A Message from the Heart to the Heart
Prepared by:
Dr. Abdulwahab Arrazaghi
(Specialist of Internal Medicine and Cardiovascular Diseases)
University of Toronto, Canada

Hypertension

1. What is hypertension ?
Hypertension, or elevated blood pressure is a common condition that affects millions of people around the globe characterized by elevated pressure (force of blood pressing against the walls of arteries), and if untreated this will cause serious damage to those vessels, and overtime if blood pressure remains uncontrolled this would lead to increased risk of heart disease, stroke, and kidney problems.

2. What are hypertension symptoms ?
High blood pressure remains to be cold silent killer as a large portion of patients may not feel or express any symptoms unless for more period of time (years), and it has been estimated that 1 in 5 people with the condition do not realize that they have it; unfortunately during that time damage to heart, lungs, blood vessels, and brain, in addition to kidneys can take place. It is a major risk factor for stroke, and heart attacks around the globe.

3. What causes hypertension ?
Overall normal blood pressure should fall at/or below 120/80 mmHg. Higher results overtime can indicate hypertension. In most cases, the underlying cause is unidentified (primary), and usually there is a genetic factor influencing the transmission of such disease entity. In minority group of patients, the cause of hypertension is able to be identified, this include primary problems with kidney, adrenal gland, thyroid glands, benign tumors, and congenital malformation of some of the large vessels.

4. What is pre-hypertension, and should I be concerned ?
Almost one quarter of North Americans have pre-hypertension. This has been defined as finding the blood pressure consistently just above the normal range (falling anywhere between 120 to 139 for systolic blood pressure, or 80 to 89 for diastolic pressure).
The patients in this range have twice the risk of developing heart diseases including myocardial infarction (heart attack) than those with lower readings. Your doctor may recommend lifestyle changes to help lower your blood pressure at this stage.

5. What is hypertension danger zone ?
You should have a concern about having elevated blood pressure (hypertension). If your blood pressure readings average 140/90 mmHg or higher, for either number you may still have no symptoms. Usually at 180/110 mmHg or higher, you may be having hypertensive crisis, if that was ever the case, and upon rechecking your blood pressure after a few minutes of resting would persistently elevate the blood pressure numbers you should be calling 911 for direct help. A hypertensive crisis can lead to stroke, heart attack, kidney failure, or loss of consciousness. This may be preceded by some symptoms including severe headache, nose bleed, and shortness of breath.

6. Who would get hypertension ?
Usually up to the age of 45 it has been found that men have higher blood pressure than women, it became more common for both men, or women as they age; interestingly more women would have hypertension by the time they reach 65 than men.
You may have greater risk to develop hypertension if you have close family member with hypertension, or if you have diabetes. It has been reported that more than 60% of diabetics do have concomitant hypertension.
Additionally African-Americans overall are more likely to develop hypertension than other races. Unusually, it is developed at younger age group. Some group of patients has increased salt sensitivity, just a half teaspoon of salt can raise the blood pressure by 5 mmHg, diet, and excessive weight can also play a role.

7. Any correlation between hypertension and sodium ?
By causing the body to retain more fluids which lead to greater pressure in the vessels, excessive sodium intake will elevate the blood pressure. The current American Heart Association recommended eating less than 1.5 g of sodium per day and that should translate to you being more careful in selecting your food items by checking the food labels and calculating the total sodium intake consumed. Processed foods which are unfortunately very commonly used nowadays contribute up to 75% of our sodium intake; canned soups, and lunch meats are prime suspects.

8. Any relation between hypertension and stress ?
So far there is no evidence that stress per se is a cause of hypertension, but it has been proven that stress can make the blood pressure rise. Additionally, stress may affect other risk factors in a negative fashion on the heart. Additionally, stress may lead to other unhealthy habits such as poor diet, alcohol use, smoking habit which can contribute to high blood pressure, and heart diseases.

