one — is conducive to a positive outcome.
About This Book
Since the last edition of this book, big changes have occurred in our understanding of high blood pressure and its treatment. The categories of high blood pressure have been reduced, and our recommendations about early treatment have changed as well. New drugs are available and old ones are off the market. A major Medicare drug plan, Part D, has confused millions of elderly Americans and changed how they pay for their drugs, including those for high blood pressure. These changes alone are more than enough justification for a new edition of High Blood Pressure For Dummies.
This edition has more emphasis on prevention. I also include new discoveries and myths about high blood pressure, so if you already have the first edition, know that I’ve packed this one with new stuff. (At the very least, buy it for your spouse — then borrow it so you stay up to date!)
But the main reason I wanted to write this update comes from an article that appears in the January 2007 issue of the journal Diabetes Care. The article points out that “despite the publication of increasingly aggressive guidelines for lowering blood pressure, [high blood pressure] remains substantially unimproved among diabetic patients.” In other words, the number of people with diabetes is increasing explosively, but they’re not achieving the level of blood pressure control that will prevent heart attacks, strokes, and amputations. I hope to change this outcome by helping the even larger population without diabetes to control their blood pressure.
Even with all the new information in this edition, no one expects you to read it cover to cover. Because the first few chapters are a general introduction to high blood pressure, you may want to start in Part I, but if you prefer to go right to the treatment or the special concerns of different populations, by all means, do so.
You’ll notice that each chapter stands alone — you don’t have to skip back to Chapter 3 to understand Chapter 12, and you don’t have to start at the beginning to understand the end. This book’s not a novel (though high blood pressure does make a pretty convincing villain!); it’s a tool to help you manage your high blood pressure.
Conventions Used in This Book
I’d love to use all nonscientific terms in this book, but if I did, you and your doctor would be speaking two different languages. So I use the scientific terms, but I explain them with simple language the first time you see them.
As for the synonymous terms high blood pressure and hypertension, I use the simpler term — high blood pressure — in all cases. This choice seems to be the trend, and I think it’s a good one.
Here are a few additional conventions that I use to guide you through this book:
Italics point out defined terms and emphasize certain words.
Boldface text highlights key words in bulleted lists and actions to take in numbered steps.
Monofont indicates Web addresses.
When this book was printed, some Web addresses may have needed to break across two lines of text. If that happened, rest assured that I haven’t put in any extra characters (such as hyphens) to indicate the break. So, when using one of these Web addresses, just type exactly what you see in this book, pretending that the line break doesn’t exist.
What You’re Not to Read
Throughout the book, shaded areas (sidebars) contain material that’s interesting but not essential to your understanding. If you don’t care to go so deeply into a subject, skip the sidebars. You’ll still understand everything else.
Foolish Assumptions
This book makes no assumptions about what you know. Key points are always marked clearly, and I explain all new terms. But if you already know a great deal, you’ll still find new information that adds to your knowledge. You probably fall into one of the following categories:
You’ve been diagnosed with high blood pressure but haven’t started treatment.
You’re being treated for high blood pressure but aren’t happy with the results.
You have a close friend or family member with high blood pressure.
How This Book Is Organized
The book is divided into six parts to help you find out all you want to know about high blood pressure.
Part I: Understanding High Blood Pressure
This part is really the introduction to the subject of high blood pressure. You discover the definition of high blood pressure, how to measure it correctly, and how to separate essential (that is, from unknown causes) high blood pressure from secondary high blood pressure (from another disease). You also discover the risk factors that increase your chances of developing high blood pressure.
Part II: Considering the Medical Consequences
High blood pressure can damage many parts of the body, but it’s especially dangerous to your heart, kidneys, and brain. In this part, you find out exactly how the damage occurs and how it affects these important organs.
Part III: Treating (Or Preventing) High Blood Pressure
In this part, I introduce everything we know about preventing high blood pressure and lowering high blood pressure after it develops. This condition is highly treatable, but first you need to know you have it and then you need to know what to do about it. High blood pressure treatment has definite goals that you must meet; you can’t just take a pill and assume you’re home free.
Part IV: Taking Care of Special Populations
Three groups of people (pregnant women, children, and the elderly) deserve special consideration because high blood pressure acts differently and has different consequences for them. This part addresses their problems.
Part V: The Part of Tens
Like many other major medical conditions, misinformation about high blood pressure is rampant. In the Part of Tens, I clear up some of it (not all, because it accumulates faster than I can address it!) and show you how to take simple measures to control your blood pressure.
