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H E A L T H Y P E O P L E L I B R A R Y P R O J E C TAmerican Association for the Advancement of Science

The Scien

ce Insid

eHigh Blood Pressure

High BloodPressure: TheScience Inside

HEALTHY PEOPLE LIBRARY PROJECTAmerican Association for the Advancement of Science

INTRODUCTION: HIGH BLOOD PRESSURE, A CONTROLLABLE DISORDER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

PART 1: THE DISEASE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Healthy blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Blood pressure problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Symptoms of high blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7How high blood pressure affects the body . . . . . . . . . . . . . . . . . . . . . 7Causes of high blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Health problems from high blood pressure . . . . . . . . . . . . . . . . . . . . 10

PART 2: THE IMPACT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Rising incidence of high blood pressure . . . . . . . . . . . . . . . . . . . . . . 15Uneven impact of high blood pressure . . . . . . . . . . . . . . . . . . . . . . . 16Reasons for uneven impact . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

PART 3: CARE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Diagnosing high blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Preventing and controlling high blood pressure . . . . . . . . . . . . . . . . 26Maintaining the right weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Eating properly. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Getting exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Avoiding alcohol and tobacco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Monitoring health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Taking blood pressure medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Blood pressure treatment plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

PART 4: RESEARCH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41Current lines of research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41The important role of volunteers. . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

CONCLUSION: LET’S BRING DOWN HIGH BLOOD PRESSURE . . . . . . . 51

T A B L E O F C O N T E N T S

APPENDIX 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Questions to Ask Your Doctor about High Blood Pressure

APPENDIX 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Taking Part in Research Studies—Questions To Ask

RESOURCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

GLOSSARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

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Your heart is the hardest work-ing muscle in your body. No big-ger than a fist, this powerfulpump circulates blood throughoutyour entire body, providing theoxygen and nutrients you need tolive. Unlike most pumps, howev-er, this pump never stops as longas you’re alive. In fact, the aver-age human heart works at a rateof 100,000 beats a day, or anincredible 2.5 billion beats over alifetime of 70 years!

Every time your heart beats, itpumps blood through arteries,exerting pressure (or force) onthe inside of your blood vessels.This is called blood pressure.To understand this, think of awater pump and hose. When youturn the pump on, it pusheswater into the hose, creatingpressure against the inner wallsof the hose and causing thewater to flow. Now, if you inter-rupt the flow of water—forexample, by putting a bend inthe hose—you create a blockagethat stops up the water. Thewater will build up behind theblockage, exerting more pressureand pushing out the walls of thehose. If you keep the hose bent,eventually either the hose willburst or the pump will shut

down. If you get rid of the block-age, water will once again flowsmoothly through the hose.

You can think of high bloodpressure, or hypertension, inthe same way. It is a condition inwhich the pressure of the bloodinside the arteries is too high. Ifthe condition is left untreated, itwill cause damage to the arteriesand put strain on the heart. Youcan develop serious complica-tions of high blood pressure,including stroke, heartattacks, heart failure, kidneyfailure, and eyesight problems oreven blindness. Developing theseand other related illnesses canlead to a life of considerable suf-fering or premature death.

INTRODUCTION: HIGH BLOODPRESSURE, A CONTROLLABLE

DISORDER

There are no clear-cut symptoms for high blood pressure—which is part of the reason it hasbecome known as“the silent killer.”

H i g h B l o o d P r e s s u r e : T h e S c i e n c e I n s i d e

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Research shows that more than 50 million Americans over the ageof 6 have high blood pressure.Roughly 1 in every 4 Americanadults has the disorder. In 1999alone, high blood pressure con-tributed to the deaths of morethan 227,000 Americans. Thisnumber is expected to rise in theyears ahead.

Sadly, millions of Americans arewalking around with high bloodpressure and don’t even know it. Itseems that most people find outthey have the disorder only whentheir doctors bring it to theirattention during an office visit.This is due to the fact that thereare no clear-cut symptoms forhigh blood pressure—which is partof the reason it has become knownas “the silent killer.”

One basic marker that people canuse to keep tabs on their bloodpressure is their age. As peoplegrow older, their chance of devel-oping the condition becomesgreater. Health experts have deter-mined that roughly 54% of peopleover 60 have high blood pressureand that two out of threeAmericans will have it by the ageof 70. For this simple fact alone, it is important for people tobecome more aware of their bloodpressure, have it measured period-ically, and learn healthy ways toprevent or control this potentiallydeadly condition.

High blood pressure does not affectall people in the same way. AfricanAmericans and older people areparticularly hard hit by the disor-der. Those with lower incomes andlower educational backgroundsalso tend to be at greater risk fordeveloping high blood pressure. In addition, research studies haveshown that people living in thesoutheastern United States haveaverage blood pressure levels thatare higher than Americans livingin other parts of the country. Theexact reasons for this still remainunclear.

What is clear is that people cantake many actions to reduce theirchances of developing high bloodpressure. This involves havingblood pressure checked regularly,since high blood pressure is simpleto detect, and making changes inlifestyle, such as increasing physi-cal activity, reducing the amountof salt consumed, and committingto a lifetime of healthier eating.

For those suffering from highblood pressure, medical scienceand modern research since the1940s and 1950s have come a longway in understanding and treatingthis silent condition. Many med-ications have been developed andproven effective in helping to getblood pressure levels under con-trol, to limit or avoid further com-plications, and to prolong life.

Introduction

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Ongoing research and technolog-ical advances also have enableddoctors to better adjust treat-ment plans to the individual,since medical remedies do notnecessarily work for everyone inthe same way.

Medical advances and greaterpublic awareness about highblood pressure are critical forsaving the lives of millions ofAmericans in the future. Whatmay be more important, howev-er, is to realize that there are anumber of healthy, natural waysthat people can prevent theirblood pressure from getting outof control in the first place.

Retired from Teaching But Not fromLearning about Her HealthSome people with high blood pressure ignore the problem or think it can’thurt them.

Not Marge Prioleau.

“High blood pressure can lead to stroke and having problems with theheart. There are so many things that can come from high blood pressure.”

Prioleau is a retired school teacher who lives in Beaufort, South Carolina.She found out that she had high blood pressure about 14 years ago.

“I started to feel dizzy and went to the school’s nurse. She took my bloodpressure and said it was high.”

Following health advice is easier said than done, but somehow Prioleaumanages to do it. She keeps her blood pressure under control by gettingexercise, eating healthy foods, and taking blood pressure medications.

Her main exercise is walking around a quarter-mile running track at anearby school. She gets up early to beat the heat, which in South Carolinacan sap even the most determined person’s willpower to exercise. She does16 to 20 laps, which equals four to five miles.

She makes sure her shoes are comfortable. Unlike many people who runand walk for their health, she doesn’t wear a Walkman.

“I like to take time to take an inventory of myself,” says Prioleau. “It gives metime to think.”

She has banned fried food from her diet except for fish and a special treat offried chicken on New Year’s. She makes juice from carrots and apples anddrinks a lot of water.

And does Prioleau eat grits, the porridge-like dish made from corn thatSoutherners crave? “Of course,” she says laughing, “but I don’t eat them with salt.”

Like many people with high blood pressure, Prioleau can’t keep it under control with diet alone. She was originally prescribed Lotrel, a calcium-channelblocker, but her blood pressure started going up again. Now she takes Norvasc,a calcium-channel blocker; Cozaar, an angiotensin II receptor blocker; and adiuretic.

Prioleau says her doctor, Dr. William Bestermann, deserves part of the credit for her outlook. “On a scale of 1 to 10, I would say Dr. Besterman is a 10. He promotes a healthy way of life.”

Many of us take our health for granted. We just go along assuming we’ll staywell or that doctors will be able to treat us if anything goes wrong. Prioleausees her health as something she has to work for.

“I am the sort of person who if there is something that is going to help mehave a better way of life, then I am going to try to do it.”


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Healthy blood pressure

Before we can understand theharmful problems related to highblood pressure, it is important tohave a basic understanding of howa normal, healthy body functions. To this end, we will examine theworkings of the cardiovascularsystem.

The cardiovascular system is madeup of the heart and blood vessels.The heart is a very powerful muscu-lar pump that delivers blood to theorgans, tissues, and cells through-out the body. The blood sends oxy-gen and nutrients that our cellsneed to live and removes the car-bon dioxide and other wastes thatcells produce. From the heart, oxy-gen-rich blood is circulated througha vast network of arteries, arteri-oles, and capillaries, and oxygen-poor blood is pushed back to theheart through venules and veins.

As mentioned earlier, blood pres-sure is the force that blood exertsagainst the arteries as it circulatesthroughout the body. The flow ofblood around the body is not con-stant, but is based on the beats ofthe pumping heart. On average,

about two ounces of blood per heart-beat is pumped through the leftventricle of the heart and into the60,000–mile– (96,500-kilometer–)long network of blood vessels thatmake up the human body.

It is also important to note thatblood pressure does not stay thesame all the time and is based onthe activities people do (and howhard or rapidly their hearts arepumping). For example, the heartmuscle can pump nearly three timesfaster during periods of exercise ascompared to times of rest. The heartpauses, or rests, between beats inorder to prepare itself for the nextbeat.

Using a sphygmomanometer, orblood pressure cuff, doctors measure

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Part 1: The Disease

Blood pressure isthe measurementof force applied toartery walls


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two key blood pressure numbers—the systolic pressure and diastolicpressure. The systolic pressureshows the highest pressure in thearteries. This is when the blood isforcefully pumped out of the heartand into the blood vessels during aheartbeat. The diastolic pressure represents the lowest pressure in the arteries. This is when the heartpauses or relaxes between beats.

The numbers that result from a read-ing usually come in the form of 100mmHg (millimeters of mercury) over70 mmHg, or 100/70 mmHg. Thehigher number represents the systolic

pressure (heart pumping) and thelower represents the diastolic pres-sure (heart resting). A consistentmeasurement of 140/90 mmHg indi-cates that the heart is pumping hard-er than it should and that the personhas high blood pressure. The optimalblood pressure reading for adults is119/79 mmHg or lower.

Blood pressure problemsHypertension is another term for highblood pressure. It is a condition inwhich blood is pushed through thebody’s blood vessels at greater forcethan normal. There are three maintypes of hypertension:

Primary hypertension (or “essen-tial hypertension”)—This form of highblood pressure is the most common,affecting over 90% of those people 45years old and over who have hyper-tension. While there is no knowncause, there are a number of factorsthat contribute to its development,including age, heredity, lifestyle, diet,ethnicity, and more.

Secondary hypertension (or “non-essential hypertension”)—Unlike pri-mary hypertension, this form of highblood pressure can be determined bya specific cause. Among the possibleshort-term causes are pregnancy andthe use of certain types of medication.The long-term causes include kidneydisorders and head injuries. This typeof hypertension accounts for nearly10% of all high blood pressure cases.

When the specific cause is identi-fied and properly treated, bloodpressure often returns to normallevels.

Isolated systolic hypertension(ISH)—This form of high bloodpressure is most common in olderpeople, affecting over 65% of peoplemore than 60 years of age. ISHcomes with no symptoms, so manypeople may have it and do notknow it. ISH is characterized byhigh pressure levels when theheart is beating (systolic), but nor-malized levels between beats, whenthe heart is resting (diastolic). This large gap between pressurelevels can lead to a straining of the arteries.

Symptoms of high bloodpressureUnlike many other conditions, highblood pressure often causes nosymptoms. However, when symp-

toms do arise, it means that bloodpressure is too high, often causingdamage to such critical organs asthe heart or kidneys. In the mostsevere cases, when symptoms canarise, they might come in the form of:

headachesexcessive perspiration (sweating)chest painsmuscle tremorsnosebleedsfatigue, weaknessnausea, vomitingheart palpitationsvision problemsblood in urineconfusion

How high blood pressureaffects the body

High blood pressure affects thebody in a variety of ways. The mostcritical effect is the strain it canput on the heart. High blood pres-sure also damages blood vessels

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Part 1: The Disease

Low blood pressure—Is it ever a problem?

Though generally regarded as a good thing, a person’s blood pressure can be toolow and potentially harmful. There may be no symptoms associated with low bloodpressure, and, in certain cases, it may actually be desirable. When blood pressuredrops below 90/60, however, it indicates that there may not be enough blood flow-ing to the heart, brain, kidneys, and other major organs. Causes may include heartdisease, dehydration, gastrointestinal bleeding, and the use or allergic reaction tocertain medications. Most common with the elderly, sudden drops in blood pressuremay lead to symptoms like fatigue, anxiety, depression, or dizziness—especiallyupon making a sudden change in body movement. In rare cases, treatment isrequired, usually in the form of medication that helps alter blood pressure receptorsor constrict arteries to reduce the likelihood of sudden or frequent drops in bloodpressure.


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and, if left untreated overtime, can greatly impair theheart, brain, kidneys, andeyes. With few or no notice-able symptoms, this silentand potentially deadly con-dition can lead to severephysical damage well beforea person understands whatis happening and seeks med-ical treatment.

High blood pressure is aserious risk factor for differ-ent forms of heart disease,including congestive heart failure,which most commonly affects the eld-erly. As high blood pressure stretchesand damages the heart from over-work, it also strains the blood vesselsand hardens the arteries, makingthem thicker and less flexible, great-ly increasing the chance of heartattack and stroke. Without diagno-sis or treatment, the kidneys canbecome stressed and damaged, hurt-ing their ability to clean the bloodand potentially leading to kidneyfailure. Among the temporary or per-manent vision problems that canresult are optic nerve swelling andbleeding in the retina.

