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Frequently Asked Questions
Medical FAQ
Question
Answer
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Is hypertension a serious condition? Top
Hypertension is the most under treated cardiovascular condition. It
can lead to heart disease, strokes and other health problems. Yet,
according to a 1997 study by the Joint National Committee on
Prevention, Detection, Evaluation and Treatment of High Blood
Pressure, only 27 percent of individuals with high blood pressure
are adequately controlled, leaving millions of others at risk of
health problems, according to statistics in the USA. Physicians
need to be more aggressive in controlling hypertension with
medications, and the public needs to be made more aware of the
risks.
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What is considered a normal blood pressure for me? Does blood
pressure go up with age? Top
Although doctors define high blood pressure as a blood pressure
above 140/90 mmHg, we know that if you are otherwise healthy and
not on blood pressure medications, the lower your blood pressure
the better off you are, and the longer your life expectancy.
Blood pressure is very variable, and is influenced greatly by
activity, foods, and medications. Although there are no absolute
rules for what constitutes a normal blood pressure, 120/80 mm Hg
is considered desirable for adults without hypertension. For
individuals with hypertension, a desirable blood pressure on
treatment is 135-140/82-86 mm Hg. Blood pressure does not
necessarily go up as we get older. Hypertension (defined as
blood pressure greater than 140/90 mm Hg) is more common in
older individuals, and isolated systolic hypertension (elevated
'top number', with normal diastolic, or 'bottom number') is
especially more common in the elderly.
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How often should I have my blood pressure monitored? Top
is particularly important for women
to have their blood pressure regularly monitored as part of every
check up. Home monitoring, which is recommended today by many
physicians for their patients with high blood pressure, not only helps
physicians gauge the effectiveness of treatment, it also can weed out
people suffering from "white-coat" hypertension.
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Are home blood pressure monitors accurate and reliable? Top
Fortunately, strides have been made in
home monitoring devices. Self-inflating blood pressure monitors that
use microprocessor chips as sensors are more reliable and easier to
use than older models, and they are less expensive to make and sell.
Portable monitors can be worn throughout the day if fluctuations in
blood pressure are suspected. A talking monitor with a voice readout
recently became available for the visually impaired so they, too, can
monitor at home.
These advances in technology and treatment must be accompanied by better
awareness, especially among women. Attention to gender differences
will make it possible to improve the quality of care and to reduce the
risks of strokes, kidney damage and heart disease.
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What are Irregular Heartbeats? Top
Many people have irregular heartbeats,
and many people have hypertension. It is important to be able to
measure blood pressure accurately in the presence of an irregular
heartbeat.
The heart contains it own pacemaker. There are specialized cells in
the heart that determine the number of heartbeats per minute that the
heart will make. The net result of a heartbeat is that the chambers of
the heart contract in a synchronous fashion, and blood is pumped
throughout the circulation. The heartbeat is easily detected by
feeling an individual's pulse in the wrist or in the neck, or by
listening to the front of the chest with a stethoscope. Normal hearts
beat at a rate of between 60-90 beats per minute, and the beats are
regular. This means that there is a uniform period of time between
each heartbeat. A disorder of the heart rate, or of the interval
between heartbeats is called an arrhythmia. A disorder of the heart
rate is either a bradyarrhythmia, which means the heart beats too
slowly, or a tachyarrhythmia, which means the heart beats too rapidly.
If the interval between heartbeats is altered, then this is called an
irregular heartbeat. Other descriptive terms for irregular heartbeats
include extra beats, extra systoles, premature beats or premature
contractions. An individual may become aware of irregular heartbeats
and have a sensation of palpitations or fluttering in the chest.
Normal persons may have irregular heartbeats occasionally. Certain
medications or foods (caffeine, alcohol) may increase the frequency of
irregular heartbeats.