Just to whet your appetite and convince you that the field’s advancing by leaps and bounds, I also provide ten new up-to-the-minute discoveries.
Appendix
New discoveries are going to make even this new edition obsolete after several years. For this reason, I want you to know the best resources for the latest information. More and more, this means the Internet. If you’re still not connected to the World Wide Web, get with it! It’s like having the world’s libraries at your fingertips.
Icons Used in This Book
Books in the For Dummies series feature icons that direct you toward information of particular interest or importance. Here’s an explanation of this book’s icons:
This icon signals information important enough to get the advice or assistance of your doctor.
This icon means the information is essential. Be sure you understand it.
This icon points out important information that can save you time and energy.
Take this icon seriously. It warns against potential problems (for example, mixing the wrong drugs).
Where to Go from Here
Where you go from here depends on your needs. Want to understand how high blood pressure develops? Head to Part I. If you or someone you know has a complication due to high blood pressure, skip to Part II. For help in treating high blood pressure (or preventing it entirely), turn to Part III. If you’re pregnant or have a child or parent with high blood pressure, Part IV is your next stop. For a bird’s-eye view of treatment, high blood pressure mythology, and the latest discoveries, check out Part V.
If you’ve experienced something funny in connection with your high blood pressure, my e-mail is [email protected]. By all means, let me know the situation. And if it’s appropriate, I’ll share it with the world in a future edition of this book.
In any case, as my mother used to say when she gave me a present, use this book in good health.
Part I
Understanding High Blood Pressure
In this part . . .
What are those two numbers your doctor gives you after measuring your blood pressure? In this part, I answer that question and describe the correct technique for taking blood pressure at home or in your doctor’s office. I also discuss who is most at risk for developing high blood pressure and what you need to know about secondary high blood pressure.
Chapter 1
Introducing High Blood Pressure
In This Chapter
Moving the blood through the cardiovascular system
Defining what determines high blood pressure and its consequences
Preventing high blood pressure and examining treatment options
Treating hypertension in special populations
Investigating up-to-date information
If you have high blood pressure, you’re in good (though not terribly healthy) company. Sixty-five million Americans (one in three adults) have high blood pressure. A list of the people in this country with high blood pressure would read like a Who’s Who. The problem is that, without proper treatment, many of those people will be on a list of Who Was Who sooner than they expect. The reason is that high blood pressure is the largest risk factor for heart attacks, brain attacks (strokes), and disease of the arteries. Don’t let yourself or a loved one get on that second list without a fight!
You can do so much about high blood pressure — you can prevent it, and if it’s already high, you can control it. But before you act, you need to know what high blood pressure is and how you measure it. You also need up-to-date information about its causes and its treatments. This book is your blood pressure companion, providing you with a solid understanding of your blood pressure: how it affects your body organ by organ, who is at risk, how you can prevent it, and how you can treat it after it’s properly diagnosed.
As you’ll discover, a few simple alterations to your lifestyle can prevent high blood pressure. My hope is that as you read this book, you’re spurred on to make these changes, not just now but in the future. High blood pressure is a chronic disease. You may lower your blood pressure in the short term, but the goal is long-term control to prevent other medical consequences (see Part II).
Take charge of your blood pressure now so you don’t suffer the fate of a health-food storeowner who posted a sign saying, “Closed due to illness.”
Understanding Your Cardiovascular System
To understand how elevated blood pressure affects your overall health, you need to understand the contribution of your heart and blood vessels. Your cardiovascular system — your heart, arteries, veins, capillaries, and the blood that fills them — nourishes your body and connects each part to every other part. The cardiovascular system carries
Food (carbohydrates, protein, fat, vitamins, and minerals) from the gastrointestinal tract to every organ in the body
Oxygen from the lungs and in the blood to distant organs
Waste, a normal product of your body’s metabolism
For example, the cardiovascular system carries carbon dioxide to the lungs and the other waste products to the liver and kidneys.
Pressure must exist to push the blood through the cardiovascular system. (Otherwise your blood would pool in your legs due to gravity when you stood up!) Just as your household water supply reaches a faucet because of pressure pushing it through the pipes, blood reaches your brain because pressure is allowing it to defy gravity and rise from the heart.
The heart muscle (the source of this pressure) squeezes out the blood forcefully so the blood not only defies gravity but also travels through the smallest passageways (the capillaries).