To avoid these and other life-threat-ening complications, doctors recom-mend having blood pressure checkedat least once a year, so patients whohave high blood pressure can betreated effectively. This is importantbecause research shows that—com-pared to people who have received

treatment for high blood pressure—those who have hypertension but donot know it are about 6 times morelikely to have congestive heart fail-ure, 7 times more likely to have astroke, and 3 times more likely tohave coronary artery disease.Since high blood pressure has virtu-ally no symptoms until it becomessevere, it is especially important forpeople to monitor and control theirblood pressure on an ongoing basis.

Causes of high blood pressure

Doctors and researchers have notbeen able to determine a specificcause of high blood pressure.Moreover, the cause of hypertensionis unknown in 90 to 95 percent of thecases. Since no single cause seemsapparent, treatment for the conditionhas been based on keeping bloodpressure at normal levels or undercontrol. This involves identifying the

specific risk factors that, when com-bined, can greatly increase a per-son’s chance of developing highblood pressure. These risk factorsinclude:

Controllable Uncontrollable

high salt intake heredityobesity raceexcessive alcohol use genderlack of exercise ageuse of certain

medicationsdrug or chemical usediabeteskidney diseasestress

Salt has been found to be a risk fac-tor because too much of it can raisefluid levels in the bloodstream, forc-ing the heart to work harder andblood pressure levels to rise. This isparticularly true if the kidneys,which regulate sodium (salt) andwater levels in the body, are notworking properly. Obesity is anoth-er key risk factor. When a persongains weight, his or her blood levelsalso increase, causing the heart topump more blood. The additionalweight also causes a person’s bloodpressure to elevate because itincreases cholesterol levels, lead-ing to a further straining and hard-ening of the blood vessels andheart. Excessive alcohol consump-tion can also reduce the heart’s abil-ity to function properly, increasingblood pressure levels. Drinking too

much alcohol can also make highblood pressure medication lesseffective.

Luckily, as suggested by the “con-trollable” factors above, there ismuch that people can do throughouttheir lives to keep their blood pres-sure at a healthy level.Unfortunately, high blood pressuredoesn’t affect all people in the sameway. For example, AfricanAmericans are much more likely todevelop the condition earlier andmore severely than whites. Also, interms of gender, men have a greaterchance of developing it between theages of 35 to 55, whereas womenare more likely to develop it afterthe age of 75. What is clear, howev-er, is that as people age, theyincrease their chances of developinghigh blood pressure.

Part 1: The Disease

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Obesity is a controllable risk factor forhigh blood pressure.

Health problems from highblood pressure

IMPORTANT NOTE: The followingcomplications of high blood pressuredescribed below can be avoided ordelayed through prevention and treat-ment. (See the section on care begin-ning on page 25.)

Stroke. High blood pressure is aleading cause for stroke, which occurswhen blood has trouble flowing to thebrain. High blood pressure can makea blood vessel rupture, causing ahemorrhage (bleeding) in the brain.Strokes, (or “brain attacks”) are alsocaused by blood clots and narrowingof the arteries (atherosclerosis).They can lead to such complicationsas the inability to speak, brain damage, paralysis, and death. Strokeis the third leading cause of death in the United States, accounting for 1 out of every 15 deaths. It is impor-tant for high blood pressure patientsin particular to monitor their healthand get effective treatment for thecondition before it leads to a stroke—the risk of which doubles every 10years after the age of 35.

Kidney Disease. The kidneys help tokeep blood pressure levels regular bycleaning the blood of extra fluids andwastes. When a person develops highblood pressure, the kidneys canbecome damaged. When the kidneysare no longer able to function proper-ly, the extra fluids and wastes thatremain in the blood can lead to evenhigher blood pressure levels and, ulti-


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A Closer Look at Stress and Emotions

Blood pressure is known to change throughout theday, depending on one’s activities or emotionalstate of mind. People who have a lot of stress intheir lives—or who suffer from emotional condi-tions like depression or anxiety—are thought tohave at least twice the risk of developing highblood pressure than others. This is because thestress hormone, cortisol, is released from the adre-nal glands in greater amounts—causing bloodpressure to increase—when a person experiencesshort-term or long-term stress. Like adrenaline,cortisol levels rise when a person is under stress.When a person’s “stress hormone” levels are ele-vated on a consistent basis, it can lead to a varietyof health problems, from depression to high bloodpressure to cancer.

Different forms of stress may also prompt peopleto escape their troubles by overeating, smoking, orabusing alcohol, all of which cause blood pressureto rise. Making gradual lifestyle changes thatreduce stress will help to control or lower bloodpressure over the long run.

mately, illness. If left untreated, aperson suffering from kidney dis-ease may need a kidney transplantor dialysis treatment, which is theuse of a machine to help the kid-neys function and clean blood. Highblood pressure is the second leadingcause of kidney failure, and leads toover 15,000 new cases in the U.Severy year. Research has alsoshown that between 20 to 25 per-cent of patients who must undergodialysis first had “slightly elevatedblood pressure” that had beenuntreated. Early and effective treat-ment of high blood pressure canhelp to prevent the occurrence ofkidney disease.

Vision Problems. Vision loss orblindness can result from opticnerve damage that is brought on byhigh blood pressure. The conditioncan also lead to bleeding in the reti-na, the light-sensing part of the eye.This disease is called retinopathy,which can result in partial or com-plete blindness. Early detection andtreatment can help to preventvision loss brought on by high bloodpressure.

Hardened Arteries. Atheroscler-osis, or a hardening and thickeningof the arteries, can result from highblood pressure. Hardened arteriescan lead to a greater buildup of fatsand cholesterol in the arteries andblood vessels, causing the heart toenlarge and weaken because it isforced to pump harder. This disease

Part 1: The Disease

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can block the proper flow of blood andoxygen that the heart, brain, and vitalorgans need to work properly. Bloodclots may also form in an artery,blocking the flow of blood entirely.While considered a slow and advanc-ing disease that mainly affects theaged, atherosclerosis (also called arte-riosclerosis) may result in a heartattack or stroke if left untreated overtime. In addition to high blood pres-sure, other risk factors that con-tribute to the progression of this dis-ease include smoking, diabetes, obesi-ty, and family history.

Heart Attack. As previously noted,hypertension can contribute to thehardening of arteries, which can leadto a heart attack. In order to functionproperly, the heart muscle itself needsa continuous supply of oxygen-richblood. When arteries become nar-rowed or blocked, this vital flowbecomes lessened, causing muscledamage and angina (chest pains).Heart attacks result when arteriesand the flow of blood to the heartbecome completely blocked. In gener-al, any disruption in the workings ofthe heart is life threatening and in

need of prompt medical attention.

Heart Failure. Another aspect of thetoll that high blood pressure can haveon the heart is in the form of heartfailure. As previously mentioned, theheart can be forced to work harderdue to complications of high bloodpressure and atherosclerosis. Underthese unhealthy, untreated conditions,the heart begins to stretch andenlarge (either partially or as awhole). Eventually, the heart fails tofunction effectively—either too much,not often enough, or irregularly—andultimately results in congestiveheart failure. This disorder mayinvolve a failing of the entire heart orjust one side of it. When the left sideof the heart fails, blood and other flu-ids get backed up in the lungs. Thefirst signs of this condition arebreathing problems, such as shortnessof breath. When the right side fails,blood may back up into other areas ofthe body as the veins fill and leakfluid into the surrounding tissue.Symptoms of right-side failure includefatigue, indigestion, liver damage, andswelling in the legs.


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Part 1: The Disease

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DASHing HighBlood Pressure

You can bring down high blood pressureby changing the way you eat. Just askJoe Wagner.

Wagner’s blood pressure was150/100 twoyears ago. Now it is 130/80, which is closeto the 119/79 level that is considered thehealthiest for adults. He also lost 20pounds.

Wagner made the changes by followinga diet called the Dietary Approaches to

Stop Hypertension—or the DASH diet, for short. He learned about the dietthrough a special computer-based project at his job.

“I didn’t exactly follow it to the letter,” says Wagner. “But I basically followed the advice on the Web site.”

Doctors at Harvard Medical School developed the DASH diet several yearsago. It emphasizes fruits, vegetables, and low-fat dairy products. The dietwas developed to test whether eating habits could lower blood pressureas much as blood-pressure pills.

Studies have shown that it does.

“The results were better than we ever dreamed of,” says Dr. Frank Sacks,the Harvard doctor who led the DASH diet studies. Sacks says if people followed DASH it could be a substitute for the “gazillions” of dollars spentevery year on blood-pressure pills.

Wagner just wanted to avoid taking pills, period. “I don’t like taking medicines for anything. I will take an aspirin for a headache but that isabout it.”

Wagner works at a computer company called EMC Corporation outside of Boston. The computer-based project he enrolled in is part of a BostonUniversity study. The researchers hope to show that weekly e-mails andpostings on a special Web site will help people stick with the DASH diet.They also collect blood pressure and weight information from people so

Wagner, continued on next page

they can track their progress. So far, about 1,000 EMC employees have participated.

Before he started the DASH diet, Wagner’s eating habits were…well, in hiswords, he was “pretty much a junk food junkie.” Burger King Whoppers on the way home. A real weakness for Twinkies.

His favorite sport to watch on TV? “The worst—football,” says Wagner,“because it is on during the late fall and winter when you’re not that activeanyway.”

Besides eating more fruits and vegetables (“vegetables for breakfast some-times, believe it or not,” he says), breakfast cereal made from whole grain, and a lot less meat, Wagner does not snack so much between meals. At work,he chomps on sugarless gum instead.

But Wagner says the DASH diet worked for him partly because it is “not reallythat severe.” It even allows for some sweets and fatty food. Every once in awhile he gives into temptation and has a big bowl of ice cream.

The e-mails have worked to encourage him to stick with it. He feels like he hasa bit more energy. His clothes fit better, too.

But Wagner’s eight-year-old son isn’t too happy about his dad’s diet. “He hatesit, laughs Wagner. “Before DASH, I used to take him out to Burger King andMcDonald’s.”


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Rising incidence of highblood pressure

Although heart disease and strokeare the first and third leading caus-es of death in the United States,there has been a continued reduc-tion in the overall death rates fromthese diseases. The medical commu-nity has attributed these improve-ments to a higher quality of medicaltreatment, lower sodium consump-tion, and more and more people giv-ing up smoking. However, mortali-ty rates from heart disease andstroke are expected to rise asAmerica’s population grows older.Finding newer and more effectiveways to treat hypertension will helpprevent the number of deaths fromboth heart disease and stroke fromgetting out of control.

While studies have shown that theincidence of high blood pressure inAmerica is declining, the statisticsand trends related to high bloodpressure remain staggering, if notmixed. For example, hypertensioncurrently affects over 25% of allAmericans—roughly 50 million peo-ple. In the United States in 1999,high blood pressure caused the

death of 42,997 people and con-tributed to the deaths of an addi-tional 227,000 others. (As comparedto the year before, this represents adecrease of 1,438 caused by highblood pressure, and an increase of17,000 due to complications fromthe condition.) What makes highblood pressure a greater health con-cern is that an estimated 31.6% ofAmericans have the disorder but donot even know it. Another obstaclein the fight for better treatment andprevention is lack of knowledgeabout treating the condition. TheAmerican Heart Association esti-mates that one-third of all people

Part 2: The Impact

Mortality ratesfrom complica-tions of highblood pressure,heart disease,and stroke areexpected to riseas America’spopulationgrows older.


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who have high blood pressure do notknow how to manage or control iteffectively.

Doctors and researchers alike attrib-ute the slight decline in the develop-ment of high blood pressure to thelifestyle improvements of youngerpeople and more effective drug thera-pies for older patients. However, withAmerica’s aging society and the sig-nificant lack of awareness about highblood pressure, future trends in thisarea continue to be a great cause forconcern.

For example, in the area of obesityalone, a disturbing 1999–2000 gov-ernment study found that 31% of allAmericans (almost 59 million people)are obese. When compared to the15% obesity rate in 1980, it meansthat twice as many Americans areobese today as were obese 20 yearsago. Obesity is a major risk for highblood pressure, heart disease,strokes, diabetes, and different typesof cancer. Adults who are even mod-erately obese are twice as likely todevelop high blood pressure as peo-ple who are not overweight.

Studies also show that obesity maybe the leading cause of high bloodpressure in older adults, and thatchildren and adolescents who areoverweight—and babies who areunderweight—stand a greaterchance of developing the conditionwhen they become adults. For theseand other reasons, high blood pres-

sure will continue to be a serious andthreatening public health concern forthe United States.

Uneven impact of highblood pressure

High blood pressure does not affectall people, races, or genders alike.For example, men are more likely todevelop the condition than women upto the age of 55, while aging womenbetween 55 and 74 become more like-ly than men to get high blood pres-sure. In fact, some statistics indicatethat the condition is harder onwomen than men. In 1999 alone, thehigh blood pressure mortality ratefor men was 17,194 as compared to25,803 for women.

A much more startling difference isthe impact that high blood pressurehas on African Americans, who areamong the most likely groups in theworld to develop the condition. Over50% of African-American males aresaid to have high blood pressure,while a little less than half of womenfrom this group suffer from it. Inaddition, African Americans are alsomuch more likely than whiteAmericans to develop high bloodpressure at an early age and to havehigher average readings. The overalldeath rate from high blood pressurein 1999 for white men and womenwas 12.8 per 100,000—as comparedto 40.3 per 100,000 for black femalesand 46.8 per 100,000 for black males.On average, African Americans with

The overall

death rate

from high

blood pressure

in 1999 for

white men

and women

was 12.8—

compared to

40.3 for black

females and

46.8 for

black males—

per 100,000.

Part 2: The Impact

17

high blood pressure have a muchgreater rate of stroke, heart failure,and other diseases than whites. Inthe area of kidney failure alone,African Americans between 25 and44 years old are 20 times more like-ly than whites to develop thishypertension-related disease. Onthe positive side, African Americansare considered more “salt sensitive”than other groups and can substan-tially improve their blood pressurelevels by losing weight and reducingtheir sodium intake.

