Wednesday, October 15, 2003

Blood pressure control - naturally

Keeping weight down, exercise and good diet help to hold off hypertension

By Peggy O'Farrell
The Cincinnati Enquirer

[IMAGE] Lauralee Sawyer helps to keep her blood pressure in check by taking a Tae Box class at the Cincinnati Sports Club.
(Tony Jones photo)
| ZOOM |
Lauralee Sawyer doesn't look like a candidate for high blood pressure.

The slim Madeira woman hits the gym four nights a week to sweat through kickboxing, step aerobics and power-lifting classes. She studies nutrition labels to make sure her food isn't too high in salt, fat or calories.

And she still has to take medication every day to keep her blood pressure from climbing dangerously high, putting her at risk for heart attack, stroke or kidney failure.

"My blood pressure's wonderful now," Sawyer, 58, says. "But it's taken years to gradually go down. That's the scary part about high blood pressure: There aren't any symptoms. I've always felt good. I've always felt healthy. It's under control now, so whatever I'm doing, I hope I'm doing it right."

Most Americans with high blood pressure, or hypertension, end up on medication for it, doctors say. But for the millions of Americans whose blood pressure is a few points shy of hypertension, diet, exercise and lifestyle changes can sometimes bring their numbers into the "safe" zone.

The warning zone

According to guidelines set earlier this year, adults with prehypertension - blood pressure levels between 120/80 and 139/89 - should be counseled to take steps to keep their blood pressure from hitting the "high" mark of 140/90 or higher.

Among those steps:

• Reaching or maintaining a healthy weight

• Exercising regularly

• Limiting alcohol intake

• Following a diet that's high in fruits, vegetables and whole grains and low in fats and sugars

• Limiting salt and sodium

• Giving up cigarettes

Convincing patients to take those steps is the hard part, doctors say.

• Lose weight and exercise
• Follow a diet that's high in fruits, vegetables and whole grains and low in fats and sugars
• Avoid salt and tobacco
Blood pressure measures the force of blood against the arterial walls as it passes through the body's blood vessels. It is expressed in two numbers, systolic (the top number) and diastolic (the bottom number). The systolic pressure measures the force as the heart beats. The diastolic numbers measures the force as the heart rests between beats.
Because high blood pressure has no symptoms, but plenty of complications - heart attack, stroke and kidney failure, to name a few - doctors say it should be checked regularly. Here's what the ranges mean:
140/90 or higher: Too high, and a serious risk for complications. Your options include medications, weight loss, exercise and giving up tobacco and salt.
139/89 to 120/80: Prehypertensive. If it gets any higher, you'll officially have high blood pressure. Options include weight loss, exercise, giving up tobacco and salt and, in some cases, medication.
119/79 and lower: Keep up the good work.
"They do work; people just don't tend to do them very often," says Dr. Brooks Gerlinger, a cardiologist with the Cardiology Center of Cincinnati.

Under the new guidelines, "normal" blood pressure is anything under 120/80.

And as far as most doctors are concerned, as long as you're still conscious, your blood pressure can't go too low.

"There are a lot of people with heart failure and kidney failure who do better with lower blood pressure, say 80/40," says Dr. James Schmidt, a cardiologist at the University of Cincinnati.

The new guidelines mark a major shift for doctors and patients, Schmidt says.

"It used to be we were happy if they were at 120/80," he says.

Now, when patients' blood pressure tops that level, it's time to talk about diet, exercise and other changes that need to be made to keep the numbers from changing from slightly elevated to dangerously high.

"Hypertension, even mild elevations, seem to progress, and all the bad things that can happen - heart attacks, strokes, kidney failure - can occur, and the goal is to start early and prevent those things from happening," Schmidt says.

In concert with medicine

Sawyer learned she had high blood pressure when she had it checked at a health fair.

"It was sky-high, and (the technician) said, you need to see a doctor ASAP," she says.

Since her diagnosis. she's started exercising and watching what she eats even more.

The hardest part, she says, has been giving up salt.

"I'm really careful about what I eat and I watch the sodium content of everything," she says. "My husband and I don't keep much junk food in the house."

She and her husband, Larry, both take medication for high blood pressure.

Jan Neal, 52, of Fairfield, watched her blood pressure climb gradually over several years.

She's working on losing weight - she estimates she still has "30 or 40" pounds to go - and walks regularly. She also meditates and practices yoga to relieve stress.

Like Sawyer, she has to take medication to keep her blood pressure in a healthy range. But, thanks to the weight loss she's achieved, she's been able to stop taking one prescription drug.

Neal gave up cigarettes 15 years ago - a promise she made to her mother, who suffered uncontrollably high blood pressure and eventually died from a stroke - and has recently given up caffeine and sugar.

"My blood pressure's not where they would ultimately like to see it, but I think I'm making progress," Neal says.

She hopes she'll be able to keep it under control without needing more medication if she keeps exercising and losing weight.

People whose blood pressure is 140/90 or higher generally need medication - usually diuretics, ACE inhibitors or beta blockers - to get their numbers into a healthy range, Schmidt says.

For some people, finding ways to ease stress - biofeedback, meditation, exercise or counseling - can reduce blood pressure. But stress is rarely the primary cause of hypertension, Schmidt says.

Most people with high blood pressure can blame genetics, he and Gerlinger say: If your parents had high blood pressure, odds are you will too.

"That's why so many of us are on medication," Schmidt says.


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