What is blood pressure?

Blood pressure is the force of blood pushing against your blood vessels. Blood pressure is always given as two numbers. The numbers are usually written one above or before the other, for example, your doctor may tell you your blood pressure is 130/70. The first number or the upper number is your systolic pressure. The second number or the lower number is your diastolic pressures.

What is a normal blood pressure?

The most recent medical guidelines suggest that our blood pressure should normally run below 120 for a systolic pressure and less that 80 for a diastolic pressure. Most people probably think that 120/80 is a normal blood pressure. According to our old guidelines, that was considered a good blood pressure. Under the most recent, national guidelines, a blood pressure of 120/80 now falls in the category of pre-hypertension. It is important that health care recognize and aggressively treat pre-hypertension to prevent the multitude of complications that can occur if this disorder is allowed to progress.

Is high blood pressure really a big deal?

YES! When your blood pressure is high, your heart has to work harder than it should to pump blood to all parts of the body. Another name for high blood pressure of course is hypertension. High blood pressure is called the “silent killer” because most people feel healthy and don’t even know that they have it. If it is not treated, high blood pressure can cause: stroke, heart attack, kidney problems, eye problems and even death. Anyone can develop high blood pressure. We are especially concerned African Americans because they are at higher risk for this serious disease than any other race or ethnic group. High blood pressure tends to be more common, happens at an earlier age, and is more severe for many African Americans. Because of hypertension and the related disease states, heart attack and strokes, we see that the life expectancy for African Americans is 6 years shorter than for people of other racial groups. African American women have a 35% higher death rate from cardiovascular disease and a 70% higher death rate from strokes than white women. The good news is that high blood pressure can be controlled—and better yet, it can be prevented!

How Can You Prevent High Blood Pressure?

Everyone--regardless of race, age, sex, or heredity--can help lower their chance of developing high blood pressure. All we need to do is follow a few basic rules. We should:

1) Maintain a healthy weight and lose weight if you are overweight,
2) Be more physically active,
3) Choose foods lower in salt and sodium, and
4) If you drink alcoholic beverages, do so in moderation.

These rules are also recommended for treating high blood pressure, although medicine is often added as part of the treatment. It is far better to keep your blood pressure from getting high in the first place. Another important measure for your health is to not smoke: while cigarette smoking is not directly related to high blood pressure, it increases your risk of heart attack and stroke.

Can you tell us a little more about the four rules and how they help prevent high blood pressure?

Certainly, one of the most important rules we should consider is how we can maintain a healthy weight. As your body weight increases, your blood pressure rises. In fact, being overweight can make you 2 to 6 times more likely to develop high blood pressure than if you are at your desirable weight. Keeping your weight in the desirable range is not only important to prevent high blood pressure but also for your overall health and well being. It's not just how much you weigh that's important: it also matters where your body stores extra fat. Your shape is inherited from your parents just like the color of your eyes or hair. Some people tend to gain weight around their belly; others, around the hips and thighs. "Apple- shaped" people who have a pot belly (that is, extra fat at the waist) appear to have higher health risks than "pear-shaped" people with heavy hips and thighs.

No matter where the extra weight is, you can reduce your risk of high blood pressure by losing weight. Even small amounts of weight loss can make a big difference in helping to prevent high blood pressure. Losing weight, if you are overweight and already have high blood pressure, can also help lower your pressure.

To lose weight, you need to eat fewer calories than you burn. But don't go on a crash diet to see how quickly you can lose those pounds. The healthiest and longest-lasting weight loss happens when you do it slowly, losing 1/2 to 1 pound a week.

To lose weight, it's not just the type of foods you eat that's important, but also the amount. To take in fewer calories, you need to limit your portion sizes. Try especially to take smaller helpings of high calorie foods like high fat meats and cheeses.

Do you know any other helpful strategies?

