Diplomate, Board Certification of Emergency Medicine
In answer to a question, there is news on hypertension. A new
report from the Joint National Committee on High Blood
Pressure in the USA appeared in the May 21 issue of the
Journal of the American Medical Association. There
were some interesting changes:
High blood pressure is silent. People feel well with it,
despite it. Nevertheless it is common -- one out of four
adults in the USA has it -- and it is dangerous. Blood
vessels become harder with age and the constant pounding of
high blood pressure can cause them to fill with deposits and
patches. The result is heart disease, heart attack, stroke
and/or kidney failure.
We used to think that the lower number was more important,
and that any blood pressure under 140/90 was safe. Now we say
that in older adults, the upper number is more important --
and harder to treat. We also say that if your blood pressure
is more than 120/80 you are in "pre-hypertension" and need to
do lifestyle modifications. These include lowering salt
intake, eating more fruits and vegetables, losing weight, and
exercising. People over fifty should have medical supervision
before starting a vigorous exercise program. Alcohol intake
should be lessened and everyone should stop smoking -- none
of this is new to my readers.
High blood pressure can have a curable cause, and in selected
patients an aggressive work up should be done. But in most,
the cause is unknown. Many drugs can help lower the blood
pressure, but a combination of low doses of two drugs is the
best strategy and one should be a diuretic, which is a drug
that causes more urine output. Different age, gender, race
and medical history may point to using certain drugs. Be in
touch with your doctor. If you are diabetic or have kidney
disease, you need to be even more aggressive.
Our correspondent asks some more relevant questions. There is
an occurrence called white coat hypertension, where the blood
pressure is only elevated when in the doctor's office. A
twenty-four hour monitoring of blood pressure can tell us the
truth. Careful on home blood pressure monitors -- many are
inaccurate or need frequent calibration.
Garlic does seem to work. You must eat one clove a day, but
much of the effect is destroyed by stomach acid, so coated
formulations are probably best. No evidence that onion
helps.
Coffee does transiently raise blood pressure and pulse. It
is, after all, an addiction, and I feel one should be careful
before becoming addicted to this. Write me in care of the
Yated.
A message from GlaxoSmithKline, sponsor of this
column. Since smoking and diabetes increase your cardiac
risk and make high blood pressure dangerous, you must
consider controlling these. Zyban helps in smoking and we
have mentioned this before. Avandia is the most modern and
effective treatment for type II diabetes. It can save your
life.
