15 THINGS YOU SHOULD KNOW ABOUT BLOOD PRES­SURE

New sci­ence on keep­ing yours at a healthy level.

Reader's Digest Asia Pacific - - Contents - PETER JARET FROM AARP BUL­LETIN

When Dr Ray­mond R. Townsend was in med­i­cal school in the 1970s, the for­mula for blood pres­sure was sim­ple. “Doc­tors were taught that the nor­mal top blood pres­sure num­ber was 100 plus a per­son’s age,” says Townsend, a pro­fes­sor of medicine at the Univer­sity of Penn­syl­va­nia and a lead­ing ex­pert on hy­per­ten­sion.

1 BLOOD PRES­SURE CLIMBS AS YOU AGE

At age 76, Dr Suzanne Oparil still has great blood pres­sure. “It’s mostly the luck of genes,” says Oparil, a pro­fes­sor of medicine at the Univer­sity of Alabama at Birm­ing­ham, in the US, whose re­search has played a key role in hy­per­ten­sion guide­lines. Like Oparil, some of us may never de­velop high blood pres­sure. But most peo­ple see an in­crease in the up­per num­ber, sys­tolic blood pres­sure, start­ing around age 40. (Hy­per­ten­sion is de­fined as blood pres­sure that is 140/90 mmHg (mil­lime­tres of mercury) or higher.) Part of the rea­son: ar­ter­ies tend to stiffen with age.

2 HIGH BLOOD PRES­SURE OF­TEN HAS NO SYMP­TOMS

Your blood pres­sure can be through the roof, and the only way you can know is by get­ting it checked. Get­ting a re­li­able read­ing, though, can be tricky. Blood pres­sure num­bers can vary 30 to 40 points through the day, Oparil says, typ­i­cally falling at night and surg­ing in the morn­ing. “It can even spike just be­cause you’re hav­ing your blood pres­sure mea­sured, a phe­nom­e­non called ‘white coat hy­per­ten­sion.’ ” The gold stan­dard for record­ing blood pres­sure is a 24-hour test that mea­sures pres­sure three or four times an hour dur­ing the day and ev­ery 30 min­utes at night.

3WATCH THE TOP NUM­BER WHEN YOU’RE OVER AGE 50

The top num­ber, sys­tolic pres­sure, mea­sures the force at the mo­ment the heart beats, pump­ing blood through­out the body. The bot­tom num­ber (di­as­tolic pres­sure) mea­sures pres­sure be­tween beats, when the heart is at rest. “The top num­ber is the one that mat­ters, be­cause sys­tolic blood pres­sure is the peak force that your ar­ter­ies and your vi­tal or­gans ex­pe­ri­ence with each heart­beat,” says Dr Sheila Sahni, a car­dio­vas­cu­lar dis­ease ex­pert at the Ronald Rea­gan UCLA Med­i­cal Cen­ter. “When pres­sure in­creases, it can dam­age your kid­neys, your eyes,

“We now know that num­bers even close to that high – as you get older – are very dan­ger­ous.” Re­search has come a long way, but there’s still con­tro­versy about op­ti­mal lev­els, the best treat­ments and even how to mea­sure blood pres­sure. There’s no de­bate, how­ever, that high blood pres­sure can lead to heart at­tacks, stroke, vi­sion prob­lems, even de­men­tia. Here are 15 facts about high blood pres­sure that might save your life.

your brain, even the lin­ing of blood ves­sels.” The lower num­ber, di­as­tolic blood pres­sure, typ­i­cally peaks at about age 55 and then grad­u­ally falls.

4 EX­PERTS DON’T AGREE ON THE IDEAL BLOOD PRES­SURE

Re­searchers are still de­bat­ing the ideal blood-pres­sure tar­get for peo­ple over 50. Un­til re­cently, the best ev­i­dence sug­gested that a rea­son­able tar­get was sys­tolic blood pres­sure be­low 140, or less than 150 for peo­ple over 60. In Septem­ber 2015, new find­ings from the Sys­tolic Blood Pres­sure In­ter­ven­tion Trial, or SPRINT, top­pled that ad­vice. In the trial of more than 9300 peo­ple at high risk of heart dis­ease or who al- ready had heart dis­ease, nearly 30 per cent of whom were age 75 or older, re­searchers com­pared one group whose tar­get was to ag­gres­sively lower their sys­tolic blood pres­sure to less than 120 to another group who were as­signed a tar­get sys­tolic blood pres­sure of less than 140. Peo­ple in the un­der-120 group were 25 per cent less likely to suf­fer a car­dio­vas­cu­lar dis­ease event or stroke dur­ing the three-year trial.

5 THE OP­TI­MUM IS DIF­FER­ENT FOR DIF­FER­ENT PEO­PLE

Of­fi­cial guide­lines are just that: they guide doc­tors and pa­tients. “But ev­ery pa­tient is dif­fer­ent,” says Townsend. For pa­tients at low car­dio­vas­cu­lar risk, a higher sys­tolic tar­get may be ac­cept­able. The same may be true for some high-risk pa­tients who can’t tol­er­ate ag­gres­sive ther­apy be­cause of side ef­fects. The best ad­vice is to ask your doc­tor what’s right for you.

6 LIFE­STYLE CHANGES CAN WORK AS WELL AS A PILL

Cut­ting back on salt and eat­ing plenty of nu­tri­ent-rich fruit and veg­eta­bles can drop high blood pres­sure by about three points. Los­ing weight also helps. Drop­ping four ki­los can shave off more than four points from your sys­tolic blood pres­sure, stud­ies show. In a 2016 re­view, Swedish re­searchers found that phys­i­cal ac­tiv­ity can re­duce sys­tolic pres­sure by an aver­age of 11 points in peo­ple with hy­per­ten­sion. “If you have mild to mod­er­ately

el­e­vated blood pres­sure, healthy changes might mean you won’t need med­i­ca­tion,” says Dr Glenn M. Cher­tow, pro­fes­sor of medicine at Stan­ford Univer­sity in Palo Alto, Cal­i­for­nia.