There are several heart disorders that are
characterized by irregular heartbeats. One of the most common is
called atrial fibrillation. In this disorder, the pacemaker of the
heart is not functioning normally and instead of a regular heartbeat,
the heartbeat is irregular. In other words, there is a variable
interval, instead of a fixed interval between heartbeats. This
condition may be due to coronary artery disease, overactive thyroid,
or there may be no detectable cause. Individuals with high blood
pressure are more likely to have this condition. This condition is
often not associated with serious consequences, however it does
require treatment. The first treatment may be directed to changing the
heart rate back to a normal regular beat, so called normal sinus
rhythm. This is usually only attempted if an individual has not had
the condition for very long, since the longer atrial fibrillation is
present the less amenable to conversion to normal sinus rhythm.
Another aspect of treatment is to control the rate ·in other words
keep the rate in the target range of 60-90 bpm. Finally, blood
thinners are sometimes recommended for this condition, since an
irregular heart beat may lead to blood clots in the heart, which then
may lead to a stroke.
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If I have hypertension am I at greater risk for developing diabetes? Top
We know that people who have diabetes
are at greater risk for developing hypertension. We are not sure if
the reverse is true - that is, whether or not individuals with
hypertension are at greater risk for diabetes. Some hypertension
experts believe that in certain individuals with high blood pressure
there is a greater propensity to be resistant to the effects of
insulin. This phenomenon, called insulin resistance, is also
associated with diabetes. Thus, in some cases hypertension may in fact
be associated with an increased risk for diabetes, but more research
needs to be done in this field. Regardless of the links between
hypertension and diabetes, we know that more people are developing
diabetes than ever, because of the rise in obesity, and more sedentary
lifestyles. Thus, all Americans should be concerned about the
possibility of developing diabetes and should make every effort to
maintain ideal body weight and to exercise regularly. Those with
hypertension should be especially concerned about the possibility of
developing diabetes, since the presence of these two risk factors
increases the risk of cardiovascular disease to a greater degree than
either one alone.
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I have diabetes. Do I have to control my blood pressure? Top
The increased prevalence of diabetes in
the affluent countries has received considerable attention in
recent years. Along with a greater prevalence of obesity in,
diabetes, particularly diabetes in older persons, is on the rise.
This is a serious public health problem because people with
diabetes are at much greater risk for strokes, heart attacks, and
kidney failure. These risks are magnified if hypertension is
present, and thus blood pressure control is as important as blood
sugar control in people with diabetes. We know that those
individuals with diabetes should have their blood pressure lowered
to levels that are lower than those recommended for patients with
hypertension without diabetes. The "target" blood pressure for a
patient with diabetes is less than 135/85 mmHg. Achieving blood
pressure control is especially important in patients with diabetes
who show signs of kidney damage, since lowering blood pressure has
been shown to protect the kidneys from further damages. All blood
pressure medications are safe in diabetic patients.
At the present time, we believe that
it is not how you lower the blood pressure, but whether or not you do
that is important, although this is an area that is being actively
investigated. In patients with kidney disease, angiotensin converting
enzyme inhibitors should be part of the treatment regiment since these
drugs have a beneficial effect of kidney function.
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What is "White Coat Hypertension"? How can an Ambulatory Blood
Pressure Monitor help detect "White Coat Hypertension"? Top
It is not unusual for blood pressure
measured in the doctor's office to be higher than blood pressure
measured at home during normal activities. The more comfortable a
person is with the office surroundings, the more likely the blood
pressure in the office will be close to the blood pressure
measured at home. However, it is estimated that 20-25 % of
patients with mild hypertension in the doctor's office
(140-160/90-104 mm Hg) have what is called "white-coat" or
isolated office hypertension.
White coat hypertension is not as
dangerous as sustained hypertension (hypertension which is present all
the time). However, individuals who have white coat hypertension may
have a higher risk of complications and cardiovascular disease than
those with completely normal blood pressure all the time. Another risk
of white coat hypertension is that individuals with this condition may
develop sustained hypertension at a later time.
There are several reasons to
identify white coat hypertension and to distinguish those individuals
whose blood pressures are only elevated in the doctor's office and are
normal at all other times. The most important reason is to prevent
unnecessary treatment of hypertension. If blood pressure medication is
prescribed to a person who only has elevated blood pressure in the
doctor's office, then the treatment may cause low blood pressure at
all other times, which may result in fatigue and light headedness.
