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15 THINGS YOU SHOULD KNOW ABOUT BLOOD PRESSURE
New science on keeping yours at a healthy level.
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.