9. What is the relationship between hypertension and weight ?
Being overweight increases your risk to develop chronic hypertension, and hence all the known guidelines for hypertension treatment do emphasize the importance of cutting the fatty foods, and added sugars while instead increasing fruits, vegetables, and lean protein, and fiber. Even losing 10 pounds sometimes can be a major contributing factor in controlling your elevated blood pressure; so please do keep that in mind.

10. Any relationship between hypertension and some medications ?
Cold and flu medicines that contain decongestants are one of several classes of medicine that can cause elevation of your blood pressure. Others include pain relievers (NSAID), diet pills, birth control pills, steroids, antidepressants, so if you have high blood pressure talk to your doctor about what medication supplements that you can use safely, and I would advice strongly before taking a cold remedy please check with the pharmacist to see if that specific medicine is safe for you to use.

11. What is White-Coat hypertension ?
Some people found to have elevated blood pressure when they are at their doctor's office, some of them just being nervous seeing the doctor or being in a clinic vicinity. Interestingly recent studies shown that group of patients have a higher tendency to develop the disease entity hypertension latter in life. To get more accurate blood pressure readings take your blood pressure at home, chart your readings, and share it with your doctor on your next follow-up visit.

12. What is the DASH diet ?
The DASH diet stands for dietary approaches to stop hypertension. This basically involves eating more fruits, vegetables, or whole grain foods, low-fat, dairy, fish and nuts. Overall you should eat less red meat, saturated fats, and sweets. Reducing the sodium intake to less than 1.5 g a day can have significant affect on lowering your blood pressure.

13. What is the benefit of exercise ?
Regular aerobic exercise activities have been found to be a major factor in reducing blood pressure that could include gardening, walking, bicycling, swimming or other format of aerobic activities. Exercise will also help in conditioning your heart. It has been recommended that aerobic sustained activity should be maintained for 25 minutes to half-an-hour in a frequency of 2 to 3 times a week for major cardiovascular conditioning effect. Try to avoid excessive anaerobic activities including heavy weight-lifting, pushing against massive resistance when you have uncontrolled elevated blood pressure.

14. Is there any relationship between sleep deprivation, and high blood pressure ?
Possibly so; it has been the thought that sleeping less than 6 hours at night could link to increased blood pressure, and also it has been found that people sleeping 5 hours or less a night maybe at higher risk of developing hypertension, or worsening already excessive hypertension disease. Sleeping 7 to 8 hours at night may play a role in the treatment and prevention of high blood pressure. So do not forget to talk to your doctor for tips on getting better sleep especially if you have high blood pressure.

15. Any link between caffeine consumption, and elevated blood pressure ?
Although caffeine per se is not a cause of chronic hypertension, but it has been found that excessive caffeine consumption can lead to short, but dramatic increase in your blood pressure even if you do not have high blood pressure to start with. The amount of caffeine in 2 to 3 cups of coffee can raise your systolic blood pressure from normal by 3 to 14 mmHg for systolic blood pressure, and can raise the diastolic blood pressure between 4 and 13 mmHg. The actual reason for that is yet unclear, but here it indicates that caffeine affect on blocking some of the dilator hormones of your blood vessels. To know if you are sensitive to caffeine, or not, measure your blood pressure before, and half-an-hour after consumption of a cup of coffee; if you find that there is elevation of blood pressure between 5 and 10 mmHg that you may be sensitive for caffeine, and it is important for you to reduce your total caffeine consumption to 2 cups or less, and that should be done gradually to prevent withdrawal headaches.

16. How long should I be on antihypertensive medications ?
Most of patients diagnosed of chronic hypertension would require being on antihypertensive medications for life. There is only a small group of patients (5 to 10%) will be able to gradually withdraw the medications, and still maintain normal blood pressure. This will be decided between you, and your family doctor upon frequent blood pressure checkup, and adjustments of medications. Overall common tips for you to maintain a low blood pressure would be to eat a healthy diet, get half-an-hour of aerobic physical activities in a sustained fashion most of the days of the week, limit your alcohol intake, and quit smoking, and most important of all schedule regular checkup with your doctor to keep track of your blood pressure readings.