7 COF­FEE RAISES BLOOD PRES­SURE – BUT DON’T FRET

Re­searchers have long known that a cup of high-oc­tane cof­fee makes blood pres­sure jump. In a 2011 ar­ti­cle in The Amer­i­can Jour­nal of Clin­i­cal Nu­tri­tion, re­searchers con­cluded that 200–300 mil­ligrams of caf­feine (or one and a half to three 235 ml cof­fees) in­creased sys­tolic blood pres­sure by an aver­age of eight points. The spike lasts about three hours, but there ap­pears to be no long-term ef­fect.

8 SOME MED­I­CA­TIONS MAY RAISE YOUR BLOOD PRES­SURE

“Many cold med­i­ca­tions con­tain pseu­doephedrine, which clamps down on blood ves­sels, rais­ing blood pres­sure,” Sahni says. Non­s­teroidal anti-in­flam­ma­tory drugs (NSAIDs), such as ibupro­fen and naproxen, can raise blood pres­sure on aver­age by three points (but this can vary con­sid­er­ably). This is enough to con­trib­ute to car­dio­vas­cu­lar risk if you take them on a reg­u­lar ba­sis.

9 KEEP AN EYE ON SALT AS YOU GET OLDER

Salty foods can raise blood pres­sure, but rec­om­men­da­tions to re­duce salt have long been con­tro­ver­sial. One rea­son: not ev­ery­one is salt sen­si­tive. But as peo­ple age, they may tend to pile on more salt, be­cause their sense of taste di­min­ishes. NHMRC guide­lines rec­om­mend no more than 1600 mg of sodium a day for adults, which is the equiv­a­lent of four grams of salt, or one tea­spoon. Most salt is hid­den in pro­cessed foods, so check la­bels and choose low-­sodium items.

10 NEW MEDICINES AREN’T NEC­ES­SAR­ILY BET­TER

Doc­tors typ­i­cally be­gin treat­ing high blood pres­sure with di­uret­ics, or ‘ wa­ter pills’, some of the old­est hy­per­ten­sion med­i­ca­tions around. They work by re­mov­ing ex­cess sodium and wa­ter from the body. Newer med­i­ca­tions called ACE (an­giotensin­con­vert­ing en­zyme) in­hibitors pre­vent the body from pro­duc­ing a hor­mone ( an­giotensin II) that raises blood pres­sure. An­giotensin II re­cep­tor block­ers, or ARBs, block the ac­tion of the same hor­mone. Re­search sug­gests that no sin­gle an­ti­hy­per­ten­sive drug is su­pe­rior to any other – the value of the drug is judged on an in­di­vid­ual pa­tient ba­sis.

11 SIM­PLE HAND-GRIP EX­ER­CISES CAN HELP

In a land­mark 2013 Hy­per­ten­sion re­port on al­ter­na­tive ways to lower blood pres­sure, re­searchers con­firmed that hand-grip ex­er­cises can re­duce your num­ber by about ten per cent. In­ex­pen­sive hand grip­pers avail­able on­line or at a lo­cal sport­ing

goods store are ef­fec­tive. Squeeze and hold the grip­per for two min­utes at a time, for a to­tal of 12 to 15 min­utes, three times a week.

12 FOR MANY PEO­PLE, ONE MED­I­CA­TION ISN’T ENOUGH

If your blood pres­sure is mod­er­ately el­e­vated, you may need only one pill to bring it down, but many peo­ple end up hav­ing to take sev­eral. “In­di­vid­ual blood pres­sure med­i­ca­tions typ­i­cally lower blood pres­sure by only a few points,” Cher­tow says. “And when you in­crease the dose, there’s a point of di­min­ish­ing re­turns. De­pend­ing on the pa­tient, we com­bine dif­fer­ent classes of med­i­ca­tions for op­ti­mal ef­fect.”

13 BLOOD PRES­SURE CAN DIP TOO LOW

The dan­ger is great­est when peo­ple stand up and blood pres­sure isn’t strong enough to pump blood to the brain – a phe­nom­e­non called or­tho­static hy­poten­sion. Older peo­ple are par­tic­u­larly at risk of falls that may cause frac­tures. If you’re on med­i­ca­tion and ex­pe­ri­ence dizzi­ness, talk to your doc­tor. A change in your pre­scrip­tion may help.

14 BREATHE SLOWLY TO BRING YOUR NUM­BER DOWN

Sim­ply slow­ing your breath­ing down to six breaths in 30 sec­onds has been shown to bring sys­tolic blood pres­sure down – at least tem­po­rar­ily.

15 STICK­ING WITH TREAT­MENT IS CRU­CIAL

A com­bi­na­tion of life­style changes and med­i­ca­tion is usu­ally enough to bring your num­bers down out of the dan­ger zone. But once you hit the tar­get, it’s es­sen­tial to go on tak­ing your pills and fol­low­ing health­ier habits. “Too many peo­ple for­get about tak­ing blood pres­sure med­i­ca­tions. Or they stop tak­ing them if they think they’re hav­ing side ef­fects,” Sahni says. If you go off your med­i­ca­tions, your blood pres­sure will go back up. Since sys­tolic blood pres­sure typ­i­cally rises with age, it’s also im­por­tant to mon­i­tor your blood pres­sure reg­u­larly. Most peo­ple with high blood pres­sure need to ad­just their med­i­ca­tion pe­ri­od­i­cally.

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