Another key group that is morelikely to develop high blood pres-sure is older people, since levelstend to rise as people become older.Over 50% of Americans over 60years old have high blood pressure,and over 65% older than 75 sufferfrom the condition. This is because,as people age, the arteries becomeharder and less flexible, causing theheart to work harder to pump bloodthroughout the body. When thistakes place, only the systolic bloodpressure increases, causing what iscalled isolated systolic hypertension

Performing 30-40 minutesof any physical exercisethree to four times a weekcan help to lower bloodpressure levels.


18

(ISH). In general, doctors have to becareful when monitoring the bloodpressures of older people becausereadings can vary greatly within thefirst several minutes of an office visit.

On a positive note, older adults wholead stable, active lives may be ableto sustain normal blood pressuresthroughout life. For those who areinactive or have unhealthy lifestyles,studies have shown that medicaltreatment for high blood pressure hasproven to be effective in lowering therisk of heart attacks, strokes, andother complications in older patients.

Geography may also play a role in thedevelopment of high blood pressure inthe United States. For example,research has shown that AfricanAmericans and whites living in thesoutheastern U.S. have a higher riskof high blood pressure and strokethan Americans living in otherregions. Part of the reason for thisdiscrepancy is that people living inthis area are more likely to be fromlower economic and educational back-grounds, which make people in gener-al more susceptible to anxiety, depres-sion, and diets that are high in saltand poor in nutrition. In fact, many ofthe states within this region have

10% higher stroke rates than otherparts of the country. The 11 statesthat make up the so-called “strokebelt” are Alabama, Arkansas,Georgia, Indiana, Kentucky,Louisiana, Mississippi, NorthCarolina, South Carolina, Tennessee,and Virginia. It still remains unclearthe extent to which environment orgenetics are influencing thesemarked differences.

The impact of high blood pressure onother racial groups in the country ismore even. For example, Hispanicand Native Americans have similarrates of developing hypertension aswhites, while Asian/Pacific Islandershave the lowest rates among allminority groups. The only problem isthat high blood pressure is not beingadequately addressed or treated

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19

WOMENAs previously mentioned, women appearto suffer from high blood pressure later inlife, as compared to men. However, highblood pressure does have a particularimpact on women during pregnancy andmenopause.

Studies have shown that high blood pres-sure is common in up to 15% of all preg-nancies. Doctors usually monitor bloodpressure levels closely during the last threemonths of pregnancy, when it can quicklydevelop. For mothers who already havehigh blood pressure before their pregnan-cy, their blood pressure levels should beproperly treated and may become evenworse. For mothers who develop hyper-tension during the pregnancy, they facethe risk of harming themselves and theirbaby if it is not treated properly. In manypatients, high blood pressure subsidesafter birth.

Older women are also prone to develophigh blood pressure after menopause,when hormone changes in their bodiesmake them susceptible to the condition.Though research has not yet uncovered

the kinds of specific effects menopausehas on high blood pressure, doctors rec-ommend that older women carefully mon-itor their blood pressures on a regularbasis.

CHILDRENThough high blood pressure in children islargely uncommon—about 1 percent of allchildren in the U.S.—the children of par-ents who have the condition are 20 to 30percent more likely to develop high bloodpressure than those with parents with nor-mal blood pressures. Another potentialcause is the lifestyle habits that childrenand adolescents learn from their parentsor siblings. For example, children are morelikely to develop high blood pressure asadults if they have poor diets, smoke ordrink, take drugs, or are inactive or over-weight. For these and other reasons, it isrecommended that children have theirblood pressure taken on regular intervalswhen they are as young as three years old.In the rare cases when children developsevere high blood pressure, it is usually asymptom of a more serious problem, likeheart irregularities or kidney disease.

Uneven Impact of HBP—High Blood Pressure in Women and Children

among these groups—particularlyAfrican and Hispanic Americans—causing yearly mortality rates fromheart disease and stroke to be unnec-essarily high.

Reasons for uneven impact

Among the other reasons for theuneven impact of high blood pressureare genetics, economics, and culture.

Health research has proven thatgenetics is one of the causes of highblood pressure and cardiovasculardisease. Genetics is the field of sci-ence that looks at how genes arepassed down from one generation to

another to influence traits.Researchers have been able to identi-fy that certain racial groups likeAfrican Americans, for example, carrycertain genes that perhaps mayincrease the likelihood of developinghigh blood pressure. Some studiesnow suggest that 30 to 60 percent ofall primary high blood pressure casesmay be genetically inherited. Otherinvestigations also suggest that a per-son is more likely to develop hyper-tension if he or she has a sibling withcoronary artery disease—as comparedto having a parent with the ailment.The genetics of high blood pressureremain a critical area of study formedical researchers, since future find-ings may help to explain why certain


20

Percent of persons who were ever told they had high bloodpressure, Adults aged 20 years and older, 2001

20%–24.3%

24.4%–26.0%

26.1%–27.8%

27.9%–32.7%

Age adjusted to the 2000 U.S.population

individuals or groups of people havea greater genetic predispositionfor high blood pressure than others.

Economics is another key factorthat can further explain the unevenimpact of high blood pressure inAmerica. For example, millions ofAmericans with lower incomes andlower educational backgrounds maynot be able to attain health insur-ance without a full-time job. ManyAmericans either work in low-pay-ing, part-time jobs or are unem-ployed, which makes them andtheir family members more likely tobe without adequate health insur-ance (or treatment if they have highblood pressure). By comparison,people with salaried jobs and higherlevels of income are better able toafford decent health coverage or theadded medical expenses that cancome from developing a conditionlike high blood pressure. Better cov-erage also increases the likelihoodof receiving better care.

Unfortunately, people from lowersocioeconomic groups also tend tohave diets that are poorer in nutri-tion and to be less physically active,both of which can lead to high bloodpressure. Many struggling familiesmay be unable to afford or fully rec-ognize that fresh fruits and vegeta-bles are the cornerstone of ahealthy diet. Instead, frozenprocessed foods or high-sodiumsnacks may be the affordable foodchoice for many. In addition, peopleliving in poor areas have feweropportunities to develop and sus-tain physically active lifestyles, dueto safety reasons and fewer parks oraffordable fitness centers.

Cultural, particularly language, dif-ferences is another cause of theuneven rise of high blood pressurein a given population. For example,in the United States, members ofminority groups who do not speakEnglish may have a harder timehearing, reading, or understandingthe basic information about high

blood pressure that istransmitted to the publicthrough television, news-papers, radio, pamphlets,or directly from healthcare providers. The lack ofexposure to health careinformation (and treat-

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21

Some studies now suggest that 30to 60 percent of all primary highblood pressure cases may begenetically inherited.

ment) is particularly common withminorities who have poor educationsand come from low-income families.Many immigrants also remain unin-formed or indifferent about the disor-der, since they may have come fromcountries or cultures with poor healthcare standards and facilities. Theymay also dispute the effectiveness ofmedicine, be afraid of doctors, or con-sider prevention efforts to be either aluxury or a waste of time.

When it comes to health, teenagersare often perceived as coming from adifferent culture than their parents oradults in general. With their energyand unbridled youth, many teenagersoften take for granted that they willalways be healthy and will live longlives. What they tend to miss or over-

look is the fact that how they livetoday can affect their health whenthey become adults. Eating poorly,avoiding physical activity, smoking,and drinking can cause them to pre-maturely and unnecessarily develophigh blood pressure—not to mention anumber of other serious conditions orillnesses. These and other barriersmake it harder for the medical com-munity to reach and inform teenagersabout the wisdom of prevention andproper treatment.

High blood pressure will continue tohave a disproportional effect on thepeople of the United States until allmajor groups are given the propersupport, information, and access tohealth care on an ongoing basis.


22

Part 2: The Impact

23Saunders, continued on next page

Making Noise aboutHypertension andAfrican AmericansPeople of all races and ethnic groups gethigh blood pressure, but it is an especiallyserious problem for African Americans.

We know that is true partly because of 30 years of work by Dr. Elijah Saunders.

Saunders is a professor at the University ofMaryland Medical School in Baltimore andhead of the hypertension section there.

His research has helped show that some blood pressure medications aremore effective than others for African Americans. He helped start anorganization called the International Society on Hypertension in Blacks.

Recently, the organization came up with guidelines telling doctors howthey should treat high blood pressure in their African Americanpatients, which is not always the same way it should be treated inwhites. For example, many African Americans need to start on at leasttwo medications to lower their blood pressure.

“Why waste time and effort prescribing just one drug when in mostcases it won’t work?” asks Saunders.

Saunders was inspired to become a doctor by the example of Dr. RalphReckling, one of the doctors in the segregated west Baltimore neigh-borhood where he grew up.

When Saunders was a medical student in the late 1950s, doctorsthought only people with extremely high blood pressure would benefitfrom treatment. “Extremely high” meant readings in the 200s and 300s.Blood pressure that high is called malignant hypertension.

The attitude about blood pressure started to change after the results of a study by the Veterans Administration were published in 1970. Thestudy included people with what was then considered moderately high


24

blood pressure. The results showed that lowering even moderately high levelslessens your risk of having a heart attack or stroke.

Those early studies didn’t include many African Americans, but others thatcame after did. Saunders worked to push the problem of African Americanhypertension into the spotlight.

“There was a lack of appreciation that this is a more serious problem inAfrican Americans that needs to be treated aggressively,” he says. Saunders also co-wrote Hypertension in Blacks, the first thorough textbookon the subject. He researched blood pressure medications and found thatdrugs called calcium-channel blockers were more effective in AfricanAmericans than other drugs.

Hypertension is still a major problem for African Americans. Approximately 30percent of adult African Americans have high blood pressure compared withapproximately 22 percent of white adults.

But Saunders says progress has been made. More doctors are aware that theymust pay extra close attention to the blood pressure of their black patients.Drug companies make a point of including African Americans in their studies.The federal government has paid for large studies of blood pressure medica-tions, including one that cost about $100 million.

He notes, “A funded study like that would have never happened if it hadn’tbeen for the noise me and my colleagues made.”

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Part 3: Care

Diagnosing high blood pressure

The diagnosis for high blood pres-sure is fairly simple and painless. Aspreviously mentioned, to measureblood pressure, a doctor or nursewraps a sphygmomanometer (bloodpressure cuff) around the upper armand pumps it with air, so the instru-ment can cut off the circulation inyour artery. Then, with the use of astethoscope, the doctor or nursegradually lets air out of the cuff inorder to listen to and accuratelymeasure the level of your blood pres-sure when it is being pumped (sys-tolic pressure) and when the beatingstops (diastolic pressure).

Since blood pressure levels andmeasurements can change quicklyand vary in degree, a doctor maydecide to take a patient’s blood pres-sure more than once. This mayinvolve taking measurements whilethe person is both standing and sit-ting down or at different points inthe week, since blood pressure maybe high on one day and more nor-malized on another. Factors thatcontribute to these fluctuationsinclude stress, worry, and the kindof usual nervousness that can arise

during a doctor’s visit(which is alsoreferred to as “whitecoat hypertension”).This broad-basedapproach enablesdoctors to more accu-rately determinewhether a personactually suffers fromhigh blood pressure.

The two numbersthat are measured—the systolic and dias-tolic pressures—canvary greatly depend-ing on the health and background ofthe patient. For example, a readingbelow 120/80 is considered averageor normal for most adults. Doctorsalso consider blood pressure read-ings like 110/70 to be “low” and,therefore, safe and acceptable.However, doctors identify someoneas having “high blood pressure”when his or her systolic pressure (top number) is at 140 or higher orwhen his or her diastolic pressure(bottom number) is at 90 or above.For instance, people with blood pres-sure readings of 110/90, 140/70, and150/90 all have high blood pressure.In these cases, patients are usually


26

prescribed some combination of treat-ment, often involving a healthier diet,physical exercise, and/or medication.

People who have a systolic pressure of120-139 or diastolic pressure of 80-90have a condition known as prehyper-tension that affects 46 millionAmericans. People who are diagnosedwith prehypertension are at high riskfor developing high blood pressurelater on, but making healthy lifestylechanges now can help prevent thatfrom happening. People with prehy-pertension should have their bloodpressure monitored regularly.

As shown in the chart below, highblood pressure is also commonly diagnosed and classified at differentlevels.

Preventing and controllinghigh blood pressure

Although there is still no cure forhigh blood pressure, it can be effec-tively controlled through treatmentthat may involve lifestyle and dietarychanges, as well as medication. Forthose who have yet to develop the con-dition, maintaining a healthy lifestyleand diet throughout life can go a longway in preventing this potentiallydeadly condition.

There are many ways people of allages, races, and family backgroundscan help to prevent or lessen theirchances of developing high blood pressure. Among the most importantrecommendations are:

• Maintain the right weight (loseweight if obese).

American Heart Association recommended blood pressure levels

Blood Pressure Systolic (top number) Diastolic (bottom number)

Category (mmHg) (mmHg)

Normal less than 120 and less than 80

Prehypertension 120-139 or 80-89

High

Stage 1 140-159 or 90-99

Stage 2 160 or higher or 100 or higher

mmHg = millimeters of mercury

Diagnosing high blood pressure levels

27

• Eat properly (limit salt intake).

• Get exercise.

• Practice relaxation techniques to reduce stress.

• Avoid alcohol and tobacco.

• Monitor your health (includingregular blood pressure readings).

• Take blood pressure medicine, if prescribed.

You can greatly reduce your chanceof developing high blood pressure byfollowing the recommendations list-ed above. In more serious cases,medication may be necessary tohelp control the condition. However,it is very important to prevent thedevelopment of high blood pressurein the first place.

