Watch your blood pressure!

When Clare Creedon dropped by his doctor’s office for a routine checkup, he never expected it would save his life. In his late 40s, the marketing representative for an oil firm was expecting the usual clean bill of health. After all, he was in the prime of life. Then he had his blood pressure checked.Now an active 84-year-old living in Toronto, he can still remember the shocked look on the doctor’s face as he removed the cuff from Creedon’s arm.“He said, ‘I don’t want to alarm you, but go home very quietly and go to bed.'” Creedon’s blood pressure was high-so high he was in danger of suffering a major stroke at any moment.

“I hadn’t felt a thing,” he says. “I went whistling into the office without a clue how bad things were.”

The numbers
High blood pressure (BP) is simply the amount of force your blood exerts on the walls of your blood vessels. When you have your BP (checked with a rubber cuff wrapped around your upper arm), you’ll get two numbers-for example, 125/85 mm Hg.

Blood pressure is measured in millimeters of mercury, abbreviated as mm Hg. The first number, 125, is the systolic pressure-the force on your bld vessels when your heart contracts.

The second number, 85, is the diastolic pressure, the pressure when your heart relaxes between beats. A reading just below 120/80 is considered ideal, but as long as the first number is below 130 and the second is below 85, your blood pressure is normal.

As either number creeps higher, you’re into the “high-normal” range and should have your blood pressure checked again within a year. If your BP consistently reads above 140/90, you have high blood pressure, or hypertension, and should discuss treatment with your physician.

Who’s at risk?
There’s no single cause for hypertension and the systems that keep our blood pressure in check are extremely complex, but risk factors include:

  • Genetics: If your parents had it, you’re more at risk of developing the condition.
  • Gender: Young men tend to have a higher incidence than young women, but by about age 70, it tends to strike both genders equally.
  • Obesity: Lifestyle also has a big impact on whether it ever develops.

“Obesity is the biggest single predictor,” says Dr. Michel Joffres, an associate professor at Dalhousie University in Halifax. He led the Alberta portion of the 1997 Canadian Heart Health Survey. Overweight people also tend to have higher levels of cholesterol, which contributes to hypertension.

  • Lack of exercise: Being out of shape is another contributing factor.
  • Eating too much salt: This may be a contributing factor. About 40 per cent of the population has blood pressure that’s salt sensitive.

While high blood pressure can lead to heart and kidney disease, it can also rear its head from the opposite direction. Up to five per cent of hypertension is due to kidney disease or other organ problems. And while smoking doesn’t increase blood pressure itself, it can lead to organ damage that, in turn, can cause or worsen hypertension.

Senility connection
New research is unveiling another concern. Hypertension may be a major factor in senility. A 1999 study in France looked at 1,200 people who showed no sign of dementia but who had isolated systolic hypertension.

Part of the group was treated and part of the group wasn’t. The researchers found that in the group treated for hypertension, only half as many people developed dementia as in the untreated group. Other studies, including a Canadian trial, are now underway to confirm the results of the French study.

Prevention, treatment 
If you’re at risk or suffer from hypertension, there are a number of ways you can help yourself.

Most importantly, exercise and eat more fruits and vegetables, which contain potassium, and other minerals that play a role in controlling blood pressure. Bananas, orange juice, tomatoes and potatoes are all high in potassium.

An effective treatment is the family of drugs called angiotensin-converting enzyme (ACE) inhibitors. These drugs prevent the body from activating angiotensin, a hormone that increases blood pressure by causing blood vessels to contract. ACE inhibitors work well, but they’re expensive. They can also cause some people to develop a cough.

Doctors may also prescribe beta-blockers. These drugs cause your heart to beat less often and with less force, so it doesn’t work as hard and your blood pressure drops. However, some recent studies have shown beta-blockers are not as effective as diuretics in older people, and many doctors now consider them to be inappropriate as a first line of treatment for the elderly.

Also commonly prescribed are calcium channel blockers-drugs that relax the blood vessels but may cause a decline in mental function.

Canadians vs. Americans
But despite advances in treatment, Canadians aren’t doing a very good job of dealing with hypertension. While there hasn’t been a study as large as the Canadian Heart Health surveys, some recent smaller studies show the situation may actually be getting worse, says Dr. Joffres.

And Canadians have a poor track record compared to Americans. In a study he is about to publish, Joffres shows U.S. physicians are twice as successful as Canadian doctors in controlling hypertension.

“Americans are more aggressive in treatment,” says Joffres. About 16 per cent of all Canadians with hypertension are treated and controlled compared to 27 per cent south of the border.

That reflects the more conservative attitude of Canadian doctors, he says. There’s a tendency in Canada not to treat people with the mildest forms of hypertension-even  though most people are in the lower end of the hypertension range.

Lower your blood pressure
A few lifestyle changes can reduce your chances of developing high blood pressure and help you control it if you do.

    1. Keep active. Exercise is one of the most effective ways to prevent and control hypertension. Check with your doctor before starting any exercise program.

    2. Watch your weight. Weight loss can sometimes be as effective as medication in lowering your blood pressure.

    3. Cut down your fat intake. Eating less of foods high in saturated fat, such as meat, cheese and whole milk, can help reduce blood pressure and prevent heart disease.

    4. Eat five to nine servings of fruits and vegetables a day. They contain potassium and other minerals that play a role in keeping blood pressure down.

    5. If you’re not taking hypertension medication, drink 2 to 2.5 litres of water a day to keep your kidneys working properly. However, if you’re on diuretics, too much water can cause problems. Consult your doctor.