By Landless, Peter N
If you don’t stop it, it will stop you . . . dead. There are seldom symptoms. Medical professionals aren’t altogether sure what causes it. Yet hypertension (high blood pressure) is one of the world’s greatest health problems. It’s mysterious, evasive, and lethal.
High blood pressure contributes significantly to death rates through stroke, heart failure, and kidney failure. Mass health screening has helped increase recognition of the problem; and wherever patients are adequately treated, death rates from the disease drop significandy.
But consider these statistics: only 50 percent of patients who have hypertension are on dierapy of any kind. Of those, only 30 percent have their blood pressure controlled at ideal levels. Much work needs to be done in order to combat this “silent killer.”
Diagnosis
Hypertension is not diagnosed on a single reading. Pressure values should be noted on at least three separate occasions, using blood pressure devices at your doctor’s office, those do-it- yourself readers at many grocery stores, or with a simple at-home blood-pressure kit.
It’s important to note that, for some, the act of visiting a doctor can temporarily raise their blood pressure, owing to uncertainty or the fear of what may be found. This “white coat” effect may make accurate readings impossible, even if repeated. That’s why it’s important that blood pressure levels be checked when a person is as relaxed and unstressed as possible.
Where the diagnosis is in doubt or to monitor treatment efficacy, the most effective measuring mediod is ambulatory blood pressure monitoring which may be performed over a 48- to 72-hour period. Blood pressure is measured and recorded on a recording device at intervals throughout the day and night, collecting an accurate reflection of blood pressures away from the stress of the clinic/ office/ hospital environment.
Cause
Despite advances in treatment, relatively little is known about the cause of hypertension. In 90 percent of patients, absolutely no cause is uncovered. This condition is called “primary” or “essential” hypertension. It’s common to find hypertension occurring in families, suggesting genetic factors. The incidence of hypertension also increases with age.
Physiology of Blood Pressure
The human heart muscle is constantly in one of two states: contracted (systole) which forces blood out of the heart and sends it coursing throughout the body, and relaxed (diastole) which allows replacement blood to enter the heart chambers, ready to be sent on its life-sustaining journey. This pumping action continues unabated until the day we die.
Normal blood pressure reading is 120/80 mm Hg (millimeter of mercury). That means die systolic pressure is at 120 mm Hg, and the diastolic reading hovers at 80.
The Creator has put in place some amazing checks and balances to keep our circulatory system operating properly. When blood pressure falls, the kidneys release the enzyme rerun into the bloodstream. Rerun splits the inactive angiotensinogen (a large protein that circulates in the bloodstream) into pieces. One piece is angiotensin I which is men split by the angiotensin-converting enzyme (ACE) forming angiotensin II-a very powerful constrictor of small arteries, thus raising the blood pressure.
Angiotensin II also triggers the release of another hormone called aldosterone from the adrenal glands. This causes the kidneys to retain sodium and eliminate potassium. The retained sodium brings about water retention, which increases the blood volume and, consequently, blood pressure.
This amazing reninangiotensinaldosterone system (RAAS) was designed by God to regulate blood pressure and keep the internal environment of our bodies constant. It’s a beautiful demonstration of how “fearfully and wonderfully” we’re made. It’s no wonder that David cried out, “Your works are wonderful, I know that full well” (Psalm 139:14).
Unfortunately, this is the very system that becomes disturbed when individuals with a tendency to high blood pressure take in excessive salt in their diet. On the upside, it’s also the target of specific “designer” medications used with good success in the treatment of hypertension.
Environmental Factors
Lifestyle choices play a leading role in both the development and control of hypertension. Perhaps, even today, you did something that can cause or aggravate the disease. If you’re a smoker, are obese, consume alcohol, lead a sedentary life, include copious amounts of salt in your diet (processed or prepackaged foods are prime suppliers), or have a sugar intolerance that’s leading you into diabetes, you may also be suffering from hypertension. Like I said before, you probably aren’t even aware of the fact that you’ve become a ticking time bomb.