The following is a more in-depthreview of the key ways that peoplewith and without high blood pres-sure can help to control or preventthe condition from becoming severeor out of control:

Maintaining the rightweight

Over 50% of all Americans are over-weight, with 31% classified as“obese.” Even more serious is thefact that the percentage of childrenand adolescents who are obese hasdoubled in the last two decades.

The link between weight and bloodpressure is often very strong anddirect. Moreover, as people gain

weight, their blood pressure levelsincrease. The same is true for manypeople who are obese but loseweight—they can expect their bloodpressure levels to decrease. In fact,losing ten pounds or more can helpto lower your blood pressure. This iswhy weight loss is considered one ofthe most important and effectivenatural treatments for preventingor reducing high blood pressure.

So, when is a person considered“obese” or “overweight”? As a gener-al rule, men are considered obesewhen they are 20 percent over theirideal weight, as based on theirheight. Women are considered obeseat 25 percent over ideal. Adults, ingeneral, are considered morbidlyobese when they are 100 pounds ormore overweight. People who areoverweight (as opposed to obese) arebelieved to be two to six times morelikely to develop high blood pressure

Part 3: Care

than those who are at or maintaintheir healthy, desirable weight levels.

It is worth noting another factor thatcan influence the likelihood of a person developing high bloodpressure. This has to do with wherean overweight person carries fat ontheir body. For example, there is evi-dence to suggest that people who are“apple-shaped,” storing extra weightaround their waists, are more at riskfor health problems than those whoare “pear-shaped,” storing excessweight around their thighs and hips.

Weight and shape aside, what is cer-tain is that weight loss can greatlyreduce the possibility of developing

high blood pressure. The key to losingweight is to take in fewer calories(energy) than you burn up. It isimportant to steer clear of weight losspills or the newest, most populardiets, because they can be dangerousand are usually ineffective in keepingweight off over the long term. Thebest way to reduce or keep bloodpressure levels healthy over thecourse of one’s life is to develop andcommit to a new lifestyle plan thatstarts with eating better and gettingmore physical activity. In general,maintaining the right weightthroughout life will not only help tolower blood pressure, but will reducethe likelihood of developing other ill-nesses like cancer, heart disease,stroke, diabetes, and kidney disease.

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29

Eating properly

The golden rule for living a longand healthy life is maintaining abalanced diet that includes fruits,vegetables, grains, and fish alongwith limited amounts of salt, fat,and sugar. This is especially impor-tant for people with high bloodpressure who are also striving tolose weight.

As mentioned earlier, more thanhalf of all Americans are over-weight. A natural consequence ofthis fact is that Americans eat moresalt and sodium than they should.As a rule, many medical organiza-tions recommended that people con-sume no more than 1 teaspoon(2,400 milligrams) of sodium a day.Americans, on average, take inbetween 4,000 to 6,500 milligrams aday! This is why more Americans—as compared to people in othercountries—have a greater risk ofdeveloping high blood pressure.(African Americans and the elderlyare particularly sensitive to sodi-um.) There are many reasons forthis health disparity, as well asmany healthy actions that peoplecan take to improve their diets,lifestyles, and blood pressures.

One critical change that people suf-fering from high blood pressureneed to make is to reduce theamount of salt and sodium theyconsume. This includes table saltand foods that are high in sodium,

like canned soups, smoked meats,seasonings, and many packaged andprocessed foods. This is why it isimportant to read the “NutritionalFacts” labels on most goods at thesupermarket in order to determinehow much sodium per serving afood item contains.

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MONITOR LABELS: Foodswith High Salt or SodiumHot dogsCanned soupsKetchupSaltinesSausagesCanned vegetablesMustardPretzelsHamPicklesCheesePotato chipsSmoked meat/fishSauerkrautSoy saucePackaged frozen dinnersCanned meat/fishOlivesTomato sauce/juicePackaged cakes/pastries


30

Sodium chloride is the equivalent of table salt. It contains about 40percent sodium. Sodium is definedas “a silvery, soft, waxy, metallic element that occurs abundantly in natural compounds, especially in saltwater.” Sodium is created naturallyin foods, often in small amounts.These foods include milk, meat,cheese, fish, and some vegetables.

Buying foods that are low in sodiumor that have labels like “no salt” or“low sodium” can help to reduce orprevent the onset of high blood pres-sure. Since “fast food” and otherrestaurant meals are high in sodium,it is also important to make healthi-er food choices. While eating out, thismay even require asking waiters tohold the salt in preparing meals.Using doctor-recommended salt sub-stitutes is another good habit thatcould go a long way in improvingblood pressure.

As with weight loss, a long-termreduction in salt consumption candirectly reduce blood pressure levels.In fact, a simple regimen of weightloss and salt reduction can help 20 to 25 percent of high blood pressurepatients normalize their levels andeven avoid the need to take specificmedications.

Getting exercise

Along with eating properly, regularphysical activity is the key to losingweight, feeling good, and ensuringbetter, lifelong health. In addition tolowering blood pressure, exercisehelps to burn calories, reduceappetites, tone muscles, alleviatestress, lower cholesterol levels, andprevent heart disease and countlessother health problems.

Whether one has high blood pressureor not, it is widely recommended thatpeople perform at least 30 to 40 min-utes of physical exercise three to fourtimes a week. The benefits are innu-merable. In terms of high blood pres-sure, people who exercise are 20 to50 percent less likely to develop highblood pressure than those who arenot physically active.

There are many forms of exercisethat can meet the standard, weeklyhealth requirement. If done on a con-tinual basis, light-to-moderate activi-ties like walking, climbing stairs, orgardening can have many health

People whoare obese

experience a greater

decrease inappetite after

physical exercise than

those who areat their idealbody weight.

benefits. While more aerobic formsof exercise like running, biking, ortennis may appear to have moresubstantial and immediate benefits,there is no concrete proof that thesemore strenuous activities are moreeffective than a regimen of moremoderate and enjoyable ones. Thatis why it is necessary for all peo-ple—particularly those diagnosedwith high blood pressure—to develop and commit to long-termexercise routines that they enjoydoing.

For those who are not physicallyactive, it is always a good idea toslowly and gradually adjust to anew and reasonable exercise rou-tine. To avoid injuries and otherserious complications, the choiceand duration of the exercise routineneeds to be consistent and appropri-ate for the age and physical condi-tioning of the person. While mostpeople do not have to consult with adoctor before starting, there are anumber of health conditions thatrequire a doctor’s approval, including:

• High blood pressure• Chest or shoulder pain• Dizziness or faintness• Being out of breath after light

exercise• History of stroke, diabetes,

or heart disease• Other serious medical or physical

conditions

Avoiding alcohol and tobacco

Using alcohol or tobacco to excesscan greatly raise blood pressure(and lead to numerous other med-ical and personal problems).

While putting a person at greaterrisk for developing high blood pres-sure, excessive alcohol consumptioncan damage the liver, heart, andbrain. High in calories, alcohol caneasily hurt one’s efforts to loseweight. As a result, it is recom-mended that people who choose to drink do so in moderation.According the Dietary Guidelinesfor All Americans, women should

31

Part 3: Care

What is considered a drink?12 ounces of beer, regular or light (150 calories),1.5 ounces of 80-proof whiskey (100 calories), or 5 ounces of wine (100 calories).

32


limit their consumptionto one drink a day, andmen to two drinks a day.(Blood pressure levels canbe raised by drinking“excessive” amounts ofalcohol such as 36 to 48ounces of beer, 3 to 4ounces of 100 proofwhiskey, or 18 ounces of wine.)

A number of recent stud-ies have shown that limit-ed alcohol consumption isnot entirely bad for peo-ple and can have somehealth benefits. Forexample, some clinicaltrials have indicated thatpeople who have one ortwo drinks a day havelower blood pressure andlive longer than thosewho drink too much.Others have found thatlimited wine consumptioncan prevent the accumu-lation of fat in the arter-ies and raise “good” bloodcholesterol. However,

these few benefits aside, what isunmistakable is that excessive alco-hol has been and continues to be thesource of countless personal, medical,and social problems throughout theworld. Those who have a history ofalcoholism in their families or who have a particular sensitivity to alcohol should keep from drinkingaltogether.

Another potentially habit-formingand health-threatening substance istobacco. Cigarette smoking increasesthe risk of heart disease, stroke, anda variety of lung diseases, such asemphysema, bronchitis, and lung can-cer. While it has not been proven todirectly increase blood pressure,smoking has played a significant rolein damaging blood vessel walls andspeeding up the hardening of thearteries—all of which lead to thedevelopment of high blood pressure.

The easy answer to the problem ofsmoking is not to start in the firstplace. This is particularly true forAmerican women who, statisticsemphasize, are 2 to 6 times morelikely to have a heart attack thanwomen who don’t smoke, with the

What is cholesterol?Cholesterol is a soft, waxysubstance that is found inall areas of the body suchas the heart, liver, intes-tines, muscle, skin, andnervous system. It is pro-duced by the body andderived from animal-basedfoods (like meat, eggs, andbutter) in the diet.

There are two types ofcholesterol: “good” and“bad.” “Good” cholesterol(HDL) helps blood vesselsand the liver to clean upand eliminate excess cho-lesterol. “Bad” cholesterol(LDL) in the diet increasesthe risk of developingplaque in the arteries,which can hamper the flowof blood and lead tostroke or heart attacks. It isrecommended that peoplemaintain blood levels thatare low in “bad” choles-terol and relatively high in“good” cholesterol.

risk increasing based on the numberof cigarettes smoked each day. Forthose who do smoke, the simple solu-tion is to gain the support you needto quit. The payoffs are remarkable, if not immediate, since the risk ofheart disease after the first year ofquitting is reduced by more than 50 percent.

Monitoring health

Another important aspect in pre-venting and treating high blood pressure and other related condi-tions involves keeping track of andbeing informed about your health on an ongoing basis. This involvesmeeting with your doctor for regularcheck-ups and having your bloodpressure measured on a regularbasis, particularly if you have highblood pressure or prehypertension.Again, it is recommended that peoplehave their blood pressure checked atleast once a year. For those withhypertension, it is important to monitor, treat, and control the disor-der on an ongoing basis.

Doctors or health care providersoften advise their patients withhypertension to keep track of theirblood pressure on a daily basis usingsome form of home monitoringdevice. This allows the doctor andpatient to monitor and record howhis or her blood pressure changesover time. It also provides a moreaccurate diagnosis of the fluctuationsat different times of the day and in

between doctor visits. Home monitor-ing also helps in cases where apatient’s blood pressure levels ormedications change frequently.Overall, it is normal for blood pressure readings to fluctuate 20 to 30 mmHg at different times of the day, particularly after per-forming some form of physical activity or while experiencingmoments of excitement. It is suggest-ed that patients do not become over-ly concerned about these fluctuationsor become obsessive about theirreadings in general.

Today, there are a number of homemonitoring equipment options tochoose from. There’s a portable, one-unit device that includes a sphygmo-manometer and stethoscope. Thereare also three types of electronicmonitoring devices to consider—mer-cury, aneroid (air), and automatic.Though each device has its ownadvantages and disadvantages, mostare affordable, easy to operate,

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33

Using homemonitoringdevices are an easy andaffordable way forpatients tokeep track of their bloodpressure on a daily basis.

widely available in pharmacies anddiscount chain stores, and usually

take less than aminute to attain anaccurate reading.Some devices evenrecord or print outyour readings. It isrecommended thatpatients talk withtheir doctor or healthcare provider aboutwhich type of devicewould best suit theirneeds.

Taking blood pressure medicine

For those whose high blood pressureis serious enough to require medica-tion, it is important to remember thatchanges in diet and lifestyle are alsoabsolutely necessary. No single “won-der” drug or large amount of medica-tion will help a person reduce his orher blood pressure to a healthylevel—how one eats and lives willneed to be improved as well. In fact, ithas been shown that only 40 to 50percent of people who rely solely onmedication to reduce their blood pres-sure to normal levels are successful.

Thanks to advancements in medicineand technology, a number of medica-tions have been developed to help peo-ple with severe high blood pressure tolive normal, functional lives well intoold age. In most cases, the addition ofmedicine to a person’s treatment can

help to dramatically improve theirblood pressure in less than a year.

When a person is first diagnosed withhigh blood pressure (and medicine isrequired), doctors typically prescribediuretics, which is in line with a2003 report and recommendation bythe Joint National Committee (JNC)on Prevention, Detection, Evaluation,and Treatment of High BloodPressure. Doctors may also prescribea second medicine, such as a betablocker, to help patients meet theirblood pressure goals. The JNC alsorecommends that otherwise healthyAfrican-American patients, who areparticularly sensitive to sodium, begintheir treatment taking only diureticsor a combination of drugs containingadequate doses of a duretic.

Depending on the patient and theseverity of the problem, doctors mayalso choose to combine one medicationwith another to help better control orlower the patient’s blood pressure.Patients are commonly prescribed two or more medications from differ-ent classes, since blood pressure med-ications often complement each otherin their efforts to reduce blood pres-sure. A very common example is thecombination of diuretics and ACEinhibitors, which has proven to help75 to 80 percent of people who setgoals of lowering their blood pressurelevels below 140/90 mmHg. (The use of only one of these medicationshelped 40 to 50 percent achieve thesame goal.) People with more serious or unstable high blood


34

Of all peoplewith high bloodpressure:• 14.8% are not on

a special diet ormedication

• 26.2% are on inadequate therapy

• 27.4% are on adequate therapy

pressure may need to take vasodila-tors—which lower blood pressure byopening up vessels—along with adiuretic or other anti-hypertensivemedication in order to help lowerfluid retention.

Once a patient’s blood pressure hasimproved and stabilized for at least12 months, doctors typically imple-ment what is called “step-down”therapy. This approach allows doc-tors to gradually lessen either thenumber or dosage of the medications

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35

High Blood Pressure MedicationsA person with high blood pressure may be prescribed one or more of the followingmedications. Each work to lower blood pressure in different ways.