When essential body organs like the kidneys don’t receive enough pressure to function properly, they signal the heart to pump harder. But what’s good for the kidneys may not be good for the brain or the blood vessels themselves. And that’s when the consequences of high blood pressure occur (see Part II).
Measuring Your Pressure and Understanding the Measurement
When the nurse in your doctor’s office measures your blood pressure, she puts the contraption with a cuff, a gauge, and some Velcro around your arm. She pumps the cuff up with air, listens with the stethoscope, turns a screw to release the air pressure, and then writes down a couple of numbers in your chart. Then your doctor enters and says those numbers are “good” or “not so good.”
What’s that contraption? What’s the meaning of those numbers? Why do they seem to have such a profound effect on your life? Good questions. The contraption is a sphygmomanometer. When your doctor reads the numbers, say 135 over 85, the first number is the systolic blood pressure, and the second number is the diastolic blood pressure. In Chapter 2, I discuss what these two pressures measure, what their numbers mean, and why the results have such a serious effect on your life.
One of the most effective steps you can take in understanding your health is to measure your own blood pressure with a home monitoring device. I cover this topic extensively in Chapter 2 as well.
Looking at the Risk Factors for High Blood Pressure
Researchers have made tremendous efforts to understand the cause of high blood pressure and which populations are at risk of developing the disease. They know that numerous unalterable factors affect blood pressure (age, sex, ethnic background, and family history) and, to some extent, how these factors contribute to high blood pressure. But they still don’t know which of these factors is the most important. I discuss risk factors in detail in Chapter 3.
Certain changeable factors (such as diet, exercise routine, and stress) can also place you at risk of developing high blood pressure. Ask yourself the following questions:
Am I less active than I could be in my day-to-day routine?
Am I overweight?
Do I eat many salty foods?
Do I have a stressful lifestyle?
Do I smoke? Drink?
If you answer “Yes” to any one of these questions, then you’re at risk of developing high blood pressure. The more questions that you answer in the affirmative, the greater your odds are for developing high blood pressure. But if you decrease the stress in your life and keep a rein on these changeable factors, you can decrease the possibility of developing high blood pressure. I discuss high blood pressure prevention further in Chapter 3.
Research indicates that high blood pressure arises in two stages:
A primary cause such as the increased blood volume or constriction of the blood vessels: At this stage, high blood pressure is reversible.
A secondary result such as the blood vessels permanently thickening: At this stage, high blood pressure becomes irreversible without the use of potent drugs.
Ninety-five percent of high blood pressure is categorized essential high blood pressure (but primary high blood pressure would be a better term); the cause is unknown. The remaining cases are secondary high blood pressure; a specific disease is identified as the cause. When that disease is treated, the blood pressure usually returns to normal. I discuss some causes of secondary high blood pressure in Chapter 4.
Focusing on the Consequences of High Blood Pressure
If untreated, your high blood pressure can wreak havoc on your heart, kidneys, and brain.
Heart attacks or heart failure may be the major consequence for your heart (see Chapter 5).
Kidney failure may eliminate the filtering function of your kidneys (see Chapter 6).
A brain attack (stroke) may destroy important brain tissue and the movements it controls in the body (see Chapter 7).
Deaths due to these conditions do occur, but the great majority of people who have serious conditions from high blood pressure suffer debilitating illness. Of those who survive a massive heart attack, kidney failure, or brain attack, many require the care of other people for the rest of their lives.
Most of this sickness and death due to high blood pressure is preventable, and Part III gives you all the tools you need to minimize those risks. The process may cost you time and resources, but the freedom from illness and the prospect of a longer life are well worth the effort.
Lowering High Blood Pressure with Different Treatments
Treating high blood pressure (or preventing it entirely) involves all the tools I discuss in Part III. Get started with the following guidelines and check out Chapter 8 for an outline of a successful plan:
Connecting cardiac output and peripheral resistance
An increase in blood volume (the amount of blood in the blood vessels) creates an increase in cardiac output (the amount of blood that the heart squeezes out with each heartbeat). For example, an increase in blood volume may result from salt intake, which then causes water retention. Because the body doesn’t permit the cardiac output to remain elevated, it lowers the output by increasing the peripheral resistance (the blood vessels constrict, reducing the amount of blood flowing through the tissues). This rise in peripheral resistance leads to increased blood pressure.
