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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Centers
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Go
Red for Women Campaign, AHA
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National
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Society
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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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