Diuretics—also known as “water pills” for their ability to flush out extra salt andwater from the body and blood vessel walls. This allows blood vessels to open wider,improving the circulation of blood in the body. Diuretics come in many different formsand range in duration, some lasting from 4 to 6 hours while others may last up to 48hours. Proven to effectively lessen the risk of heart attacks and stroke. Often usefulwith other blood pressure medications.

Beta Blockers—have been prescribed for over 30 years to make the heart beat slowerby reducing or “blocking” the effect of nerve impulses to the heart and blood vessels.This helps the heart work less strenuously, therefore lowering blood pressure levels andreducing the chance of heart failure and stroke in many patients.

ACE Inhibitors—Angiotensin Converting Enzyme (ACE) inhibitors are a class of drugsthat are commonly used to prevent the production of the hormone angiotensin II,which causes blood vessels to constrict, causing blood pressure to rise. ACE inhibitorshelp the blood vessels relax and open up and lower blood pressure. When combinedwith other blood pressure medications, ACE inhibitors can help to effectively treat peo-ple who have suffered from heart failure or those with diabetes and kidney disease.

Angiotensin Receptor Blockers (ARBs)—work by reducing the effects ofangiotensin II. For angiotensin II to cause blood vessels to constrict, it must bind to areceptor in much the same way that a key must fit into a lock to open a door. ARBsblock angiotensin II from binding to its receptor, which helps blood vessels to relax.

Calcium Channel Blockers (CCBs)—have been used for over 20 years to prevent cal-cium from entering the muscle cells of the heart and blood vessels, causing the vesselsto relax and open up, and lowering blood pressure.

Alpha Blockers—work to reduce or “block” nerve impulses to blood vessels, causingthem to relax and blood pressure to go down.

Alpha-beta Blockers—combine the blood vessel relaxing alpha blockers with betablockers, which cause the heart to beat more slowly. The combined effect lessens theamount of blood (and pressure) through the vessels.

Nervous System Inhibitors—help to lower blood pressure by controlling nerveimpulses that allow blood vessels to relax and widen.

Vasodilators—help to lower blood pressure by causing the muscle in the artery wallsto relax and blood vessels to open up.

the patient has been taking. The pur-pose is to see if the patient can stillstabilize his or her blood pressurewhile either reducing the number ordosage of the medications being pre-scribed. While some patients cannotafford to reduce their blood pressuremedications, any lifestyle or dietarychanges they undertake can ultimate-ly help to “step down” their relianceon medications in the long run.

Most patients tolerate blood pressuremedications without side effects. But some patients may experience a variety of side effects. These includeirritating ones—like dizziness,

drowsiness, or skin rash—and poten-tially serious ones, including depres-sion, hallucinations, and heart prob-lems. Diuretics have also been provento cause muscle cramps and fatigue in some patients, while ACE inhibi-tors are known to cause chroniccoughing. However, most people feelfew or no side effects while takinghigh blood pressure medicine.

Patients who are prescribed medica-tions and develop one or more sideeffects should inform their doctors,since there are a number of othermedications or dosage amounts thatcan help to stabilize blood pressurelevels with few or no side effects. This is particularly true for high bloodpressure patients also suffering fromdiabetes, kidney disease, or other dis-orders, since doctors often prescribestronger medications or higherdosages to treat these more threaten-ing illnesses. It may be necessary fora patient to try different types ofblood pressure medications in order to find the one that works most effec-tively.

As with other medications, it isstrongly recommended that patientscontinue taking the prescribed medi-cine unless a doctor decides different-ly. It is also suggested that patientsconsult with their doctor about othermedications they might be taking,since certain types of drugs cause arise in blood pressure levels. It is alsoimportant to tell your doctor aboutany herbs or other natural or alterna-


36

Medications That Can Causeor Aggravate HypertensionAntidepressants (monoamine

oxidase [MAO] inhibitors and tricyclics)

Anti-inflammatory drugsAppetite suppressantsCold remediesCyclosporineNasal decongestantsOxymetazoline Phenylephrine Phenylpropanolamine Pseudoephedrine Nonsteroidal anti-inflammatory drugs

(NSAIDs)Aspirin Ibuprofen Naproxen sodium Oral contraceptives

Excerpted from: Essential Guide to Hypertension, American MedicalAssociation, 1998.

tive medicines you may be taking.Just because an alternative medicineis considered “natural” does notmean that it is safe. Some herbs maylower the effectiveness of your med-ication or actually raise your bloodpressure.

Blood pressure treatmentplansOne of the primary purposes of atreatment plan is to bring bloodpressure levels down in order toreduce the chances of health-threat-ening complications, like stroke,heart disease or kidney failure.Depending on the circumstances, thedoctor and patient will work closelytogether to develop an appropriateand individually tailored plan oftreatment. The plan itself may take

some time to get used to and willeither be implemented in the hospi-tal, at home (while under closesupervision), or both. Most plansmay involve a number of lifestylechanges, medication, and an ongoingmonitoring of blood pressure levels.

As emphasized earlier, all treatmentplans involve making changes in dietand lifestyle to facilitate weight lossand the lowering of blood pressurelevels. This may include adjusting toa diet that is low in fat and sodium,and lifestyle changes that involvelots of physical activity and an avoid-ance of alcohol and smoking.

These and other basic, personallifestyle changes will go far in help-ing to reduce one’s blood pressure,particularly those who have to rely

Part 3: Care

37

Ten Ways to Control Your High Blood Pressure

Know your blood pressure. Have it checked regularly.

Know what your weight should be. Keep it at that level or below.

Don’t use excessive salt in cooking or at meals. Avoid salty foods.

Eat a low-fat diet according to American Heart Association recommendations.

Don’t smoke cigarettes or use tobacco products.

Take your medicine exactly as prescribed. Don’t run out of pills even for a single day.

Keep appointments with the doctor.

Follow your doctor’s advice about exercise.

Make certain your parents, brothers, sisters and children have their bloodpressure checked regularly.

Live a normal life in every other way.

From the American Heart Association

on medication to get their conditionunder control. In time, these changeswill also help to limit the number anddosage amounts of medications need-ed to lower a person’s blood pressure.Naturally, treatment plans alsoinvolve regular check-ups with thedoctor, where possible side effects arediscussed, goals and adjustments aremade, and ongoing support and adviceare given. Doctors will most likely rec-ommend that the patient use an at-home blood pressure monitor on a reg-ular basis in order to make a detailedrecord of his or her readings betweenoffice visits and throughout the courseof the treatment plan.

If carefully followed and adjustedappropriately, treatment plans canwork wonders for people with highblood pressure. Unfortunately, it isoften hard to tell whether the changesand medications are helping becausea patient may or may not feel any different than he or she had before.Remember, the symptoms of this“silent killer” are hard to detect.Nevertheless, the unrecognizable ben-efits of treatment plans may very wellsave a patient’s life over the long run,since risk of stroke, heart disease,kidney failure, and other relatedhealth problems will be greatlyreduced.


38

39

Part 3: Care

One Doctor’s Reasonsfor Deciding How toTreat High BloodPressure

Sometimes the more choices you have, theharder it is to make a decision.

Doctors have that problem when it comes to picking the medication that is best for high blood pressure.

There are five major types to choose from: ACE inhibitors; angiotensin-receptor blockers; beta blockers; calcium-channel blockers; and diuretics.

It gets even more complicated. There are subtypes within those five types.And different medications are combined into a single pill. Lotensin HCT isone example. It is a combination of an ACE inhibitor and a diuretic.

So how do doctors decide what to prescribe?

To see what one doctor does, we spoke with Dr. Sandra Taler. Taler is aphysician at the Mayo Clinic, the world-famous medical center inRochester, Minnesota.

Taler says the first type of drug that she usually prescribes is a diuretic: “I have always been a big fan of diuretics.”

She is right in step with new government guidelines that say most peoplewith high blood pressure should try a diuretic first.

Diuretics work by helping the kidneys get rid of sodium (a chemical that ispart of salt) and water from the body. That decreases the volume of theblood, so there is less blood pounding against the walls of your blood ves-sels, creating high blood pressure.

There are two main types: loop and thiazide (pronounced THIGH-ah-zide).Most people taking a diuretic to control high blood pressure take a thiazide diuretic.

Taler, continued on next page

Many patients worry that the pills will make them have to go to the bathroommore often. At first, a thiazide diuretic does increase urination. But after sev-eral weeks, most people’s bodies adjust and levels return to normal.

Taler takes a different approach with her patients who have had a heartattack or experience the chest pain called angina that comes from the heartpumping without enough blood. For them, she’ll prescribe a beta blocker.

Beta blockers slow down the heart, so it is not pumping blood through yourblood vessels with as much force. Slowing down the heart helps if you’ve hadheart trouble, because it means the heart isn’t working as hard and can get bywith less blood.

If someone has diabetes, Taler says she orders some kidney tests. Dependingon the results, she would prescribe an ACE inhibitor. ACE inhibitors affectblood pressure by relaxing blood vessels but are less effective with excess sodium and water levels.

But treating high blood pressure with pills is no substitute for avoiding it inthe first place. People get high blood pressure for many reasons, but weightgain and eating too much salty food are two of the main ones. Salty food rais-es blood pressure, and Taler says people don’t have any idea just how salty thefood is when they eat out.

“That’s true at fancy restaurants,” she adds. “It is not just McDonald’s.”


40

Current lines of researchAs science, technology, and the fieldof medicine have advanced over thecenturies, so has humankind’sunderstanding about the mysteri-ous nature and widespread effectsof high blood pressure. Over theyears, many researchers have dedi-cated their lives to investigatingand discovering more effective waysof identifying, diagnosing, treating,and reducing the complications ofhigh blood pressure in all kinds ofpeople with all types of conditions.We read or hear about many ofthese exciting discoveries in thenews. While much has beenlearned, many questions remain tobe answered. The progress so farhas helped to improve—if notsave—the lives of millions of peoplewho have developed hypertension.As with other life-threatening dis-eases and disorders, the hope isthat explorations in the area ofhigh blood pressure will one daylead to a cure.

Today, there are still many ques-tions about high blood pressurethat researchers are trying to deter-mine. They include: How can highblood pressure be prevented ormore effectively treated? Why does

it affect African Americans and theelderly more than other groups ofpeople? How can the medical com-munity more effectively educate thepublic about this potentially deadlycondition? Research conducted inall areas and fields of science ishelping to build upon the reservoirof knowledge that we presentlyhave about high blood pressure.The following are examples of thetypes of research that are currentlyand actively taking place:

Population Studies. By studyinga group of people over time,researchers learn a great dealabout the nature and mechanics ofthe disorder. One such study is theJackson Heart Study (JHS), whichhas been focusing on cardiovasculardisease among African Americansfrom Jackson, Mississippi. Startingin the fall of 2000, the JHS beganto study 6,500 African-Americanmen and women between the agesof 35 and 84. Through question-naires, lab tests, and other investi-gations, the researchers hope todetermine how the common disor-ders of high blood pressure, dia-betes, and obesity influence thedevelopment of cardiovascular disease in African Americans.

41

Part 4: Research

Over the

years, many

researchers

have dedicated

their lives to

investigating

and discover-

ing more

effective ways

of identifying,

diagnosing,

treating, and

reducing the

complications

of high blood

pressure in all

kinds of people

with all types

of conditions.

42


The JHS is an extension of theAtherosclerosis Risk in Communities(ARIC) Study that took place in fourU.S. cities more than a decade ago.The ARIC Study involved a compre-hensive examination of 15,792 peopleover a 12-year period from fourdiverse regions in the U.S.: Minne-apolis, Minnesota; Forysth County,North Carolina; Washington County,Maryland; and Jackson, Mississippi.The purpose of the ARIC Study hasbeen to identify and study genetic andchemical risk factors of cardiovasculardisease.

The JHS represents the largestresearch study of cardiovascular dis-ease on an African-American popula-

tion to date. The research promises toyield significant findings that willhelp to better educate, prevent, andtreat cardiovascular disease and relat-ed disorders (like high blood pressure)among this particularly susceptiblegroup of Americans.

Another similar study is the clinicalAfrican-American Heart Failure Trial(A-HeFT) currently being sponsoredby NitroMed, a pharmaceutical com-pany. The study involves the recruit-ment of about 600 African-Americanmen and women from over 100 clinicsacross the United States who sufferfrom moderate-to-severe heart failure.Among other things, the trial isdesigned to test the effectiveness of

The JHS represents the largest research

study of cardiovasculardisease on an African-American population

to date, and promises to yield significant

findings that will helpto better educate, prevent, and treat

cardiovascular diseaseand related disorders

like high blood pressure among this

particularly susceptiblegroup of Americans.

a special nitric oxide–enhancedheart medication called BiDil® tosee if it can prolong or enhance thequality of the trial members’ lives.This important study is also spon-sored by the Association of BlackCardiologists and is bound to shedsignificant light on the relationshipbetween heart failure and highblood pressure in the high-riskgroup of African Americans.

Researchers also continue to inves-tigate the effects that high bloodpressure has on the aging. Onerecent study established a linkbetween depression and heart fail-ure among the elderly who havehigh blood pressure. This studyinvolved 4,538 people over the ageof 60 who were part of the SystolicHypertension and the ElderlyProgram (SHEP). Researchers dis-covered that heart failure developedin 18 of 221 depressed patients(8.1%), while it only affected 138 of4,317 (3.2%) other patients whowere not depressed. The investiga-tion represents one of the first stud-ies to establish a link betweendepression and the development ofheart failure. These and other find-ings from the investigation willhelp in understanding and address-ing the serious long-term complica-tions of high blood pressure amongthe elderly.