A minor alteration in body chemistry may be enough to cause persistent high blood pressure. For example, a slight increase in angiotensin II (a hormone produced when the kidney detects a low blood pressure) may cause thickening and narrowing of the blood vessels that leads to sustained high blood pressure. Other hormones, called growth factors, can lead to narrow arteries and increased peripheral resistance as well.
On the other hand, nitric oxide (a chemical made in the endothelial cells that line the inside of the blood vessels) is the most potent cause of widening blood vessels. If anything blocks the production of nitric oxide, the blood pressure rises. And because nitric oxide is reduced in essential (unknown causes) high blood pressure, this reduction may be an additional cause of increased peripheral resistance.
1.Switch from a diet that promotes high blood pressure to a diet that lowers blood pressure (see Chapters 9 and 10).
2.Eliminate the poisons like tobacco, excessive alcohol, and some caffeine (see Chapter 11).
3.Add regular exercise (see Chapter 12).
Just these three steps may be enough to lower your pressure to normal. If not, you have the option of adding one or more drugs (see Chapter 13). Note: Drugs aren’t substitutes; they’re additions to lifestyle changes.
Protecting Children, Pregnant Women, and the Elderly
Special factors must be considered when evaluating and treating high blood pressure in children, pregnant women, and the elderly:
The elderly (see Chapter 14) usually have other complicating diseases, are taking many other medications, and may have special dietary requirements.
Children (see Chapter 15) are growing, maturing, and subject to the problems of relating to their peers; kids certainly don’t want to be sick or even labeled as sick. Diagnosis and treatment of high blood pressure in children is challenging to say the least.
Throughout pregnancy, a woman is making new hormones while her body undergoes major changes. The high blood pressure that occasionally develops as a direct complication of pregnancy can harm both a mother and her unborn baby (see Chapter 16).
Staying Informed
The Part of Tens chapters in this book give you helpful tips on reducing your blood pressure and debunking blood pressure myths.
In Chapter 17, you can find ten simple ways to prevent or reduce blood pressure. Individually, they each help to lower the pressure by a few millimeters of mercury. But taken together, they help you avoid the medical complications of high blood pressure. You can add them to your lifestyle one at a time or several at once — if you’re up to it.
In Chapter 18 I take on ten or so myths about high blood pressure and its treatment that are the most popular and the most detrimental to your health. (If you know of a myth that you think is damaging to many people with high blood pressure, by all means e-mail me at [email protected] and let me know.)
As in all fields of medicine that affect large numbers of people, the research on high blood pressure is enormous and ongoing. Chapter 19 introduces some of the latest information that may save your life.
Finally, the book has a publication deadline date. Discoveries made after that date can’t be in this edition (but will be in a future one). To keep up with future developments, the appendix provides the best places to look for new information. Some of that info is also on my Web site (www.drrubin.com) or linked to it (click on the Web addresses in the high blood pressure section).
All this material comes to you at a bargain price. As the sign on the farmer’s gate reads: “The farmer allows walkers to cross the field for free but the bull charges.”
Chapter 2
Detecting High Blood Pressure
In This Chapter
Getting an accurate reading
Comprehending the numbers
Assessing blood pressure at home
Finding the cause and getting a thorough evaluation
Measuring blood pressure correctly is key to diagnosing high blood pressure. You or another trained individual can take that measurement. This chapter shows you how to take that measurement because everything that follows will depend on its accuracy. If you notice that your healthcare provider isn’t measuring your blood pressure accurately, don’t hesitate to tell him. It’s your life, your health, and your future that I’m talking about.
Much goes into an accurate blood pressure measurement. It requires a properly working instrument, a patient who is physically and mentally prepared for the measurement, and someone who knows how to measure blood pressure properly. And after it’s done properly, it needs to be repeated to be sure of the numbers.
Following a diagnosis of high blood pressure, the evaluation process determines whether there is a secondary cause for the high blood pressure (that is, a definite disease that brings it on; see Chapter 4). I provide that proper evaluation at the end of this chapter so you can confirm that no stone is left unturned.
Focusing on Blood Pressure Gauge Fundamentals
The instrument that measures your blood pressure is a sphygmomanometer (pronounced sfig-mo-ma-nom-et-er — so why don’t they spell it that way?). However, I think blood pressure gauge is clearer and easier to pronounce. I hope you don’t mind if I call it that from now on.