Here's a good tip to help control or change your eating habits: keep track of what you eat, when you eat, and why, by writing it down. Note whether you snack on high fat foods in front of the television, or if you skip breakfast and then eat a large lunch. Once you see your habits, you can set goals for yourself: cut back on TV snacks and, when you do snack, have fresh fruit, unsalted air-popped popcorn, or unsalted pretzels. If there's no time for breakfast at home, take a low fat muffin, or cereal with you to eat at work. Changing your behavior will help you change your weight for the better. So essentially, a successful weight loss plan must include a new, healthier attitude toward eating.

What should we know about physical activity?

Obviously there's more to weight loss than just eating less. Another important ingredient is increasing physical activity, which burns calories. Cutting down on fat and calories combined with regular physical activity can help you lose more weight and keep it off longer than either way by itself. A lot of people feel that they don’t have time for an exercise program or they may think of exercise as tedious and boring. Alternatively, some folks think that you have to exercise at the level of a professional athlete to gain any benefit. But these are all negative thoughts that keep us from moving toward a healthy way of living. A very inexpensive and easy exercise that most everyone can perform is walking. Start with something as simple as walking away from your front door for 10 minutes and then walk back home. That’s a 20 minutes exercise program. We need to exercise 30 to 60 minutes at a moderate level each day to maintain our current body weight. This could be walking at a moderate pace, working in your garden or dancing. In order to loose weight, we actually need to exercise at a moderate to intense level for about 90 minutes a day. I often hear people say that their eating habits haven’t changed over the past years but they notice that, as they get older, that their weight has slowly increased. This happens because as we get older we tend to slow down in terms of our activity level but, unfortunately, we continue to take in about the same amount of calories.

Are there other reasons for being physically active?

Being physically active can reduce your risk for heart disease, help lower your total cholesterol level and raise HDL-cholesterol - the "good" cholesterol. More importantly, exercise will help lower high blood pressure. People who are physically active have a lower risk of getting high blood pressure than people who are not active. You don't have to be a marathon runner to benefit from physical activity. Even light activities, if done daily, can help lower your risk of heart disease. Alternatively, you can just include more physical activity in your daily routine. For example, use the stairs instead of the elevator or you could park at the far end of the parking lot when you go to work or the store. If you can fit physical activity into your daily routine, even in small amounts you can substantially improve your health profile. Most people don't need to see a doctor before they start exercising, since a gradual, sensible exercise program has few health risks. But if you have a health problem like high blood pressure; if you have pains or pressure in the chest or shoulder area; if you tend to feel dizzy or faint; if you get very breathless after a mild workout; or are middle-age or older and have not been active, and you are planning a vigorous exercise program, you should check with your health care provider first. Most everyone can participate in some sort of exercise program. If you have not been in the habit of exercising, you must start slow and build your way up. Even young people without physical conditions can cause themselves harm by starting a sudden, strenuous exercise program.

I think that everyone can understand the importance of eating well and exercising, can you explain the importance of eating foods that are low in salt?

Americans eat more salt than we need. And guess what? We also have higher rates of high blood pressure than people in other countries who eat less salt. Often, if people with high blood pressure cut back on salt, their blood pressure falls. Keep in mind, when you see sodium or sodium chloride on a food label, this is the same thing as salt. Cutting back on salt / sodium also prevents blood pressure from rising. Some people like African-Americans and the elderly are more affected by salt / sodium than others. Since there's really no practical way to predict exactly who will be affected by sodium, it makes sense to limit intake of salt and sodium to help prevent high blood pressure.

All Americans, especially people with high blood pressure, should eat no more than about 6 grams of salt a day. That's about 1 teaspoon of table salt. But remember, in addition to the salt we add to our food there is also salt in many types of prepared foods. For example, luncheon meats and canned soups have very high amounts of salt. Look for products that say "sodium free," "low sodium," or "unsalted". When possible, try to use fresh fruit and vegetables as well as meat and chicken that aren’t previously prepared. And of course, don’t reach for the salt shaker at the table. I know my husband has a bad habit of putting salt on his food before he even tastes the dish. There are numerous ways to enhance the flavor of our food without adding salt.

So, too much salt is obviously a bad thing. I’ve heard that drinking a glass of red wine each day is “Heart Healthy”, but you mentioned earlier that we should watch our alcohol intake as well. Why is that?