Second, it is also useful to identify whether blood pressure
elevations are simply isolated to the doctor's office, or whether they
are present at other times as well, for example, at work.
Ambulatory blood pressure
monitoring is a technique that involves automated inflation of the BP
cuff and recording of the BP at 15 to 20 minute intervals throughout
the day and every 30 to 60 minutes during sleep. This technique
permits identification of those with white coat hypertension. It also
permits a more comprehensive assessment of the blood pressure profile
of an individual throughout the day and night. These parameters are
important in determining how to best treat hypertension.
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Are women more likely to have "White Coat Hypertension"? Top
Women of all ages are
disproportionately afflicted by a common condition known as "white
coat" hypertension, in which their blood pressure rises significantly
in the doctor's office - anywhere from 10 to 30 points - yet remains
normal at home and work. This "false positive" response may be an
involuntary conditioned reflex to the anxiety of being tested,
according to recent studies, and strikes somewhere between 20 percent
and 39 percent of patients diagnosed with mild-to-moderate
hypertension. Those with normal readings at home are believed to be at
no greater risk for health complications and could be taking blood
pressure medications needlessly.
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Who is at greater risk of having high blood pressure - a man or a
woman? Top
Many women are surprised to learn that,
after age 59, they are more likely than men to have hypertension,
and their risks continue to increase at a faster pace as they age.
Even more alarming, dangerous complications such as strokes and
kidney problems caused by prolonged high blood pressure occur at
the same rate in women as in men, while the risk of developing
heart disease lags only a little behind that of their male
partners.
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Why are men and women at different risks of high blood pressure? Top
Reasons for gender differences in blood
pressure are not known but are being investigated by many
scientists. It has been suggested but not proven that estrogen is
responsible for the lower blood pressure in younger women, but the
relationship between estrogen levels and blood pressure is
complex. While numerous studies have shown that hypertension is
twice as prevalent after menopause, it is unclear whether the
increased risk is caused by the drop in estrogen or by other
factors such as weight gain, decreased physical activity and
increased alcohol intake. Adding fuel to the controversy is a
study in Finland that showed women who had undergone hysterectomy
had higher blood pressure than women who had not undergone
hysterectomy, even when their estrogen-producing ovaries were left
intact.
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What are the risks of having high blood pressure during pregnancy? Top
High blood pressure during pregnancy is
a common problem. It may be due to either preeclampsia (toxemia),
which is a disorder of late pregnancy characterized by elevated
blood pressure and protein in the urine, or it may be due to
hypertension that was present prior to pregnancy (chronic
hypertension). Both conditions are associated with risks of
premature delivery, low birth weight babies, and occasionally
bleeding. Blood pressure should be monitored closely during
pregnancy, particularly if a woman has a history of high blood
pressure.
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Should younger women be concerned about hypertension? Top
Younger women need to know about
increased risks for hypertension associated with pregnancy,
obesity and contraceptive pills. Pregnant women have estrogen and
progesterone levels 50 to 100 times higher than normal and,
indeed, blood pressure decreases during pregnancy in most women,
as would be expected. However, high blood pressure complicates as
many as one in 10 pregnancies and can progress to preeclampsia, a
dangerous condition in which convulsions can threaten the lives of
both mother and baby. Clearly, other variables besides estrogen
are at work.
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Can birth control pills reduce my risk of developing high blood
pressure? Top
One would assume that birth control
pills, which contain estrogen, would lower blood pressure.
However, the estrogen in oral contraceptive pills causes a small
but detectable increase in blood pressure in most women, which
means that hypertension is two to three times more common in women
on the pill. The Walnut Creek Contraceptive Drug Study, which
included 11,672 women, showed an increase of 5 to 6 points in
systolic blood pressure (the higher of the two readings) and 1 to
2 points in diastolic pressure for white women, with
African-American women experiencing less of an increase. That risk
becomes greater with age, duration of pill use and increased body
mass.