The blood pressure gauge consists of a cuff that goes around your arm above the elbow. The bladder is the part of the cuff that fills with air. A tube connects the cuff to a column of mercury (that looks like an outdoor thermometer) at one end and a rubber bulb at the other. When the rubber bulb is squeezed, the air pressure in this closed system forces the column of mercury to rise as the bladder fills with air. Numbers along the column of mercury indicate how much pressure is present.
The mercury blood pressure gauge is the gold standard for blood pressure measurement. Very little can cause this device to malfunction because the column of mercury is the only moving part. Note: The mercury blood pressure gauge is becoming less common because mercury is toxic and has the potential to contaminate the environment.
An alternative blood pressure gauge that’s rising in popularity is the aneroid blood pressure gauge — a spring-gauge model that uses air pressure to move a needle on a scale. Each degree the needle moves represents one millimeter of mercury. This gauge is inexpensive and easier to transport than the mercury blood pressure gauge. Figure 2-1 shows both mercury and aneroid blood pressure gauges.
Figure 2-1: Mercury and aneroid blood pressure gauges.
Both models require a certain degree of upkeep.
Mercury blood pressure gauge: Check periodically to be sure the top of the column is at zero before pressure is added and that the mercury moves freely.
Aneroid blood pressure gauge: Calibrate and validate it on a regular basis at your doctor’s office (at least every six months) by attaching it to the pressure system of a mercury manometer. The gauges should read the same pressure when air is introduced.
Unlike the mercury gauge, the aneroid gauge has many parts that can wear down after a period of time. But according to a Mayo Clinic study in the March 2001 Archives of Internal Medicine, “Well-maintained aneroid devices are an accurate and useful alternative [to mercury devices].”
Taking Your Blood Pressure Correctly
Your blood pressure can be taken with a mercury blood pressure gauge, an aneroid manometer, or an electronic device for measuring the blood pressure, so long as the device has been recently calibrated and validated. (For more on the differences between mercury and aneroid blood pressure gauges, see the previous section. I discuss electronic gauges in the “Taking Your Blood Pressure at Home” section later in this chapter.)
Don’t use blood pressure gauges in supermarkets or pharmacies; they’re rarely well maintained.
Follow these few simple rules to get an accurate reading:
Don’t smoke or drink alcohol or coffee within 15 minutes of a blood pressure measurement.
The length of the bladder should be 80 percent of the circumference of the upper arm. This means that heavy or very muscular people with thick arms need a larger bladder, while children need a smaller bladder.
Your posture and actions are important:
• Sit with your back and arm supported; your supported elbow should be at about the level of your heart.
• Keep your legs from dangling.
• Rest for several minutes in that position before the measurement.
• Remain silent during the measurement.
To take the reading, follow these numbered steps:
1.Place the cuff over your bare arm, leaving the cuff’s lower edge about an inch above the bend of the elbow. Close the cuff around the arm, and then stick the Velcro together at the ends of the cuff.
2.Place the earpieces of the stethoscope in your ears and place the stethoscope bell at the side of the cuff away from your heart and over the brachial artery (in the inner area of your bent elbow; see Figure 2-2).
The stethoscope is a convenient device to listen for sounds at various body sites; its bell is the point of contact. The two earpieces at the other end of the stethoscope enable the individual taking the measurement to hear the steady thump in the brachial artery.
3.Tighten the screw at the side of the gauge’s rubber bulb and then squeeze the bulb. Air is pumped into the bulb, and the cuff expands until the blood flow through your brachial artery stops.
The pressure in the cuff rapidly increases to 30 millimeters of mercury above that point. No sound can be heard in the stethoscope and no pulse can be felt in the wrist.
4.Turn the screw again, this time loosening the valve in the bulb and lessening the air pressure. Pressure decreases at the rate of 2 millimeters per second. Blood begins to flow through the artery again.
5.When you hear the first sound in the stethoscope, note the number beside the top of the mercury column. This first sound in the stethoscope is the systolic blood pressure (SBP), the first number in the blood pressure reading. (See the “Understanding the Numbers” section later in this chapter.)
6.When the sound ceases, note the number beside the top of the mercury column. At this point, the cuff decompresses and blood flows freely in the artery.This is the diastolic blood pressure (DBP), the second number in the blood pressure reading. (See the “Understanding the Numbers” section later in this chapter.)
7.Record the SBP and the DBP numbers immediately (don’t depend on memory) and note which arm (right or left) you used.
8.If the first measurement is above 140 systolic or 90 diastolic, take another measurement in the same arm after 60 seconds. Then measure the other arm.
