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