A prudent approach to oral
contraceptive use is to monitor blood pressure at least every 6
months. If high blood pressure is found, then a decision to
discontinue the pill should be based on the degree of hypertension,
the potential hazards of pregnancy, and the individual's risk of
developing heart disease.
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Will Hormone Replacement Therapy (HRT) to reduce symptoms of
menopause increase or decrease my blood pressure? Top
The effects of hormone replacement
therapy on blood pressure are not as clear cut as the effects of
oral contraceptive pills. Perhaps because the dosages are lower,
the increase in blood pressure is not as consistently observed,
and some studies have even documented a decrease in blood
pressure. Preliminary evidence suggests synthetic progestin
increases sodium retention. But a three-year study of women ages
45-64 using a variety of hormone replacement therapies showed no
differences in blood pressure in any of the treatment groups
compared to the placebo group. These women started out with normal
blood pressure, however, and it is not known how women with high
blood pressure would fare over time. More studies are needed.
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What lifestyle changes can I make to reduce my chances of
developing high blood pressure or to lower my pressure if it is
already high? Top
The good news for women is that
hypertension responds well to diet changes and weight loss, or to
medications when lifestyle changes aren't enough. Obesity merits
especially close watching because it is significantly more common
in middle-aged women than men. Furthermore, body weight has a
greater impact on blood pressure in females than in males,
according to new evidence.
When it comes to dietary changes,
studies have shown women's blood pressure readings respond slightly
better than men's to lowered salt intake, while abundant fruits,
vegetables and low-fat dairy products are beneficial to health in
general. On the flip side, excessive alcohol - which means more than
two or three drinks per day - is associated with increases in blood
pressure, and most studies have shown that it takes less alcohol to
have toxic effects in women than men.
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Will exercise help? Top
Studies of the benefit of exercise to
reduce blood pressure in women are scant. However, given the
beneficial effects of exercise on weight control, prevention of
osteoporosis, and insulin and glucose metabolism, women with
hypertension whose heart function is normal would do well to
exercise regularly.
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If lifestyle changes fail, must I take medications? Top
Medications are an important addition to
the arsenal of weapons against high blood pressure. The health
benefits of medications to lower blood pressure have been observed
most clearly in African-American and elderly women, although the
cardiovascular benefits in women have not been studied separately from
that of men. Reduction in strokes was clearly noted in women who
participated in large clinical studies, but the impact of medications
on overall death rates is less clear.
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Is one blood pressure medication better than another?
Top
It has been clearly demonstrated that
treatment of hypertension prevents strokes, heart attacks and deaths
from cardiovascular disease. This has been shown by studying thousands
of patients with hypertension and enrolling them in clinical trials in
which the effects of anti hypertensive treatment has been compared to
either placebo (inactive medication), or a less rigorous treatment
approach. The studies that demonstrated the beneficial effects of
blood pressure lowering medication were conducted over the last 25
years, and the drugs utilized were diuretics and beta blockers. Many
physicians treat hypertension in the year 2000 with more recently
developed drugs such as angiotensin converting enzyme inhibitors,
angiotensin receptor antagonists and calcium channel blockers. These
drugs compare favorably with diuretics and beta blockers with respect
to their ability to lower blood pressure.
However, so far, less information is
available regarding the ability of these drugs to prevent strokes,
heart attacks and deaths from cardiovascular disease. This situation
will change in the near future, because a very large clinical trial
now in progress called the ALLHAT trial will be completed in the next
few years. In this trial, the newer drugs will be compared with the
older drugs to determine if they have the same long term benefits in
patients with hypertension. Until the results of this study is
available, it is good practice to treat hypertension with diuretics
and beta blockers. However, since most patients need more than one
medication to lower their blood pressure to normal, the newer agents
are often very effective, and well tolerated. Furthermore, in patients
with kidney disease, particularly diabetic kidney disease, angiotensin
converting enzyme inhibitors are effective in slowing the progression
of kidney disease.
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