Secondary hypertension
Five percent of hypertensive patients have an associated disease or condition, which, by default, raises blood pressure. These include problems with the kidneys, the endocrine system (which creates hormonal controls), nervous system disorders, and chronic stress.
As mentioned, alcohol wreaks havoc on the body, as do some nonsteroidal anti-inflammatory medications on the kidneys. Pregnancy can be complicated by elevated blood pressure as well.
Complications
Hypertension affects a number of bodily systems, some profoundly. It’s in these complications where the silent killer’s face is clearly seen.
Arteries: Uncontrolled hypertension accelerates atherosclerosis (degeneration and hardening of the arteries) and further increases the risk of potentially deadly aneurysm formation. An aneurysm is a weakness of the arterial wall, which creates a bulge, like a balloon. If this aneurysm bursts in the aorta or brain, the results can be catastrophic, quickly generating permanent damage or death. It’s possible for the circulatory system to lose all of its blood supply through an aneurysm, filling the body cavity like a broken dam fills a valley. Death swiftly follows.
Brain: Hypertension can cause strokes, either by causing clotting in the small arteries of the brain, or creating a “bleed out” into the brain.
Heart: Chronic high blood pressure accelerates the disease process in the coronary arteries and places undue strain on the heart muscle itself, making it thicken and eventually lose its flexibility and ability to function adequately. Heart failure follows. Regular, even strenuous exercise generally does not thicken the heart muscle in this way.
Kidneys: Increased blood pressure damages the delicate filtration units of the kidney, leading, ultimately, to kidney failure.
Eyes: Hypertension can damage the small blood vessels of the retina of the eye. If the pressure is extremely high and uncontrolled, it can lead to visual disturbance.
Understanding the Readings
The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure monitors and studies the trends in hypertension treatment and outcomes. Here are its most recent recommendations:
Normal blood pressure:
* Systolic 120 mm Hg
* Diastolic 80 mm Hg
Even when blood pressure readings are normal, risk factor monitoring is needed and healthy lifestyle encouraged.
Prehypertension:
* Systolic 120 – 139 mm Hg
* Diastolic 80 – 89 mm Hg
This may be regarded as the early stage of hypertension. Lifestyle modification is essential to prevent it from worsening and developing complications.
Stage 1 hypertension:
* Systolic 140 – 159 mm Hg
* Diastolic 90 – 99 mm Hg
Patients who have these readings require immediate lifestyle modification, plus the use of medication, which is introduced gradually as a doctor monitors the response and any possible side effects, until the blood pressure is back to normal range (120/80 or less).
Stage 2 hypertension:
* Systolic greater than 160 mm Hg
* Diastolic greater than 100 mm Hg
At this level of hypertension, lifestyle modification is vital. In addition, the evidence of multicenter studies of many thousands of patients (as recorded in scientific literature) shows that it’s most likely that the patient will require treatment with at least two different medications.
Educating yourself about the disease and its complications could save your life. But along with education must come compliance. If you have hypertension, you must adhere to the lifestyle modification and take the prescribed medication as directed. To do otherwise is allowing the silent killer full access to your future.
Treatment
There are two approaches to the treatment of hypertension, both vital to success. In most cases, to do one without the other raises the risk that the disease won’t be conquered.
The first is nondrug treatment and is essential in all cases of high blood pressure. The list is short but very, very powerful.
1. Stop smoking completely and permanently. I cannot emphasize this enough. Smoking is the most damaging thing you can do to your body and undoubtedly causes premature death.
2. Stop alcohol consumption.
3. Exercise daily. If you’ve been sedentary up until now, begin with 30 minutes of exercise per day. Then build up to 45-90 minutes daily.
Walking is one of the best ways to lower your risk of most diseases including diabetes and cancer. A brisk, daily walk is good for your body, mind, and relationship with God, especially if you invite Him to come along. 4. Restrict salt intake. Excessive salt in the diet increases water retention, which increases blood volume, which raises blood pressure. Most highly processed and prepackaged foods contain an incredible amount of salt and can quickly aggravate hypertension (see sidebar).