In addition, numerous other highblood pressure studies are beingconducted to search for possiblehidden insights about the disorder

among lower-risk groups. Manyrecent epidemiological studieshave found that small babies whogain weight too rapidly are morelikely than others to develop highblood pressure as adults. One particular study of 346 British menand women found that small babieswho experienced significant weightgain between the ages of one andfive developed higher blood pres-sure in adulthood. These findingshave brought into question theeffectiveness of pediatricians whooften encourage “catch up” growthfor small, underweight babies. Suchdiscoveries have caused doctors andresearchers to think about how andwhy high blood pressure can devel-op during pregnancy and infancy.

Part 4: Research

43

Many recent epidemiological studies havefound that small babies who gain weighttoo rapidly are more likely than others todevelop high blood pressure as adults.


44

Genetic Research. Diseases and dis-orders such as stroke, heart disease,and high blood pressure involve high-ly complex and countless interactionsbetween genes. This is whyresearchers across the world are try-ing to identify and isolate the specificgenes that may contribute to thedevelopment of high blood pressure.

Past and present studies have beenable to prove that there is indeed alink between our genetic (family) his-tory and high blood pressure. Thoughsome genes have been identified,researchers have yet to find anygenetic variations that have clearlyand repeatedly proven to influence

the development of hypertension. It has been shown, however, thatgenes produce proteins that ultimate-ly regulate body functions. In thissense, some gene-produced proteinscan make blood pressure levels rise,while others can cause them to godown. Under certain circumstances—like aging and exercise—some pro-teins can have a stronger effect onblood pressure levels than others.

One of the serious challenges ofresearching the genetics of high bloodpressure is the amount of resourcesand expertise needed to effectivelystudy the connection. Moreover, manymedical, scientific, and statisticalexperts are needed to properly design

Diseases and disorders such as

stroke, heart disease, and high

blood pressureinvolve highlycomplex and

countless interac-tions between

genes. This is whyresearchers across

the world are trying to identify

and isolate the specific genes that

may contribute to the develop-

ment of highblood pressure.

and implement the study. In addi-tion, researchers need a large poolof participants and a considerableamount of time to thoroughly testand gather massive amounts of datain order to accurately sift throughall the various factors—like medicalconditions or race—that can influ-ence blood pressure besides genetics.

As a result, a considerable amountof time and money are going to beneeded before a clear picture of thegenetic workings of high blood pres-sure can be determined.

Among the many benefits possiblefrom genetic research on blood pres-sure is that it may one day helpidentify early on who is more pre-disposed to develop the conditionthan others. As a result, people andtheir doctors could more easily pre-vent the development of high bloodpressure. Research on the geneticsof hypertension could also potential-ly address why some medicationsare effective in controlling bloodpressure in certain types ofpatients, but not in others. Withthese kinds of insights, doctorswould then be better able to identifyand prescribe the best medicationfor different kinds of patients.

The findings of one genetic researchstudy in 2002 helps to highlighthow real these possibilities are. The study found that people carry-ing a certain type of mutant genethat causes heart arrhythmias

face an increased risk of developingthis disorder if they take certaintypes of medication, including bloodpressure drugs. Researchers wereable to determine that the geneticvariant is found most often in peo-ple of African descent. Researchersare now hoping to confirm theirfindings and develop a test that will help them more easily identifycarriers of the gene, so that theymay be prescribed safer and moreeffective medications.

Weight management.For years, researchershave been searching forbetter and more effec-tive ways for people tolose weight and to keepit off. In the variousstudies dealing withweight loss and highblood pressure, there is added significancesimply because over-weight people sufferingfrom hypertension mayface serious complica-tions if they don’t loseor manage their weighteffectively.

One major 1997 research effortseeking to help high blood pressurepatients lower their sodium intakeand lose weight is the DietaryApproaches to Stop Hypertension(DASH) study. Supported by theNational Heart, Lung, and BloodInstitute (NHLBI), the DASH dietis a healthy low-sodium, low-fat,

Part 4: Research

45

The DASH diet is ahealthy low-sodium,low-fat, low-choles-terol eating planthat was clinicallyproven within weeksto significantlyreduce blood pres-sure levels andweight in men andwomen of all ages,races, physical condi-tions, and medicalbackgrounds.


46

low-cholesterol eating plan that wasclinically proven within weeks to sig-nificantly reduce blood pressure levelsand weight in men and women of allages, races, physical conditions, andmedical backgrounds. Studies haveshown that the DASH diet also lowers“bad” (LDL) cholesterol and homocys-teine (an amino acid), which hasshown to cause a greater risk forheart disease. In addition to samplemenus and recipes, the DASH dietplan also provides a form to documenteating habits before starting the dietand a chart that will help manageand guide a person’s shopping and

meal planning. As with the DASHdiet and other nutrition-based efforts,researchers work to find better ways for people on both sides of thehypertension fence to eat healthy and manage their eating habits moreeffectively.

Roughly 20 to 30 percent of allAmericans are considered “physicallyinactive.” Inactivity increases a per-son’s chances of developing high bloodpressure (as well as diabetes, heartdisease, and countless other healthproblems). Research continues touphold and reinforce the benefits of

Part 4: Research

47

exercise, weight loss, and lower bloodpressure. One recent study investi-gated the effects of aerobic exer-cise on blood pressure by examining54 previous exercise trials involving2,419 physically inactive adults.

Researchers found that after twoweeks of performing aerobic exercis-es like jogging, cycling, and swim-ming, the blood pressure levels of theparticipants decreased by 3.84/2.58mmHg. This average decrease wasexperienced by all groups within thestudy—those with and without highblood pressure and those who wereoverweight or of normal weight, aswell as members of all racial groups.The results of these and other exer-cise-based studies help to emphasizehow moderate amounts of exercisecan directly lower blood pressure,while improving the quality of one’slife and overall weight and fitnesslevel.

Prediction. Another related branchof the research effort involves tryingto predict who is at risk for develop-ing high blood pressure. Thisincludes trying to determine whichpeople or groups are more at risk fordeveloping complications from highblood pressure. Being able to predictdifferent aspects of the disorder willgo far in helping health careproviders more accurately preventand treat high blood pressure. Thework researchers are doing in thearea of genetics could help the med-

ical community more effectively identify, test, and treat individualswho, for example, are more likely todevelop high blood pressure or whowill not respond well to certain typesof medication.

The important role of volunteers

Researchers and medical science ingeneral would not be able to under-stand or make inroads against highblood pressure and other diseaseswithout the help of thousands of vol-unteers in the last century alone. Asparticipants in research studies, vol-unteers are willing to share theirpersonal medical history, participatein clinical studies often for long peri-ods of time, and accept many othersacrifices in order to helphumankind’s effort to uncoverinsights about high blood pressureand find better ways of treating it.Because high blood pressure affectspeople of all ages, races, andlifestyles—and often to varieddegrees—it is critical for researchersto be able to access and study hun-dreds, if not thousands, of membersof these different subgroups withinour population. This enables them togather more accurate race-, age-, orgender-specific information and pos-sibly uncover new insights or ways oftreating these special groups for highblood pressure.


48

When different subgroups or commu-nities participate in a research study,they are able to take advantage of themost current and perhaps effectivemedical treatment for, in this case,high blood pressure. The quality ofcare that volunteer patients receive

during the course of a study is oftenvery high and very beneficial.Volunteers also benefit from knowingthat their participation may one dayhelp others who are suffering from oraffected by high blood pressure.

Researchers

and medical

science in

general

would not

be able to

understand

or make

inroads

against

high blood

pressure

and other

diseases

without

the help of

thousands

of volunteers

in the last

century

alone.

49

Part 4: Research

Forecasting NewMedications’ Effect on the High BloodPressure Front

Statistics can be confusing—and be usedon purpose to cause confusion. But Dr.Lemuel Moyé says they are also somethingelse: the truth.

“Statistics tell how real something wethink we are seeing really is,” he says.

Moyé is a professor at the University ofTexas Health Science Center in Houston. He is one of the leading biostatis-ticians in the country. Biostatisticians are statistics experts who do medicalresearch and work closely with doctors.

Moyé was an important member of the research team that showed highsystolic blood pressure increases your risk for heart attack and stroke.Systolic blood pressure is the first, or top, number in a blood pressurereading. So if your blood pressure is 140/90, your systolic blood pressure is 140.

Doctors used to think that it was natural for older people to have a highsystolic blood pressure because their arteries got stiffer.

Moyé says, “Just because you are older doesn’t mean you don’t have toworry about systolic blood pressure.”

Moyé grew up in Queens in New York City. He had an interest in keepingtrack of numbers as a boy. Every day, he carefully recorded the weather—the temperature, humidity, and barometric pressure.

After majoring in math in college, Moyé graduated from medical schooland saw patients. But medical research, especially when it involved num-bers, was his true love.

Moye, continued on next page

50


The type of research that Moyé does is called a clinical trial. Many of themedical studies you hear about are clinical trials. They are done to testwhether a new medication is safe and effective.

In a typical clinical trial, the researchers give half of the people who volun-teered to be in the trial an experimental medication. They give the otherhalf a pill that looks and tastes like the experimental medication but, inreality, contains no medication. This “dummy pill” is called a placebo.

A lot of information is collected during the trial, including information onside effects. After the trial is over, biostatisticians like Moyé analyze thatinformation to see if there are important differences between the peoplewho got the medication and the people who got the placebo.

Objectivity and large numbers of patients are the reasons that clinical trialsare so important to medical research, notes Moyé.

He adds, “Physicians are supposed to be exclusively patient oriented. But itis that point of view that blinds them to an objective view of the therapy.Physicians drawing conclusions just from their own experience is fatallyflawed. ”

Moyé has slightly high blood pressure. Although he has studied blood pres-sure medications, his goal is keep his blood pressure under control withoutany pills. He keeps his weight down, doesn’t add salt to his food, and getshis blood pressure checked regularly.

“High blood pressure is like rain on a picnic. Everything about your healthis worse with it,” he says.

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Conclusion: Let’s bring downhigh blood pressure

We do not have to continue to lethigh blood pressure slowly andsilently creep up on millions of peo-ple each year. This life-threateningtrend can be changed or improvedupon, but it takes greater aware-ness and a lifelong commitment tohealthy living.

Below are a number of suggestionsand resources that can help every-day people steer clear of this debili-tating condition and educate othersabout this serious public healthproblem. Look on page 57 for fur-ther resources. The local library isalso a good source of information onhigh blood pressure.

Educate yourself about highblood pressure. Reading this bookis a great start. It is important tocontinue to educate yourself on highblood pressure, particularly as youget older and as new informationand research from the medical com-munity arises. Good sources ofinformation are the library and theInternet. Ask a librarian for help inyour search, if necessary. Make sureto share the interesting and poten-tially lifesaving insights you havelearned here and in the future

with your family, friends, and community.

Eat healthy and stay fit. Eatingwell and being physically activehave always been the golden formu-la for a long, healthy, and positivelife. The lives of those diagnosedwith high blood pressure maydepend on these simple and smartchanges. Adjusting to a low-fat, low-sodium diet has shown to improveblood pressure levels, not to men-tion all the other lifelong benefitsthat can come with weight loss.Getting out, exercising, and doingthings you enjoy help lower bloodpressure. The trick is to continuallythink about and take time to com-mit to this healthier way of living.Help friends and loved ones who are


52

less active and healthy to become bet-ter informed, since they are likely toface the kind of hypertensive treat-ment options explained in this book.

Quit smoking and avoid alcohol.High blood pressure aside, quittingsmoking and limiting alcohol con-sumption are just good ideas. Thebenefits are countless—from short-term financial savings to long-termhealth benefits. Getting these twoareas under control, if you do drink orsmoke to excess, will help to improveyour blood pressure (and many otherareas your life). If you know peoplewho smoke or drink too much, maketime to talk about it with them andsupport their efforts if they ultimatelytry to quit their use.

Monitor your health. In addition towatching your diet and gettingenough exercise, it is recommendedthat all people have their blood pres-sure checked at least once a year. Forthose with the disorder, checking yourblood pressure may be something youneed to measure and record severaltimes a day. Taking this initiative willhelp you and your doctor better con-trol, treat, and ultimately lower yourblood pressure. Monitoring otherrelated aspects of your health anddiet are also an important part of life.

Stick to your treatment plan. If you have high blood pressure andare prescribed a treatment plan,make sure to follow closely your doc-tor’s recommendations. For some peo-

ple, this may involve self-monitoringyour blood pressure and quittingsmoking. Sticking to your treatmentplan is the best way to lower yourhigh blood pressure and fend off otherserious illnesses.

Educate others in the community.Share what you have learned abouthigh blood pressure with your familyand friends. You can also get involvedin high blood pressure prevention pro-grams or volunteer for any researchstudies, particularly if you have thecondition. It may also be worthwhileto find out if your local schools areadequately addressing the problem interms of lunch menus, physical activi-ties, and general student awarenessabout high blood pressure. Gettinginvolved on the educational side ofthis “silent killer” will ensure thatyou and those you care about stayinformed over time and continue towork at maintaining a healthylifestyle.

53

Appendix 1: Questions to Ask YourDoctor about High Blood PressureIf you have not been diagnosed with high blood pressure…

• Am I at risk for high blood pressure?• Should I be tested for high blood pressure?• What is my body mass index?• Do I need to lose weight?• Do I need to make changes in my lifestyle to prevent high blood pres-

sure?• What help is available for making those changes?

If you have been diagnosed with high blood pressure...

• What can be my short-term goals for control of the high blood pressure?• What can be my long-term goals?• What is the treatment plan?• What lifestyle changes are required by this treatment plan?• What other specialists do I need to see?• What medications will help control the high blood pressure and compli-

cations?• What is the schedule for check-ups?• Can you help me locate a clinical trial to join?