Some news reports suggest that people who consume a drink or two a day have lower blood pressure and live longer than those who consume excessive amounts of alcohol. Others note that wine raises the "good" blood cholesterol that prevents the build up of fats in the arteries. Drinking too much alcohol, however, can raise your blood pressure. It may also lead to the development of high blood pressure. So to help prevent high blood pressure, if you drink alcohol, limit how much you drink to no more than 2 drinks a day if you are a man and no more than 1 drink for a woman. Remember, a drink is:

• 1-1/2 ounces hard liquor, or
• 5 ounces of wine, or
• 12 ounces of beer (regular or light).

If someone has high blood pressure, what are some important treatment considerations?

Because high blood pressure is so common, especially in the African American community, its management requires a major commitment from the patient and his or her health care provider. In addition, an effective therapeutic regimen must include a plan for diet, exercise and appropriate medications. In this country, there are numerous medications for hypertension. These drugs have been thouroghy evaluated in clinical research trials. Unfortunately, only small numbers of African Americans participated in many of these clinical trials. This does not mean that the medications are unsafe or ineffective in the African American population. But we do not more African Americans to participate in clinical trials so that we can better understand and improve the treatment of hypertension in this group.

Why is high blood pressure different in the African American population?

I’m glad you asked. I don’t want our viewers to go away thinking that there is some special or different about being of African American heritage. Quite the contrary, people of different racial / ethnic groups have more similarities than differences. I’m sure most people know that racial groups are actually an arbitrary designation of people in our society. What you do see is that people in a particular racial or ethnic group tend to marry someone in the same racial and ethnic group. So what we are really seeing is traits and genetic factors that are then passed on to the next generation. In my family for example, my father had high blood pressure and so does my mother. Out of the eight children in my family, 5 have high blood pressure. This inherited risk for hypertension increases the chance that my children may develop high blood pressure. The same is true for the African American population in all of the United States. High blood pressure is a problem because our grandparents and our parents had high blood pressure. Chances are higher that we will have high blood pressure and that our children may also develop hypertension. But again, the good news is that not only can we treat high blood pressure but we can effectively prevent high blood pressure.

Are the treatments for high blood pressure the same for African Americans as they are for other racial groups?

As we said earlier, there are medications that we can use to treat hypertension in African Americans as effectively we treat this disorder in other racial / ethnic groups. Investigators have tried to determine why there are higher rates of morbidity and mortality rates for African Americans with hypertension in comparison to other racial groups. Several studies have confirmed what has been suspected for some time: African Americans are less likely to be offered appropriate diagnostic testing, aggressive interventional treatments, and life-saving drug therapy. There are efforts in the health care community to try to correct the health disparities that we see in this area. The American Heart Association’s “Get With the Guidelines” progam is a hospital based program designed to assist health care providers in taking care of coronary heart disease with the most updtated treatment guidelines and tools. Application of this program has been shown to markedly improve the use of evidence based, guideline ­ recommended therapies and decrease gender, and perhaps racial, disparities in heart disease treatment. African American patients should seek to arm themselves with the latest information about hypertension. When you see your health care provider, ask why you are on certain medications versus another. Ask about testing for heart disease. Ask about your cardiovascular risk profile.

Once someone starts medical therapy, what follow ­ up should they expect from their health care provider?

Achieving and maintaining target blood pressure often requires continuing encouragement for lifestyle modification and medication adjustment. Most people should be seen 1 to 2 months after starting therapy to determine the adequacy of hypertension control and the presence of adverse effects. Once blood pressure is stabilized, follow-up at 3 to 6 month intervals is generally appropriate. At no point should anyone stop taking their blood pressure medications.

Do you have a take home message for today?

The cost of managing hypertension is lower overall than the sum of direct and indirect costs that may be avoided by reducing hypertension associated heart disease, stroke, and renal failure, especially because these adverse events often lead to expensive hospitalizations, surgical procedures, and high cost technologies. Patients have the right and responsibility to be active and well-informed participants in their own care. Health care professionals have the responsibility to provide patients with complete and accurate information about their health status and to allow patients the opportunity to participate in their care and to achieve goal blood pressure.