In the future, use the arm that has the higher blood pressure (although they’re often the same). The average of the two measurements in the arm that supplies the higher readings is the correct blood pressure.
Figure 2-2: The correct position of the patient, the blood pressure cuff, and the stethoscope.
Also measure the blood pressure while the patient is in a standing position, especially if the patient experiences lightheadedness on standing. If a fall of 20 or more millimeters of mercury occurs in systolic blood pressure or 10 or more in diastolic blood pressure, the patient has orthostatic hypotension, an abnormally great fall in blood pressure with standing.
If your blood pressure isn’t normal, don’t start any treatment on the basis of one office visit. This is treatment for life and should begin only after confirmation at a second and even a third office visit. As I show in the next section, your blood pressure in your doctor’s office may not be an accurate assessment of your blood pressure despite entirely correct techniques. Note: A blood pressure reading greater than 180/120 millimeters of mercury (mm Hg, the chemical notation for mercury) requires immediate treatment.
Avoiding an Inaccurate Reading
Because your reading can mean the difference between a lifetime of taking pills and freedom from such a task, you want to avoid the many problems that may lead to an inaccurate blood pressure reading. Such problems can arise at every stage of taking a measurement as a result of equipment failures, faulty observation, or patient difficulties. Remember the points in the next two sections whenever your blood pressure is measured.
Steering clear of equipment problems
A faulty stethoscope can lead to an inaccurate blood pressure reading. To get a good reading, make sure
The earpieces aren’t plugged and sound can be heard clearly. If the earpieces are broken, replace them.
The bell of the stethoscope (the part that’s placed on the arm) is not cracked.
The stethoscope includes an acceptable length of tubing (usually 22 to 28 inches) between the bell and the earpieces. Tubing that’s too long may diminish the sound so it can’t be heard.
To ensure an accurate reading when using a mercury blood pressure gauge, make sure
The top of the column of mercury registers at zero when the blood pressure gauge has no air pressure.
The column of mercury is vertical.
The tubing is clean and unobstructed. If you disconnect the tubing, you should be able to blow air through it. If the air doesn’t flow freely, get new tubing.
The size of the cuff (bladder) is correct.
• A cuff that’s too narrow for the patient’s arm gives a high reading.
• A cuff that’s too wide for the patient’s arm gives a low reading.
Sidestepping faulty observation and patient problems
To avoid faulty observation, make sure
The person taking your blood pressure doesn’t allow a preconceived notion of your blood pressure to influence the reading.
The person who measures your blood pressure writes down your reading rather than memorizing it. Poor memory often leads to an inaccurate charting of the numbers.
To avoid patient problems and ensure an accurate blood pressure reading, make sure
The blood pressure cuff is at heart level. If the cuff is above heart level, the reading may be inaccurately low. If the cuff is below heart level, the reading may be inaccurately high.
The patient’s back is supported and his legs aren’t dangling. He should be in a chair, not on an exam table.
If the patient has a large, muscular arm (that may cause an inaccurately high reading), you use a blood pressure gauge with a cuff that’s large enough to accommodate the arm.
If the patient has calcified arteries (common among the elderly) that are hard to compress, you use another method of blood pressure measurement like direct insertion of a blood pressure gauge into the artery.
Whew! You have quite a few factors to keep in mind while taking your blood pressure. After you have an accurate reading, it’s time to process the information. Read on for more about the meaning of those numbers.
Understanding the Numbers
When your doctor says, “Your blood pressure is 135 over 85,” what do the numbers really mean?
The first number is the systolic blood pressure (SBP), the amount of pressure in your arteries as the heart pumps. Systole is the rhythmic contraction of your heart muscle when it’s expelling blood from your left ventricle — the large chamber on the left side of your heart. The aortic valve sits between that chamber and your aorta, the large artery that takes blood away from the heart to the rest of the body. During systole, the aortic valve is open and blood flows freely to the rest of your body.
The second number is the diastolic blood pressure (DBP), the lowest point of blood pressure. After your heart empties the blood from the ventricle, the aortic valve shuts to prevent blood from returning into the heart from the rest of your body. Your heart muscle relaxes and the ventricle expands as blood from the lungs fills it up. At that moment, the blood pressure rapidly falls within your arteries until it reaches its DBP, its lowest point. Before the pressure falls further, the ventricle contracts again and the blood pressure starts to rise back up to the systolic level.
With this information and the guidance in the following sections, you can determine whether your numbers are normal or high.