Appendix 2: Taking Part in ResearchStudies—Questions to AskA research study is a way for finding answers to difficult scientific or healthquestions. Here are important questions you should ask of anyone whowants you or members of your family or community to be part of aresearch study on high blood pressure.

1. What is the study about?

• Why are you doing this study?• Why do you want to study me or people like me? Who else is being stud-

ied?• What do you want to get out of this study?• What will you do with the results?


54

• Have you or others done this type of study ever before? Around here? Whatdid you learn?

2. Who put this study together?

• Who is running or in charge of this study?• Whose idea was this study?• How were people like me part of putting it together?• Who are the researchers? Are they doctors or scientists? Who do they

work for?• Have they done studies like this before?• Is the government part of this study? Who else is a part of this study?• Who is paying for this study?• Who will make money from the results of this study?

3. How can people like me share their ideas as you do this study?

• How will the study be explained in my community?• Who of people like me will look at this study before it starts?• Who of people like me are you talking to as you do this study? A Community

Advisory Board?• Who from the study can I go to with ideas, questions, or complaints?• How will people like me find out about how the study is going?

4. Who is going to be in this study?

• What kinds of people are you looking for? Why?• Are you trying to get minorities in this study?• Are you including people less than 18 years old?• How are you finding people for this study?• Are transportation and/or daycare provided for people in this study?• Do I need to sign to participate?• Will you answer all of my questions before I sign the consent form?• Can I quit the study after signing the consent form? If I quit the study, will

anything happen to me?

5. What will I get out of this study?

• What are the benefits?• Is payment involved? How will I be paid?• Will I get free health care or other services if I participate? For how long?• Will I get general health care and/or psychological care if I participate? For

how long?

Appendix

55

6. How will I be protected from harm?

• Do I stand a chance of being harmed in this study? In the future?• Does the study protect me from all types of harm?• If I get harmed, who will take care of me? Who is responsible?• If I get harmed in any way, will I get all needed treatment? Who pays for

treatment?

7. How will my privacy be protected?

• Who is going to see the information I give?• Will my name be used with the information?• What happens to the information I gave if I quit the study?• Is there a written guarantee of privacy?

8. What do I have to do in this study?

• When did you start this study? How long will it last?• How much of this study have you already done?• Have there been any problems so far?• Will I get treated the same as everyone else?• What kinds of different treatments are offered in this study? Are there

both a real and a fake treatment?

9. What will be left behind after the study is over?

• What will happen to the information people give? How will it be kept?• What are you going to do with the results of the study?• How will the public learn about the results? Will results be in places

where the public can see them?• Are you going to send me a copy of the results? When?• What other studies are you planning to do here?

The questions above are from a pamphlet developed by Project LinCS (Linking Communitiesand Scientists), Community Advisory Board (Durham, NC), and Investigators (University ofNorth Carolina Center for Health Promotion and Disease Prevention) in cooperation with theCenters for Disease Control and Prevention, Atlanta, GA. [email protected] For copies of thisbrochure: CDC National Prevention Information Network 1-800-458-5231

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ResourcesAmerican Heart AssociationA privately funded, non-profit health organization providing basic informa-tion, news, personal stories, and health tips on various medical diseases andconditions including high blood pressure.American Heart Association—National Center7272 Greenville AvenueDallas, TX 75231800-AHA-USA-1www.americanheart.org

American Society of HypertensionThe largest American organization dedicated exclusively to research, diagno-sis, and treatment of hypertension and related cardiovascular disease.515 Madison Ave, Suite #1212New York, NY 10022212-644-0650www.ash-us.org

Bloodpressure.com—The Hypertension NetworkA web-based service that provides patients and the public with accurate andup-to-date information on hypertension and highlights effective ways to man-age the condition. A service of Lifeclinic.www.bloodpressure.com

ClinicalTrials.govA web-based resource for finding clinical trials in need of volunteers.www.clinicaltrials.govSelect the “hypertension” topic to search for high blood pressure–related tri-als.

Combined Health Information DatabaseA web-based service that combines resources on high blood pressure and otherdiseases from several federal agencies. A service of the National Institutes ofHealth.www.chid.nih.gov/simple/simple.html

Family Blood Pressure ProgramA large multi-center genetics study of high blood pressure and related condi-tions in multiple racial groups. Affiliated with the National Heart, Lung, andBlood Institute.www.sph.uth.tmc.edu/hgc/fbpp/


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Healthy People 2010A nationwide health promotion and disease prevention campaign sponsored bythe Department of Health and Human Services. One of the goals of the cam-paign is to reduce health disparities.Office of Disease Prevention and Health Promotion200 Independence Avenue S.W., Room 738GWashington, DC 20201www.healthypeople.govFor information on the Healthy People 2010 Microgrant program that financescommunity-based prevention activities:www.healthypeople.gov/implementation/community/

Hypertension Education Foundation, Inc. (H.E.F)An organization seeking “to improve health and possibly save lives by generat-ing and distributing information about hypertension and by promoting researchand teaching in the field of hypertension.”P.O. Box 651Scarsdale, NY 10583www.hypertensionfoundation.org/index.htm

International Society on Hypertension in Blacks (ISHIB)A non-profit, medical membership society dedicated to fostering research, devel-oping programs, and “promoting public awareness of the harmful effects ofhypertension, especially among ethnic populations.”2045 Manchester Street, NEAtlanta, GA 30324404-875-6263www.ishib.org

MEDLINEplusA comprehensive source of health information provided by the National Libraryof Medicine.www.nlm.nih.gov/medlineplus/highbloodpressure.html

National Center for Chronic Disease Prevention and Health PromotionPromotes the transfer of research knowledge into actual prevention and treat-ment strategies. Provides information to the general public. Affiliated with the Centers for Disease Control and Prevention’s Cardiovascular Health Program.www.cdc.gov/cvh/

National Heart, Lung, and Blood Institute Information CenterProvides patient education and professional materials on topics of interest tohigh blood pressure patients.P.O. Box 30105Bethesda, MD 20824-0105301-592-8573www.nhlbi.nih.gov/health/infoctr/National High Blood Pressure Education Programwww.nhlbi.nih.gov/hbp/index.html

National Hypertension AssociationAn organization dedicated to “conquering hypertension through research, edu-cation, and detection.”324 East 30th StreetNew York, NY 10016212-889-3557www.nathypertension.org

National Kidney and Urologic Diseases Information ClearinghouseProvides information about kidney disease as it relates to high blood pressure.A clearinghouse of NIDDK.3 Information WayBethesda, MD 20892-3580800-891-5390 or 301-654-4415www.niddk.nih.gov/health/kidney/pubs/highblood/highblood.htm

Native American Research Centers for HealthResearch centers that link the Native American community with healthresearch and that work to increase the number of Native American scientistsand health professionals.National Institute of General Medical SciencesNational Institutes of Health45 Center Drive MSC 6200Bethesda, MD 20892-6200301-496-7301www.nigms.nih.gov

New York Online Access to HealthA searchable health information resource in English and Spanish.www.noah-health.org/index.html

Office for Protection from Research RisksA source of information on the guidelines and ethics of research studies withhumans.

Resources

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National Institutes of HealthOffice for Protection from Research Risks6100 Executive Blvd, Room 3D01Rockville, MD 20892-7507

Office of Minority Health Resource CenterServes as a national resource and referral service on minority health issues,including high blood pressure. Affiliated with the U.S. Department of Healthand Human Services.P.O. Box 37337Washington, DC 20013-7337800-444-6472www.omhrc.gov/omhrc/

Office for Research on Minority HealthPromotes the health of racial and ethnic populations through research and education and through support of minority involvement in research careers.Affiliated with the National Institutes of Health.6707 Democracy Blvd., Suite 800MSC 5465Bethesda, MD 20892-5465800-444-6472 or 301-402-1366ncmhd.nih.gov

PHCentral.org—Pulmonary HypertensionFounded in the effort “to be the definitive internet resource for PulmonaryHypertension related information for Patients, Caregivers and MedicalProfessionals.”www.phcentral.org

Weight-Control Information NetworkHealth information and educational materials on weight loss. A clearinghouse of NIDDK.1 WIN WayBethesda, MD 20892-3665800-WIN-8098 or 301-984-7378www.niddk.nih.gov/health/nutrit/win.htm

The World Hypertension LeagueA global federation that is “devoted to the advancement of hypertension preven-tion and control through joint efforts of all national leagues and societies.”www.mco.edu/org/whl/index.html


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61

BibliographyAmerican Association for the Advancement of Science (AAAS). “Gene Mutation May

Boost Risk of Heart Arrhythmias,” Science 2002 August 23.www.sciencemag.orgwww.sghms.ac.uk/depts/gp/Science%202002%20News.pdf

American Heart Association. High Blood Pressure.216.185.112.5/presenter.jhtml?identifier=4623

A Special Message for Women.www.americanheart.org/presenter.jhtml?identifier=2123

Am I at Risk? www.americanheart.org/presenter.jhtml?identifier=2142

Biostatistical Fact Sheet—Risk Factors, High Blood Pressure. (2002)www.americanheart.org/downloadable/heart/1014995824974FS14H BP2WEB.pdf

Heredity as a Risk Factor. 216.185.112.5/presenter.jhtml?identifier=4610

High Blood Pressure Statistics. 216.185.112.5/presenter.jhtml?identifier=4621)

High Blood Pressure Statistics. 216.185.112.5/presenter.jhtml?identifier=2139

Small Babies Who Gain Weight Too Fast Have Higher BP as Adults.www.americanheart.org/presenter.jhtml?identifier=3000664

Ten Commandments for the Person with High Blood Pressure216.185.112.5/presenter.jhtml?identifier=578

American Society of Hypertension. Understanding Hypertension Pamphlet.www.ash-us.org/2001a/info/hypertensionfaq.html

Annals of Internal Medicine. Exercise Lowers Blood Pressure.www.annals.org/issues/v136n7/fpdf/200204020-00001.pdf

British Columbia Ministry of Health. Diet and High Blood Pressure.www.hlth.gov.bc.ca/hlthfile/hfile68b.html#E46E5

British Heart Foundation. Any Questions?—What is low blood pressure?www.bhf.org.uk/questions/index.asp?secondlevel=370&thirdlevel=501#1924

Centers for Disease Control and Prevention, National Center for Health Statistics.Hypertension. www.cdc.gov/nchs/fastats/hyprtens.htm

Fact Sheet: High Blood Pressure.www.cdc.gov/od/oc/media/pressrel/fs020531.htm

Table 68. Hypertension among persons 20 years of age and over, according to sex, age, race, and Hispanic origin: United States…www.cdc.gov/nchs/products/pubs/pubd/hus/tables/2002/02hus068.pdf

High Blood Pressure Fact Sheet. Data based on Behavioral Risk FactorSurveillance System, 1999.www.cdc.gov/cvh/fs-bloodpressure.htm


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Family Blood Pressure Program. Blood Pressure and Genes.www.sph.uth.tmc.edu:8052/hgc/fbpp/BPGenetics.htm

Blood Pressure General Information.www.sph.uth.tmc.edu:8052/hgc/fbpp/General.htm

Dietician.com. Salt & High Blood Pressure — Ask a Dietician.www.dietitian.com/salt.html

From Awareness to Action/National Alliance to Reach Blood Pressure Goals. About Hypertension. www.fromatoa.org/

Good News in Cholesterol. Cholesterol and Heart Disease Info Center.Good and Bad Cholesterol.www.goodnewscholesterol.com/cholestinfo/good.shtml

HealthAtoZ.com. JAVA’s JOLT BAD FOR BLOOD PRESSURE?www.healthatoz.com/atoz/healthupdate/Alert07122001.html

Healthy People 2010. Fitness & Nutrition. Catherine Baker, editor. 2002

High Blood Pressure Foundation. Causes and Treatments.www.hbpf.org.uk/underst.html

Humana.com. Humana and NitroMed Form Program to Expand Clinical Trial Access toMinorities Press Release, August 8, 2002www.humana.com/corporatecomm/newsroom/releases/PR-News-20020808-150024-NR.html

Hypertension Education Foundation, Inc. (HEF) High Blood Pressure Booklet. www.hypertensionfoundation.org/booklet.pdf

Jackson Heart Study. www.jsums.edu/~jhs/main.html

Lifeclinic.com. Disease Risks of High Blood Pressure.www.lifeclinic.com/focus/blood/disease.asp

KidsHealth.com. Hypertension.www.kidshealth.org/PageManager.jsp?dn=KidsHealth&lic=1&ps=107&cat_id=141&article_set=20233

Living-with-Hypertension.com. Hypertension Exercisewww.living-with-hypertension.com/html/excercise.php3

Los Angeles Eye Institute. High Blood Pressure and Your Vision.www.laei.org/pressure.htm

Medical College of Wisconsin Healthlink. Genetic Clues to the Riddle of High Blood Pressure. healthlink.mcw.edu/article/925840771.html

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Medem: Medical Library. Essential Guide of Hypertension: Blood PressureClassifications

Essential Guide of Hypertension: Hypertension Research

Essential Guide of Hypertension: Hypertension in Special Groups

Essential Guide of Hypertension: Medications and Hypertension

Essential Guide of Hypertension: Treatment Planning

Essential Guide of Hypertension: When Drugs Do Not Workwww.medem.com/search/default.cfm?act=next&querystr=essential%20guide%20to%20hypertension&from=1&to=10

High Blood Pressure in Childrenwww.medem.com/search/article_display.cfm?path=n:&mstr=/ZZZ1B14HGDC.html&soc=AAP&srch_typ=NAV_SERCH

News from the AMA: Depression Linked With Increased Risk of Heart Failure Among Elderly With Hypertension.www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZUKQQ9EPC&sub_cat=73

