High blood pressure: I don't notice it, so is it really that bad?

Hello readers!

Yes, it's been awhile, but I'm back with another blog post for you!
This post is going to focus on high blood pressure AKA "the disease you are most likely to get in your lifetime"...it's serious! 1 in 4 Americans are affected by this disease.

What is high blood pressure?
It's defined as a blood pressure reading above 140/90 mmHg on 3 separate occasions. High blood pressure is known as "the silent killer" because there are no noticeable symptoms until very late in the course of the disease after there has been irreversible, permanent damage to the body's vital organs.

What will happen if I have uncontrolled or poorly controlled high blood pressure?
1) damage to your blood vessels--Atherosclerosis
The blood vessels in your body are made of elastic material (like a rubber band) that can stretch in response to temporary increases in blood pressures. If there are chronically higher pressures, however, the blood vessels can become damaged by the constant forces upon them. One common result of damaged blood vessels is the development of a disease called atherosclerosis. In this disease, plaques form on your body's blood vessels due to damage from high blood pressures. Over time,  these can grow to obstruct blood flow completely and cause a heart attack or can rupture and travel in your blood to a distant site, such as the brain, where they will cause a stroke. This process is made worse by other conditions such as high cholesterol.

Atherosclerosis is the leading cause of death in the USA right now, and leading cause of sudden death. Just remember that one of it's main causes is high blood pressure.

2) damage to your blood vessels--Aneurysm
Damage to blood vessels can not only cause atherosclerosis, but can lead to aneurysm, or a dilation of a blood vessel making it prone to bursting--a potentially fatal event depending on where the blood vessel is in your body. If the aneurysm affects the Aorta (the largest blood vessel in the body) or the blood vessels of the brain it can be instantly fatal!


3) damage to your heart leading to congestive heart failure
the heart has to work harder to pump at higher pressures. This causes it to get larger (like any other muscle would in response to work). When the heart gets larger, the size of the muscle increases, but the size of the heart chambers gets smaller. This is because the muscle grows into the chamber space. This process leads to a disease called congestive heart failure. In this disease, the heart gets so large and damaged that it cannot pump enough blood to meet the demands of the rest of the body. This process happens slowly, but results in very serious, irreversible changes that are at first correctable by medications (which have very poor side effects) and are eventually fatal. A person with congestive heart failure easily gets out of breath, has poor exercise tolerance, and may eventually be unable to get up and get around on his/her own.

These are the most common complications of high blood pressure, but there are obviously many more I did not write about. High blood pressure and its resultant complications of Atherosclerosis and Congestive Heart Failure are often "silent" diseases that progress slowly but can have very serious outcomes if steps are not taken to prevent them!


What causes high blood pressure?
in 95% of people, there is no definable cause of high blood pressure!
in the other 5%, it could be due to genetics, kidney disorders, certain drugs, endocrine disorders, pulmonary disorders or many other causes.

Who is at risk for developing high blood pressure?
There are 4 major "unmodifiable" risk factors for getting high blood pressure:
Age (the older you are, the more at risk you are for developing high blood pressure)
Genetics
Gender (men more than women)
Race (african americans more than other races)

Since you can't really do anything to change these, let's focus on the major "modifiable" risk factors that can lead to high blood pressure:
Sodium intake
Obesity
Heavy alcohol consumption
Medications
Sedentary lifestyle
Stress

What can I do!?!

The first recommendation is lifestyle modification

1) weight reduction--check your BMI (body mass index) here  and see if you fall into normal body weight for your height. Studies have shown that in overweight patients, a 10 kg weight loss can drop blood pressure by 5-20 mmHg

2) adopt a "DASH" diet--rich in fruits, vegetables, and low-fat dairy. Low total fat and saturated fat. Follow this link for guidelines. This can reduce blood pressure by 8-14 mmHg.

3) restrict dietary sodium--guidelines say to aim for less than 2.4 g of sodium per day. Food with notoriously high sodium content are: canned soups/boullion cubes, salami and cured meats, cheeses, sun dried tomatos. For instance, 5 one-inch cubes of Parmesan cheese has 71% of your daily allotment of sodium. Feta has 48%, provolone has 37%, mozzarella has 31%. 1 slice of salami contains 10% of daily allotment of sodium, and a single sun dried tomato has 2% of your daily allotment. Reducing sodium intake can drop BP by 2-8 mmHg. Although it is hard to keep track of eating exactly 2.4 g of sodium per day, any conscious measures to limit sodium intake (don't use the salt shaker as much, reduce eating salty foods) will be helpful!

4) physical activity --aerobic activity (such as brisk walking) at least 30 minutes on most days of the week. This can drop BP by 4-9 mmHg.

