Tag Archives: High blood pressure

Insane Medicine – A few points on cardiovascular health and interventions

Here’s some general cardiovascular stuff that is useful:

  • There is now a trend to treat your hypertension and cholesterol based on risk factors rather than just specific targets. Looking at the overall cardiovascular risk is more important tan focusing on just one factor.  The decision to treat cholesterol issues should be based on not just the absolute LDL – cholesterol number but also the coexisting problems, such as obesity or hypertension. It is important to modify other lifestyle issues including losing weight, maintaining regular exercise, eating a low-salt diet, and taking your prescribed medications. Look at the overall picture and not just a single parameter.
  • Be certain to stay active. Check with your doctor about the safety of exercise for you before you start on a program. Engage in aerobic activity such as walking or jogging at least four to five times a week and be certain to mix this with muscle-strengthening exercise at least twice a week. Get moving!30-60 minutes a day, and be certain to use good form, standing upright and keeping your back straight, walking on even surfaces so you don’t fall, with good heel-strike and arm swing to maintain balance. Wear comfortable, well-fitted shoes. Stretch after a brief walk and be careful to do the stretching appropriately without any bouncing so you don’t damage your muscles. As winter approaches, you may need to exercise indoors due to the cold. Consider working out a variety of muscle groups to spice it up and keep you interested. This stimulates other muscle groups to maintain overall fitness. You thereby avoid burnout and keep motivated! Consider indoor sports that you can add to your regimen such as swimming, indoor rowing, stair-climbing machines, ellipticals, aerobics, yoga, and racquetball. Keep social. Get a training partner to keep things fun.
  • Be certain to stay on the best diet, rich in fruits, vegetables, whole grains, and lean proteins with low saturated and trans-fats as well as low cholesterol and sodium. Avoid processed foods and added sugar. Keep your Vitamin D intake at the appropriate levels, with 600 IU a day being recommended for ages 51-70 and 800 IU a day for ages over 70. The goal is a blood level of more than 30 nanograms per milliliter. Sources of foods wit Vitamin D include salmon, swordfish, tuna, canned sardines, milk, eggs, yogurt, orange juice, and cereals fortified with it. Vitamin D provides cardiovascular, neurological, and immune system health. People with high levels of vitamin D have had lower in-hospital death and morbidity rates.
  • Try to get 8 hours of sleep a night.

Insane Medicine – High Blood pressure and the new Rules

Insane Medicine - Blood pressure cuff
Insane Medicine – Blood pressure cuff
  • Blood pressure is force that is exerted on your arteries with every heart beat, with the systolic pressure (top number) being the peak pressure the moment the hear contracts, while the diastolic number (bottom number) is the pressure when the heart relaxes. There is always residual pressure in the circulatory system when the heart is at rest due to the elastic, expansile ability of veins and arteries in the cardiac cycle that expand and collapse with each heart beat.
  • normal blood pressure is anything less than 120/80
  • When a person develops high blood pressure, that puts stress on the vital organs inside the body, especially the brain, heart, and kidneys. This increases your risk of stroke, heart disease, and kidney failure. Vascular dementia due to damaged vessels and strokes in the brain results in dementia.
  • As people age, high blood pressure becomes more and more common, with ~70% having high blood pressure by the age of 65-74.
  • There have been recent changes in the blood pressure goals per a recent report by JNC-8.  If you are age 60 or older, any blood pressure up to 150/90 mm of Hg is acceptable, unless you have diabetes, in which case 140/90 mm Hg is the acceptable goal. This new goal has not been accepted by all the medical authorities.
  • The American Society on Hypertension (ASH) suggests that patients age 80 and over should be allowed to have a blood pressure up to 150/90, unless they have high risk issues like diabetes or kidney disease, in which the 140/90 upper limit should be used. If the person is less than age 80, then 140/90 is the upper limit of acceptable and probably a goal of 130/80 should be used if they have poor heart function or kidney disease.
  • Which target should you be using? Ask your doctor, but it seems reasonable to be more aggressive with blood pressure treatment if you have diabetes, kidney disease, protein in your urine, or heart disease.
  • Lowering a person’s blood pressure too low may make them dizzy when they stand or even pass out due to low blood pressure. This is something we want to avoid!
  • First line treatment includes lifestyle changes such as dietary modifications such as reducing salt intake and eating more antioxidant-rich fruits and vegetables. Physical activity is a key component as well.
  • Have your doctor check for possible secondary causes of high blood pressure such as ‘white-coat’ hypertension (stress in the doctor’e office that goes away when you measure blood pressure at home). Also medications such as prednisone, or over-the-counter agents for colds and cough can increase blood pressure. Have your doctor review your non-prescribed medicines.
  • Have your doctor consider looking for thyroid disorders, kidney disorders, or sleep apnea that can elevate blood pressure.
  • Keep track of your home blood pressure with a home blood pressure cuff that is properly calibrated and used. This can be more accurate when properly done than a doctor’s office single reading of blood pressure.
  • For those who need medications, doctors will start low and titrate medication upwards slowly. There is more evidence that ACE inhibitors or ARB inhibitors mixed with amlodipine ( a calcium channel blocker) are excellent first line therapies. Beta blockers are not in favor for primary or secondary use unless there is some specific reason to be taking them (such as heart disease). Be prepared to take two or even three medicines to control your blood pressure.
  • Again, the best treatments to start with are lifestyle modifications! Lose weight, take in less salt. Consider following the DASH diet!

The DASH diet to help control high blood pressure:  http://dashdiet.org/