MEDLINEplus.com. MEDLINEplus: High Blood Pressure.www.nlm.nih.gov/medlineplus/highbloodpressure.html

MEDLINEplus Medical Encyclopedia: Blood Pressure–Low.www.nlm.nih.gov/medlineplus/ency/article/003083.htm

MEDLINEplus Medical Encyclopedia: Hypertension.www.nlm.nih.gov/medlineplus/ency/article/000468.htm

MEDLINEplus Medical Encyclopedia: High Blood Pressure–High.www.nlm.nih.gov/medlineplus/ency/article/003082.htm

MEDLINEplus Medical Encyclopedia: Obesity.www.nlm.nih.gov/medlineplus/ency/article/003101.htm

MEDLINEplus Medical Encyclopedia: Physical Activity.www.nlm.nih.gov/medlineplus/ency/article/001941.htm

Different Types of Weight Gain.www.nlm.nih.gov/medlineplus/ency/imagepages/19265.htm

Facts About the DASH Diet. (PDF)www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf

Food Guide Pyramid.www.nlm.nih.gov/medlineplus/ency/imagepages/9337.htm

National Heart, Lung, and Blood Institute Information Center. Your Guide to Lowering High Blood Pressure. www.nhlbi.nih.gov/hbp/index.html

Design, Rationale, and Objectives.www.nhlbi.nih.gov/about/jackson/2ndpg.htm

Limiting Alcohol Intake.www.nhlbi.nih.gov/hbp/prevent/l_alcohol/l_alcohol.htm

Quitting Smoking. www.nhlbi.nih.gov/hbp/prevent/q_smoke/q_smoke.htm

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Types of Blood Pressure Medications.www.nhlbi.nih.gov/hbp/treat/bpd_type.htm

Tips to Help You Remember to Take Your Medicinewww.nhlbi.nih.gov/hbp/treat/tips.htm

The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.www.nhlbi.nih.gov/guidelines/hypertension/jnc6.pdf

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Assessed Nov. 12, 2003www.nhlbi.nih.gov/guidelines/hypertension/express.pdf

The Jackson Heart Study: Design, Rational, and Objectives.www.nhlbi.nih.gov/about/jackson/2ndpg.htm

National Committee for Quality Assurance. Controlling High Blood Pressure.www.ncqa.org/somc2001/BLOOD_PR/SOMC_2001_CBP.html

National High Blood Pressure Education Month. Fact Sheet: Systolic High BloodPressure. hin.nhlbi.nih.gov/nhbpep_kit/systolic.htm

National Kidney and Urologic Diseases Information Clearinghouse (NIDDK). “High Blood Pressure and Kidney Disease.www.niddk.nih.gov/health/kidney/pubs/highblood/highblood.htmwww.niddk.nih.gov/health/kidney/pubs/summary/hypotens.htm

Tanner, Lindsey, AP Medical Writer. Nearly a Third of Adults Rated Obese.Associated Press. October 8, 2002.

Texas Heart Institute. Anatomy of the Heart and Cardiovascular System.www.tmc.edu/thi/anatomy1.html

University of Iowa Health Care. Cholesterol: ‘good’ And ‘bad’www.uihealthcare.com/topics/cardiovascularhealth/card3025.html

University of Michigan Health System. What is Congestive Heart Failure?www.med.umich.edu/1libr/heart/fail01.htm

USA Today.com. Humana and NitroMed Collaboration Will Increase African Americans’Access to a Unique Heart Failure Trial. Press Release, August 8, 2002.

funds.usatoday.com/custom/usatoday-com/html-tory.asp?guid=%7BABE038AD-64B6-4DFE-B27A-A5086C56A98E%7D

U.S. Food and Drug Administration. FDA Consumer Magazine. Lessening the Pressure:Array of Drugs Tames Hypertension.www.fda.gov/fdac/features/1999/499_hbp.html

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GlossaryACE (An•gi•o•ten•sin-Con•ver•ting En•zyme)in•hi•bi•tors: a group of medicationsused to treat hypertension by causingblood vessels to relax.

aer•o•bic ex•er•cise: activities thatincrease breathing and heart rates.

an•gin•a: a painful tightening in thechest, which may spread to the jaw orarms.

ar•rhyth•mi•a: an irregularity in therhythm of the heartbeat.

ar•ter•ies: any of the muscular elastictubes that form a branching system andthat carry blood away from the heart tothe cells, tissues, and organs of thebody.

ar•ter•i•oles: the small terminalbranches of an artery, especially thosethat connect with capillaries.

ath•er•o•scle•ro•sis,ar•ter•i•o•scle•ro•sis: a conditioninvolving the build-up of fatty depositsinside the arterial walls.

be•ta block•ers: a group of medica-tions used to treat hypertension byreducing the work load on the heart.

blood pres•sure: pressure of bloodagainst artery walls. Recorded as twonumbers: systolic and diastolic.

blood ves•sels: the pipelines throughwhich blood travels to all parts of thebody.

cal•o•ries: small units of energy thatare contained in food and released upondigestion by the body.

cap•il•lar•ies: the tiny blood vesselsthat connect arterioles and venules.These blood vessels form an intricatenetwork throughout the body for theinterchange of various substances, suchas oxygen and carbon dioxide, betweenblood and tissue cells.

car•bon di•ox•ide: a gas that isformed during respiration and releasedupon exhaling (breathing out).

car•di•o•vas•cu•lar: term thatdescribes the heart and blood vessels.

car•di•o•vas•cu•lar dis•ease: ill-ness of the heart and blood vessels,including high blood pressure, heartattack, angina, stroke, and heart fail-ure.

car•di•o•vas•cu•lar sys•tem: (also called the “circulatory system”)The body network made up of the heartand blood vessels.

cho•lest•er•ol: a waxy substance produced by the body and taken in withfood. The body needs cholesterol for certain body functions, but too muchcholesterol can lead to atherosclerosis,or “hardening of the arteries.”

chron•ic: long-lasting and on-going.

clin•i•cal tri•als: research tests, performed using people, that determinethe success of a medical treatment,medicine, or prevention strategy. A clinical trial usually is conducted onlyafter the test has been successful in thelaboratory and on animals.

com•pli•ca•tions of high bloodpres•sure: problems that occurbecause of hypertension. These includestroke, heart attacks, heart failure, kid-ney failure, and eyesight problems.

con•ges•tive heart fail•ure: a condi-tion marked by weakness, swelling, andshortness of breath that is caused bythe inability of the heart to maintainenough blood circulation in the lungsand body tissues.

cor•o•nary ar•ter•y dis•ease: astage of atherosclerosis involving fattydeposits inside the arterial walls.

di•a•bet•es: a set of illnesses charac-terized by improper amounts of glucose(sugar) in the blood.

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di•ag•no•sis: a professional medicalopinion, based on an exam of thepatient, about what is causing symptomsof illness.

di•al•y•sis: the use of a machine toperform the function of the kidneys,which is to clean the blood.

di•as•tol•ic pressure: minimum pressure that remains within the arterywhen the heart is at rest.

di•u•ret•ics: a group of medicationsused to treat hypertension by reducingthe amount of water in the body byincreasing the flow of urine.

ep•i•de•mi•ol•o•gy: the branch ofmedicine that deals with the study ofthe causes, distribution, and control ofdisease in populations.

genes: units of hereditary informationcontained in each cell of the body.

ge•net•ic pre•dis•pos•i•tion: theterm for a person’s increased likelihoodof developing some trait or illnessbecause he or she carries certain genes.

ge•net•ic var•i•ant: an individualthat is recognizably different from astandard type.

ge•net•ics: the field of science thatlooks at how genes are passed downfrom one generation to another to influence traits.

health dis•par•i•ty: the unevenimpact of a health problem that mayoccur between groups of people.

heart at•tack: sudden problem withthe heart where oxygen-rich blood cannot reach it, causing cells in theheart muscle to die.

heart dis•ease: illness of the heart, theorgan that pumps blood through thebody. It is one of the possible complica-tions of high blood pressure.

high blood pres•sure: a condition inwhich blood is pushed through the

body’s blood vessels at greater force thannormal. It can lead to tiredness, heartattack, stroke and other health prob-lems. High blood pressure is also knownas hypertension.

hy•per•ten•sion: the medical term forhigh blood pressure.

i•so•lat•ed sys•tol•ic hy•per•ten-sion (ISH): elevated systolic blood pres-sure (more than 140 mmHg) in conjunc-tion with normal diastolic blood pres-sure (less than 90 mmHg)

kid•ney dis•ease: an illness of the kidneys that can lead to kidney failure.It is also called “neuropathy.” It is one ofthe possible complications of high bloodpressure.

kid•neys: the pair of organs that havethe job of filtering the blood.

left ven•tri•cle: the portion of theheart that pumps oxygen-rich blood tothe rest of the body.

mmHg: abbreviation for “millimeters(mm) of mercury (Hg).” It is used toexpress measures of blood pressure andrefers to the height to which the pres-sure in your blood vessels would push acolumn of mercury.

mor•tal•i•ty rate: the number ofdeaths from a certain cause.

o•be•si•ty: the condition of being sub-stantially overweight.

pre•hy•per•ten•sion: a conditionmarked by systolic pressure reading of120-139 or diastolic pressure reading of80-89 that makes one likely to develophigh blood pressure later on.

pri•mar•y hy•per•ten•sion: alsoknown as “essential hypertension,” thisis a disorder in which the blood pressurein the arteries of the lungs is abnormallyhigh, in the absence of other diseases ofthe heart or lungs.


67

Glossary

ret•i•na: the part of the eye that senseslight.

ret•i•nop•a•thy: a disease of the eye’sretina that can lead to blindness. It is oneof the possible complications of highblood pressure.

salt: common table salt or sodium chlo-ride.

sec•ond•ar•y hy•per•ten•sion: also referred to as “non-essential hyper-tension,” this is a form of high blood pres-sure in which a definite cause can be determined. It accounts for only 5 to 10 percent of all high blood pressurecases.

so•di•um: a mineral that can contributeto high blood pressure in some people. Itis found in baking soda, some antacids,and the food preservative MSG(monosodium glutamate), among otheritems.

sphyg•mo•ma•nom•e•ter: a deviceused to measure blood pressure.

steth•o•scope: a medical instrument forlistening to the sounds generated insidethe body.

stroke: damage to the blood vessels inthe brain because of loss of blood flow,which can result in the inability to speakor move part of the body.

symp•tom: a sign of a problem, such asa disease.

sys•tol•ic pres•sure: maximum pres-sure in the artery produced as the heartcontracts and blood begins to flow.

treat•ment plan: a strategy put togeth-er by a doctor or team of health care pro-fessionals working with a patient. Thepatient is responsible for following theplan, with the goal of lessening or delay-ing the complications of high blood pres-sure.

vas•o•di•la•tors: a group of medica-tions used to treat hypertension by caus-ing blood vessels to expand, loweringblood pressure and reducing the workload on the heart.

veins: any of the membranous tubes thatform a branching system and carry bloodto the heart.

ven•ules: small veins, especially onesthat join capillaries to the larger veins.

AcknowledgementsProject AdvisorsPhilip Abelson, PhDAmerican Association for the Advancement ofScience (AAAS)

Yolanda CuestaCuesta Multicultural Consulting

Yolanda GeorgeAmerican Association for the Advancement ofScience (AAAS)

Robert D. Goldman, PhDNorthwestern University Medical School

Max Gomez, PhDWNBC, Health & Science Editor

Beatrix (Betty) Ann Hamburg, MD Cornell University Medical College

Marcia HarringtonDistrict of Columbia Public Library

Constance Hendricks, PhDChair, Graduate Nursing ProgramsSouthern University and A&M College Schoolof Nursing

Eric Jolly, PhDEducation Development Center Inc. (EDC)

Betty LawrenceRochester Public Library, New York

Audrey Manley, PhDPresident Emerita, Spelman College


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Photo Credits:Cover: EyeWire Images and Eric NevinPage 1: Custom Medical Stock Photo (CMSP)

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#Z400-MM-10810: Indian Health Service11: www.photoresearchers.com13: Joe Wagner15: Eyewire Images17: Omni Photo Communications 18: Eyewire Images21: Custom Medical Stock Photo (CMSP)

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Cardiologists, Inc.

Marsha Lakes Matyas, PhDThe American Physiological Society

Sandra NegroSenior Librarian, Wheaton Library, Maryland

Delores Parron, PhDScientific Advisor for Capacity DevelopmentOffice of the Director, National Institutes ofHealth

Joseph Perpich, MD, PhDJ.G. Perpich, LLC

Marcy Pride, MLS, MADirector, Oyer Memorial Library Washington Bible College and Capital BibleSeminary, Lanham, Maryland

Josefina Tinajero, EdDAssociate Dean, College Of Education University of Texas at El Paso

Hypertension ContentReviewers/AdvisorsSharonne N. Hayes, MD, FACCDirector, Women’s Heart Clinic, Mayo Clinic, Rochester, Minnesota

Ruben Pamies, MDVice Chancellor for Academic Affairs, Dean for Graduate StudiesUniversity of Nebraska Medical Center

Project Staff and ConsultantsShirley M. Malcom, Principal InvestigatorMaria Sosa, Co-Principal Investigator andProject Director

Kirstin Fearnley, Project Manager

Mary Chobot, PhD, Library Consultant andProject Evaluator

Ann Williams, Art Director

Susan Mahoney and Associates, Peter Wehrwein, Writers

Tracy Gath, Writer, Editor

Betty Calinger, Editor

Maggie Sliker, Photo Researcher

Heather Beecheler, Chickona Royster,Project Associates

Special thanks go to Nathan Bell, HarrietPickett, Catherine Baker, and Lisa Boesen fortheir assistance with the development of thisbook series.

Acknowledgements, cont.

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