5) moderate consumption of alcohol-- no more than 2 drinks per day in men, or 1 drink per day in women/small men is recommended to reduce blood pressure. This can drop BP by 2-4 mmHg.

In addition to these guidelines, there are drugs which may also be used to lower blood pressure.

In summary: prevention is key!!!!!

Current Recommendations for Physical Activity for Health and Wellness

So, where to start? I thought it would be appropriate to begin by laying out some of the current guidelines for physical activity which physicians (at least this future physician!) are encouraged to use to educate patients. The American College of Sports Medicine updated the following guidelines in 2007, and these are also a part of the US government's "Healthy People 2020" recommendations:

 1) A minimum of 30 minutes of moderate aerobic exercise 5 days a week or 20 minutes of vigorous exercise 3 days a week. Combinations of moderate and vigorous exercise may be used to meet this recommendation.

 What is moderate vs. vigorous? Without performing exercise testing, it's hard to determine an exact number for this, but in general we can say that "Moderate" means you are exercising at 50% of your maximum aerobic capacity (50% VO2max). "Vigorous" would be at higher intensity levels, such as 75% of your aerobic capacity.

 Examples of moderate exercise are: biking slowly, canoeing, dancing, gardening (raking or trimming shrubs), single's tennis, walking briskly, water aerobics

 2) Alternatively to #1, it's ok to accumulate 150 minutes (2 hours and 30 minutes) of aerobic exercise per week. This means you can break down the 30 minutes of exercise into 3 10 minute intervals, or 2 15 minute intervals, with the smallest interval at 10 minutes.

 3) Include moderately-intense resistance training of major muscle groups at least 2 days per week. What's important is that you target each major muscle group: legs, hips, back, chest, stomach, shoulders, and arms and that you do 8-12 reps per session. What counts as resistance training? Heavy gardening (digging, shoveling), weight training, resistance bands, push ups/sit ups/squats

 So, again, these are minimum guidelines for all adults! Quite a schedule! I know what you are thinking after reading this--I dont have time! I haven't been active in a long time! It sounds expensive! 

You can do this! Here are some techniques to get you going:
1) Build up over time. Start slowly, do what you are capable of, especially if you have not been active for a while. After a few weeks/months do these activities more often or for longer times.
 2) The easiest way to add physical activity is to walk briskly. Start by trying to do 10 minutes/day a few days a week at first. Build slowly--add another day, do 15 minutes instead of 10, then pick up the pace!

 What are the health implications of regular exercise? Here's an abbreviated list
1) Enhanced sense of well-being.
2) Retardation of loss of work capacity, strength, and balance that occur with age **Take note parents!**
3) Better accommodation of stress
4) Prevention or reversal of risk factors for many chronic diseases

 I'd like to elaborate more on the beneficial effects of exercise on chronic diseases in future posts...stay tuned!

Welcome

I heard a statistic today in lecture that stuck with me--95% of patients who are put on a diet/exercise plan by their doctor fail.

 I can't find any sources for this number, and it may have been made up by my professor in class today (I hope not!), but it opens a discussion on an aspect of medicine I am truly interested in and would like to share with anyone who is willing to listen--how do we achieve healthy living to prevent disease and promote quality of life? There is so much conflicting information presented to us about this topic by the media: Should we supplement with antioxidants? Wait, now antioxidants cause cancer? Endurance exercise is the best way to lose weight...or is it resistance training? Or is it more sleep? It's hard to know what are the exact goals we should aim for to live a "healthy lifestyle" (and it may not be the same for each person!). So, this is my attempt to share what I'm learning from my professors in medical school with family (ahem, parents!) and friends who are interested in this topic too. I'm no expert, but I hope that what I write is some reflection of the current accepted theories and practices in the medical world in 2012 and will be useful as a guide.

 So why do 95% of patients fail to reach diet/exercise goals set by their physicians? It could be because the emphasis of these interventions is on weight loss only. Healthy living is more than just losing weight. Yes, it involves eating more nutritious foods, appropriate portion sizes, and exercising regularly, all of which may lead to weight loss, but healthy living also involves a regular sleep schedule, appropriate hydration, a balance of daily activities and the sense of well-being and energy that result from following this lifestyle. The goals of healthy living should not be based solely on weight, especially because other factors, such as distribution of weight on the body's frame (pear vs. apple shape) and % body fat vs. muscle, may be better indicators of overall health than a single number-- pounds or BMI.

 So before I write a thesis here, I'd just like to say that I hope to write small nuggets in this blog every so often that will be helpful to readers who want to move closer to healthy living. Disclaimer: I'm not a doctor, so don't take any of this as serious medical advice, just suggestions based on what I'm learning.