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Harvard Commentaries
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Harvard Commentaries
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Man to Man Man to Man
 

Men -- Respect Your Blood Pressure


January 20, 2013


Most men don't give high blood pressure, or hypertension, the respect it deserves. It's as important as cholesterol, but most people don't know they have hypertension until they've had a stroke or heart attack. Treatment prevents problems, but most patients are not meeting their goals.

New research has changed the way doctors think about hypertension. It's time men learned about blood pressure, too.

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What is Blood Pressure?

Blood pressure is the force that propels your blood through your arteries. Since blood pressure can swing up and down, any one reading is just a snapshot of your usual pressure. When it comes to predicting complications, your average pressure is more important than your peaks and valleys. But in most cases, one reading is all you'll get. That's good enough, if it's done right.

Quick Tip
To get an accurate blood pressure reading:
  • Avoid caffeine, nicotine, and exercise before your reading.
  • Stress can also boost blood pressure, so try to be relaxed.
  • Your doctor should always repeat your reading if it's high, often by leaving the cuff on your arm while you rest for several minutes before a second check.
  • If your pressure is still high, your doctor may arrange to have a nurse or technician measure it at home or work.
  • Learn to check your own blood pressure with an automated digital arm cuff; it's a good way to tell stress from true hypertension. It can also help track your treatment.

Nosebleeds, mental tension, headaches and facial flushing don't indicate hypertension. Many men who look and feel perfectly well have high blood pressures. The only way to know is to have your blood pressure checked.

You should have your blood pressure taken with every annual check-up. If it's borderline or high, you may need it checked more often, and anti-hypertensive therapy always calls for close monitoring. It's also good to ask for a blood pressure check whenever you go to a doctor, even if the problem is a sore throat or rash. Don't pass a health fair without rolling up your sleeve and putting out your arm.

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What's Normal?

There is no "normal" pressure. The higher your pressure, the higher your risk. For many years, doctors overlooked systolic readings (the top number), but they now know both numbers count. And the risk of heart attacks and strokes begins to rise with systolic pressures above 115 and diastolic pressures the bottom number) above 75, readings that were long considered "low normal."

Based on new research, a major report called the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) revised our blood pressure standards in 2003 and established the new diagnosis of prehypertension, which increases the risk of strokes and heart attacks. The table below shows the new standards for people 18 years and older.

Classification

Systolic BP

Diastolic BP

Normal
Below 120 and
Below 80
Prehypertension
120 – 139 or
80 - 89
Stage 1 Hypertension
140 - 159 or
90 - 99
Stage 2 Hypertension
160 and higher or
100 and higher

If your systolic and diastolic pressures place you in different categories, use the number that puts you in the higher classification; for example, if your reading is 114/84, you have prehypertension. If your two arms give different readings, use the higher one.

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The Burden of Hypertension

About 72 million Americans have hypertension and about 69 million have prehypertension. Both conditions are more prevalent in men than women. That means more than half of all American men have unhealthy blood pressures.

The American Heart Association calls hypertension "the silent killer." High blood pressure means the heart is working too hard. This puts extra stress on the arteries with every beat. Hypertension won't make you look or feel ill until your circulation is damaged. It may take years, but it can cause strokes, heart attacks, congestive heart failure, kidney failure, visual loss, memory loss, erectile dysfunction and more.

About 54,000 Americans die from hypertension each year. It clearly deserves more research, better treatment and lots of respect.

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The Benefit of Lowering Blood Pressure

By lowering your systolic pressure by 10 points or your diastolic pressure by 5 points, you reduce your risk of stroke by 30% to 40% and your risk of heart attack by 15% to 25%. The average, healthy individual should aim for blood pressure reading below 140/90. The goal for a person with diabetes, chronic kidney disease, heart disease or other forms of atherosclerosis is 130/80 or lower. People with these conditions are at high risk and need to maintain a lower BP.

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Lower Blood Pressure With Lifestyle Changes

These lifestyle changes are the basis of every program to lower blood pressure. Healthy men should also follow them.

  • Diet. You can lower your blood pressure by following the Dietary Approaches to Stop Hypertension (DASH) eating plan from the National Heart, Lung, and Blood Institute. It limits dietary sodium to 2,300 mg a day or less for healthy young men and to 1,500 mg a day or less for middle-aged men and people with hypertension. DASH also suggests limiting how much saturated fat and cholesterol you eat, along with processed foods. It calls for eating lots of fruits, vegetables, whole grains, and low- or nonfat dairy products.
  • Exercise. Regular exercise is important for your blood pressure and your overall health. You don't have to spend long hours in a gym. In fact, as few as 30 minutes of moderate exercise, such as brisk walking, will help a lot, as long as you do it nearly every day.
  • Weight Control. It's one of the best ways to reduce blood pressure is to lose weight. It's also one of the hardest. Still, you can win at the losing game with a low-calorie diet and regular exercise.
  • Moderate Alcohol Use. Small amounts of alcohol won't raise your blood pressure, but heavier drinking will. If you choose to drink, limit yourself to 1 to 2 drinks day ( Five ounces of wine, 12 ounces of beer, or 1½ ounces of spirits counts as one drink.)
  • Stress Control. Mental tension and hypertension are not the same, and plenty of laid-back folks have high blood pressure. But if you're under stress, winding down will protect your health.