5. Increase fruits and vegetables in your diet.
6. Learn to manage your stress. Ask yourself, “Is this project, or job, or concern worth dying for?” A good stress-management seminar or Bible-based book on the subject can mean the difference between life and death for many… perhaps even you. And never underestimate the power of personal, from-the-heart prayer.
Diet to the Rescue
The best eating plan for improving blood pressure was confirmed in the Dietary Approach to Stop Hypertension (DASH) study. It’s based on the large multicenter study that showed, conclusively, that a certain diet is most effective in the control and prevention of hypertension. The DASH diet includes the following components:
1. It’s low in saturated fats and total fat. A plant-based diet assures the right amount-and the right kinds-of fats.
2. It contains eight to 10 servings of fruits and vegetables per day. The potassium in fruits and vegetables is particularly important in this instance. Fiber is healthy too.
3. It’s low in salt (sodium chloride). The latest recommendation is 1,500 milligrams per day for patients with hypertension. We need much less salt than we think we do.
New Developments
Lifestyle interventions retain their absolute importance in the prevention and management of hypertension. But in those cases where genetics plays a more stubborn role, new medications are being developed that will also work in partnership with lifestyle changes and minimize the unwanted side effects associated with drug therapy.
A fascinating-but still experimental-approach, which is being studied, is targeting specific components of the RAAS with a vaccine. This offers the potential of reducing-or even eliminating- the need for medications altogether. However, this approach requires long-term study to identify any side effects and assure safety.
In some cases, individuals with high blood pressure have been able to improve their condition with lifestyle choices and supplemental medications to the point where medications are no longer needed or where doses may be reduced. It’s important that you work with your doctor before attempting to alter any prescribed drug therapy. He or she will monitor your progress and help you find the right balance that will keep you safe and healthy.
Conclusion
Hypertension is a lifelong problem that requires lifelong treatment. There’s no doubt that lifestyle changes, as described, are essential. For most patients, medication is required as well. Since medications have side effects, the patient must be professionally helped to find the treatment that’s best tolerated.
There are many types of medications, and a “recipe” that suits each individual patient and their economic circumstances can be crafted. It’s important to remember that the only treatment that works is the one that you follow.
Many outcomes in common diseases such as hypertension, heart failure, and coronary heart disease are influenced by choices; the choice to eat healthfully, to exercise, to be active in lifestyle interventions, and to take appropriate medications when needed.
When it comes to health, once you know what needs to be done, you need to follow Nike’s example and “Just do it!” The “silent killer” is stalking you. With what you now know, you can begin to fight back today!
Hypertension is not diagnosed on a single reading. Pressure values should be noted on at least three separate occasions.
HOW MUCH SALT DO YOU NEED?
The human body needs only about ? ,000 milligrams (1 gram) of salt per day. That requirement can easily be met by eating only foods “as grown.” The typical American diet, however, provides in excess of 10,000 milligrams (10 grams) of salt per day. This means that people consume 10 times more salt than their body needs to function well.
Salt is sodium chloride. Food labels list sodium rather than salt content. When reading a nutrition facts panel on a food product, look for the sodium content. Foods that are low in sodium are low in salt.
The Food and Drug Administration recommends that we consume less than 2,300 milligrams of sodium (approximately 1 teaspoon of salt) per day. Individuals with hypertension, African-Americans, and middle-aged and older adults should aim to consume no more than 1,500 mg of sodium (approximately /4 teaspoon of salt) per day. Source: Health Power
Dr. Peter Landless, a cardiologist, is the executive director of the International Commission for the Prevention of Alcoholism and Drug Dependency (ICPA) and an associate director in the General Conference Health Ministries Department of the Seventh-day Adventist Church. Originally from South Africa, he’s been actively involved in medical mission work his entire career.
Copyright Vibrant Life Jul/Aug 2008
(c) 2008 Vibrant Life. Provided by ProQuest Information and Learning. All rights Reserved.
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