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When Medication Is Necessary

When lifestyle changes aren't enough to bring your blood pressure down, there are many classes of medication can lower pressure. Therapy must always fit the individual. The goal is to control blood pressure and protect the circulation with the fewest side effects. The JNC7 report recommends five classes of drugs, which are discussed below. Patients with special needs, such as diabetes, heart disease and kidney disease require special consideration.

It often takes two or more drugs to do the job. Patients who need to lower their pressures by 20/10 or more will often need several medications. Many combination drugs are available; they make double therapy more convenient, but they're usually more expensive than individual pills.

Your doctor should monitor you carefully, checking for side effects as well as for blood pressure control. Since most blood pressure medications take time to work, doctors will generally adjust therapy about once a month. Once you reach your goal, you can see your doctor less often. You can help by monitoring your pressure at home, Always report side effects to your doctor as they occur. Patients with urgent medical problems need more intensive therapy.

Here are the major drug categories recommended by the JNC 7:

  • Thiazide diuretics. The thiazides have been a top choice to treat hypertension for many years. Although very effective in low doses for most people, other drugs classes are equally effective. And for some a thiazide might be an add-on drug rather than the first choice. The thiazides flush sodium into the urine. Frequent urination, dehydration, and low potassium levels are among the side effects. Less common problems include erectile dysfunction, elevated blood sugar levels, gout and sensitivity to the sun. They are particularly useful in patients with congestive heart failure and previous strokes. They are less useful in patients with kidney disease and generally should be avoided in people who have gout.

 

  • Angiotensin converting enzyme inhibitors (ACEIs). ACEIs prevent the body from producing a protein that narrows blood vessels and retains salt. ACEIs rival thiazides in their ability to prevent complications. ACEIs are particularly helpful for patients with diabetes, congestive heart failure, recent heart attacks or major cardiac risk factors, previous strokes and various forms of kidney disease. Coughing is the most frequent side effect. Other problems may include high potassium levels, abnormal kidney function, dizziness and impaired taste and smell.

 

  • Angiotensin receptor blockers (ARBs). The ARBs are similar to the ACEIs but they don’t cause coughing. Many experts recommend an ARB when a cough or allergic reaction prevents the use of an ACEI.

 

  • Calcium channel blockers (CCBs). CCBs widen blood vessels. Some also slow the heart rate. CCBs are particularly effective in African-Americans and people with angina. Potential side effects include dizziness, fluid retention, constipation, flushing, headache and slow heart rates.

 

  • Beta-blockers. These old standbys were rated first-line medication for hypertension for a long time. But recent studies have raised doubts about them. Still, they can be very useful as add-on medications, and they have advantages for some patients with recent heart attacks, angina, and (with special care) congestive heart failure. Beta-blockers widen blood vessels, relax the heart muscle and slow the heart rate by blocking some actions of adrenaline. Potential side effects include an excessive slowing of the heart, wheezing, fatigue, cold extremities and sleep disturbances. Depression and sexual dysfunction are less common than once believed.

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Respect Your Blood Pressure

Don't turn your back on hypertension. Have your pressure checked regularly and keep a record of the results. Adopt the healthful lifestyle that will keep your pressure as low as possible. And if that's not enough to bring you to your goal, work with your doctor to build a medication program that will succeed. You'll have to take your pills faithfully, stay alert for side effects, and report to your doctor on schedule. It takes time and patience, but the reward is huge: good health.

Finally, remember that while controlling your blood pressure is essential, it's not enough to insure good health. Rather, it should be part of an overall program to prevent premature death and disability. To be well, eat right, exercise properly, avoid tobacco, drink responsibly, keep your weight down, reduce stress, be sure your cholesterol and blood sugar levels are where they should be, and — of course — control your blood pressure.

Harvey B. Simon, M.D. is an Associate Professor of Medicine at Harvard Medical School and a member of the Health Sciences Technology Faculty at Massachusetts Institute of Technology. He is the founding editor of the Harvard Men's Health Watch newsletter and author of six consumer health books, including The Harvard Medical School Guide to Men's Health (Simon and Schuster, 2002) and The No Sweat Exercise Plan, Lose Weight, Get Healthy and Live Longer (McGraw-Hill, 2006). Dr. Simon practices at the Massachusetts General Hospital; he received the London Prize for Excellence in Teaching from Harvard and MIT.

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